A New Space for Patients. How Space Enters Innovation Translation Processes

The contribution takes organizational space to the analytical fore and analyzes the spatial mediation of the translation of patient-centered care. By bridging theories on innovations' translation and the literature on organizational space, the chapter explores how the redesign of healthcare spaces is used to materialize ideas of patient-centredness and what happens when consolidated clinical practices resist and change these spatial translations of an innovation. Specifically the work focuses on a) how patient-centredness translates into the spatial arrangement of the hospital and b) how, in turn, clinical practitioners work with or around the new spatial setup by both taking up the patient-centredness discourse and working around the spatial arrangement

Patient centredness, values, equity and sustainability: Professional, organizational and institutional implications

The concept of “patient centredness”, or “patient-centred care”, has been studied so far in a variety of declinations, perspectives, and practices. This paper suggests conceiving it as a collective achievement that is negotiated between multiple actors of a system, and that includes social practices and relationships that are woven together through the material and immaterial resources available in organizational settings and contexts. By focusing on the three core dimensions that compose the value of patient centredness, which are the attention to the individual, to the relational and to the organizational dimension, the paper invites to consider new and critical perspectives for research and intervention on such essential topic. Three directions are indicated for future studies: (1) Rec-onciling evidence-based medicine and patient-centred care through mixed-method sensitivity to healthcare research; (2) Revisiting the traditional assumptions on validity and impact, investing on new ways for assessing, measuring, and monitoring patient-centred care; (3) Investing in participa-tive, practice-based and situated processes for guaranteeing the possibility to get close to the com-plexity of processes and to work on personal, professional, and organizational developments. The invitation is to consider these pathways to connect patient-centred care with new meanings of value, sustainability, and ethics in healthcare

What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation

Background: Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. Methods: Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff and members of the boards of directors (n=30). We used a constant comparative approach to develop a framework for guiding implementation. Findings: We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as ‘positions’. The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians’ perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related with the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians’ reasoning and fostering organizational learning. Discussion: Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians’ attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships and an organizational ethos of transparency and accountability need to considered when exploring the readiness of a hospital to adopt CDSSs.This work is supported by the Italian Ministry of Health (GR-2009-1606736), Regione Lombardia (D.R.G. IX/4340 26/10/2012), and the Wellcome Trust (WT097899)