The role of organizational factors in how efficiency-thoroughness trade-offs potentially affect clinical quality dimensions – a review of the literature

Purpose The purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these trade-offs potentially affect clinical quality dimensions. Design/methodology/approach The paper is a thematic synthesis of the literature concerning health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality. Findings Identified organizational factors imposing trade-offs were high workload, time limits, inappropriate staffing and limited resources. The trade-offs done by health personnel were often trade-offs weighing thoroughness (e.g. providing extra handovers or working additional hours) in an environment weighing efficiency (e.g. ward routines of having one single handover and work-hour regulations limiting physicians' work hours). In this context, the health personnel functioned as regulators, balancing efficiency and thoroughness and ensuring patient safety and patient centeredness. However, sometimes organizational factors limited health personnel's flexibility in weighing these aspects, leading to breached medication rules, skipped opportunities for safety debriefings and patients being excluded from medication reviews. Originality/value Balancing resources and healthcare demands while maintaining healthcare quality is a large part of health personnel's daily work, and organizational factors are suspected to affect this balancing act. Yet, there is limited research on this subject. With the expected aging of the population and the subsequent pressure on healthcare services' resources, the balancing between efficiency and thoroughness will become crucial in handling increased healthcare demands, while maintaining high-quality care.publishedVersio

The Headaches of Case Study Research: A Discussion of Emerging Challenges and Possible Ways Out of the Pain

Case study research is a widely-used approach in qualitative research. The advantages of case study research include its ability to investigate complex social phenomena and to handle dense data. However, it has several drawbacks, such as defining the case and ensuring rigour. The large variety in descriptions of case study implementation makes the application of case study research a challenge for novice and experienced researchers alike. The aim of this paper is to describe a novice’s foray into case study research, illustrating advantages, drawbacks, and applications of case study research through examples from a previously conducted case study. By mapping consistencies and differences in the case study descriptions, this paper offers a way for novice researchers to familiarize themselves with the range of case study perspectives and with the choices and considerations that must accompany the choice of case study research. This paper shows the definitional and structural challenges that case study researchers may face. We identified 14 descriptions of case study research with unclear or overlapping distinctions. Despite the large number of variations in case study descriptions, we singled out one main distinction: the distinction between multiple and single case studies. The sheer proliferation of how case study research should be conducted underlines the great responsibility case study researchers have when choosing an analytical and methodological approach and ensuring rigour in their research.publishedVersio

Nurses´ experience with presenteeism and the potential consequences on patient safety: a qualitative study among nurses at out-of-hours emergency primary care facilities

Abstract Objectives This study aimed to gain new insight and knowledge on out-of-hours emergency primary care nurses’ experience of presenteeism in their workplace and their outlook on the impact they recognised the phenomenon to have on patient safety when caring for acute patients. Design An explorative qualitative study. Setting The study was conducted at three out-of-hours primary care facilities in southwest Norway. Participants A total of 10 female nurses were recruited as interviewees. Nurses providing direct patient care were included in the study. Results The analysis resulted in four major themes: strong work ethics influence the decision to attend work unwell; work environment factors have a negative impact on nurses’ health; nurses’ awareness of consequences on the quality of care and patient safety and nurses make use of coping strategies when engaging in presenteeism. Conclusion Presenteeism is a common experience among nurses at out-of-hours emergency primary care clinics, with work-related stress being a significant contributing factor. Despite recognising a decrease in performance while engaging in presenteeism, nurses displayed adaptive behaviour. They were confident that their suboptimal health issues did not significantly impact patient safety while caring for acute patients. However, the true impact of presenteeism on patient safety in an out-of-hours emergency care setting remains uncertain due to the reliance on subjective reporting systems as quality indicators. More research is needed to understand the phenomenon and its implications on patient safety fully.publishedVersio

The relationship between understaffing of nurses and patient safety in hospitals - A literature review with thematic analysis

Introduction: Patient safety and the occurrence of adverse events in hospitals is a topic which has been widely addressed over the last decades. In that respect, there has been an increasing interest in the effect of working conditions on patient safety, and whether understaffing and adverse events are correlated. This paper therefore reports results from a study of under- staffing of nurses understood as a lack of nurses available to conduct the tasks required of them. This implies that nurses are forced to ignore or postpone important tasks, thereby compromising patient safety. Purpose: The purpose of the study is to increase the knowledge of understaffing of hospital nurses, and the consequences that understaffing may have on patient safety. Methods: A literature search of the databases Chinal, Medline, Cochrane library, Isi Web of Science and Academic Search premiere was conducted in the period January 2014 to February, 2016. Results: Results are categorized into two main themes and four subthemes. The first main theme describes the direct relationship between understaffing and patient safety. Poor staffing increases the risk of mortality, and adverse conditions such as pressure ulcers, deep vein thrombosis and hospital-related infections. The second main theme relates to the indirect implications of understaffing for patient safety. These implications pertain to the lack of time that nurses could give each patient, limitations in the quality of nursing, and challenges in safe medication administration. Conclusions: The study documents the relationship between understaffing of nurses and adverse events in hospitals, revealingthat understaffing of nurses is a risk factor for hospitalized patients.publishedVersio

Exploring physicians' decision-making in hospital readmission processes - a comparative case study

© The Author(s) 2018Background Hospital readmissions is an increasingly serious international problem, associated with higher risks of adverse events, especially in elderly patients. There can be many causes and influential factors leading to hospital readmissions, but they are often closely related, making hospital readmissions an overall complex area. In addition, a comprehensive coordination reform was introduced into the Norwegian healthcare system in 2012. The reform changed the premises for readmissions with economic incentives enhancing early transfer from secondary to primary care, making research on readmissions in the municipalities more urgent than ever. General practitioners (GPs) and nursing home physicians, have traditionally held a gatekeepers function in hospital readmissions from the municipal healthcare service, as they are the main decision-makers in questions of hospital readmissions. Still, the GPs’ gatekeeper function is an under-investigated area in hospital readmission research. The aim of the study was to increase knowledge about factors that lead to hospital readmissions among elderly in municipal healthcare, with special attention to GPs’ and nursing home physicians’ decision making. Method The study was conducted as a comparative case study. Two municipalities affiliated with the same hospital, but with different readmission rates were recruited. Twenty GPs and nursing home physicians from each municipality were recruited and interviewed. Forty hours of observation were conducted during the huddles in one long-term and one short-term nursing home in each municipality. Results Seven themes describing how different factors influence physicians’ decision-making in the hospital readmission process in two municipalities were identified. Poor communication, continuity and information flow account for hospital readmissions in both municipalities. Several factors, including nurse staffing and competence, patients and their families, time constraints and experience affected physicians’ decision-making. Conclusion Communication, continuity and information flow contributed to hospital readmissions in both municipalities. The cross-case analysis revealed slight differences between municipalities. More research focusing on GPs’ and nursing home physicians’ decision-making, nursing home nurses and home care nurses’ experience of hospital readmissions and discharges is needed.publishedVersio

Would you be interested in participating in a study about hospital readmissions…? Experiences with methodological strategies and techniques for recruiting GPs to participate in qualitative research

General Practitioners (GPs) are an asset in healthcare research, considering the amount of knowledge they hold about the primary healthcare service. However, GPs have proven difficult to recruit as participants in both quantitative and qualitative research (Asch, Connor, Hamilton, & Fox, 2000; Hummers-Pradier et al., 2008; Parkinson et al., 2015). The difficulties in recruiting GPs have been attributed to their great workload and their perception of a gap between the theory-laden research and their own practical work (Rosemann & Szecsenyi, 2004; Leysen et al., 2019). However, own experiences of recruiting GPs to participate in a qualitative study disclosed that the picture might be more nuanced than described in previous reports. The objective of this paper is to describe the methodological strategies and techniques for the recruitment process, and discuss the difficulties in recruiting GPs to participate in research and possible reasons for such difficulties. It was based on experiences from a recently conducted study on GPs, which aimed to increase knowledge about the GPs’ role in hospital readmissions from the primary healthcare service (Glette, Kringeland, Røise, & Wiig, 2018).publishedVersio

The Headaches of Case Study Research: A Discussion of Emerging Challenges and Possible Ways Out of the Pain

Case study research is a widely-used approach in qualitative research. The advantages of case study research include its ability to investigate complex social phenomena and to handle dense data. However, it has several drawbacks, such as defining the case and ensuring rigour. The large variety in descriptions of case study implementation makes the application of case study research a challenge for novice and experienced researchers alike. The aim of this paper is to describe a novice’s foray into case study research, illustrating advantages, drawbacks, and applications of case study research through examples from a previously conducted case study. By mapping consistencies and differences in the case study descriptions, this paper offers a way for novice researchers to familiarize themselves with the range of case study perspectives and with the choices and considerations that must accompany the choice of case study research. This paper shows the definitional and structural challenges that case study researchers may face. We identified 14 descriptions of case study research with unclear or overlapping distinctions. Despite the large number of variations in case study descriptions, we singled out one main distinction: the distinction between multiple and single case studies. The sheer proliferation of how case study research should be conducted underlines the great responsibility case study researchers have when choosing an analytical and methodological approach and ensuring rigour in their research

The role of medication management in hospital readmissions in Norwegian primary healthcare services : A secondary analysis

Medication management and the transmission of medication information between healthcare services have proven to be essential factors in hospital readmissions. The patients primary healthcare services are caring for at present have complex medical conditions, leading to even greater challenges in transferring correct information across different healthcare services. This chapter describes how healthcare personnel perceive medication management as an influencing factor in hospital readmissions, and explores which elements may lead to medication-related hospital readmissions from the primary healthcare service.publishedVersio

The Headaches of Case Study Research: A Discussion of Emerging Challenges and Possible Ways Out of the Pain

Case study research is a widely-used approach in qualitative research. The advantages of case study research include its ability to investigate complex social phenomena and to handle dense data. However, it has several drawbacks, such as defining the case and ensuring rigour. The large variety in descriptions of case study implementation makes the application of case study research a challenge for novice and experienced researchers alike. The aim of this paper is to describe a novice’s foray into case study research, illustrating advantages, drawbacks, and applications of case study research through examples from a previously conducted case study. By mapping consistencies and differences in the case study descriptions, this paper offers a way for novice researchers to familiarize themselves with the range of case study perspectives and with the choices and considerations that must accompany the choice of case study research. This paper shows the definitional and structural challenges that case study researchers may face. We identified 14 descriptions of case study research with unclear or overlapping distinctions. Despite the large number of variations in case study descriptions, we singled out one main distinction: the distinction between multiple and single case studies. The sheer proliferation of how case study research should be conducted underlines the great responsibility case study researchers have when choosing an analytical and methodological approach and ensuring rigour in their research

The role of organizational factors in how efficiency-thoroughness trade-offs potentially affect clinical quality dimensions – a review of the literature

Purpose The purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these trade-offs potentially affect clinical quality dimensions. Design/methodology/approach The paper is a thematic synthesis of the literature concerning health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality. Findings Identified organizational factors imposing trade-offs were high workload, time limits, inappropriate staffing and limited resources. The trade-offs done by health personnel were often trade-offs weighing thoroughness (e.g. providing extra handovers or working additional hours) in an environment weighing efficiency (e.g. ward routines of having one single handover and work-hour regulations limiting physicians' work hours). In this context, the health personnel functioned as regulators, balancing efficiency and thoroughness and ensuring patient safety and patient centeredness. However, sometimes organizational factors limited health personnel's flexibility in weighing these aspects, leading to breached medication rules, skipped opportunities for safety debriefings and patients being excluded from medication reviews. Originality/value Balancing resources and healthcare demands while maintaining healthcare quality is a large part of health personnel's daily work, and organizational factors are suspected to affect this balancing act. Yet, there is limited research on this subject. With the expected aging of the population and the subsequent pressure on healthcare services' resources, the balancing between efficiency and thoroughness will become crucial in handling increased healthcare demands, while maintaining high-quality care