The Perspectives of Healthcare Professionals and Managers on Patient Involvement in Care Pathway Development:A Discourse Analysis

Background: The WHO advocates patient and public involvement as an ethical imperative, due to the value of the lived experience of patients. A deeper understanding of the shared meanings and underlying beliefs of healthcare professionals and managers for and against including patients in care pathway development. Objective: To explore the considerations of healthcare professionals and managers on the involvement of patients and public in care pathway development. Methods: In a medical rehabilitation centre we conducted a single case study that was part of a 2-year action research programme on blended care pathway development. Following 14 semistructured interviews with healthcare professionals and managers, we analysed their discourses on the value of patient involvement as well as the potential threats and opportunities. Results: We identified four discourses. Patient as expert frames involvement as relevant, as adding new perspectives and as required to fully understand the patient's needs. Skills and representation is based on the construct that obtaining valuable insights from patients requires certain skills and competences. Self-protection focusses on personal, interprofessional objections to patient involvement. Professional knows best reveals expertise-related reasons for avoiding or postponing involvement. Conclusion: These discourses explain why patient and public involvement in care pathway development is sometimes postponed, limited in scope and level of participation, and/or avoided. The following strategies might minimise the paralysing effect of these discourses: strengthen the capabilities of all stakeholders involved; use a mix of complementary techniques to gain involvement in distinct phases of care pathway development; and create/facilitate a safe environment. Put together, these strategies would foster ongoing, reciprocal learning that could enhance patient involvement. Patient or Public Contribution: This study belonged to an action research programme on blended care pathway development (developing an integrated, coordinated patient care plan that combines remote, digital telehealth applications, self-management tools and face-to-face care). Multidisciplinary teams took a quality collaborative approach to quality improvement (considering patients as stakeholders) to develop 11 blended care pathways. Although professionals and managers were instructed to invite patients onto their teams and to attend care pathway design workshops, few teams (3/11) actually did. Unravelling why this happened will help improve patient and public involvement in care pathway development.</p

The Perspectives of Healthcare Professionals and Managers on Patient Involvement in Care Pathway Development:A Discourse Analysis

Background: The WHO advocates patient and public involvement as an ethical imperative, due to the value of the lived experience of patients. A deeper understanding of the shared meanings and underlying beliefs of healthcare professionals and managers for and against including patients in care pathway development. Objective: To explore the considerations of healthcare professionals and managers on the involvement of patients and public in care pathway development. Methods: In a medical rehabilitation centre we conducted a single case study that was part of a 2-year action research programme on blended care pathway development. Following 14 semistructured interviews with healthcare professionals and managers, we analysed their discourses on the value of patient involvement as well as the potential threats and opportunities. Results: We identified four discourses. Patient as expert frames involvement as relevant, as adding new perspectives and as required to fully understand the patient's needs. Skills and representation is based on the construct that obtaining valuable insights from patients requires certain skills and competences. Self-protection focusses on personal, interprofessional objections to patient involvement. Professional knows best reveals expertise-related reasons for avoiding or postponing involvement. Conclusion: These discourses explain why patient and public involvement in care pathway development is sometimes postponed, limited in scope and level of participation, and/or avoided. The following strategies might minimise the paralysing effect of these discourses: strengthen the capabilities of all stakeholders involved; use a mix of complementary techniques to gain involvement in distinct phases of care pathway development; and create/facilitate a safe environment. Put together, these strategies would foster ongoing, reciprocal learning that could enhance patient involvement. Patient or Public Contribution: This study belonged to an action research programme on blended care pathway development (developing an integrated, coordinated patient care plan that combines remote, digital telehealth applications, self-management tools and face-to-face care). Multidisciplinary teams took a quality collaborative approach to quality improvement (considering patients as stakeholders) to develop 11 blended care pathways. Although professionals and managers were instructed to invite patients onto their teams and to attend care pathway design workshops, few teams (3/11) actually did. Unravelling why this happened will help improve patient and public involvement in care pathway development.</p

Enacting quality improvement in ten European hospitals: a dualities approach

Background: Hospitals undertake numerous initiatives searching to improve the quality of care they provide, but these efforts are often disappointing. Current models guiding improvement tend to undervalue the tensional nature of hospitals. Applying a dualities approach that is sensitive to tensions inherent to hospitals’ quest for improved quality, this article aims to identify which organizational dualities managers should particularly pay attention to. Methods: A set of cross-national, multi-level case studies was conducted involving 383 semi-structured interviews and 803h of non-participant observation of key meetings and shadowing of staff in ten purposively sampled hospitals in five European countries (England, the Netherlands, Portugal, Sweden, and Norway). Results: Six dualities that describe the quest for improved quality, each embracing a seemingly contradictory feature were identified: plural consensus, distributed connectedness, orchestrated emergence, formalized fluidity, patient coreness, and cautious generativeness. Conclusions: We advocate for a move from the usual sequential and project-based and systemic thinking about quality improvement to the development of meta-capabilities to balance the simultaneous operation of opposing ideas or concepts. Doing so will help hospital managers to deal with major challenges of change inherent to quality improvement initiatives.publishedVersio

Shades of support: An empirical assessment of D&I policy support in organizations

In this research, we aim to develop a better understanding of the different ways in which employees can advance or resist the diversity and inclusion (D&I) policies implemented by their organization. To this end, we complement prior work by distinguishing between employees' attitudinal and behavioral opposition versus support for D&I policies. We combine these to distinguish different combinations of attitudinal and behavioral responses that characterize specific groups of employees, which we label opponents, bystanders, reluctants, and champions. In a large-scale survey study conducted among employees from seven organizations located in the Netherlands (n = 2913), we find empirical support for the validity of this taxonomy and its value in understanding the likelihood that employees advance or resist D&I policies. Furthermore, we find more convergence between attitudinal and behavioral support when employees perceive a more positive climate for inclusion. Together, these results advance existing scholarly work by providing both a theoretical account of and empirical evidence for the different ways in which D&I policies may find support or resistance from employees. In addition, our work offer practitioners a practical tool to examine the likelihood that D&I policies meet support or opposition from their employees and therefore enables them to design and implement more effective D&I interventions

In vitro and in silico assessment of flow modulation after deploying the Contour Neurovascular System in intracranial aneurysm models

Background The novel Contour Neurovascular System (Contour) has been reported to be efficient and safe for the treatment of intracranial, wide-necked bifurcation aneurysms. Flow in the aneurysm and posterior cerebral arteries (PCAs) after Contour deployment has not been analyzed in detail yet. However, this information is crucial for predicting aneurysm treatment outcomes. Methods Time-resolved three-dimensional velocity maps in 14 combinations of patient-based basilar tip aneurysm models with and without Contour devices (sizes between 5 and 14 mm) were analyzed using four-dimensionsal (4D) flow MRI and numerical/image-based flow simulations. A complex virtual processing pipeline was developed to mimic the experimental shape and position of the Contour together with the simulations. Results On average, the Contour significantly reduced intra-aneurysmal flow velocity by 67% (mean w/ = 0.03m/s; mean w/o = 0.12m/s; p-value=0.002), and the time-averaged wall shear stress by more than 87% (mean w/ = 0.17Pa; mean w/o = 1.35Pa; p-value=0.002), as observed by numerical simulations. Furthermore, a significant reduction in flow (P<0.01) was confirmed by the neck inflow rate, kinetic energy, and inflow concentration index after Contour deployment. Notably, device size has a stronger effect on reducing flow than device positioning. However, positioning affected flow in the PCAs, while being robust in effectively reducing flow. Conclusions This study showed the high efficacy of the Contour device in reducing flow within aneurysms regardless of the exact position. However, we observed an effect on the flow in PCAs, which needs to be investigated further

A summary of the 2012 JHU CLSP Workshop on Zero Resource Speech Technologies and Models of Early Language Acquisition

We summarize the accomplishments of a multi-disciplinary workshop exploring the computational and scientific issues surrounding zero resource (unsupervised) speech technologies and related models of early language acquisition. Centered around the tasks of phonetic and lexical discovery, we consider unified evaluation metrics, present two new approaches for improving speaker independence in the absence of supervision, and evaluate the application of Bayesian word segmentation algorithms to automatic subword unit tokenizations. Finally, we present two strategies for integrating zero resource techniques into supervised settings, demonstrating the potential of unsupervised methods to improve mainstream technologies.5 page(s

Prospects for comparing European hospitals in terms of quality and safety

Purpose. Being able to compare hospitals in terms of quality and safety between countries is important for a number of reasons. For example, the 2011 European Union directive on patients’ rights to cross-border health care places a requirement on all member states to provide patients with comparable information on health-care quality, so that they can make an informed choice. Here, we report on the feasibility of using common process and outcome indicators to compare hospitals for quality and safety in five countries (England, Portugal, The Netherlands, Sweden and Norway). Main Challenges Identified. The cross-country comparison identified the following seven challenges with respect to comparing the quality of hospitals across Europe: different indicators are collected in each country; different definitions of the same indicators are used; different mandatory versus voluntary data collection requirements are in place; different types of organizations oversee data collection; different levels of aggregation of data exist (country, region and hospital); different levels of public access to data exist; and finally, hospital accreditation and licensing systems differ in each country. Conclusion. Our findings indicate that if patients and policymakers are to compare the quality and safety of hospitals across Europe, then further work is urgently needed to agree the way forward. Until then, patients will not be able to make informed choices about where they receive their health care in different countries, and some governments will remain in the dark about the quality and safety of care available to their citizens as compared to that available in neighbouring countries

Do You Need a Foot-in-the-Door or Is A Toe Enough? Scripting Introductions That Induce Tailoring and Increase Participation in Telephone Interviews

Substantial research and practical experience shows that a telephone interviewer is most successful at gaining cooperation and avoiding refusals when they are free to tailor their introductory pitch to the potential respondent or household informant they reach. However, survey designers are often uncomfortable allowing interviewers to work “off-script,” and instruct interviewers to read introductory text verbatim. Further, some interviewers report being more comfortable with a script than without one. To bridge this gap between research and practice we asked, “Can we create a scripted introduction that engages the potential respondent, gets a foot-in-the-door, and facilitates interviewer tailoring?” This paper reports on a randomized experimental test of two such scripts, each implemented within the Washington Behavioral Risk Factor Surveillance System (BRFSS), a random digit dial (RDD) phone survey. In both phases of the experiment, sampled phone numbers were randomized to the standard BRFSS introduction or the new script. Phase 1 (August, 2018) implemented a “conversational” introduction that added or revised three features of the standard BRFSS introduction: First, the introduction included three “hook questions” (e.g., “Have you heard of the survey?”). One hook question was randomly displayed each time a phone number was called. Second, the script displayed on the first three CATI screens was modified to sound more conversational and less abrupt. Third, pause points were created to make sure the interviewer slows down and listens to the potential respondent. Each of these features is hypothesized to increase tailoring, and thus cooperation, by encouraging interaction between the interviewer and potential respondent. Phase 2 (September, 2018) replaced the conversational introduction with a “progressive scheduling” script that instructed interviewers to ask for a good time to call back to complete the interview rather than asking for complete cooperation on the call. This approach encourages a dynamic that shows respect for the respondent’s time. It also changes a large, unexpected request to a small one that the respondent can plan. While call-backs are sometimes considered undesirable outcomes, they can be a good “toe-in-the-door” technique that leads to full cooperation later. Our primary outcomes are cooperation, scheduled callbacks, and refusals. Additionally, a more conversational introduction might influence answers to questions within the interview, such as if increased rapport depresses reports of sensitive behaviors. Thus, we will also assess the effect of the modified scripts on responses to assess the nonresponse / measurement error trade-offs of this approach