99 research outputs found
Information Technology Sophistication in Hospitals: A Field Study in Quebec
The Quebec health sector has been experiencing a period of great turmoil over the last five years. Among other institutions, hospitals are faced with huge pressures from government funding cuts. Several empirical studies in the information systems field have shown that the use of computer-based information systems could have positive impacts on organizational performance. Many agree to say that health care institutions are no exceptions. But if one wishes to identify the effects of IT on the delivery of care, one must be able to characterize IT for operationalization purposes. The objective of this research project is twofold. Our first aim consists in developing and validating a measurement instrument of IT sophistication in hospitals. Such instrument should provide hospital managers with a diagnostic tool capable of indicating the profile of their respective institutions in regard to IT use and comparing this profile to those of other similar health institutions. In this line of thought, our second objective consists in presenting the IT sophistication profile of Quebec hospitals. Le secteur de la santĂ© au QuĂ©bec vit Ă l'heure des grands bouleversements. Plusieurs s'entendent Ă dire que les hĂŽpitaux n'ont d'autre alternative que de faire appel aux technologies de pointe afin d'assurer un niveau de qualitĂ© des soins adĂ©quat tout en minimisant les coĂ»ts associĂ©s Ă ces mĂȘmes soins. Or, si l'on veut identifier les effets de la TI sur la performance des hĂŽpitaux, il faut ĂȘtre capable de dĂ©finir cette TI en tant que construit et caractĂ©riser cette derniĂšre dans un but d'opĂ©rationalisation en tant que variable indĂ©pendante, dĂ©pendante ou modĂ©ratrice dans un cadre conceptuel de recherche. Cette Ă©tude vise deux objectifs particuliers. Le premier consiste Ă dĂ©velopper un questionnaire mesurant le degrĂ© de sophistication des TI en milieu hospitalier et Ă le valider auprĂšs de la population des hĂŽpitaux quĂ©bĂ©cois. Notre second objectif est de prĂ©senter, de façon sommaire, le profil des hĂŽpitaux du QuĂ©bec en matiĂšre de sophistication des TI.IT sophistication, measurement instrument, hospital information systems, Sophistication des TI, instrument de mesure, SI en milieu hospitalier
Le concept dâautonomie . Indicateur synthĂ©tique et opĂ©rationnel du mode de vieillissement : une approche systĂ©mique
Dans le présent article, nous précisons d'abord le contexte et les objectifs de l'étude. Dans un deuxiÚme temps, nous définissons le concept d'autonomie, indiquant comment celui-ci s'est traduit concrÚtement à l'étape de la cueillette d'informations (formulaire d'évaluation d'autonomie fonctionnelle). Dans un troisiÚme temps, nous présentons la méthode de mesure ainsi que certains résultats obtenus avec un indice de comportements observables (activités de vie quotidienne, d'exploration extérieure et d'entretien ménager).The present study is a follow-up of a research project made in 1978 by the Equipe de Recherche Opérationnelle en Santé (EROS) of the Department of Health Administration at the Université de Montréal. The aims were a) firstly to construct a classification instrument by type for long-term care patients, enabling us, to identify these beneficiaries' needs, as well as to guide their placement in a health services' system. And b) to evaluate this instrument (realibility and validity), c) to initiate its implementation and d) to utilize it for evaluating the present placement system. This study constitutes the first stage in an approach aimed at producing, on the basis of a systematic scanning of data collected within the framework of the above-mentioned project; a comprehensive descriptive analysis of the social/health characteristics of an aged population (65 years and over) in one of Quebec's social/ health regions i.e. Montreal's South Shore. At first, the authors define the context and the objectives of the study undertaken; secondly, they define the concept of autonomy by showing how the latter is expressed concretely according to the observation instrument (evaluation form of the individual's functional autonomy). Thirdly, a presentation is made of the method of measurement, as well as certain results concerning an index of restricted autonomy directly released to situations of observable behaviour (e, g. daily-life activities, exploring the outside world, and housekeeping)
Managing Customization in Health Care: A Framework Derived from the Services Sector Literature
Organizations that provide health services are increasingly in need of systems and approaches that will enable them to be more responsive to the needs and wishes of their clients. Two recent trends, namely, patient-centered care (PCC) and personalized medicine, are first steps in the customization of care. PCC shifts the focus away from the disease to the patient. Personalized medicine, which relies heavily on genetics, promises significant improvements in the quality of healthcare through the development of tailored and targeted drugs. We need to understand how these two trends can be related to customization in healthcare delivery and, because customization often entails extra costs, to define new business models. This article analyze how customization of the care process can be developed and managed in healthcare. Drawing on relevant literature from various services sectors, we have developed a framework for the implementation of customization by the hospital managers and caregivers involved in care pathways
Informatisation incrémentale ou de rupture? : le cas du dossier patient hospitalier
Au niveau international, lâinformatisation de la production des soins hospitaliers ne se dĂ©veloppe que
lentement. Un terme souvent utilisé dans la littérature pour expliquer ce phénomÚne est celui des
"facteurs organisationnels", mais sans, la plupart du temps, que ce terme soit prĂ©cisĂ©. Lâarticle, Ă
partir dâune recherche observationnelle multi-sites, analyse sur le cas français les Ă©volutions
organisationnelles des unitĂ©s cliniques consĂ©cutives Ă lâimplantation dâun Dossier Patient InformatisĂ©
(DPI). Il montre que le systĂšme en place nâa subi que peu de transformations, au prix
dâaccommodements avec lâoutil informatique. Une telle situation peut paraitre satisfaisante aux yeux
des tutelles qui promeuvent lâinnovation technologique, mais pose la question de la crĂ©ation de valeur
organisationnelle, câest-Ă -dire la possibilitĂ© pour les professionnels de soins de se saisir de lâoutil dans
une optique de transformation et dâamĂ©lioration Ă terme des diffĂ©rentes composantes de la
performance.At the international level, the computerization of hospital care production develops only slowly. Past
research has often used the term "organizational factors" to explain this phenomenon, but without
specification so far. This article builds on results from an empirical research led in multiple French
hospitals to investigate the organizational evolutions of clinical units due to the implementation of an
Electronic Patient Record. It shows that the extant organizational system underwent only few
transformations, thanks to local adjustments with the IT tool. Such a situation may be satisfactory for
the eyes of the supervising structures which promote the technological innovation, but raises the issue
of true organizational value creation
Le dĂ©ploiement dâune politique publique dâĂ©valuation de la qualitĂ© par les indicateurs hospitaliers : genĂšse et dĂ©veloppement du cas français
Cet article porte un regard rĂ©trospectif sur les quinze derniĂšres annĂ©es considĂ©rĂ©es comme une pĂ©riode charniĂšre dans la rĂ©gulation de la qualitĂ© hospitaliĂšre. Il se concentre principalement sur lâinnovation instruÂmentale quâa pu constituer lâadoption des indicateurs de qualitĂ©. FondĂ© sur une dĂ©marche historique appuyĂ©e par un travail dâenquĂȘte, il restitue les facteurs clĂ©s qui ont contribuĂ© Ă lâĂ©mergence de ce nouvel instrument. Ce faisant, lâarticle prĂ©sente Ă la fois les enjeux dont il a fait lâobjet, les soutiens dont il a bĂ©nĂ©ficiĂ© et les rĂ©sistances rencontrĂ©es lors de sa mise en Ćuvre.In a context of growing concern for patient safety and service quality, this article aims at identifying the key factors for indicators implementation in the French healthcare system. It is based on an historical approach of the case of quality regulation in hospitals. This study underlines the necessary steps of implementation carÂried by different institutional actors (politics, academÂics, professional). It focuses on the conditions for the emergence of this new kind of regulation
LâintĂ©gration des services sur une base locale : acquis et limites
Cet article rend compte d'une expĂ©rience locale d'intĂ©gration des services auprĂšs d'une clientĂšle souffrant de troubles mentaux. L'expĂ©rience s'est dĂ©roulĂ©e dans une rĂ©gion rurale entre 1998 et 2001 et a Ă©tĂ© financĂ©e par le Fonds pour l'adaptation des services de santĂ© (FASS). Les auteurs dĂ©crivent le contexte particulier de l'expĂ©rimentation, le modĂšle d'intervention qui, fait particulier, comprend une intĂ©gration des services de santĂ© au niveau populationnel ainsi que des interventions spĂ©cifiques pour la clientĂšle de la santĂ© mentale. Les auteurs procĂšdent ensuite Ă l'Ă©valuation de cette expĂ©rimentation et plus particuliĂšrement son implantation en s'appuyant sur le concept de partenariat. Les relations dyadiques entre les acteurs institutionnels, non institutionnels et les personnes utilisatrices sont ainsi examinĂ©es. AprĂšs avoir mis en Ă©vidence les avantages d'une telle expĂ©rimentation locale, ils discutent des limites et des enjeux particuliers de ce projet dans le contexte de la santĂ© mentale.Service integration on a local basis : advantages and limits This article describes an experience of integration of services to people with mental health disorders on a local basis. The experience took place in a rural region between 1998 and 2001 and was funded by the Fonds pour l'adaptation des services de santĂ© (FASS). The authors describe th specific context of the experience, the intervention model which includes integration of health services on a population level as well as specific interventions for mental health patients. The authors then evaluate the experience and more particularly, its implementation on the basis of the concept of partnership. Dyadic relationships between institutional, non institutional protagonists and consumers are examined. After emphasizing the advantages of such an experience, the authors discuss the limits and particular stakes of such a project in the context of mental health.La integraciĂłn de servicios sobre una base local: adquiridos y limites Este artĂculo da cuenta de una experiencia local de integraciĂłn de servicios con personas que padecen de problemas mentales. La experiencia se efectuĂł en una regiĂłn rural entre 1998 y 2001 y ha sido financiada por el Fondos para la adaptaciĂłn de servicios de salud (FASS). Los autores describen el contexto particular de la experimentaciĂłn, el modelo de intervenciĂłn, cual, hecho particular, incluye una integraciĂłn de servicios de salud al nivel poblacional aisi que de intervenciones especĂficas para la clientela de salud mental. Los autores proceden despues a una evaluaciĂłn de esta experimentaciĂłn y mĂĄs particularmente, su establecimiento, apoyandose sobre el concepto de colaboraciĂłn. Las relaciones dyadicas entre los actores institucionales, non institucionales y las personas utilizadoras estan examinadas. Ponen en evidencia las ventajas de tal experimentaciĂłn local y discuten de las limites y de cuestiones particulares de este proyecto en el contexto de la salud mental.Integração dos serviços prestados localmente: conquistas e limites Este artigo trata de uma experiĂȘncia local de integração dos serviços prestados junto a uma clientela que sofre de problemas mentais. A experiĂȘncia foi realizada em uma regiĂŁo rural entre 1998 e 2001 e foi financiada pelo Fundo para Adaptação dos Serviços de SaĂșde (FASS). Os autores descrevem o contexto especĂfico da experiĂȘncia, o modelo da atuação que, especificamente neste caso, inclui uma integração dos serviços de saĂșde em nĂvel popular e as atuaçÔes especĂficas da clientela de saĂșde mental. Os autores fazem em seguida uma avaliação desta experiĂȘncia e, mais especificamente, de sua implantação, apoiando-se no conceito de parceria. Eles examinam as relaçÔes diĂĄdicas entre os atores institucionais, nĂŁo institucionais e os usuĂĄrios. Depois de evidenciar as vantagens desta experiĂȘncia local, eles discutem sobre os limites e as questĂ”es especĂficas deste projeto no contexto da saĂșde mental
Keys to successful implementation of a French national quality indicator in health care organizations: a qualitative study
International audienceBackground: Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice
Clinicians' perceptions of organizational readiness for change in the context of clinical information system projects: insights from two cross-sectional surveys
Users' perspectives of barriers and facilitators to implementing EHR in Canada: A study protocol
<p>Abstract</p> <p>Background</p> <p>In Canada, federal, provincial, and territorial governments are developing an ambitious project to implement an interoperable electronic health record (EHR). Benefits for patients, healthcare professionals, organizations, and the public in general are expected. However, adoption of an interoperable EHR remains an important issue because many previous EHR projects have failed due to the lack of integration into practices and organizations. Furthermore, perceptions of the EHR vary between end-user groups, adding to the complexity of implementing this technology. Our aim is to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators influencing the adoption of an interoperable EHR among its various users and beneficiaries.</p> <p>Methods</p> <p>First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to the implementation of the EHR. Standardized literature search and data extraction methods will be used. Studies' quality and relevance to inform decisions on EHR implementation will be assessed. For each group of EHR users identified, barriers and facilitators will be categorized and compiled using narrative synthesis and meta-analytical techniques. The principal factors identified for each group of EHR users will then be validated for its applicability to various Canadian contexts through a two-round Delphi study, involving representatives from each end-user groups. Continuous exchanges with decision makers and periodic knowledge transfer activities are planned to facilitate the dissemination and utilization of research results in policies regarding the implementation of EHR in the Canadian healthcare system.</p> <p>Discussion</p> <p>Given the imminence of an interoperable EHR in Canada, knowledge and evidence are urgently needed to prepare this major shift in our healthcare system and to oversee the factors that could affect its adoption and integration by all its potential users. This synthesis will be the first to systematically summarize the barriers and facilitators to EHR adoption perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. This comprehensive and rigorous strategy could be replicated in other settings.</p
Improving performance in medical practices through the extended use of electronic medical record systems: a survey of Canadian family physicians
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