Integrating eHealth within a transforming mental healthcare setting:A qualitative study into values, challenges, and prerequisites

Mental health care is shifting towards more person-centered and community-based health care. Although integrating eHealth within a transforming healthcare setting may help accomplishing the shift, research studying this is lacking. This study aims to improve our understanding of the value of eHealth within a transforming mental healthcare setting and to define the challenges and prerequisites for implementing eHealth in particular within this transforming context. In this article, we present the results of 29 interviews with clients, social network members, and professionals of an ambulatory team in transition within a Dutch mental health care institute. The main finding is that eHealth can support a transforming practice shifting towards more recovery-oriented, person-centered, and community-based service in which shared-decision making is self-evident. The main challenge revealed is how to deal with clients’ voices, when professionals see the value of eHealth but clients do not want to start using eHealth. The shift towards client-centered and network-oriented care models and towards blended care models are both high-impact changes in themselves. Acknowledging the complexity of combining these high-impact changes might be the first step towards creating blended client-centered and network-oriented care. Future research should examine whether and how these substantial shifts could be mutually supportive

Approximate performance analysis of production lines with continuous material flows and finite buffers

In this paper, we analyze production lines consisting of a number of machines or servers in series with a finite buffer between each pair of machines. The flow of products through the machines is continuous. Each machine suffers from breakdowns, because of, for example, failures, cleaning and changeover. The up- and downtimes are independent and generally distributed. We develop a new method to efficiently and accurately estimate the throughput and the mean buffer content of the production line. This method relies on decomposition of the production line into two-stage, one-buffer subsystems aggregating the up- and downstream part of the line. For each subsystem, the parameters of the aggregate up- and downtimes are determined iteratively by employing matrix-analytic techniques. The proposed method performs very well on a large test set consisting of over 49,000 cases. Remarkably, the performance of the method does not deteriorate in case of highly unpredictable up- and downtimes, as often seen in practice. We apply the method to a bottling line at brewery Heineken Den Bosch and an assembly line at NXP Semiconductors

Performance analysis of production lines with continuous material flows and finite buffers

This paper deals with the approximative analysis of production lines with continuous material flow consisting of a number of machines or servers in series and finite buffers in between. Each server suffers from operational dependent breakdowns, characterized by exponentially distributed up- and down-times. We construct an iterative method to efficiently and accurately estimate performance characteristics such as throughput and mean total buffer content. The method is based on decomposition of the production line into single-buffer subsystems. Novel features of the method are (i) modeling of the aggregate servers in each subsystem, (ii) equations to iteratively determine the processing behavior of these servers, and (iii) use of modern matrix-analytic techniques to analyze each subsystem. The proposed method performs very well on a large test set, including long and imbalanced production lines. For production lines with imbalance in mean down-times, we show that a more refined modeling of the servers in each subsystem performs significantly better. Lastly, we apply the iterative method to predict the throughput of a bottle line at brewery Heineken Den Bosch yielding errors of less than two percent

Looking to the future: Framing the implementation of interprofessional education and practice with scenario planning

Background: Adapting to interprofessional education and practice requires a change of perspective for many health professionals. We aimed to explore the potential of scenario planning to bridge the understanding gap and framing strategic planning for interprofessional education (IPE) and practice (IPP), as well as to implement innovative techniques and technology for large‑group scenario planning. Methods: A full‑day scenario planning workshop incorporating innovative methodology was designed and offered to participants. The 71 participants included academics from nine universities, as well as service providers, government, students and consumer organisations. The outcomes were evaluated by statistical and thematic analysis of a mixed method survey questionnaire. Results: The scenario planning method resulted in a positive response as a means of collaboratively exploring current knowledge and broadening entrenched attitudes. It was perceived to be an effective instrument for framing strategy for the implementation of IPE/IPP, with 81 percent of respondents to a post‑workshop survey indicating they would consider using scenario planning in their own organisations. Discussion: The scenario planning method can be used by tertiary academic institutions as a strategy in developing, implementing and embedding IPE, and for the enculturation of IPP in practice settings.Government of Western Australia, Department of Health

Whether and how top management create flexibility in mental healthcare organizations:COVID-19 as a test case

Purpose: Flexibility is essential for healthcare organizations to anticipate the increasing internal and external dynamics. Mental healthcare organizations in the Netherlands face major policy reforms made by the government, increasing involvement from municipalities and gradual replacement of clinical care with outpatient care. Top management plays an important strategic role in creating this flexibility because they make important choices, give direction and structure the organization. To create flexibility, managers have to deal with complexity and paradoxes. In this study, the authors aim to contribute to the knowledge on how healthcare managers can create flexibility in their organizations. Design/methodology/approach: This is a qualitative empirical field study. In total, 21 managers of mental healthcare organizations participated in open in-depth interviews. The authors explored flexibility on three perspectives: organizational direction, structure and operations. The COVID-19 pandemic has provided an opportunity to explore flexibility. The authors asked participants to reflect on their organization's response to the pandemic. Findings: Most mental healthcare organizations create flexibility in an implicit way. Flexibility and resilience are closely linked mechanisms. Flexibility ensures a quick response while resilience provides the counterforce and rebound needed to adapt. Adaption ensures that healthcare professionals learn from their experiences and do not return completely to the way things were done before. The primary urge to survive ensured rapid and adequate responses to the COVID-19 pandemic. Whether this is a manifestation of flexibility remains difficult to conclude. Practical implications: The complexity theory offers some guidance in creating a flexible organization without losing consistency. Flexibility and resilience are closely linked mechanisms that antagonize and protect each other. With this insight, managers in mental healthcare can utilize the qualities and balance them without falling into the various pitfalls. Originality/value: In this research, the authors are concerned with flexibility as a proactive attitude and capacity of organizations. By looking at the response of organizations to the COVID-19 crisis, the authors find out that responding to a disaster out of survival instinct is something else than flexibility. There is an interesting relationship between flexibility, resilience and adaptability, and they can balance each other