Muutos psykiatristen avohoitokäyntien toteutuksessa ja johtajien kokemukset etäasiointia estävistä ja edistävistä tekijöistä COVID-19 aikakaudella

Vertaisarvioitu. English abstract.Peer reviewe

Leadership in the context of digital health services:a hypothetical model

Abstract The aim of this study was to propose a hypothetical model of leadership in the context of digital health services. The study consisted of two phases: phase I aimed to clarify and define the concept of leadership and describe leadership in the context of digital health services; phase II proposed a hypothetical model of leadership in the context of digital health services, based on the results of phase I. In phase I, a conceptual framework for the hypothetical model of leadership in the context of digital health services was created using the Walker and Avant concept analysis model and qualitative studies. First, the concept of leadership in the context of digital health services was clarified and defined. A total of 23 scientific papers were analysed. Based on the concept analysis, leadership attributes were identified concerning leaders’ behaviour, roles, and qualities. Antecedents were related to IT skills and competences, information and tools, understanding the complexity of care systems, and possessing a sufficient education level. Finally, consequences were related to organization, professionals, and patients and their care. Second, two qualitative descriptive studies were conducted. The data were collected using individual interviews (n=21) in primary care and focus group interviews (n=6) in specialized medical care with healthcare leaders (n=20). Data were analysed using inductive and deductive-inductive content analyses. Based on the first qualitative sub-study, six main categories were formed, namely strategic leadership, operative leadership, transformational leadership, leading one’s own and employees’ digital competence, remote leadership, and leading collaboration and co-creation. The second qualitative sub-study identified traits, cognition, affects, and behaviours concerning e-leadership. In phase II, a hypothetical model of leadership in the context of digital health services was proposed. This hypothetical model summarized the results of phase I and proposed antecedents, attributes, and consequences of leadership in the context of digital health services. The attributes of leadership were related to traits and qualities, roles, behaviours, affects, and cognition. This study provides a novel and comprehensive view of leadership in the context of digital health services. The hypothetical model can be utilized in advancing healthcare digitalization, developing education for healthcare leaders, and advancing future leadership and digitalization research.Tiivistelmä Tämän tutkimuksen tarkoituksena oli muodostaa hypoteettinen malli johtajuudesta digitaalisten terveyspalveluiden kontekstissa. Tutkimus sisälsi kaksi vaihetta. Ensimmäisen vaiheen tarkoituksena oli määritellä johtajuuden käsite sekä kuvata johtajuutta digitaalisten terveyspalvelujen kontekstissa. Toisessa vaiheessa muodostettiin hypoteettinen malli johtajuudesta digitaalisen terveyden kontekstissa perustuen aikaisemman vaiheen tuloksia. Vaiheessa I tunnistettiin ja määriteltiin johtajuuden käsite digitaalisten terveyspalvelujen kontekstissa käyttäen Walkerin ja Avantin käsiteanalyysia. Yhteensä 23 tieteellistä artikkelia analysoitiin. Käsiteanalyysin perusteella johtajuuden piirteisiin sisältyivät johtajien käyttäytymistä, rooleja ja ominaisuuksia. Edellytykset liittyivät informatiikan osaamiseen, tietoon ja työvälineisiin, palvelujärjestelmien monimutkaisuuden ymmärtämiseen ja riittävään koulutukseen. Seuraukset kytkeytyivät organisaatioihin, ammattilaisiin sekä potilaisiin ja heidän hoitoonsa. Seuraavaksi toteutettiin kuvaileva laadullinen tutkimus, joka sisälsi kaksi osatutkimusta. Aineistot kerättiin yksilöhaastatteluilla (n=21) perusterveydenhuollossa ja ryhmähaastatteluilla (n=6) erikoissairaanhoidossa toimivilta johtajilta (n=20). Aineistot analysoitiin induktiivisella ja deduktiivis-induktiivisella sisältöanalyysilla. Ensimmäisen osatutkimuksen perusteella muodostettiin kuusi pääkategoriaa, joita olivat strateginen, operatiivinen ja transformationaalinen johtajuus, oman ja työntekijöiden digitaalisen osaamisen varmistaminen, etäjohtajuus sekä yhteistyön johtajuus ja yhteiskehittäminen. Toisessa osatutkimuksessa kuvattiin johtajien piirteitä, kognitiota ja käyttäytymistä. Vaiheessa II muodostettiin hypoteettinen malli johtajuudesta digitaalisten terveyspalvelujen kontekstissa. Hypoteettisessa mallissa kuvattiin johtajuuden edeltäjiä, ominaisuuksia ja seuraamuksia digitaalisten terveyspalvelujen kontekstissa. Johtajuuden piirteet liittyivät ominaisuuksiin, rooleihin, käyttäytymiseen, affekteihin ja kognitioon. Tutkimus tuotti uutta tietoa johtajuudesta digitaalisten terveyspalvelujen kontekstissa. Hypoteettista mallia voidaan hyödyntää terveydenhuollon digitalisaation edistämisessä, johtajien koulutuksen kehittämisessä sekä terveydenhuollon johtajuuden ja digitalisaation tutkimuksessa

Health and social care frontline leaders’ perceptions of competence management in telemedicine in Finland:an interview study

Abstract Aim: This work aims to describe competence management in telemedicine from the perspective of health and social care frontline leaders. Background: The increasing use of services in health and social care is a challenging aspect of modern telemedicine; it requires staff to develop relevant professional competence and good telemedicine practices. Methods: The study was conducted using thematic interviews of frontline leaders from primary health care, specialized medical care and social care (n = 10) in the spring of 2021. The data were analysed by inductive content analysis. Results: The following main categories were identified: Activities of frontline leaders while managing competence in telemedicine, promotion of community learning, competence management in determining telemedicine content, and recognizing health and social care professionals’ competence in telemedicine. Conclusions: Achieving the goals set for telemedicine requires ensuring that knowledge from leaders is widely disseminated and shared and that staff are adequately trained. The results can be utilized in the practical work of other telemedicine and in the development of their operations. Implications for Nursing Management: Managing competence in telemedicine requires from the leaders an encouraging attitude and improved personal interactions in the work community

Nurse leaders’ and digital service developers’ perceptions of the future role of artificial intelligence in specialized medical care:an interview study

Abstract Aim: To describe nurse leaders’ and digital service developers’ perceptions of the future role of artificial intelligence (AI) in specialized medical care. Background: Use of AI has rapidly increased in health care. However, nurse leaders’ and developers’ perceptions of AI and its future in specialized medical care remain under-researched. Method: Descriptive qualitative methodology was applied. Data were collected through six focus groups, and interviews with nurse leaders (n = 20) and digital service developers (n = 10) conducted remotely in 2021 at a university hospital in Finland. The data were subjected to inductive content analysis. Results: The data yielded 25 sub-categories, 10 categories and three main categories of participants’ perceptions. The main categories were designated AI transforming: work, care and services and organizations. Conclusions: According to our respondents, AI will have a significant future role in specialized medical care, but it will likely reinforce, rather than replace, clinicians or traditional care. They also believe that it may have several positive consequences for clinicians’ and leaders’ work as well as for organizations and patients. Implications for nursing management: Nurse leaders should be familiar with the potential of AI, but also aware of risks. Such leaders may provide betters support for development of AI-based health services that improve clinicians’ workflows

Consumer-led health-related online sources and their impact on consumers:an integrative review of the literature

Abstract The aim of the review was to describe consumer-led health-related online sources and their impact on consumers. The review was carried out as an integrative literature review. Quantisation and qualitative content analysis were used as the analysis method. The most common method used by the included studies was qualitative content analysis. This review identified the consumer-led health-related online sources used between 2009 and 2016 as health-related online communities, health-related social networking sites and health-related rating websites. These sources had an impact on peer support; empowerment; health literacy; physical, mental and emotional wellbeing; illness management; and relationships between healthcare organisations and consumers. The knowledge of the existence of the health-related online sources provides healthcare organisations with an opportunity to listen to their consumers’ ‘voice’. The sources make healthcare consumers more competent actors in relation to healthcare, and the knowledge of them is a valuable resource for healthcare organisations. Additionally, these health-related online sources might create an opportunity to reduce the need for drifting among the healthcare services. Healthcare policymakers and organisations could benefit from having a strategy of increasing their health-related online sources

Leadership in the context of digital health services:a concept analysis

Abstract Aim: To define and clarify the concept of leadership in the context of digital health services using Walker’s and Avant’s concept analysis model. Background: Conceptualizing leadership in the context of digital health services is needed to deliver higher quality services and advance research. Method: Searches were conducted of MEDLINE (Ovid), Scopus, CINAHL (EBSCO) and ProQuest (ABI/INFORM). Empirical articles were included if they reported attributes, antecedents or consequences of leadership in the study context. A total of 4037 references were identified; 23 were included. Results: Leadership attributes concerned leaders’ behaviour, roles and qualities. Antecedents concerned informatics skills and competence, information and tools, understanding care systems and their complexity and education. Consequences related to organization, professionals and patient and care. Conclusion: Based on our results, the term ’leadership’ should be more widely utilized in nursing practice and research. Implications for nursing management: Nurse leaders need to be strong leaders; they need to be visionary and use strategic thinking to develop existing and new digital solutions. By becoming e-leaders, nurse leaders may increase the successful development and implementation of eHealth and benefit clinicians and patients

The roles of primary care middle managers in the implementation of eHealth in Finland:a qualitative interview study

Abstract Background: Healthcare middle managers play a critical role in the implementation of innovations as their actions and behaviours affect the success of implementation. Nevertheless, healthcare middle managers’ experiences of their involvement in eHealth implementation remain an understudied topic. Aim: To describe and understand primary care middle managers’ roles in eHealth implementation. Methods: A descriptive qualitative interview study was conducted. A total of 10 Finnish primary care middle managers were interviewed in 2020. The data were analysed through inductive content analysis. Findings: Primary care middle managers in Finland perform tasks that fall under support, implementation advancement, managerial, and informational roles. The interactions between these roles may be highly complex when the implementation is part of a national scheme involving numerous organisations. Conclusions: A clear, comprehensive understanding of the roles of middle managers, as well as the linkages between these roles, is critical to creating best practices for eHealth implementation

Identifying the roles of healthcare leaders in HIT implementation:a scoping review of the quantitative and qualitative evidence

Abstract Despite major investment, health information technology (HIT) implementation often tends to fail. One of the reasons for HIT implementation failure is poor leadership in healthcare organisations, and thus, more research is needed on leaders’ roles in HIT implementation. The aim of the review was to identify the role of healthcare leaders in HIT implementation. A scoping review with content analysis was conducted using a five-step framework defined by Arksey and O’Malley. Database searches were performed using CINAHL, Business Source Complete, ProQuest, Scopus and Web of Science. The included studies were written either in English or Finnish, published between 2000 and 2019, focused on HIT implementation and contained leadership insight given by various informants. In total, 16 studies were included. The roles of healthcare leaders were identified as supporter, change manager, advocate, project manager, manager, facilitator and champion. Identifying healthcare leaders’ roles in HIT implementation may allow us to take a step closer to successful HIT implementation. Yet, it seems that healthcare leaders cannot fully realise these identified roles and their understanding of HIT needs enforcement. Also, healthcare leaders seem to need more support when actively participating in HIT implementation

Patients’ experiences of patient-centred care in hospital setting:a systematic review of qualitative studies

Abstract Background: Patient-centred care (PCC) has been proposed as an appropriate approach for addressing current shifts in healthcare needs. Although the importance of PCC is generally recognised, PCC is poorly understood by patients in the hospital settings. Objectives: To identify patients’ experiences of PCC in hospital settings. Methodological design: This systematic review followed the Joanna Briggs Institute’s (JBI) guidance for systematic reviews of qualitative evidence and the PRISMA checklist for reporting systematic reviews. The search strategy included peer-reviewed qualitative studies published after 2010 in English or Finnish. The databases searched were SCOPUS, MEDLINE, CINAHL and Medic. Unpublished studies and grey literature were searched in MedNar. Ten qualitative studies were included, and their quality was assessed by two independent reviewers using JBI quality assessment criteria. The data were analysed using thematic analysis. Setting and participants: Studies were included if they had explored adult patient experiences of PCC in hospital settings. Results: A thematic analysis produced 14 subthemes which were grouped into five analytical themes: the presence of the professional, patient involvement in care, receiving information, the patient–professional relationship and being seen as a person. Conclusions and implications: This review suggests that the implementation and provision of PCC in hospitals is incomplete and patients’ involvement in their own care should be in the focus of PCC. The majority of patients experienced receiving PCC, but others did not. The need for improvement of patient involvement was strongly emphasised. Patients highlighted the importance of professionals being present and spending time with patients. Patients felt well-informed about their care but expressed the need for better communication. Meaningful patient–professional relationships were brokered by professionals demonstrating genuine care and respecting the patient as an individual. To improve the implementation of PCC, patient experiences should be considered in the development of relevant hospital care strategies. In addition, more training in PCC and patient–professional communication should be provided to health care professionals

Hospital nurse leaders’ experiences with digital technologies:a qualitative descriptive study

Abstract Aim: To describe hospital nurse leaders’ experiences with digital technologies. Design: A qualitative descriptive study. Methods: Semi-structured focus group interviews in one university-affiliated hospital in Finland. Data were collected from October to November 2021 and analysed using content analysis an e-leadership framework. Results: A total of 20 frontline nurse leaders and middle-managers participated. Leaders had different kinds of experiences that concerned their traits, cognition, affect and behaviour with digital technologies. Leaders experienced that they needed to be open-minded towards digitalization, which sometimes eased their work by making it more efficient. Occasionally, they also got frustrated with digitalization, which caused them stress. Leading digital technologies required collaboration with several different stakeholders, and leaders were especially responsible for ensuring nurses’ digital competence. Also, leaders own digital capability was highlighted, although some leaders experienced that their digital capability was low. Conclusion: The e-leadership framework is useful for describing the conduct of leadership roles in the context of digital services. Digitalization has transformed leadership, yet nurse leaders’ education and training do not seem to have been sufficiently modified to these rapid changes. In addition, more attention should be given to how nurse leaders can be distressed by digitalization. Impact: This study provides insight into leadership in the context of digitalized specialized medical care based on nurse leaders’ direct statements. Furthermore, the results highlight nurse leaders’ educational needs concerning digitalization. Adequately educating nurse leaders to become e-leaders is crucial to successful digitalization in the nursing domain. Patient or public contribution: The study focused on nurse leaders’ experiences