The impacts of an inflammatory bowel disease nurse specialist on the quality of care and costs in Finland.

INTRODUCTION: A specialized inflammatory bowel disease (IBD) nurse is considered a valuable and cost-effective member of a multidisciplinary team, not all clinics responsible for IBD care employ such nurses. We evaluated IBD nurse resources, quality of care and cost effects on IBD patients care in a nationwide study in Finland. METHODS: A healthcare professional electronic survey was conducted in order to assess the impact of an IBD nurse on the quality of care. To study the cost effects, we obtained nationwide comprehensive data covering years between 2008 and 2016 from major administrative healthcare districts of Finland. Patients with a diagnosis of IBD (ICD-code K50 or K51) were identified from the data and their personal contacts and hospitalization were analyzed. The results were compared between healthcare districts with an IBD nurse and healthcare districts without an IBD nurse. RESULTS: Forty-nine physicians and 88 nurses responded to the survey. Of the physicians, 92% reported that an established IBD nurse had released physician's resources. The most important IBD nurse contributions listed were patient support and follow-up (79-81% of the respondents). Healthcare district, which had an established IBD nurse, produced more patient contacts. A larger proportion of the contacts was managed by the IBD nurse. Clinics with an IBD nurse reported less patient hospitalization (4-9% vs 11-19%, p < .001). Estimated annual cost savings while employing an IBD nurse may be significant. CONCLUSION: The introduction of an IBD nurse led to better quality of care and potentially significant cost savings by reducing hospitalization rates and reallocating physician's time resources.

Stakeholder approach for evaluating organizational change projects.

PURPOSE: This paper aims to create a model for evaluating organizational change initiatives from a stakeholder resistance viewpoint. DESIGN/METHODOLOGY/APPROACH: The paper presents a model to evaluate change projects and their expected benefits. Factors affecting the challenge to implement change were defined based on stakeholder theory literature. The authors test the model's practical validity for screening change initiatives to improve operating room productivity. FINDINGS: Change initiatives can be evaluated using six factors: the effect of the planned intervention on stakeholders' actions and position; stakeholders' capability to influence the project's implementation; motivation to participate; capability to change; change complexity; and management capability. RESEARCH LIMITATIONS/IMPLICATIONS: The presented model's generalizability should be explored by filtering presented factors through a larger number of historical cases operating in different healthcare contexts. The link between stakeholders, the change challenge and the outcomes of change projects needs to be empirically tested. PRACTICAL IMPLICATIONS: The proposed model can be used to prioritize change projects, manage stakeholder resistance and establish a better organizational and professional competence for managing healthcare organization change projects. ORIGINALITY/VALUE: New insights into existing stakeholder-related understanding of change project successes are provided.

Improved detection and pharmacotherapy of major depression from 1989 to 2001 in psychiatric outpatient care in Finland.

There have been several reports of non-detection and undertreatment of major depression during the past decades. In this study, we investigated how accurately major depression was assessed, diagnosed and treated according to gold standards, and whether any trend could be found from 1989 to 2001 in Finland. In total, documents of 4447 patients were retrospectively checked at most four times to find the patients fulfilling the study criteria. Finally, 531 patients were included in the study. The major finding of the study was the improved diagnostic assessment of patients with major depression seen in psychiatric settings. However, a systematic and comprehensive approach in asking about and recording subtyping, severity and comorbidity of depression was insufficient. Another major finding of the study was the improved pharmacotherapy of patients with major depression. It seems to be relevant that problems in the quality of care for depression in psychiatric settings are now more likely to be related to suboptimal intensity and monitoring of treatment than to mere lack of treatment.

Managing urgent surgery as a process: Case study of a trauma center.

OBJECTIVES: Industrial management principles could be used to improve the quality and efficiency of health care. In this study, we have evaluated the effects of a process management approach to trauma patient care. The major objective was to reduce the waiting times and increase the efficiency of the hospital. METHODS: Urgent surgery care was analyzed as an overall process. The process development followed the Plan-Do-Check-Act (PDCA) cycle and was based on statistical analysis of certain performance metrics. Data were collected from hospital databases and by personnel interviews. To develop the process, the anesthesia induction was performed outside the operating room, better process guidance was developed, and patient flow was reorganized. The transition time for these changes was 1 year (2002 to 2003). RESULTS: Waiting times decreased by 20.5 percent (p < .05), nonoperative times in the operating room were reduced by 23.1 percent (p < .001), and efficiency was increased by 9.7 percent (p < .001) after reengineering of the care process. Overtime hours decreased by 30.9 percent. CONCLUSIONS: Managing urgent surgical care as a process can improve the productivity and quality of care without a need to increase personnel resources. The focus should be on reducing waiting times and waste times.