Managing intergroup silos to improve patient flow.

BACKGROUND: Health care managers face the critical challenge of overcoming divisions among the many groups involved in patient care, a problem intensified when patients must flow across multiple settings. Surprisingly, however, the patient flow literature rarely engages with its intergroup dimension. PURPOSE: This study explored how managers with responsibility for patient flow understand and approach intergroup divisions and "silo-ing" in health care. METHODOLOGY/APPROACH: We conducted in-depth interviews with 300 purposively sampled senior, middle, and frontline managers across 10 Canadian health jurisdictions. We undertook thematic analysis using sensitizing concepts drawn from the social identity approach. RESULTS: Silos, at multiple levels, were reported in every jurisdiction. The main strategies for ameliorating silos were provision of formal opportunities for staff collaboration, persuasive messages stressing shared values or responsibilities, and structural reorganization to redraw group boundaries. Participants emphasized the benefits of the first two but described structural change as neither necessary nor sufficient for improved collaboration. CONCLUSION: Silos, though an unavoidable feature of organizational life, can be managed and mitigated. However, a key challenge in redefining groups is that the easiest place to draw boundaries from a social identity perspective may not be the best place from one of system design. Narrowly defined groups forge strong identities more easily, but broader groups facilitate coordination of care by minimizing the number of boundaries patients must traverse. PRACTICE IMPLICATIONS: A thoughtfully designed combination of strategies may help to improve intergroup relations and their impact on flow. It may be ideal to foster a "mosaic" identity that affirms group allegiances at multiple levels.

The "hard, relentless, never-ending" work of focusing on discharge: a qualitative study of managers' perspectives.

PURPOSE: Interventions to hasten patient discharge continue to proliferate despite evidence that they may be achieving diminishing returns. To better understand what such interventions can be expected to accomplish, the authors aim to critically examine their underlying program theory. DESIGN/METHODOLOGY/APPROACH: Within a broader study on patient flow, spanning 10 jurisdictions across Western Canada, the authors conducted in-depth interviews with 300 senior, middle and frontline managers; 174 discussed discharge initiatives. Using thematic analysis informed by a Realistic Evaluation lens, the authors identified the mechanisms by which discharge activities were believed to produce their impacts and the strategies and context factors necessary to trigger the intended mechanisms. FINDINGS: Managers' accounts suggested a common program theory that applied to a wide variety of discharge initiatives. The chief mechanism was inculcation of a sharp focus on discharge; reinforcing mechanisms included development of shared understanding and a sense of accountability. Participants reported that these mechanisms were difficult to produce and sustain, requiring continual active management and repeated (re)introduction of interventions. This reflected a context in which providers, already overwhelmed with competing demands, were unlikely to be able (or perhaps even willing) to sustain a focus on this particular aspect of care. ORIGINALITY/VALUE: The finding that "discharge focus" emerged as the core mechanism of discharge interventions helps to explain why such initiatives may be achieving limited benefit. There is a need for interventions that promote timely discharge without relying on this highly problematic mechanism.

Assessing staff awareness and effectiveness of educational training on IT security and privacy in a large healthcare organization.

BACKGROUND: The increased use of health information systems and information technology (IT) in healthcare heightens the risk of security and privacy breaches. Necessary measures such as effective IT training and education are required to meet the challenges of protecting patient information. PURPOSE: The objective of the study was to determine the effectiveness of existing educational and awareness modules in delivering the key messages around IT security and privacy. METHODS: The study was conducted in a large healthcare organization in Western Canada from September 2016 to March 2017. Using proportionate stratified random sampling, an online survey was distributed to all professional groups including clinical and non-clinical staff. In total, 586 participants responded to questions pertaining to whether or not they were aware of the IT education material, common potential breaches, and knowledge in preventing IT security and privacy breaches. Data were analyzed in SPSS version 19. RESULTS: The study found that most of the participants (80.9%) completed the online IT training. Staff perceived the online training as effective (57.5%). There was a significant positive correlation between staff perception about the effectiveness of IT security educational material and satisfaction with IT security in the organization (r=0.34, P<0.01). Those who completed the training were 4.2-times (CI=2.0-8.8) more likely to correctly report the action upon receiving spam emails than those who had not completed the training. The most common type of breach stated was not knowing how to encrypt emails when sending emails outside the organization. Only a small proportion of clinical (25.5%) and non-clinical staff (30.4%) reported knowing how to encrypt emails. Also, participants identified various strategies for improving the module content and compliance. CONCLUSION: Online training provides a basic understanding of IT security and privacy concepts to prevent potential breaches. The training should be an integral part of healthcare staff continuing education to protect patient information.

Using integrated technology to create quality care for older adults: a feasibility study.

PURPOSE: Slow changes in older adults' health status are often not detected until they escalate. Our aim was to understand if e-technology can enhance the safety and quality of older adult care by detecting changes in health status early. METHODS: E-technology was implemented with 30 seniors in an assisted living facility. We used wireless devices to monitor blood pressure, oxygen saturation, weight, and hydration. This 1-year feasibility study included: a readiness assessment, procuring devices, developing an alert software, training staff, and weekly monitoring for several months. RESULTS: Analysis of service utilization data showed no significant differences in number of emergency or hospital visits between the intervention and control group. Qualitative data suggested residents were satisfied with the e-technology. Among staff, several saw value in weekly monitoring, however staff emphasized the need for devices to be suitable for older adults. CONCLUSION: It is imperative that researchers work with facilities to ensure there is value-added in implementing new technology. Staff feedback helped fine-tune devices, training materials, and measurement process. It took longer than anticipated to procure suitable devices, set up the software, and recruit residents, thus limiting data collection. Future studies should dedicate more time to implementation and propose longer timelines.

Evaluation of the awareness and effectiveness of IT security programs in a large publicly funded health care system.

BACKGROUND: Electronic health records are becoming increasingly common in the health care industry. Although information technology (IT) poses many benefits to improving health care and ease of access to information, there are also security and privacy risks. Educating health care providers is necessary to ensure proper use of health information systems and IT and reduce undesirable outcomes. OBJECTIVE: This study evaluated employees' awareness and perceptions of the effectiveness of two IT educational training modules within a large publicly funded health care system in Canada. METHOD: Semi-structured interviews and focus groups included a variety of professional roles within the organisation. Participants also completed a brief demographic data sheet. With the consent of participants, all interviews and focus groups were audio recorded. Thematic analysis and descriptive statistics were used to evaluate the effectiveness of the IT security training modules. RESULTS: Five main themes emerged: (i) awareness of the IT training modules, (ii) the content of modules, (iii) staff perceptions about differences between IT security and privacy issues, (iv) common breaches of IT security and privacy, and (v) challenges and barriers to completing the training program. Overall, nonclinical staff were more likely to be aware of the training modules than were clinical staff. We found e-learning was a feasible way to educate a large number of employees. However, health care providers required a module on IT security and privacy that was relatable and applicable to their specific roles. CONCLUSION: Strategies to improve staff education and mitigate against IT security and privacy risks are discussed. Future research should focus on integrating health IT competencies into the educational programs for health care professionals.