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1.
Bull Cancer ; 107(2): 254-261, 2020 Feb.
Artículo en Francés | MEDLINE | ID: mdl-32035652

RESUMEN

The context and constraints of modern medicine (hospital beds and caregivers' reductions, ambulatory shift, new therapeutic approaches, integration of supportive care…) combined with new societal and Health system changes (ageing population, chronic diseases, new requirements of the patients…) redefine the orientations of care and question professional practices. The participative approach (PA) as a model of team organization proposes solutions involving the skills of the various interacting caregivers and experimental knowledge and consideration of patient needs. The multi-professional staff (MPS) is a collaborative tool of this participative approach that federates a team around a health or care project personalized from the crosschecked eyes of care professionals and from a shared decision-making process. Its objective is to combine the improvement of quality of care with quality of life at work. It requires a transversal mindset of teams, intrinsic values and specific characteristics. Its organization is simple but requires some rules and we will develop the main steps to success. This article, which is the result of a joint reflection and experience of health professionals, shows the principles and wants to demonstrate the weakness of MPS. The interest of the French National Cancer Institute for this collaborative tool is an asset for further work in the perspective of generalization of MPS for all patients with chronic disease and not only for patients at palliative phase.


Asunto(s)
Guías como Asunto , Sector de Atención de Salud/organización & administración , Personal de Salud/organización & administración , Neoplasias/terapia , Admisión y Programación de Personal/organización & administración , Humanos , Grupo de Atención al Paciente/organización & administración , Mejoramiento de la Calidad , Calidad de Vida
2.
Int J Med Inform ; 132: 103924, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31569006

RESUMEN

BACKGROUND: In many countries, including Germany, older people are increasing in numbers, while fewer caregivers are available. A way to address the problem is to develop new medical assistance and monitoring systems that are operated by the elderly on their own, e.g. in-home aftercare systems. OBJECTIVE: The development of a set of eight data-based personas in terms of a best practice approach is presented. METHOD: "Personas" are an integral method of the user-centered design approach. They address the problem of incomplete knowledge of individual user behaviour by introducing archetypal user groups. Thus, personas can be used at an early stage of development to raise the awareness of developers to the needs, skills, and abilities of the elderly. Personas are also a cost-effective method and quickly and easily accessible. In order to guarantee representativeness the development of personas needs to occur based on a robust data set of a certain user group. RESULTS: This article presents the data-driven development of eight personas. The applied data set results from a nationwide questionnaire study on the elderly's use of information and communication technology, out of elderly people in Germany. The results will be presented in terms of best practice. CONCLUSION: To conclude, survey-based personas of older end users can play an important role in the research and development of innovative devices. APPLICATION: The personas presented in this paper can be used in research and development to raise awareness of the needs and demands of end users.


Asunto(s)
Sector de Atención de Salud/organización & administración , Comunicación en Salud , Difusión de la Información/métodos , Atención Dirigida al Paciente/normas , Encuestas y Cuestionarios , Anciano , Bases de Datos Factuales , Femenino , Alemania , Humanos , Masculino , Proyectos de Investigación , Interfaz Usuario-Computador
6.
BMJ Health Care Inform ; 26(1)2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31072821

RESUMEN

BACKGROUND: This study describes learning from procurement of a comprehensive electronic patient record (EPR/electronic health record (EHR)), system for a specialist clinical academic institution. METHOD: Retrospective review of procurement process in addition to evaluation of peer-reviewed literature in the field. RESULTS: Main lessons learned include the importance of detailed preparation of organisational requirements/specifications and organisational 'readiness'. Early staff involvement, resulting in ownership of the selected system by the organisation was a key achievement. The scoring process used required significant resource commitment but, despite being extensive in scope, provided relatively poor distinction between suppliers, despite significant variation in supplier self-scoring. Other elements, such as demonstrations and site visits, provided superior evaluation of functional abilities, and specification requirements should be regarded as threshold evaluation. CONCLUSION: While principles should be followed, the procurement process must be modified to meet the needs of the specific organisation, in terms of its clinical activities, digital maturity, existing infrastructure and budget.


Asunto(s)
Eficiencia Organizacional , Registros Electrónicos de Salud , Sector de Atención de Salud/organización & administración , Departamento de Compras en Hospital , Humanos , Estudios Retrospectivos , Encuestas y Cuestionarios
7.
Recenti Prog Med ; 110(5): 251-254, 2019 05.
Artículo en Italiano | MEDLINE | ID: mdl-31140458

RESUMEN

INTRODUCTION: Job performance has several predictors that are both individual and organizational. According to the existing literature, the learning climate meant as organizational dimension can boost a virtuous circle involving identity factors, proactivity and care for customers as well. METHODS: It has been applied a quantitative methodology, 57 workers from the health department have filled in an ad hoc questionnaire. Learning climate, general health and job performance have been evaluated. RESULTS: The tested mediation model is statistically significant, showing that the learning climate has both a direct effect on job performance and an indirect effect mediated by the general health. CONCLUSIONS: The small sample is the most relevant limit of the study, on the positive side the study takes into account all the dimensions of the learning climate and of the general health, while in the past the focus was just on single aspects of those variables.


Asunto(s)
Salud Laboral , Estrés Laboral/epidemiología , Rendimiento Laboral , Sector de Atención de Salud/organización & administración , Humanos , Aprendizaje , Masculino , Encuestas y Cuestionarios
9.
Cien Saude Colet ; 24(3): 705-714, 2019 Mar.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-30892493

RESUMEN

The present study highlighted the labour process of the dental surgeon (DS) in the private healthcare sector from the healthcare professional's perspective based on intervention bioethics. An observational, cross-sectional survey study was performed within the Federal District (Distrito Federal) region. Data were collected from 108 questionnaires completed by DSs affiliated with two types of private health insurers, self-insurance and group insurance, to assess job perception and the degree of job satisfaction in the dentistry market. The main source of dissatisfaction for healthcare professionals was related to the pay for dental procedures by insurers. For self-insurer 1, 38.1% healthcare professionals replied that the pay was satisfactory, whereas in self-insurance 2 and in the group insurance, 100% of healthcare professionals were dissatisfied. Another finding was that the group insurer considerably restricted elective treatments. In conclusion, loss of professional autonomy, depreciation of insurance claims and precarisation of dentistry occurs in the private healthcare sector, thus demonstrating the ethical conflicts in this relationship.


Asunto(s)
Actitud del Personal de Salud , Odontología/organización & administración , Odontólogos/estadística & datos numéricos , Satisfacción en el Trabajo , Bioética , Estudios Transversales , Odontólogos/economía , Odontólogos/psicología , Sector de Atención de Salud/economía , Sector de Atención de Salud/organización & administración , Humanos , Seguro de Salud/economía , Sector Privado/economía , Sector Privado/organización & administración , Autonomía Profesional , Encuestas y Cuestionarios
10.
Disasters ; 43 Suppl 2: S187-S209, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30821363

RESUMEN

This paper examines how the discourse on state fragility affects the preferences of key actors in humanitarian governance for different types of health-sector interventions in the Democratic Republic of Congo. It argues that, instead of focusing on the actual meaning of state fragility, attention should be paid to interactive processes around the discourse among stakeholders in the health sector. The lack of consensus on state fragility influences humanitarian governance, especially the perceptions of and interactions between the host government, donors, and international non-governmental organisations. The latter have legitimised the persistence of vertical, emergency-based interventions by emphasising state fragility, whereas state officials have preferred to assert political statehood and a higher degree of control. Nevertheless, they agree that donors' financial contributions ensure the survival of the public health sector. Looking ahead, a policy coalition based on harmonised views about addressing fragility is necessary for effective engagement and the sustainability of interventions, but this is unlikely to happen any time soon.


Asunto(s)
Sector de Atención de Salud/organización & administración , Sistemas de Socorro/organización & administración , República Democrática del Congo , Gobierno , Humanos , Organizaciones
11.
Int J Health Care Qual Assur ; 32(1): 176-190, 2019 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-30859879

RESUMEN

PURPOSE: The purpose of this paper is to investigate the role of service quality (SQ), customer satisfaction (CS) and customer loyalty (CL) in Ghana's health sector and a comparative analysis of private and public hospital SQ. DESIGN/METHODOLOGY/APPROACH: A convenient sample of 1,236 respondents was generated from both private and public hospitals. The study utilises an asymptotic distribution free estimation technique in CB-SEM using LISREL to test the relationships, while Wilcoxon-Mann-Whitney test was used to determine the differences in SQ performances between private and public hospitals. FINDINGS: The study found a significant positive relationship between SQ and CS. Also, the study found a significant positive relationship between CS and CL. Finally, SQ was found to be better in private hospitals, resulting higher CS and CL. PRACTICAL IMPLICATIONS: The study highlights the significant role SQ plays in generating CS and CL to guide healthcare provider policy decision making to improve healthcare delivery. It also serves as a guide to patients to make informed decisions regarding the choice of alternative hospitals. ORIGINALITY/VALUE: The study provides a useful guide to strategy and policy formulation in the healthcare sector by exploring the potential viability of SERVQUAL-related model as a relevant tool for assessing SQ in Ghana's health sector. The results also identified SQ gap between private and public hospitals and thus have implications on how hospitals should strategise to improve their SQ.


Asunto(s)
Sector de Atención de Salud/organización & administración , Satisfacción del Paciente , Calidad de la Atención de Salud , Encuestas y Cuestionarios , Países en Desarrollo , Femenino , Ghana , Encuestas de Atención de la Salud , Hospitales Privados/organización & administración , Hospitales Públicos/organización & administración , Humanos , Masculino , Percepción , Estadísticas no Paramétricas
12.
Global Health ; 15(1): 25, 2019 03 29.
Artículo en Inglés | MEDLINE | ID: mdl-30922344

RESUMEN

BACKGROUND: The launch of Global Health Initiatives in early 2000' coincided with the end of the war in Burundi. The first large amount of funding the country received was ear-marked for human immunodeficiency virus (HIV) and immunization programs. Thereafter, when at global level aid effectiveness increasingly gained attention, coordination mechanisms started to be implemented at national level. METHODS: This in-depth case study provides a description of stakeholders at national level, operating in the health sector from early 2000' onwards, and an analysis of coordination mechanisms and stakeholders perception of these mechanisms. The study was qualitative in nature, with data consisting of interviews conducted at national level in 2009, combined with document analysis over a 10 year-period. RESULTS: One main finding was that HIV epidemic awareness at global level shaped the very core of the governance in Burundi, with the establishment of two separate HIV and health sectors. This led to complex, nay impossible, inter-institutional relationships, hampering aid coordination. The stakeholder analysis showed that the meanings given to 'coordination' differed from one stakeholder to another. Coordination was strongly related to a centralization of power into the Ministry of Health's hands, and all stakeholders feared that they may experience a loss of power vis-à-vis others within the development field, in terms of access to resources. All actors agreed that the lack of coordination was partly related to the lack of leadership and vision on the part of the Ministry of Health. That being said, the Ministry of Health itself also did not consider itself as a suitable coordinator. CONCLUSIONS: During the post-conflict period in Burundi, the Ministry of Health was unable to take a central role in coordination. It was caught between the increasing involvement of donors in the policy making process in a so-called fragile state, the mistrust towards it from internal and external stakeholders, and the global pressure on Paris Declaration implementation, and this fundamentally undermined coordination in the health sector.


Asunto(s)
Sector de Atención de Salud/economía , Sector de Atención de Salud/organización & administración , Cooperación Internacional , Conflictos Armados , Burundi/epidemiología , Gobierno , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Investigación Cualitativa , Participación de los Interesados
15.
Global Health ; 15(1): 8, 2019 01 22.
Artículo en Inglés | MEDLINE | ID: mdl-30670026

RESUMEN

BACKGROUND: Fragmentation across governance structures, funding, and external actor engagement in Sierra Leone continues to challenge the efficiency and coherence of health sector activities and impedes sustained health system strengthening. Three examples are discussed to highlight the extent, causes, and impacts of health sector fragmentation in Sierra Leone: the community health worker programme, national medical supply chain, and service level agreements. RESULTS: In these examples we discuss factors contributing to fragmentation, the impact on efficiency of systems and sustainability of interventions, and persistent barriers to achieving sustainable improvements in health system performance. Prolonged external dependence and a proliferation of partner and donor involvement tending towards vertical programming and funding have contributed to this fragmentation. CONCLUSION: Alignment of policy and planning initiatives, investment in proactive (to reduce need for reactive) policy and plan development, strengthened partnerships, and strengthened governance and accountability mechanisms offer opportunities for greater health sector integration.


Asunto(s)
Sector de Atención de Salud/organización & administración , Humanos , Sierra Leona
16.
Int J Health Serv ; 49(2): 237-259, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30678522

RESUMEN

Portugal has faced an economic and financial crisis that began circa FY2009 and whose effects are still ongoing. In FY2011, the Portuguese state and the European triumvirate - composed of the European Commission, the International Monetary Fund, and the European Central Bank - signed the Memoranda of Understanding. This troika agreement aimed to improve the operational efficiency of public services. This crisis had a considerable impact on the Portuguese citizens' life and productivity, as well as on the public health care system. Cuts over public expenditures have been made to reduce the risk of noncompliance with budgetary targets, despite their potential impact on quality and access to health care services. We analyzed the main policies and measures undertaken by the Portuguese Ministry of Health with respect to the bailout program associated with the troika agreement. Then, we focused on the budgetary cuts-related risks over the social performance of the care system. Evidence suggests that structural reforms in the health care sector in the troika period had positive effects in terms of drugs administration and consumption, on the one hand, and secondary care expenditures reduction, on the other hand. Nonetheless, we observed some divestitures on infrastructures and the worsening of access to health care services.


Asunto(s)
Recesión Económica , Sector de Atención de Salud/economía , Financiación Gubernamental/economía , Financiación Gubernamental/organización & administración , Sector de Atención de Salud/organización & administración , Gastos en Salud , Política de Salud , Humanos , Modelos Econométricos , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/organización & administración , Portugal
17.
Expert Rev Pharmacoecon Outcomes Res ; 19(3): 245-250, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30626231

RESUMEN

INTRODUCTION: Real-world evidence (RWE) is increasingly being used in coverage, reimbursement and formulary decisions for medicines globally. Areas covered: The Middle East (ME) region is significantly behind in generating and using RWE in health policy decisions due to several factors that shaped the health sector over the past few decades. The trend, however, is changing due to several factors that are shaping the future of the healthcare industry in the region. Among other factors, rising healthcare cost, changing population and disease demographics, increased focus on the quality of healthcare, digitization of medical data, increased demand for local clinical and economic data, and overall greater influence of global trends in the healthcare industry. For the region to realize the benefit of RWE in healthcare decisions, it needs to overcome several challenges including embracing the value that RWE brings to healthcare decisions, building trust between stakeholders, establishing reliability and validity of databases used to generate RWE, enhancing technical capabilities, investing in local data generation, and conducting high-quality RWE studies while maintaining patients' confidentiality. Expert commentary: We believe that the next decade will witness significant increase in RWE generation in the region, and will play a key role in driving efficiency in healthcare delivery.


Asunto(s)
Toma de Decisiones , Prestación de Atención de Salud/organización & administración , Política de Salud/tendencias , Bases de Datos Factuales/normas , Prestación de Atención de Salud/tendencias , Medicina Basada en la Evidencia , Costos de la Atención en Salud/tendencias , Sector de Atención de Salud/organización & administración , Humanos , Medio Oriente , Reproducibilidad de los Resultados
18.
Environ Sci Pollut Res Int ; 26(4): 3196-3207, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29270899

RESUMEN

The aim of this research is to design a multi-criteria model for environmental assessment of health care organizations. This is a model which guarantees the objectivity of the results obtained, is easy to apply, and incorporates a series of criteria, and their corresponding descriptors, relevant to the internal environmental auditing processes of the hospital. Furthermore, judgments were given by three experts from the areas of health, the environment, and multi-criteria decision techniques. From the values assigned, geometric means were calculated, giving weightings for the criteria of the model. This innovative model is intended for application within a continuous improvement process. A practical case from a Spanish hospital is included at the end. Information contained in the sustainability report provided the data needed to apply the model. The example contains all the criteria previously defined in the model. The results obtained show that the best-satisfied criteria are those related to energy consumption, generation of hazardous waste, legal matters, environmental sensitivity of staff, patients and others, and the environmental management of suppliers. On the other hand, those areas returning poor results are control of atmospheric emissions, increase in consumption of renewable energies, and the logistics of waste produced. It is recommended that steps be taken to correct these deficiencies, thus leading to an acceptable increase in the sustainability of the hospital.


Asunto(s)
Contaminación Ambiental , Sector de Atención de Salud/organización & administración , Hospitales/normas , Modelos Teóricos , Administración de Residuos/normas , Toma de Decisiones , Contaminación Ambiental/análisis , Contaminación Ambiental/prevención & control , Sector de Atención de Salud/economía , Humanos , Administración de Residuos/economía
19.
Int J Health Plann Manage ; 34(1): e21-e33, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30370564

RESUMEN

Portugal has one of the most complete public systems worldwide. Since 1979, the Portuguese National Health Service (NHS) was developed based on the integration and complementarity between different levels of care (primary, secondary, continued, and palliative care). However, in 2009, the absence of economic growth and the increased foreign debt led the country to a severe economic slowdown, reducing the public funding and weakening the decentralized model of health care administration. During the austerity period, political attention has focused primarily on reducing health care costs and consolidating the efficiency and sustainability with no structural reform. After the postcrisis period (since 2016), the recovery of the public health system begun. Since then, some proposals have required a reform of the health sector's governance structure based on the promotion of access, quality, and efficiency. This study presents several key issues involved in the current postcrisis reform of the Portuguese NHS response structure to citizens' needs. The article also discusses the implications of this Portuguese experience based on current reforms with impact on the future of citizens' health.


Asunto(s)
Reforma de la Atención de Salud/organización & administración , Sector de Atención de Salud/organización & administración , Programas Nacionales de Salud/organización & administración , Recesión Económica , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/métodos , Sector de Atención de Salud/economía , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Portugal , Sector Privado/organización & administración , Salud Pública , Sector Público/organización & administración
20.
Geriatr Nurs ; 40(3): 296-301, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30528039

RESUMEN

Despite cumulative and integrative evidence of registered nurse (RN) staffing on nursing home residents' outcomes worldwide, few studies integrate the effects of residents' case mix, healthcare markets, and nurse staffing on psychotropic-medication use and weight loss in Korea. This article examined the relationship between nurse staffing and residents' quality-of-care outcomes, controlling for long-term healthcare market characteristics in Korea. Using a multilevel cross-sectional design, a disproportionate stratified random sampling was used. Of 87 nursing homes contacted, 60 agreed to participate. Weighted linear regression was used to test the hypotheses. RN hours per resident day (HPRD) had a statistically significant positive impact on reducing the number of residents with psychotropic medication (ß = - .331, p = .008). Greater RN HPRD positively marginally related to fewer residents with cognitive impairment (ß = - 0.201, p = .139). Higher turnover of RN staff related to decreased proportions of residents with weight loss (ß = - .331 p = .008). Policymakers should cautiously consider requiring mandatory nurse staffing in nursing homes in Korea, where it is still acceptable to have certified nurse aids as substitutes for RNs.


Asunto(s)
Enfermeras y Enfermeros/provisión & distribución , Casas de Salud/organización & administración , Admisión y Programación de Personal/organización & administración , Estudios Transversales , Sector de Atención de Salud/economía , Sector de Atención de Salud/organización & administración , Humanos , Asistentes de Enfermería/estadística & datos numéricos , Admisión y Programación de Personal/economía , Reorganización del Personal/estadística & datos numéricos , República de Corea
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