Data Cleaning Process for mHealth Log Data to Inform Health Worker Performance.

Log data, captured during use of mobile health (mHealth) applications by health providers, can play an important role in informing nature of user engagement with the application. The log data can also be employed in understanding health provider work patterns and performance. However, given that these logs are raw data, they require robust cleaning and curation if accurate conclusions are to be derived from analyzing them. This paper describes a systematic data cleaning process for mHealth-derived logs based on Broeck's framework, which involves iterative screening, diagnosis, and treatment of the log data. For this study, log data from the demonstrative mUzima mHealth application are used. The employed data cleaning process uncovered data inconsistencies, duplicate logs, missing data within logs that required imputation, among other issues. After the data cleaning process, only 39,229 log records out of the initial 91,432 usage logs (42.9%) could be included in the final dataset suitable for analyses of health provider work patterns. This work highlights the significance of having a systematic data cleaning approach for log data to derive useful information on health provider work patterns and performance.

Follower strengths-based leadership and follower innovative behavior: the roles of core self-evaluations and psychological well-being / El liderazgo basado en las fortalezas de los subordinados y su comportamiento innovador: el papel de las autoevaluaciones y del bienestar psicológico

This study investigated the relationship between followers' strengths-based leadership (FSBL) and innovative behavior and the mediating role of psychological well-being (PWB) and the moderating role of core self-evaluations (CSE) in the relationship. In order to test our hypotheses data from Chinese enterprises were used. Results of multiple linear regression and bootstrapping analyses showed that FSBL is positively related to follower innovative behavior and PWB significantly mediates the FSBL-innovative behavior relationship. In addition, CSE negatively moderates the direct effect of FSBL on PWB and the indirect effect of FSBL on innovative behavior via PWB such that the direct effect of FSBL on PWB and the indirect effect of FSBL on innovative behavior via PWB will be stronger for followers with a low level of CSE rather than for followers with a high level of CSE. Theoretical implications, practical implications and future research were also discussed

Este estudio analiza la relación entre el liderazgo sustentado en las fortalezas de los subordinados (FSBL), su comportamiento innovador y el papel mediador del bienestar psicológico (PWB), así como el papel que juegan en dicha relación las autoevaluaciones principales (CSE). Para poner a prueba nuestras hipótesis se dispuso de datos emparejados de empresas chinas. Los resultados de la regresión linear múltiple y de los análisis bootstrapping mostraron que el FSBL se relaciona positivamente con el comportamiento innovador de los subordinados y el bienestar psicológico mediatiza de modo significativo la relación entre el FSBL y el comportamiento innovador. Por otra parte, las evaluaciones principales moderan negativamente el efecto directo del FSBL en el bienestar psicológico y el efecto indirecto del FSBL en el comportamiento innovador a través del bienestar psicológico, de modo que dichos efectos directo e indirecto del FSBL serán mayores en los subordinados con un bajo nivel en las autoevaluaciones principales que en los subordinados que tienen un nivel elevado en las mismas. Se comentan las implicaciones teóricas y prácticas y la investigación futura

Reflective Practice for Patient Benefit: An Analysis of Doctors' Appraisal Portfolios in Scotland.

INTRODUCTION: Reflective practice has become the cornerstone of continuing professional development for doctors, with the expectation that it helps to develop and sustain the workforce for patient benefit. Annual appraisal is mandatory for all practicing doctors in the United Kingdom as part of medical revalidation. Doctors submit a portfolio of supporting information forming the basis of their appraisal discussion where reflection on the information is mandated and evaluated by a colleague, acting as an appraiser. METHODS: Using an in-depth case study approach, 18 online portfolios in Scotland were examined with a template developed to record the types of supporting information submitted and how far these showed reflection and/or changes to practice. Data from semistructured interviews with the doctors (n = 17) and their appraisers (n = 9) were used to contextualize and broaden our understanding of the portfolios. RESULTS: Portfolios generally showed little written reflection, and most doctors were unenthusiastic about documenting reflective practice. Appraisals provided a forum for verbal reflection, which was often detailed in the appraisal summary. Portfolio examples showed that reflecting on continued professional development, audits, significant events, and colleague multisource feedback were sometimes considered to be useful. Reflecting on patient feedback was seen as less valuable because feedback tended to be uncritical. DISCUSSION: The written reflection element of educational portfolios needs to be carefully considered because it is clear that many doctors do not find it a helpful exercise. Instead, using the portfolio to record topics covered by a reflective discussion with a facilitator would not only prove more amenable to many doctors but would also allay fears of documentary evidence being used in litigation.

Getting performance metrics right: a qualitative study of staff experiences implementing and measuring practice transformation.

BACKGROUND: Quality improvement is a central goal of the patient-centered medical home (PCMH) model, and requires the use of relevant performance measures that can effectively guide comprehensive care improvements. Existing literature suggests performance measurement can lead to improvements in care quality, but may also promote practices that are detrimental to patient care. Staff perceptions of performance metric implementation have not been well-researched in medical home settings. OBJECTIVE: To describe primary care staff (clinicians and other staff) experiences with the use of performance metrics during the implementation of the Veterans Health Administration's (VHA) Patient Aligned Care Team (PACT) model of care. DESIGN: Observational qualitative study; data collection using role-stratified focus groups and semi-structured interviews. PARTICIPANTS: Two hundred and forty-one of 337 (72 %) identified primary care clinic staff in PACT team and clinic administrative/other roles, from 15 VHA clinics in Oregon and Washington. APPROACH: Data coded and analyzed using conventional content analysis techniques. KEY RESULTS: Primary care staff perceived that performance metrics: 1) led to delivery changes that were not always aligned with PACT principles, 2) did not accurately reflect patient-priorities, 3) represented an opportunity cost, 4) were imposed with little communication or transparency, and 5) were not well-adapted to team-based care. CONCLUSIONS: Primary care staff perceived responding to performance metrics as time-consuming and not consistently aligned with PACT principles of care. The gaps between the theory and reality of performance metric implementation highlighted by PACT team members are important to consider as the medical home model is more widely implemented.

Development and implementation of a balanced scorecard in an academic hospitalist group.

BACKGROUND: Academic hospitalist groups (AHGs) are often expected to excel in multiple domains: quality improvement, patient safety, education, research, administration, and clinical care. To be successful, AHGs must develop strategies to balance their energies, resources, and performance. The balanced scorecard (BSC) is a strategic management system that enables organizations to translate their mission and vision into specific objectives and metrics across multiple domains. To date, no hospitalist group has reported on BSC implementation. We set out to develop a BSC as part of a strategic planning initiative. METHODS: Based on a needs assessment of the University of California, San Francisco, Division of Hospital Medicine, mission and vision statements were developed. We engaged representative faculty to develop strategic objectives and determine performance metrics across 4 BSC perspectives. RESULTS: There were 41 metrics identified, and 16 were chosen for the initial BSC. It allowed us to achieve several goals: 1) present a broad view of performance, 2) create transparency and accountability, 3) communicate goals and engage faculty, and 4) ensure we use data to guide strategic decisions. Several lessons were learned, including the need to build faculty consensus, establish metrics with reliable measureable data, and the power of the BSC to drive goals across the division. CONCLUSIONS: We successfully developed and implemented a BSC in an AHG as part of a strategic planning initiative. The BSC has been instrumental in allowing us to achieve balanced success in multiple domains. Academic groups should consider employing the BSC as it allows for a data-driven strategic planning and assessment process.

Reciprocity of temporary and permanent workers: an exploratory study in an industrial company

The increasing use of temporary work prompts the need to understand to what degree workers with this type of contract differ from permanent workers as to the relationship they establish with the organization they work for. This study used a sample of temporary workers (N = 78) and permanent workers (N = 196) within the same company of electronics in Portugal. The results show that, regardless of the type of contract, the perception of human resource practices was related to the perception of psychological contract fulfillment by the company. Additionally and according to the norm of reciprocity, we verified that when workers thought the company was fulfilling its obligations they responded favorably showing more affective commitment towards the company. However, we found differences between these two groups of workers: for the permanent performance appraisal, training and rewards were human resources practices that were significantly related to psychological contract fulfillment, while for the temporary ones there weren’t any specific practices that had a significant relationship with that variable. The practical implications of these findings for the management of temporary workers are discussed (AU)

El uso creciente de trabajo temporal hace que surja la necesidad de comprender en qué medida los trabajadores con este tipo de contrato difieren de los trabajadores con contratos permanentes en cuanto a la relación que establecen con la organización para la que trabajan. Este estudio utilizó una muestra de trabajadores temporales (N = 78) y otra de trabajadores permanentes (N = 196) de la misma empresa de electrónica en Portugal. Los resultados muestran que, independientemente del tipo de contrato, la percepción de las prácticas de recursos humanos se relaciona con la percepción de cumplimiento del contrato psicológico por parte de la empresa. Adicionalmente y de acuerdo con la norma de reciprocidad, se comprobó que cuando los trabajadores pensaban que la compañía estaba cumpliendo con sus obligaciones, respondieron favorablemente mostrando un mayor compromiso afectivo con la empresa. Sin embargo, encontramos diferencias entre estos dos grupos de trabajadores: para los permanentes, las prácticas de recursos humanos que se relacionaron significativamente con el cumplimiento del contrato psicológico son la evaluación del desempeño, la formación, y las recompensas; mientras que para los temporales hubo prácticas específicas significativas en relación con esta variable. Se discuten las implicaciones prácticas de estos hallazgos para la gestión de los trabajadores temporales (AU)

El clima emocional en los equipos de atención primaria. Una aproximación cualitativa / Emotional climate in Primary Health Care teams. A qualitative approach

Fundamento. Las interacciones sociales en los equipos de trabajo de Atención primaria movilizan importantes aspectos emocionales que afectan el ambiente, rendimiento y satisfacción de profesionales y pacientes. El objetivo del estudio es describir el clima emocional de los equipos de trabajo de Atención primaria, planteando si hay diferencias en la percepción del clima emocional en función de la categoría profesional y de la pertenencia a un grupo con clima emocional positivo o negativo. Métodos. Se ha empleado metodología cualitativa: 2 grupos nominales y 2 grupos focales, con 18 profesionales (personal médico y de enfermería) de Atención primaria de 2 distritos sanitarios andaluces. La información se ha grabado y posteriormente, se ha realizado un análisis de contenido. Resultados. El personal sanitario identificó las siguientes dimensiones explicativas del clima emocional: relaciones profesionales (con un alto peso), proyecto común, reconocimiento profesional, estilo de liderazgo, desgaste y actitudes personales y condiciones de trabajo. Se perciben diferencias entre las opiniones del personal médico y enfermero, asociado a la existencia de un clima emocional negativo. Conclusiones. Se requieren más investigaciones sobre el clima emocional en Atención primaria, de cara a proponer líneas de actuación para mejorar la satisfacción y la calidad de vida de los y las profesionales(AU)

Objective. The social interactions met in the Primary Health Care work teams are driven by important emotional aspects that affect the environment, results and the satisfaction of the professional and the patients. The objective of this work is to describe the emotional climate of Primary Care work teams, looking for the perceptions of different professional category and different work groups (selected by the quality of their emotional climate). Methods. A qualitative methodology was used: 2 nominal groups and 2 focal groups, with 18 physicians and nurses working in the Andalusian Primary Health Care system. The information was recorded and then a content analysis was made. Results. Health care professionals identify the following explanatory dimensions: professional relationship (high scored), shared work project, professional recognition, leadership, burnout and personal attitudes, as well as work conditions. Different opinions were recorded among physicians and nurses, especially when the group had a bad emotional atmosphere. Conclusions. More studies on the emotional climate in Primary Health Care are needed in order to propose strategies to improve satisfaction and quality of work life among professionals(AU)

Estudio Psicométrico del Índice de Carga Mental NASA-TLX con una Muestra de Trabajadores Españoles / Psychometric Study of NASA-TLX Mental Workload Index in a Sample of Spanish Workers

El objetivo de este estudio fue evaluar las propiedades psicométricas del instrumento de evaluación de la carga mental de trabajo NASA-TLX en distintos grupos profesionales españoles. La muestra estuvo formada por 398 trabajadores que pertenecían a siete sectores profesionales diferentes. Todos los trabajadores evaluaron la carga mental percibida en sus puestos de trabajo, debida a cada una de las seis dimensiones de carga que distingue el NASA-TLX: esfuerzo, demanda mental, demanda física, demanda temporal, rendimiento y frustración. Los resultados mostraron una consistencia interna aceptable y una estructura factorial constituida por dos factores. Uno de los factores estaba formado únicamente por la dimensión “frustración”, mientras que el otro factor englobaba a las cinco dimensiones restantes. Por último, se encontraron diferencias importantes en los perfiles de carga mental entre los grupos profesionales considerados, en todas las dimensiones de carga, excepto en rendimiento(AU)

The objective of this study was to assess the psychometric properties of NASA-Task Load Index using several groups of Spanish workers. The sample consisted of 398 workers who belonged to seven different jobs. All workers assessed the perceived mental workload when perform their jobs, due to each of the six dimensions of mental workload that distinguishes the NASA-TLX: effort, mental demand, physical demand, temporal demand, performance and frustration. The results showed that NASA-Task Load Index had a acceptable internal consistency and a factorial structure formed by two components. The first of the two components was formed by all of the NASA-TLX dimensions except frustration. The second was formed only by frustration dimension. Significant differences in the profiles of mental workload experienced by workers on the basis of their jobs were found for all NASA-TLX dimensions except in performance(AU)

Pay for performance: quality- and value-based reimbursement.

There is urgent need to reform health care reimbursement models, including physician compensation, to address high health care costs, despite numerous quality initiatives. Pay for performance (P4P) is a model that attempts to align financial incentives with better outcomes and value rather than the current system of rewarding volume and intensity of care delivered. P4P has been implemented in other countries besides the United States and is perhaps most advanced in the United Kingdom. Measurement for P4P is evolving, as are the types of incentives; neither is perfect at this time. For P4P to succeed, all health care stakeholders will need to collaborate.

The role of the Internet in doctor performance rating.

Historically, if a patient was dissatisfied with care, he or she could tell his or her friends and family. The criticism was limited to a small circle of people. If the patient was injured negligently, he or she could hire an attorney to prosecute a lawsuit. The threshold for finding an attorney and prevailing posed a significant barrier for the patient achieving redress. With the Internet, if a patient is unhappy he or she needs do little more than access a growing number of Internet physician rating sites. Such criticism can be rendered anonymously. The posts are disseminated worldwide, and once posted, the criticism rarely comes down. While transparency is a laudable goal, such sites often lack accountability. More formal sites run by authoritative bodies, such as medical licensing boards, also provide data about physicians, but such data is often unfiltered, making it difficult for the public to properly interpret. Given how important reputation is to physicians, the traditional remedy of suing for defamation because of libelous posts is ordinarily ineffective. First, many patients who post libelous comments, do so anonymously. Next, the Internet Service Providers (ISPs) hosting such sites are generally immune from liability for defamation. Finally, the law has a very formal definition for libel, and a negative rating does not necessarily equate to "defamation." A novel method of addressing un-policed physician rating sites in the Internet age is described. The system embraces the use of mutual privacy contracts to provide physicians a viable remedy to anonymous posts. In exchange, patients receive additional privacy protections above and beyond that mandated by law.