Practices and Perceptions of Family Centered Care among Healthcare Providers: A Cross-sectional Study in a Pediatric Hospital.

PURPOSE: This study aimed to: (1) investigate the extent to which Family Centered Care (FCC) principles are currently applied in clinical practice by healthcare providers working in inpatient units; (2) evaluate the extent to which FCC principles are perceived as necessary; and (3) examine the associations between FCC principles and socio-demographic and job characteristics of participants. Design and Methods A cross-sectional study was conducted at a large pediatric hospital using the Italian version of the FCC Questionnaire Revised (FCCQ-R). Univariate and multivariate analyses were performed. RESULTS: Data from 469 healthcare providers were used for analysis. Scores for the FCC daily practices (Current activities) were significantly lower than those for their perceived necessity (Necessary activities) (p < .001). Participants who were male, younger, with work experience >20 years and working in rehabilitation reported a significantly higher perception of Current activities of FCC than others. The older and the more educated the participants, the greater was the perceived necessity of FCC activities. Female, older, and less experienced participants employed by the hospital but not working in the rehabilitation setting perceived a greater gap between Necessary and Current activities of FCC. CONCLUSIONS: Scores for the Current and Necessary activities of FCC were lower than those reported in other studies. The lower scores in the Current activities and the significant gap can be due to organizational barriers or lack of skills, but the lower scores in the Necessary activities should be interpreted as a deficit of knowledge about FCC. PRACTICE IMPLICATIONS: There is a need for further education about FCC in order to increase its perceived relevance in clinical practice.

Return on Investment (ROI) and Development of a Workplace Disability Management Program in a Hospital-A Pilot Evaluation Study.

The progressive ageing of the working population and the increase in related chronic diseases tend to affect working capacity. The aim of this study was to evaluate a Workplace Disability Management Program (WDMP) within a pediatric hospital. Absenteeism due to healthcare workers' (HCWs) pre- and post- WDMP and the related costs were used for the program evaluation. The Return on Investment (ROI), the Break-Even Analysis (BEA) and the value of the average annual productivity of HCWs who took advantage of the Disability Management (DM) interventions to assess the economic impact of the program, were also used. The HCWs enrolled in the program were 131 (approximately 4% of hospital staff), of which 89.7% females and with an average age of 50.4 years (SD ± 8.99). Sick leave days of the HCWs involved decreased by 66.6% in the year following the end of WDMP compared to the previous one (p < 0.001). The total estimated cost reduction of absenteeism is 427,896€ over a year. ROI was equal to 27.66€. BEA indicated that the break-even point was reached by implementing the program on 3.27 HCWs. The program evaluation demonstrated the particular effectiveness of the implemented WDMP model, acting positively on the variables that affect productivity and the limitation to work.

Effectiveness of an improvement programme to prevent interruptions during medication administration in a paediatric hospital: a preintervention-postintervention study.

OBJECTIVE: To assess the effectiveness of an improvement programme to reduce the number of interruptions during the medication administration process in a paediatric hospital. DESIGN AND METHODS: A prestudy-post study design was used to monitor nursing interruptions during medication cycles in a paediatric hospital. Interruptions were reported on an observation sheet (MADOS-P) adapted to the paediatric context. SETTING: A 600-bed tertiary paediatric research hospital in Italy. INTERVENTION: The interventions included a yellow sash worn by nurses during medication cycles, a yellow-taped floor area indicating the 'No interruption area', visual notices in the medication areas, education sessions for healthcare providers and families, patient and parent information material. RESULTS: 225 medication cycles were observed before the intervention (T0) and 261 after the intervention (T1). The median of interruptions occurring in each cycle decreased significantly from baseline to postintervention (8.0 vs 2.0, p=0.002), as the rate ratios (interruptions/patient post-pre ratio: 0.34; interruptions/medication post-pre ratio: 0.37; interruptions/hour of medication cycle post-pre ratio: 0.53, p<0.001). During preintervention, the main causes of interruptions were 'other patients' (19.9%), 'other nurses' (17.2%) and 'conversation' (15.7%); during postintervention, they were 'other nurses' (26.1%), 'conversation' (18.2%) and 'other patients' (17.4%). CONCLUSIONS: This bundle of interventions proved to be an effective improvement programme to prevent interruptions during medication administration in a paediatric context.

A systematic review of hospital foodservice patient satisfaction studies.

The quality of hospital foodservice is one of the most relevant items of health care quality perceived by patients and by their families. Patient satisfaction is considered a way of measuring the quality of services provided. The purpose of this study was to retrieve and review the literature describing patient satisfaction with hospital foodservices. The systematic review was conducted on three electronic archives, PubMed, Excerpta Medica Database, and the Cumulative Index to Nursing and Allied Health Literature (1988 through 2012), to search for any articles reporting patient satisfaction with hospital foodservices. A total of 319 studies were identified. After removing duplicates, 149 abstracts were reviewed, particular attention being given to the presence of a description of the tool used. Thirty-one articles were selected and the full texts were reviewed. Half the studies (n=15) were performed in North America. Patient satisfaction scores were generally high, with some variation among hospitals and different modes of food delivery that was investigated through intervention studies. Qualitative studies were also reported (ethnographic-anthropologic methods with interviews and focus groups). Quantitative tools were represented by questionnaires, some of which relied on previous literature and only a few were validated with factorial analysis and/or Cronbach's α for internal consistency. Most analyses were conducted assuming a parametric distribution of results, an issue not primarily tested. More studies on the quality of hospital foodservice have been carried out in North America than in Europe. Also, a variety of tools, most of which have not been validated, have been used by the different investigating facilities.

Accreditation of birth centres: advantages for newborns.

UNLABELLED: Accreditation or certification of Health Care Providers is a crucial tool to improve health care quality, and to promote excellence. Excellent healthcare should have the following six characteristics: Safe, Effective, Person-centred, Timely, Efficient, Equitable. Safety in health care should consider the analysis and reduction of medical systematic errors and their related patients' harm. In 1999 the U.S. Institute of Medicine defined medical errors as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. In neonatal intensive care units and pediatric intensive care units the areas most frequently associated with medical errors are medication, including prescribing, preparation, administration and monitoring; health-care associated infections; mechanical ventilation; events related to the use of medical devices or procedures and, more recently, caregivers fatigue and communication strategies. In Italy, Maternal-Neonatal Health is one of the national priorities, but there are still wide and deep differences among Regions. In 2008, more than 9% of the deliveries occurred in Hospitals with less than 500 births per year, a volume considered too small to guarantee optimal standard of care. In 2010, the National Government and the Regional Health Authorities agreed to set to 1000 births/year the standard threshold for Hospital Birth Centers, considering the same volume for obstetric-gynecologic and neonatal-pediatrics Units. Despite most indicators attest the good performance of the National health care, a further area to be addressed is the perception of its quality by the people. The discrepancy between quality of care and its public perception is in fact reported in many industrialized countries. Accreditation programs can improve the availability and access to a standardized quality of care. A well-established worldwide accreditation program is led by Joint Commission International (JCI). As far as accreditation of perinatal care is regarded, in 2010 the U.S. Joint Commission has defined a set of measures known as the perinatal care core measure set, which consider elective delivery, cesarean section, antenatal steroids, healthcare-associated bloodstream infections in newborns, exclusive breastmilk feeding. In Italy, the 2011-2013 National Health Care Plan underline the need for developing and implementing certification programs for Hospital Birth Centers. In 2011, a multidisciplinary working group (Italian Group for Safe Birth) has thus been established. CONCLUSION: the main goal of each Health Care Organization should be to achieve the best quality and safety. Health Care Organizations must reduce random variations and improve activities by a standardized process whose results can be measured both in terms of patients outcome and in terms of transparency of each activity. Newborn and infants are one of the weakest population group; to improve their health outcome is thus mandatory to do all efforts to obtain a safe, effective, efficient and patient-centered health care assistance.