What happens when healthcare innovations collide?: Table 1 (original) (raw)
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Evaluation of a changed model of care delivery in a Canadian province using outcome mapping
The International Journal of Health Planning and Management, 2013
Background Collaboration between the Nova Scotia Department of Health and Wellness, the province's District Health Authorities (DHAs) and the Izaak Walton Killam (IWK) Health Center led to the development and implementation of a new collaborative model of patient-centered care delivery in the province. Objective The objective was to determine the effectiveness of the initiative in arriving at the envisioned care model by investigating its impacts (if any) on patient, system, and providers outcomes. Methods A repeated surveys study design with mixed methods in an outcome mapping framework was used to measure process and outcome indicators for patients and families, providers, and the system. Results Almost all outcomes at the patient and family, provider, and system level improved following the implementation of the model, and these effects were stronger on units where the model was more fully implemented. Conclusions The efforts of the province, DHAs and IWK to improve patient care through the new care model have been successful. This evaluation is unique in the broad range of indicators it incorporates. Comprehensive monitoring and evaluation of health system changes is critical to system effectiveness.
Integrated versus fragmented implementation of complex innovations in acute health care
Background: Increased demand and escalating costs necessitate innovation in health care. The challenge is to implement complex innovations—those that require coordinated use across the adopting organization to have the intended benefits. Purpose: We wanted to understand why and how two out of five similar hospitals associated with the same health care authority made more progress with implementing a complex inpatient discharge innovation while the other three experienced more difficulties in doing so. Methodology: We conducted a qualitative comparative case study of the implementation process at five comparable urban hospitals adopting the same inpatient discharge innovation mandated by their health care authority. We analyzed documents and conducted 39 interviews of the health care authority and hospital executives and frontline managers across the five sites over a one-year period while the implementation was ongoing. Findings: In two and a half years, two of the participating hospitals had made significant progress with implementing the innovation and had begun to realize benefits; they exemplified an integrated implementation mode. Three sites had made minimal progress, following a fragmented implementation mode. In the former mode, a semi-autonomous health care organization developed a clear overall purpose and chose one umbrella initiative to implement it. The integrative initiative subsumed the rest and guided resource allocation and the practices of hospital executives, frontline managers and staff who had bought into it. In contrast, in the fragmented implementation mode, the health care authority had several overlapping, competing innovations that overwhelmed the sites and impeded their implementation. Practice Implications: Implementing a complex innovation across hospital sites required: (1) early prioritization of one initiative as integrative; (2) the commitment of additional (traded-off or new) human resources; (3) deliberate upfront planning and continual support for and evaluation of implementation; and (4) allowance for local customization within the general principles of standardization. Key Words: Complex innovation, implementation, integration, acute health care
Hospitals-As-Hubs: Integrated Care for Patients - NAO Rapid Review No. 17
North American Observatory on Health Systems and Policies Rapid Review No. 17, 2019
The creation of Ontario Health Teams represents a major shift towards integrated care across the health system in the province. Integrated models of care intend to improve the care experiences of people and providers as well as the outcomes of care for populations across the care continuum. Approaches to integrate care involve a number of organizations and providers, often with an organization or a group of providers acting as the lead of the integration effort. This rapid review aims to understand the role that hospitals can play as lead integrators of care delivery models that span multiple sectors.
Journal of General Internal Medicine, 2012
BACKGROUND: Patients are vulnerable to poor quality, fragmented care as they transition from hospital to home. Few studies examine the discharge process from the perspectives of multiple healthcare professionals. OBJECTIVE: To understand care transitions from the perspective of diverse healthcare professionals, and identify recommendations for process improvement. DESIGN: Cross sectional qualitative study. PARTICIPANTS AND SETTING: Clinicians, care teams, and administrators from the inpatient general medicine services at one urban, academic hospital; two outpatient primary care clinics; and one Medicaid managed care plan. APPROACH: We conducted 13 focus groups and two in-depth interviews with participants prior to initiating a hospital-funded, multi-component transitional care intervention for uninsured and low-income publicly insured patients, the Care Transitions Innovation (C-TraIn). We used thematic analysis to identify emergent themes and a cross-case comparative analysis to describe variation by participant role and setting. KEY RESULTS: Poor transitional care reflected healthcare system fragmentation, limiting the ability of healthcare professionals to provide optimal patient care. Lack of standardized processes, poor multidisciplinary communication within the hospital, and fragmented communication across settings led to chaotic, unsystematic transitions, poor patient outcomes, and feelings of futility and dissatisfaction among providers. Patients with complex psychosocial needs were especially vulnerable during care transitions. Recommended changes to improve transitional care included improving hospital multidisciplinary hospital rounds, clarifying accountability as patients move across settings, standardizing discharge processes, and providing additional medical staff training. CONCLUSIONS: Hospital to home care transitions are critical junctures that can impact health outcomes, experience of care, and costs. Transitional care quality improvement initiatives must address system fragmentation, reduce communication barriers within and between settings, and ensure adequate professional training.
The care innovation and transformation program
The Center for Care Innovation and Transformation is the laboratory that leaders improve the ability sets needed to style new care models. The Care Innovation and Transformation Program is a conniving, workshop-style of series of lectures and training modules conducted by The American Organization of Nurse Executives designed to assist nursing unit leaders and their staff improve patient care, hospital performance, and employee engagement. The Care Innovation and Transformation program teaches nurses and interdisciplinary teams how to make innovation, how to improve healing and how to measure change and strengthens the organization. The Care Innovation and Transformation program encourages health professionals to improve the quality of care and empowers staff to apply these innovations. It also develops the responsibility and accountability of nursing practices. Some of the benefits of the program include shortening of the time of transfer from the emergency unit to the inpatient clinic, reduction in falls, improvement in nurse-patient communication, and reduced working hours. This review was carried out in order to introduce The Care Innovation and Transformation Program. Keywords: Care; innovation; program