scholarly journals Exploring the Organizational Culture in Adult Day Services (ADS) and Its Effect on Healthcare Delivery in Taiwan

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Chih-Ling Liou ◽  
Mary Dellmann-Jenkins
Keyword(s):  
Organizational Culture ◽  
Care Delivery ◽  
Quality Care ◽  
Healthcare Delivery ◽  
Competing Values ◽  
Group Culture ◽  
Cultural Elements ◽  
Adult Day Services ◽  
Quantitative And Qualitative Research ◽  
Day Services

Studies conducted in nursing homes/hospitals have shown that organizational culture plays an important role in care delivery and group culture leads to better quality of care. To explore the organizational culture and care delivery in adult day services (ADS) centers in Taiwan, we used both quantitative and qualitative research methods. Quantitative data from the Competing Values Framework (CVF) assessment showed that the group culture was dominant at all three centers. Qualitative data from observation and staff interviews uncovered both group and nongroup cultural elements. The group cultural elements, such as flexible management, teamwork environment, and sharing the same values, contributed to good care; however, the nongroup cultural elements, such as the staff-centered view, hierarchy, and conflicts within the leadership, led to negative staff-staff and staff-clients interactions. Further research is needed to untangle the complexity between quality care delivery and organizational culture.

scholarly journals Daily Cortisol Total Output Mediated Sleep and Affect Among Dementia Family Caregivers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 180-180
Author(s):  
Daniel Fleming ◽  
Elizabeth Fauth ◽  
Yin Liu
Keyword(s):  
Family Caregivers ◽  
Quality Care ◽  
High Stress ◽  
Area Under The Curve ◽  
Total Output ◽  
Night Time ◽  
Wake Time ◽  
Adult Day Services ◽  
Time In Bed ◽  
Day Services

Abstract Cortisol is a primary stress hormone associated with sleep. We examined daily cortisol as the potential mechanism linking prior night’s sleep and daily mood among 173 dementia family caregivers (M (SD) age = 61.97 (10.66)) who used adult day services (ADS) at least two days a week. Caregivers self-reported sleep characteristics (bed and wake time, sleep quality, care receiver’s night-time problems) and affect (anxiety, depressive symptoms) across eight consecutive ADS/non-ADS days. Salivary cortisol was collected five times each day. Multilevel mediation analysis suggested that daily cortisol total output (assessed as “area under the curve”) mediated prior nights’ total time in bed and daily anxiety, but only on high-stress (non-ADS) days. Mediation was non-significant on low-stress (ADS) days, and at the between-person level. ADS use is respite from a chronically stressful role. Reducing exposure to stress via respite may protect against harmful processes related to sleep, cortisol reactivity, and daily anxiety.

Real-time locating systems to improve healthcare delivery: A systematic review

2021 ◽  
Author(s):  
Kevin M Overmann ◽  
Danny T Y Wu ◽  
Catherine T Xu ◽  
Shwetha S Bindhu ◽  
Lindsey Barrick
Keyword(s):  
Systematic Review ◽  
Real Time ◽  
Care Delivery ◽  
Quality Care ◽  
Healthcare Delivery ◽  
Healthcare Setting ◽  
Lessons Learned ◽  
Clinical Environment ◽  
Qualitative Synthesis ◽  
Meta Analyses

Abstract Objective Modern health care requires patients, staff, and equipment to navigate complex environments to deliver quality care efficiently. Real-time locating systems (RTLS) are local tracking systems that identify the physical locations of personnel and equipment in real time. Applications and analytic strategies to utilize RTLS-produced data are still under development. The objectives of this systematic review were to describe and analyze the key features of RTLS applications and demonstrate their potential to improve care delivery. Materials and Methods We searched MEDLINE, SCOPUS, and IEEE following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were articles that utilize RTLS to evaluate or influence workflow in a healthcare setting. We summarized aspects of relevant articles, identified key themes in the challenges of applying RTLS to workflow improvement, and thematically reviewed the state of quantitative analytic methodologies. Results We included 42 articles in the final qualitative synthesis. The most frequent study design was observational (n = 24), followed by descriptive (n = 12) and experimental (n = 6). The most common clinical environment for study was the emergency department (n = 12), followed by entire hospital (n = 7) and surgical ward (n = 6). Discussion The focus of studies changed over time from early experience to optimization to evaluation of an established system. Common narrative themes highlighted lessons learned regarding evaluation, implementation, and information visibility. Few studies have developed quantitative techniques to effectively analyze RTLS data. Conclusions RTLS is a useful and effective adjunct methodology in process and quality improvement, workflow analysis, and patient safety. Future directions should focus on developing enhanced analysis to meaningfully interpret RTLS data.

Police transformational leadership and organizational commitment

2015 ◽  
Vol 38 (4) ◽  
pp. 754-774 ◽  
Author(s):  
Hee S. Shim ◽  
Youngoh Jo ◽  
Larry T. Hoover
Keyword(s):  
Transformational Leadership ◽  
Organizational Culture ◽  
Organizational Commitment ◽  
Police Officers ◽  
Small Sample Size ◽  
Small Sample ◽  
Competing Values ◽  
Group Culture ◽  
Content Type ◽  
Multiple Variables

Purpose – The purpose of this paper is to explore whether the relation between police transformational leadership and organizational commitment is mediated by organizational culture. Drawing on the competing values framework (Quinn, 1988), four types of cultural orientations (group, developmental, hierarchical, and rational) are analyzed. Design/methodology/approach – In total, 358 South Korean police officers are surveyed. Using competing values as multiple mediators, a parallel four mediator model is estimated. Bias-corrected bootstrapping methods are employed to consider the small sample size, as well as the possible non-normal distribution of specific indirect effects. Findings – The linkage between transformational leadership and commitment appears to be fully mediated by group culture. Interestingly, multiple individual officer characteristics, duty type, and departmental size do not impact respective constructs overall. Research limitations/implications – The use of cross-sectional data hinders causal ordering among constructs included. Practical implications – Given the full mediation relationships among the three constructs, it is advisable to develop more nuanced leadership training programs optimized for fostering “considerate and supportive leaders” who have been known to impact group culture. Originality/value – Including two understudied police organizational correlates (i.e. transformational leadership and organizational culture), this study accounts for the mediating role of organizational culture in the transformational leadership-commitment link with multiple variables frequently used in previous research being controlled.

scholarly journals COVID-19 Telehealth Impact Study

2021 ◽  
Author(s):  
Francis Campion ◽  
Stephen Ommen ◽  
Helayne Sweet ◽  
Nilay Shah ◽  
Barbra Rabson ◽  
...  
Keyword(s):  
Natural Experiment ◽  
Care Delivery ◽  
Quality Care ◽  
Private Insurance ◽  
Healthcare Delivery ◽  
Patient Survey ◽  
Impact Study ◽  
Provide Quality Care ◽  
Provider Survey ◽  
The U.S

Importance:  This three-part study characterizes the widespread implementation of telehealth during the first year of the COVID-19 pandemic, giving us insight into the role of telehealth as we enter a stage of “new normal” healthcare delivery in the U.S. Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic.  Using a large claims data stream and surveys of providers and patients, we studied telehealth in all 50 states to inform healthcare leaders.  Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC), to respond to the pandemic. We report trends using a dataset of over 2 billion healthcare claims covering over 50% of private insurance activity in the U.S. (January 2019-December 2020), along with key elements from our provider survey (July-August 2020) and patient survey (November 2020 - February 2021). Main Outcomes and Measures: There was rapid and widespread adoption of telehealth in Spring 2020 with over 12 million telehealth claims in April 2020, accounting for 49.4% of total health care claims. Providers and patients expressed high levels of satisfaction with telehealth. 75% of providers indicated that telehealth enabled them to provide quality care.  84% of patients agreed that quality of their telehealth visit was good. Results: Peak levels of telehealth use varied widely among states ranging from 74.9% in Massachusetts to 25.4% in Mississippi.  Every clinical discipline saw a steep rise with the largest claims volume in behavioral health. Provision of care by out-of-state provider was common at 6.5% (October-December 2020). Providers reported multiple modalities of telehealth care delivery.  74% of patients indicated they will use telehealth services in the future. Conclusions and Relevance: Innovation shown by providers and patients during this period of rapid telehealth expansion constitutes a great natural experiment in care delivery with evidence supporting widespread clinical adoption and satisfaction on the part of both patients and clinicians. The authors encourage continued broad access to telehealth over the next 12 months to allow telehealth best practices to emerge, creating a more effective and resilient system of care delivery.

scholarly journals The ‘PRICE’ of Physical Activity Referral Schemes (PARS): Stakeholders’ Recommendations for Delivering Quality Care to Patients

2021 ◽  
Vol 18 (16) ◽  
pp. 8627
Author(s):  
Francis A. Albert ◽  
Aduli E. O. Malau-Aduli ◽  
Melissa J. Crowe ◽  
Bunmi S. Malau-Aduli
Keyword(s):  
Physical Activity ◽  
Care Delivery ◽  
Quality Care ◽  
Healthcare Delivery ◽  
Professional Relationships ◽  
Quality Patient Care ◽  
Telephone Interviews ◽  
Care Services ◽  
Evaluation Approach

Evidence-based strategies are needed to curb the growing cases of physical inactivity related morbidities. Delivering holistic care through collaborative shared decision making could boost the effectiveness of physical activity referral schemes (PARS) and foster the quality of care for patients with multimorbidity. A qualitative study involving semi-structured telephone interviews was utilised to gain insights from Australian PARS stakeholders (general practitioners, exercise physiologists, and patients). A pluralistic evaluation approach was employed to explore and integrate participants’ opinions and experiences of PARS and their recommendations were used to develop a model for quality care delivery in PARS initiatives. Five overarching themes: promote, relate, incentivise, communicate, and educate were identified as the ‘PRICE’ for developing effective and functional PARS programmes that foster quality patient care. It was evident that PARS programmes or policies aimed at optimising publicity, encouraging incentives, improving interdisciplinary information sharing and professional relationships between patients and healthcare professionals can transform healthcare delivery and provide top quality PARS care services to patients. Therefore, governments, healthcare systems, and PARS administrators can translate and leverage the insights from this study to optimise the delivery of high quality care to PARS patients.

The Experience of Community Neurologists Providing Care for Patients With Neurodegenerative Illness During the COVID-19 Pandemic

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012363
Author(s):  
Roman Ayele ◽  
Zachary A Macchi ◽  
Megan Dini ◽  
Meredith Bock ◽  
Maya Katz ◽  
...  
Keyword(s):  
Care Delivery ◽  
Quality Care ◽  
Healthcare Delivery ◽  
Models Of Care ◽  
Matrix Analysis ◽  
Political Climate ◽  
Personal Lives ◽  
New Models ◽  
Professional Isolation ◽  
The Impact

Objective:Healthcare delivery systems transformed rapidly at the beginning of the COVID-19 pandemic to slow the spread of the virus while identifying novel methods for providing care. In many ways the pandemic impacted both persons with neurologic illness and neurologists. This study describes the perspectives and experiences of community neurologists providing care for patients with neurodegenerative illnesses during the COVID-19 pandemic.Methods:We conducted a qualitative study with 20 community neurologists from a multisite, comparative effectiveness trial of outpatient palliative care from July 23, 2020 to November 11, 2020. Participants were interviewed individually about the impact of the COVID-19 pandemic on their professional and personal lives. Interviews were analyzed using matrix analysis to identify key themes.Results:Four main themes illustrated the pandemic’s impact on community neurologists: 1) challenges of the current political climate, 2) lack of support for new models of care, 3) being on the frontline of suffering, and 4) clinician self-care. Taken together, the themes capture the unusual environment in which community neurologists’ practice, the lack of clinician trust among some patients, patient and professional isolation, and opportunities to support quality care delivery.Conclusions:The COVID-19 pandemic and pandemic politics created an environment that made care provision challenging for community neurologists. Efforts to improve care delivery should proactively work to reduce clinician burnout while incorporating support for new models of care adopted due to the pandemic.

scholarly journals Policy Challenges and Opportunities to Address Changing Paradigms in Cancer Care Delivery

2019 ◽  
Vol 17 (5) ◽  
pp. 424-431
Author(s):  
Katy Winckworth-Prejsnar ◽  
James McCanney ◽  
Alyssa A. Schatz ◽  
Warren Smedley ◽  
Leonidas C. Platanias ◽  
...  
Keyword(s):  
Cancer Care ◽  
Working Group ◽  
Care Delivery ◽  
Quality Care ◽  
Healthcare Delivery ◽  
Policy Recommendations ◽  
Healthcare Delivery System ◽  
Challenges And Opportunities ◽  
Innovative Therapies ◽  
Payment Models

Multiple factors are forcing the healthcare delivery system to change. A movement toward value-based payment models is shifting these systems to team-based integration and coordination of care for better efficiencies and outcomes. Workforce shortages are stressing access and quality of care for patients with cancer and survivors, and their families and caregivers. Innovative therapies are expensive, forcing payers and employers to prioritize resources. Patients are advocating for care models centered on their needs rather than those of providers. In response, payment policies have recently focused on the promotion of alternative payment models that incentivize coordinated, high-quality care with consideration for value and controlling the increasing overall costs associated with cancer and its treatment. Given the multitude of factors confounding cancer care, NCCN convened a multistakeholder working group to examine the challenges and opportunities presented by changing paradigms in cancer care delivery. The group identified key challenges and developed policy recommendations to address 4 high-visibility topics in cancer care delivery. The findings and recommendations were then presented at the NCCN Policy Summit: Policy Challenges and Opportunities to Address Changing Paradigms in Cancer Care Delivery in September 2018, and multistakeholder roundtable panel discussions explored these findings and recommendations along with additional items. This article encapsulates the discussion from the NCCN Working Group meetings and the NCCN Policy Summit, including multistakeholder policy recommendations on delivery issues in cancer care designed to help inform national policies moving forward.

scholarly journals Adapting the ADS Plus Program and Study for a Spanish Speaking Population

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 486-486
Author(s):  
Katherine Marx ◽  
Manka Nkimbeng ◽  
Joseph Gaugler ◽  
Laura Gitlin ◽  
Lauren Parker ◽  
...  
Keyword(s):  
Community Based ◽  
Dementia Caregivers ◽  
Cultural Elements ◽  
Community Based Research ◽  
Predominantly Hispanic ◽  
Spanish Speaking ◽  
Adult Day Services ◽  
Increased Risk ◽  
Hispanic Latinos ◽  
Day Services

Abstract While Hispanic/Latinos are at increased risk for Alzheimer’s Disease, they are often cited as a “difficult-to-reach population” to engage in community-based research or clinical trials. One reason may be that many community-based supportive interventions for dementia caregivers are not adapted for Spanish-speaking populations. The purpose of this presentation is to describe the process of adapting the Adult Day Services Plus (ADS Plus) program for this population. In addition to translating ADS Plus into Spanish, staff, familiar with the program from four sites, which serve a predominantly Hispanic population, participated in a set of three focus groups that reviewed recruitment and intervention materials. Emerging themes included, Hispanic caregivers do not refer to themselves as caregivers but as the familial relationship (e.g. daughter, son, wife), and Hispanics often view research as a waste of resources. Future studies should consider these cultural elements towards caregiving in developing programs for Spanish-speaking dementia caregivers.

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