scholarly journals A Systems Thinking Approach to Designing Clinical Models and Healthcare Services

Systems ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 18 ◽  
Author(s):  
Inas Khayal
Keyword(s):  
Chronic Diseases ◽  
Systems Thinking ◽  
Chronic Conditions ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Healthcare Delivery System ◽  
Clinical Model ◽  
Organ Systems ◽  
Clinical Models ◽  
High Level

Chronic diseases are on the rise, increasing in number and treatment regimen complexity. Consequently, the needs of patients with chronic diseases are increasing and becoming more complex and multi-faceted. Such chronic conditions require addressing not only the physical body, but also psychosocial and spiritual health. The healthcare delivery system, however, organically organized into departments based on physical organ systems. Such a configuration makes it ill-suited to provide comprehensive multi-faceted healthcare services that span multiple departments and specialties (e.g., podiatry and endocrinology for diabetes; primary care and psychiatry for behavioral health; and palliative care physicians, chaplains, and social workers for end-of-life care). To deliver new services, the medical field typically designs new clinical models to base its new services on. Several challenges arise from typical approaches to designing healthcare services and clinical models, including addressing only single conditions, describing models only at a high-level of abstraction, and using primarily narrative documents called text-based toolkits for implementation. This paper presents and uses systems thinking as an alternative strategy to designing clinical system models and healthcare services to alleviate many of the current design challenges in designing integrated services for chronic conditions. An illustrative example taking a clinical model and describing it as a system model is presented.

Active and Healthy Aging

2017 ◽  
pp. 369-391
Author(s):  
Emine Özmete
Keyword(s):  
Qualitative Research ◽  
Delivery System ◽  
Healthy Aging ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Capital City ◽  
Elderly Persons ◽  
Healthcare Delivery System ◽  
Care And Support ◽  
Depth Interviews

This study aims to investigate the difficulties experienced by elderly persons in accessing healthcare services and their satisfaction with issues as regards the healthcare system. In this study, qualitative research was carried out to assess the difficulties regarding the healthcare delivery system and satisfaction with the healthcare services. This qualitative research was performed through in-depth interviews with 6 men and 4 women aged 65+ years, in Ankara, the capital city of Turkey. It was discovered that elderly persons required the support of others to access a doctor, a health institution or hospital and the care and support of others for the regular intake of their drugs with increasing age. They were satisfied with the current family physician program. The most significant challenges experienced by elderly persons regarding the healthcare delivery system included crowded hospitals, difficulty walking, the unavailability of wheel chairs, and inadequate assistance from support staff.

Simulation Modeling of Healthcare Delivery

2011 ◽  
pp. 69-89
Author(s):  
Ian W. Gibson
Keyword(s):  
Simulation Modeling ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Healthcare Delivery System ◽  
Scarce Resources ◽  
Power Simulation ◽  
Modeling Analysis ◽  
Management Techniques ◽  
The Cost ◽  
Delivery Models

Healthcare has delivered incredible improvements in diagnosis and treatment of diseases but faces challenges to improve the delivery of services. Healthcare is a complex system using expensive and scarce resources. Benchmarking, experience, and lean management techniques currently provide the basis for developing service delivery models and facility planning. Simulation modeling can supplement these methods to enable a better understanding of the complex systems involved. This provides the basis for developing and evaluating options to provide improved healthcare delivery. Simulation modeling enables a better understanding of the processes and the resources used in delivering healthcare services and improving healthcare delivery systems. Options to improve the cost effectiveness can be evaluated without experimenting with patients. This chapter reviews the current challenges and methods including the use of simulation modeling. Analysis of emergency patient flows through a major hospital shows the capability of simulation modeling to enable improvement of the healthcare delivery system. This chapter enables healthcare managers to understand the power simulation modeling brings to the improvement of healthcare delivery.

Challenges in Providing Comprehensive and Coordinated Care to HIV/AIDS Patients: A Canadian Perspective

2000 ◽  
Vol 13 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Peter Tsasis
Keyword(s):  
Chronic Illness ◽  
Hiv Infection ◽  
Chronic Conditions ◽  
Opportunistic Infections ◽  
Healthcare Delivery ◽  
Coordinated Care ◽  
Healthcare Delivery System ◽  
Canadian Perspective ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

This article focuses our attention on the means by which healthcare is provided to HIV-infected patients who require comprehensive and coordinated care to address the variety of changing and challenging needs presented by the acquired immunodeficiency syndrome (AIDS). Improved clinical management of HIV infection over the past decade, with antiretroviral agents, protease inhibitors and prophylactic therapies against opportunistic infections has transformed HIV infection from an acute to a chronic illness. Many individuals with AIDS are now living longer with more chronic conditions. Concomitant with the transformation of HIV infection from an acute to a chronic illness comes the challenge to provide effective, humane and economical care to patients with chronic conditions that continue to reside in the community, within a healthcare delivery system that has evolved to treat patients with acute diseases.

scholarly journals Towards a Shariah Compliance Model for Healthcare Centres with reference to Spiritual Healers: Issues and Challenges

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Ramizah Wan Muhammad
Keyword(s):  
Public Health ◽  
Tertiary Care ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Healthcare Delivery System ◽  
Factors Affecting ◽  
Healthcare Centre ◽  
The Public ◽  
The People ◽  
Spiritual Healers

Generally, a good healthcare centre comprises of qualified manpower, right policies and right procedures in providing primary care, secondary care and tertiary care for the patients as well as in public health. Other than manpower, healthcare centres must also look at social, religious and cultural factors affecting the recipients of the healthcare services given by the healthcare centres. In this paper, the author will look at some pertinent issues such as the need to have spiritual healers in any healthcare centre to help the patients in dealing with fatal illness. The spiritual healer is to help the patient and give him motivation so that he could have a positive mind throughout his journey in battling with his illness. Sometimes we have patients who refused to listen to the doctor's advice. Thus, the role of the spiritual healer would be important in assisting the healthcare centres and its management to convince him. Another issue is the privacy, respect and trust between patients and doctors as well as with the management of the healthcare centres. One of the duties of the healthcare centres’ management and doctors is, to respect the patient's religion and his faith. These three issues are amongst the important issues which every healthcare centre must look upon. Definitely there are a lot of challenges in addressing the above mentioned issues such as the procedures, methods on how to execute these issues and most importantly the perception of the public. In Islam, health care is one of the five important elements in which the Prophet SAW has mentioned in one hadith to be taken care of. A study has shown that a nation-building efforts has no meaningwithout the best public health and healthcare delivery system to the people.

scholarly journals Investigating Perceptions of Patients on Healthcare Pricing Within The Private Healthcare Sector In Sri Lanka

2021 ◽  
Vol 16 (3) ◽  
pp. 235-242
Author(s):  
Kanchana Sajeeva Narangoda ◽  
Estie Kruger ◽  
Marc Tennant
Keyword(s):  
Sri Lanka ◽  
Private Sector ◽  
Healthcare Delivery ◽  
Target Population ◽  
Healthcare Services ◽  
Healthcare Sector ◽  
Sufficient Evidence ◽  
Healthcare Delivery System ◽  
Private Hospitals ◽  
Private Healthcare

Demand for private sector healthcare services in Sri Lanka is on the rise. This is very evident from the increase in the number of registered private healthcare institutions from 1990 to 2017. [1,2] With the increasing utilization of private sector healthcare services, various qualitative factors,  and service-related issues associated with the healthcare delivery system have become common debates. A major concern, patients have expressed, is about the fees charged by doctors and hospitals. Principle aim of this study was to investigate the perceptions of patients on healthcare pricing within the private healthcare sector in Sri Lanka. The target population of the study was defined as Sri Lankans who have been inpatients in private hospitals within the past year. The focus districts were Colombo, Kandy, and Galle. These 3 districts represented nearly 60% of the total private sector bed capacity. From each district, three main private hospitals were selected. Over 700 patients were invited to participate, 246 surveys were completed, and 215 were retained as 31 had excessive missing and/or unclear data. In all 3 districts the majority of patients were either dissatisfied with or remained neutral (69%) on the hospital fees,(66%) on doctor’s fees,(74%) on the overall price they ended up paying,(76%)  on whether they think the healthcare services they received are value for money. This study did not investigate the reasons or the factors that may affect the satisfaction or dissatisfaction of patients towards the fees they paid Multiple factors can affect patient’s perception on the fees they paid. With negative perception on the above it can be concluded that there is sufficient evidence to challenge private sector healthcare satisfaction level vs price/fees equilibrium in Sri Lanka.

scholarly journals 1107. The MAAGE Study: Health Care Utilization for the Treatment of Medically Attended Acute Gastroenteritis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S331-S332
Author(s):  
Claire P Mattison ◽  
Holly Groom ◽  
Judy Donald ◽  
S Bianca Salas ◽  
Zachary Marsh ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Acute Gastroenteritis ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Care Utilization ◽  
Comorbid Condition ◽  
Inpatient Setting ◽  
Healthcare Delivery System ◽  
Kaiser Permanente ◽  
Demographic Patterns

Abstract Background Acute gastroenteritis (AGE) exacts a substantial disease burden across the age spectrum, although healthcare utilization for AGE is not well characterized. Through active surveillance of medically attended acute gastroenteritis (MAAGE) encounters within a large, integrated healthcare delivery system, we analyzed demographic patterns of healthcare utilization among AGE patients. Methods From April 1, 2014 to September 30, 2016, we collected information on all MAAGE encounters in Kaiser Permanente Northwest (KPNW) patients through daily abstraction from electronic health records using ICD-9/-10 codes. For each patient, a MAAGE episode was defined as all MAAGE encounters <30 days apart. Results There were 109,493 MAAGE encounters among 39,451 patients. Patients were 60.4% female and 39.6% male; 10.3% were <5 years old, 9.7% were 5–17, 31.1% were 18–44, 25.4% were 45–64, and 23.5% were ≥65. Among those with known race, 87.2% were white; 4.1% were Asian, 3.6% were black, and 5.1% were other or multiple races. Prevalence of any chronic comorbid condition was 52.9%. Of 52,107 MAAGE episodes, 81.0% first presented as outpatients; this was most common in those aged <5 (92.1%) and decreased with age to 75.0% in those ≥65. First presenting remotely (email or telephone) ranged from 4.0% in those aged <5 to 19.3% in those ≥65; 52.7% of episodes first presenting remotely had no subsequent visits. Few episodes first presented to an emergency department (3.8% in <5 year olds to 6.6% in 18–44 year olds) or inpatient setting (0.1% in <5 year olds to 1.7% in ≥65 year olds). Most MAAGE episodes comprised of one encounter (median: 1.0, mean: 2.1). The number of encounters per episode was lowest in those <5 years old (median: 1.0, mean: 1.5) and highest in those ≥65 (median: 2.0, mean: 2.5). Most deaths within 30 days from the start of an episode (131/161) were in those ≥65; there were none in those <5, 1 in those 5–17, 5 in those 18–44, and 24 in those 45–64. Conclusion We found that the number of encounters per MAAGE episode increased with age and that outpatient and remote encounters are important settings for the initial clinical management of MAAGE in all ages. These data can help to better quantify the economic burden of AGE and guide appropriate delivery of healthcare services. Disclosures All authors: No reported disclosures.

Active and Healthy Aging

2017 ◽  
pp. 384-406
Author(s):  
Emine Özmete
Keyword(s):  
Qualitative Research ◽  
Delivery System ◽  
Healthy Aging ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Capital City ◽  
Elderly Persons ◽  
Healthcare Delivery System ◽  
Care And Support ◽  
Depth Interviews

This study aims to investigate the difficulties experienced by elderly persons in accessing healthcare services and their satisfaction with issues as regards the healthcare system. In this study, qualitative research was carried out to assess the difficulties regarding the healthcare delivery system and satisfaction with the healthcare services. This qualitative research was performed through in-depth interviews with 6 men and 4 women aged 65+ years, in Ankara, the capital city of Turkey. It was discovered that elderly persons required the support of others to access a doctor, a health institution or hospital and the care and support of others for the regular intake of their drugs with increasing age. They were satisfied with the current family physician program. The most significant challenges experienced by elderly persons regarding the healthcare delivery system included crowded hospitals, difficulty walking, the unavailability of wheel chairs, and inadequate assistance from support staff.

Health Care from a Systems Thinking Perspective

2017 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Health Care ◽  
Systems Thinking ◽  
Delivery System ◽  
Healthcare Delivery ◽  
Healthcare Delivery System ◽  
Quality Health Care ◽  
Healthcare Design ◽  
Design Structure ◽  
Quality Health

Highlight the systems thinking perspective inensuring quality health care. Transforming the healthcare delivery system, changing healthcare DESIGN, STRUCTURE AND processes to correct inherent structural deficiencies.

scholarly journals India’s RMNCH+A Strategy: approach, learnings and limitations

2019 ◽  
Vol 4 (3) ◽  
pp. e001162 ◽  
Author(s):  
Gunjan Taneja ◽  
Vegamadagu Suryanarayana-Rao Sridhar ◽  
Jaya Swarup Mohanty ◽  
Anurag Joshi ◽  
Pranav Bhushan ◽  
...  
Keyword(s):  
Health Planning ◽  
Healthcare Delivery ◽  
Monitoring And Evaluation ◽  
Healthcare Services ◽  
Evaluation Framework ◽  
Public Healthcare ◽  
Healthcare Delivery System ◽  
District Health ◽  
Public Health Challenges ◽  
The Government

Building on the gains of the National Health Mission, India’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Strategy, launched in 2013, was a milestone in the country’s health planning. The strategy recognised the interdependence of RMNCH+A Interventions across the life stages and adopted a comprehensive approach to address inequitable distribution of healthcare services for the vulnerable population groups and in poor-performing geographies of the country. Based on innovative approaches and management reforms, like selection of poor-performing districts, prioritisation of high-impact RMNCH+A healthcare interventions, engagement of development partners and institutionalising a concurrent monitoring system the strategy strived to improve efficiency and effectiveness within the public healthcare delivery system of the country. 184 High Priority Districts were identified across the country on a defined set of indicators for implementation of critical RMNCH+A Interventions and a dedicated institutional framework comprising National and State RMNCH+A Units and District Level Monitors supported by the development partners was established to provide technical support to the state and district health departments. Health facilities based on case load and available services across the High Priority Districts were prioritised for strengthening and were monitored by an RMNCH+A Supportive Supervision mechanism to track progress and generate evidence to facilitate actions for strengthening ongoing interventions. The strategy helped develop an integrated systems-based approach to address public health challenges through a comprehensive framework, defined priorities and robust partnerships with the partner agencies. However, lack of a robust monitoring and evaluation framework and sub-optimal focus on social determinants of health possibly limited its overall impact and ability to sustain improvements. Guided by the learnings and limitations, the Government of India has now designed the ‘Aspirational Districts Program’ to holistically address health challenges in poor-performing districts within the overall sociocultural domain to ensure inclusive and sustained improvements.

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