Background: Despite the large availability of caregivers, there are no standardized care pathways for patients with acne. This increases the risk of ineffective care and unnecessary medicalizing. To better understand how to provide effective, efficient, and patient-satisfying care, it is necessary to gain insights into the patient journey through acne healthcare services. Objective: To explore the patient journeys, assessed by a series of consecutive steps through acne healthcare. Methods: A cross-sectional survey was conducted among Dutch individuals with acne. Results: A total of 371 respondents completed the questionnaire. Data revealed 58 different pathways through acne healthcare services. Patient with severe acne had a stronger tendency to seek professional care than those with mild acne (p<.05). The highest proportion of clinically relevant improvement was found in patients treated by dermatologists, compared to respondents treated by beauticians, p¼.023 and dermal therapists, p¼.018. Conclusions: Mapping the patient journeys contributed to a better understanding of the gap between professional guidelines and the experiences of patients. Identifying these areas of care implies that there is potential to bring acne care services more in line with the patients’ needs. Further research is recommended; for example by comparing the clinical treatment outcomes of multiple sequences of caregivers.
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Background and aim – Patients undergo one or more medical interventions in a hospital. In the hospital, patients are surrounded by spaces and services. The output in a hospital is the patients’ outcome.To gain understanding about a holistic experience of patients, we assessed the experience and well-being of patients at specific focal points of the entire patient journey: from the arrival, to the diagnosis and the actual treatment in a hospital.Methods – This article describes three field experiments that were conducted in a Dutch hospital. First, in an age-simulation study the effect of route complexity and physical ageing was assessed during 108 wayfinding tasks. Second, in a quasi-randomized experiment the use of a motion-nature projection was assessed during a diagnostic scan (N = 97) . Lastly, in a quasi-randomized experiment the effect of a nontalking rule during an outpatient infusion treatment was assessed (N = 263).Results – A wide variety of patients visit a hospital and all patients of course bring an opinion of their own and experience their hospital visit differently. However, patients benefit from a simple building structure during wayfinding, inexpensive beamers to project nature during diagnostics, and a mix of treatment places with respect to social interest during infusion treatments.Originality – There is little discussion about the holistic experience of patients, that concerns the cognitive, emotional, physical, and social well-being of patients. In our study we applied a holistic and patient-centered approach.Practical or social implications – The well-being of patients can be significantly improved when the built, natural, and sound environment is taken into account with respect to individual differences.Type of paper – Research paper.
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A hospital visit is often an anxious and uncertain event for patients andtheir relatives. Patients are often concerned about a diagnosis and/or thetreatment of their disease in an outpatient or inpatient setting. In thesehospital settings, the impact of the environment on patients is still notwell understood. Knowledge regarding the inuence of the hospitalenvironment on patients is essential for facilitating the quality of healthcare. Understanding the experience of patients will allow designers anddecision-makers in hospitals to positively inuence the well-being ofpatients.The aim of this thesis was to gain an improved understanding about amore holistic experience and well-being of patients at specic focalpoints of the entire patient journey from the arrival, to the diagnosis, andto the actual treatment in a hospital. For example, results showed thatpatients sometimes experience diculties in finding their way to anoutpatient clinic, that nature projection during a CT-scan can reduceanxiety, and that (the opportunity of) interaction with other patients is apleasant distraction or, on the contrary, an invasion of their own privacy.Understanding patients' experiences during the patient journey enableshospitals to make more informed decisions about space and serviceswhich enables us to improve experiences and well-being of patients inhospitals.This thesis emphasizes the relations between the hospital environmentand the psychosocial and physical well-being of patients. The resultsshow that it is of great importance to listen carefully to patients’experiences and needs when designing a hospital as many of the resultsshowed individual dierences with patients that emphasize that one sizedoes not t all. The well-being of patients in future hospitals can beimproved by aligning the hospital environment with individual patientcharacteristics, needs, and preferences.
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The promotor was Prof. Erik Jan Hultink and copromotors Dr Ellis van den Hende en Dr R. van der Lugt. The title of this dissertation is Armchair travelling the innovation journey. ‘Armchair travelling’ is an expression for travelling to another place, in the comfort of one’s own place. ‘The innovation journey’ is the metaphor Van de Ven and colleagues (1999) have used for travelling the uncharted river of innovation, the highly unpredictable and uncontrollable process of innovation. This research study began with a brief remark from an innovation project leader who sighed after a long and rough journey: ‘had I known this ahead of time…’. From wondering ‘what could he have known ahead of time?’ the immediate question arose: how do such innovation journeys develop? How do other innovation project leaders lead the innovation journey? And could I find examples of studies about these experiences from an innovation project leader’s perspective that could have helped the sighing innovation project leader to have known at least some of the challenges ahead of time? This dissertation is the result of that quest, as we do know relatively little how this process of the innovation project leader unfolds over time. The aim of this study is to increase our understanding of how innovation project leaders lead their innovation journeys over time, and to capture those experiences that could be a source for others to learn from and to be better prepared. This research project takes a process approach. Such an approach is different from a variance study. Process thinking takes into account how and why things – people, organizations, strategies, environments – change, act and evolve over time, expressed by Andrew Pettigrew (1992, p.10) as catching “reality in flight”.
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Ladies and gentlemen, this is quality awareness. Like brushing your teeth, quality is a daily personal obligation.
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Introduction F-ACT is a flexible version of Assertive Community Treatment to deliver care in a changing intensity depending on needs of individuals with severe mental illnesses (Van Veldhuizen, 2007). In 2016 a number of the FACT-teams in the Dutch region of Utrecht moved to locations in neighborhoods and started to work as one network team together with neighborhood based facilities in primary care (GP’s) and in the social domain (supported living, social district teams, etc.). This should create better chances on clinical, social and personal recovery of service users. Objectives This study describes the implementation, obstacles and outcomes for service users. The main question is whether this Collaborative Mental Health Care in the Community produces better outcome than regular FACT. Measures include (met/unmet) needs for care, quality of life, clinical, functional and personal recovery, and hospital admission days. Methods Data on care utilization regarding the innovation are compared to regular FACT. Qualitative interviews are conducted to gain insight in the experiences of service users, their family members and mental health care workers. Changes in outcome measures of service users in pilot areas (N=400) were compared to outcomes of users (matched on gender and level of functioning) in regular FACT teams in the period 2015-2018 (total N=800). Results Data-analyses will take place from January to March 2019. Initial analyses point at a greater feeling of holding and safety for service users in the pilot areas and less hospital admission days. Conclusions Preliminary results support the development from FACT to a community based collaborative care service.
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BACKGROUND: The mainstay of colorectal cancer care is surgical resection, which carries a significant risk of complications. Efforts to improve outcomes have recently focused on intensive multimodal prehabilitation programs to better prepare patients for surgery, which make the perioperative process even more complex and demanding for patients. Digital applications (eCoaches) seem promising tools to guide patients during their care journey. We developed a comprehensive eCoach to support, guide, and monitor patients undergoing elective colorectal surgery through the perioperative phase of the care pathway.OBJECTIVE: The primary aim of this study was to determine its feasibility, in terms of recruitment rate, retention rate, and compliance. Also, usability and patient experience were examined.METHODS: A single-center cohort study was conducted from April to September 2023 in a tertiary teaching hospital in the Netherlands. All elective colorectal surgery patients were offered an eCoach that provided preoperative coaching of the prehabilitation protocol, guidance by giving timely information, and remote monitoring of postoperative recovery and complications. Recruitment and retention rate, as well as compliance for each part of the care pathway, were determined. Secondary, patient-reported usability measured by the Usefulness, Satisfaction, and Ease of Use questionnaire and patient experiences were reported.RESULTS: The recruitment rate for the eCoach was 74% (49/66). Main reasons for exclusion were digital illiteracy (n=10), not owning a smartphone (n=3), and the expected burden of use being too high (n=2). The retention rate was 80% (37/46). Median preoperative compliance with required actions in the app was 92% (IQR 87-95), and postoperative compliance was 100% (IQR 100-100). Patient-reported usability was good and patient experiences were mostly positive, although several suggestions for improvement were reported.CONCLUSIONS: Our results demonstrate the feasibility of a comprehensive eCoach for guiding and monitoring patients undergoing colorectal surgery encompassing the entire perioperative pathway, including prehabilitation and postdischarge monitoring. Compliance was excellent for all phases of the care pathway and recruitment and retention rates were comparable with rates reported in the literature. The study findings provide valuable insights for the further development of the eCoach and highlight the potential of digital health applications in perioperative support.
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Abstract: This case study examines the use of an eHealth application for improving preoperative rehabilitation (prehabilitation). We have analysed healthcare professionals' motivators and drivers for adopting eHealth for a surgical procedure at academic medical facilities. The research focused on when and why healthcare professionals are inclined to adopt eHealth applications in their way of working? For this qualitative study, we selected 12 professionals involved in all levels of the organisation and stages of the medical process and conducted semi-structured interviews. Kotter’s transformational change model and the Technology Acceptance Model were used as analytical frameworks for the identification of the motivation of eHealth adoption. The findings suggest that contrary to Kotter’s change model, which argues that adoption of change is based on perceptions and feelings, the healthcare drivers are rational when it comes to deciding whether or not to adopt eHealth apps. This study further elaborates the observation made by the Dutch expertise centre on eHealth, Nictiz, that when the value of an eHealth pplication is clear for a stakeholder, the adoption process accelerates. Analysis of the motivations and drivers of the healthcare professionals show a strong relationship with an evidence-based grounding of usefulness and the responsibility these professionals have towards their patients. We found that healthcare professionals respond to the primary goal of improving healthcare. This is true if the eHealth application will innovate their work, but mainly when the application will improve the patient care they are responsible for. When eHealth applications are implemented, rational facts need to be collected in a study before deployment of eHealth applications on how these applications will improve the patient's health or wellbeing throughout their so-called medical journey for their treatment. Furthermore, the preference to learn about new eHealth applications from someone who speaks from authority through expertise on the subject matter, suggests adoption by healthcare professionals may be accelerated through peers. The result of this study may provide healthcare management with a different approach to their eHealth strategy. Future research is needed to validate the findings in different medical organisational settings such as regional healthcare facilities or for-profit centers which do not necessarily have an innovation focus but are driven by other strategic drivers.
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Sinds september 2015 is de ‘business rule management wereld’ / ‘decision management wereld’ weer een standaard rijker: The Decision Model and Notation (DMN). De Object Management Group (OMG) heeft deze nieuwe standaard uitgebracht met als doel een standaard taal te creëren om 1) requirements voor beslissingen en 2) de beslissingen zelf te modelleren. De adoptie van DMN heeft een wat lange aanloop gehad, maar begint nu serieuze vormen aan te nemen. Om deze reden brengen wij een vierdelige serie over DMN en het gebruik van DMN uit. In dit deel (deel 2) gaan we in op de basis principes die gelden bij het creëren van een DRD.
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Introduction: The implementation of oncology care pathways that standardize organizational procedures has improved cancer care in recent years. However, the involvement of “authentic” patients and caregivers in quality improvement of these predetermined pathways is in its infancy, especially the scholarly reflection on this process. We, therefore, aim to explore the multidisciplinary challenges both in practice, when cancer patients, their caregivers, and a multidisciplinary team of professionals work together on quality improvement, as well as in our research team, in which a social scientist, health care professionals, health care researchers, and experience experts design a research project together. Methods and design: Experience-based co-design will be used to involve cancer patients and their caregivers in a qualitative research design. In-depth open discovery interviews with 12 colorectal cancer patients, 12 breast cancer patients, and seven patients with cancer-associated thrombosis and their caregivers, and focus group discussions with professionals from various disciplines will be conducted. During the subsequent prioritization events and various co-design quality improvement meetings, observational field notes will be made on the multidisciplinary challenges these participants face in the process of co-design, and evaluation interviews will be done afterwards. Similar data will be collected during the monthly meetings of our multidisciplinary research team. The data will be analyzed according to the constant comparative method. Discussion: This study may facilitate quality improvement programs in oncologic care pathways, by increasing our real-world knowledge about the challenges of involving “experience experts” together with a team of multidisciplinary professionals in the implementation process of quality improvement. Such co-creation might be challenging due to the traditional paternalistic relationship, actual disease-/treatment-related constraints, and a lack of shared language and culture between patients, caregivers, and professionals and between professionals from various disciplines. These challenges have to be met in order to establish equality, respect, team spirit, and eventual meaningful participation.
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