In the dynamic environment of increasing regulations, increasing patient demand, decentralization of budgets and enforcement of efficiency, small sized healthcare institutions in the Netherlands are having a difficult time. Although these service providers are usually capable of flexibly delivering healthcare, the investment and overhead for implementing and executing on required quality management standards like ISO 9001 is difficult. In this paper we construct a method for the implementation of an IT-enabled quality management system for small sized healthcare institutions, which is applied through case study. The case organisation provides intra- and extramural care for mentally handicapped persons and young adults with a psychiatric disorder. The quality management system implementation is based on 1) a lightweight IT infrastructure (based at a secure data centre and accessible through remote login) implying secure storage of patients' medical and personal information. Furthermore, the Deming (Deming, 1982) cycle enabled processes and protocols are 2) described in an e-handbook and prototyped via an open source process management system which supports the quality regulation demanded for providing care to patients. The case study supports the validity of our method and the fact that small sized healthcare institutions are able to execute their care while adhering to ISO 9001-like standards, with limited initial costs and relatively low cost of ownership
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Despite the increased use of activity trackers, little is known about how they can be used in healthcare settings. This study aimed to support healthcare professionals and patients with embedding an activity tracker in the daily clinical practice of a specialized mental healthcare center and gaining knowledge about the implementation process. An action research design was used to let healthcare professionals and patients learn about how and when they can use an activity tracker. Data collection was performed in the specialized center with audio recordings of conversations during therapy, reflection sessions with the therapists, and semi-structured interviews with the patients. Analyses were performed by directed content analyses. Twenty-eight conversations during therapy, four reflection sessions, and eleven interviews were recorded. Both healthcare professionals and patients were positive about the use of activity trackers and experienced it as an added value. Therapists formulated exclusion criteria for patients, a flowchart on when to use the activity tracker, defined goals, and guidance on how to discuss (the data of) the activity tracker. The action research approach was helpful to allow therapists to learn and reflect with each other and embed the activity trackers into their clinical practice at a specialized mental healthcare center.
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Abstract: Self-management interventions (SMIs) may fail if they misalign with the local context. To optimize the implementation of SMIs in Chinese people with chronic lung disease (CLD), the local context was identified in Chinese primary care (PC) and secondary care (SC). A mixed-method study using semi-structured interviews and quantitative surveys was conducted on people with CLD and healthcare professionals (HCPs). The qualitative data was collected until data saturation was reached, and participants were invited to complete the survey after the interview. The qualitative data—analyzed with the framework approach—was triangulated with the quantitative data. A total of 52 participants completed the interviews, and 48 also finished the survey. Four themes were identified; (a) illness perceptions (e.g., patients had poor CLD knowledge and SM, inadequate resources lead to suboptimal disease control in PC); (b) self-management skills (e.g., most patients delayed exacerbation recognition and action, and some were admitted at the crisis point); (c) factors influencing self-management skills (e.g., (in)adequate disease knowledge and medical expenditure affordability); and (d) needs for self-management (e.g., increased disease knowledge, individualized self-management plan, eHealth, (healthcare insurance) policy support). Identified themes were dependent on each other and should be leveraged when implementing SMIs. Ultimately, such SMIs can optimize patient health outcomes.
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Abstract from article: The Dutch healthcare system has changed towards a system of regulated competition to contain costs and to improve efficiency and quality of care. This paper provides: (1) a brief as-is overview of the changes for primary care, based on explorative literature reviews; (2) provides noteworthy remarks as for the way primary and secondary healthcare is organised; (3) an example of an E-health portal illustrating implemented processes within the Dutch context and (4) a proposed research agenda on various e-health topics. Noteworthy remarks are: (1) government, insurer, healthcare provider and patient are main actors within the Dutch healthcare system; (2) general practitioners (GP’s) are gatekeepers to secondary and other care providers; (3) the illustrated portal with a patient oriented design, provides access to applications implemented at care providers resulting in increased electronic availability and increased patient satisfaction; (4) a variety of fragmented information systems at health care providers exists, which leaves room for standardisation and increased efficiency. We end with suggestions for future research.
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Although many pilots with new eHealth products have been developed, only very few of these products reach widespread adoption within healthcare organisations. The literature mentions a wide range of bottlenecks for the acceptance of new technology in the healthcare industry, among which insufficient attention for change management and acceptance by intended users. In this paper, we argue that agile software development, with its practices for user involvement and product visibility, can be used as a change management approach in healthcare innovation projects. We compare agile methods with the change approach of Kotter (1995). As an illustration of our theoretical findings, we describe a development project of an innovative eHealth application to support the care for persons with intellectual disability.
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Background: Knee and hip osteoarthritis (OA) among older adults account for substantial disability and extensive healthcare use. Effective pain coping strategies help to deal with OA. This study aims to determine the long-term relationship between pain coping style and the course of healthcare use in patients with knee and/or hip OA over 10 years. Methods: Baseline and 10-year follow-up data of 861 Dutch participants with early knee and/or hip OA from the Cohort Hip and Cohort Knee (CHECK) cohort were used. The amount of healthcare use (HCU) and pain coping style were measured. Generalized Estimating Equations were used, adjusted for relevant confounders. Results: At baseline, 86.5% of the patients had an active pain coping style. Having an active pain coping style was significantly (p = 0.022) associated with an increase of 16.5% (95% CI, 2.0–32.7) in the number of used healthcare services over 10 years. Conclusion: Patients with early knee and/or hip OA with an active pain coping style use significantly more different healthcare services over 10 years, as opposed to those with a passive pain coping style. Further research should focus on altered treatment (e.g., focus on self-management) in patients with an active coping style, to reduce HCU.
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Acne vulgaris is considered one of the most common medical skin conditions globally, affecting approximately 85% of individuals worldwide. While acne is most prevalent among adolescents between 15 to 24 years old, it is not uncommon in adults either. Acne addresses a number of different challenges, causing a multidimensional disease burden. These challenges include clinical sequelae, such as post inflammatory hyperpigmentation (PIH) and the chance of developing lifelong disfiguring scars, psychological aspects such as deficits in health related quality of life, chronicity of acne, economic factors, and treatment-related issues, such as antimicrobial resistance. The multidimensionality of the disease burden stipulates the importance of an effective and timely treatment in a well organised care system. Within the Netherlands, acne care provision is managed by several types of professional care givers, each approaching acne care from different angles: (I) general practitioners (GPs) who serve as ‘gatekeepers’ of healthcare within primary care; (II) dermatologists providing specialist medical care within secondary care; (III) dermal therapists, a non-physician medical professional with a bachelor’s degree, exclusively operating within the Australian and Dutch primary and secondary health care; and (IV) beauticians, mainly working within the cosmetology or wellness domain. However, despite the large variety in acne care services, many patients experience a delay between the onset of acne and receiving an effective treatment, or a prolonged use of care, which raises the question whether acne related care resources are being used in the most effective and (cost)efficient way. It is therefore necessary to gain insights into the organization and quality of Dutch acne health care beyond conventional guidelines and protocols. Exploring areas of care that may need improvement allow Dutch acne healthcare services to develop and improve the quality of acne care services in harmony with patient needs.
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Background: To be accountable to laws and regulations, healthcare professionals spend more than 40% of their time on administrative tasks. The Compulsory Mental Healthcare Act (CMHA) was introduced in Dutch mental healthcare in 2020. It was hypothesized that this legislative amendment would raise the administrative burden for some care professionals. Pilot studies in 2020 and 2021 visualized the exponentially rise of the administrative burden for care professionals, especially psychiatrists due to the transition. However the total response was too small and not generalizable. Aim: gain more nationwide insight in the hypothesized raise of administrative burden of psychiatrists due to the implementation of the CMHA. Method: Under the leadership of an advisory board of three medical director psychiatrists, a Likert scale questionnaire was further developed to investigate the administrative burden of psychiatrists in the Netherlands before and after transition. Open-ended questions provided the opportunity for feedback from the psychiatrists. The study was supported by the Department of Medical Directors (DMD) of The Netherlands Psychiatric Association (NPA). Results: all mental health institutions members of the DMD of the NPA received an invitation to participate. 14 institutions (total N=158) responded. The data show a significant change in the time spent on administrative tasks, the usefulness of the administrative actions, the fit for use and ease of use of supporting systems. The forementioned all decreased significantly after the implementation. Conclusion and discussion: Psychiatrists spend more time on administration than before the legislative amendment instead of helping vulnerable patients. None of the institutions has been able to use the transition to its advantage given the time spent on administrative tasks and the usefulness of these tasks. This is an unacceptable development in the field of mental health in the Netherlands and should be addressed to those who are responsible for the decision making, especially policy makers. These results show that the introduction of the CMHA have made the field of Dutch mental health an impossible area to work for. , Administrative burden, Legislative amendment, Public governance, Information Management
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In solving systemic design challenges designers co-create with professionals from various fields. In the context of innovation in healthcare practices, this study investigates design abilities that healthcare professionals develop by participating in co-design projects. We conducted a mixed-methods research approach consisting of five retrospective interviews with healthcare researchers involved in co-design projects, and a multiple case study (three cases) on the collaboration between design researchers and healthcare professionals. The three cases all aimed at designing tools for healthcare innovation. The cases differ in the healthcare context and the professionals involved: Paediatric physical therapists in the treatment of babies (0-2 years), supervisors (e.g. in assisted living) of people with intellectual disabilities, and academic researchers in social sciences and design research developing e-health applications for elderly people with early stages of dementia. Literature states that healthcare professionals may be competent in specific abilities related to design, but they are not trained to mode-shift and to use two different ways of working for creativity. We found that the healthcare professionals involved in co-design projects developed design ability over time, and that the research setting was supportive. Based on design abilities that the five healthcare researchers explicated in the interviews as having adopted, we suggest eight mode-shift practices related to design, which we investigated in the cases. Findings of the case-study show that two mode-shift practices related to design and innovation are difficult to adopt for healthcare professionals: Generate and synthesize; and keeping track on overview and details. These two design abilities require more training and/or experience than the other six design abilities that ran smoothly in the cases, if healthcare professionals were facilitated in the process. Healthcare professionals specifically relate two of these practices to design: Collaboration and slow down – sprint. This study discusses these findings by referring to an analogy of kayaking on a wild water river: The collaboration aspect of switching between working in a group and by yourself, like a group of kayakers who collaborate in going down stream a river but peddle by themselves in their own boats; the slowdown and sprint aspect, like kayakers who oversee the river in turning waters and sprint in between, rather than go with the flow in a raft.
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Abstract: The need for mental healthcare professionals in the Netherlands is increasing caused by the growth of patient complexity. The administration burden causes outflow of professionals and therefor they become increasingly scares. Improvement initiatives are aimed as the intended strategy and starts with (re)-structuring organizations through legislation and regulations. They entail both experienced and measured administration burden for healthcare professionals working in Long-Term Care (LTC). However, most studies only provide insight into the current administration burden or the impact of legislation and regulations on the administration burden from a broad perspective. These insights are useful to LTC managers, but more in-depth research is needed to implement laws and regulations to reduce the administration burden for LTC professionals in the future. The Compulsory Mental Healthcare Act (CMHA) was implemented in the Dutch mental healthcare and replaced the Special Admissions Act in Psychiatric Hospitals (SAAPH) on January 1, 2020. The aim of this study is to investigate the effect of the legislative transition and to determine the effect on the administration burden of Dutch mental healthcare professionals. A survey concerning the administration burden for especially psychiatrists before and after the transition was distributed to an addiction institute with a diversity of different mental healthcare professionals and a psychiatric institute that has been led by psychiatrists. Also some interviews with the lead professionals where held. The results show that the administration burden among psychiatrists has increased due to the contact with external healthcare providers and contact with the patient, family and their loved ones (a consequence of the amendment of the law). This effect was significant and in line with the results of the interviews. Therefor we conclude that the administration burden has increased as a result of the legislative amendment.
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