Implementing Prudent Healthcare in the NHS in Wales; what are the barriers and enablers for clinicians?

Addis, Samia; Holland-Hart, Daniella; Edwards, Adrian; Neal, Richard D; Wood, Fiona

doi:10.1111/jep.13023

Cited by 18 publications

(31 citation statements)

References 16 publications

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“…The observation findings were analyzed in a structured approach using a fishbone chart, and the identified factors were categorized to ensure the risks are systematically defined. 10 The semi-structured interviews were con- 15,17,19 This corroborates with our findings in which the therapists tend to forget steps in the therapy process due to confusion in a chaotic situation. Additionally, Vincent contends that the decision taken by the higher echelons of an organization may result in latent failures whose consequences lie dormant for a long time yet are difficult to foresee and become evident after the combination of local triggers breaching the system.…”

Section: Methodssupporting

confidence: 80%

A Case Study: Negative Effects of Unscheduled Appointment System to Physiothera-pists and Paediatric Patients

Karnadipa

2020

MKMI

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Community-Based Rehabilitation (CBR) units are growing in developing countries, including Indonesia. However, patient safety measures in CBR units have not yet been conducted, especially regarding flexible, unscheduled appointment system. This study aims to evaluate the unscheduled appointment system as a cause of errors in the care delivery of a CBR unit for children with disabilities in Makassar city. This case study conducted 278-hours observation and three structured interviews. The observation findings, encoded interview findings, field notes, and self-reflective notes were triangulated and link thematically. Four key findings were illustrated in an explorative model. The CBR unit implements a day-based scheduling system without time slots. Working in this system, the therapists experienced random visits, long waiting times, and excessive workload as results from this flexible scheduling system. Significant risks of human errors and patient safety were revealed due to these consequences. As flexible scheduling systems produce more negative effects to the therapists and children, it is suggested that a CBR unit or a health care unit implement a scheduled appointment system with timeslots to achieve prudent healthcare.

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Section: Methodssupporting

confidence: 80%

A Case Study: Negative Effects of Unscheduled Appointment System to Physiothera-pists and Paediatric Patients

Karnadipa

2020

MKMI

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“…Reflective motivation refers to intentions, plans, convictions, and considerations, whereas automatic motivation refers to wishes, needs, feelings, and habits [39,51]. This model has previously proven useful in efforts to identify barriers and facilitators to co-production of health and care [9,14] and other co-production-related behaviors such as patient participation in health care safety promotion [52], patients planning advanced care [53], and shared decision making [54].…”

Section: Discussionmentioning

confidence: 99%

“…Patient-related barriers include acute illness [2,9], frailty and old age [9,15], limited health literacy (HL) [9][10][11], and low self-efficacy and engagement [9,11]. In addition, a reluctance of some professionals to use new ways of working is a barrier to co-production [2,14]. Insufficient communication skills among professionals can also hinder co-production [9][10][11].…”

Section: Co-production Of Health and Carementioning

confidence: 99%

“…Insufficient communication skills among professionals can also hinder co-production [9][10][11]. Further barriers are resource constraints, such as staff shortages, poor continuity, and shorter appointments [1,7,9,12,14]. Conditions that can facilitate co-production include individual motivation [13], support from leaders [15][16][17][18][19], and "learning networks" that include patients, nonformal caregivers, and professionals [2].…”

Section: Co-production Of Health and Carementioning

confidence: 99%

“…There is growing interest in co-production of health care services-involving patients, families of patients, and professionals in care processes-to create joint learning about how to meet patients' needs, thus promoting the best possible health [1][2][3][4][5][6]. Although barriers and facilitators to co-production have been examined previously in various health care contexts [1,2,[7][8][9][10][11][12][13][14][15][16][17][18][19], the preconditions in Swedish chronic cardiac care contexts are yet to be explored. The present study is set in the health system of the Swedish region of Jönköping County and is part of system-wide efforts to promote better health for persons with heart failure (HF).…”

Section: Introductionmentioning

confidence: 99%

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Improving Health for People Living With Heart Failure: Focus Group Study of Preconditions for Co-Production of Health and Care

Suutari¹,

Thor²,

Nordin³

et al. 2021

J Particip Med

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Background Co-production of health and care involving patients, families of patients, and professionals in care processes can create joint learning about how to meet patients’ needs. Although barriers and facilitators to co-production have been examined previously in various health care contexts, the preconditions in Swedish chronic cardiac care contexts are yet to be explored. This study is set in the health system of the Swedish region of Jönköping County and is part of system-wide efforts to promote better health for persons with heart failure (HF). Objective The objective of this study was to test the usefulness of the Capability, Opportunity, and Motivation Behavior (COM-B) model when assessing the barriers to and facilitators of co-production of health and care perceived by patients with HF, family members of patients with HF, and professionals in a Swedish chronic cardiac care context as a guide for subsequent initiatives. Methods Data collection involved 1 focus group interview (FGI) with patients with HF (n=5), 1 FGI with family members of patients with HF (n=5), 1 FGI with professionals in primary care (n=7), and 1 FGI with professionals in cardiac care (n=4). In addition, patients with HF kept diaries of their thoughts regarding co-production. Using a deductive approach to content analysis, underpinned by the COM-B model, barriers and facilitators were categorized into capabilities, opportunities, and motivations to co-produce health and care. Results The participants showed limited understanding of co-production as a practice. They appeared to view it as a privilege to be offered to patients on top of traditional care and rarely as an approach for improving health care processes. The interviews revealed the limited health literacy among patients and the struggle of professionals to convey health information to these patients. Co-production was considered to be more resource-intensive than traditional care. Different expectations of stakeholders’ roles were revealed: professionals expected older patients not to want to co-produce health and care, and all participants expected professionals to be in charge of health care services. The family members’ position involved trying to balance their desire to support their relatives with understanding when, how, and with whom to co-produce. Presumed benefits motivated stakeholders: co-production was recognized to motivate patients to improve self-care. However, the participants recognized that motivation to get involved in health and care decisions varies over time among stakeholders. Conclusions Co-production can be facilitated by the stakeholders’ motivation. However, varying levels of understanding of co-production, patients’ limited health literacy, unease with power sharing between patients and professionals, and resource constraints are barriers that need to be managed to promote co-produced care and better health for persons living with HF. Further research is warranted to explore how to co-produce health care services with patients with HF and how leaders can facilitate the inevitable cultural change it requires and represents.

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The Role of Patient-Reported Outcomes (PROs) in the Improvement of Healthcare Delivery and Service

Aiyegbusi

Hughes

Calvert

2022

Handbook of Quality of Life in Cancer

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Implementing Prudent Healthcare in the NHS in Wales; what are the barriers and enablers for clinicians?

Cited by 18 publications

References 16 publications

A Case Study: Negative Effects of Unscheduled Appointment System to Physiothera-pists and Paediatric Patients

A Case Study: Negative Effects of Unscheduled Appointment System to Physiothera-pists and Paediatric Patients

Improving Health for People Living With Heart Failure: Focus Group Study of Preconditions for Co-Production of Health and Care

The Role of Patient-Reported Outcomes (PROs) in the Improvement of Healthcare Delivery and Service

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