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  Subjects -> HEALTH AND SAFETY (Total: 1292 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (524 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (377 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (105 journals)
    - PHYSICAL FITNESS AND HYGIENE (101 journals)
    - WOMEN'S HEALTH (81 journals)

HEALTH AND SAFETY (524 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 23)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 5)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 4)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Health Economics     Full-text available via subscription   (Followers: 12)
American Journal of Health Education     Hybrid Journal   (Followers: 29)
American Journal of Health Promotion     Hybrid Journal   (Followers: 23)
American Journal of Health Sciences     Open Access   (Followers: 4)
American Journal of Health Studies     Full-text available via subscription   (Followers: 10)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 22)
American Journal of Public Health     Full-text available via subscription   (Followers: 217)
American Journal of Public Health Research     Open Access   (Followers: 29)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 9)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access   (Followers: 1)
Archive of Community Health     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 3)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 6)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 5)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 8)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 19)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 17)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 12)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 12)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 20)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 12)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 2)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 2)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 13)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 5)
electronic Journal of Health Informatics     Open Access   (Followers: 5)
ElectronicHealthcare     Full-text available via subscription   (Followers: 4)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access  
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 4)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 19)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 1)
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 2)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 6)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 6)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 11)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 5)
Global Health Promotion     Hybrid Journal   (Followers: 16)
Global Journal of Health Science     Open Access   (Followers: 9)
Global Journal of Public Health     Open Access   (Followers: 12)
Global Medical & Health Communication     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 15)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 7)
Health and Social Work     Hybrid Journal   (Followers: 49)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 14)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 13)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Policy     Hybrid Journal   (Followers: 36)
Health Policy and Technology     Hybrid Journal   (Followers: 1)
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 21)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 15)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 48)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 40)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 11)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Services Insights     Open Access   (Followers: 2)
Health Systems     Hybrid Journal   (Followers: 3)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 12)
Health, Risk & Society     Hybrid Journal   (Followers: 11)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Healthy-Mu Journal     Open Access  
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 10)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 4)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 2)
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 6)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 33)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 7)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 20)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 16)
International Journal of Health & Allied Sciences     Open Access   (Followers: 3)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 9)
International Journal of Health Geographics     Open Access   (Followers: 6)

        1 2 3 | Last

Journal Cover Health Systems
  [3 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2047-6965 - ISSN (Online) 2047-6973
   Published by Springer-Verlag Homepage  [2352 journals]
  • Logistics for Emergency Medical Service systems
    • Authors: Melanie Reuter-Oppermann; Pieter L. van den Berg; Julie L. Vile
      Pages: 187 - 208
      Abstract: Abstract Emergency Medical Service (EMS) systems worldwide are complex systems, characterized by significant variation in service providers, care pathways, patient case-mix and quality care indicators. Analysing and improving them is therefore challenging. Since EMS systems differ between countries, it is difficult to provide generic rules and approaches for EMS planning. Nevertheless, the common goal for all service providers is to offer medical assistance to patients with serious injuries or illnesses as quickly as possible. This paper presents an overview of logistical problems arising for EMS providers, demonstrating how some of these problems are related and intertwined. For each individual planning problem, a description as well as a concise literature overview of solution approaches considered is given. A summary table classifies the literature according to the problems addressed and connects it to the proposed taxonomy.
      PubDate: 2017-11-01
      DOI: 10.1057/s41306-017-0023-x
      Issue No: Vol. 6, No. 3 (2017)
       
  • Organizing multidisciplinary care for children with neuromuscular diseases
           at the Academic Medical Center, Amsterdam
    • Authors: Nikky Kortbeek; M. F. van der Velde; N. Litvak
      Pages: 209 - 225
      Abstract: Abstract The Academic Medical Center (AMC) in Amsterdam, The Netherlands, recently opened the ‘Children’s Muscle Center Amsterdam’ (CMCA). The CMCA diagnoses and treats children with neuromuscular diseases. The patients with such diseases require care from a variety of clinicians. Through the establishment of the CMCA, children and their parents will generally visit the hospital only once a year, while previously they used to visit on average six times a year. This is a major improvement, because the hospital visits are both physically and psychologically demanding for the patients. This paper describes how quantitative modelling supports the design and operations of the CMCA. First, an integer linear program is presented that selects which patients are to be invited for a treatment day and schedules the required combination of consultations, examinations and treatments on one day. Second, the integer linear program is used as input to a simulation study to estimate the capacity of the CMCA, expressed in terms of the distribution of the number patients that can be seen on one diagnosis day. Finally, a queueing model is formulated to predict the access time distributions based upon the simulation outcomes under various demand scenarios. Its contribution on the case under study is twofold. First, we design highly constrained appointment schedules for multiple patients that require service from multiple disciplines’ resources. Second, we study the effect of the trade-offs between scheduling constraints and access times. As such, the contribution of this case study paper is that it illustrates the value of applying Operations Research techniques in complex healthcare settings, by designing context-specific combinations of mathematical models, thereby improving delivery of the highly-constrained multidisciplinary care.
      PubDate: 2017-11-01
      DOI: 10.1057/s41306-016-0020-5
      Issue No: Vol. 6, No. 3 (2017)
       
  • Organizational citizenship behavior and implementation of evidence-based
           practice: Moderating role of senior management’s support
    • Authors: Sajid Haider; Antonio Fernandez-Ortiz; Carmen de Pablos Heredero
      Pages: 226 - 241
      Abstract: Abstract This study sought to empirically examine the link between OCB and EBP implementation, and tested senior management’s support as a moderator of this relationship. A cross-sectional survey design was used. Data were based on the survey of participants’ perceptions of the study variables. The participants were professionals involved in the treatment of acute myocardial infarction at five hospitals in Madrid Community of Spain. Hypothetico-deductive method was applied, and partial least squares structural equation modeling (PLS-SEM) was used for data analysis. The relationship between OCB and EBP implementation was supported. A significant moderating effect was also found, which indicates that with an increase in senior management’s support OCBs become more important for explaining their effect on EBP implementation. The findings of this research are promising to organizations and agencies that take into account the importance of implementing EBP. This research provides conditions valuable to successful use of EBP. Especially, where senior management interacts positively with other variables such as OCB, the likelihood of EBP implementation and its effectiveness may increase. An improvement in these factors and their interaction is liable to guide an improved continuity in healthcare resulting from positive organizational ethos.
      PubDate: 2017-11-01
      DOI: 10.1057/s41306-017-0026-7
      Issue No: Vol. 6, No. 3 (2017)
       
  • Awareness and utilization of Rashtriya Swasthaya Bima Yojana and its
           
    • Authors: Shikha Gupta
      Pages: 242 - 259
      Abstract: Abstract Rashtriya Swasthya Bima Yojana (RSBY), a national flagship health insurance scheme of India, was launched in 2008 with an aim to improve access to cashless inpatient care for the families below poverty line. Delhi being the national capital of India was one of the first states where this scheme was implemented. The objectives of this study were to find out the awareness of the scheme among the enrolled families, utilization of its services, and the extent to which RSBY provided cost-free access to inpatient care to its enrolled beneficiaries. A mixed method study was conducted in ten slum areas of East and North East Delhi. Data were collected through the household survey with 120 families having RSBY cards (service recipients) and qualitative interviews with 30 professionals responsible for managing various aspects of the RSBY program. Quantitative data were analysed using statistical package of social sciences (SPSS) whereas thematic analysis was done for qualitative data. The findings suggest that RSBY benefitted only 20% of the families among the total sample. It appeared that families who were relatively more aware about the range of benefits and operational mechanisms of the scheme were able to utilize its benefits as compared to others who were not. However, the families who utilized or tried to utilize the RSBY benefits were not satisfied with the scheme and faced many problems while accessing hospital care through RSBY. They faced refusals for the treatment by RSBY empaneled hospitals, demands for extra money, and poor quality treatment provided to them. These situations forced few families to approach another public or private hospitals in case of illness and incur significant out-of-pocket expenditure on emergency health care despite having RSBY insurance coverage. The data obtained through the interviews illuminated the challenges associated with the implementation of RSBY from service provider’s perspective. The study recommends that if RSBY scheme aspires to cover the entire Indian poor population under its umbrella of risk protection, the government should adopt rigorous administrative mechanisms with robust monitoring and evaluation systems at different levels to ensure quality and timely healthcare is provided to the beneficiaries.
      PubDate: 2017-11-01
      DOI: 10.1057/s41306-017-0022-y
      Issue No: Vol. 6, No. 3 (2017)
       
  • When the world calls for emergency services, who answers' A surgeon
           general’s perspective on running a high performance health services
           organization
    • Authors: Suzanne J. Wood; Matthew L. Nathan
      Pages: 91 - 101
      Abstract: Abstract This article records an interview by the author with Vice Admiral (retired) Matthew L. Nathan, 37th surgeon general of the United States (U.S.) Navy and chief of the U.S. Navy’s Bureau of Medicine and Surgery. The interview provides insights into developing a globally dispersed yet highly integrated health system managed and operated by an agile, mission-focused team of devoted professionals whose credo is to deliver “World-Class Care…Anytime, Anywhere.” We examine characteristics of Navy Medicine that align with evidence-based factors of high performance organizations (HPOs) to determine whether the system itself should be classified as an HPO. In conclusion, we summarize key implications for practice.
      PubDate: 2017-07-01
      DOI: 10.1057/s41306-017-0028-5
      Issue No: Vol. 6, No. 2 (2017)
       
  • Optimized staff allocation for inpatient phlebotomy and
           electrocardiography services via mathematical modelling in an acute
           regional and teaching hospital
    • Authors: Kenneth C M Yip; Kevin W H Huang; Esther W Y Ho; W K Chan; Irene L Y Lee
      Pages: 102 - 111
      Abstract: Abstract Adhering to pre-defined service routes that cover a fixed set of wards in a shift, the inpatient phlebotomy service provides 24-hour coverage for a 27-storey, 1,400-bed hospital. We present an application of mathematical optimization to improve its service efficiency without injecting additional resources. A mixed integer programming model was implemented to revamp the service route configuration to minimize workload discrepancies among service routes, limit maximum daily workload per route and restrict routes to span a maximum number of floor levels, while taking into consideration the ward-specific demand for each duty (i.e. daytime, evening, and night time) throughout the day. This data-driven and evidence-based approach has facilitated an overhaul of the existing route configuration of the inpatient phlebotomy service, which resulted in a more effective and contented workforce, as well as a more efficient service with an evened-out workload among phlebotomists and increased time spent on direct patient care by phlebotomists. Subsequent scenario analysis revealed that more manpower on a micro-level is not necessarily better and highlighted the importance to strategically design duty hours and allocate manpower across different duties on a system level.
      PubDate: 2017-07-01
      DOI: 10.1057/s41306-016-0001-8
      Issue No: Vol. 6, No. 2 (2017)
       
  • Using electronic health records and nursing assessment to redesign
           clinical early recognition systems
    • Authors: Muge Capan; Pan Wu; Michele Campbell; Susan Mascioli; Eric V Jackson
      Pages: 112 - 121
      Abstract: Abstract As health-care organizations transition from paper to electronic documentation systems, capturing the nursing assessment electronically can play a fundamental role in transforming health-care delivery. Especially in preventive health, electronic capture of nursing assessment, combined with vital sign-based monitoring, can support early detection of physiological deterioration of patients. While vital sign-based Early Warning Systems have the potential to detect signals of physiological deterioration, their clinical interpretation and integration into the workflow in hospital-based care setting remain a challenge. This study presents a clinical early recognition algorithm using electronic health records (EHRs) coupled with an electronic Nurse Screening Assessment (NSA) that targets various health assessment categories and its integration into the nursing workflow. Data was collected retrospectively from a single institution (N=2,405 visits). χ 2 tests showed significant differences between algorithms with and without NSA (P<0.01). This study provides a practical framework for facilitating the meaningful use of EHRs in hospitals.
      PubDate: 2017-07-01
      DOI: 10.1057/hs.2015.19
      Issue No: Vol. 6, No. 2 (2017)
       
  • Preliminary evidence for the use and efficacy of mobile health
           applications in managing posttraumatic stress disorder symptoms
    • Authors: Stefanie M Keen; Nicholas Roberts
      Pages: 122 - 129
      Abstract: Abstract Mobile health applications like PTSD Coach are emerging as tools to help individuals manage post traumatic stress disorder (PTSD) symptoms. However, these applications will not be effective if people do not use them. Using PTSD Coach as the focal application, we address two interrelated questions: (1) what are the primary determinants of PTSD Coach use' and (2) is PTSD Coach use related to changes in PTSD symptomatology' Building on the Unified Theory of Acceptance and Use of Technology, we develop and test a research model that addresses these questions. Our results show that performance expectancy and social influence are positively related to PTSD Coach use; however, effort expectancy and facilitating conditions are not related to PTSD Coach use. We also found that PTSD Coach use is positively related to improvements in PTSD symptomatology. Our results provide preliminary evidence for the use and efficacy of mobile health applications in managing PTSD symptoms.
      PubDate: 2017-07-01
      DOI: 10.1057/hs.2016.2
      Issue No: Vol. 6, No. 2 (2017)
       
  • A systems thinking approach to prospective planning of interventions for
           chronic kidney disease care
    • Authors: Hyojung Kang; Harriet Black Nembhard; William Curry; Nasrollah Ghahramani; Wenke Hwang
      Pages: 130 - 147
      Abstract: Abstract Chronic kidney disease (CKD) is a growing health problem. Previous approaches to improve CKD care tend to focus on the linear relationships between a specific intervention and its effects on the target CKD population. The objective of this paper is to investigate how a systems thinking approach can support decision making on system-level interventions for chronic disease management. Our research team conducted a case study at an academic health-care organization. To support prospective planning of interventions at the study institution, we adopted a systems thinking approach in three phases: intervention structuring, causal loop modeling, and implementation planning. In the first phase, four potential interventions were proposed to address gaps in the current system. In the second phase, a causal loop diagram was developed to identify feedback loops and evaluate potential impacts of the interventions on patients and care providers. In the last phase, the analysis was linked to decision making on intervention implementation. Overall, this whole process based on systems thinking helped the health-care organization to holistically understand the impact of various components of their CKD care system. Furthermore, the findings from the qualitative modeling and analysis provided the leadership with insights into gaps in care and a way forward for implementing interventions more successfully and effectively.
      PubDate: 2017-07-01
      DOI: 10.1057/hs.2015.17
      Issue No: Vol. 6, No. 2 (2017)
       
  • Workforce design in primary care-mental health integration: a case study
           at one veterans affairs medical center
    • Authors: Renata Konrad; Christine Tang; Brian Shiner; Bradley V Watts
      Pages: 148 - 160
      Abstract: Abstract Many Veterans screen positive for mental health disorders in primary care, yet it appears that only a fraction of those who could benefit receive treatment. One potential way to ensure that a larger proportion of these Veterans receive appropriate care would be to increase access to mental health services through primary care-mental health integration (PC-MHI) clinics. Yet a systematic method to evaluate the impact of projected increases in patient volumes on PC-MHI clinics is lacking. As a first step, we develop and validate a discrete-event simulation model to understand how the clinic could respond to a projected increase in PC-MHI utilization at one Veterans Affairs Medical Center. Numerical results illustrate the impact of increased patient volume and the availability of providers on patient wait times and patients seen by mental health providers outside of clinic hours. We also note that although discrete-event simulation has a long history in health care, it is rarely used in the assessment of the resource allocation decisions in mental health.
      PubDate: 2017-07-01
      DOI: 10.1057/hs.2015.18
      Issue No: Vol. 6, No. 2 (2017)
       
  • Improving accessibility through referral management: setting targets for
           specialist care
    • Authors: James Greenwood-Lee; Geoff Wild; Deborah Marshall
      Pages: 161 - 170
      Abstract: Abstract The use of optimized referral distribution strategies to improve access to specialty care is assessed. A mathematical model of a generalized care pathway is developed and the distribution of referrals is posed as an optimization problem. The objective is to minimize time from referral to a targeted stage in the care pathway (e.g., specialist consult, surgery, etc.). Numerical simulations informed by data on hip and knee surgeries demonstrate wait reductions from 21 to 38 days (16.8–30.4%) from time of referral to time of consult and from 33 to 66 days (12.6–24.7%) to time of surgery. However, the optimized referral distribution strategy minimizes wait times to the targeted stage only; wait times to non-targeted stages in the care pathway are suboptimal and may increase as an unintended consequence. Consequently, to achieve desired improvements in access, the targeted stage for wait time minimization must be carefully identified and prioritized.
      PubDate: 2017-07-01
      DOI: 10.1057/hs.2015.20
      Issue No: Vol. 6, No. 2 (2017)
       
  • Multi-level factors affecting timely electronic documentation of
           medication administration: a hierarchical linear modeling approach
    • Authors: Roopa Raman; Kimberly Green
      Pages: 171 - 185
      Abstract: Abstract This study applies a systematic hierarchical linear modeling approach to identify factors impacting timely documentation of medication administration on electronic medication administration record (eMAR) systems. Delayed documentation of medications poses significant risks to patient safety. Multi-level quantitative data were collected from a large urban hospital system, spanning the non-physician clinician workforce across 27 patient-care units. Data suggests the overall perception of psychological safety on one’s unit was a significant predictor of individual clinicians’ timely eMAR documentation. The impact of each clinician’s personal psychological safety was nuanced by his/her patient-care unit and type of hospital. Other characteristics of the provider’s patient-care unit were also relevant. Thus, even though timely eMAR documentation is an individual-level activity, it is predicted by characteristics beyond complete control of the individual. We illustrate the value of applying systematic hierarchical linear modeling approach to better illuminate the problem of consistently achieving timely eMAR documentation across all providers.
      PubDate: 2017-07-01
      DOI: 10.1057/hs.2016.3
      Issue No: Vol. 6, No. 2 (2017)
       
  • Demand and capacity modelling for acute services using discrete event
           simulation
    • Authors: Eren Demir; Murat M Gunal; David Southern
      Pages: 33 - 40
      Abstract: Abstract Increasing demand for services in England with limited healthcare budget has put hospitals under immense pressure. Given that almost all National Health Service (NHS) hospitals have severe capacity constraints (beds and staff shortages), a decision support tool (DST) is developed for the management of a major NHS Trust in England. Acute activities are forecasted over a 5-year period broken down by age groups for 10 specialty areas. Our statistical models have produced forecast accuracies in the region of 90%. We then developed a discrete event simulation model capturing individual patient pathways until discharge (in accident and emergency, inpatient and outpatients), where arrivals are based on the forecasted activity outputting key performance metrics over a period of time, for example, future activity, bed occupancy rates, required bed capacity, theatre utilisations for electives and non-electives, clinic utilisations and diagnostic/treatment procedures. The DST allows Trusts to compare key performance metrics for thousands of different scenarios against their existing service (baseline). The power of DST is that hospital decision makers can make better decisions using the simulation model with plausible assumptions that are supported by statistically validated data.
      PubDate: 2017-03-01
      DOI: 10.1057/hs.2016.1
      Issue No: Vol. 6, No. 1 (2017)
       
  • A two-stage stochastic programming model for phlebotomist scheduling in
           hospital laboratories
    • Authors: Laquanda Leaven; Xiuli Qu
      Abstract: Abstract This paper introduces a two-stage stochastic integer linear programming model to improve phlebotomist scheduling in laboratory facilities of healthcare delivery systems. The model developed enables laboratory management to determine optimal scheduling policies that minimize work overload. The stochastic programming model considers the uncertainty associated with the blood collection demand in laboratory environments when optimizing phlebotomist scheduling. The paper presents an application of the model to a hospital laboratory in urban North Carolina as a case study discussing the implications for hospital laboratory management.
      PubDate: 2017-07-25
      DOI: 10.1057/s41306-017-0033-8
       
  • Waiting time-based staff capacity and shift planning at blood collection
           sites
    • Authors: S. P. J. van Brummelen; N. M. van Dijk; K. van den Hurk; W. L. de Kort
      Abstract: Abstract Sanquin, the organization responsible for blood collection in the Netherlands, aims to be donor-friendly. An important part of the perception of donor-friendliness is the experience of waiting times. At the same time, Sanquin needs to control the costs for blood collection. A significant step to shorten waiting times is to align walk-in arrivals, and staff capacity and shifts. We suggest a two-step procedure. First, we investigate two methods from queuing theory to compute the minimum number of staff members required for every half hour. Next, these minimum numbers of staff members will be used to determine optimal lengths and starting times of shifts with an Integer Linear Program. Finally, the practical implications of the method are shown with numerical results. These results show that the presented approach can bring significant savings while at the same time guaranteeing a waiting time-based service level for blood donors.
      PubDate: 2017-07-03
      DOI: 10.1057/s41306-017-0032-9
       
  • Large-scale clinical implementation of PROMIS computer adaptive testing
           with direct incorporation into the electronic medical record
    • Authors: M. O. Papuga; C. Dasilva; A. McIntyre; D. Mitten; S. Kates; J. F. Baumhauer
      Abstract: Abstract The objective of this research was to assess the implementation of collecting patient-reported outcomes data in the outpatient clinics of a large academic hospital and identify potential barriers and solutions to such an implementation. Three PROMIS computer adaptive test instruments, (1) physical function, (2) pain interference, and (3) depression, were administered at 23,813 patient encounters using a novel software platform on tablet computers. The average time to complete was 3.50 ± 3.12 min, with a median time of 2.60 min. Registration times for new patients did not change significantly, 6.87 ± 3.34 to 7.19 ± 2.69 min. Registration times increased for follow-up (p = .007) from 2.94 ± 1.57 (p < .01) min to 3.32 ± 1.78 min. This is an effective implementation strategy to collect patient-reported outcomes and directly import the results into the electronic medical record in real time for use during the clinical visit.
      PubDate: 2017-04-12
      DOI: 10.1057/s41306-016-0016-1
       
  • Using cognitive and causal modelling to develop a theoretical framework
           for implementing innovative practices in primary healthcare management in
           New Zealand
    • Authors: David Rees; Robert Y. Cavana; Jacqueline Cumming
      Abstract: Abstract The continuing rise in chronic health conditions requires major changes in how healthcare is managed and delivered. While research has identified a number of factors key to bringing this about, implementing these changes requires an understanding of how the factors interact over time in different contexts. In this research study, seven senior health experts in New Zealand were interviewed, using cognitive mapping, to ascertain their thinking about major implementation challenges to enhance primary healthcare systems. The resulting cognitive maps were then consolidated and developed into a causal loop diagram, which describes a set of interlinked feedback loops representing the processes involved in implementing changes. It is concluded that these systems methods are very effective in better understanding the contextual and behavioural factors necessary for the development of a theoretical framework to support the successful implementation of innovative primary healthcare programmes.
      PubDate: 2017-03-28
      DOI: 10.1057/s41306-017-0029-4
       
  • A systematic literature review of operational research methods for
           modelling patient flow and outcomes within community healthcare and other
           settings
    • Authors: Ryan Palmer; Naomi J. Fulop; Martin Utley
      Abstract: Abstract An ambition of healthcare policy has been to move more acute services into community settings. This systematic literature review presents analysis of published operational research methods for modelling patient flow within community healthcare, and for modelling the combination of patient flow and outcomes in all settings. Assessed for inclusion at three levels – with the references from included papers also assessed – 25 “Patient flow within community care”, 23 “Patient flow and outcomes” papers and 5 papers within the intersection are included for review. Comparisons are made between each paper’s setting, definition of states, factors considered to influence flow, output measures and implementation of results. Common complexities and characteristics of community service models are discussed with directions for future work suggested. We found that in developing patient flow models for community services that use outcomes, transplant waiting list may have transferable benefits.
      PubDate: 2017-03-23
      DOI: 10.1057/s41306-017-0024-9
       
  • Care and Flow: Using Soft Systems Methodology to understand tensions in
           the patient discharge process
    • Authors: Michael Emes; Stella Smith; Suzanne Ward; Alan Smith; Timothy Ming
      Abstract: Abstract Many hospitals face a daily struggle to manage capacity, especially where wards contain patients with a combination of health and social care needs. In this study, Soft Systems Methodology was used to understand the process of discharging patients from an acute hospital and to answer the question ‘Why do patients with complex needs often spend longer on the wards than is necessary?’. Through a series of twenty structured interviews, several problems with the discharge planning process were identified. Problems included ineffective communication, slow processing of paperwork, limited forward planning, no clear ownership of the process and delays in finding care in the community. The persistence of these problems despite longstanding guidance on discharge planning can be understood by recognising the tension between two different philosophies in hospitals – a traditional ‘Care’ mindset focusing on the immediate needs of patients on the wards, and a planning-focused ‘Flow’ mentality, where the hospital’s responsibility to the wider community dominates. Soft Systems Methodology was found to be an effective approach for discussing discharge planning and highlighting this tension. Based on the insights gained from the interviews, three practical initiatives have now been implemented to reconcile the tension and thereby reduce delays in the hospital.
      PubDate: 2017-03-07
      DOI: 10.1057/s41306-017-0027-6
       
  • Rapid diagnoses at the breast center of Jeroen Bosch Hospital: a case
           study invoking queueing theory and discrete event simulation
    • Authors: Maartje van de Vrugt; Richard J. Boucherie; Tineke J. Smilde; Mathijn de Jong; Maud Bessems
      Abstract: Abstract When suspected tissue is discovered in a patient’s breast, swiftly available diagnostic test results are essential for medical and psychological reasons. The breast center of the Jeroen Bosch Hospital aims to comply with new Dutch standards to provide 90% of the patients an appointment within three working days, and to communicate the test results to 90% of the patients within a week. This case study reports on interventions based on a discrete time queueing model and discrete event simulation. The implemented interventions concern a new patient appointment schedule and an additional multi-disciplinary meeting, which significantly improve in both the appointment and diagnostics delay. Additionally, we propose a promising new patient schedule to further reduce patient waiting times and staff overtime and provide guidelines for how to achieve implementation of Operations Research methods in practice.
      PubDate: 2016-12-12
      DOI: 10.1057/s41306-016-0013-4
       
 
 
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