Evaluating user involvement in primary healthcare

Current health policies, both in the UK and internationally, call for a shift from secondary to primary healthcare, and for increased involvement of service users and communities in decisions about their own care and about the way in which health services are provided. This study investigated the way in which users were involved in two London-based primary healthcare projects. Two projects were selected from a broader sample. A case study approach was adopted and a range of methods used to identify the types of user involvement, users' views of the process and, in one case study, users' preferences for participation. Arnstein's conceptual framework for participation was used in the analysis. In this paper, the findings of the study are discussed in relation to Cohen's notions of breadth, depth and range of participation. The paper illustrates how these notions may provide a mechanism for providers and commissioners of health services to assess their strategies in relation to user or community involvement, and the degree of success they achieve in implementation.

Healthcare identifiers legislation : a whiff of Fourberie

The Healthcare Identifiers Bill 2010 (Cth), which will establish “the national e-health Healthcare Identifiers Service to provide that patients, healthcare providers and provider organisations can be consistently identified”, is in the process of being enacted by the Australian Federal Parliament. The legislation will enable the government to assign to each “healthcare recipient” a 26-digit electronic “Healthcare Identifier”, which will be accessible, with or without the recipient’s consent, to a broad range of health care service providers as well as other entities. The individual Healthcare Identifier file will initially contain such identifying information as, where applicable, the Medicare number and/or the Veterans’ Affairs number; name; address; gender; date of birth; and “the date of birth accuracy indicator”, presumably birth certificate. However, since each “service” provided by a health care provider to a health care recipient will be automatically recorded on each individual’s Healthcare Identifier file, in time these electronic files should contain a full record of such services or contacts. Moreover, the Healthcare Identifiers are considered a “key” to, or a “foundation stone” for, the implementation of the shared electronic health records scheme, because they will enable linkage with and retrieval of each patient’s clinical records throughout the health care service system. However, there has been virtually no discussion about the legal, ethical and social implications of this legislation.

The relationship between characteristics of context and research utilization in a pediatric setting

Background
Research utilization investigators have called for more focused examination of the influence of context on research utilization behaviors. Yet, up until recently, lack of instrumentation to identify and quantify aspects of organizational context that are integral to research use has significantly hampered these efforts. The Alberta Context Tool (ACT) was developed to assess the relationships between organizational factors and research utilization by a variety of healthcare professional groups. The purpose of this paper is to present findings from a pilot study using the ACT to elicit pediatric and neonatal healthcare professionals' perceptions of the organizational context in which they work and their use of research to inform practice. Specifically, we report on the relationship between dimensions of context, founded on the Promoting Action on Research Implementation in Health Services (PARIHS) framework, and self-reported research use behavior.

Methods
A cross-sectional survey approach was employed using a version of the ACT, modified specifically for pediatric settings. The survey was administered to nurses working in three pediatric units in Alberta, Canada. Scores for three dimensions of context (culture, leadership and evaluation) were used to categorize respondent data into one of four context groups (high, moderately high, moderately low and low). We then examined the relationships between nurses` self-reported research use and their perceived context.

Results
A 69% response rate was achieved. Statistically significant differences in nurses' perceptions of culture, leadership and evaluation, and self-reported conceptual research use were found across the three units. Differences in instrumental research use across the three groups of nurses by unit were not significant. Higher self-reported instrumental and conceptual research use by all nurses in the sample was associated with more positive perceptions of their context.

Conclusions
Overall, the results of this study lend support to the view that more positive contexts are associated with higher reports of research use in practice. These findings have implications for organizational endeavors to promote evidence-informed practice and maximize the quality of care. Importantly, these findings can be used to guide the development of interventions to target modifiable characteristics of organizational context that are influential in shaping research use behavior.

ICT corporate governance : a case study of a not-for-profit community healthcare organisation

Organisations, regardless of sector and size, are increasingly deploying information and communication technology (ICT) to transact with their stakeholders. Whilst on the one hand this offers efficiencies like improved communication and better resource usage through a reduction in duplication, on the other hand it raises issues of responsiveness, trust, privacy and confidentiality, In this paper we report how an Australian not-for-profit community healthcare organisation experienced and responded to the challenges of governance with respect to its ICT. The lessons From the case study are that comprehensive documentation, top management commitment, and appropriate skills to manage tasks and time are crucial when planning to implement such systems.

Daring to Care : is spirituality sustainable in organizations providing healthcare?

Healthcare workers are challenged to dare to care enough to provide a service that is holistic. This involves being in tune with their own spirituality and the spiritual needs of their patients or clients. Spirituality and compassion are important concepts in the ministry of nurses and other health professionals. Compassion also has links with mercy, although there is debate as to whether mercy is the same as compassion for deserving or undeserving sufferers. However, healthcare workers need to care for sufferers even if their suffering is not deserved, where such compassion is intrinsic and/or out of duty. It involves acting altruistically. Faith-based organizations are best equipped to undertake this holistic ministry but as they are becoming increasingly reliant on government funding to help finance expensive health services they encounter rationalistic pressures from these funding sources may restrict the way they deliver these services. Decision and policymakers are encouraged to embrace altruistic values rather than the egoistic values of economic rationalism, not least because the nature of healthcare has an inherent emphasis on altruistic emotions, especially compassion.

A critical review of performance measurement methods for healthcare facilities management

This paper aims to define the tools used for performance measurement in Healthcare Facilities Management. The research analyses relevant literature on various tools of performance measurement for healthcare facilities. Contributions made from the literature will be divided into three attributes namely soft performance measurement, hard performance measurement and a hybrid performance measurement. The findings discussed in this paper may give valuable insights to service providers with regards to the incorporation of both soft and hard attributes of performance measurement to strategically manage facilities. The organisation business strategy will eventually gain the benefits by cost saving of non-core activities.

Contextual influences on user satisfaction with mobile computing : findings from two healthcare organizations

Mobile information technologies (IT) are transforming individual work practices and organizations. These devices are extending not only the boundaries of the ‘office’ in space and time, but also the social context within which use occurs. In this paper, we investigate how extra-organizational influences can impact user satisfaction with mobile systems. The findings from our longitudinal study highlight the interrelatedness of different use contexts and their importance in perceptions of user satisfaction. The data indicate that varying social contexts of individual use (individual as employee, as professional, as private user, and as member of society) result in different social influences that affect the individual’s perceptions of user satisfaction with the mobile technology. While existing theories explain user satisfaction with IT within the organizational context, our findings suggest that future studies of mobile IT in organizations should accommodate such extra-organizational contextual influences.