scholarly journals Performance improvement programs may help reduce the surgical backlog in South African hospitals

2021 ◽  
Vol 8 (6) ◽  
pp. 1945
Author(s):  
Shamal V. Ramesar
Keyword(s):  
Performance Improvement ◽  
Best Practice ◽  
Enhanced Recovery ◽  
Public Healthcare ◽  
Public And Private ◽  
Healthcare Facilities ◽  
Elective Surgical Procedures ◽  
Operative Care ◽  
Full Capacity ◽  
Improvement Programs

The COVID-19 pandemic has presented an unprecedented dilemma to healthcare systems around the world, leaving many countries with the burden of massive surgical backlogs, caused by the postponement or cancellation of elective surgical procedures. Current ideas to reduce the consequential impact of this surgical backlog on patient morbidity and mortality is to increase surgical volumes, however in under-resourced countries such as South Africa this idea may be more difficult to implement due to a shortage of facilities and clinical staff. In addition, the current infrastructure, especially those in many public healthcare facilities are poor and this coupled with limited financial resources presents further challenges. Also, all hospitals both public and private alike, cannot function at full capacity due to COVID-19 protocols. Given these limitations, performance improvement strategies must be implemented with some urgency in order to limit further backlogs and disruptions to surgical outputs. Evidence-based, best practice strategies such as surgical bundles, care pathways and enhanced recovery after surgery programs have been shown to improve surgical outcomes and reduce hospital stay. Since the bottleneck to surgical volume lies in post-operative care and not theatre capacity, implementation of such programs may help to improve patient throughput, thereby increasing surgical volumes and could possibly be the answer towards reducing these overwhelming backlogs.

scholarly journals Surgery in Brazilian Health Care: funding and physician distribution

2017 ◽  
Vol 44 (2) ◽  
pp. 202-207 ◽  
Author(s):  
NIVALDO ALONSO ◽  
BENJAMIN B. MASSENBURG ◽  
RAFAEL GALLI ◽  
LUCAS SOBRADO ◽  
DARIO BIROLINI
Keyword(s):  
Local Population ◽  
Surgical Care ◽  
National Database ◽  
Public Healthcare ◽  
Health Coverage ◽  
Inequality Index ◽  
Public And Private ◽  
Healthcare Facilities ◽  
The Public ◽  
The North

ABSTRACT Objective: to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. Methods: data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Results: Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. Conclusions: A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce.

scholarly journals Perioperative management in bariatric surgery using eras

2019 ◽  
Vol 1 (7) ◽  
pp. 61-70
Author(s):  
V. Cherniy ◽  
V. Yevsieieva ◽  
M. Serbul
Keyword(s):  
Bariatric Surgery ◽  
Best Practice ◽  
Enhanced Recovery ◽  
Bypass Graft ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Term Treatment ◽  
Successful Implementation ◽  
Operative Care ◽  
Long Term Treatment

Purpose of review. The aim of the work is to collect in a single whole the disparate information devoted to certain aspects of ERAS methods application for the creation of the project of Ukrainian-language recommendations on optimization of perioperative period in the bariatric patients. Recent findings. Bariatric surgery today is a gold standard in the long-term treatment of morbid obesity and associated comorbid conditions such as metabolic syndrome, type 2 diabetes, and others. Laparoscopic longitudinal resection of the stomach (LPRS) and gastric bypass graft (LSH) are the most common bariatric interventions in the world. But despite the fact that the global epidemic of obesity for several decades has had an impact on perioperative tactics of the management of barrier patients, there is currently a relative lack of management in the treatment of this group of patients. They still feel pain and are traditionally injecting opioids for early postoperative analgesia, suffering from nausea and vomiting, which significantly delay the onset of enteral nutrition and prolong the duration of hospitalization. Consequently, postoperative pain, PONV and malnutrition, rather than factors associated with the operation, often lead to prolonged hospitalization and elimination of which benefits the healthcare system and patients by returning them home earlier. Protocols of Enhanced Recovery After Surgery (ERAS), introduced in medical practice Prof. Kehlet in the nineties of the last century, widely used in various fields of surgeons. The most studied application of these protocols in colorectal, thoracic surgery and operative urology. There are recent studies and meta-analyzes that have demonstrated the feasibility of introducing ERAS into bariatric surgery. In 2016, recommendations were published on the implementation of ERAS components in bariatric surgery. The ERABS protocol has been implemented in many Western European bariatric centers and includes the best practice of preoperative preparation and standardization of perioperative and post-operative care that will provide rapid recovery and improve treatment outcome. But it remains unclear whether all components of the classical protocol, namely, epidural anesthesia, are necessary for successful implementation in bariatric surgery. Conclusions. ERAS protocols are successfully used in obese patients after bariatric surgery, and the principles of multimodal analgesia minimize the need for opioids. The principles of ERAS have already proved themselves in many clinics and should be reflected in the National Clinical Recommendations for Bariatric Surgery.

scholarly journals Diagnostic Radiology in Nigeria: A Country Report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Bukunmi Michael Idowu ◽  
Tolulope Adebayo Okedere
Keyword(s):  
Healthcare System ◽  
Healthcare Delivery ◽  
Diagnostic Radiology ◽  
Public Healthcare ◽  
Country Report ◽  
Public And Private ◽  
Healthcare Facilities ◽  
Adequate Funding ◽  
Radiology Training ◽  
Wide Range

Nigeria is located in West Africa. The Nigerian healthcare system is stratified into three tiers corresponding to the three tiers of government: primary (local), secondary (state), and tertiary (federal). In addition to this public health structure, private facilities play a significant role in healthcare delivery. Nigeria has a shortage of healthcare equipment and personnel, with a doctor per 1,000 population ratio of 0.17, which is one of the lowest on the African continent. Despite these challenges, a wide range of medical imaging services is available in the country, through a network of public and private facilities. The public healthcare system, which serves the majority of Nigerians, is weak due to lack of adequate funding, personnel and equipment. This gap is closely bridged by private healthcare facilities, which account for 70% of health services coverage in the country. Training in diagnostic radiology is evolving, with two postgraduate colleges being responsible for the regulation of radiology training in the country: the National Postgraduate Medical College of Nigeria and the West African College of Surgeons. There are also higher institutions of learning which are responsible for the training of other imaging professionals. The major challenges of radiology practice in Nigeria are the unavailability of constant electricity as well as the problems of equipment availability and repair.

scholarly journals “Just So You Know, It Has Been Hard”: Food Retailers’ Perspectives of Implementing a Food and Nutrition Policy in Public Healthcare Settings

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2053
Author(s):  
Kristy Karying. Law ◽  
Claire Elizabeth. Pulker ◽  
Janelle Diann. Healy ◽  
Christina Mary. Pollard
Keyword(s):  
Nutrition Policy ◽  
Public Healthcare ◽  
Healthcare Facilities ◽  
Voluntary Standards ◽  
Policy Success ◽  
Healthcare Settings ◽  
Food Retailers ◽  
Food And Nutrition ◽  
The Cost ◽  
Public Health Practitioners

Mandated policies to improve food environments in public settings are an important strategy for governments. Most Australian governments have mandated policies or voluntary standards for healthy food procurement in healthcare facilities, however, implementation and compliance are poor. A better understanding of the support required to successfully implement such policies is needed. This research explored food retailers’ experiences in implementing a mandated food and nutrition policy (the Policy) in healthcare settings to identify barriers, enablers, and impacts of compliance. Three 90-min workshops facilitated by two public health practitioners were undertaken with 12 food retailers responsible for operating 44 outlets across four hospitals in Perth, Western Australia. Workshop discussions were transcribed non-verbatim and inductive thematic content was analyzed. Three main themes were identified: (1) food retailers had come to accept their role in implementing the Policy; (2) the Policy made it difficult for food retailers to operate successfully, and; (3) food retailers needed help and support to implement the Policy. Findings indicate the cost of implementation is borne by food retailers. Communications campaigns, centralized databases of classified products, reporting frameworks, recognition of achievements, and dedicated technical expertise would support achieving policy compliance. Feasibility assessments prior to policy implementation are recommended for policy success.

scholarly journals As predicted by theory: choice and competition in a publicly funded and regulated regional health system yield improved access and cost control

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jonas Wohlin ◽  
Clara Fischer ◽  
Karin Solberg Carlsson ◽  
Sara Korlén ◽  
Pamela Mazzocato ◽  
...  
Keyword(s):  
Cost Control ◽  
Care Quality ◽  
Patient Choice ◽  
Public Healthcare ◽  
Successful Implementation ◽  
Publicly Funded ◽  
Public And Private ◽  
Bundled Payment ◽  
Private Providers ◽  
Number Of Patients

Abstract Background New Public Management (NPM) has been widely used to introduce competition into public healthcare. Results have been mixed, and there has been much controversy about the appropriateness of a private sector-mimicking governance model in a public service. One voice in the debate suggested that rather than discussing whether competition is “good” or “bad” the emphasis should be on exploring the conditions for a successful implementation. Methods We report a longitudinal case study of the introduction of patient choice and allowing private providers to enter a publicly funded market. Patients in need of hip or knee replacement surgery are allowed to choose provider, and those are paid a fixed reimbursement for the full care episode (bundled payment). Providers are financially accountable for complications. Data on number of patients, waiting lists and times, costs to the public purchaser, and complications were collected from public registries. Providers were interviewed at three points in time during a nine-year follow-up period. Time-series of the quantitative data were exhibited and the views of actors involved were explored in a thematic analysis of the interviews. Results The policy goals of improving access to care and care quality while controlling total costs were achieved in a sustained way. Six themes were identified among actors interviewed and those were consistent over time. The design of the patient choice model was accepted, although all providers were discontent with the level of reimbursement. Providers felt that quality, timeliness of service and staff satisfaction had improved. Public and private providers differed in terms of patient-mix and developed different strategies to adjust to the reimbursement system. Private providers were more active in marketing and improving operation room efficiency. All providers intensified cooperation with referring physicians. Close attention was paid to following the rules set by the purchaser. Discussion and conclusions The sustained cost control was an effect of bundled payment. What this study shows is that both public and private providers adhere long-term to regulations by a public purchaser that also controls entrance to the market. The compensation was fixed and led to competition on quality, as predicted by theory.

scholarly journals ‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa

2021 ◽  
Vol 6 (4) ◽  
pp. e004360
Author(s):  
Dumisani MacDonald Hompashe ◽  
Ulf-G Gerdtham ◽  
Carmen S Christian ◽  
Anja Smith ◽  
Ronelle Burger
Keyword(s):  
Health Systems ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Quality Care ◽  
Public Healthcare ◽  
Health Coverage ◽  
Access To Health Services ◽  
Healthcare Provision ◽  
Healthcare Facilities ◽  
Patients Experience

Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction. Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ experiences of non-clinical dimensions. Results We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers’ explanations of health conditions. Conclusion Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.

scholarly journals Public and private sectors collective response to combat COVID-19 in Malaysia

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ching Siang Tan ◽  
Saim Lokman ◽  
Yao Rao ◽  
Szu Hua Kok ◽  
Long Chiau Ming
Keyword(s):  
Insurance Coverage ◽  
Healthcare Providers ◽  
Screening Tests ◽  
Public Healthcare ◽  
Private Hospitals ◽  
Public And Private ◽  
The Public ◽  
Private Healthcare ◽  
Care Services ◽  
Challenges And Opportunities

AbstractOver the last year, the dangerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world. Malaysia has not been excluded from this COVID-19 pandemic. The resurgence of COVID-19 cases has overwhelmed the public healthcare system and overloaded the healthcare resources. Ministry of Health (MOH) Malaysia has adopted an Emergency Ordinance (EO) to instruct private hospitals to receive both COVID-19 and non-COVID-19 patients to reduce the strain on public facilities. The treatment of COVID-19 patients at private hospitals could help to boost the bed and critical care occupancy. However, with the absence of insurance coverage because COVID-19 is categorised as pandemic-related diseases, there are some challenges and opportunities posed by the treatment fees management. Another major issue in the collaboration between public and private hospitals is the willingness of private medical consultants to participate in the management of COVID-19 patients, because medical consultants in private hospitals in Malaysia are not hospital employees, but what are termed “private contractors” who provide patient care services to the hospitals. Other collaborative measures with private healthcare providers, e.g. tele-conferencing by private medical clinics to monitor COVID-19 patients and the rollout of national vaccination programme. The public and private healthcare partnership must be enhanced, and continue to find effective ways to collaborate further to combat the pandemic. The MOH, private healthcare sectors and insurance providers need to have a synergistic COVID-19 treatment plans to ensure public as well as insurance policy holders have equal opportunities for COVID-19 screening tests, vaccinations and treatment.

scholarly journals Commentary: Quality nutrition care is integral to the Oncology Care Model

2021 ◽  
Author(s):  
Mary Beth Arensberg ◽  
Beth Besecker ◽  
Laura Weldishofer ◽  
Susan Drawert
Keyword(s):  
Best Practice ◽  
Treatment Guidelines ◽  
Nutrition Therapy ◽  
Care Model ◽  
Nutrition Care ◽  
Ambulatory Oncology ◽  
Oncology Care ◽  
Improvement Programs ◽  
And Performance ◽  
Registered Dietitian Nutritionists

AbstractThe Oncology Care Model (OCM) is a US Centers for Medicare & Medicaid Services (CMS) specialty model implemented in 2016, to provide higher quality, more highly coordinated oncology care at the same or lower costs. Under the OCM, oncology clinics enter into payment arrangements that include financial and performance accountability for patients receiving chemotherapy treatment. In addition, OCM clinics commit to providing enhanced services to Medicare beneficiaries, including care coordination, navigation, and following national treatment guidelines. Nutrition is a component of best-practice cancer care, yet it may not be addressed by OCM providers even though up to 80% of patients with cancer develop malnutrition and poor nutrition has a profound impact on cancer treatment and survivorship. Only about half of US ambulatory oncology settings screen for malnutrition, registered dietitian nutritionists (RDNs) are not routinely employed by oncology clinics, and the medical nutrition therapy they provide is often not reimbursed. Thus, adequate nutrition care in US oncology clinics remains a gap area. Some oncology clinics are addressing this gap through implementation of nutrition-focused quality improvement programs (QIPs) but many are not. What is needed is a change of perspective. This paper outlines how and why quality nutrition care is integral to the OCM and can benefit patient health and provider outcomes.

Abstract 218: Expanding a Learning Collaborative Model in Chicago to Improve Door to Needle for Stroke Thrombolysis: Raising the Bar

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Renee M Sednew ◽  
Kathleen O’Neill
Keyword(s):  
Best Practices ◽  
Performance Improvement ◽  
Best Practice ◽  
Learning Collaborative ◽  
Collaborative Model ◽  
Stroke Registry ◽  
Chicago Area ◽  
Regional Collaboration ◽  
Content Expert ◽  
And Performance

Background: There remains significant opportunities to reduce door-to-needle (DTN) times for stroke despite regional and national efforts. In Chicago, Quality Enhancement for the Speedy Thrombolysis for Stroke (QUESTS) was a one year learning collaborative (LC) which aimed to reduce DTN times at 15 Chicago Primary Stroke Centers. Identification of barriers and sharing of best practices resulted in achieving DTN < 60 minutes within the first quarter of the 2013 initiative and has sustained progress to date. Aligned with Target: Stroke goals, QUESTS 2.0, funded for the 2016 calendar year, invited 9 additional metropolitan Chicago area hospitals to collaborate and further reduce DTN times to a goal < 45 minutes in 50% of eligible patients. Methods: All 24 hospitals participate in the Get With The Guidelines (GWTG) Stroke registry and benchmark group to track DTN performance improvement in 2016. Hospitals implement American Heart Association’s Target Stroke program and share best practices uniquely implemented at sites to reduce DTN times. The LC included a quality and performance improvement leader, a stroke content expert, site visits and quarterly meetings and learning sessions, and reporting of experiences and data. Results: In 2015, the year prior to QUESTS 2.0, the proportion of patients treated with tPA within 45 minutes of hospital arrival increased from 21.6% in Q1 to 31.4% in Q2. During the 2016 funded year, this proportion changed from 31.6% in Q1 to 48.3% in Q2. Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 24 Chicago area hospitals continues to impact times. Regional collaboration, data sharing, and best practice sharing should be a model for rapid and sustainable system-wide quality improvement.

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