04:00 PM - 04:30 PM
Understanding care pathways for frail older people: from mapping to modelling
In the English National Health Service, commissioning organisations (local Clinical Commissioning Groups and the national body NHS England) are responsible for planning and purchasing health care on behalf of their populations from primary, secondary and tertiary care providers. This project was undertaken with Southampton City Clinical Commissioning Group (CCG) and was concerned with the strategic planning of care for frail older people. In common with most developed countries, this patient group is placing increased levels of demand upon already stretched resources. The main researcher (Melinda Taylor) was an academic, but was based within - and employed by - the CCG. The project involved the development of a model of patient flows and capacity bottlenecks across the whole health and care system, including patients’ own homes, residential and social care, and the hospital system. Firstly, through around 80 interviews with clinicians, care providers and managers, as well as direct observation and “job shadowing”, we developed a visual pathway map of what turned out to be a massively complex system. This map was validated at several stakeholder meetings. A simplified version of this map was then developed into a system dynamics model and used to explore potential scenarios for change. In this talk, we describe the modelling process, discuss some of the challenges and positive outcomes from the project, and present the results for a couple of selected scenarios.
04:30 PM - 05:00 PM
Core Capabilities Related to Modularization in Health Care Service Design
Background and purpose: Health care design, development and coordination play an important role in both controlling the increasing health care expenditures and enabling more customized services to patients. Modularization and mass customization have been seen as methods to increase patient-oriented care delivery and customization of health care services. The aim of this study is to create a framework of capabilities needed in health care delivery modularization.
Methods: The framework is created by systematically reviewing and analyzing previous studies related to modularization in health care delivery and comparing the findings with capabilities that arise from general modularity studies.
Findings: The analysis of the identified studies shows that capabilities related to health care modularization can be divided into three categories: i) Capabilities related to categorizing of customers/patients and their needs, ii) Capabilities concerning the processes and categorization of services and iii) Capabilities concerning organizational issues. The identified capabilities can be linked with the ability to develop and enhance both variety of services and coherence between different service modules and professionals.
Conclusions: This study combines general modularity studies with health care modularity studies to identify and categorize main capabilities related to modularization in health care. Most included studies regarded elderly care, thus future research is needed to analyze whether the identified capabilities are present in other primary care areas as well as in secondary and tertiary care. Altogether, this study provides tools to both researchers and health care managers to enhance the development work of health care organizations.
05:00 PM - 05:30 PM
E-mail as Appropriate Method of Communication for Decision-Maker Obtaining Advice from Expert for Operational Research Implementation
Previously, we reviewed that the odds of a team (i.e., a small operating room management committee) making correct (optimal) decisions for many operating room management problems is very low without study. Decision-makers need to rely on experts. Literature search is the easiest approach, conceptually, to obtaining expert advice. However, we also found in our prior studies that literature search is ineffective for such problems without the decision-maker already knowing the vocabulary. Those findings, together, show that decision-makers’ reliance on 1:1 communication with experts is not just typical but necessary.
In our new study, we used narrative review of experimental and observational studies, including reanalysis of published data and results, to compare different communication methods between decision-maker(s) and expert(s) for applying analytical methods: e-mail (i.e., asynchronous written communication), face-to-face, video conference, telephone, live electronic chat, and discussion group (e.g., social media). Studies find e-mail to have greater or equivalent effectiveness: 1) ease-of-use across organizational boundaries; 2) convertibility to tasks; 3) asynchronicity (no appointment); 4) no expectation of immediate response; 5) expectation of a response; 6) reduced social loafing; and 7) training significantly increases productivity of use. E-mail advantages apply from decision-makers’ perspectives: 1) messages can be carefully constructed (framed) to increase the likelihood of a useful response; 2) response can be read when least distracted; 3) reduced cognitive load; and 4) written text is consistently easier to understand and as effective in changing behavior for factual material. E-mail has significant advantages from experts’ perspectives: 1) ability to control credibility cues; 2) titles and degrees in signature line are expected; 3) ability to focus on message construction rather than visual cues; 4) ability to include attachments with details; and 5) written expression(s) of confidence in advice (the best predictor of usage of advice in experimental studies).