Adoption of high technology medical imaging and hospital quality and efficiency: Towards a conceptual framework

Measuring the value of medical imaging is challenging, in part, due to the lack of conceptual frameworks underlying potential mechanisms where value may be assessed. To address this gap, this article proposes a framework that builds on the large body of literature on quality of hospital care and the classic structure‐process‐outcome paradigm. The framework was also informed by the literature on adoption of technological innovations and introduces 2 distinct though related aspects of imaging technology not previously addressed specifically in the literature on quality of hospital care: adoption (a structural hospital characteristic) and use (an attribute of the process of care). The framework hypothesizes a 2‐part causality where adoption is proposed to be a central, linking factor between hospital structural characteristics, market factors, and hospital outcomes (ie, quality and efficiency). The first part indicates that hospital structural characteristics and market factors influence or facilitate the adoption of high technology medical imaging within an institution. The presence of this technology, in turn, is hypothesized to improve the ability of the hospital to deliver high quality and efficient care. The second part describes this ability throughout 3 main mechanisms pointing to the importance of imaging use on patients, to the presence of staff and qualified care providers, and to some elements of organizational capacity capturing an enhanced clinical environment. The framework has the potential to assist empirical investigations of the value of adoption and use of medical imaging, and to advance understanding of the mechanisms that produce quality and efficiency in hospitals.     

Strengthening women's health visiting work with women

AIMS: The aim of the paper is to show how life events contributed to ways in which health visitors related to women in their professional work. BACKGROUND: Health visiting work has been labelled 'invisible' and since, 'invisibility' is an issue in feminist literature, this concept was explored in relation to health visiting. METHODS: A qualitative research design was developed, with a conceptual framework based in feminist and educational literature. Semi-structured, tape-recorded interviews were conducted with a purposeful sample of 35 women health visitors. A systematic approach to data analysis took place, through which key themes and analytic categories were identified. FINDINGS: The findings showed three levels of interaction between health visitor and client that overlapped in the working relationship. First, the public face of the work is exemplified in the planned purposes of the health visiting contact. Secondly, during this contact, health visitors may draw on their lay knowledge of 'life events', that is, their private knowledge of the situation being described by the client. Thirdly, and at the same time, health visitors manage hidden personal feelings that arise within the interaction. CONCLUSIONS: The invisible private knowledge gained in life events can have a transforming effect for both health visitors and clients. However, there is no educational model which legitimizes private and personal knowledge as a resource for use by health visitors. Understanding women's own position as 'women in a gendered society' would enhance the way in which health visiting is conducted and could lead to more productive outcomes in public health work.     

Enhancing interprofessional education and practice: Development and implementation of a new graduate-level course using the international classification of functioning,disability, and health

Since the introduction of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), there is increasing awareness among health professionals to consider a biopsychosocial approach to patients’ health and functioning. Although diffusion of the ICF as a concept is widely recognized, application of the ICF within health education and practice requires attention, training, and support. This article describes the development and implementation of a new graduate-level course using the ICF to assist health professionals and graduate trainees in rehabilitation. The innovation behind this course is its focus on application of the ICF in research and practice through a combination of peer support and instructor mentorship. The value of the ICF for interprofessional education, research, and practice includes promotion of a broad perspective to health, application of theory in practice, and enhanced communication and collaboration in healthcare.     

Instructing Occupational Therapy Students in Use of Theory to Guide Practice

ABSTRACT. We investigated the effectiveness of instructing students in occupational therapy practice models to facilitate their competence in applying theory in clinical practice. Course evaluation data were gathered and analyzed retrospectively. We found that perceived understanding of theory and its application improved significantly after instruction. The students’ perceived competence in theory use predicted their level of confidence in their assessment and intervention skills. We concluded that emphasis on instruction of students in the use of occupational therapy practice models could be a viable method of improving practice through consistent use of theoretical guidelines in clinical reasoning.     

Framework for assessing the capacity of a health ministry to conduct health policy processes—a case study from Tajikistan

An adequate capacity of ministries of health (MOH) to develop and implement policies is essential. However, no frameworks were found assessing MOH capacity to conduct health policy processes within developing countries. This paper presents a conceptual framework for assessing MOH capacity to conduct policy processes based on a study from Tajikistan, a former Soviet republic where independence highlighted capacity challenges. The data collection for this qualitative study included in‐depth interviews, document reviews and observations of policy events. Framework approach for analysis was used. The conceptual framework was informed by existing literature, guided the data collection and analysis, and was subsequently refined following insights from the study. The Tajik MOH capacity, while gradually improving, remains weak. There is poor recognition of wider contextual influences, ineffective leadership and governance as reflected in centralised decision‐making, limited use of evidence, inadequate actors' participation and ineffective use of resources to conduct policy processes. However, the question is whether this is a reflection of lack of MOH ability or evidence of constraining environment or both. The conceptual framework identifies five determinants of robust policy processes, each with specific capacity needs: policy context, MOH leadership and governance, involvement of policy actors, the role of evidence and effective resource use for policy processes. Three underlying considerations are important for applying the capacity to policy processes: the need for clear focus, recognition of capacity levels and elements, and both ability and enabling environment. The proposed framework can be used in assessing and strengthening of the capacity of different policy actors. Copyright © 2013 John Wiley & Sons, Ltd.     

Cerebral coherence between communicators marks the emergence of meaning

How can we understand each other during communicative interactions? An influential suggestion holds that communicators are primed by each other’s behaviors, with associative mechanisms automatically coordinating the production of communicative signals and the comprehension of their meanings. An alternative suggestion posits that mutual understanding requires shared conceptualizations of a signal’s use, i.e., “conceptual pacts” that are abstracted away from specific experiences. Both accounts predict coherent neural dynamics across communicators, aligned either to the occurrence of a signal or to the dynamics of conceptual pacts. Using coherence spectral-density analysis of cerebral activity simultaneously measured in pairs of communicators, this study shows that establishing mutual understanding of novel signals synchronizes cerebral dynamics across communicators’ right temporal lobes. This interpersonal cerebral coherence occurred only within pairs with a shared communicative history, and at temporal scales independent from signals’ occurrences. These findings favor the notion that meaning emerges from shared conceptualizations of a signal’s use.Human sociality is built on the capacity for mutual understanding, but its principles and mechanisms remain poorly understood (1). Given the pervasive ambiguity of communicative signals (2), how can we expect to understand each other? For instance, I might think of tacitly asking my friend Tom to enter a pub by virtue of a pointing gesture toward a nearby bike, believing that both of us recognized the bike of his girlfriend Emma, only to realize how my gesture would be interpreted differently as Tom tells me about his recent split from Emma (2, 3).An influential suggestion holds that communicators are mutually primed by each other’s behaviors, with associative mechanisms automatically coordinating the production of communicative signals and the comprehension of their meanings (4–8). In this framework, mutual understanding arises by virtue of individual experiences with a signal’s properties, as when linguistic features of a word are biased by recent experience of those features (9, 10). Alternatively, mutual understanding might require shared conceptualizations of a signal’s use, abstracted away from specific experiences during a communicative interaction (11–14). In this framework, mutual understanding arises from what communicators mutually know, “conceptual pacts” that are negotiated by communicators over the course of their interactions (11). Although both possibilities emphasize that communicative signals are context dependent (15), they put different emphasis on the relevance of the communicative signal. Both possibilities predict that mutual understanding is neurally implemented through temporally coherent and spatially overlapping activity across communicators (7, 16–18), but with different cerebral dynamics. If meaning is shared by virtue of signals’ features, then communicators’ cerebral coherence should be synchronized to the occurrence of those signals (7, 19, 20). If meaning is shared through conceptual pacts, then communicators’ cerebral coherence should be synchronized to abstractions generalized over multiple communicative episodes, without reference to the occurrence of a specific experience (1, 11, 14). Those predictions can be tested by manipulating the dynamics of mutual understanding across communicators, while capturing the dynamics of their interpersonal cerebral coherence.Mutual understanding was manipulated with an experimentally controlled communicative task (16, 21). This task precludes the use of communication channels and preexisting shared representations used during daily communication (e.g., a common idiom, body emblems, facial expressions), thereby gaining control over the communicative environment and the history of that environment (16, 21). The cerebral characteristics of mutual understanding were isolated through three nested analyses performed on functional magnetic resonance imaging (fMRI) activities simultaneously recorded in pairs of communicators engaged in understanding each other over a series of communicative interactions (22, 23). First, a model-based analysis isolated cerebral signals whose temporal profile matched the behavioral dynamics of mutual understanding observed across Communicators and Addressees. Second, a model-free analysis determined the frequency and phase characteristics of the interpersonal cerebral coherence of Communicator–Addressee pairs. Third, a model-based analysis tested whether interpersonal cerebral coherence in Communicator–Addressee pairs is specifically driven by the creation of novel shared meanings, independently from responses to transient signals.     

Reasons for Not Intensifying Medications: Differentiating “Clinical Inertia” from Appropriate Care

Background “Clinical inertia” has been defined as inaction by physicians caring for patients with uncontrolled risk factors such as blood pressure. Some have proposed that it accounts for up to 80% of cardiovascular events, potentially an important quality problem. However, reasons for so-called clinical inertia are poorly understood. Objective To derive an empiric conceptual model of clinical inertia as a subset of all clinical inactions from the physician perspective. Methods We used Nominal Group panels of practicing physicians to identify reasons why they do not intensify medications when seeing an established patient with uncontrolled blood pressure. Measurements and Main Results We stopped at 2 groups (N = 6 and 7, respectively) because of the high degree of agreement on reasons for not intensifying, indicating saturation. A third group of clinicians (N = 9) independently sorted the reasons generated by the Nominal Groups. Using multidimensional scaling and hierarchical cluster analysis, we translated the sorting results into a cognitive map that represents an empirically derived model of clinical inaction from the physician’s perspective. The model shows that much inaction may in fact be clinically appropriate care. Conclusions/Recommendations Many reasons offered by physicians for not intensifying medications suggest that low rates of intensification do not necessarily reflect poor quality of care. The empirically derived model of clinical inaction can be used as a guide to construct performance measures for monitoring clinical inertia that better focus on true quality problems.     

Qualitative convergence of three nursing concepts: art of nursing, presence and caring

Title.  Qualitative convergence of three nursing concepts: art of nursing, presence and caring.
Aim.  This paper is a report of the development of a theoretical framework of nursing practice based on the convergence of the concepts art of nursing, presence and caring.
Background.  Convergence of similar concepts to form broad yet useful theories is a relatively unexplored area, despite the fact that systematically examining and integrating nursing concepts can help to build theory and leads to enhanced understanding of the discipline. Research results suggest that unarticulated similarities exist among the art of nursing, presence and caring; thus, qualitative convergence of these concepts is justified.
Data sources.  Findings from qualitative studies of the art of nursing (published between 1993 and the third quarter of 2006) and meta-syntheses of presence and caring (published in 2006 and 2007 respectively) were inductively analysed and integrated.
Results.  A theoretical framework of nursing practice was developed to illustrate the areas of convergence among the concepts art of nursing, presence and caring. Nursing involves an intimate relationship-centred partnership between the nurse and patient. Situation-specific nursing actions result from multiple forms of personal and professional knowledge and are based on a value system of holistic beneficence and patient empowerment. Nursing actions are promoted by a conducive work environment and result in enhanced well-being among patients and nurses.
Conclusion.  Results of this concept convergence provide an enhanced understanding of nursing practice and offer insight into areas of nursing practice that are not encompassed within the concepts art of nursing, presence and caring. Further work is recommended to expand the proposed framework, especially in terms of the wide variety of nurse–patient relationships that exist.     

国际卫生系统绩效评价的递嬗历程与比较分析

绩效评价是监督卫生系统和提高卫生服务质量的有效方法,各国政府均对其给予重要关注。通过对世界卫生系统评价先进国的评价历史背景的递嬗过程、概念框架及维度设计、政策支撑环境三个方面进行分析和归纳,探究其对中国卫生系统绩效评价实践的指导意义。