Can connected technologies improve sleep quality and safety of older adults and care-givers? An evaluation study of sleep monitors and communicative robots at a residential care home in Japan

A sheet-shaped body vibrometer (SBV) is a type of assistive technology which offers a constant and noninvasive method of recording and monitoring the physical condition and sleep patterns of care recipients. With the aim of creating a safer environment for both care recipients and caregivers, we connected the SBV to a communicative robot (com-robot), to function as an integrated system. The robot has a sensor which activates when a care recipient tries to stand up, whereupon it sends an alert to care staff and speaks to the care recipient. The combined technologies offer an enhanced sense of security, as they watch over older people during the night, visualise sleep patterns and alert care staff. As proof of concept, this study examines the usefulness of this connected system by testing its effectiveness among two types of users (care recipients and professionals) in a residential care home in Japan. For the former, sleep parameters were investigated to see if there was any change over time in and impact on an older person's quality of life. As a measurement of quality of life, the interRAI method was used as a comprehensive assessment tool, based on which a care plan was also created for each care recipient. The interRAI is a nursing care evaluation and nursing care plan creation guideline package that provides unbroken care that can be used at home, in facilities or in the community For the latter, the study tests the level of fatigue among care professionals during night shifts before and after the intervention. For triangulation of data, semi-structured interviews and usability tests were carried out. Despite a few points for improvement, the results highlight multiple benefits for care recipients and professionals of using the SBV and com-robot integrated system in a residential care home.     

人性化设计及其在产品设计中的应用

任何设计不仅仅要重视和协调工程设计，更重要的是要以人为中心进行设计，努力通过设计活动来提高人类的生活和工作质量，设计人类的生活方式。人性化设计正是强调这种设计思想，把人的因素放在首位。     

中日社区居家养老设施设计比较研究

目的研究中日社区居家养老设施差异性,为我国社区居家养老设施的发展提供借鉴。方法通过比较研究中日两国在社区居家养老设施的发展历程、服务理念和功能应用,总结日本先进养老经验,提出符合我国社区居家养老设施发展的构想。结论日本社区居家养老服务设施的规划设计相对完备,而我国社区居家养老设施在设计理念、无障碍设计等方面存在不足。借鉴日本先进经验,建立适合我国国情的社区居家养老设施设计体系,有着重要意义。     

Identifying and using tools for reducing risks to patients and health care workers: a nursing perspective

BACKGROUND: Research efforts and policy initiatives in health care errors and injury to health care workers have attracted increasing attention in recent years. An emerging theme in both these areas is the importance of organizational and other systems factors in the occurrence of medical error and health care worker injury. These commonalities call for the identification of common research efforts and, when appropriate, policy efforts. MOVING FROM HYPOTHESIS TO CONCLUSION: The proposition that health care error and worker injury are linked to the same organizational variables requires further research and deserves the same type of human factors approach that has characterized much of the investigative efforts that have occurred in the patient safety arena during the past decade. Serious problems exist with respect to access to data on staffing levels, skill mix, consecutive work hours, and other information that is crucial to examining the link between practice conditions, health care error, and health care worker injury. HUMAN FACTORS: One important resource in identifying effective approaches to prevent error and health care worker injury is the field of human factors, the discipline concerned with the design of tools, machines, and systems that takes into account human capabilities, limitations, and characteristics. CONCLUSION: The potential benefits of linking patient safety and health care worker safety efforts are significant. The research, experience, and successful practices from multiple disciplines must be utilized in identifying areas of common interest and concern in advancing work in both of these important areas.     

我国医养结合养老服务标准体系概况及对比分析

通过对我国养老服务标准化建设现状进行文献调研,概括现有的医养结合养老服务标准体系和我国四大经济区域医养结合服务标准化现状,总结各区域发展情况,对比分析。同时,找出可借鉴的经验和做法,为广东省医养结合模式下的养老服务标准体系建设提供参考。     

Understanding patient willingness to recommend and return: a strategy for prioritizing improvement opportunities.

BACKGROUND: Beginning in April 1995, an ongoing, comprehensive measurement system has been developed and refined at BJC Health System, a regional integrated delivery and financing system serving the St Louis metropolitan area, mid-Missouri, and Southern Illinois, to assess patient satisfaction with inpatient treatment, outpatient treatment, outpatient surgery, and emergency care. This system has provided the mechanism for identifying opportunities, setting priorities, and monitoring the impact of improvement initiatives. METHODS: Satisfaction with key components of the care process among 23,361 patients (7,083 inpatients, 8,885 patients undergoing outpatient tests/procedures, 5,356 patients undergoing outpatient surgery, and 2,037 patients receiving emergency care) at 15 BJC Health System facilities was assessed through weekly surveys administered in April 1995 through December 1996. RESULTS: Structural equation models were developed to identify the key predictors of patient advocation-willingness to return for or recommend care. Across all venues of care the compassion provided to patients had the strongest relationship to patient advocation. Within each venue of care, however, a slightly different set of secondary factors emerged. The resulting models provided important information to help prioritize competing improvement opportunities in BJC Health System. In one hospital, a general medicine unit working for several years with little success to improve its patient satisfaction decided to focus on two primary factors predicting patient advocation: nursing care delivery and compassionate care. Root cause analysis was used to determine why two items-staff willingness to help with questions/concerns and clear explanation about tests and procedures-were rated low. On the basis of feedback from phone interviews with discharged patients, the care delivery process was changed to encourage patients to ask questions. Across the next two quarters, this unit experienced significant improvements in both targeted items. DISCUSSION: The significance of compassionate care and care delivery again speaks not only to the importance of the technical quality of clinical care but also to the customer-focused way in which this care was provided. After the primary predictors of patient advocation were identified, management was able to strategically focus improvement initiatives to maximize their impact. Across the organization, improvement teams scanned their data to find key factors where performance was lacking. Once these key opportunities were identified, the teams developed potential solutions and launched initiatives to improve their performance. SUMMARY AND CONCLUSIONS: Results suggest that some core issues are of extreme importance to patients regardless of whether they are receiving care in an inpatient, outpatient, or emergency setting. The compassion with which care is provided appears to be the most important factor in influencing patient intentions to recommend/return, regardless of the setting in which care is provided.     

The impact of staffing and the organization of work on patient outcomes and health care workers in health care organizations

BACKGROUND: Numerous reports in the popular press express concern about the restructuring or lowering of staffing levels in health care organizations and the impact on the quality of patient care. Overtime and other extended shifts also represent work stresses for health care workers. This article reviews the research literature on the relationships among staffing, organization of work, and patient outcomes, and it discusses research findings on the relationship between staffing and the health of health care workers. RESEARCH ON STAFFING, ORGANIZATION, AND PATIENT OUTCOMES/STAFF WELL-BEING: Safe staffing level requirements have been identified for nursing homes, but only in extremely limited cases for hospitals, home care, or other health settings. There is little information about the impact of staffing levels and the organization of work on health personnel or on patient outcomes. There is almost no information about staffing and patient outcomes in home health and ambulatory care. Much of the research on staffing and quality has been discipline specific; future research should reflect the interdisciplinary nature of health care delivery rather than the impact of a particular occupation. RESEARCH USE: Research is conducted to increase the scientific base per se and to inform decision making. Who should decide staffing levels and the organization of work? Professionals, employers/owners, the government, and consumers all have significant interest in staffing levels and the organization of care. Improving health care quality requires research about the critical staffing and organization of work variables. This requires obtaining appropriate data, conducting the research, and widely disseminating the findings.     

Occupational stress, social support, and the costs of health care.

Relationships among health care costs, social support, and occupational stress are investigated. Health care cost data were collected over two years for 260 working individuals. Multiple regression analyses were used to control for initial health care costs, age, and gender in predicting later costs; independent variables were stress, strain, social support, and their interactions. Main effects and interactions each accounted for significant proportions of the variance in various health care costs.     

Telemedicine and tele-health services for cancer-care delivery in India

Noncommunicable diseases including cancer are emerging as major public health problems in India. Awareness of cancer and its management are being taken as a high priority at the national level because of the increase in the incidence of the disease in the country. Telemedicine provides expert-based health care to understaffed remote sites and advanced emergency care through modern telecommunication and information technologies. The incidence of cancer can be reduced if the people are aware of cancer and its root causes. Recently, the introduction of telemedicine in oncology plays a vital role. Telemedicine helps in prevention, early detection, a faster cure, palliative care and rehabilitation in the management of cancer. The status of telemedicine services for cancer care in Kerala, India, and how telemedicine can be an effective solution of cancer- care delivery in India are explored.     

Professional values,technology and future health care: The view of health care professionals in The Netherlands

Perceptions and values of care professionals are critical in successfully implementing technology in health care. The aim of this study was threefold: (1) to explore the main values of health care professionals, (2) to investigate the perceived influence of the technologies regarding these values, and (3) the accumulated views of care professionals with respect to the use of technology in the future. In total, 51 professionals were interviewed. Interpretative phenomenological analysis was applied. All care professionals highly valued being able to satisfy the needs of their care recipients. Mutual inter-collegial respect and appreciation of supervisors was also highly cherished. The opportunity to work in a careful manner was another important value. Conditions for the successful implementation of technology involved reliability of the technology at hand, training with team members in the practical use of new technology, and the availability of a help desk. Views regarding the future of health care were mainly related to financial cut backs and with a lower availability of staff. Interestingly, no spontaneous thoughts about the role of new technology were part of these views. It can be concluded that professionals need support in relating technological solutions to care recipients' needs. The role of health care organisations, including technological expertise, can be crucial here.     

From production systems to health care delivery systems: a retrospective look on similarities,difficulties and opportunities

Manufacturing systems have attracted substantial research attentions during the last 50 years. In recent years, there has been growing interest in health care systems research to improve efficiency, safety and care quality. The similarities identified between manufacturing systems and health care delivery systems heighten the importance of transferring the experience and knowledge in manufacturing to health care. In this paper, based on the lessons we learned and the experience we obtained during our journey from production systems research to health care delivery systems study, we discuss the similarities between production systems and health care delivery systems in system modelling, design, performance evaluation and continuous improvements and investigate the differences and difficulties that stem from variability, constraints, dynamics and human behaviour. Building upon these, the opportunities encompassing care operations, planning and scheduling, patient transitions, and safety and teamwork in health care delivery systems are discussed. Finally, the challenges and future directions are proposed. We expect this work to serve as a catalyst to stimulate more in-depth and comprehensive studies.     

The advanced practice nurse–nephrologist care model: Effect on patient outcomes and hemodialysis unit team satisfaction

The tertiary care nurse practitioner/clinical nurse specialist (NP/CNS) is an advanced practice nurse with a relatively new role within the health‐care system. It is stated that care provided by the NP/CNS is cost‐effective and of high quality but little research exists to document these outcomes in an acute‐care setting. The clinical coverage pattern by nephrologists and NP/CNS of a hemodialysis unit in a large academic center allowed such a study. Two NP/CNS plus a nephrologist followed two of three hemodialysis treatment shifts per day; only a nephrologist followed the third shift. The influence of this care pattern of patients was examined using a cross‐sectional review of outcomes such as adequacy of delivered dialysis, anemia management, phosphate control, hospitalizations, etc. In addition, the level of satisfaction of the dialysis team and perceptions of care delivered with the care models was assessed. The care model staff‐to‐patient‐number ratio was similar in both groups (1:27 for NP/CNS plus nephrologist; 1:29 for nephrologist alone). Patient demographics were similar in both groups but the NP/CNS–nephrologist group had patients with more comorbidities. No statistically significant (p < 0.05) differences existed between the groups in patient laboratory data, adherence to standards, medications, inter‐ and intradialytic blood pressure, achievement of target postdialysis weights, and hospitalizations or emergency room visits. Significantly more adjustments were made to target weights and medications and more investigations were ordered by the NP/CNS–nephrologist team. Team satisfaction and perceptions of care delivery were higher with the NP/CNS–nephrologist model. It is concluded that the NP/CNS–nephrologist care model may increase the efficiency of the care provided by nephrologists to chronic hemodialysis patients. The model may also be a solution to the problem of providing nephrologic care to an ever‐growing hemodialysis population.     

The effects of age,gender, and crash types on drivers’ injury-related health care costs

There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers’ age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers’ age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs.     

The impact of quality report cards on choice of physicians, hospitals, and HMOs: a midcourse evaluation

BACKGROUND: Increasing competition in health care markets and ongoing pressures to contain costs raise concerns about possible deterioration in the quality of medical care. Publicly disseminated quality report cards are designed to inform consumers' choice of providers and health plans, thus counteracting incentives to provide low-quality care and improving the functioning of health care markets. METHODS: This article reviews and evaluates the published evidence on the impact of quality report cards on patients' choice of health care providers and health plans. RESULTS: Studies found only minimal effect of quality report cards on patient referral choices. These findings can be explained by several study design issues and by the economic forces governing health care markets. They cannot be construed to imply that quality report cards are not effective. DISCUSSION: Whether report cards are effective or not is still an unanswered question. Further efforts to improve the information contained in report cards and to make them more understandable could increase their effectiveness.     

Understanding barriers to home‐based and self‐care in‐center hemodialysis

Despite superior outcomes and lower associated costs, relatively few patients with end‐stage renal disease undergo self‐care or home hemodialysis. Few studies have examined patient‐ and physician‐specific barriers to self‐care and home hemodialysis in the modern era. The degree to which innovative technology might facilitate the adoption of these modalities is unknown. We surveyed 250 patients receiving in‐center hemodialysis and 51 board‐certified nephrologists to identify key barriers to adoption of self‐care and home hemodialysis. Overall, 172 (69%) patients reported that they were “likely” or “very likely” to consider self‐care hemodialysis if they were properly trained on a new hemodialysis system designed for self‐care or home use. Nephrologists believed that patients were capable of performing many dialysis‐relevant tasks, including: weighing themselves (98%), wiping down the chair and machine (84%), clearing alarms during treatment (53%), taking vital signs (46%), and cannulating vascular access (41%), but thought that patients would be willing to do the same in only 69%, 34%, 31%, 29%, and 16%, respectively. Reasons that nephrologists believe patients are hesitant to pursue self‐care or home hemodialysis do not correspond in parallel or by priority to reasons reported by patients. Self‐care and home hemodialysis offer several advantages to patients and dialysis providers. Overcoming real and perceived barriers with new technology, education and coordinated care will be required for these modalities to gain traction in the coming years.     

The impact of quality practices and employee empowerment in the performance of hospital units

Healthcare is a unique services environment with increasing demand for services coupled with widely diverse patient needs. In addition, hospitals are under increased pressure to provide quality care yet simultaneously decrease associated costs. This study examines how the use of quality practices and employee empowerment impact hospital unit outcomes. Specifically, the sociotechnical theory is used to explain the relationship of quality practices and employee empowerment in respiratory care services. Utilising data from 101 different hospital units, survey responses from managers and physicians within the same hospital units are used to test the impact on quality and cost of care performance metrics via path modelling. The results show the social side of improvement programs, i.e. employee empowerment, may be a critical component to true quality improvement in hospital units. Furthermore, while respiratory care managers feel that employee empowerment reduces costs of patient care, physicians felt that there was no impact on costs. The implications of these findings and differing perspectives are discussed.     

Effecting and leading change in health care organizations

BACKGROUND: Understanding change is crucial to implementing quality improvement (QI) initiatives. Widespread change will be required to correct what many consider to be outmoded and deficient systems of care. This article summarizes the current literature--within both health care and the fields of business and management--regarding how change occurs at the individual and organizational levels. Part 1 focuses on changing clinician behavior, which is instrumental to any effort directed in the health care setting. Part 2 examines the culture of change. Part 3 addresses issues of leadership, along with the necessary steps to guide change in an organization. Part 4 summarizes key elements of change. Finally, Part 5 provides three case examples of QI initiatives reported in the recent literature to illustrate how the application of the knowledge of change management can assist in the successful implementation of QI programs. KEY ELEMENTS OF CHANGE: The knowledge base regarding successful change in health care organizations can be summarized in eight crucial strategies or principles: (1) develop a vision for change, (2) focus on the change process, (3) analyze which individuals in the organization must respond to the proposed change and what barriers exist, (4) build partnerships between physicians and the administration, (5) create a culture of continuous commitment to change, (6) ensure that change begins with leadership, (7) ensure that change is well communicated, and (8) build in accountability for change. CONCLUSION: A knowledge of change management can help leaders of QI programs in health care organizations successfully apply these concepts to bring about much-needed transformations in health care.     

Articulating care and responsibility in design: A study on the reasoning processes guiding health innovators' ‘care-making’ practices

This article explores how health innovation designers articulate care and responsibility when designing new health technologies. Towards this end, we draw on Tronto's ethic of care framework and Responsible Research and Innovation (RRI) scholarship to analyse interviews with Canadian health innovators (n = 31). Our findings clarify how respondents: 1) direct their attention to needs and ways to improve care; 2) mobilise their skill set to take care of problems; 3) engage in what we call ‘care-making’ practices by prioritising key material qualities; and 4) operationalise responsiveness to caregivers and care-receivers through user-centred design. We discuss the inclusion of health innovation designers within the care relationship as ‘care-makers’ as well as the tensions underlying their ways of caring and their conflicting responsibilities.     

Automation, interaction, complexity, and failure: A case study

Although proponents of advanced information technology argue that automation can improve the reliability of health care delivery, the results of introducing new technology into complex systems are mixed. The complexity of the health care workplace creates vulnerabilities and problems for system designers. In particular, some forms of failure emerge from the interactions of independently designed and implemented components. We present a case study of such an emergent, unforeseen failure and use it to illustrate some of the problems facing designers of applications in health care.     

Working together but apart: barriers and routes to nurse--physician collaboration

The authors argue that the aircraft safety model may be of limited relevance for health care and suggest strategies for greater collaboration between nurses and physicians in the care of patients.