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Table 2 Main evidence reported by scientific literature

From: Exploring “patient-centered” hospitals: a systematic review to understand change

  General evidence Managerial Accounting tools HRM tools ICT tools Outcomes Open issues
Progressive patient care model In some contexts implementation by law (e.g. Tuscany)
Great autonomy of organizations on how to implement model
Forms of implementation:
poles; separation elective/unscheduled/emergency patients; distinct inpatient/outpatient pathways; emphasis on ED; pool beds; centralization of functions
Integrated Planning, Budgeting and Control systems (e.g. BSC)
In concrete, however, MA tools not aligned to model (e.g. budgets still assigned to clinical wards)
New professional roles and a general reassignment of responsibilities (nurses and physicians)
Need for:
Competency based model;
Separate professional/managerial career paths;
Multi-source and 360° feedback system
Integrated electronic health records, to be jointly used and updated by physicians and nurses Improved efficiency indicators
Increased patient satisfaction (medical and/or nursing tutor)
More coordination between medical and surgical staff
Better implementation of clinical pathways
Lack of evidence in terms of improved clinical outcomes
Effective allocation of nurses to different settings
Correct triage activity in ED and efficient allocations of patients
Desirability of medical day- or week- hospitals
Involving professionals and of overcoming cultural barriers
Definition of clear repartition of responsibilities among professionals
Patient centered approach The most analyzed aspect of PC is related to continuity of care among different settings (poorly explored within hospitals)
An exception: analysis of general process improvements within EDs
  New professional roles in hospitals (e.g. liason nurse) ICT tools should ideally:
prioritize information and detect individuals’ contextual situations,
promote stronger inter-professional relationships with adequate exchange of information,
enable interoperability and scalability between and within institutions,
function across different platforms.
Few pioneer experiences (e.g. Shared care platform)
ICT tools still rudimental if compared to their potential
Significant relationships between specific elements of PC and outcomes, or between PC approach in general and a reduced ED utilization.
Liason activities are associated with slightly higher (not significant), quality care transitions.
Greater patient satisfaction
Improved communication among professionals
General evidence about the effects of PCC on clinical outcomes very limited
Poor attention of literature to PC within hospitals
Necessary switch from hospital information systems to health care information systems
Non exhaustive information
Individuals involved are not traced
Lack of tools to clearly assess PC
Lean approach Application of various features of lean such as new employee roles, staffing and scheduling, communication and coordination, workspace layout, process design etc.
Application of lean tools within settings (EDs, ORs, outpatient settings)
Only few examples of lean applied to pathways
  Staff empowerment and “bottom-up approach”, by allowing the frontline staff to identify problems and come up with appropriate solutions   Many examples of improvement in efficiency indicators
Fewer examples of improvement in clinical outcomes
A number of studies find inconsistent the evidence about lean’s contribution to higher organizational performance
Lean is often felt to be “a constellation of disjointed and poorly connected activities”
Lack of “system-wide” improvement philosophy
The “bottom-up approach” is not fully implemented in concrete and barriers to implementation persist
Need of more formation for inter-professional collaboration