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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