Health Care Delivery Practices in Huntington's Disease Specialty Clinics : An International Survey

The CHDI Foundation, Inc. funds Enroll-HD and the activities of the Enroll-HD Care Improvement Committee, including the present survey. We would like to acknowledge the Enroll-HD and REGISTRY administrative staff that assisted in the recruitment of sites and sites that completed the survey.Peer reviewedPublisher PD

Makten i helse- og omsorgstjenestene

Leder i tidsskrift om makten i helse- og omsorgstjenestene, og behovet for en pasientsentrert tjeneste.Forfatteren konkluderer med: de siste tiår har maktbalansen mellom pasient, bruker og system endret seg dramatisk. Medvirkning og involvering av brukere og pasienter på individ- og systemnivå er blitt en viktig helse- og omsorgspolitisk målsetting. Utviklingen innebærer en nødvendig styrking av bruker- og pasientperspektivet, men utviklingen fører samtidig til nye begreper om ansvar, krav til egenomsorg og forventninger til pårørende. Makten syns ikke, men blir ikke borte med en demokratisering av tjenestene – den uttrykker seg på nye måter som det er verd å reflektere over. (Frich 2015: 149

Naming the “baby” or the “beast”? The importance of concepts and labels in healthcare safety investigation

This paper focuses on concepts and labels used in investigation of adverse events in healthcare. The aim is to prompt critical reflection of how different stakeholders frame investigative activity in healthcare and to discuss the implications of the labels we use. We particularly draw attention to issues of investigative content, legal aspects, as well as possible barriers and facilitators to willingly participate, share knowledge, and achieve systemic learning. Our message about investigation concepts and labels is that they matter and influence the quality of investigation, and how these activities may contribute to system learning and change. This message is important for the research community, policy makers, healthcare practitioners, patients, and user representatives.publishedVersio

Reducing unwarranted variation: can a ‘clinical dashboard’ be helpful for hospital executive boards and top-level leaders?

Background/aim: In the past decades, there has been an increasing focus on defining, identifying and reducing unwarranted variation in clinical practice. There have been several attempts to monitor and reduce unwarranted variation, but the experience so far is that these initiatives have failed to reach their goals. In this article, we present the initial process of developing a safety, quality and utilisation rate dashboard (‘clinical dashboard’) based on a selection of data routinely reported to executive boards and top-level leaders in Norwegian specialist healthcare. Methods: We used a modified version of Wennberg’s categorisation of healthcare delivery to develop the dashboard, focusing on variation in (1) effective care and patient safety and (2) preference-sensitive and supply-sensitive care. Results: Effective care and patient safety are monitored with outcome measures such as 30-day mortality after hospital admission and 5-year cancer survival, whereas utilisation rates for procedures selected on cost and volume are used to follow variations in preference-sensitive and supply-sensitive care. Conclusion: We argue that selecting quality indicators of patient safety, quality and utilisation rates and presenting them in a dashboard may help executive hospital boards and top-level leaders to focus on unwarranted variation

Contextual factors of external inspections and mechanisms for improvement in healthcare organizations: a realist evaluation

External inspections constitute a key element of healthcare regulation. Improved quality of care is one of the important goals of inspections but the mechanisms of how inspections might contribute to quality improvement are poorly understood. Drawing on interviews with healthcare professionals and managers and health record data from inspected organizations, we used a realist evaluation approach to explore how twelve inspections of healthcare providers in x= Norway influenced quality improvement. We found that for inspections to contribute to quality improvement, there must be contextual structures present supporting accountability and engaging staff in improvement work. When such structures are present, inspections can contribute to improvement by creating awareness of gaps between desired and current practices, which leads to readiness for change and stimulates intra-organizational reasoning around quality improvement. We discuss our findings using the theory of de- and recoupling, noting how regulators can identify decoupling between intended goals, management systems, practices, and patient outcomes. We further argue that regulators can contribute to a recoupling between these levels by having the capacity to track the providers' clinical performance over time. This will hold the organization accountable for implementing improvement measures and evaluate the effects of the measures on quality of care.publishedVersio

Naming the “baby” or the “beast”? The importance of concepts and labels in healthcare safety investigation

This paper focuses on concepts and labels used in investigation of adverse events in healthcare. The aim is to prompt critical reflection of how different stakeholders frame investigative activity in healthcare and to discuss the implications of the labels we use. We particularly draw attention to issues of investigative content, legal aspects, as well as possible barriers and facilitators to willingly participate, share knowledge, and achieve systemic learning. Our message about investigation concepts and labels is that they matter and influence the quality of investigation, and how these activities may contribute to system learning and change. This message is important for the research community, policy makers, healthcare practitioners, patients, and user representatives

Health related quality of life, service utilization and costs for patients with Huntington’s disease in Norway

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Organisatoriske forhold og løsninger i spesialisthelsetjenesten – hva mener sykehuslegene?

Det er gjort få forsøk på å kartlegge hva sykehuslegene mener om dagens styring og organisering av spesialisthelsetjenesten. Vi gjennomførte en spørreundersøkelse blant 971 medlemmer av Overlegeforeningen og Yngre legers forening i Legeforeningen for å belyse følgende spørsmål: Hvilke oppfatninger har sykehusleger av ulike organisatoriske forhold og løsninger i dagens sykehusorganisering? Hvilke endringer av dagens modell mener sykehusleger vil være gunstig? Samlet sett synes norske sykehusleger å være skeptiske til den nåværende modell og en god del av legene mener at den tidligere fylkeskommunale forvaltningsmodellen vil være å foretrekke. Våre resultater indikerer at sykehusleger ønsker mer lokal ledelse, kortere beslutningsveier, mindre incentivbasert styring og bedre ITsystemer. Legene vil ikke ha politisk innblanding i driftsmessige spørsmål, men kan akseptere at politikere treffer beslutninger i større saker. Respondenter med lederansvar hadde signifikant lavere sannsynlighet for å betrakte både foretaksmodellen, fravær av stedlig ledelse og samling av avdelingen som problematisk sammenliknet med leger uten en lederrolle. En rekke aspekter ved dagens styringsmodell oppleves som mer problematisk i Helse Sør-Øst enn i de øvrige regionene. Undersøkelsen indikerer at sykehusleger ønsker seg tilbake til en sektor som i sterkere grad enn i dag er profesjonsstyrt.publishedVersion© 2017. Det norske medicinske Selskab. Open access. Published electronically at www.dnms.no and www.michaelquarterly.no

Mellom politikk og administrasjon - organisering av spesialisthelsetjenesten i Norge

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Electrosurgery and Temperature Increase in Tissue With a Passive Metal Implant

Importance: During monopolar electrosurgery in patients, current paths can be influenced by metal implants, which can cause unintentional tissue heating in proximity to implants. Guidelines concerning electrosurgery and active implants such as pacemakers or implantable cardioverter defibrillators have been published, but most describe interference between electrosurgery and the active implant rather than the risk of unintended tissue heating. Tissue heating in proximity to implants during electrosurgery may cause an increased risk of patient injury.Objective: To determine the temperature of tissue close to metal implants during electrosurgery in an in-vitro model.Design, Setting, and Participants: Thirty tissue samples (15 with a metal implant placed in center, 15 controls without implant) were placed in an in vitro measurement chamber. Electrosurgery was applied at 5–60 W with the active electrode at three defined distances from the implant while temperatures at four defined distances from the implant were measured using fiber-optic sensors.Main Outcomes and Measures: Tissue temperature increase at the four tissue sites was determined for all power levels and each of the electrode-to-implant distances. Based on a linear mixed effects model analysis, the primary outcomes were the difference in temperature increase between implant and control tissue, and the estimated temperature increase per watt per minute.Results: Tissues with an implant had higher temperature increases than controls at all power levels after 1 min of applied electrosurgery (mean difference of 0.16°C at 5 W, 0.50°C at 15 W, 1.11°C at 30 W, and 2.22°C at 60 W, all with p < 0.001). Temperature increase close to the implant was estimated to be 0.088°C/W/min (95% CI: 0.078–0.099°C/W/min; p < 0.001). Temperature could increase to above 43°C after 1 min of 60 W. Active electrode position had no significant effect on temperature increases for tissues with implant (p = 0.6).Conclusions and Relevance: The temperature of tissue close to a metal implant increases with passing electrosurgery current. There is a significant risk of high tissue temperature when long activation times or high power levels are used