Kaat De Pourcq

The impact of logarithmic dose banding of anticancer drugs on pharmacy compounding efficiency at Ghent University Hospital

Background Dose banding (DB) (dose rounding with predetermined variation with prescription) enables in-advance preparation of high-turnover anticancer drugs with potential benefit for pharmacy compounding work flow. Objectives To analyse the impact of potential situations on the efficiency of DB in the pharmacy (safe and maximum storage), calculate preparation lead times and the potential full-time equivalent (FTE) benefit. Methods Candidate intravenous anticancer drugs were selected for logarithmic DB according to prescribing frequency, infusion volume and stability (usage data 2015 of the tertiary Ghent University Hospital, Belgium). With a selected DB set already stored, a 2-week time study (April/November 2015) provided lead times (between prescription and transfer) for just-in-time and DB preparations. A ‘maximal’ storage (using all drugs with a relative incidence of ≥2% recurrent monthly prescription) and a ‘safe’ storage scenario (lowest monthly prescribing pattern) were used to calculate the potential future FTE change. Results Mean lead times for DB storage and just-in-time preparation were 17.1 min (95% CI 13.5 to 21.0) and 26.5 min (23.3 to 29.8). For 21 164 yearly preparations with already 5292 in DB (25%), 11 157 and 6 862 could be batch-produced in advance in a maximum storage and safe storage scenario, respectively. The existing FTE in 2015 of 5.41 could then be reduced to 4.91 and 5.27. Conclusion Further development of DB could contribute to pharmacy compounding efficiency.

The role of hospitals in bridging the care continuum : A systematic review of coordination of care and follow-up for adults with chronic conditions

BackgroundMultiple studies have investigated the outcome of integrated care programs for chronically ill patients. However, few studies have addressed the specific role hospitals can play in the downstream collaboration for chronic disease management. Our objective here is to provide a comprehensive overview of the role of the hospitals by synthesizing the advantages and disadvantages of hospital interference in the chronic discourse for chronically ill patients found in published empirical studies.MethodSystematic literature review. Two reviewers independently investigated relevant studies using a standardized search strategy.ResultsThirty-two articles were included in the systematic review. Overall, the quality of the included studies is high. Four important themes were identified: the impact of transitional care interventions initiated from the hospital’s side, the role of specialized care settings, the comparison of inpatient and outpatient care, and the effect of chronic care coordination on the experience of patients.ConclusionOur results show that hospitals can play an important role in transitional care interventions and the coordination of chronic care with better outcomes for the patients by taking a leading role in integrated care programs. Above that, the patient experiences are positively influenced by the coordinating role of a specialist. Specialized care settings, as components of the hospital, facilitate the coordination of the care processes. In the future, specialized care centers and primary care could play a more extensive role in care for chronic patients by collaborating.

A three-step methodology for process-oriented performance: how to enhance automated data collection in healthcare

ABSTRACT Background. Healthcare managers often attempt to enhance process-oriented performance. However, this remains a challenge. New approaches aimed at increasing the implementation success of process-oriented performance measurement should be investigated. Methods. This study investigates and discusses a step-by-step methodology to implement an automated and effective process-oriented performance measurement system in a hospital. The methodology is based on a framework for developing dashboards based on three steps: the demand side, supply side, and the fit between the two. An illustrative case of the process of hip surgery in the operating room of two hospitals is used. Results. A methodology has been developed to define a reliable set of process-oriented performance metrics, allowing analysis and management of the different flows in healthcare in an integrated way, several methods were investigated to automatically integrate the data gathered into a reporting infrastructure that can be used to disseminate the results. Conclusion. This step-by-step methodology allows healthcare organizations to develop and implement effective process-oriented performance measurement in an automated way. This allows the alignment of the goals of hospital management and various stakeholders with the more analytical analysis of business process management notation and hospital information system (HIS) data.

Hospital networks: how to make them work in Belgium? Facilitators and barriers of different governance models

Abstract Objectives This study aims to identify the facilitators and barriers to governance models of hospital collaborations. The country-specific characteristics of the Belgian healthcare system and legislation are taken into account. Methods A case study was carried out in six Belgian hospital collaborations. Different types of governance models were selected: two health systems, two participant-governed networks, and two lead-organization-governed networks. Within these collaborations, 43 people were interviewed. Results All structures have both advantages and disadvantages. It is important that the governance model fits the network. However, structural, procedural, and especially contextual factors also affect the collaborations, such as alignment of hospitals’ and professionals’ goals, competition, distance, level of integrated care, time needed for decision-making, and legal and financial incentives. Conclusion The fit between the governance model and the collaboration can facilitate the functioning of a collaboration. The main barriers we identified are contextual factors. The Belgian government needs to play a major role in facilitating collaboration.

Measuring Performance in Hospitals: The Development of an Operational Dashboard to Coordinate and Optimize Patient, Material and Information Flows

Currently, many Western countries are seeking ways to increase the efficiency and quality of health care. These efforts reflect stakeholders’ expectations of improving performance in response to two important challenges. First, health care expenditures rise continuously and question the financial sustainability of current delivery systems. Secondly, health care systems suffer from unexplained variability and gaps in the quality of the patient-centered care. To make hospitals more patient-centered it is necessary to intervene on patient flow logistics. This assumes an integrated view on patient, material and information flows to align the different steps in the care process with the supporting processes and the required resources. Consequently, the development of process-oriented performance measurement systems is crucial. Most performance measures in hospitals are not process-oriented at the moment and cannot help a health care system to better synchronize the patient, material and information flows. This research describes a method to develop a reliable and valid set of both quality-focused and process-oriented key performance indicators and applies the findings to a case study on the process of hip replacement patients taking the opinion of internal stakeholders into account.