Asia-Pacific Journal of Health Management (ACHSM)
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Understanding Pharmacist Communication and Medication Errors: A Systematic Literature Review
Get PDFObjective: To better understand the inter-professional clinical communication between pharmacists, other health professionals and medication errors.
Methods: This research study used a systematic literature review approach by searching online databases including Medline, PubMed and CINHAL to understand the relationship between pharmacist clinical communication and medication errors. The results of this study show that from 1158 studies that were screened and assessed, only 454 studies were initially selected after the application of inclusion and exclusion criteria. A PRISMA chart and descriptive analysis was used to present the result.
Results: The results concluded that of the 18 studies, 17 showed a relationship between communication and medication errors, while only one study indicated no relationship. Thematic synthesis was used to classifythe result of the 17 studies. The result was classified into five general themes based on the literature review and similarity among the studies.
Conclusions: This systematic literature review investigated the interrelationship between communication and medication errors. In regards to patient safety, the research highlights that structured communication iseffective in preventing medication errors. These errors can occur within the medication management cycle at any point of the drug distribution chain. This is due to the involvement of different health professionals, anddifferent steps in the cycle from the correct prescription through to correct administration. Thus, to effectively prevent medication errors and reduce the rate of patient harm, structured communication (verbally andnon-verbally) is highly recommended.
Abbreviations: GP – General Practitioner; SLR – Systematic Literature Revie
Launching Hong Kong’s Healthcare Financing Reform: why continued inaction? 87
No full textHong Kong has sought without progress in the past 25 years to introduce reform proposals to enhance the long-term financial sustainability of its healthcare system. Through a systematic review of the consultation documents released over the years, this paper examines what might have been done right or wrong and pinpoints lessons learned for healthcare leaders, executives and reformers facing looming opportunities for reform. The findings suggest that the phased-approach of introducing reform options, involving step-by-step public consultations, to engaging the community to give their views on the healthcare financing reform options has not been effective. Other factors, including changes in the stewardship of the reform initiatives and the top-down elitist-led preparations of pre-launch work, added to the resultant inaction of not taking any of the reform proposals forward for launch and to produce reform. The study proposes that a broadly participatory approach, involving a wider base of members of the community in an inclusive guiding coalition charged to drive the reform from prelaunch to implementation, be undertaken. This coalition should start afresh and, based on renewed evidencebased assessments of the need and urgency of reform, proceed accordingly to formulate, if indicated, an overarching healthcare financing reform agenda that motivates people with conflicting interests to take mutually beneficial actions or that gives stakeholders the right incentives to work effectively together
Implementation of Shared Decision-Making in Australia
Get PDFShared decision-making (SDM) is the process of clinicians and patients participating jointly in making healthcare decisions, having discussed evidence-based treatment options and the potential risks and benefits of each option, taking into consideration the patient’s individual preferences and values. SDM is ubiquitous in Australian healthcare policy. While there is good evidence for utilising SDM, clinicians’ knowledge of SDM, the current uptake, effectiveness and acceptability of SDM in Australia is largely unknown. The challenges perceived by clinicians to implementing SDM in clinical practice and potential moral, legal and ethical dilemmas require further debate and consideration.
Abbreviations: SDM – Shared Decision-Making
Addressing Health Insurance Deductions through an Interventional Study: the Case of a Large Central Hospital
Get PDFObjective: A large proportion of hospitals’ private income is provided by insurance organisations. Hospitals in Iran face various problems in terms of insurance deductions from insurance organisations resulting from inefficient performance by both the hospitals and the insurers. These problems necessitate more specific cost control in this area. This research assesses the causes of insurance deductions by using the Failure Mode Effects Analysis (FMEA) technique, and addresses the issues resulting in deductions by providing some interventions through the Pareto technique.
Design: The 10-step pattern of FMEA was implemented for assessing the main causes of insurance deduction in this study.
Setting: Data was collected from deduced amounts by three main/largest contracting party insurance organisations (e.g. the Social Security Insurance Organisation, Medical Services Insurance Organisation and Armed Forces Medical Services Insurance Organisation of Namazi Hospital, a large healthcare provider in the South of Iran, in 2014.
Findings: Sixty-five potential failure causes were identified, of which 26 were related to the anaesthesia unit, 23 were related to the surgery room unit and 16 were related to the hospitalisation unit. Deductions in the anaesthesia and hospitalisation units and the surgery room were reduced after intervention programs by 14.42%, 57.76%, and 51.52%, respectively.
Conclusions: Using the FMEA technique in a large healthcare provider in Iran resulted in identifying the main causes of insurance deductions and provided intervention programs in order to increase the efficiency and productivity of healthcare services.
Abbreviations: FMEA – Failure Mode Effects Analysis; RPN – Risk Priority Number
Health Workforce Migration in the Asia Pacific: implications for the achievement of sustainable development goals
Get PDFThe maldistribution of health workers globally and within the Asia Pacific region remains problematic. While globalisation, and the increasing mobility of capital and labour, helps to reduce inequalities between countries, it increases inequality within countries. This study examines health workforce data and densities in the Asia Pacific region through a health workforce migration lens. The main implication relevant to achievement of sustainable development goals is the need for countries to work in a co-ordinated way in this region to increase substantially health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing states, most notably the Maldives, Timor- Leste, Kiribati, Samoa, Solomon Islands, Tuvalu and Vanuatu.
Abbreviations: OECD – Organisation of Economic Co-operation and Development; SDG – Sustainable Development Goals; SIDS – Small Island Development States
Healthcare System Restructuring in New Zealand: problems and proposed solutions
Get PDFNew Zealand’s healthcare system is, like most, in a continual process of restructuring and change. While the country has endured several major system-wide changes in recent decades, more recent change has been incremental and evolutionary. Current changes are in response to a set of challenges, which are not unique to New Zealand. This article overviews the New Zealand healthcare system. It then describes a series of problems facing the system and proposed solutions. These include the need for team care, providing services closer to patients’ homes, focusing on a population of interest, connecting up the system, and engaging patients more closely in care design and delivery.
Abbreviations: DHS – District Health Board;GP – General Practitioner; PHO – Primary Health Organisation
Financing Healthcare in Indonesia
Get PDFIntroduction: There have been two major transitions for healthcare in Indonesia: the implementation of government decentralisation and universal health insurance. A universal public health insurance called Badan Penyelenggara Jaminan Sosial (BPJS) was launched in January 2014 and aims to cover all Indonesian people.
Objective: The objective of this paper is to discuss the funding of healthcare in Indonesia through a comparison with other South East Asian countries.
Methodology: A search for relevant literature was undertaken using electronic databases, Ovid Medline, ProQuest Central, and Scopus from their commencement date until December 2015. The grey literature from the Indonesian government, the WHO’s and World Bank’s website, has been included.
Results: There were nine articles from Ovid Medline, eight from ProQuest Central, and 12 from Scopus that met the criteria. Seventeen articles were duplicates leaving 12 articles to be reviewed. Nine documents have been identified from grey literature.
Discussion: Most people in Indonesia sought health services from the private sector and were out-ofpocket financially or did not receive the required care. The private sector delivered 62.1% of health services compared to 37.9% by the government. Despite some inappropriate use of previous health insurance, the BPJS is expected to have improved management and will cover all citizens by the end of 2019.
Conclusion: Indonesia has undergone a series of changes to health system funding and health insurance. There are lessons that can be learnt from other countries, such as Thailand, Cambodia, and Vietnam, so that Indonesia can improve its health funding.
Abbreviations: BPJS – Badan Penyelenggara Jaminan Sosial
From Global to Local: strengthening district health systems management as entry point to achieve health-related sustainable development goals
Get PDFThailand has performed admirably in its health reform over the last few decades. Healthcare is provided at a relatively low cost and healthcare needs have transitioned to begin to address diseases and mortality of developed countries. The challenges now faced by Thailand are similar to most developed countries reflecting adult mortality and risk factors of an uppermiddle income population and the need to modify institutional structures to reflect these changing circumstances.
The approach to these challenges has focused on the ‘implementation of knowledge based health development’ and critically identifies ‘the triangle that moves the mountain’ (health reform) as a movement that mobilises; the creation of relevant knowledge, social movement and political involvement’ to address ‘inter-connected, complex and extremely difficult to solve’ problems. The move to District Health Systems as the access point to healthcare and the service delivery structure demands competent qualified leadership and management. It requires an understanding of the differences in managing professionally dominated complex adaptive systems compared to traditional approaches of managing within bureaucratic structures.
This can be best described as managing connected, integrated care focused both on individuals as patients and communities with a strong emphasis on primary healthcare, prevention and evidence-based practice. It also requires an understanding of how distributed networks of practice (DNOP) provide the potential for researchers, practitioners and other agencies and communities to collaborate, learn and improve healthcare across geographic, jurisdictional and organisational boundaries.
This approach provides recognition of the need to build the capacity and capability of health professionals in the management and leadership of health systems and Thailand is moving towards this goal in implementing specific health systems management curriculum which focuses on action-based research and learning together at the District health level augurs well for continued ability to address current health challenges and to achieve SDGs.
Abbreviations: DHS – District Health System; DNOP – Distributed Networks of Practice; HSRI – Health Systems Research Institute; MoPH – Ministry of Public Health; NHSO – National Health Security Office; SDG – Strategic Development Goal; UHC – Universal Health Coverage
Employability Skills in Health Services Management: perceptions of recent graduates
Get PDFBackground: Employer skill requirements of graduates are monitored by Graduate Careers Australia, but health services management (HSM) specific employability skills (ES) perceived by graduates to be important on the job and their perceptions of skills they need to improve are not well reported. Academics need this feedback to improve course employment outcomes by helping current students identify and articulate appropriatecompetencies to potential employers. Also teaching of industry requirements can help improve job matching for employers.
Method: Recent graduates working in HSM in New South Wales, Australia were surveyed to rate ES for importance and rate their own skill levels on the same items. The gap between these two ratings was identified for 44 ES. Results: ES important to recent graduates in rank order were: verbal communication skills, integrity and ethical conduct, time management, teamwork, priority setting, ability to work independently, organisational skills, written communication, being flexible and open minded and networking. Highest self-ratings were found for integrity and ethical conduct, ability to work independently, being flexible and open minded, tertiary qualifications, interpersonal skills, written communication skills, time management, life-long learning, priority setting and administration skills. Generally graduates rated their skills lower than their ratings of importance.
Conclusions: Recent graduates can provide valuable feedback to universities about ES required for HSM positions and identify their own skill gaps for development at work or through study. Generic skills rather than job-specific skills are what they rate as most important. Closer engagement of universities and employers is recommended especially through placements.
Abbreviations: ES – employability skills; GCA – Graduate Careers Australia; HEI – higher education institutions; HRM – human resource management; HSM – health services management; IPC – interpersonal and communication skills