The implementation and impacts of the Comprehensive Care Standard in Australian acute care hospitals: a survey study.


Journal

BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677

Informations de publication

Date de publication:
11 Jul 2024
Historique:
received: 15 10 2023
accepted: 26 06 2024
medline: 12 7 2024
pubmed: 12 7 2024
entrez: 11 7 2024
Statut: epublish

Résumé

Comprehensive care (CC) is becoming a widely acknowledged standard for modern healthcare as it has the potential to improve health service delivery impacting both patient-centred care and clinical outcomes. In 2019, the Australian Commission on Safety and Quality in Health Care mandated the implementation of the Comprehensive Care Standard (CCS). However, little is known about the implementation and impacts of the CCS in acute care hospitals. Our study aimed to explore care professionals' self-reported knowledge, experiences, and perceptions about the implementation and impacts of the CCS in Australian acute care hospitals. An online survey using a cross-sectional design that included Australian doctors, nurses, and allied health professionals in acute care hospitals was distributed through our research team and organisation, healthcare organisations, and clinical networks using various methods, including websites, newsletters, emails, and social media platforms. The survey items covered self-reported knowledge of the CCS and confidence in performing CC, experiences in consumer involvement and CC plans, and perceptions of organisational support and impacts of CCS on patient care and health outcomes. Quantitative data were analysed using Rstudio, and qualitative data were analysed thematically using Nvivo. 864 responses were received and 649 were deemed valid responses. On average, care professionals self-reported a moderate level of knowledge of the CCS (median = 3/5) and a high level of confidence in performing CC (median = 4/5), but they self-reported receiving only a moderate level of organisational support (median = 3/5). Only 4% (n = 17) of respondents believed that all patients in their unit had CCS-compliant care plans, which was attributed to lack of knowledge, motivation, teamwork, and resources, documentation issues, system and process limitations, and environment-specific challenges. Most participants believed the CCS introduction improved many aspects of patient care and health outcomes, but also raised healthcare costs. Care professionals are confident in performing CC but need more organisational support. Further education and training, resources, multidisciplinary collaboration, and systems and processes that support CC are needed to improve the implementation of the CCS. Perceived increased costs may hinder the sustainability of the CCS. Future research is needed to examine the cost-effectiveness of the implementation of the CCS.

Sections du résumé

BACKGROUND BACKGROUND
Comprehensive care (CC) is becoming a widely acknowledged standard for modern healthcare as it has the potential to improve health service delivery impacting both patient-centred care and clinical outcomes. In 2019, the Australian Commission on Safety and Quality in Health Care mandated the implementation of the Comprehensive Care Standard (CCS). However, little is known about the implementation and impacts of the CCS in acute care hospitals. Our study aimed to explore care professionals' self-reported knowledge, experiences, and perceptions about the implementation and impacts of the CCS in Australian acute care hospitals.
METHODS METHODS
An online survey using a cross-sectional design that included Australian doctors, nurses, and allied health professionals in acute care hospitals was distributed through our research team and organisation, healthcare organisations, and clinical networks using various methods, including websites, newsletters, emails, and social media platforms. The survey items covered self-reported knowledge of the CCS and confidence in performing CC, experiences in consumer involvement and CC plans, and perceptions of organisational support and impacts of CCS on patient care and health outcomes. Quantitative data were analysed using Rstudio, and qualitative data were analysed thematically using Nvivo.
RESULTS RESULTS
864 responses were received and 649 were deemed valid responses. On average, care professionals self-reported a moderate level of knowledge of the CCS (median = 3/5) and a high level of confidence in performing CC (median = 4/5), but they self-reported receiving only a moderate level of organisational support (median = 3/5). Only 4% (n = 17) of respondents believed that all patients in their unit had CCS-compliant care plans, which was attributed to lack of knowledge, motivation, teamwork, and resources, documentation issues, system and process limitations, and environment-specific challenges. Most participants believed the CCS introduction improved many aspects of patient care and health outcomes, but also raised healthcare costs.
CONCLUSION CONCLUSIONS
Care professionals are confident in performing CC but need more organisational support. Further education and training, resources, multidisciplinary collaboration, and systems and processes that support CC are needed to improve the implementation of the CCS. Perceived increased costs may hinder the sustainability of the CCS. Future research is needed to examine the cost-effectiveness of the implementation of the CCS.

Identifiants

pubmed: 38992627
doi: 10.1186/s12913-024-11252-0
pii: 10.1186/s12913-024-11252-0
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

800

Subventions

Organisme : National Health and Medical Research Council of the Australian Government
ID : APP1140459

Informations de copyright

© 2024. The Author(s).

Références

Lloyd HM, Pearson M, Sheaff R, Asthana S, Wheat H, Sugavanam TP, Britten N, Valderas J, Bainbridge M, Witts L, et al. Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care. Health Res Policy Syst. 2017;15(1):98–98.
doi: 10.1186/s12961-017-0263-z pubmed: 29166917 pmcid: 5700670
Van Den Ende ES, Schouten B, Kremers MNT, Cooksley T, Subbe CP, Weichert I, Van Galen LS, Haak HR, Kellett J, Alsma J et al. Understanding what matters most to patients in acute care in seven countries, using the flash mob study design. BMC Health Serv Res 2021, 21(1).
Afilalo M, Xue X, Soucy N, Colacone A, Jourdenais E, Boivin JF. Patient needs, required level of Care, and reasons delaying Hospital Discharge for Nonacute patients occupying Acute Hospital beds. J Healthc Qual. 2017;39(4):200–10.
doi: 10.1111/jhq.12076 pubmed: 28658090
Hirshon JM, Risko N, Calvello EJ, Stewart De Ramirez S, Narayan M, Theodosis C, O’Neill J. Health systems and services: the role of acute care. Bull World Health Organ. 2013;91(5):386–8.
doi: 10.2471/BLT.12.112664 pubmed: 23678202 pmcid: 3646345
Hopman P, de Bruin SR, Forjaz MJ, Rodriguez-Blazquez C, Tonnara G, Lemmens LC, Onder G, Baan CA, Rijken M. Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: a systematic literature review. Health Policy. 2016;120(7):818–32.
doi: 10.1016/j.healthpol.2016.04.002 pubmed: 27114104
Grimmer K, Kennedy K, Fulton A, Guerin M, Uy J, Wiles L, Carroll P. Does comprehensive care lead to improved patients outcomes in acute care settings? An Evidence Check rapid review. In. Sydney: The Sax Institute (www.saxinstitute.org.au) for the ACSQHC; 2015.
Profile of Australia’s population [ https://www.aihw.gov.au/reports/australias-health/profile-of-australias-population ].
Chronic conditions and multimorbidity. [ https://www.aihw.gov.au/reports/australias-health/chronic-conditions-and-multimorbidity ].
The Australian health system [ https://www.health.gov.au/about-us/the-australian-health-system ].
Health system overview [ https://www.aihw.gov.au/reports/australias-health/health-system-overview ].
ACSQHC. National Safety and Quality Health Sevice Standards. 2nd ed. In. Sydney: ACSQHC; 2021.
Xiong B, Stirling C, Martin-Khan M. The implementation and impacts of national standards for comprehensive care in acute care hospitals: an integrative review. Int J Nurs Sci 2023.
ACSQHC. Implementing the Comprehensive Care Standard-A Conceptual Model for Supporting Comprehensive Care Delivery. In. Sydney: ACSQHC; 2018.
Murgo M, Dalli A. Australian health service organisation assessment outcome data for the first 2 years of implementing the Comprehensive Care Standard. Aust Health Rev. 2022;46(2):210–6.
doi: 10.1071/AH21299 pubmed: 35235765
ACSQHC. Comprehensive Care Standard: review of implementation. In. Sydney: ACSQHC; 2022.
Roohi G, Mahmoodi G, Khoddam H. Knowledge implementation in health care management: a qualitative study. BMC Health Serv Res 2020, 20(1).
Xiong B, Stirling C, Martin-Khan M. Implementation Challenges and Impacts of the Comprehensive Care Standard in Australian Acute Care Hospitals: Protocol for a Mixed-Method Study. In: 20th National Conference of Emerging Researchers in Ageing: 2022; 2022: 91.
Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, Huy NT, Marušić A, Paul CL, Kwok J, et al. A Consensus-based checklist for reporting of Survey studies (CROSS). J Gen Intern Med. 2021;36(10):3179–87.
doi: 10.1007/s11606-021-06737-1 pubmed: 33886027 pmcid: 8481359
Modified Monash Model. [ https://www.health.gov.au/topics/rural-health-workforce/classifications/mmm ].
Hill R. What sample size is enough in internet survey research? Interpers Comput Technol Electron J 21st Century. 1998;6(3):1–10.
Weisberg HF, Krosnick JA, Bowen BD. An introduction to survey research and data analysis. 2nd ed. Glenview, IL, US: Scott, Foresman & Co; 1989.
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101.
doi: 10.1191/1478088706qp063oa
Clarke V, Braun V, Hayfield N. Thematic analysis. Qualitative Psychology: Practical Guide Res Methods. 2015;222(2015):248.
Health workforce [ https://www.aihw.gov.au/reports/workforce/health-workforce ].
Albright K, Navarro EI, Jarad I, Boyd MR, Powell BJ, Lewis CC. Communication strategies to facilitate the implementation of new clinical practices: a qualitative study of community mental health therapists. Transl Behav Med. 2022;12(2):324–34.
doi: 10.1093/tbm/ibab139 pubmed: 34791490
Vaismoradi M, Tella S, Khakurel PAL, Vizcaya-Moreno J. F: Nurses’ Adherence to Patient Safety Principles: A Systematic Review. Int J Environ Res Public Health 2020, 17(6).
Drummond C, Simpson A. Who’s actually gonna read this?’ An evaluation of staff experiences of the value of information contained in written care plans in supporting care in three different dementia care settings. J Psychiatr Ment Health Nurs. 2017;24(6):377–86.
doi: 10.1111/jpm.12380 pubmed: 28238207
Clay-Williams R, Plumb J, Luscombe GM, Hawke C, Dalton H, Shannon G, Johnson J. Improving teamwork and patient outcomes with daily structured interdisciplinary bedside rounds: a multimethod evaluation. J Hosp Med. 2018;13(5):311–7.
doi: 10.12788/jhm.2850 pubmed: 29698537
Paterson C, Roberts C, Bail K. Paper care not patient care’: nurse and patient experiences of comprehensive risk assessment and care plan documentation in hospital. J Clin Nurs. 2022;32(3–4):523–38.
pubmed: 35352417 pmcid: 10084263
Russell CK, McNeill M. Implementing a Care Plan System in a Community Hospital Electronic Health Record. Comput Inf Nurs. 2023;41(2):102–9.
Eden R, Burton-Jones A, Staib A, Sullivan C. Surveying perceptions of the early impacts of an integrated electronic medical record across a hospital and healthcare service. Aust Health Rev. 2020;44(5):690.
doi: 10.1071/AH19157 pubmed: 32907698
Dykes PC, DaDamio RR, Goldsmith D, Kim HE, Ohashi K, Saba VK. Leveraging standards to support patient-centric interdisciplinary plans of care. AMIA Annu Symp Proc. 2011;2011:356–63.
pubmed: 22195088 pmcid: 3243254
Ramoo V, Kamaruddin A, Wan Nawawi WNF, Che CC, Kavitha R. Nurses’ perception and satisfaction toward Electronic Medical Record System. Florence Nightingale J Nurs. 2023;31(1):2–10.
pubmed: 36751711 pmcid: 10081040
Zhang S, Kong X, Lamb KV, Wu Y. High nursing workload is a main associated factor of poor hand hygiene adherence in Beijing, China: an observational study. Int J Nurs Pract. 2019;25(2):e12720.
doi: 10.1111/ijn.12720 pubmed: 30609173
Jam R, Mesquida J, Hernández Ó, Sandalinas I, Turégano C, Carrillo E, Pedragosa R, Valls J, Parera A, Ateca B, et al. Nursing workload and compliance with non-pharmacological measures to prevent ventilator-associated pneumonia: a multicentre study. Nurs Crit Care. 2018;23(6):291–8.
doi: 10.1111/nicc.12380 pubmed: 30182383
Farmer J, Bigby C, Davis H, Carlisle K, Kenny A, Huysmans R. The state of health services partnering with consumers: evidence from an online survey of Australian health services. BMC Health Serv Res 2018, 18(1).
Dalton J, Chambers D, Harden M, Street A, Parker G, Eastwood A. Service user engagement in health service reconfiguration: a rapid evidence synthesis. J Health Serv Res Policy. 2016;21(3):195–205.
doi: 10.1177/1355819615623305 pubmed: 26689536
Wiles LK, Kay D, Luker JA, Worley A, Austin J, Ball A, Bevan A, Cousins M, Dalton S, Hodges E, et al. Consumer engagement in health care policy, research and services: a systematic review and meta-analysis of methods and effects. PLoS ONE. 2022;17(1):e0261808.
doi: 10.1371/journal.pone.0261808 pubmed: 35085276 pmcid: 8794088
Shnaigat M, Downie S, Hosseinzadeh H. Effectiveness of patient activation interventions on chronic obstructive pulmonary disease self-management outcomes: a systematic review. Aust J Rural Health. 2022;30(1):8–21.
doi: 10.1111/ajr.12828 pubmed: 35034409

Auteurs

Beibei Xiong (B)

Centre for Health Services Research, The University of Queensland, Brisbane, QLD, 4102, Australia. Beibei.Xiong@uq.edu.au.

Christine Stirling (C)

School of Nursing, University of Tasmania, Hobart, TAS, 7000, Australia.

Daniel X Bailey (DX)

Centre for Health Services Research, The University of Queensland, Brisbane, QLD, 4102, Australia.
Centre for Clinical Research, The University of Queensland, Brisbane, QLD, 4102, Australia.

Melinda Martin-Khan (M)

Centre for Health Services Research, The University of Queensland, Brisbane, QLD, 4102, Australia.
Department of Health and Life Sciences, University of Exeter, EX1 2HZ, Exeter, England, United Kingdom.
School of Nursing, University of Northern British Columbia, British Columbia, V2N 4Z9, Prince George, Canada.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH