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Biomedical subjects

Irene Fraser

Publications and source records attributed to Irene Fraser.

7 recordsLinked to original sources
PubMed2006

Redesigning health systems for quality: Lessons from emerging practices.

BACKGROUND: It has been five years since the Institute of Medicine (IOM) report, Crossing the Quality Chasm, proposed systemwide changes to transform our health care system. What progress has been made? What lessons have been learned? How should we move forward? METHODS: Semistructured telephone interviews were conducted with 16 health care providers and researchers at organizations involved in system redesign. The findings were supplemented with a focused literature review and discussions from a national expert meeting. RESULTS: Many promising and innovative examples of redesign were identified. However, even delivery systems that are redesigning care in pursuit of the six IOM aims face daunting challenges, reflecting the need to align system changes across multiple levels and to integrate redesign efforts with ongoing system features. Four success factors were reported by providers as crucial in overcoming redesign barriers: (1) directly involving top and middle-level leaders, (2) strategically aligning and integrating improvement efforts with organizational priorities, (3) systematically establishing infrastructure, process, and performance appraisal systems for continuous improvement, and (4) actively developing champions, teams, and staff. A framework that integrates these success factors to facilitate a systems approach to redesigning health care organizations and delivery systems for improved performance is provided. CONCLUSIONS: Successful system redesign requires coordinating and managing a complex set of changes across multiple levels rather than isolated projects.

Attitude of Health Personnel↗
PubMed2004

Organizational research with impact: working backwards.

BACKGROUND OR RATIONALE: To improve health care, we need to improve the organization of care, along with the payment systems that shape organizational priorities and behavior. The opportunity and challenge for research are to find a way to work with health care leadership so that future management decisions can make use of strong evidence. AIMS AND METHODS: This article uses findings from research on nursing to illustrate the potential for organizational research and management research to improve health care. It then distills recommendations from six focused stakeholder meetings to identify five ways in which we might improve organizational, management, and policy research to maximize its use. RESULTS AND DISCUSSION: Hospital, health plan, and other system leaders have five recommendations for research: (1) Design studies that answer user questions, with a focus on the "why" and "what if" rather than just the "what." (2) Present findings in leaders' time and space, defining evidence as they do and identifying generalizability of findings. (3) Change the incentive system for researchers so that they are rewarded for the activities that maximize impact on decision making. (4) Build user-researcher collaborations and dialogue. (5) Change the way we disseminate evidence, with dissemination through "early adopters," trade association meetings, consultants, etc. IMPLICATIONS FOR RESEARCH, PRACTICE, AND POLICY: System and policy leaders control important levers for improving health care, since they shape organizational structure, processes and culture, payment strategies, program design, and regulation. Just as evidence-based medicine can improve clinical practice, evidence-based management and policymaking can change how these powerful levers are used. But for evidence to inform the decisions of system and policy leaders, we will need to rethink and restructure the research enterprise itself, bringing the potential users of evidence into the production process.

Communication↗
PubMed2004

Translation research: where do we go from here?

AIM: Where do we go from here? This article draws on other articles in this supplement, the dialogue from the meeting that generated it, and other sources to identify steps to advance translation research, and in particular to achieve broader translation and use of evidence. IMPLICATIONS: To move from the growing accumulation of individual successes in translation to broader scale translation and implementation of evidence, those who use research and those who do research will need to do four things: (1) increase synergy and synchronization across studies, through cross-disease studies, adoption of a common and precise language to describe interventions, addressing issues of customization of interventions, and finding commonality in quality and outcomes measures; (2) take account of organizational factors that can shape the impact of interventions, and also move to the implementation of organizational evidence; (3) address environmental factors such as reimbursement and market competition; and (4) take findings to a larger scale through national demonstrations, efforts of national agents of change, challenge or partnership grants, or use of provider-based networks.

Diffusion of Innovation↗
PubMed2002

Reducing disparities through culturally competent health care: an analysis of the business case.

Finding ways to deliver high-quality health care to an increasingly diverse population is a major challenge for the American health care system. The persistence of racial and ethnic disparities in health care access, quality, and outcomes has prompted considerable interest in increasing the cultural competence of health care, both as an end in its own right and as a potential means to reduce disparities. This article reviews the potential role of cultural competence in reducing racial and ethnic health disparities, the strength of health care organizations' current incentives to adopt cultural competence techniques, and the limitations inherent in these incentives that will need to be overcome if cultural competence techniques are to become widely adopted.

Cost-Benefit Analysis↗
PubMedDate not supplied

Volume thresholds and hospital characteristics in the United States.

Procedure volume has been used as a proxy for quality and recommended as a basis for hospital referrals. We studied the volume, mortality, and associated hospital and staffing characteristics of ten complex procedures in U.S. hospitals using the 2000 HCUP Nationwide Inpatient Sample. Although the majority of patients had their procedures performed in high-volume hospitals, for seven procedures, more than three-fourths of hospitals would be considered low-volume. Unadjusted mortality rates were significantly higher at low-volume hospitals for five procedures. Low-volume hospitals also tended to have lower mean numbers of residents and RNs. However, for two procedures, low-volume hospitals had RN and resident staffing equal to or higher than those of high-volume hospitals, and the unadjusted mortality rates were no different.

Geography↗
PubMedDate not supplied

Crossing the language chasm.

The quality of communication between patients and clinicians can have a major impact on health outcomes, and limited English proficiency can interfere with effective communication. More than ten million U.S. residents speak English poorly or not at all, constituting a language chasm in the health care system. This paper reviews the evidence on the link between linguistic competence and health care quality and the impact of particular language-assistance strategies. Drawing on the experiences of fourteen health plans that have been at the forefront of linguistic competence efforts, we identify lessons for plans, purchasers, policymakers, and researchers on ways to improve the availability and quality of interpreter services.

Communication Barriers↗