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The SIGLIC system for improving the access to surgery in Portugal
Abstract
This paper describes the design and first results of an information system (SIGLIC) that supports the new integrated management program (SIGA) to improve the access to surgery in Portugal. SIGIC, the Ministry of Health's agency responsible for access to surgery management, started re-thinking the system in 2005 by redefining key processes and workflows. The designed information system SIGLIC integrates all hospitals with surgery with every other hospital, where it picks the data to allow the search for optimal solutions for each patient. In the context of SIGIC (Waiting List for Surgery's Integrated Management System) "access" means to assure the treatment by services in terms of quality, standards, equity, process and transparency. The existence of a significant number of patients waiting for treatment that exceed the clinical acceptable times has ominous consequences not only for the individuals (increasing suffering, reduce treatment success, more complex treatments) but also for the society (more expensive use of resources, higher absenteeism, etc), which made the government to create SIGIC program. SIGIC's goals are to reduce waiting time for surgery, to apply identical standards to all patients, to profit from good use of resources and, to create a national structure of homogeneous information based in a system of data collection. The methodology followed was to: a) "survey of information systems and technology in Demand/Supply/Resources" b) "institutionalization and monitoring of procedural standards for management of the Waiting List for Surgery (WLS)", c) provide "evaluation by results" and, d) "Correction of deviations to the standard". To fulfill SIGIC's objectives it was created a management model (SIGA) and SIGLIC to support it. By now 57 public hospitals and 96 private clinics and hospitals (with convention in SIGIC) had joined the SIGIC network. The Information model include the following items: information on patients and events to allow "Process management", "clinical information" for "Disease Management" and "financial data" to allow management between the health units, from which data is gathered to improve access management. The information is recorded by hospitals in accordance with a set of standards and integrated into the central database of SIGIC. The quality of integrated information from the hospitals is guaranteed by a set of tools to validate its consistency, rejecting non-compliant data. The information is recorded in hospitals throughout the process of managing the patient on WLS and integrated daily in the central database. The results since 2005 show the importance of an integrated information system to overcome the bureaucracy: There was a 36% improvement in number of scheduled surgical episodes and 60% reduction in days on waiting time.
... The main goals of SIGIC were to: (1) reduce waiting times, (2) ensure equity of access, (3) promote overall efficiency of the system, and (4) provide information quality and transparency [26]. ...
Objective:
This paper evaluates the gender gap in waiting times for scheduled surgery, using information on 2.6 million surgical episodes in Portuguese National Health Service hospitals covering the period from 2011 to 2015.
Methodology:
We estimated the gross gender gap, i.e., the differential between the waiting times of men and women, and then add several explanatory variables that can account for this difference to estimate an adjusted gender gap. The variables are added in a way that permits the most flexible parametric specification. Next, we used Gelbach’s decomposition to understand the contribution of each variable to the difference between the gross and the adjusted gender gaps.
Results:
The gross gender gap of 10% is reduced to a 3% adjusted gender gap after accounting for observable explanatory factors. Gelbach’s decomposition shows that patient priority and hospital-fixed effects are the variables that contribute the most to the explained component of the gap. The analysis suggests that men tend to be ranked with more severe priorities, and that there are hospital specificities that cause men to have shorter waiting times.
Conclusions:
Overall, we identified a gender bias against women in surgery waiting times, but the size of the bias is smaller than was previously suggested in the literature.
... 71 Besides that, management methodologies can provide an additional understanding of the dynamics of an organization to better align the design of new pharmacy services with operations. 46,72,73 Limitations This was an exploratory study involving four pharmacies to elicit potential barriers and opportunities to improve pharmaceutical services provision. It can be argued that to improve evidence strength, a larger number of pharmacies needed to be included. ...
Background:
Primary health care disease management models are rooted in multidisciplinary participation; however, implementation of services is lagging behind desires and predictions. Barriers like workload and lack of demand have been described. The aim of this research is to observe the workload and work patterns of Portuguese community pharmacists, and relate it with the demand of pharmaceutical services.
Method:
A time-and-motion observational study was performed to describe community pharmacists' workload in a sample of four pharmacies in the metropolitan Lisbon area. A reference list of activities to be observed was developed by reviewing other studies of community pharmacy work. This study took place during a weekday's 8-h shift, focusing on pharmacists' activities. Data to be collected included the type and duration of the activity, who performed it and where. To estimate the demand of pharmaceutical care services, "thematic-patient scenarios" were developed. These scenarios were based on the defined daily dose and package size of the most consumed medicines in Portugal, combined with data obtained from the four pharmacies' information systems on the day the observational study took place.
Results:
Between 67.0% and 81.8% of the registered activities were pharmacist-patient interactions. These interactions summed 158.44 min, with a mean duration of 3.98 min per interaction. On average, participant pharmacies' professionals handled 4.2 prescriptions and 0.9 over-the-counter (OTC) consultations per hour. About one third of the day was spent performing administrative and non-differentiated tasks. About 54.92 min were registered as free time, 50% of which were "micro pauses" with 1 min or less. The most dispensed therapeutic subgroup was antihypertensive drugs, while the dispensation of antidiabetics was characterized by a high number of packages sold per interaction. From the developed scenarios, one can estimate that a chronic patient may visit the pharmacy 4-9 times per year, depending on the condition presented.
Conclusion:
Workload results are very similar to findings from studies in other countries, which may be an indication of uniformity of community pharmacy practice across countries. The amount of time a pharmacist has at the counter to interact with a patient during a year renders disease management or therapeutic management non-viable. Also, the perception of "lack of time," many times reported as a barrier for service provision, must be called into question, since substantial available time was found. However, to turn this available time into usable time, redesign of work processes and new role definition are necessary. Both better management and new communication channels should be developed to address this gap and increase patient follow-up services.
Background
Patient flow describes the progression of patients along a pathway of care such as the journey from hospital inpatient admission to discharge. Poor patient flow has detrimental effects on health outcomes, patient satisfaction and hospital revenue. There has been an increasing adoption of health information systems (HISs) in various healthcare settings to address patient flow issues, yet there remains limited evidence of their overall impacts.
Objective
To systematically review evidence on the impacts of HISs on patient flow management including what HISs have been used, their application scope, features, and what aspects of patient flow are affected by the HIS adoption.
Methods
A systematic search for English-language, peer-review literature indexed in MEDLINE and EMBASE, CINAHL, INSPEC, and ACM Digital Library from the earliest date available to February 2022 was conducted. Two authors independently scanned the search results for eligible publications, and reporting followed the PRISMA guidelines. Eligibility criteria included studies that reported impacts of HIS on patient flow outcomes. Information on the study design, type of HIS, key features and impacts was extracted and analysed using an analytical framework which was based on domain-expert opinions and literature review.
Results
Overall, 5996 titles were identified, with 44 eligible studies, across 17 types of HIS. 22 studies (50%) focused on patient flow in the department level such as emergency department while 18 studies (41%) focused on hospital-wide level and four studies (9%) investigated network-wide HIS. Process outcomes with time-related measures such as ‘length of stay’ and ‘waiting time’ were investigated in most of the studies. In addition, HISs were found to address flow problems by identifying blockages, streamlining care processes and improving care coordination.
Conclusion
HIS affected various aspects of patient flow at different levels of care; however, how and why they delivered the impacts require further research.
Aim:
To describe the development and implementation of a person-centered endoscopy safety checklist and to evaluate the effects of a "checklist intervention".
Methods:
The checklist, based on previously published safety checklists, was developed and locally adapted, taking patient safety aspects into consideration and using a person-centered approach. This novel checklist was introduced to the staff of an endoscopy unit at a Stockholm University Hospital during half-day seminars and team training sessions. Structured observations of the endoscopy team's performance were conducted before and after the introduction of the checklist. In addition, questionnaires focusing on patient participation, collaboration climate, and patient safety issues were collected from patients and staff.
Results:
A person-centered safety checklist was developed and introduced by a multi-professional group in the endoscopy unit. A statistically significant increase in accurate patient identity verification by the physicians was noted (from 0% at baseline to 87% after 10 mo, P < 0.001), and remained high among nurses (93% at baseline vs 96% after 10 mo, P = nonsignificant). Observations indicated that the professional staff made frequent attempts to use the checklist, but compliance was suboptimal: All items in the observed nurse-led "summaries" were included in 56% of these interactions, and physicians participated by directly facing the patient in 50% of the interactions. On the questionnaires administered to the staff, items regarding collaboration and the importance of patient participation were rated more highly after the introduction of the checklist, but this did not result in statistical significance (P = 0.07/P = 0.08). The patients rated almost all items as very high both before and after the introduction of the checklist; hence, no statistical difference was noted.
Conclusion:
The intervention led to increased patient identity verification by physicians - a patient safety improvement. Clear evidence of enhanced person-centeredness or team work was not found.
Primary health care (PHC) is acknowledged as strategic means to improve
access to health care and, at the same time, to address the issues
of rising costs and users’ quality expectations. The paper gives an overview
of the last 50 years of PHC reform in Portugal and provides the
background for understanding the role of the various reform and implementation
strategies from the perspective of policy making and change
management. Kingdon’s »three streams« theory of policy development
was used to analyze and identify the cycles of policy making during the
reform process. This theory helps defi ning the relevance of individuals,
institutions, and leadership for successful reforms that have to make
use of appropriate windows of opportunity. The paper depicts highlights
of the PHC reform in Portugal implemented as a set of focused
reforms or »reform waves«
To diagnose the hospital information systems' situation in Portugal.
Developing a survey on HIS department heads.
Several weaknesses were identified in most HIS departments, such as substantial lack of people and of qualifications to deal with HIS challenges. The Nolan and McFarlan Matrix helped assess the SNS IS maturity at stage 3, characterized by the generalized lack of IS integration.
The results are very relevant to explain the many delays (and conflicts) in implementing HIS and therefore the actual status of HIS in Portugal. The most successful cases of HIS implementation were recognized as related to the existence of an active CIO. Complexity theory can further define guidelines for the development of HIS that help keep the navigation towards "smart healthcare".