0Research has shown that 95 percent of diets fail over the long term. Oddly enough, various studies show that 60 to 80 percent of major change initiatives also fail.
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In both cases, it is certainly not for lack of good intentions. For a person who has been on a successful diet, it is frustrating to see those pounds sneak back on. And it is just as frustrating for an organization which has implemented a major improvement initiative to have costs, errors or inefficiencies creep in again. This is the short-term-gain, long-term-wane syndrome.Why are both kinds of change not more successful?
Often, the failures can be traced to a few missing ingredients:. A fundamental acceptance or realignment in thinking. Appropriate guidance or knowledge.
Resistance to change is a common barrier to organizational learning. People who have been at their jobs for a long time and are set in their ways often don’t want to learn new processes. People who have been at their jobs for a long time and are set in their ways often don’t want to learn new processes. 4 Key Obstacles in Strategy Implementation and How to Overcome Them. To achieve success you’ll need to both formulate a good strategy and flawlessly execute that strategy. Here’s how to move past four key strategy execution obstacles. Developing a great strategy is a vital part of your business, but it certainly isn’t the only part.
Clear strategies and tactics for maintaining long-term resultsThe upside to past failures is that they usually provide some valuable lessons for the future. For instance, healthcare organizations currently contemplating Six Sigma or Lean as one aspect of transformation can learn from the experiences of others, both inside and outside the industry. While avoiding a “cookie cutter” approach to change initiatives, such examination can provide useful insight into what worked well, and what gaps may have been overlooked.
An Industry in Need of ChangeThough debate over specific solutions may continue, there seems to be widespread consensus for changes in healthcare in the United States to address inconsistencies in quality and efficiency. Some of the primary market forces serving as catalysts for change include the following:Patient Safety and Clinical Quality – The emphasis on quality and patient safety has not abated since the release of the Institute of Medicine’s 1999 report on medical errors. Recent reports shine an even harsher light on a “Swiss cheese” healthcare system that allows nearly 200,000 people to die needlessly each year.The Move Toward Digitization – Both for safety and efficiency improvements, the push to adopt information technology (IT) systems will continue, as patient care settings increasingly seek to go “filmless and paperless.” If this migration is to be successful, it must be accompanied by process adaptation and change management techniques that engender acceptance among staff and clinicians. Demographic Changes – Shifting demographics and an aging population will continue to impact healthcare in the United States, particularly for specialties such as cardiovascular services.
Healthcare workforce also is aging, with only 9.1 percent of all registered nurses (RNs) under the age of 30, and the average age 45.2 years.Workforce Issues – Workforce shortages – especially acute in certain regions and specialties – continue to strain the system.
BackgroundAccess to appropriate, affordable, acceptable and comprehensive primary health care (PHC) is critical for improving the health of Indigenous populations. Whilst appropriate infrastructure, sufficient funding and knowledgeable health care professionals are crucial, these elements alone will not lead to the provision of appropriate care for all Indigenous people. This systematic literature review synthesised international evidence on the factors that enable or inhibit the implementation of interventions aimed at improving chronic disease care for Indigenous people. MethodsA systematic review using Medical Literature Analysis and Retrieval System Online (MEDLINE) (PubMed platform), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Excerpta Medica Database (EMBASE), ATSIHealth, Australian Indigenous HealthInfoNet via Informit Online and Primary Health Care Research and Information Service (PHCRIS) databases was undertaken. Studies were included if they described an intervention for one or more of six chronic conditions that was delivered in a primary health care setting in Australia, New Zealand, Canada or the United States. Attitudes, beliefs, expectations, understandings and knowledge of patients, their families, Indigenous communities, providers and policy makers were of interest. Published and unpublished qualitative and quantitative studies from 1998 to 2013 were considered.
Qualitative findings were pooled using a meta-aggregative approach, and quantitative data were presented as a narrative summary. ResultsTwenty three studies were included. Meta-aggregation of qualitative data revealed five synthesised findings, related to issues within the design and planning phase of interventions, the chronic disease workforce, partnerships between service providers and patients, clinical care pathways and patient access to services. The available quantitative data supported the qualitative findings. Three key features of enablers and barriers emerged from the findings: (1) they are not fixed concepts but can be positively or negatively influenced, (2) the degree to which the work of an intervention can influence an enabler or barrier varies depending on their source and (3) they are inter-related whereby a change in one may effect a change in another. ConclusionsFuture interventions should consider the findings of this review as it provides an evidence-base that contributes to the successful design, implementation and sustainability of chronic disease interventions in primary health care settings intended for Indigenous people. Most Indigenous populations in colonised countries experience poor health outcomes relative to their non-Indigenous counterparts.
The poor health status of the Aboriginal and Torres Strait Islander population is well documented , with the life expectancy gap between Indigenous and non-Indigenous people one of contemporary Australia’s most enduring health divides. Among the Australian Indigenous population, chronic diseases (CDs) are the greatest contributor to these health disparities. For example, cardiovascular disease (CVD) is the single leading cause of death among Aboriginal and Torres Strait Islander people , and type 2 diabetes (T2DM) is at epidemic proportions.
Rates of chronic kidney disease (CKD) are also disproportionately higher among Aboriginal and Torres Strait Islander people compared with non-Indigenous Australians. Collectively, these conditions account for up to 50% of the life expectancy gap between Aboriginal and Torres Strait Islander and non-Indigenous Australians.The role of primary health care (PHC), as intended by the Declaration of Alma Ata, includes promoting health, preventing disease and managing the poor health of local populations by maximising the use of local resources.
Access to appropriate, affordable, acceptable and comprehensive PHC is critical for improving the health of Aboriginal and Torres Strait Islanders and Indigenous populations worldwide. In support of this, a recent study has shown that better access to PHC that is responsive to the needs of Aboriginal and Torres Strait Islander people has reduced the rates of avoidable hospitalisation among them.The success of PHC services relies not only on the provision of sufficient resources. Whilst appropriate infrastructure, sufficient funding and knowledgeable health care professionals are crucial, these elements alone will not lead to the provision of appropriate care for all Indigenous people. Low quality or racist treatment afforded to some Indigenous patients, for example, continues to discourage people from accessing services ,.
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Inclusion criteriaParticipants were Indigenous people of any age with a CD, their family or community members, PHC providers (doctors, nurses, administrators, Indigenous Health Workers (IHW)), and policy and decision makers working in Indigenous health. Studies were included if they involved an intervention for the management of CVD, CKD, chronic respiratory disease (CRD), T2DM, mental health conditions/depression, and/or HIV/AIDS. Interventions were implemented in PHC settings in Australia, New Zealand (NZ), Canada or the United States (US). For the purpose of this review, a PHC setting was defined as those outside of the inpatient setting that patients could directly access, such as general practices, outpatient treatment and rural outreach services. Interventions of interest included any strategies designed to improve the effectiveness or accessibility of clinical care in the PHC setting for Indigenous people with one or more of the six CDs listed above. The phenomena of interest were participant perceptions of enablers and/or barriers, based on their attitudes, beliefs, expectations, understandings and knowledge, arising from their participation in CD preventative or management interventions.
Qualitative studies, programme evaluations that support quantitative data collection with some qualitative inquiry, and descriptive studies, such as surveys, were considered for inclusion. Search strategyPublished and unpublished literature written in the English language was searched. Studies published from January 1998 to July 2013 were included in order to capture the introduction of evidence-based guidelines and systematic approaches to CD management. It is acknowledged, however, that the extent of guideline implementation and changes in the approach to CD care may have varied between countries during this time period. MEDLINE (PubMed platform), Web of Science, CINAHL, PsycINFO, EMBASE, ATSIHealth, Australian Indigenous HealthInfoNet via Informit Online, and PHCRIS were searched using key words and index terms that are provided in Additional file.