Assessment of Healthcare Professional’s Knowledge, Skills, Motivation, and Commitment to Clinical Pathways Implementation

Ivana Alona; Juliandi Harahap; Andike Aribi; Riyadh Ikhsan; Muhammad Iqbal Rizki Siregar

doi:10.3889/oamjms.2021.5656

Authors

Ivana Alona Department of Medical Services, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan, Indonesia
Juliandi Harahap Department of Community Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
Andike Aribi Department of Medical Services, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan, Indonesia
Riyadh Ikhsan Department of Medical Services; Department of Dermatology and Venereology
Muhammad Iqbal Rizki Siregar Department of Medical Services, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.5656

Keywords:

Integrated healthcare, Clinical pathway, Coordination, Communication, Motivational Interview, Acceptance and Commitment Therapy

Abstract

BACKGROUND: Healthcare providers are facing challenges to deliver qualified and efficient health services in response to the current health system. Clinical pathways (CPs) are a tool to achieve the best clinical outcomes at the lowest cost. The implementation should be supported by healthcare professional’s capacity involved in the process.

AIM: The aim of the study was to assess healthcare professionals’ knowledge, skills, motivation, and commitment to clinical pathways (CPs) implementation in Universitas Sumatera Utara (USU) Hospital.

METHODS: This cross-sectional study was conducted at USU Hospital with 65 healthcare professionals as participants who consist of 10 specialist doctors, 50 nurses, and 5 pharmacists. These participants were selected using quota sampling and interviewed using a developed and structured questionnaire. This questionnaire was tested for its validity and reliability with r > 0.5 and Cronbach’s Alpha > 0.6. Pearson correlation test with p < 0.05 was used for analyzing the relationship among variables on CPs implementation.

RESULTS: The healthcare professionals in USU Hospital had high knowledge, motivation, and commitment, but moderate skills in CPs implementation. There were positive correlations between knowledge and skill (p = 0.039), motivation and skill (p = 0.001), commitment and skill (p = 0.001), and motivation and commitment (p = 0.001) on CPs implementation.

CONCLUSION: USU Hospital healthcare professional’s knowledge, motivation, and commitment to CPs implementation were adequate, but their skills were moderate. The motivation is substantially related to the healthcare professional’s commitment to CPs implementation. This study recommended the hospital explore and grow skills in communication, coordination, and affective commitment among individuals, teamwork, and leaders for the sake of willingness to achieve the values or goals of the CP implementation in their organization.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Ronellenfitsch U, Rossner E, Jakob J, Post S, Hohenberger P, Schwarzbach M. Clinical pathways in surgery should we introduce them into clinical routine? A review article. Langenbecks Arch Surg. 2008;393(4):449-57. https://doi.org/10.1007/s00423-008-0303-9 PMid:18297305 DOI: https://doi.org/10.1007/s00423-008-0303-9

Cheah, J. Development and implementatiton of a clinical pathway programme in an acute care general hospital in Singapore. Int J Qual Health Care. 2000;12(5):403-12. https://doi.org/10.1093/intqhc/12.5.403 PMid:11079220 DOI: https://doi.org/10.1093/intqhc/12.5.403

Rotter T, de Jong RB, Lacko SE, Ronellenfitsch U, and Kinsman L. Clinical pathways as a quality strategy. In: Busse R, Klazinga N, Panteli D, Quentin W, editors. Improving Healthcare Quality in Europe:Characteristics, Effectiveness and Implementation of Different Strategies. Copenhagen, Denmark: European Observatory on Health Systems and Policies; 2019. https://doi.org/10.1787/b11a6e8f-en DOI: https://doi.org/10.1787/b11a6e8f-en

Firmanda D. Panduan Manajemen Risiko Klinisdan Keamanan/ Keselamatan Pasien (Clinical Risks Management and Patient Safety). Jakarta: KomiteMedik RS Fatmawati; 2005.

Holloway NM. Medical Surgical Care Planning. Orinda, California: Lippincott Williams and Wilkins; 2004.

Rotter T, Kinsman L, James EL, Machotta A, Gothe H, Willis S, et al. Clinical pathways: Effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010;3:CD006632. https://doi.org/10.1002/14651858. cd006632 PMid:20238347 DOI: https://doi.org/10.1002/14651858

Sung KH, Chung, CY, Lee KM, Lee SY, Ahn S, Park S, et al. Application of clinical pathway using electronic medical record system pediatric patients with supracondylar fracture of the humerus: A before and after comparative study. BMC Med Inform Decis Mak. 2013;13:87. https://doi.org/10.1186/1472-6947-13-87 PMid:23938025 DOI: https://doi.org/10.1186/1472-6947-13-87

Alona I, Harahap J, Aribi A. A Quasi-Experimental Study of Dengue Hemorhagic Fever Grade 1 and 2 Clinical Pathway Implementation in Universitas Sumatera Utara Hospital, North Sumatera, Indonesia. The 3rd International Conference Community Research and Service Engagements (IC2RSE) Proceeding Book. EAI; 2000. https://doi.org/10.4108/eai.4-12-2019.2293799 DOI: https://doi.org/10.4108/eai.4-12-2019.2293799

Dewi P, Sandra C, Witcahyo E. Resources required in clinical pathway for typhoid fever treatment at kaliwates genneral hospital in 2017. J Adm Kesehatan Indones. 2019;7(2):155-61. https://doi.org/10.20473/jaki.v7i2.2019.155-161 DOI: https://doi.org/10.20473/jaki.v7i2.2019.155-161

Azwar A. Pengantar Administrasi Kesehata. 3rd ed. Jakarta: Jakarta Binarupa Aksara; 2010.

World Health Organization. Health Services Delivery: A Concept Note. Health Services Delivery Programme WHO Regional Office for Europe. Geneva: World Health Organization; 2015.

Balbeid M, Rachmi A, Alamsyah A. Pengaruh pengetahuan dan sikap dokter dan perawat terhadap kesiapan berubah dalam menerapkan clinical pathway. E-Prodent J Dent 2018;2:98-107. https://doi.org/10.21776/ub.eprodenta.2018.002.01.1 DOI: https://doi.org/10.21776/ub.eprodenta.2018.002.01.1

Suhartini Y. Faktor-faktor yang mempengaruhi minat mahasiswa dalam berwiraswasta (studi pada mahasiswa universitas PGRI Yogyakarta). J Akmen UPY. 2011;7:38-59. https://doi.org/10.22225/jraw.1.2.1838.37-45 DOI: https://doi.org/10.22225/jraw.1.2.1838.37-45

Kuncoro M. Mudah Memahami dan Menganalisis Indikator Ekonomi. Yogyakarta: UPP STIM YKPN; 2013.

Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: Time for a map? J Contin Educ Heal Prof 2006;26(1):13-24. https://doi.org/10.1002/chp.47 PMid:16557505 DOI: https://doi.org/10.1002/chp.47

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks A, DeCristofaro A, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635- 45. https://doi.org/10.1056/nejmsa022615 PMid:12826639 DOI: https://doi.org/10.1056/NEJMsa022615

Huckson S, Davies J. Closing evidence to practice gaps in emergency care: The Australian experience. Acad Emerg Med. 2007;14(11):1058-63. https://doi.org/10.1197/j.aem.2007.06.015 PMid:17704351 DOI: https://doi.org/10.1197/j.aem.2007.06.015

Seddon ME, Marshall MN, Campbell SM, Roland MO. Systematic review of studies of quality of clinical care in general practice in the UK, Australia and New Zealand. Qual Health Care. 2001;10(3):152-8. https://doi.org/10.1136/qhc.0100152 PMid:11533422 DOI: https://doi.org/10.1136/qhc.0100152

Lougheed MD, Garvey N, Chapman KR, Cicutto L, Dales R, Day AG, et al. The Ontario asthma regional variation study: Emergency department visit rates and the relation to hospitalization rates. Chest. 2006;129(4):909-17. https://doi.org/10.1378/chest.129.4.909 PMid:16608938 DOI: https://doi.org/10.1378/chest.129.4.909

Freedman SB, Gouin S, Bhatt M, Black KJ, Johnson D, Guimont C, et al. Pediatric emergency research Canada: prospective assessment of practice pattern variations in the treatment of pediatric gastroenteritis. Pediatrics. 2011;127(2):e287-95. https://doi.org/10.1542/peds.2010-2214 PMid:21262881 DOI: https://doi.org/10.1542/peds.2010-2214

Goodman DC. Unwarranted variation in pediatric medimedical care. Pediatr Clin North Am. 2009;56(4):745-55. PMid:19660625

Rosentain A, O’ Daniel M. Disruptive behaviour and clinical outcomes: Perceptions of nurses and physicians. Am J Nurs. 2005;105(1):54-64. PMid:15659998

Jabbour M, Curran J, Scott SD, Guttman A, Rotter T, Ducharme FM, et al. Best strategies to implement clinical pathways in an emergency department setting: Study protocol for a cluster randomized controlled trial. Implement Sci. 2013;8(55):55. https://doi.org/10.1186/1748-5908-8-55 PMid:23692634 DOI: https://doi.org/10.1186/1748-5908-8-55

Daniel MO, Rosentain AH. Professional communication and team collaboration. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Ch. 33. Rockville, MD: Agency for Healthcare Research and Quality; 2008.

World Health Organization. Regional Office for Europe. Transforming Health Services Delivery Towards People-centred Health Systems. World Health Organization; 2014. p. 14.

Bai J, Bai F, Zhu H, Xue D. The perceived and objectively measured effects of clinical pathways’ implementation on medical care in China. PLoS One. 2018;3(5):e0196776. https://doi.org/10.1371/journal.pone.0196776 PMid:29734350 DOI: https://doi.org/10.1371/journal.pone.0196776

Jabbour M, Newton AS, Johnson D, Curran JA. Defining barriers and enablers for clinical pathway implementation in complex clinical settings. Implement Sci. 2018;13(1):139 https://doi.org/10.1186/s13012-018-0832-8 PMid:30419942 DOI: https://doi.org/10.1186/s13012-018-0832-8

Manullang, M. Dasar-Dasar Manajemen. Yogyakarta: Gajah Mada University; 2012.

Thakor MV, Joshi AW. Motivating salesperson customer orientation: Insights from the job characteristics model. J Bus Res. 2005;58(5):584-92. https://doi.org/10.1016/j.jbusres.2003.10.002 DOI: https://doi.org/10.1016/j.jbusres.2003.10.002

Mahaney CR, Lederer AL. The effect of intrinsic and extrinsic rewards for developers on information systems project success. Proj Manage J. 2006;37:42-54. https://doi.org/10.1177/875697280603700405 DOI: https://doi.org/10.1177/875697280603700405

Altindis S. Job motivation and organizational commitment among the health professionals: A questionnaire survey. Afr J Bus Manag. 2011;5(21):8601-9. https://doi.org/10.5897/ajbm11.1086 DOI: https://doi.org/10.5897/AJBM11.1086

Sopiah. Perilaku Organisasional. Yogyakarta: Andi Press; 2008.

Chang H, Chi N, Miao M. Testing the relationship between three-component organizational/occupational commitment and organizational occupational turnover intention using a non-recursive model. J Vocal Behav 2007;70:352-68. https://doi.org/10.1016/j.jvb.2006.10.001 DOI: https://doi.org/10.1016/j.jvb.2006.10.001

Meyer J, Becker T, Vandenberghe C. Employee commitment and motivation: A conceptual analysis and integrative model. J Appl Phys. 2004;89:991-1007. https://doi.org/10.1037/0021-9010.89.6.991 DOI: https://doi.org/10.1037/0021-9010.89.6.991

Johnson RE, Chang CH, Yang LQ. Commitment and motivation at work: The relevance of employee identity and regulatory focus. Acad Manag Rev. 2010;35:226-45. https://doi.org/10.5465/amr.35.2.zok226 DOI: https://doi.org/10.5465/amr.35.2.zok226

Eby LT, Freeman DM, Rush MC, Lance CE. Motivational bases of affective organizational commitment: A partial test of an integrative theoretical model. J Occup Organ Psychol. 1999;72:463-83. https://doi.org/10.1348/096317999166798 DOI: https://doi.org/10.1348/096317999166798

DeSilva DAM, Yamao M. In: Choo PS, Hall SJ, Williams MJ, editors. The Involvement of Female Labor in Seafood Processing in Sri Lanka: Impact of Organizational Fairness, Organizational Commitment and Supervisor Evaluation on Employee Commitment. Penang, Malaysia: Global Symposium on Gender and Fisheries. Seventh Asian Fisheries Forum, 1-2 December, 2004; 2006. p. 103-14.

Pool S, Pool B. A management development model: Measuring organizational commitment and its impact on job satisfaction among executives in a learning organization. J Manag Dev. 2007;26:353-69. https://doi.org/10.1108/02621710710740101 DOI: https://doi.org/10.1108/02621710710740101

Kim WG, Leong JK, Lee YK. Effect of service orientation on job satisfaction, organizational commitment, and intention of leaving in a casual dining chain restaurant. Hosp Manage. 2005;24:171- 93. https://doi.org/10.1016/j.ijhm.2004.05.004 DOI: https://doi.org/10.1016/j.ijhm.2004.05.004

Mowday RT, Steers RM, Porter LW. The measurement of organizational commitment. J Vocat Behav 1979;14:224-47. DOI: https://doi.org/10.1016/0001-8791(79)90072-1

McCabe TJ, Garavan TN. A Study of the drivers of commitment amongst nurses: The salience of training, development and career issues. J Eur Ind Train. 2008;32:528-68. https://doi.org/10.1108/03090590810899829 DOI: https://doi.org/10.1108/03090590810899829

Hassaballa H, Payne J, Mcfolling S, Marder RJ. Enhancing clinical pathway placement. Qual Manag Health Care. 1998;7(1):13-7. https://doi.org/10.1097/00019514-199807010-00002 PMid:10344978 DOI: https://doi.org/10.1097/00019514-199807010-00002

Mathieu JE, Zajac D. A review and meta-analysis of antecedents, correlates, and consequences of organizational commitment. Psychol Bull. 1990;108:171-94. https://doi.org/10.1037/0033-2909.108.2.171 DOI: https://doi.org/10.1037/0033-2909.108.2.171

Meyer JP, Stanley DJ, Herscovitch L, Topolnytsky L. Affective, continuance and normative commitment to the organization: A meta-analysis of ante-cedents, correlates and consequences. Journal of Vocat Behav 2002;61:20-52. https://doi.org/10.1006/jvbe.2001.1842 DOI: https://doi.org/10.1006/jvbe.2001.1842

Wang L, Bishop JW, Chen X, Scot KD. Collectivist orientation as a predictor of affective organizational commitment: A study conducted in china. Int J Organ Anal 2002;10:226-40. https://doi.org/10.1108/eb028951 DOI: https://doi.org/10.1108/eb028951

Hilaire WA, de la Robertie C. Correlates of affective commitment in organizational performance: Multi-level perspectives. Aust J Career Dev. 2018;27(1):3-8. https://doi.org/10.1177/1038416217744215 DOI: https://doi.org/10.1177/1038416217744215

Ramlall S. A review of employee motivation theories and their implications for employee retention within organizations. J Am Acad Bus. 2004;5:52-64.

Maslach C, Leiter MP. Burnout and quality in a sped-up world. J Qual Partic. 2001;24:48-52.

Bjurling-Sjoberg P, Wadensten B, Poder U, Nordgren L, Jansson I. Factors affecting the implementation process of clinical pathways: A mixed method study within the context of Swedish intensive care. J Eval Clin Pract. 2015;21(2):255-61. https://doi.org/10.1111/jep.12301 PMid:25678495 DOI: https://doi.org/10.1111/jep.12301

Mcconnell T, O’Halloran P, Porter S, Donnelly M. Systematic realist review of key factors affecting the successful implementation and sustainability of the Liverpool care pathway for the dying patient. Worldviews Evid Based Nurs. 2013;10(4):218-37. https://doi.org/10.1111/wvn.12003 PMid:23489967 DOI: https://doi.org/10.1111/wvn.12003

Mamolen NL, Brenner PS. The impact of a burn wound education program and implementation of a clinical pathway on patient outcomes. J Burn Care Rehabil. 2000;21:440-5. https://doi.org/10.1097/00004630-200021050-00010 PMid:11020052 DOI: https://doi.org/10.1097/00004630-200021050-00010

Kate W, Masako T. Reframing Organizational Commitment within a Contemporary Careers Framework. New York: Cornell University; 2002.

Fischer F, Lange K, Klose K, Greiner W, Kraemer A. Barriers and strategies in guideline implementation a scoping review. Healthcare. 2016;4(3):36. https://doi.org/10.3390/healthcare4030036 DOI: https://doi.org/10.3390/healthcare4030036

Cluzeau FA, Littlejohns P, Grimshaw JM, Feder G, Moran SE. Development and application of a generic methodology to assess the quality of clinical guidelines. Int J Qual Health Care. 1999;11(1):21-8. https://doi.org/10.1093/intqhc/11.1.21 PMid:10411286 DOI: https://doi.org/10.1093/intqhc/11.1.21

Doherty SR, Jones PD. Use of an “evidence-based implementation” strategy to implement evidence-based care of asthma into rural district hospital emergency departments. Rural Remote Health. 2006;6(1):529. PMid:16569189

Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, et al. Changing provider behaviour: An overview of systematic reviews of interventions. Med Care. 2001;39(8):II2- 45. https://doi.org/10.1097/00005650-200108002-00002 PMid:11583120 DOI: https://doi.org/10.1097/00005650-200108002-00002

Grimshaw JM, Zwarenstein M, Tetroe JM, Godin G, Graham ID, Lemyre L, et al. Looking inside the black box: A theory-based process evaluation alongside a randomised controlled trial of printed educational materials (the Ontario printed educational message, OPEM) to improve referral and prescribing practices in primary care in Ontario, Canada. Implement Sci. 2007;2:38. https://doi.org/10.1186/1748-5908-2-38 PMid:18039362 DOI: https://doi.org/10.1186/1748-5908-2-38

Kinsman L, James E, Ham J. An interdisciplinary, evidencebased process of clinical pathway implementation increases pathway usage. Lippincotts Case Manag. 2004;9(4):184-96. https://doi.org/10.1097/00129234-200407000-00006 PMid:15273604 DOI: https://doi.org/10.1097/00129234-200407000-00006

Pugh-Bernard A, Nickels S, Melendez J, Shawkat J, Rolison E, Swanson A, et al. A strategy for the renovation of a clinical pathways program. Pediatr Qual Saf. 2019;4(3):e178. https://doi.org/10.1097/pq9.0000000000000178 DOI: https://doi.org/10.1097/pq9.0000000000000178