Saudi Cultural Missions Theses & Dissertations
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Item Restricted Nudges: A Behavioural Approach for Mitigating Missed Appointments at a Private Dental Clinic in Saudi Arabia(Saudi Digital Library, 2023-12-01) Alghamdi, Zeyad; Davies, JulieMissed appointments continue to bedevil private healthcare providers globally. It implies failure by a patient to arrive for an appointment or to cancel an appointment in advance. Clinics management plays an important role in mitigating no-shows among their patients. Some interventions have been implemented, such as sending reminder messages to patients about their upcoming appointments and imposing sanctions against those who fail to attend. However, the interventions have yet to mitigate the challenge completely. As a result, it is essential to explore alternative interventions with behavioural economics approaches considered more effective. Nudge theory is a behavioural theory, which seeks to influence the attainment of desired decisions among various populations, in this context, patients with clinical appointments. Subsequently, the review sought to assess the effectiveness of nudges in mitigating missed appointments. Methodology The study adopted a narrative literature review methodology to examine the use of nudges in mitigating missed appointments within Nayel Clinics (NC), a private dental health facility in Saudi Arabia. The adoption of nudges is analysed based on its influence on behaviour and appointment attendance. Findings The review concluded that missed appointments pose significant financial losses to clinics. However, the application of behavioural nudges was found to evoke more profound thoughts and analysis among patients leading to desirable decisions. The effective practices identified and recommended for applying nudges in NC involve developing an exclusive loyalty programme, creating a feedback loop for patients, and digitising the appointment confirmation process. These recommendations are suggested to encourage patients to attend clinical appointments or to make timely cancellations. Research limitations The study adopted a narrative literature review rather than a meta-analysis to explore interventions for missed appointments. Consequently, the findings may not have yielded precise recommendations. Additionally, the methodological quality of the reviewed studies varied, which may have influenced the outcomes. Future studies should focus on generating empirical evidence to validate the findings presented in the current review. Practical implications No-shows negatively impact healthcare systems globally by decreasing continuity of care and clinic capacity. Healthcare providers can implement recommendations from this review to increase appointment attendance. Keywords Missed appointments, No-show, Nudge theory, Nudge, Kingdom of Saudi Arabia, patient, behavioural economics, hospital, management. Article classification Research paper, A critical evaluation of nudge theory.14 0Item Restricted The Impact of Electronic Health Records on Nursing Burnout in a Hospital Setting in Saudi Arabia: Mixed-Methods Study(Saudi Digital Library, 2023-11-27) Alobayli, Fatimah Yahya; Holloway, Aisha; Cresswell, KathrinBackground: There is growing evidence suggesting that electronic health records (EHRs) can be associated with clinicians’ burnout, which may hamper the effective use of EHRs and introduce risks to patient safety and quality of care. Nursing research in this area is minimal in comparison with studies conducted on burnout among physicians. In addition, although the majority of research on the impact of EHR use on nursing burnout was conducted in Western contexts, this study fills the gap by exploring this prevalent issue within the context of Saudi Arabia. Aim: The research aim was to examine the association between nursing burnout and EHR use and to explore the contributing factors to nursing burnout related to EHR use in a hospital setting in Saudi Arabia. Methods: The study used a mixed-methods approach with an explanatory sequential design: a quantitative study followed by a qualitative study. The study was conducted in a hospital that was adopting an advanced EHR system, in Riyadh, Saudi Arabia. Using a purposive sampling method, registered nurses working in inpatient units using an EHR system on a daily basis were included in the study. Two validated instruments were used in the online survey, the Mini-Z and EHR perceptions, to examine the association between nursing burnout and EHR-related factors. Qualitative interviews, undertaken both online and in- person, were used to gain an in-depth understanding of factors associated with nursing burnout and hospital EHR use. Survey data were analysed using regression analysis. Thematic analysis was utilised for the interview data. The study was informed by a iii sociotechnical approach to understanding the relationship between the social system (nurses) and the technical system (EHR use) in a given context (a hospital in Saudi Arabia). Results: A total of 282 completed survey responses were included in the study, and a total of 21 nurses participated in the interviews. Participants were predominantly female and worked in acute and critical care units. Most survey respondents were from the Philippines (53%), Malaysia (21%), and Saudi Arabia (11.7%), with South African and European nurses accounting for about 5% each. Interviewees were primarily from the Philippines and Saudi Arabia (33% each), and 24% from Malaysia. The findings indicated that despite the overall acceptance of the EHR among the nurse participants being relatively high, negative perceptions of the EHR and stress related to EHR use were found. There was a slight inconsistency between the quantitative and qualitative results regarding the perceived burnout outcome. The survey statistics showed that the minority of nurses who reported negative perceptions about the EHR were likely to be burnt out while the interviews showed that all participants who reported stress related to the EHR did not think that EHR-related stress would lead to burnout. This inconsistency suggests there is a weak link between EHR use and burnout may exist, possibly indicating the mitigating role of resilience identified in the qualitative study. In this qualitative study, I identified specific perceived organisational stressors associated with EHR use, such as high EHR documentation workload creating a conflict between organisational requirements and direct patient care. Technological stressors were also identified, including usability issues causing disruption to nurses’ workflow, and concerns about data privacy through unauthorised access by healthcare workers at the hospital. Despite these stressors, resilience was demonstrated at both individual and organisational levels, which emerged as a protective factor from EHR-related burnout. Factors like computer literacy, perceived usefulness of the EHR, and nurses’ adaptability to iv change were key contributors to individual resilience that aided nurses in navigating EHR stressors and adjusting to the EHR system. At the organisational level, health information infrastructure facilitated smoother interaction with the EHR system, reducing potential stressors while supportive organisational culture fostered teamwork, work–life balance, continuous learning, and iterative improvement, thereby bolstering resilience among nurses. Conclusion: EHR did not significantly contribute to nursing burnout in a specific Saudi Arabian hospital context. The resilience mechanisms in place at both individual and organisational levels mitigated the potential impact of EHR-related stress on nurses’ burnout. The unique contribution of this research is the introduction of a novel conceptual model elucidating the impact of EHR on nursing burnout. This renewed perspective emphasises the role of resilience at both individual and organisational levels and their collective influence on mitigating EHR-related burnout among nurses. This model has the potential for further development and application both locally and globally. This study signals a need for healthcare organisations to foster resilience-building strategies in their EHR implementation processes and usability that should be tailored to the specific needs and circumstances of each organisation, to effectively manage EHR-related stress and prevent potential burnout. These include encouraging self-care practices among nurses, promoting work–life balance, fostering supportive workplace culture, improving health information infrastructure, providing training and continuous learning, and improving EHR usability through regular feedback sessions from EHR users. Additional research is needed to corroborate this finding with different types of clinicians in the same hospital, and in other hospital settings within Saudi Arabia.42 0