International Journal Of Health Care Quality Assurance[JOURNAL]
Sun
200 papers
Primary healthcare accreditation standards: a systematic review.
Tabrizi JS, Gharibi F
Int J Health Care Qual Assur · 2019 Mar · PMID 31017069 · Publisher ↗
PURPOSE: Accreditation is an essential component in primary healthcare (PHC) systems. The purpose of this paper is to investigate the most suitable PHC accreditation models and standards, worldwide, and to prepare a comp...
PURPOSE: Accreditation is an essential component in primary healthcare (PHC) systems. The purpose of this paper is to investigate the most suitable PHC accreditation models and standards, worldwide, and to prepare a comprehensive and unbiased summary from research on these models. DESIGN/METHODOLOGY/APPROACH: A systematic search was undertaken using Web of Science, Scopus, Science Direct, Springer, PubMed and ProQuest databases in August 2016 and updated in January 2018. English language studies addressing PHC accreditation standards and models, published between 1995 and January 2018, were included, resulting in 9051 citations. After excluding duplicates and irrelevant studies, 19 were included in the final review. Two independent reviewers critically appraised the studies. Consequently, accreditation standards in the models were extracted and compared. FINDINGS: Results indicate that USA, Australia, Canada, UK and New Zealand (non-eastern Mediterranean regions (EMR)) and Jordan, Saudi Arabia, Lebanon and Egypt (EMR) had well-developed and high-quality PHC accreditation models. The Jordanian, Egyptian and Saudi models had the highest diversity in their PHC standards domains. Community-oriented care, safe care, high-quality care, care continuity and human resource management had the highest priority among PHC accreditation programs. ORIGINALITY/VALUE: The authors provide PHC accreditation benchmarks and determine high priority practical domains in accreditation standards. The findings should help health system managers and policymakers design new PHC accreditation programs and promote PHC service quality.
Improving healthcare through process standardization: a general hospital case study.
Rusjan B, Kiauta M
Int J Health Care Qual Assur · 2019 Mar · PMID 31017068 · Publisher ↗
PURPOSE: The purpose of this paper is to analyze two process standardization theoretical conceptual constructs: process variants unification; and distinction between standard, routine and non-routine processes. DESIGN/ME...
PURPOSE: The purpose of this paper is to analyze two process standardization theoretical conceptual constructs: process variants unification; and distinction between standard, routine and non-routine processes. DESIGN/METHODOLOGY/APPROACH: The authors analyze two conceptual constructs based on a single case study representing a general hospital's (GH) process standardization, approach and results. The authors research whether process standardization implemented in a GH conforms to the process variants unification concept approach and its assumed benefits and whether implemented process standardization enables process management improvement based on distinguishing standard, routine and non-routine processes. FINDINGS: In accordance with the process variants unification conceptual construct, the hospital task force determined a uniform basic patient comprehensive treatment process at the hospital level, which allows synergy among departments. Uniform process activities reflect the differences between standard, routine and non-routine processes. PRACTICAL IMPLICATIONS: Process standardization through unification improves performance by establishing a common framework enabling shared experience based on improved process understanding. Distinguishing standard, routine and non-routine processes is useful for analyzing process management. This distinction provides guidelines for process implementation and measurement improvement. The paper also shows that increased routinization and standardization represent levers for process improvement. ORIGINALITY/VALUE: The authors analyze theoretical constructs based on a single case study and confirm that theoretical conceptual construct application can provide better process management, which is important for practitioners.
Pediatric discharge against medical advice.
Al-Mohammadi E
Int J Health Care Qual Assur · 2019 Mar · PMID 31017067 · Publisher ↗
PURPOSE: The purpose of this paper is to identify the reasons for discharges against medical advice (DAMA) and the possible outcomes among pediatric patients. DESIGN/METHODOLOGY/APPROACH: A retrospective cohort study was...
PURPOSE: The purpose of this paper is to identify the reasons for discharges against medical advice (DAMA) and the possible outcomes among pediatric patients. DESIGN/METHODOLOGY/APPROACH: A retrospective cohort study was conducted on all children admitted and then discharged against medical advice in two maternity and children's hospitals in Jeddah, 2014. Phone interviews were conducted, and medical records were reviewed for DAMA and control groups; a semi-structured questionnaire was used to collect this information. FINDINGS: The top three reasons identified for DAMA were parent's false assumption that their child's condition had improved (43.8 percent), dissatisfaction with treating/managing team (16.2 percent) and difficulties arranging care for patient's siblings at home (7.7 percent). The readmission rate was significantly higher among DAMA pediatric patients compared to the control group (28.5 percent vs 11.5 percent) at 30-day follow-up, which highlights the importance for developing interventions aimed at reducing DAMA. ORIGINALITY/VALUE: This study helps us to better understand DAMA reasons and outcomes. Understanding these factors can encourage appropriate interventions and policies for reducing DAMA rates. In this way, pediatric patients can be protected from inappropriate discharge consequences.
Patient safety culture in Hungarian hospitals.
Granel N, Manresa-Domínguez JM, Barth A … +2 more , Papp K, Bernabeu-Tamayo MD
Int J Health Care Qual Assur · 2019 Mar · PMID 31017066 · Publisher ↗
PURPOSE: The Hospital Survey on Patient Safety Culture (HSOPSC) is a rigorously designed tool for measuring inpatient safety culture. The purpose of this paper is to develop a cross-cultural HSOPSC for Hungary and determ...
PURPOSE: The Hospital Survey on Patient Safety Culture (HSOPSC) is a rigorously designed tool for measuring inpatient safety culture. The purpose of this paper is to develop a cross-cultural HSOPSC for Hungary and determine its strengths and weaknesses. DESIGN/METHODOLOGY/APPROACH: The original US version was translated and adapted using existing guidelines. Healthcare workers (=371) including nurses, physicians and other healthcare staff from six Hungarian hospitals participated. Answers were analyzed using exploratory factor analyses and reliability tests. FINDINGS: Positive responses in all dimensions were lower in Hungary than in the USA. Half the participants considered their work area "acceptable" regarding patient safety. Healthcare staff worked in "crisis mode," trying to accomplish too much and too quickly. The authors note that a "blame culture" does not facilitate patient safety improvements in Hungary. PRACTICAL IMPLICATIONS: The results provide valuable information for promoting a more positive patient safety culture in Hungary and for evaluating future strategies to improve patient safety. ORIGINALITY/VALUE: Introducing a validated scale to measure patient safety culture in Hungary improves healthcare quality.
Patient-centered communication: dissecting provider communication.
Platonova EA, Qu H, Warren-Findlow J
Int J Health Care Qual Assur · 2019 Mar · PMID 31017065 · Publisher ↗
PURPOSE: The purpose of this paper is to examine the relationship between patients' provider communication effectiveness and courteousness with patients' satisfaction and trust at free clinics. DESIGN/METHODOLOGY/APPROAC...
PURPOSE: The purpose of this paper is to examine the relationship between patients' provider communication effectiveness and courteousness with patients' satisfaction and trust at free clinics. DESIGN/METHODOLOGY/APPROACH: This cross-sectional survey (=507), based on the Consumer Assessment of Healthcare Providers and Systems instrument, was conducted in two Southeastern US free clinics. Latent class analysis (LCA) was used to identify patient subgroups (clusters) with similar but not immediately visible characteristics. FINDINGS: Across the items assessing provider communication effectiveness and courteousness, five distinct clusters based on patient satisfaction, trust and socio-demographics were identified. In clusters where communication and courteousness ratings were consistent, trust and satisfaction ratings were aligned with these domains, e.g., 54 percent rated communication and courteousness highly, which was associated with high patient satisfaction and trust. When communication effectiveness and courteousness ratings diverged (e.g., low communication effectiveness but high courteousness), patient trust and satisfaction ratings aligned with communication effectiveness ratings. In all clusters, the association was greater for communication effectiveness than for provider courteousness. Thus, provider courteousness was important but secondary to communication effectiveness. PRACTICAL IMPLICATIONS: Investment in patient-centered communication training for providers will improve patient satisfaction and trust. ORIGINALITY/VALUE: The study is the first to examine individual provider communication components and how they relate to patient satisfaction and trust in free clinics. LCA helped to more fully examine communication constructs, which may be beneficial for more nuanced quality improvement efforts.
A decision support simulation model for bed management in healthcare.
Cudney EA, Baru RA, Guardiola I … +6 more , Materla T, Cahill W, Phillips R, Mutter B, Warner D, Masek C
Int J Health Care Qual Assur · 2019 Mar · PMID 31017064 · Publisher ↗
PURPOSE: In order to provide access to care in a timely manner, it is necessary to effectively manage the allocation of limited resources. such as beds. Bed management is a key to the effective delivery of high quality a...
PURPOSE: In order to provide access to care in a timely manner, it is necessary to effectively manage the allocation of limited resources. such as beds. Bed management is a key to the effective delivery of high quality and low-cost healthcare. The purpose of this paper is to develop a discrete event simulation to assist in planning and staff scheduling decisions. DESIGN/METHODOLOGY/APPROACH: A discrete event simulation model was developed for a hospital system to analyze admissions, patient transfer, length of stay (LOS), waiting time and queue time. The hospital system contained 50 beds and four departments. The data used to construct the model were from five years of patient records and contained information on 23,019 patients. Each department's performance measures were taken into consideration separately to understand and quantify the behavior of departments individually, and the hospital system as a whole. Several scenarios were analyzed to determine the impact on reducing the number of patients waiting in queue, waiting time and LOS of patients. FINDINGS: Using the simulation model, it was determined that reducing the bed turnover time by 1 h resulted in a statistically significant reduction in patient wait time in queue. Further, reducing the average LOS by 10 h results in statistically significant reductions in the average patient wait time and average patient queue. A comparative analysis of department also showed considerable improvements in average wait time, average number of patients in queue and average LOS with the addition of two beds. ORIGINALITY/VALUE: This research highlights the applicability of simulation in healthcare. Through data that are often readily available in bed management tracking systems, the operational behavior of a hospital can be modeled, which enables hospital management to test the impact of changes without cost and risk.
BeWell: quality assurance health promotion pilot.
Piwowarczyk LA, Ona F
Int J Health Care Qual Assur · 2019 Mar · PMID 31017063 · Publisher ↗
PURPOSE: The purpose of this paper is to determine the experience participating in a health promotion program for refugee and asylum seekers and torture survivors in a safety net clinical setting. DESIGN/METHODOLOGY/APPR...
PURPOSE: The purpose of this paper is to determine the experience participating in a health promotion program for refugee and asylum seekers and torture survivors in a safety net clinical setting. DESIGN/METHODOLOGY/APPROACH: Refugee and asylum seeker torture survivors participated in a seven-week health promotion program at a safety-net clinic. Participants interviewed before, during and after the program was designed to improve and maintain health promotion program quality. FINDINGS: Six major themes emerged: social networks; tools/techniques/skills; wellness planning; spiritualism; health maintenance; and social/group interaction. Preliminary results suggest that this multi-pronged approach is feasible and acceptable to foreign-born torture survivors. RESEARCH LIMITATIONS/IMPLICATIONS: Torture impacts many facets of one's life. A program which addresses health from a multidisciplinary perspective has promise to facilitate healing. PRACTICAL IMPLICATIONS: The impact of torture and human rights violations significantly affects many facets of peoples' lives including emotional, social, physical and spiritual dimensions. Therefore a program which utilizes a multidisciplinary integrated bio-psychosocial and spiritual approach has the potential to simultaneously address many domains facilitating healing. ORIGINALITY/VALUE: BeWell, a bio-psychosocio-spiritual health promotion strategy aimed at improving health service quality and increasing patient satisfaction to support positive health outcomes by implementing in-classroom/person modules for patients, to the authors' knowledge is unique in its efforts to encompass multiple domains simultaneously and fully integrate an approach to wellbeing.
Verifying alternative measures of healthcare service quality.
Shafei I, Walburg J, Taher A
Int J Health Care Qual Assur · 2019 Mar · PMID 31017062 · Publisher ↗
PURPOSE: The purpose of this paper is to determine the best measure among several alternatives (SERVQUAL, weighted SERVQUAL, SERVPERF, weighted SERVPERF) and develop a scale which healthcare providers can use for measure...
PURPOSE: The purpose of this paper is to determine the best measure among several alternatives (SERVQUAL, weighted SERVQUAL, SERVPERF, weighted SERVPERF) and develop a scale which healthcare providers can use for measurement of healthcare service quality. DESIGN/METHODOLOGY/APPROACH: The study involved two phases. The first phase was through a series of in-depth interviews with experts and patients followed by a pilot study. Subsequently, the second phase involved a quantitative phase through surveys with 384 patients. Alternative measures were analyzed using coefficient (Cronbach) , composite reliability, factor analysis and logistic regression analysis. FINDINGS: Findings confirmed "Weighted SERVPERF" using an interactive methodology as the most appropriate for measurement of healthcare service quality. ORIGINALITY/VALUE: Using the model and scale developed, healthcare providers will be able to measure healthcare service quality and identify areas of shortfall and act accordingly to improve delivery through allocating resources in service areas that would generate the greatest returns in customer satisfaction. Enhancing satisfaction will ultimately generate patient loyalty and positive recommendation behavior.
Iranian hospital efficiency: a systematic review and meta-analysis.
Rezaei S, Hajizadeh M, Nouri B … +4 more , Ahmadi S, Rezaeian S, Salimi Y, Karyani AK
Int J Health Care Qual Assur · 2019 Mar · PMID 31017061 · Publisher ↗
PURPOSE: The purpose of this paper (systematic review and meta-analysis) is to synthesize and analyze studies that assessed Iranian hospital efficiency. DESIGN/METHODOLOGY/APPROACH: A systematic literature search was con...
PURPOSE: The purpose of this paper (systematic review and meta-analysis) is to synthesize and analyze studies that assessed Iranian hospital efficiency. DESIGN/METHODOLOGY/APPROACH: A systematic literature search was conducted using both international (the Institute for Scientific Information, Scopus and PubMed) and Iranian scientific (Magiran, IranMedex and Scientific Information Database) databases. The review included original studies that used the Pabon Lasso Model to examine Iranian hospital performance, published in Persian or English. A self-administered checklist was used to collect data. In total, 12 questions were used for quality assessment. FINDINGS: In total, 34 studies met our inclusion criteria. The fixed-effects meta-analysis indicated that 19.2 percent (95% confidence interval (CI): 15.6-23.2 percent) of hospitals were in Zone 1 (poor performance: low bed turnover rate (BTR) and bed occupancy rate (BOR) and high average hospital stay (ALoS)), 23.7 percent (95% CI: 20.1-27.8 percent) were in Zone 2, 31.7 percent (95% CI: 27.7-36 percent) in Zone 3 (good performance: high BTR and BOR and low ALoS) and 25.4 percent (95% CI: 21.7-29.5 percent) in Zone 4. PRACTICAL IMPLICATIONS: Results help Iranian health policymakers to understand hospital performance, which, in turn, may lead to promoting greater awareness and policy attention to improve Iranian hospital efficiency. ORIGINALITY/VALUE: This study indicated that most Iranian hospitals had sub-optimal performance. Further studies are required to understand factors that explain the country's hospital inefficiency.
Hospital quality indicators: a systematic review.
Breyer JZ, Giacomazzi J, Kuhmmer R … +6 more , Lima KM, Hammes LS, Ribeiro RA, Kops NL, Falavigna M, Wendland EM
Int J Health Care Qual Assur · 2019 Mar · PMID 31017060 · Publisher ↗
PURPOSE: The purpose of this paper is to identify and describe hospital quality indicators, classifying them according to Donabedian's structure, process and outcome model and in specific domains (quality, safety, infect...
PURPOSE: The purpose of this paper is to identify and describe hospital quality indicators, classifying them according to Donabedian's structure, process and outcome model and in specific domains (quality, safety, infection and mortality) in two care divisions: inpatient and emergency services. DESIGN/METHODOLOGY/APPROACH: A systematic review identified hospital clinical indicators. Two independent investigators evaluated 70 articles/documents located in electronic databases and nine documents from the grey literature, 35 were included in the systematic review. FINDINGS: In total, 248 hospital-based indicators were classified as infection, safety, quality and mortality domains. Only 10.2 percent were identified in more than one article/document and 47 percent showed how they were calculated/obtained. Although there are scientific papers on developing, validating and hospital indicator assessment, most indicators were obtained from technical reports, government publications or health professional associations. RESEARCH LIMITATIONS/IMPLICATIONS: This review identified several hospital structure, process and outcome quality indicators, which are used by different national and international groups in both research and clinical practice. Comparing performance between healthcare organizations was difficult. Common clinical care standard indicators used by different networks, programs and institutions are essential to hospital quality benchmarking. ORIGINALITY/VALUE: To the authors' knowledge, this is the first systematic review to identify and describe hospital quality indicators after a comprehensive search in MEDLINE/PubMed, etc., and the grey literature, aiming to identify as many indicators as possible. Few studies evaluate the indicators, and most are found only in the grey literature, and have been published mostly by government agencies. Documents published in scientific journals usually refer to a specific indicator or to constructing an indicator. However, indicators most commonly found are not supported by reliability or validity studies.
Using informatics to improve healthcare quality.
Otokiti A
Int J Health Care Qual Assur · 2019 Mar · PMID 31017059 · Publisher ↗
PURPOSE: The purpose of this paper is to provide insights into contemporary challenges associated with applying informatics and big data to healthcare quality improvement. DESIGN/METHODOLOGY/APPROACH: This paper is a nar...
PURPOSE: The purpose of this paper is to provide insights into contemporary challenges associated with applying informatics and big data to healthcare quality improvement. DESIGN/METHODOLOGY/APPROACH: This paper is a narrative literature review. FINDINGS: Informatics serve as a bridge between big data and its applications, which include artificial intelligence, predictive analytics and point-of-care clinical decision making. Healthcare investment returns, measured by overall population health, healthcare operation efficiency and quality, are currently considered to be suboptimal. The challenges posed by informatics/big data span a wide spectrum from individual patients to government/regulatory agencies and healthcare providers. PRACTICAL IMPLICATIONS: The paper utilizes informatics and big data to improve population health and healthcare quality improvement. ORIGINALITY/VALUE: Informatics and big data utilization have the potential to improve population health and service quality. This paper discusses the challenges posed by these methods as the author strives to achieve the aims.
TORS for OSA: a practice, pitfalls and literature review.
Hassaan A, Trinidade A, Kotecha B … +1 more , Tolley N
Int J Health Care Qual Assur · 2019 Mar · PMID 31017058 · Publisher ↗
PURPOSE: Trans-oral robotic surgery (TORS) is increasingly employed in obstructive sleep apnoea (OSA) management. Objective outcomes are generally assessed through polysomnography. Pre-operative magnetic resonance imagin...
PURPOSE: Trans-oral robotic surgery (TORS) is increasingly employed in obstructive sleep apnoea (OSA) management. Objective outcomes are generally assessed through polysomnography. Pre-operative magnetic resonance imaging (MRI) can be a useful adjunct in objective upper airway assessment, in particular the tongue base, providing useful information for surgical planning and outcome assessment, though care must be taken in patient positioning during surgery. The purpose of this paper is to identify pitfalls in this process and suggest a protocol for pre-operative MRI scanning in OSA. DESIGN/METHODOLOGY/APPROACH: This study is a four-patient prospective case-series and literature review. Outcome measures include pre- and post-operative volumetric changes in the pharynx as measured on MRI and apnoea-hypopnea indices (AHI), with cure being OSA resolution or a 50 per cent reduction in AHI. FINDINGS: All patients achieved AHI reduction and/or OSA cure following TORS, despite a decrease in pharyngeal volume measurements at the tongue base level. This study and others lacked standardisation in the MRI scanning protocol, which resulted in an inability to effectively compare pre- and post-operative scans. Pitfalls were related to variation in head/tongue position, soft-tissue marker usage and assessed area boundary limits. PRACTICAL IMPLICATIONS: TORS appears to be effective in OSA management. A new protocol for patient positioning and anatomical landmarks is suggested. ORIGINALITY/VALUE: The findings could provide directly comparable data between scans and may allow correlation between tongue base volumetric changes and AHI through subsequent and historical study meta-analysis.
Evaluating and prioritizing hospital service quality.
Torkzad A, Beheshtinia MA
Int J Health Care Qual Assur · 2019 Mar · PMID 31017057 · Publisher ↗
PURPOSE: Hospital evaluations create competition between healthcare providers. In this study, a multi criteria decision-making (MCDM) method is used to evaluate criteria that affect hospital service quality. The paper ai...
PURPOSE: Hospital evaluations create competition between healthcare providers. In this study, a multi criteria decision-making (MCDM) method is used to evaluate criteria that affect hospital service quality. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: Criteria affecting hospital service quality are identified. Four Iranian public hospitals are evaluated using these criteria. Four hybrid methods, including modified digital logic-technique for order of preference by similarity to an ideal solution, analytical hierarchy process-technique for order of preference by similarity to an ideal solution, analytical hierarchy process-elimination and choice expressing reality and modified digital logic-elimination and choice expressing reality are used to evaluate hospital service quality. Results are aggregated using the Copeland method and final ranks are determined. FINDINGS: The four main criteria for evaluating hospital service quality are: environment; responsiveness; equipment and facilities; and professional capability. Results suggest that professional capability is the most important criterion. The Copeland method, used to integrate four MCDM hybrid methods, provides the final hospital ranks. PRACTICAL IMPLICATIONS: The criteria the authors identified and their weight help hospital managers to achieve comprehensive organizational growth and more efficient resource usage. Moreover, the decision matrix helps managers to identify their strengths and weaknesses. ORIGINALITY/VALUE: New and comprehensive criteria are proposed for hospital quality assessments. Moreover, a new hybrid MCDM approach is used to achieve final hospital rankings.
The tinnitus patient information pack: usefulness in intrusive tinnitus.
Hassaan A, Trinidade A
Int J Health Care Qual Assur · 2019 Mar · PMID 31017056 · Publisher ↗
PURPOSE: The purpose of this paper is to determine a tinnitus patient information pack's (TPIP) usefulness in patients suffering with tinnitus with respect to their need for further tinnitus retraining therapy (TRT) and...
PURPOSE: The purpose of this paper is to determine a tinnitus patient information pack's (TPIP) usefulness in patients suffering with tinnitus with respect to their need for further tinnitus retraining therapy (TRT) and in reducing TRT cancellations and non-attenders. DESIGN/METHODOLOGY/APPROACH: The paper consists of prospective case series in a district general hospital ENT out-patient department. FINDINGS: Patients with tinnitus-related symptoms constitute around 2 per cent of the ENT OPD workload at the West Middlesex Hospital, Chelsea & Westminster NHS Trust, London, i.e., 365 patients with intrusive tinnitus were referred by the ENT surgeon for TRT; 56/365 patients (15.3 per cent) failed to attend and 60 (16.4 per cent) cancelled their appointments. The following year, a TPIP was administered to all tinnitus sufferers, despite the affliction's intrusiveness, and told to contact the audiology department if they felt that TRT was required, which resulted in 43/233 patients (18.5 per cent) over a one-year period self-referring for TRT; 2/233 (0.9 per cent) did not attend, and 1/233 (0.4 per cent) were cancelled appointments. PRACTICAL IMPLICATIONS: The patient-focussed TPIP acts as an initial therapy for the tinnitus sufferer by providing reassurance and self-therapy. This results in patients who are less likely to seek TRT, leading to more efficient clinical resource usage (<0.01). ORIGINALITY/VALUE: The data suggest that all tinnitus sufferers presenting to ENT clinics could be handed a TPIP and empowered with the decision whether they require further intervention.
Intervention analysis and classification: key to health outcomes optimization.
Nkwocha O
Int J Health Care Qual Assur · 2019 Mar · PMID 31017055 · Publisher ↗
PURPOSE: Measures are important to healthcare outcomes. Outcome changes result from deliberate selective intervention introduction on a measure. If measures can be characterized and categorized, then the resulting schema...
PURPOSE: Measures are important to healthcare outcomes. Outcome changes result from deliberate selective intervention introduction on a measure. If measures can be characterized and categorized, then the resulting schema may be generalized and utilized as a framework for uniquely identifying, packaging and comparing different interventions and probing target systems to facilitate selecting the most appropriate intervention for maximum desired outcomes. Measure characterization was accomplished with multi-axial statistical analysis and measure categorization by logical tabulation. The measure of interest is a key provider productivity index: "patient visits per hour," while the specific intervention is "patient schedule manipulation by overbooking." The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: For statistical analysis, interrupted time series (ITS), robust-ITS and outlier detection models were applied to an 18-month data set that included patient visits per hour and intervention introduction time. A statistically significant change-point was determined, resulting in pre-intervention, transitional and post-effect segmentation. Linear regression modeling was used to analyze pre-intervention and post-effect mean change while a triangle was used to analyze the transitional state. For categorization, an "intervention moments" table was constructed from the analysis results with: time-to-effect, pre- and post-mean change magnitude and velocity; pre- and post-correlation and variance; and effect decay/doubling time. The table included transitional parameters such as transition velocity and transition footprint visualization represented as a triangle. FINDINGS: The intervention produced a significant change. The pre-intervention and post-effect means for patient visits per hour were statistically different (0.38, =0.0001). The pre- and post-variance change (0.23, =0.01) was statistically significant (variance was higher post-intervention, which was undesirable). Post-intervention correlation was higher (desirable). Decay time for the effect was calculated as 11 months post-effect. Time-to-effect was four months; mean change velocity was +0.094 visits per h/month. A transition triangular footprint was produced, yielding 0.35 visits per hr/month transition velocity. Using these results, the intervention was fully profiled and thereby categorized as an intervention moments table. RESEARCH LIMITATIONS/IMPLICATIONS: One limitation is sample size for this time series, 18 monthly cycles' analysis. However, interventions on measures in healthcare demand short time cycles (hence necessarily yielding fewer data points) for practicality, meaningfulness and usefulness. Despite this shortcoming, the statistical processes applied such as outliers detection, -test for mean difference, -test for variances and modeling, all consider the small sample sizes. Seasonality, which usually affects time series, was not detected and even if present, was also considered by modeling. PRACTICAL IMPLICATIONS: Obtaining an intervention profile, made possible by multidimensional analysis, allows interventions to be uniquely classified and categorized, enabling informed, comparative and appropriate selective deployment against health measures, thus potentially contributing to outcomes optimization. SOCIAL IMPLICATIONS: The inevitable direction for healthcare is heavy investment in measures outcomes optimization to improve: patient experience; population health; and reduce costs. Interventions are the tools that change outcomes. Creative modeling and applying novel methods for intervention analysis are necessary if healthcare is to achieve this goal. Analytical methods should categorize and rank interventions; probe the measures to improve future selection and adoption; reveal the organic systems' strengths and shortcomings implementing the interventions for fine-tuning for better performance. ORIGINALITY/VALUE: An "intervention moments table" is proposed, created from a multi-axial statistical intervention analysis for organizing, classifying and categorizing interventions. The analysis-set was expanded with additional parameters such as time-to-effect, mean change velocity and effect decay time/doubling time, including transition zone analysis, which produced a unique transitional footprint; and transition velocity. The "intervention moments" should facilitate intervention cross-comparisons, intervention selection and optimal intervention deployment for best outcomes optimization.
Adherence to surgical antimicrobial prophylaxis: "checking-the-box" is not enough.
Karamchandani K, Barden K, Prozesky J
Int J Health Care Qual Assur · 2019 Mar · PMID 31017054 · Publisher ↗
PURPOSE: The purpose of this paper is to review surgical antimicrobial prophylaxis administration practices in a small cohort and assess compliance with national guidelines. DESIGN/METHODOLOGY/APPROACH: Patients that dev...
PURPOSE: The purpose of this paper is to review surgical antimicrobial prophylaxis administration practices in a small cohort and assess compliance with national guidelines. DESIGN/METHODOLOGY/APPROACH: Patients that developed surgical site infections (SSI) in a tertiary care academic medical center over a two-year period were identified. Their electronic medical records were reviewed for compliance with national guidelines with respect to surgical antibiotic prophylaxis. FINDINGS: Over a two-year period, 283 SSI patients were identified. An appropriate antibiotic was chosen in 80 percent, an appropriate dose was administered in 45 percent and timing complied in 89 percent. The antibiotics were appropriately re-dosed in only 9.2 percent in whom the requirement was met. The prescribing guidelines were adhered to in entirety in only 54 patients (23.8 percent). PRACTICAL IMPLICATIONS: Timely and appropriate antibiotic administration prior to surgery is essential to prevent SSI. Proper diligence is required to accomplish this task effectively. ORIGINALITY/VALUE: Based on the findings, it appears that merely, "checking a box" for antibiotic administration during surgery is not enough, and a multidisciplinary approach should be followed to ensure "appropriate" antibiotic administration.
Discrete event simulation and pharmacy process re-engineering.
Al Badi K
Int J Health Care Qual Assur · 2019 Mar · PMID 31017053 · Publisher ↗
PURPOSE: The purpose of this paper is to describe a case study undertaken at Al Buraimi Hospital in Oman, which used computer simulation and the Delphi approach to improve efficiency by reducing prescription dispensing w...
PURPOSE: The purpose of this paper is to describe a case study undertaken at Al Buraimi Hospital in Oman, which used computer simulation and the Delphi approach to improve efficiency by reducing prescription dispensing waiting times. DESIGN/METHODOLOGY/APPROACH: This study's framework was based on a discrete event simulation (DES) to identify the as-is pharmacy process and to create a to-be (future situation) to achieve an improvement in pharmacy workflow and service quality. Owing to healthcare environment complexity, and to gain a deeper understanding about Al Buraimi Hospital pharmacy problems, a Delphi technique was also used. FINDINGS: Based on Delphi, and according to the expert panel suggestions, two alternative scenarios were proposed to improve Al Buraimi Hospital pharmacy efficiency: fast-track and direct-dispensing, which should help to reduce the prescription dispensing waiting time process by 7.3 and 9.8 min, respectively. RESEARCH LIMITATIONS/IMPLICATIONS: The main limitation is the pharmacists' shortage, which may affect the prescription dispensing process's quality as insufficient manpower to check the prescriptions may increase the medication errors' risk. ORIGINALITY/VALUE: Based on this case study's real-world data, findings can be used to improve public healthcare sector pharmacy efficiency. The DES can be used in healthcare services to describe and test actual and proposed situations.
Implementing Lean Six Sigma in a Kuwaiti private hospital.
Al-Zain Y, Al-Fandi L, Arafeh M … +4 more , Salim S, Al-Quraini S, Al-Yaseen A, Abu Taleb D
Int J Health Care Qual Assur · 2019 Mar · PMID 31017052 · Publisher ↗
PURPOSE: The purpose of this paper is to use Lean Six Sigma (LSS) to reduce patient waiting time in a Kuwaiti private hospital obstetrics and gynaecology clinic. APPROACH: The define, measure, analyse, improve and contro...
PURPOSE: The purpose of this paper is to use Lean Six Sigma (LSS) to reduce patient waiting time in a Kuwaiti private hospital obstetrics and gynaecology clinic. APPROACH: The define, measure, analyse, improve and control methodology was used. The "define" stage involved identifying patients' needs, system capabilities and project objectives. The "measure" stage assessed the system's current state through data collection on waiting times. Dunnett's test, control charts and process capability analysis were used to ensure data accuracy. In the "analyse" stage, an Ishikawa diagram and Pareto chart were constructed, showing that overbooking appointments, doctors' unscheduled breaks and doctors not arriving on time were the root causes of the problem. The "improve" stage used an Arena simulation model to represent current and improved system status. The proposed solutions were implemented and monitored in the "control" stage. FINDINGS: A sigma-level improvement of 300 per cent (0.5-2.0) was realized for appointment patients on Saturdays, with a 67 per cent reduction in waiting time. For walk-ins, the sigma level improved by 288 per cent (0.8-3.1), with a 55 per cent reduction in waiting time. For weekday appointments, the sigma level improved by 111 per cent (0.9-1.9), with a 63 per cent reduction in waiting time. For walk-ins, the sigma level improved by 69 per cent (1.6-2.7), with a 46 per cent reduction in waiting time. A cost-benefit analysis estimated the present project value at $656,459, leading to a total of $5,820,319 in savings by 2025. ORIGINALITY/VALUE: This paper fulfils the need for process improvement, increasing patients' satisfaction and hospitals' profitability using LSS.
Bedside vital parameters that indicate early deterioration.
Bunkenborg G, Poulsen I, Samuelson K … +2 more , Ladelund S, Akeson J
Int J Health Care Qual Assur · 2019 Feb · PMID 30859885 · Publisher ↗
PURPOSE: The purpose of this paper is to determine associations between initially recorded deviations in individual bedside vital parameters that contribute to total Modified Early Warning Score (MEWS) levels 2 or 3 and...
PURPOSE: The purpose of this paper is to determine associations between initially recorded deviations in individual bedside vital parameters that contribute to total Modified Early Warning Score (MEWS) levels 2 or 3 and further clinical deterioration (MEWS level=4). DESIGN/METHODOLOGY/APPROACH: This was a prospective study in which 27,504 vital parameter values, corresponding to a total MEWS level⩾2, belonging to 1,315 adult medical and surgical inpatient patients admitted to a 90-bed study setting at a university hospital, were subjected to binary logistic and COX regression analyses to determine associations between vital parameter values initially corresponding to total MEWS levels 2 or 3 and later deterioration to total MEWS level ⩾4, and to evaluate corresponding time intervals. FINDINGS: Respiratory rate, heart rate and patient age were significantly ( p=0.012, p<0.001 and p=0.028, respectively) associated with further deterioration from a total MEWS level 2, and the heart rate also ( p=0.009) from a total MEWS level 3. Within 24 h from the initially recorded total MEWS levels 2 or 3, 8 and 17 percent of patients, respectively, deteriorated to a total MEWS level=4. Patients initially scoring MEWS 2 had a 27 percent 30-day mortality rate if they later scored MEWS level=4, and 8.7 percent if they did not. PRACTICAL IMPLICATIONS: It is important to observe all patients closely, but especially elderly patients, if total MEWS levels 2 or 3 are tachypnoea and/or tachycardia related. ORIGINALITY/VALUE: Findings might contribute to patient safety by facilitating appropriate clinical and organizational decisions on adequate time spans for early warning scoring in general ward patients.
The privatisation of healthcare system in Bangladesh.
Rahman R
Int J Health Care Qual Assur · 2019 Feb · PMID 30859884 · Publisher ↗
PURPOSE: The purpose of this paper is to examine the factors that triggered the privatisation of Bangladesh's health sector. DESIGN/METHODOLOGY/APPROACH: This study follows systematic reviews in its undertaking and is ba...
PURPOSE: The purpose of this paper is to examine the factors that triggered the privatisation of Bangladesh's health sector. DESIGN/METHODOLOGY/APPROACH: This study follows systematic reviews in its undertaking and is based on an extensive review of both published and unpublished documents. Different search engines and databases were used to collect the materials. The study takes into account of various research publications, journal articles, government reports, policy and planning documents, relevant press reports/articles, and reports and discussion papers from the World Health Organization, the World Bank and the Asian Development Bank. FINDINGS: While Bangladesh's healthcare sector has undergone an increasing trend towards privatisation, this move has limited benefits on the overall improvement in the health of the people of Bangladesh. The public sector should remain vital, and the government must remobilise it to provide better provision of healthcare. RESEARCH LIMITATIONS/IMPLICATIONS: The paper focusses only on the public policy aspect of privatisation in healthcare of a country. PRACTICAL IMPLICATIONS: The paper examines the issue of privatisation of healthcare and concludes that privatisation not only makes services more expensive, but also diminishes equity and accountability in the provision of services. The study, first, makes a spate of observations on improving public healthcare resources, which can be of value to key decision makers and stakeholders in the healthcare sector. It also discourages the move towards private sector interventions. ORIGINALITY/VALUE: This study is an independent explanation of a country's healthcare system. Lesson learned from this study could also be used for developing public policy in similar socio-economic contexts.
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