International Journal Of Health Care Quality Assurance[JOURNAL]
Sun
200 papers
Objective measures of workload in healthcare: a narrative review.
Fishbein D, Nambiar S, McKenzie K … +7 more , Mayorga M, Miller K, Tran K, Schubel L, Agor J, Kim T, Capan M
Int J Health Care Qual Assur · 2019 Dec · PMID 31940153 · Publisher ↗
PURPOSE: Workload is a critical concept in the evaluation of performance and quality in healthcare systems, but its definition relies on the perspective (e.g. individual clinician-level vs unit-level workload) and type o...
PURPOSE: Workload is a critical concept in the evaluation of performance and quality in healthcare systems, but its definition relies on the perspective (e.g. individual clinician-level vs unit-level workload) and type of available metrics (e.g. objective vs subjective measures). The purpose of this paper is to provide an overview of objective measures of workload associated with direct care delivery in tertiary healthcare settings, with a focus on measures that can be obtained from electronic records to inform operationalization of workload measurement. DESIGN/METHODOLOGY/APPROACH: Relevant papers published between January 2008 and July 2018 were identified through a search in Pubmed and Compendex databases using the Sample, Phenomenon of Interest, Design, Evaluation, Research Type framework. Identified measures were classified into four levels of workload: task, patient, clinician and unit. FINDINGS: Of 30 papers reviewed, 9 used task-level metrics, 14 used patient-level metrics, 7 used clinician-level metrics and 20 used unit-level metrics. Key objective measures of workload include: patient turnover (=9), volume of patients (=6), acuity (=6), nurse-to-patient ratios (=5) and direct care time (=5). Several methods for operationalization of these metrics into measurement tools were identified. ORIGINALITY/VALUE: This review highlights the key objective workload measures available in electronic records that can be utilized to develop an operational approach for quantifying workload. Insights gained from this review can inform the design of processes to track workload and mitigate the effects of increased workload on patient outcomes and clinician performance.
Impact of caregiver overnight stay on postoperative outcomes.
Griffin S, McGrath L, Chesnut GT … +7 more , Benfante N, Assel M, Ostrovsky A, Levine M, Vickers A, Simon B, Laudone V
Int J Health Care Qual Assur · 2019 Dec · PMID 31940152 · Full text
PURPOSE: The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative clinical outcomes. DESIGN/METHODOL...
PURPOSE: The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative clinical outcomes. DESIGN/METHODOLOGY/APPROACH: This was a retrospective cohort study of patients undergoing surgery requiring overnight stay in a highly resourced free-standing oncology ambulatory surgery center. Postoperative outcomes in patients who had caregivers stay with them overnight were compared with outcomes in those who did not. All other care was standardized. Primary outcomes were postoperative length of stay, hospital readmission rates, urgent care center (UCC) visits within 30 days and perioperative complication rates. FINDINGS: Among patients staying overnight, 2,462 (57 percent) were accompanied by overnight caregivers. In this group, time to discharge was significantly lower. Readmissions (though rare) were slightly higher, though the difference was not statistically significant (=0.059). No difference in early (<30 day) complications or UCC visits was noted. Presence of a caregiver overnight was not associated with important differences in outcomes, though further research in a less well-structured environment is likely to show a more robust benefit. Caregivers are still recommended to stay overnight if that is their preference as no harm was identified. ORIGINALITY/VALUE: This study is unique in its evaluation of the clinical impact of having a caregiver stay overnight with ambulatory surgery patients. Little research has focused on the direct impact of the caregiver on patient outcomes, especially in the ambulatory setting. With increased adoption of minimally invasive surgical techniques and enhanced recovery pathways, a larger number of patients are eligible for short-stay ambulatory surgery. Factors that impact discharge and early postoperative complications are important.
Analysis of the operational risk factors in public hospitals in an Indian state.
Vishnu CR, Sridharan R, Ram Kumar PN … +1 more , Regi Kumar V
Int J Health Care Qual Assur · 2019 Dec · PMID 31940151 · Publisher ↗
PURPOSE: Risk management in the healthcare sector is a highly relevant sub-domain and a crucial research area from the humanitarian perspective. The purpose of this paper is to focus on the managerial/supply chain risk f...
PURPOSE: Risk management in the healthcare sector is a highly relevant sub-domain and a crucial research area from the humanitarian perspective. The purpose of this paper is to focus on the managerial/supply chain risk factors experienced by the government hospitals in an Indian state. The present paper analyzes the inter-relationships among the significant risk factors and ranks those risk factors based on their criticality. DESIGN/METHODOLOGY/APPROACH: The current research focuses on 125 public hospitals in an Indian state. Questionnaire-based survey and personal interviews were conducted in the healthcare sector among the inpatients and hospital staff to identify the significant risk factors. An integrated DEMATEL-ISM-PROMETHEE method is adopted to analyze the impact potential and dependence behavior of the risk factors. FINDINGS: The analysis asserts the absence of critical risk factors that have a direct impact on patient safety in the present healthcare system under investigation. However, the results illustrate the remarkable impact potential attributed to the risk factor, namely, staff shortage in inducing other risk factors such as employee attitudinal issues, employee health issues and absenteeism altogether resulting in community mistrust/misbeliefs. Maintenance mismanagement, monsoon time epidemics, physical infrastructure limitations are also found to be significant risk factors that compromise patient satisfaction levels. PRACTICAL IMPLICATIONS: Multiple options are illustrated to mitigate significant risk factors and operational constraints experienced by public hospitals in the state. The study warrants urgent attention from government officials to fill staff vacancies and to improve the infrastructural facilities to match with the increasing demand from the society. Furthermore, this research recommends the hospital authorities to start conducting induction and training programs for the hospital employees to instill the fundamental code of conduct while working in hectic, challenging and even in conditions with limited resources. ORIGINALITY/VALUE: Only limited papers are visible that address the identification and mitigation of risk factors associated with hospitals. The present paper proposes a novel DEMATEL-ISM-PROMETHEE integrated approach to map the inter-relationships among the significant risk factors and to rank those risk factors based on their criticality. Furthermore, the present study discloses the unique setting of the public healthcare system in a developing nation.
Testing the Integrative Quality Care Assessment Tool (INQUAT).
Amati R, Bellandi T, Kaissi AA … +1 more , Hannawa AF
Int J Health Care Qual Assur · 2019 Dec · PMID 31940150 · Publisher ↗
PURPOSE: Identifying the factors that contribute or hinder the provision of good quality care within healthcare institutions, from the managers' perspective, is important for the success of quality improvement initiative...
PURPOSE: Identifying the factors that contribute or hinder the provision of good quality care within healthcare institutions, from the managers' perspective, is important for the success of quality improvement initiatives. The purpose of this paper is to test the Integrative Quality Care Assessment Tool (INQUAT) that was previously developed with a sample of healthcare managers in the USA. DESIGN/METHODOLOGY/APPROACH: Written narratives of 69 good and poor quality care episodes were collected from 37 managers in Italy. A quantitative content analysis was conducted using the INQUAT coding scheme, to compare the results of the US-based study to the new Italian sample. FINDINGS: The core frame of the INQUAT was replicated and the meta-categories showed similar distributions compared to the US data. Structure (i.e. organizational, staff and facility resources) covered 8 percent of all the coded units related to quality aspects; context (i.e. clinical factors and patient factors) 10 percent; process (i.e. communication, professional diligence, timeliness, errors and continuity of care) 49 percent; and outcome (i.e. process- and short-term outcomes) 32 percent. However, compared to the US results, Italian managers attributed more importance to different categories' subcomponents, possibly due to the specificity of each sample. For example, professional diligence, errors and continuity of care acquired more weight, to the detriment of communication. Furthermore, the data showed that process subcomponents were associated to perceived quality more than outcomes. RESEARCH LIMITATIONS/IMPLICATIONS: The major limitation of this investigation was the small sample size. Further studies are needed to test the reliability and validity of the INQUAT. ORIGINALITY/VALUE: The INQUAT is proposed as a tool to systematically conduct in depth analyses of successful and unsuccessful healthcare events, allowing to better understand the factors that contribute to good quality and to identify specific areas that may need to be targeted in quality improvement initiatives.
Leadership and quality management measurement models: an empirical study.
Chansatitporn N, Pobkeeree V
Int J Health Care Qual Assur · 2019 Dec · PMID 31898882 · Publisher ↗
PURPOSE: The purpose of this paper is to explore, confirm and verify leadership with regards to quality management measurement models. This research focused on identifying individual staff members' leadership attributes...
PURPOSE: The purpose of this paper is to explore, confirm and verify leadership with regards to quality management measurement models. This research focused on identifying individual staff members' leadership attributes at the Thai National Institute of Health in relation to quality management. DESIGN/METHODOLOGY/APPROACH: The research instrument used in this study was a modified questionnaire on self-leadership and quality management that was distributed to the institute's staff. Leadership and quality management construct variables were observed and measured through staff perceptions, attitudes, practices and existing facts at the institute. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to examine the data. FINDINGS: The questionnaire had a 65 percent response rate. EFA revealed six factors from 27 questionnaire items and CFA was used to confirm the measurement models that were fitted to the data. The leadership attributes of staff members at the institute were statistically associated to and impacted on quality management by SEM analysis. RESEARCH LIMITATIONS/IMPLICATIONS: In-depth understanding of leadership and quality management could be done through a longitudinal study because the two factors would change over time. Even though this model is not a longitudinal study, it could help the institute facilitate and manage quality in practice through leadership. ORIGINALITY/VALUE: A cross-sectional study is used to examine the effect of leadership on quality management through factor analysis and SEM, which provided empirical evidence for future research. Leadership and quality management measurement models have statistically proven to be appropriately, technically and theoretically correct by design for observing variables used in the leadership measurement model that affects quality management.
Epidemiological shift of hepatitis A in EAGLE countries - a projection.
Ghildayal N
Int J Health Care Qual Assur · 2019 Dec · PMID 31895507 · Publisher ↗
PURPOSE: Many world regions are developing quickly and experiencing increasing levels of sanitation, causing an epidemiological shift of hepatitis A in these areas. The shift occurs when children avoid being infected wit...
PURPOSE: Many world regions are developing quickly and experiencing increasing levels of sanitation, causing an epidemiological shift of hepatitis A in these areas. The shift occurs when children avoid being infected with the disease until a later age due to cleaner water sources, food, and hygiene practices in their environment; but if they are infected at later age, the disease is much more severe and lost productivity costs are higher. The purpose of this paper is to examine what could occur if an epidemiological shift of the disease continues in these regions, and what type of future burden hepatitis A may have in a hypothetical rapidly developing country. DESIGN/METHODOLOGY/APPROACH: Initially, annual hepatitis A mortality was regressed on the Human Development Index (HDI) for each country classified as an emerging and growth-leading economy (EAGLE) to provide an overview of how economic development and hepatitis A mortality related. Data from the various EAGLE countries were also fit to a model of hepatitis A mortality rates in relation to HDI, which were both weighted by each country's 1995-2010 population of available data, in order to create a model for a hypothetical emerging market country. A second regression model was fit for the weighted average annual hepatitis A mortality rate of all EAGLE countries from the years 1995 to 2010. Additionally, hepatitis A mortality rate was regressed on year. FINDINGS: Regression results show a constant decline of mortality as HDI increased. For each increase of one in HDI value in this hypothetical country, mortality rate declined by 2.3016 deaths per 100,000 people. The hypothetical country showed the HDI value increasing by 0.0073 each year. Also, results displayed a decrease in hepatitis A mortality rate of 0.0168 per 100,000 people per year. Finally, the mortality rate for hepatitis A in this hypothetical country is projected to be down to 0.11299 deaths per 100,000 people by 2030 and its economic status will fall just below the HDI criteria for a developed country by 2025. ORIGINALITY/VALUE: The hypothetical country as a prototype model was created from the results of regressed data from EAGLE countries. It is aimed to display an example of the health and economic changes occurring in these rapidly developing regions in order to help understand potential hepatitis A trends, while underscoring the importance of informed and regular policy updates in the coming years. The author believes this regression provides insight into the patterns of hepatitis A mortality and HDI as these EAGLE countries undergo rapid development.
Six sigma approach for neonatal jaundice patients in an Indian rural hospital - a case study.
Prajapati D, Suman G
Int J Health Care Qual Assur · 2019 Dec · PMID 31886954 · Publisher ↗
PURPOSE: The purpose of this paper is to implement Six Sigma approach to decrease the length of stay (LOS) of neonatal jaundice patients in an Indian government rural hospital situated in northern hill region. DESIGN/MET...
PURPOSE: The purpose of this paper is to implement Six Sigma approach to decrease the length of stay (LOS) of neonatal jaundice patients in an Indian government rural hospital situated in northern hill region. DESIGN/METHODOLOGY/APPROACH: Six Sigma's Define-Measure-Analyse-Improve-Control procedure is applied in order to decrease the LOS of neonatal jaundice patients. The mean and standard deviation have been computed as 34.53 and 20.01 h, respectively. The cause and effect diagram is used in the "Analyse" phase of the Six Sigma. The regression analysis and GEMBA observation techniques are used to validate the causes identified through cause and effect diagram. FINDINGS: The waiting time for registration, waiting time for tests, waiting time for phototherapy and time for discharge implementation are the main factors that are responsible for longer LOS. Based on the identified root causes, some recommendations are suggested to the hospital administration and staff members in order to reduce the LOS. RESEARCH LIMITATIONS/IMPLICATIONS: The present research is limited to provide recommendations to the hospital administration to reduce LOS and it entirely depends upon the implementation of the administration. However, target of administration is to reduce the LOS up to 24 h. PRACTICAL IMPLICATIONS: Six Sigma model will reduce bottlenecks in LOS and enhance service quality of hospital. The developed regression model will help the doctors and staff members to assess and control the LOS by controlling and minimising the independent variables. SOCIAL IMPLICATIONS: The project will directly provide benefits to society, as LOS will decrease and patients' satisfaction will automatically increase. ORIGINALITY/VALUE: Six Sigma is a developed methodology, but its application in paediatric department is very limited. This is the first ever study of applying Six Sigma for neonatal jaundice patients in India.
Implementation of the CLiP database.
Lee KKS, Silim UA
Int J Health Care Qual Assur · 2019 Dec · PMID 31886638 · Publisher ↗
PURPOSE: The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital i...
PURPOSE: The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital in Malaysia with the aim of improving the quality CLiP services. DESIGN/METHODOLOGY/APPROACH: All inpatient referrals to the CLiP team were recorded over a three-month period and compared to previous audit data from 2017. Four audit standards were assessed: the reporting of referrals, timeliness of response indication of reason for referral and presence of a management plan. FINDINGS: The compliance of reporting using the CLiP form was 70.1 per cent compared to 28 per cent in the audit data from 2017 after interventions were conducted. Analysis of the completed CLiP form reveals that 89 per cent of referrals were seen within the same working day. All referrals included the reason for referral. The most common reason for referral was for depressive disorders, but post-assessment, delirium was the most common diagnosis. In total, 87.8 per cent satisfied the audit criteria for a completed written care plan. ORIGINALITY/VALUE: Specialised CLiP services are relatively new in Malaysia and this is the first paper to examine the quality of such services in the country. Interventions were effective in improving the compliance of reporting using the CLiP database. The findings suggest that the CLiP services are on par with international audit standards. Furthermore, data from this clinical audit can serve as a benchmark for the development of national operating policies in similar settings.
Cross-sectional study of the quality of neonatal care services in Armenia.
Galstyan SH, Kalenteryan HZ, Djerdjerian AS … +3 more , Ghazaryan HS, Gharakhanyan NT, Kalenteryan VY
Int J Health Care Qual Assur · 2019 Oct · PMID 31566515 · Publisher ↗
PURPOSE: The purpose of this paper is to report the assessment results of the quality of neonatal care services in Armenia and to describe the identified obstacles to improving the quality of care for newborn infants. DE...
PURPOSE: The purpose of this paper is to report the assessment results of the quality of neonatal care services in Armenia and to describe the identified obstacles to improving the quality of care for newborn infants. DESIGN/METHODOLOGY/APPROACH: The study carried out a cross-sectional descriptive design. The data were collected in health facilities with different levels of neonatal care that were selected employing a multi-stage, stratified purposeful sampling design. The quality of neonatal services was assessed using the generic WHO tool. Data collection was performed using face-to-face semi-structured interviews, hospital statistics, medical records and direct observations. FINDINGS: In 31 study hospitals, 31,976 deliveries were performed resulting in 31,701 live births and 734 stillbirths. About 85 percent of all neonatal deaths was attributable to early neonatal deaths with over 48 percent occurring during the first 24 h of life. The proportion of neonatal deaths was highest in infants with low birth weight constituting 92.8 percent of all neonatal deaths. The total neonatal mortality rate was 3.50 per 1,000 live births, whereas stillbirth rate and perinatal mortality rate were 22.60 and 25.26 per 1,000 total births in 2015. Specific indicators with relatively lower mean scores included neonatal resuscitation, early breastfeeding, monitoring of newborn conditions, neonatal sepsis, feeding standards, total parenteral nutrition, and infection treatment. ORIGINALITY/VALUE: Given the limited scope of research on quality assessment, this paper provides valuable information on the status of quality of neonatal care services in Armenian health facilities. This work also extends the existing studies focused on quality assessment through applying the model of Avedis Donabedian with the structure-process-outcomes approach as a theoretical basis.
Cost-effectiveness of Hepatitis A vaccination in a developed and developing country.
Ghildayal N
Int J Health Care Qual Assur · 2019 Oct · PMID 31566514 · Publisher ↗
PURPOSE: Hepatitis A is a prevalent disease that is largely preventable by vaccine usage. The vaccine for this illness is highly underused in most regions. In an attempt to find the strategies that are most beneficial in...
PURPOSE: Hepatitis A is a prevalent disease that is largely preventable by vaccine usage. The vaccine for this illness is highly underused in most regions. In an attempt to find the strategies that are most beneficial in regard to quality-adjusted life years (QALYs) and cost in current environments, the purpose of this paper is to conduct cost-effectiveness analyses to investigate vaccination strategies in a more economically developed country (MEDC), generally known as a "developed" area: the USA, and a less economically developed country (LEDC), generally known as a "developing" area: the state of Rio de Janeiro, Brazil. DESIGN/METHODOLOGY/APPROACH: This study used a dynamic transmission model for comparative effectiveness analyses. The model ran two different scenarios. The two regions studied have different policies and strategies for Hepatitis A vaccination currently, and also used different strategies in 2009. In the USA, a universal vaccination policy was modeled, along with a scenario in which it was removed. In Rio de Janeiro, a no vaccination policy was modeled, along with a scenario in which a universal vaccination policy was effected. FINDINGS: The comparison of resulting incremental cost-effectiveness ratio values to accepted threshold values showed universal vaccination to be cost-effective in both the USA and Rio de Janeiro as compared to no vaccination. When episode and vaccination costs and vaccination efficacy were varied, this still remained true. Universal vaccination was found to result in lower incidence of Hepatitis A in both the USA and Rio de Janeiro. Over the twenty-year time horizon, universal vaccination is projected to prevent 506,945 cases of symptomatic Hepatitis A in the USA and 42,318 cases of Hepatitis A in Rio de Janeiro. Other benefits include a projected increase in cumulative QALYs through the use of universal vaccination. ORIGINALITY/VALUE: This analysis showed universal vaccination to be cost-effective as compared to no vaccination, and portions of the study's approach had not previously been applied in tandem to investigate Hepatitis A interventions. The results may help foster higher compliance rates for Hepatitis A vaccination and even greater per-person economic benefits of universal vaccination, particularly in the USA. The purpose of this study is also to encourage elevated levels of surveillance on age of infection in developing regions and consistent reevaluation utilizing dynamic transmission models in both the USA and Brazil, as well as other rapidly developing regions, in order to prevent future epidemics and costs associated with the disease.
Senior citizens' acceptance of connected health technologies in their homes.
Etemad-Sajadi R, Gomes Dos Santos G
Int J Health Care Qual Assur · 2019 Oct · PMID 31566513 · Publisher ↗
PURPOSE: The objective of this paper is to focus on seniors' acceptance of the usage of connected healthcare technologies in their homes. The authors integrated into technology acceptance model (TAM) several latent varia...
PURPOSE: The objective of this paper is to focus on seniors' acceptance of the usage of connected healthcare technologies in their homes. The authors integrated into technology acceptance model (TAM) several latent variables such as social presence, trust and degree of intrusiveness perceived with the use of connected health technologies. DESIGN/METHODOLOGY/APPROACH: The authors distributed the survey by post to 605 seniors. The authors targeted elderly people using connected health technologies (assistive alarm, telecare, sensors, etc.) at home and/or receiving healthcare at home. The authors received 213 questionnaires back. As The authors had several latent variables, the authors used partial least squares (PLS), a variance-based structural equation modeling method. FINDINGS: The results show that the level of trust in these technologies impacts significantly the perception of usefulness and the degree of intrusiveness. In parallel, the degree of usefulness of these technologies impacts positively elderly people's intention to accept their usage. Finally, one can claim that the perception of the social presence with the use of these technologies impacts positively the degree of perceived usefulness, trust and intrusiveness. RESEARCH LIMITATIONS/IMPLICATIONS: The sample covers a population benefiting from similar connected health technologies. It was difficult to distinguish and interpret the added value of each technology separately. As more and more elderly people use or are least familiarizing themselves with a range of connected technologies it would be interesting to identify which sets of connected technologies contribute the most to a positive feeling of social presence. SOCIAL IMPLICATIONS: These results are particularly relevant to stakeholders in the health industry in their quest to improve their products/services. A better understanding of the relation that the elderly have with connected health technologies is an essential prerequisite to supporting the development of new solutions capable of meeting the specific needs of our seniors. ORIGINALITY/VALUE: The authors want to apply the TAM to connected health technologies designed for elderly people and the authors also want to extend it by integrating the social presence, trust and degree of intrusiveness variables to our research model.
Creating a development force in Swedish healthcare.
Kahm T, Ingelsson P
Int J Health Care Qual Assur · 2019 Oct · PMID 31566512 · Publisher ↗
PURPOSE: The purpose of this paper is to present the results from a study that investigates first-line healthcare managers' views on their role and the conditions that influence their ability to drive improvement work ba...
PURPOSE: The purpose of this paper is to present the results from a study that investigates first-line healthcare managers' views on their role and the conditions that influence their ability to drive improvement work based on Lean. DESIGN/METHODOLOGY/APPROACH: A questionnaire was sent to all first-line managers in a healthcare organization to investigate their views on their role, conditions and ability to create change according to Lean. The results from four of the questions are presented, which focus on how crucial they consider their role to be for managing improvement work based on Lean, what work tasks their time is spent on, what factors they consider to be important to their ability to drive change and what factors best describe what Lean provides. FINDINGS: The results show that first-line managers claim that their role is crucial in improvement work, but when they defined their work tasks, the time spent on improvements was not frequently described. Time, support from coworkers, and a clear vision and clear goals were the three factors that they considered to be most important to their ability to drive improvement work. Considering their leadership, Lean contributed to the structure with tools and supportive methods. ORIGINALITY/VALUE: The questions can be used separately or as part of the entire questionnaire before and along a Lean process to obtain a better understanding of how to create a sustainable Lean approach in healthcare. Understanding the factors that first-line managers consider supporting their ability in improvement work and what they consider Lean provides is important in creating a development force in Swedish healthcare.
Developing strategies for patient safety implementation: a national study in Iran.
Maher A, Ayoubian A, Rafiei S … +3 more , Sheibani Tehrani D, Mostofian F, Mazyar P
Int J Health Care Qual Assur · 2019 Oct · PMID 31566511 · Publisher ↗
PURPOSE: Today, healthcare organizations focus mainly on development and implementation of patient safety strategic plan to improve quality and ensure safety of provided services. The purpose of this paper is to recommen...
PURPOSE: Today, healthcare organizations focus mainly on development and implementation of patient safety strategic plan to improve quality and ensure safety of provided services. The purpose of this paper is to recommend potential strategies for successful implementation of patient safety program in Iranian hospitals based on a strengths, weaknesses, opportunities, threats (SWOT) analysis. DESIGN/METHODOLOGY/APPROACH: In this qualitative study, key informant interviews and documentation review were done to identify strength and weakness points of Iranian hospitals in addition to opportunities and threats facing them in successful implementation of a patient safety program. Accordingly, the research team formulated main patient safety strategies and consequently prioritized them based on Quantitative Strategic Planning Matrix (QSPM) matrix. FINDINGS: The study recommended some of the potential patient safety strategies including provision of education for employees, promoting a safety culture in hospitals, managerial support and accountability, creating a safe and high-quality delivery environment, developing national legislations for hospital staff to comply with patient safety standards and developing a continuous monitoring system for quality improvement and patient safety activities to ensure the achievement of predetermined goals. PRACTICAL IMPLICATIONS: Developing a comprehensive and integrated strategic plan for patient safety based on accurate information about the health system's weaknesses, strengths, opportunities and threats and trying to implement the plan in accordance with patient safety principles can help hospitals achieve great success. ORIGINALITY/VALUE: Ministry of Health and Medical Education (MOHME) conducted a national study to recommend potential strategies for successful implementation of patient safety in Iranian hospitals based on a SWOT analysis and QSPM matrix.
Efficacy of physician associate delivered virtual outpatient clinic.
Meehan D, Balhareth A, Gnanamoorthy M … +2 more , Burke J, McNamara DA
Int J Health Care Qual Assur · 2019 Aug · PMID 31411096 · Publisher ↗
PURPOSE: The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and co...
PURPOSE: The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and considering new processes all have a role in improving delivering these services. The purpose of this paper is to evaluate the safety of a physician associate (PA) delivered virtual outpatient department (VOPD) consultation service that was established in a General and Colorectal Surgery Department at an Irish teaching hospital. DESIGN/METHODOLOGY/APPROACH: A series of low-risk surgical patients were referred by senior surgeons to a PA delivered virtual clinic (VOPD). Medical records belonging to half the included patients were randomly selected for review by two doctors three months following discharge back to primary care to confirm appropriate standards of care and documentation and to audit any recorded adverse incidents or outcomes. FINDINGS: In total, 191 patients had been reviewed by the PA in the VOPD with 159 discharged directly back to primary care. Among the 95 medical records that were reviewed by the NCHDs, there were no recorded adverse incidents after discharge. Medical record keeping was deficient in 1 out of 95 reviewed cases. PRACTICAL IMPLICATIONS: Using a PA delivered VOPD consultation appears to have a role in following up patients who have undergone low-risk procedures irrespective of age or co-morbidity when selected appropriately. This may assist in reducing the demand on outpatient services by reducing unnecessary return visits, thereby increasing the capacity for new referrals. ORIGINALITY/VALUE: While there are reported examples to date of virtual clinics, these relate to services delivered by registered medical practitioners. Here, the authors demonstrate the acceptability of this model of care in an Irish population as delivered by a PA.
Quality improvement in hospice settings: perceptions of leaders.
Singh J, Sillerud B, Omar M
Int J Health Care Qual Assur · 2019 Aug · PMID 31411095 · Publisher ↗
PURPOSE: The purpose of this paper is to explore and examine attitudes and perceptions of leaders on application of quality improvement (QI) strategies in a palliative and hospice care organization. DESIGN/METHODOLOGY/AP...
PURPOSE: The purpose of this paper is to explore and examine attitudes and perceptions of leaders on application of quality improvement (QI) strategies in a palliative and hospice care organization. DESIGN/METHODOLOGY/APPROACH: This study employed qualitative research methodology where leaders working in a hospice and palliative care organization were invited to participate in 45-60-min-long semi-structured interview. Interviews were recorded and transcribed verbatim. Qualitative content analysis was utilized to analyze the data collected during participant interviews. FINDINGS: Seven leaders participated in the interviews. Five themes were developed from data analysis: patient-centered care; continuous QI; leadership involvement and commitment; communication as a foundation for QI; and perceived barriers. Data analysis suggests that use of QI approach in palliative and hospice care enhances the quality of care provided for patients, and can help improve patient satisfaction. PRACTICAL IMPLICATIONS: Because there is a paucity of research on implementation of QI strategies in hospice and palliative care settings, this research can have wide practical implications. This research can provide useful practical tips to leaders as they work on implementing QI projects in their organization. ORIGINALITY/VALUE: This manuscript can be of value to leaders, administrators and academicians who are interested in applying QI principles to healthcare processes especially in palliative and hospice care settings. Ability to work with others, solid communication and involvement of employees from all levels can help in streamlining current systems of care.
An innovative medical consultation model in mainland China.
Xu XP, Ke DG, Deng DN … +4 more , Houser SH, Li XN, Wang Q, Shan NC
Int J Health Care Qual Assur · 2019 Aug · PMID 31411094 · Publisher ↗
PURPOSE: The purposes of this paper are two-fold: first, to introduce a new concept of primary care consultation system at a mainland Chinese hospital in response to healthcare reform; and second, to explore the factors...
PURPOSE: The purposes of this paper are two-fold: first, to introduce a new concept of primary care consultation system at a mainland Chinese hospital in response to healthcare reform; and second, to explore the factors associated with change resistance and acceptance from both patients' and medical staff's perspectives. DESIGN/METHODOLOGY/APPROACH: A survey design study, with two questionnaires developed and distributed to patients and medical staff. Convenience and stratified random sampling methods were applied to patient and medical staff samples. FINDINGS: A 5-dimension, 21-item patient questionnaire and a 4-dimension, 16-item staff questionnaire were identified and confirmed, with 1020 patients (91.07 percent) and 202 staff (90.18 percent) as effective survey participants. The results revealed that patient resistance mainly stems from a lack of personal experiences with visiting general practice (GP) and being educated or having lived overseas; while staff resistance came from occupation, education, GP training certificate, and knowledge and experience with specialists. Living in overseas and knowledge of GP concepts, gender and education are associated with resistance of accepting the new practice model for both patients and staff. ORIGINALITY/VALUE: There are few Chinese studies on process reengineering in the medical sector; this is the first study to adopt this medical consultation model and change in patients' consultation culture in Mainland China. Applying organizational change and process reengineering theories to medical and healthcare services not only extends and expands hospital management theory but also allows investigation of modern hospital management practice. The experience from this study can serve as a reference to promote this new consultation model in Chinese healthcare reform.
Safety attitudes in hospital emergency departments: a systematic review.
Alzahrani N, Jones R, Rizwan A … +1 more , Abdel-Latif ME
Int J Health Care Qual Assur · 2019 Aug · PMID 31411093 · Full text
PURPOSE: The purpose of this paper is to perform and report a systematic review of published research on patient safety attitudes of health staff employed in hospital emergency departments (EDs). DESIGN/METHODOLOGY/APPRO...
PURPOSE: The purpose of this paper is to perform and report a systematic review of published research on patient safety attitudes of health staff employed in hospital emergency departments (EDs). DESIGN/METHODOLOGY/APPROACH: An electronic search was conducted of PsychINFO, ProQuest, MEDLINE, EMBASE, PubMed and CINAHL databases. The review included all studies that focussed on the safety attitudes of professional hospital staff employed in EDs. FINDINGS: Overall, the review revealed that the safety attitudes of ED health staff are generally low, especially on teamwork and management support and among nurses when compared to doctors. Conversely, two intervention studies showed the effectiveness of team building interventions on improving the safety attitudes of health staff employed in EDs. RESEARCH LIMITATIONS/IMPLICATIONS: Six studies met the inclusion criteria, however, most of the studies demonstrated low to moderate methodological quality. ORIGINALITY/VALUE: Teamwork, communication and management support are central to positive safety attitudes. Teamwork training can improve safety attitudes. Given that EDs are the "front-line" of hospital care and patients within EDs are especially vulnerable to medical errors, future research should focus on the safety attitudes of medical staff employed in EDs and its relationship to medical errors.
Study of safety culture in healthcare institutions: case of an Algerian hospital.
Boughaba A, Aberkane S, Fourar YO … +1 more , Djebabra M
Int J Health Care Qual Assur · 2019 Aug · PMID 31411092 · Publisher ↗
PURPOSE: For many years, the concept of safety culture has attracted researchers from all over the world, and more particularly in the area of healthcare services. The purpose of this paper is to measure safety culture d...
PURPOSE: For many years, the concept of safety culture has attracted researchers from all over the world, and more particularly in the area of healthcare services. The purpose of this paper is to measure safety culture dimensions in order to improve and promote healthcare in Algeria. DESIGN/METHODOLOGY/APPROACH: The used approach consists of getting a better understanding of healthcare safety culture (HSC) by measuring the perception of healthcare professionals in order to guide promotion actions. For this, the Hospital Survey on Patient Safety Culture questionnaire was used in a pilot hospital setting where it was distributed on a number of 114 health professionals chosen by stratified random sampling. FINDINGS: The results showed that the identified priority areas for HSC improvement help in establishing a trust culture and a non-punitive environment based on the system and not on the individual. ORIGINALITY/VALUE: Safety is recognized as a key aspect of service quality, thus measuring the HSC can help establish an improvement plan. In Algerian health facilities, this study is considered the first to examine perceptions in this particular area. The current results provide a baseline of strengths and opportunities for healthcare safety improvement, allowing the managers of this type of facilities to take steps that are more effective.
Improving pediatric experience of pain during vaccinations: a quality improvement project.
MacDougall T, Cunningham S, Whitney L … +1 more , Sawhney M
Int J Health Care Qual Assur · 2019 Jul · PMID 31282265 · Publisher ↗
PURPOSE: The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies...
PURPOSE: The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC). DESIGN/METHODOLOGY/APPROACH: The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project. FINDINGS: Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form. RESEARCH LIMITATIONS/IMPLICATIONS: This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide. PRACTICAL IMPLICATIONS: Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice. ORIGINALITY/VALUE: This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.
Quality assurance as a foundational element for an integrated system of dementia care.
Heckman GA, Crutchlow L, Boscart V … +6 more , Hillier L, Franco B, Lee L, Molnar F, Seitz D, Stolee P
Int J Health Care Qual Assur · 2019 Jul · PMID 31282264 · Publisher ↗
PURPOSE: Many countries are developing primary care collaborative memory clinics (PCCMCs) to address the rising challenge of dementia. Previous research suggests that quality assurance should be a foundational element of...
PURPOSE: Many countries are developing primary care collaborative memory clinics (PCCMCs) to address the rising challenge of dementia. Previous research suggests that quality assurance should be a foundational element of an integrated system of dementia care. The purpose of this paper is to understand physicians' and specialists' perspectives on such a system and identify barriers to its implementation. DESIGN/METHODOLOGY/APPROACH: The authors used interviews and a constructivist framework to understand the perspectives on a quality assurance framework for dementia care and barriers to its implementation from ten primary care and ten specialist physicians affiliated with PCCMCs. FINDINGS: Interviewees found that the framework reflects quality dementia care, though most could not relate quality assurance to clinical practice. Quality assurance was viewed as an imposition on practitioners rather than as a measure of system integration. Disparities in resources among providers were seen as barriers to quality care. Greater integration with specialists was seen as a potential quality improvement mechanism. Standardized electronic medical records were seen as important to support both quality assurance and clinical care. PRACTICAL IMPLICATIONS: This work identified several challenges to the implementation of a quality assurance framework to support an integrated system of dementia care. Clinicians require education to better understand quality assurance. Additional challenges include inadequate resources, a need for closer collaboration between specialists and PCCMCs, and a need for a standardized electronic medical record. ORIGINALITY/VALUE: Greater health system integration is necessary to provide quality dementia care, and quality assurance could be considered a foundational element driving system integration.
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