INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE最新文献

Purpose: The purpose of this paper is to validate the Press Ganey Questionnaire (PGQ) (Bahasa Melayu version) using Hospital Universiti Sains Malaysia (HUSM) patients.

Design/methodology/approach: This cross-sectional study comprised 252 patients visiting HUSM. Patients were selected using the convenience sampling method. The PGQ (Bahasa Melayu version) had three main factors: during your visit; your care provider and overall assessment. Data were analyzed using the structural equation modeling.

Findings: The exploratory factor analysis resulted in item reduction from 21 to 17, which contained four factors with eigenvalues greater than 1. Meanwhile, confirmatory factor analysis results showed that data fitted the model: χ²/df at 1.764, comparative fit index at 0.952, Tucker-Lewis index at 0.941 and root mean square error of approximation at 0.073. The average variance extracted value for the four factors was greater than 0.50, which indicated that PGQ convergent validity was met. Overall, PGQ produced good reliability with composite reliability score equals to 0.966. Four factors were reclassified as "during your registration," "hospital staff attitude," "doctor's attitude" and "overall assessment."

Research limitations/implications: Patient satisfaction is an important and frequently used indicator for measuring healthcare quality; hence, a validated and reliable instrument is important for measuring patient satisfaction that leads to healthcare service quality assessment.

Practical implications: Validated PGQ provides some useful information for doctors, medical assistants, nurses and staff in the emergency department to help them become more prominent and efficient in their role as healthcare providers.

Social implications: Validated PGQ will help healthcare providers to deliver the best and exceptional care toward emergency patient, and thus improve their quality of work life. The findings in this study can be used as a guide or as baseline data for further research in this area.

Originality/value: The PQG (Bahasa Melayu version) was confirmed as a reliable and valid instrument for measuring patient satisfaction. This research is the first PGQ validation study in Southeast Asia, specifically focusing on Malaysian respondents.

Purpose: Risk identification plays a key role identifying patient safety risks. As previous research on risk identification practices, as applied to patient safety, and its association with safety culture is limited, the purpose of this paper is to evaluate current practice to address gaps and potential room for improvement.

Design/methodology/approach: The authors carry out interview-based questionnaires in one UK hospital to investigate real-world risk identification practices with eight healthcare staff, including managers, nurses and a medical consultant. Considering various aspects from both risk identification and safety culture practices, the authors investigate how these two are interrelated.

Findings: The interview-based questionnaires were helpful for evaluating current risk identification practices. While gaining significant insights into risk identification practices, such as experiences using current tools and methods, mainly retrospective ones, results also explicitly showed its link with the safety culture and highlighted the limitation in measuring the relationship.

Originality/value: The interviews addressed valuable challenges affecting success in the risk identification process, including limitations in safety culture practice, training, balancing financial and safety concerns, and integrating risk information from different tools and methods.

Purpose: This paper presents an interpretive data analysis from a superordinate study that aimed to determine foodservice satisfaction. The purpose of this paper is to determine inpatient hospital foodservice experiences.

Design/methodology/approach: The authors used secondary data obtained from 419 respondents: (225 (53.70 per cent) males, 178 (42.48 per cent) females and 16 (3.82 per cent) undisclosed) participants. A comparative, quantitative and cross-sectional approach was applied to provide insight into hospital foodservice experiences. The Wilcoxon-Mann-Whitney test, interpreted at 0.05 error rate, was used to compare male and female patient experiences.

Findings: Male patients had significantly higher rank-sum scores than female patients in almost all items (p<0.0001). The study revealed that hospital personnel, especially foodservice staff, had an unsatisfactory communication approach.

Originality/value: This is the first South African study that compares female and male inpatient foodservice perceptions. Hospital managers and stakeholders may need to consider patient's gender, as a significant factor that is associated with patient experiences, when embarking on improving foodservice systems.

Purpose: To respect the patients' physical privacy, they should be provided with proper clothing that prevents the exposure of unnecessary parts of the body. The purpose of this paper is to evaluate patient satisfaction upon wearing customized, high-coverage, procedure-specific dresses.

Design/methodology/approach: New designs of clothing adapted for different kinds of procedures, and offering a good coverage of the body and easy access to the required parts were compared with regular patient clothing. Patients from six different wards of a university hospital filled out a questionnaire inquiring about general and demographic variables, and patient satisfaction was evaluated based on six main features of the clothing design. p<0.005 was considered as the level of statistical significance.

Findings: Overall, 256 patients were entered into the regular-design and new-design groups (n=128 in each). In Group 1 (regular design), the rate of dissatisfaction was about 98, 84, 84, 78, 77 and 38 percent for ease of wearing, comfort, design, material, coverage level and size, respectively. In Group 2 (new design), the highest satisfaction rates were associated with ease of wearing, size, coverage level, material, design and comfort as 93.7, 91.4, 89.9, 87.1, 86, and 80.5 percent, respectively.

Originality/value: The present study is the first to investigate customized patient clothing and demonstrated that these clothes can improve the patients' satisfaction in terms of coverage, comfort, design and size.

Purpose: Residents collect information from the electronic health record (EHR) to present during rounds, but this crucial process is understudied. The purpose of this paper is to examine the feasibility of utilizing an EHR embedded time-tracking software to quantify resident pre-round EHR activity and how patient acuity impacts this activity.

Design/methodology/approach: This was a retrospective observational study that quantified resident EHR activities (total time spent, tasks performed and patient encounters accessed) during pre-rounds on their pediatric intensive care unit rotation between May 2016 and December 2016. Patient encounters were reviewed to determine resident ownership and critical care resources provided.

Findings: Allo 21 eligible participants were included. In total, 907 patient encounters were included to evaluate patient acuity impact. EHR usage per patient encounter (median in minutes (25th, 75th percentile)) was significantly affected by the critical care resources utilized. Total EHR time: both ventilator and vasoactive support (10.54 (6.68, 17.19)); neither ventilator nor vasoactive support (8.23 (5.07, 12.72)); invasive/noninvasive ventilator support (8.74 (5.69, 13.2)); and vasoactive support (10.37 (7.72, 11.65)), p<0.001. Chart review, order entry and documentation EHR times demonstrated similar trends.

Practical implications: Residents spend more time utilizing the EHR to collect data on patients who require significant critical care resources. This information can be useful to determine optimal resident to patient workload. Future research is required to assess this EHR tool's ability to contribute to physician workflow study.

Originality/value: EHR embedded time-tracking software can offer insights into resident workflow.

Purpose: The purpose of this paper is three-fold: first, to assess nurse satisfaction levels with working environment (known as favourability) in five Greek public hospitals using the practice environment scale (PES); second, to compare perceptions among nurses employed in surgical and medical departments; and third, to examine relationships between perceptions and nurse educational level and experience.

Design/methodology/approach: In total, 532 nurses from five major public hospitals in Greece completed the PES. Descriptive statistics, t-tests and Spearman correlations were employed to analyse the data.

Findings: Nurses perceived their work settings as unfavourable in all five hospitals, with collegial nurse-physician relations emerging as the only positive factor. Compared to medical wards, surgical departments emerged as slightly more positive working environments. Work department notwithstanding, in some cases, education and experience levels affected their perceptions on management, poor care quality, limited nurse involvement in hospital affairs and nursing shortage.

Practical implications: Hospital managers do not provide sufficient support for Greek nurses in their working environments.

Originality/value: The authors attempted to evaluate nursing practice environments in Greek hospitals, viewed from nurse perspectives. The authors identified insufficient support for nurses' working in these hospitals.

Purpose: Hospitals are complex and complicated organizations and are prone to the conflict. The purpose of this paper is to identify the intensity and type of conflict experienced by hospital managers and explore their conflict management strategies in hospitals affiliated with Tehran University of Medical Sciences.

Design/methodology/approach: This quantitative, descriptive and cross-sectional study was conducted in 2015. A self-administered questionnaire was used to collect data from top, middle and front line managers. In total, 563 managers from 14 hospitals responded to the questionnaires. Data were analyzed using SPSS software version 19.

Findings: Hospital managers reported average level of conflict (2.73 score out of 5). Organizational factors produced more conflict for managers than personal factors. High workload, resource shortage, bureaucracy and differences in managers' personality, knowledge, capabilities and skills were the main causes of organizational and personal conflict. Top managers experienced more conflict than middle and front line managers. Conflict was higher in specialized hospitals compared to general hospitals. Less conflict was observed in administrative and support departments than diagnostic and therapeutic departments. Conflict was meaningfully associated with management level, education, size of hospital, number of employees and willingness to leave the hospital. The dominant conflict management style of managers was collaborating. There were significant relationships between collaborating style and management level, manager's age, work experience and management experience.

Practical implications: The nature of hospitals requires that managers use collaborating, compromising and accommodating styles to interact better with different stakeholders. Managers by acquiring necessary training and using the right conflict resolution strategies should keep the conflict in a constructive level in hospitals.

Originality/value: This is the first study conducted in Iran examining the level of conflict, its types and identifying managers' dominant conflict resolution strategies at front line, middle and top management levels.

Purpose: A clinical pathway for patients with acute ischemic stroke was implemented in 2014 by one Italian teaching hospital multidisciplinary team. The purpose of this paper is to determine whether this clinical pathway had a positive effect on patient management by comparing performance data.

Design/methodology/approach: Volume, process and outcome indicators were analyzed in a pre-post retrospective observational study. Patients' (admitted in 2013 and 2015) medical records with International Classification of Diseases, ICD-9 code 433.x (precerebral artery occlusion and stenosis), 434.x (cerebral artery occlusion) and 435.x (transient cerebral ischemia) and registered correctly according to hospital guidelines were included.

Findings: An increase context-sensitive in-patient numbers with more severe cerebrovascular events and an increase in patient transfers from the Stroke to Neurology Unit within three days (70 percent, p=0.25) were noted. Clinical pathway implementation led to an increase in patient flow from the Emergency Department to dedicated specialized wards such as the Stroke and Neurology Unit (23.7 percent, p<0.001). Results revealed no statistically significant decrease in readmission rates within 30 days (5.7 percent, p=0.85) and no statistically significant differences in 30-day mortality.

Research limitations/implications: The pre-post retrospective observational study design was considered suitable to evaluate likely changes in patient flow after clinical pathway implementation, even though this design comes with limitations, describing only associations between exposure and outcome.

Originality/value: Clinical pathway implementation showed an overall positive effect on patient management and service efficiency owing to the standardized application in time-dependent protocols and multidisciplinary/integrated care implementation, which improved all phases in acute ischemic stroke care.

Purpose: The purpose of this paper is to evaluate the nonlinear impact of users' memories on their general evaluation of outpatient healthcare services by the integration of two methodologies: critical incidents technique (CIT) and penalty-reward contrast analysis (PRCA).

Design/methodology/approach: The authors carried out a survey with 356 respondents, users of seven outpatient clinics located in the city of Blumenau/SC, Brazil, during 2016. The participants were asked about their perceptions of positive and negative aspects of the service; and, using CIT, the answers were categorized according to the following dimensions: empathy, communication, facilities, access, promptness, medicines availability, complementary services, safety/confidentiality and service performance. Then, the authors evaluated the nonlinear impact of critical incidents on users' general evaluation of the service using the identified incidents as input variables in a PRCA.

Findings: The findings show that users of healthcare services tend to remember emotion and health aspects positively, while technical and formal aspects tend to be more negatively than positively remembered. On the other hand, PRCA identifies that incidents of three dimensions positively influence the overall perception of the service (empathy, complementary services and privacy) and five negatively (empathy, facilities, speed, drugs/pharmacy and health performance), explaining 26.3 percent of the variation in clients' general satisfaction.

Originality/value: The present paper explores the integration of two methodologies, showing how we can use open listening to healthcare service users to identify the nonlinear impact of different incidents on their general evaluation of the service. The results show that what customers remember does not necessarily influence overall customer satisfaction. The present approach allows companies to improve the process of listening to customers. There are no other papers exploring this approach, particularly in relation to healthcare services.

Purpose: The purpose of this paper is to share insights, research findings and discuss key issues related to graduate experiences with transnational nursing education (TNE).

Design/methodology/approach: The authors used a qualitative approach and sampled national and international nurse graduates to identify challenges and best operating practices in cross-border nursing program facilitation.

Findings: This research paper has provided a platform for graduates to lend their voices to the promotion of effective cross-border nursing education delivery and suggests that although international collaborations endeavor to maintain high academic standards in TNE, there is still a need to re-engineer, revise and adapt curricular content, learning, teaching and assessment practices to aid the nursing student.

Research limitations/implications: Identified challenges affecting the facilitation and delivery of cross-border nursing education programs can act as levers to improving service quality of present and future cross-border programs to the nursing student. This will assist future nursing students to recognize culture shock and embrace their decision to pursue nursing.

Practical implications: The experience of being involved in TNE for nursing students may not be that much different than students of other disciplines. While not able to be generalized to the entire population, the reports by the nursing students in this sample appear to be valuable and worthwhile to continue supporting and encouraging other TNE opportunities.

Originality/value: This paper explores cross-border nursing education experiences from national and international perspectives. The authors were able to explore inherent TNE challenges from diverse population and cultural backgrounds.