INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE最新文献

Purpose: Health improves the proficiency and output generated by individuals. It also raises physical as well as mental abilities, which are required for the growth and advancement of any economy. Many infant diseases have been recognised via contemporary technology in a bid to tackle these diseases. However, children within the African continent (Including Nigeria) die en masse from diseases. This has made the government of Nigeria allocate sizeable part of the nation's budget to healthcare system. The allocation to health is, however, yet to translate to improved health condition for Nigerians. It does not measure up to the World Health Organization's (WHO) standards for apportioning budget to the health sector. This study also analyses empirically the impact of healthcare expenses on the mortality level of infants as well as Nigeria's neonatal mortality level.

Design/methodology/approach: The paper focuses on Nigeria. Vector auto regression model techniques, unit root tests and cointegration test were carried out using time series date for the period between 1986 and 2016.

Findings: The outcome has revealed that expenditure on healthcare possesses a negative correlation with the mortality of infants and neonates. The study discovers that if the Nigerian government raises and maintains health expenditure specifically on activities focused on minimising infant mortality, it will translate to reduction in infant mortality in Nigeria.

Originality/value: This paper has contributed exhaustively to solution to poor expenditure on healthcare, especially child mortality, in Nigeria.

Purpose: There was limited study available on successful intervention for central-line-associated bloodstream infection (CLABSI) done at nonintensive care unit (ICU) and resources-limited setting. The objective of this study was to design, implement and evaluate a strategy to reduce CLABSI rate in non-ICU settings at general medical wards of Hospital Tuanku Ja'afar Seremban.

Design/methodology/approach: Preinterventional study was conducted in one-month period of January 2019, followed by intervention period from February to March 2019. Postintervention study was conducted from April to July 2019. The CLABSI rates were compared between pre and postintervention periods. A multifaceted intervention bundle was implemented, which comprised (1) educational program for healthcare workers, (2) weekly audit and feedback and (3) implementation of central line bundle of care.

Findings: There was a significant overall reduction of CLABSI rate between preintervention and postintervention period [incidence rate ratio (IRR) of 0.06 (95 percent CI, 0.01-0.33; P = 0.001)].

Practical implications: CLABSI rates were reduced by a multifaceted intervention bundle, even in non-ICU and resource-limited setting. This includes a preinterventional study to identify the risk factors followed by a local adaption of the recommended care bundles. This study recommends resources-limited hospitals to design a strategy that is suitable for their own local setting to reduce CLABSI.

Originality/value: This study demonstrated the feasibility of a multifaceted intervention bundle that was locally adapted with an evidence-based approach to reduce CLABSI rate in non-ICU and resource-limited setting.

Purpose: Incident reporting systems are commonly deployed in healthcare but resulting datasets are largely warehoused. This study explores if intelligence from such datasets could be used to improve quality, efficiency, and safety.

Design/methodology/approach: Incident reporting data recorded in one NHS acute Trust was mined for insight (n = 133,893 April 2005-July 2016 across 201 fields, 26,912,493 items). An a priori dataset was overlaid consisting of staffing, vital signs, and national safety indicators such as falls. Analysis was primarily nonlinear statistical approaches using Mathematica V11.

Findings: The organization developed a deeper understanding of the use of incident reporting systems both in terms of usability and possible reflection of culture. Signals emerged which focused areas of improvement or risk. An example of this is a deeper understanding of the timing and staffing levels associated with falls. Insight into the nature and grading of reporting was also gained.

Practical implications: Healthcare incident reporting data is underused and with a small amount of analysis can provide real insight and application to patient safety.

Originality/value: This study shows that insight can be gained by mining incident reporting datasets, particularly when integrated with other routinely collected data.

Purpose: There is a growing interest in applying continuous quality improvement (CQI) methodologies and tools to medical education contexts. One such tool, the "Are We Making Progress" questionnaire from the Malcolm Baldrige National Quality Award framework, adequately captures the dimensions critical for performance excellence and allows organizations to assess their performance and identify areas for improvement. Its results have been widely validated in business, education, and health care and might be applicable in medical education contexts. The measurement properties of the questionnaire data were analyzed using Rasch modeling to determine if validity evidence, based on Messick's framework, supports the interpretation of results in medical education contexts. Rasch modeling was performed since the questionnaire uses Likert-type scales whose estimates might not be amenable to parametric statistical analyses.

Design/methodology/approach: Leaders and teachers at 16 of the 17 Canadian medical schools were invited in 2015-2016 to complete the 40-item questionnaire. Data were analyzed using the ConQuest Rasch calibration program, rating scale model.

Findings: 491 faculty members from 11 (69 percent) schools participated. A seven-dimensional, four-point response scale model better fit the data. Overall data fit to model requirements supported the use of person measures with parametric statistics. The structural, content, generalizability, and substantive validity evidence supported the interpretation of results in medical education contexts.

Originality/value: For the first time, the Baldrige questionnaire results were validated in medical education contexts. Medical education leaders are encouraged to serially use this questionnaire to measure progress on their school's CQI focus.

Purpose: This article describes a framework for evaluating efficiency of OR procedures incorporating time measurement, personnel activity, and resource utilization using traditional industrial engineering tools of time study and work sampling.

Methods: The framework measures time using time studies of OR procedures and work sampling of personnel activities, ultimately classified as value-added or non-value-added. Statistical methods ensure that the collected samples meet adequate levels of confidence and accuracy. Resource utilization is captured through documentation of instrument trays used, defects in instruments, and trash weight and classification at the conclusion of surgeries.

Findings: A case study comprising 12 observations of total knee arthroplasty surgeries illustrates the use of the framework. The framework allows researchers to compare time, personnel, and resource utilization simultaneously within the OR setting.

Practical implications: The framework provides a holistic evaluation of methods, instrumentation and resources, and staffing levels and allows researchers to identify areas for efficiency improvement.

Originality/value: The methods presented in this article are rooted in traditional industrial engineering work measurement methods but are applied to a healthcare setting in order to efficiently identify areas for improvement including time, personnel, and processes in operating rooms.

Purpose: The purpose of this paper is to assess the association between shift schedule realignment and patient safety culture.

Design/methodology/approach: Using difference in differences model, BIMC Hospitals and Siloam Hospital Bali were compared before and after shift schedule realignment to test the association between shift schedule realignment and patient safety culture.

Findings: Shift schedule realignment was associated with a significant improvement in staffing (coefficient 1.272; 95% CI 0.842 - 1.702; p<0.001), teamwork within units (coefficient 1.689; 95% CI 1.206 - 2.171; p<0.001), teamwork across units (coefficient 1.862; 95% CI 1.415 - 2.308; p<0.001), handoffs and transitions (coefficient 0.999; 95% CI 0.616 - 1.382; p<0.001), frequency of error reported (coefficient 1.037; 95% CI 0.581 - 1.493; p<0.001), feedback and communication about error (coefficient 1.412; 95% CI 0.982 - 1.841; p<0.001) and communication openness (coefficient 1.393; 95% CI 0.968 - 1.818; p<0.001).

Practical implications: With positive impact on patient safety culture, shift schedule realignment should be considered as quality improvement initiative. It stretches the compressed workload suffered by staff while maintaining 40 h per week in accordance with applicable laws and regulations.

Originality/value: Shift schedule realignment, designed to improve patient safety culture, has never been implemented in any Indonesian private hospital. Other hospital managers might also appreciate knowing about the shift schedule realignment to improve the patient safety culture.

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.

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.

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.

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 (n=9), volume of patients (n=6), acuity (n=6), nurse-to-patient ratios (n=5) and direct care time (n=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.