INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE最新文献

Purpose: Healthcare-associated infections (HAIs) constitute a major threat to patient safety and affect hundreds of millions of people worldwide. The World Health Organization in 2016 published guidelines on the core components for infection prevention and control (IPC) programme. This was in response to a global call for focused action. The purpose of this paper is to examine and promote understanding of the tenets of the IPC guidelines and highlight their implications for implementation in low-income countries.

Design/methodology/approach: Drawing from personal experiences in leading the implementation of health programmes as well as a review of published and grey literature on IPC, authors discussed and proposed practical approaches to implement IPC priorities in low-income setting.

Findings: Availability of locally generated evidence is paramount to guide strengthening leadership and institutionalisation of IPC programmes. Preventing infections is everybody's responsibility and should be viewed as such and accorded the required attention.

Originality/value: Drawing from recent experiences from disease outbreaks and given the heavy burden of HAIs especially in low-income settings, this paper highlights practical approaches to guide implementation of the major components of IPC.

Purpose: The purpose of this paper is to provide an empirical basis for considering in-service training, tenure prolongation and continuing education as methods for enhancing nursing performance.

Design/methodology/approach: A self-reported questionnaire was used to collect data from 532 nurses, who were selected using the simple random sampling method from ten hospitals in Accra North, Ghana. Confirmatory factor analysis (CFA) was used to test the study's hypotheses.

Findings: The resulting model is of good fit at 5 per cent significance level (χ²=1.492, p=0.222), with in-service training found to be the ultimate method for enhancing nursing performance. The fitted CFA model also shows that in-service training is positively associated with education and tenure at 1 per cent significance level (p<0.001). The overall evidence suggests that training, continuing formal education and tenure prolongation are methods for improving nursing performance.

Originality/value: Apart from its contribution to the literature, this study applies validated primary data to empirically identify key methods for enhancing nursing performance.

Purpose: According to literature, interruptions during drug administration lead to a significant proportion of medication errors. Evidence on the effectiveness of interventions to reduce interruption is still limited. The purpose of this paper is to explore main reasons for interruptions during drug administration rounds in a geriatric ward of an Italian secondary hospital and test the effectiveness of a combined intervention.

Design/methodology/approach: This is a pre and post-intervention observational study based on direct observation. All nurse staff (24) participated to the study that lead to observe a total of 44 drug dispensing rounds with 945 drugs administered to 491 patients in T0 and 994 drugs to 506 patients in T1.

Findings: A significant reduction of raw number of interruptions (mean per round from 17.31 in T0 to 9.09 in T1, p<0.01), interruptions/patient rate (from 0.78 in T0 to 0.40 in T1, p<0.01) and interruptions/drugs rate (from 0.44 in T0 to 0.22 in T1, p<0.01) were observed. Needs for further improvements were elicited (e.g. a greater involvement of support staff).

Practical implications: Nurse staff should be adequately trained on the risks related to interruptions during drug administration since routine activity is at high risk of distractions due to its repetitive and skill-based nature.

Originality/value: A strong involvement of both MB and leadership, together with the frontline staff, helped to raise staff motivation and guide a bottom-up approach, able to identify tailored interventions and serve concurrently as training instrument tool.

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.

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.

Purpose: The purpose of this paper is to investigate managers' leadership styles, from the perspective of registered nurses, and its effects on the quality of nursing care in both the private and public healthcare sectors. An additional aim is to assess the relationship between leadership styles and particular organisational outcomes.

Design/methodology/approach: The sample for this quantitative research study was comprised of 400 respondents, among which 50 were nurse managers, 150 were staff nurses and the remaining respondents were patients. Two questionnaires were used in this study: the multi-factor leadership questionnaire (MLQ) 5X short and a patient satisfaction with nursing care quality questionnaire (PSNCQQ).

Findings: A positive correlation was found between the transformational leadership style with leadership outcomes and the quality of nursing care (r=0.811**, 0.759**, 0.789** and 0.877** for extra effort, job satisfaction, leader effectiveness and quality, respectively).

Practical implications: Although the sample study was extensive, a possible limitation is that the research utilised convenient sample who are working in the private and public healthcare sectors thus limiting the generalisability of the study.

Originality/value: This study was proposed as a baseline for upcoming studies in areas of education, nursing practice, research and quality. Moreover, this study was expected to be imperative to the hospital's management, in order to improve the current level of leadership, education models and advancement programs for the healthcare sector's senior staff.

Purpose: The purpose of this paper is to investigate the effect of nurse staffing, nurse education and work experience on patients' length of stay (LOS) in the Greek public hospitals.

Design/methodology/approach: A cross-sectional study, with retrospective administrative data, was implemented. From all seven Regional Health Authorities of Greece, 25 general surgical units in 17 public hospitals participated in the study.

Findings: All over the hospitals were studied, 32,287 patients ⩾17 years old and 203 nursing staff, who were working in the study units, were included in the analysis. According to the multivariate linear regression model, increased years of experience as a nurse (b= -0.04, 95% CI= -0.06 to -0.02, p=0.001) and increased percentage of registered nurse to the total nursing staff (b= -1.18, CI= -1.88 to -0.47, p=0.03) were associated with decreased patient LOS.

Originality/value: This was the first extended study in Greece, which explored the relationship between nurse staffing, nurse education, work experience and the LOS. The role that nurse staffing play together with its characteristics in the provision toward the quality healthcare services has already been recognized worldwide. The findings revealed the great shortage of nursing staff and the significant correlation between the work experience and educational level to patients' LOS.

Purpose: The purpose of this paper is to examine the use of power tactics by hospital administrators in order to gain employee compliance. It attempts to understand the influence of power bases of hospital administrators on the employee compliance using an analytic hierarchy process (AHP) technique.

Design/methodology/approach: The study adopted a mixed method technique and was conducted in two phases. In the first phase, qualitative analysis was carried out through content analysis of the anecdotes collected from the employees working in tertiary hospitals. Content analysis of responses aided in obtaining a list of criteria and sub-criteria affecting employee behavioural compliance. In the second phase, quantitative analysis was carried out using the AHP technique. While applying AHP, the issue pertaining to employee behavioural compliance with hospital's policies, procedures and related instructions was formulated in form of a hierarchy of one objective, two criteria, six sub-criteria and five alternatives established through literature review and content analysis. Furthermore, the subject matter experts were asked to conduct pairwise comparison wherein priority rankings were achieved.

Findings: The results indicated that reward power (25 per cent) is the most significant power style exercised by effective hospital administrators in achieving employee behavioural compliance followed by expert (24 per cent), referent (22 per cent) and legitimate powers (17 per cent). As coercive (12 per cent) came out to be the least preferred power style, it should be cautiously exercised by hospital administrators in the present day scenario.

Research limitations/implications: The major limitation of this study is that the sample was drawn only from three tertiary hospitals in Jammu district that limits the generalizability of the findings in all the hospital settings across different regions. No attempt is made in this study to understand the variations with regard to demographics of the respondents that can be taken as a future research study. This study is cross-sectional in nature and provides the perspective of specific time. A longitudinal study could further provide insights into different time variations and the comparison and henceforth can be more comprehensive, thus supporting the generalizability of this study.

Practical implications: The study empirically identifies the relative importance of exercising power styles in order to gain employee behavioural compliance. The study helps in understanding the complex problem of behavioural compliance in hospital setting by examining the intensity of each factor affecting employee behavioural compliance. This knowledge is very critical in effective hospital management and getting the work done. The priority rankings obtained for power styles can be used for developing selection batteries and perf

Purpose: The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016.

Design/methodology/approach: The authors collected data from surgical records in the Teikyo University electronic medical record system from April 1 till September 30, 2016. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated each surgeon's efficiency score using output-oriented Charnes-Cooper-Rhodes model of data envelopment analysis. The authors compared the efficiency scores of each surgical specialty using the Kruskal-Wallis and the Steel method.

Findings: The authors analyzed 2,558 surgical procedures performed by 109 surgeons. The difference in efficiency scores was significant (p = 0.000). The efficiency score of neurosurgery was significantly greater than obstetrics and gynecology, general surgery, orthopedics, emergency surgery, urology, otolaryngology and plastic surgery (p<0.05).

Originality/value: The authors demonstrated that the surgeons' efficiency was significantly different among their specialties. This suggests that the Japanese surgical reimbursement scales fail to reflect resource utilization despite the revision in 2016.

Purpose: The purpose of this paper, a point prevalence study, is to quantify the incidence of isolation and identify the type of communicable diseases in isolation. The paper evaluates isolation precaution communication, availability of personal protective equipment (PPE) as well as other equipment necessary for maintaining isolation precautions.

Design/methodology/approach: A standardised audit tool was developed in accordance with the National Standards for the Prevention and Control of Healthcare Associated Infections (May 2009). Data were collected from 14 March 2017 to 16 March 2017, through observation of occupied isolation rooms in an academic hospital in Dublin, Ireland. The data were subsequently used for additional analysis and discussion.

Findings: In total, 14 per cent (125/869) of the total inpatient population was isolated at the time of the study. The most common isolation precaution was contact precautions (96.0 per cent). In all, 88 per cent of known contact precautions were due to multi-drug resistant organisms. Furthermore, 96 per cent of patients requiring isolation were isolated, 92.0 per cent of rooms had signage, 90.8 per cent had appropriate signs and 93.0 per cent of rooms had PPE available. Finally, 31 per cent of rooms had patient-dedicated and single-use equipment and 2.4 per cent had alcohol wipes available.

Practical implications: The audit tool can be used to identify key areas of noncompliance associated with isolation and inform continuous improvement and education.

Originality/value: Currently, the rate of isolation is unknown in Ireland and standard guidelines are not established for the evaluation of isolation rooms. This audit tool can be used as an assessment for isolation room compliance.