INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE最新文献

Purpose: Mental health service improvement initiatives often involve the setting of targets and monitoring of performance. The purpose of this paper is to describe the application of appreciative enquiry (AE), a radically different but complementary approach to quality assurance and improvement, to specialist mental health services across a health region.

Design/methodology/approach: This case study describes a regional quality improvement (QI) project involving 12 early intervention in psychosis (EIP) services in South West England. In total, 40 people were trained in AE interviewing skills and in non-reciprocal peer review visits 59 interviews were conducted involving 103 interviewees including service users, carers, clinicians, managers and commissioners. Immediate verbal feedback was provided and main themes summarised in individual reports to host teams using the following headings: team values, strengths, dreams and development plans. A thematic analysis was conducted on team reports and a project report produced which summarised the stages and results of this regional initiative.

Findings: All participants rated the experience as positive; it enhanced staff motivation and led to service development and improvement.

Research limitations/implications: The experiences of these 12 EIP teams may not necessarily be generalisable to other services/regions but this positive approach to service improvement could be widely applied.

Practical implications: AE is applicable in large-scale QI initiatives.

Originality/value: To the authors knowledge this is the first time that AE has been applied to large-scale mental health service improvement and innovation.

Purpose: Nowadays health systems in most of the countries are trying to build their healthcare provision system based on scientific knowledge based evidence. Evidence-based practice (EBP) is a crucial factor for quality improvement focusing on compliance with clinical standards. The purpose of this paper is to assess evidence-based knowledge and skills among healthcare providers in Qazvin hospitals in 2016.

Design/methodology/approach: This was a descriptive study conducted among 300 health professionals working in hospitals affiliated by Qazvin University of Medical Sciences in 2016. A self-administered questionnaire was used to gather data on health providers' attitude, knowledge and skill regarding EBP. Descriptive statistics and multiple linear regressions were used to analyze data using SPSS 16 software.

Findings: A total of 254 participants (84.6 percent) completed the questionnaire in which their attitude, knowledge and skill toward EBP were assessed at a low level. Study results indicated that among different occupational groups, physicians and those with greater awareness toward EBP terminology had a more positive attitude compared with others. Furthermore, a higher level of knowledge and skill toward EBP was associated with being a physician and having a positive attitude toward the issue.

Practical implications: Given the importance of EBP and due to insufficient knowledge of healthcare providers about the issue, it is necessary to hold appropriate educational courses to empower health workforce in implementing EBP principles.

Originality/value: The authors applied a self-administered questionnaire to assess health workforce knowledge and skills toward EBP. The results obtaining from the analysis not only highlights weaknesses related to service providers' knowledge and capabilities to implement EBP but also reveals facilities required for realization of the subject in hospital settings.

Purpose: The purpose of this paper is to assess the patient's perspective on a dedicated clinic set up for patients diagnosed with an inflammatory arthritis who are being treated with a biologic. It proposes that dedicated clinics offer better overall care. The aim of this quality improvement survey is to evaluate the level of patient satisfaction with this clinic and identify any unmet needs.

Design/methodology/approach: This study was based on a quality improvement survey, which was developed using Zineldin's five qualities model and assessed various aspects pertaining to service quality and improvement. A structured interview approach was used and 44 consecutive patients were recruited.

Findings: This paper explores key aspects that influence patient satisfaction within a rheumatology outpatient setting such as education on arthritis and biologics and involvement in decision making. It provides insight on what patients value most and it also addresses organizational aspects that can have an impact on patient satisfaction. It suggests that service quality can be linked to the degree of patient satisfaction.

Research limitations/implications: Direct interviewing of patients could have introduced a source of bias whilst questions are being answered. On the other hand, it provided an opportunity to clarify instantly any doubts and therefore avoiding any inadvertent errors.

Practical implications: This paper reinforces that specialized clinics enable the caring rheumatologist to provide better care for patients on biologics. Service providers should continue developing their services around the patient's needs and perspectives in order to continue improving the service.

Social implications: Dedicated biologic clinics allow more judicious monitoring of patients who are taking these highly efficacious but costly medications.

Originality/value: This survey has reinforced that patients highly value dedicated clinics. These results strengthen the case that healthcare services should continue investing on specialized clinics.

Purpose: The purpose of this paper is to investigate the attitudes of healthcare professionals in Greece toward safety practices in gynecological Operation Rooms (ORs).

Design/methodology/approach: An anonymous self-administered questionnaire was distributed to surgical personnel asking for opinions on safety practices during vaginal deliveries (VDs) and gynecological operations (e.g. sponge/suture counting, counting documentation, etc.). The study took place in Hippokration Hospital of Thessaloniki including 227 participants. The team assessed and statistically analyzed the questionnaires.

Findings: Attitude toward surgical counts and counting documentation, awareness of existence and/or implementation in their workplace of other surgical safety objectives (e.g. WHO safety control list) was assessed. In total, 85.2 percent considered that surgical counting after VDs is essential and 84.9 percent admitted doing so, while far less reported counting documentation as a common practice in their workplace and admitted doing so themselves (50.5/63.3 percent). Furthermore, while 86.5 percent considered a documented protocol as necessary, only 53.9 percent admitted its implementation in their workplace. Remarkably, 53.1 percent were unaware of the WHO safety control list for gynecological surgeries.

Originality/value: Most Greek healthcare professionals are well aware of the significance of surgical counting and counting documentation in gynecology ORs. However, specific tasks and assignments are unclear to them. Greek healthcare professionals consider surgical safety measures as important but there is a critical gap in knowledge when it comes to responsibilities and standardized processes during implementation. More effective implementation and increased personnel awareness of the surgical safety protocols and international guidelines are necessary for enhanced quality of surgical safety in Greece.

Purpose: There is a growing interest in living labs (a research concept in which innovations are co-created with end-users and tested in practice) as a method to test and develop health and social care innovations. However, little is known about their effect on the care organization and care providers' quality of working life. By using the Flanders Care Living Labs program (Belgium) as a case study, the purpose of this paper is to explore how innovations in a living lab context may affect those issues.

Design/methodology/approach: This qualitative study combined data from document analysis, in-depth interviews and focus groups involving 23 care innovation projects. Deductive category application was used for analyzing data.

Findings: Outcomes indicate that 22/23 care innovation projects resulted in organizational changes, and that 22 affected at least one care provider's quality of working life. Surprisingly, no project deliberately intended to affect the care organization and quality of working life. Future care innovation projects should focus on actual innovation and its implications for specific end-users, and on the broader organizational consequences and the possible effect on the care providers' work.

Originality/value: This is the first study that specifically focused on care innovation's effect on the care organization and on the quality of working life within a living labs context.

Purpose: The purpose of this paper is to summarize studies that have examined patient safety culture in maternity units and describe the different purposes, study designs and tools reported in these studies while highlighting gaps in the literature.

Design/methodology/approach: Peer-reviewed studies, published in English during 1961-2016 across eight electronic databases, were subjected to a narrative literature review.

Findings: Among 100 articles considered, 28 met the inclusion criteria. The main purposes for studying PSC were: assessing intervention effects on PSC (n=17), and assessing PSC level (n=7). Patient safety culture was mostly assessed quantitatively using validated questionnaires (n=23). The Safety Attitude Questionnaire was the most commonly used questionnaire (n=17). Interventions varied from a single action lasting five weeks to a more comprehensive four year package. The time between baseline and follow-up assessment varied from 6 to 24 months. No study reported measurement or intervention costs, and none incorporated the patient's voice in assessing PSC.

Practical implications: Assessing PSC in maternity units is feasible using validated questionnaires. Interventions to enhance PSC have not been rigorously evaluated. Future studies should report PSC measurement costs, adopt more rigorous evaluation designs and find ways to incorporate the patient's voice.

Originality/value: This review summarized studies examining PSC in a highly important area and highlighted main limitations that future studies should consider.

Purpose: The purpose of this paper is to analyse the accounts of Swedish cardiologists concerning patient involvement in consultations for atrial fibrillation (AF). The questions were: how cardiologists handle and provide scope for patient involvement in medical consultations regarding AF treatment and how cardiologists describe their familiarity with shared decision-making.

Design/methodology/approach: A descriptive study was designed. Ten interviews with cardiologists at four Swedish hospitals were held, and a qualitative content analysis was performed on the collected data.

Findings: The analysis shows cardiologists' accounts of persuasive practice, protective practice, professional role and medical craftsmanship when it comes to patient involvement and shared decision-making. The term "shared decision-making" implies a concept of not only making one decision but also ensuring that it is finalised with a satisfactory agreement between both parties involved, the patient as well as the cardiologist. In order for the idea of patient involvement to be fulfilled, the two parties involved must have equal power, which can never actually be guaranteed.

Research limitations/implications: Methodologically, this paper reflects the special contribution that can be made by the research design of descriptive qualitative content analysis (Krippendorff, 2004) to reveal and understand cardiologists' perspectives on patient involvement and participation in medical consultation and shared decision-making. The utility of this kind of analysis is to find what cardiologists said and how they arrived at their understanding about patient involvement. Accordingly, there is no quantification in this type of research.

Practical implications: Cardiologists should prioritise patient involvement and participation in decision-making regarding AF treatment decisions in consultations when trying to meet the request of patient involvement.

Originality/value: Theoretically, the authors have learned that the patient involvement and shared decision-making requires the ability to see patients as active participants in the medical consultation process.

Purpose: Patients with extended hospital admissions had no recreation facilities in the ward. They were often confined to spaces around their beds, using the ward corridor for rehabilitation. The purpose of this paper is to outline a quality improvement (QI) intervention-provision of a recreational space for long-stay patients.

Design/methodology/approach: An exploratory quantitative pre-, post-test design was utilised, and executed in three phases: patients, visitors and staff survey to explore recreation and comfort needs and preferences; store room refurbishment; and patient, visitor and staff satisfaction with the recreation room.

Findings: Overall, 77 questionnaires were completed (n=49 staff; n=28 patient/visitor). Almost two-thirds (64.7 per cent; n=11) of patients had a stay greater than six weeks. Insufficient private space and concerns about disturbing other patients were identified as barriers to taking part in activities. Consequently, a store room was refurbished as a recreation room (9.0 m × 6.0 m) and furnished in three distinct areas. Following refurbishment, over 90 per cent (n=24) of respondents agreed that there was a suitable space where patients could "go and chat" and spend time with family and visitors or speak to the healthcare team.

Practical implications: The physical environment in acute hospitals is seldom prioritised. Needs-based QI projects can improve patient hospital experiences.

Originality/value: This case study highlights how nursing staff can be informed by patients' and families' needs and preferences, and initiate QI projects that improve patient hospital experiences.

Purpose: Comprehensive geriatric assessment (CGA) is a widely used approach in geriatric care and involves multidisciplinary assessments focused on determining a frail elderly person's medical, psychological and functional capability to develop an integrated plan for treatment. The purpose of this paper is to describe and scrutinize the CGA implementation process at six acute geriatric departments in three county councils and to study the outcome by the documentation in the patient medical records, and the staff perceptions using CGA.

Design/methodology/approach: The paper describes the implementation process stages. Outcome measures were based on patient medical records reviews at baseline and follow-ups at year 1 and year 2. Staff perceptions of using CGA were gathered by a questionnaire at the second follow-up.

Findings: The implementation had not yet reached sustainability so the implementation process must continue. Results show that documentation on the different areas increased in year 1, as well as the use of standardized assessment tools. However, results from the reviews for year 2 showed some decrease. Staff considered CGA to have high value for the geriatric patient but pointed out the need for continuing education.

Originality/value: Successful strategies for this implementation were strong support from the managers, small seminars, CGA rounds, good introduction routines for new staff and the use of reminders such as pocket-sized focus cards. A high staff turnover occurred during the study, which probably had a significant negative impact on the results.