INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE最新文献

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.

Purpose: Nowadays, the importance of infant birth weight (IBW) as a key factor in determining the future of physical and mental development of children is a growing concern. The purpose of this paper is to investigate the relationship between maternal characteristics and IBW among pregnant women who were referred to health centers in Qazvin city in the year 2016.

Design/methodology/approach: A descriptive-analytical study was conducted among pregnant women in 28-36 weeks of gestation who referred to healthcare centers and facilities affiliated by the Qazvin University of Medical Sciences in April-June 2016. The associations between maternal physical activity, mothers' socioeconomic status and birth weight were examined by SPSS Software Package version 16 through linear and logistic regression tests.

Findings: Linear regression modeling suggested that maternal weight (p=0.001), income (p=0.04), gestational age of delivery (p=0.00) and pre-pregnancy BMI (p=0.02) were positively associated with birth weight, while occupational and heavy physical activity (p=0.003 and 0.008, respectively) were negatively associated with IBW. In this study, low birth weight infants are compared to those with normal weight belonged to mothers who have spent more time in doing heavy physical activities (OR=1.11, 95% CI 1.01-1.23). Also infants with low birth weight compared to others in the normal weight category were born from mothers with lower pre-pregnancy BMI (OR=0.65, 95% CI 0.62-0.78), gestational age of delivery (OR=0.82, 95% CI 0.79-0.86), maternal weight (OR=0.86, 95% CI 0.84-0.88) and income (OR=0.79, 95% CI 0.69-0.83).

Practical implications: The study findings revealed that certain maternal characteristics could play a significant role in IBW. Despite the importance, in most of developing countries (particularly Iran), future mothers are not advised about an appropriate weight gain during pregnancy or the optimal level of physical activity in such a period of time. Therefore, counseling pregnant women and giving them proper information on appropriate perinatal care would be helpful in order to have pregnancies with optimal outcomes.

Originality/value: The authors applied several statistical methods to analyze IBW among mothers with different maternal characteristics and predict birth weight based on contributing factors.

Purpose: The purpose of this paper is threefold: first, to draw health managers', clinicians', entrepreneurs' and mobile apps designers' attention toward new mobile health applications (mHealth apps); second, to define mHealth apps design characteristics intended for doctors; and third, to highlight how mHealth apps can be designed using quality function deployment/house of quality (QFD/HOQ) techniques from doctors' perspectives.

Design/methodology/approach: Data were collected through a survey and in-depth interviews with doctors to understand their needs and attitudes toward mHealth apps. Analytic hierarchy process, QFD and HOQ methods were used to analyze data.

Findings: Doctors agreed that mHealth apps provide them with the tools to improve their service and to become more efficient. Once the 12 doctors' wants were collected, they were prioritized according to their significance and used for mHealth apps development. Eight technical characteristics that cater to doctors' expectations were sorted. The authors suggest that mHealth app designers need to provide design requirements recommended by health personnel for a higher satisfaction level.

Originality/value: Healthcare managers are focusing on increasing their efficiency, patient satisfaction and care quality, and decreasing costs. For these purposes, mHealth revolution and mHealth apps have high potential for improving doctor effectiveness and healthcare quality. This study is among the first to: define Turkish doctors' wants from mHealth apps; elaborate the app's technical characteristics; and increase design quality, which is implied in improving app design. This research makes a significant contribution to define doctors' wants from mHealth apps, to elaborate their technical characteristics and to increase mHealth apps design quality using QFD.

Purpose: The purpose of this paper is to confirm and examine organization-related factors that could affect quality management at the Thai national reference laboratory known as National Institute of Health.

Design/methodology/approach: The authors invited 340 laboratory staff members to complete a questionnaire that enquired about their skills, opinions, perceptions, leadership, work environment, organizational culture and organizational commitment in relation to quality management. Confirmatory factor analysis (CFA) and multiple linear regression were used to analyze the data.

Findings: In total, 65 percent of institute members responded to the questionnaire. CFA revealed that all factors were related to quality management. Three factors, leadership, organizational commitment and work environment, significantly affected quality management, but organizational culture did not.

Research limitations/implications: Other data types should be collected for an in-depth understanding, i.e. focus groups or in-depth interviews. A longitudinal study could also enhance quality management understanding to see how each variable changes over time.

Originality/value: Analyzing quality management through confirmatory factor and regression analysis showed that the four analyzed variables are statistically significant in relation to quality management at the laboratory. Managers could apply this information to revise the current policy.

Purpose: The purpose of this paper is to examine whether Bahraini individuals accept e-health system and the prominent factors affecting e-health system adoption in Bahrain.

Design/methodology/approach: The authors adopted a quantitative and qualitative approach, i.e., a self-administered questionnaire, unstructured and a semi-structured interview, which were used to collect the data. A questionnaire was distributed to Bahraini residents selected randomly. The framework was based on the technology acceptance model (TAM) and theory of reasoned action (TRA). Important variables from both the TAM model and TRA theory were extracted and jointly used to build the research model.

Findings: The findings indicated that the most factors affecting e-health adoption are trust, health literacy and attitude. Additionally, people in the private and government sectors understand e-health benefits.

Practical implications: If healthcare professionals understand the factors affecting e-health system adoption from an individual and organisational perspective, then nurses, pharmacists and others will be more conscious about e-health and its adoption status.

Originality/value: E-health system adoption has become increasingly important to governments, individuals, and researchers in recent years. A novel research framework, based on TAM and TRA, was used to produce a new integrated model.