International journal of health care quality assurance incorporating Leadership in health services最新文献

Purpose: To demonstrate that effective re-engineering of healthcare pipelines requires selecting both the "best" process (how we shall do it in the future) and the best trajectory for change (how we get from here to there).

Design/methodology/approach: Exploitation of Braess' Paradox to identify strategic factors necessary to enable change in the re-engineering of NHS healthcare pipelines.

Findings: Route to maximising the chance of achieving effective change is displayed via a Johari Window. Each cell is then related to no change (despite significant investment); failure; or successful implementation.

Research limitations/implications: The demonstrator pipeline is an NHS cataract repair supply chain. However, via the "Power of Analogy" concept the NHS scenario is readily related to a substantial number of industrial case studies.

Practical implications: The need to understand both process and trajectory is the key to effective re-engineering of pipelines. All "actors" in re-engineering programmes should acquire this knowledge and benefit from the new way of doing things.

Originality/value: Formalises the strategic route to enabling healthcare delivery "best practice".

Purpose: This article seeks to explore ways in which one can share and spread best practice, that have the potential for transformational change. It describes the cultural and behavioural mindset that is needed to make this happen.

Design/methodology/approach: The overall approach is aimed at documenting the essential features of a best practice, giving pointers to relevant experts in that practice, deducing general guidelines, diffusing basic knowledge, and using subject-matter experts to apply and adapt the practices in a new context.

Findings: Best practice resources require to be actively promoted, otherwise one may end up with databases and people that are under-used and not fulfilling their potential. One should resist the temptation to focus on explicit knowledge; databases of best practices are insufficient. Databases point to examples and people, but it is through people that deep knowledge is transferred.

Originality/value: The information provided in this article is the viewpoint of the authors, who are experts in the field. Hopefully, their views will give the potential for transformational change.

Purpose: Achieving excellence is a current preoccupation in U.K. public health organisations. This article aims to use a case study to explain how a mental health trust delivers excellent performance using a balanced scorecard (BSC) management approach.

Design/methodology/approach: Reports a project to implement a BSC approach in the South West Yorkshire Mental Health NHS Trust to achieve its "excellence" objectives. The authors were participants in the project. The design of the pilot project was informed theoretically by the work of Kaplan and Norton and practically by in-house discussions on a strategy to achieve excellence.

Findings: Explains the process of building a BSC strategy step-by-step. Discusses how the vision and strategies of a mental health trust can be translated into tangible measures, which are the basis for actions that are driven strategically.

Research limitations/implications: There are many possibilities for a BSC management approach and this case study is specific to mental health trusts in the UK, although it is believed that the case has a universally applicable modus operandi.

Practical implications: This article will help healthcare managers to evaluate the benefits of a BSC management approach.

Originality/value: This article explains how actions can be structured in connection with a BSC management approach.

Purpose: There is evidence that some strategies for guideline implementation are more successful than others. This paper aims to describe the process of developing an evidence-based guideline implementation strategy for use in rural emergency departments.

Design/methodology/approach: Participation in a nationally funded, research fellowship program involved attendance at workshops run by internationally renowned experts in the field of knowledge translation. Attendance at these workshops, associated reading and a literature review allowed those implementation strategies with the most supportive evidence of effectiveness to be determined.

Findings: A multi-faceted implementation strategy was developed. This strategy involved the use of an implementation team as well as addressing issues surrounding individual clinicians, the "emergency department team", the physical structure and processes of the ED and the culture of the department as a whole. Reminders, audit and feedback, education, the use of opinion leaders, and evidence-based formatting of guidelines were all integral to the process.

Practical implications: It is postulated that an evidence-based implementation strategy will lead to greater changes in clinician behaviour than other strategies used in quality improvement projects.

Originality/value: This is an important article as it describes the concept and development of evidence-based interventions, which, if tailored to the individual hospital (as evidence-based medicine is tailored to the individual patient), has the potential to improve compliance with clinical guidelines beyond that achieved with most QI projects.

Purpose: To evaluate the application of one particular quality measurement tool, the SERVQUAL instrument, as a potential mechanism to measure quality in services for children with disabilities

Design/methodology/approach: Staff and family of children with an intellectual disability in two organisations providing specialist therapy and day completed an adapted SERVQUAL questionnaire. A total of 81 SERVQUAL questionnaires were distributed and 59 questionnaires were returned (response rate of 73 per cent).

Findings: The SERVQUAL instrument can be considered as a useful diagnostic tool to identify particular strengths and areas for improvement in services for people with disabilities as the instrument lends itself for the monitoring of the effectiveness of quality improvement initiatives over time. The findings also showed relatively high customer expectations and the organisations involved in this research are currently not meeting all of these high expectations as significant quality gaps were found in the areas of reliability and responsiveness.

Research limitations/implications: The sample size was relatively small and the measurement of quality using the SERVQUAL instrument remains a challenge, due to the conceptual and empirical difficulties.

Practical implications: The SERVQUAL instrument is probably most be attractive to service managers and funding organisations because of its ability to identify gaps in the quality of the service.

Originality/value: The tool had been used to measure quality in services for people with disabilities and the research has shown that this tool might be an important additional quality measurement tool for services.

Purpose: The aim of this paper is to undertake a holistic comparison between NHS and Kaiser Permanente (KP) healthcare delivery systems.

Design/methodology/approach: The paper reviews in detail the many papers and communications published on KP via the "logistics lens" which is focussed on smooth patient flow from onset of problem to completion of treatment.

Findings: The paper finds that healthcare "best practice" is readily related to conventional supply chain performance metrics and engineering change model attributes. Much of the apparent success of KP is due to cultural and organisational factors. A noteworthy example deserving wide dissemination and application is in the effectiveness of interfaces between clinicians and managers.

Research limitations/implications: This review exposes the need for the NHS to be driven by end-to-end processing times rather than the present salami principle of separating in-patient, out-patient and other queues into neat statistics, which can be meaningless to an individual patient.

Practical implications: Introduces clinicians and healthcare professionals to a range of tools and techniques for engineering "best practice". This method is well understood and proven in other areas of application. Particular aspects of the KP study are thus confirmatory of what is actually happening in small pockets of the NHS.

Originality/value: The paper provides a new perspective on the performance of healthcare supply chains. New knowledge and deeper understanding of the mechanisms of success emerge from a study adopting a different viewpoint.

Purpose: Business process redesign (BPR) is used to implement organizational transformations towards more customer-focused and cost-effective care. Ideally, these innovations should be carefully described and evaluated so that "best practices" can be re-applied. To investigate this, available evidence was collected on patient care redesign projects.

Design/methodology/approach: The Ebsco Business Source Premier, Embase and Medline databases were searched. Studies on innovations related to re-engineering patient care that used before-after design as minimum prerequisites were selected. General characteristics, logistic parameters and other outcome measures to determine the objectives and results and interventions used were looked at.

Findings: A total of 86 studies that conformed to the criteria were found: a minority mentioned measurable parameters in their objectives. In the majority of studies, multiple interventions were combined within single studies, making it impossible to compare the effects of individual interventions. Only three randomized controlled trials were found. Furthermore, inconsistencies were noted between the study objectives and the reported results. Many more issues were reported in the results than were mentioned in the study aims. It would appear that publications were hard to find owing to a lack of specific MeSH headings. Nearly 7,500 abstracts were scanned and from these it was concluded that clear and univocal research methods, terms and reporting guidelines are advisable and must be developed in order to learn and benefit from BPR innovations in health care organizations.

Originality/value: This appears to be the first time available evidence about redesign projects in hospitals has been systematically collected and assessed.

Purpose: Medical device users are one of the principal medical device technology stakeholders. The involvement of users in medical device technology development and assessment is central to meet their needs. This study aims to examine this issue.

Design/methodology/approach: A structured review of the literature published from 1980 to 2005 in peer-reviewed journals was carried out from a social science perspective to investigate user involvement practice in the development and assessment of medical device technologies. This was followed by a qualitative thematic analysis.

Findings: Medical device users include clinicians, patients, carers and others. Different kinds of medical devices are developed and assessed by user involvement. The user involvement occurs at different stages of the medical device technology lifecycle and the degree of user involvement is in the order of: design > testing and trials > deployment > concept stages. The methods most commonly used for capturing users' perspectives are usability tests, interviews and questionnaire surveys.

Research limitations/implications: The relevant engineering, medical and nursing literature, which might have been useful, was not reviewed. However, useful findings emerge that apply to health care generally.

Originality/value: This study shows that medical device users are not homogeneous but heterogeneous in several aspects, such as needs, skills and working environments. This is an important consideration for incorporating users' perspectives in medical device technologies.