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

Purpose: To evaluate the service quality and usability of a student health clinic.

Design/methodology/approach: A measurement tool, termed SERVUSE, was created by modifying SERVQUAL. The modified survey included all five original dimensions in addition to a usability dimension. The survey was administered to 200 patients at the health clinic.

Findings: SERVUSE was found to be a valid tool for measuring service quality in this setting. The health clinic received a gap score of -0.357, showing that customer expectations were not met.

Research limitations/implications: The student health clinic and subject participants are a special population that may display different characteristics from other healthcare providers.

Practical implications: SERVUSE is a tool that can be used to aid in improving a health clinic's service quality. Usability is an important feature for healthcare providers to improve.

Originality/value: This paper provides useful information to healthcare providers, especially in a university setting.

Purpose: In 2002 the Singapore Ministry of Health (MOH) audited doctors' compliance with diabetes clinical practice guidelines in public healthcare institutions and attempted to postulate factors that influenced the degree of conformity. This study aims to address this issue.

Design/methodology/approach: A retrospective cross-sectional chart review of diabetes patient records sampled from hospital specialist outpatient clinics (SOCs) and polyclinics was performed. Childhood, gestational and secondary diabetes cases were excluded. The nine audit parameters used were process measures concerning the assessment of HbA1c, weight, blood pressure, urinary protein, serum creatinine, serum lipids, electrocardiography, retina and feet. Age-standardised prevalence rate ratios of parameter adherence were calculated. Of the SOC cases, 89 per cent were analysed. Of the polyclinic cases, 94 per cent were analysed.

Findings: Adherence to ECG and foot assessment parameters was poor among SOC cases, while poor adherence to weight and foot assessment parameters was seen in the polyclinics. There was poorer adherence to blood pressure and ECG parameters in the SOCs, but better adherence was seen for weight assessment. Among the SOC cases, Cluster A fared better than Cluster B in ECG monitoring. In the polyclinics, better adherence was seen in Cluster A for urinary protein, serum creatinine, lipids, ECG, retinal and foot assessment parameters.

Originality/value: Based on pre-existing information on local diabetes care, certain system, physician, patient and guideline factors are postulated to explain clinical practice guideline non-compliance among doctors.

Purpose: The paper seeks to present findings from an evaluation of a quality management system implemented in a low-income country hospital.

Design/methodology/approach: This is a single-case before and after evaluation.

Findings: The quality system, although only 70 per cent implemented, resulted in increasing compliance with a few selected standards and produced modest improvements in patient satisfaction and utilisation. Hospital doctors and managers wanted to continue to develop the system and described conditions they thought important to spread to other hospitals.

Research limitations/implications: No objective, clinical outcomes data were gathered, and the short timescale meant that the system was not fully implemented at the time of the evaluation.

Practical implications: It is possible to improve patient care in rural hospitals with a few extra resources, in a culture not familiar with management processes, and to engage otherwise poorly motivated doctors in systematic improvement. However, certain conditions are necessary for introducing, sustaining and spreading quality improvement programmes.

Originality/value: This study and report is one of the first, detailed and systematic evaluations of a hospital quality management system in a highly resourced constrained situation in an Arabic country, which has implications for improving health care in other developing countries.

Purpose: This out-of-hours primary and community care services (more recently called unscheduled care) literature review sets out to build on the foundations set by earlier publications by examining old and fresh issues after the new General Medical Service contract was implemented in 2004.

Design/methodology/approach: Almost 140 publications were located, including a range of theoretical and empirical publications.

Findings: A total of seven themes emerge--varying from the most frequently discussed (service nature and value) to the least examined (information management and technology).

Originality/value: Analysis not only underlines service problems and tensions noted previously but also generates new insights, which cannot be ignored if services are to be developed. Consequently, several recommendations are made.

Purpose: The aim of this article is to examine the differences in service quality between public and private hospitals in Turkey.

Design/methodology/approach: This study applies the principles behind the SERVQUAL model and compares Turkey's public and private hospital care service quality. The study sample contains a total of 200 outpatients. Through the identification of 40 service quality indicators and the use of a Likert-type scale, two questionnaires containing 80-items was developed. The former measured patients' expectations prior to admission to public and private hospital service quality. The latter measured patient perceptions of provided service quality.

Findings: The results indicate that inpatients in the private hospitals were more satisfied with service quality than those in the public hospitals. The results also suggest that inpatients in the private hospitals were more satisfied with doctors, nurses and supportive services than their counterparts in the public hospitals. Finally, the results show that satisfaction with doctors and reasonable costs is the biggest determinants of service quality in the public hospitals.

Originality/value: Consequently, SERVQUAL, as a standard instrument for measuring functional service quality, is reliable and valid in a hospital environment.

Purpose: The purpose of this article is to report on case study research conducted in a German hospital and describe the implications that the "Management by walking about" approach had on healthcare employees. "Management by walking about" is widely seen as one of the favoured procedures for increasing employee commitment and shared understanding as well as supporting high trust work relations.

Design/methodology/approach: This case study set out to examine the actual labour processes and the concrete experiences of healthcare employees behind the "Management by walking about" approach in a German hospital. This was achieved by means of a six month field study of day-to-day life in the hospital's nursing division.

Findings: In this case study, the popular initiative of "Management by walking about" was used as a means of managerial control and, as such, the internal promotion of soaring values and path-finding visions was met with both scepticism and cynicism.

Practical implications: Pre-commitment and motivation levels were high among healthcare employees, they were passionate about their healthcare work and they actively engaged in open communication and organisational development. But all this had little to do with "Management by walking about", and its implications raise questions about its influence on high trust work relations more generally.

Originality/value: The paper concludes that a more critical analysis is necessary to challenge the way in which "Management by walking about" is examined by healthcare management academics and practitioners.

Purpose: To assess patients' attitude towards information leaflets, their understanding of the given information, and the time factor involved in an out-patient clinic set-up.

Design/methodology/approach: A total of 50 patients who received depot preparation of Methyl Prednisolone as local injections in an out-patient hand-clinic were given 15 minutes to read the patient information leaflet and were simultaneously asked to answer a questionnaire.

Findings: Patients want to be informed and are willing to spend more time and effort on information leaflets. Their ability to grasp and retain the relevant information is highly variable. Excess of information, poor presentation/format, lack of time, irrelevant data are factors which seem to adversely affect the effectiveness of information leaflets.

Originality/value: This study gives recommendations to those providing patient care. Emphasises the need for a careful review of all written information with respect to patients' better understanding of the treatment they will receive for the condition being treated.

Purpose: The purpose of this paper is to highlight the role of national health registries in three European countries in order to improve patient care.

Design/methodology/approach: The methodology used was a literature review of databases in Sweden, the UK and Portugal, and a search on Medline and Pubmed as well. In addition case studies from the three countries are included.

Findings: In Sweden registries encompassing cardiac intensive care, hip-fractures and stroke are the most developed. In the UK, the collection of information on healthcare performance, both specific to particular specialties and general hospital performance, is widespread. There are some national and regional registries in Portugal, but the most developed areas are the Cardiovascular and the Oncology areas. The collection of information on health quality/performance indicators, based on administrative and clinical data is an important tool for quality improvement.

Originality/value: This paper showed differences and similarities between the three countries with a common aim; to improve quality of care, delivered on equal terms for the whole populations, and in an effective and efficient way and will be useful to those in the field of patient care.

Purpose: The aim of this article is to show how Taguchi methods can be applied to health care.

Design/methodology/approach: The quadratic loss function is at the heart of Taguchi methods. It is a powerful motivator for a quality strategy and can be used to adequately model the loss to society in health care. It also establishes a relationship between cost and variability. Therefore, it can be integrated with the performance and parameters of the design of medical applications. Signal-to-noise ratios give a sense of how close is the performance to the ideal. By maximizing the signal-to-noise ratio, quality-engineering activities can be aimed at identifying near-optimum levels of factors and making quality equal to zero.

Findings: This article shows that, when the patients' requirements are consistently met, lower losses can provide an impetus to improve patient satisfaction.

Originality/value: The article outlines areas in health care where Taguchi methods can easily be applied.