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

Purpose: Hospital cleaning and healthcare associated infections (HCAIs) continue to attract adverse media attention and consumer concern. Parallels exist with similar publicity relating to cleaning and food safety in the food industry almost 13 years earlier. This paper examines some of the management solutions developed in the food industry, and discusses their application to healthcare delivery.

Design/methodology/approach: The food industry is managing food safety by adopting a dual approach based on pre-requisite programmes and Hazard Analysis Critical Control Points (HACCP). How these differ is described and how the approaches and terminology can be adapted for use in healthcare is discussed.

Findings: The food industry is moving towards external certification of safety using national and international standards. The HACCP approach, a management tool and a central requirement of these standards, is evolving and there is interest worldwide from the healthcare community. Its application to the decontamination of endoscopes, using conventional HACCP, is presented, as well as suggestions for a simplified format for managing patient-related procedures. Taking this type of approach to the management of HCAIs could provide greater transparency, reduce infection rates and increase consumer confidence.

Practical implications: Potential problems in adopting HACCP, including cost and human resource, are discussed.

Originality/value: The HACCP method/approach has previously been mentioned in the medical literature but this paper is one of the few to examine, from basic principles, its infection control application within a broader approach to quality assurance.

Purpose: The purpose of this paper is to explore the concept of moral distress in particular as it impacts on the pediatric intensive care nurse caught between caring for infants and children who would not otherwise be alive were it not for the advances of modern medical technology, and their personal beliefs concerning the societal value of life at any cost.

Design/methodology/approach: Describes cases and real incidents to illustrate the moral distress experienced by-these nurses caught between caring for the children and at the same time interacting with the families. Such families are too often living on hope, with a profound faith in the ever advancing world of medical technology to keep loved ones alive with little thought to the consequences.

Findings: Suggests that the impact of moral distress on pediatric nurses, particularly as it relates to burnout, may well jeoparidize their ability to deliver effective care and is another unrecognized cost in the medical world.

Practical implications: Suggests that an ethical approach to care is necessary through hard to answer questions. Due to the fact that such questions are not often addressed, the author suggests consideration be given to medical ethicists to mediate and assist those caught in this dilemma.

Originality/value: This paper will be of value to those concerned with how medical and life-saving technologies are outstripping our human abilities to comprehend and live with the consequences, and some of the ethical issues that arise.

Purpose: The purpose of the paper is to present an alternative to the supply chain model of health care delivery that currently informs most thinking about the design of care processes.

Design/methodology/approach: The paper draws on arguments from systems theories and public administration, to generate an analysis of the nature of health care processes. It sets out a model of services characterised by treatment and care needs that vary over time, that are inherently uncertain, involve frequent assessment and re-assessment, and provide patients and service providers with choices about treatment and care. Evidence from an evaluation of intermediate care is used to illustrate the analysis.

Findings: The analysis suggests that both the supply chain and a more network-like model of health care processes can help us to understand health care processes. The two are complementary.

Research limitations/implications: Largely conceptual in nature. The empirical evidence is taken from one study. The ideas are presented to stimulate thinking rather than to prove an argument.

Practical implications: The conceptualisation of care processes as network-like has implications for the way in which we think about the design and performance of health care systems.

Originality/value: There have been few publications that seek to use both systems and network approaches to understand health care processes.

Purpose: The aim of the paper is to compare the computer administration method (touch-screen) with the original paper-and-pen approach when measuring patients' perceptions of care quality.

Design/methodology/approach: The study group consisted of 199 patients who responded to touch-screen and 219 who responded to paper-and-pen questionnaires, receiving care between January and March 2003 at two out-patient clinics in one county in Sweden. The response rate was 75 per cent. A modified version of the quality from the patient's perspective questionnaire was used.

Findings: Two main findings emerged: first, both methods yielded almost identical results in quality of care ratings, and second, the touch-screen method was perceived to be easier to use and to take less time to complete.

Originality/value: The paper shows that both methods are acceptable, but the touch-screen method appears to be preferred by patients.

Purpose: The purpose of this article is to describe the design and development of an e-health strategy for the Spanish health care system. Using quality function deployment and benchmarking analysis as an analytical model, a strategy in e-health care is proposed.

Design/methodology/approach: This article uses the case of a Spanish community to build a general framework for e-health system development. Based on a multi-disciplinary literature, and the specific needs of a community, the process of e-health system development is analyzed and reduced into a series of phases that form an integrated method. Best practice managerial techniques are adapted to the healthcare industry and the inter-relationships between them are mapped in a theoretical model that results in the desired outcomes.

Findings: This analysis produces a road-map to e-health system development consisting of several phases: analysis of the current situation of the system and determination of objectives; collection and analysis of customer expectations; development of an action plan through cross-evaluation of customer and system needs; cost and strategic analyses; and evaluation and control systems. Managerial implications are provided.

Originality/value: The strategy proposed in this article is a prototype and an ongoing study in the Castilla-La Mancha community.

Purpose: The paper seeks to investigate decision-making processes within hospital improvement activity, to understand how performance measurement systems influence decisions and potentially lead to unsuccessful or unsustainable process changes.

Design/methodology/approach: A longitudinal study over a 33-month period investigates key events, decisions and outcomes at one medium-sized hospital in the UK. Process improvement events are monitored using process control methods and by direct observation. The authors took a systems perspective of the health-care processes, ensuring that the impacts of decisions across the health-care supply chain were appropriately interpreted.

Findings: The research uncovers the ways in which measurement systems disguise failed decisions and encourage managers to take a low-risk approach of "symptomatic relief" when trying to improve performance metrics. This prevents many managers from trying higher risk, sustainable process improvement changes. The behaviour of the health-care system is not understood by many managers and this leads to poor analysis of problem situations.

Practical implications: Measurement using time-series methodologies, such as statistical process control are vital for a better understanding of the systems impact of changes. Senior managers must also be aware of the behavioural influence of similar performance measurement systems that discourage sustainable improvement. There is a risk that such experiences will tarnish the reputation of performance management as a discipline.

Originality/value: Recommends process control measures as a way of creating an organization memory of how decisions affect performance--something that is currently lacking.

Purpose: The objective of the paper is to confirm the feasibility and value of using the balanced scorecard (BSC) to measure performance in two hospitals in different countries.

Design/methodology/approach: One hospital from China and another from Japan were chosen and key indicators were selected according to the BSC framework. A comparative hospital performance measurement model was set up using the BSC framework to comprehensively compare hospital performance in two countries.

Findings: The BSC was found to be effective for underlining existing problems and identifying opportunities for improvements. The BSC also revealed the hospitals' contribution to performance improvement of each country's total health system.

Research limitations/implications: Hospital performance comparisons between countries using the BSC depend on the selection of feasible and appropriate key performance indicators, which is occasionally limited by data collection problems.

Originality/value: The first use of the BSC to compare hospital performance between China and Japan shows benefits that not only suggests performance improvements in individual hospitals but also reveals effective health factors allowing implementation of valid national health policies.

Purpose: The purpose of this paper is to describe and assess the process undertaken by Capital Health responsible for planning and developing a new primary care centre in an older urban, and demographically mixed neighbourhood in Edmonton, Alberta, Canada.

Design/methodology/approach: The approach to the paper is to describe how health centres, if they are to be fully effective in terms of meeting community needs, need more than technical excellence; they also need to fit into the community where they are to be located. Primary care centres, through helping people stay healthy and manage their own health in their own communities, can be an essential antidote to the challenges presented by an aging population. The paper uses the Capital Health initiative as a means of demonstrating how a primary care centre can achieve this objective, in terms of design and physical location, as well as planning process.

Findings: The paper describes the process the project planners have developed to enter into dialogue with representatives of the community. The proposed site selected for the clinic was met with some resistance because it was formerly a school built in the 1930s in the middle of a large area of green space and surrounded by mature elms in the midst of a mixed urban residential area. Through an intense two-way communication process with residents of the area, the plans for the centre are iterative, evolving in such a way that the clinic will not only integrate architecturally and structurally, but better meet the needs of the community it serves.

Practical implications: The paper has practical implications for anyone interested in designing and locating new health centres in already existing urban communities.

Originality/value: Discusses the issues of building a new primary care centre, while preserving precious green space and considering opinions of local residents.