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

Purpose: This paper seeks to analyse clinical pathways (CP) as a useful tool for the improvement of all aspects of quality in medical assistance - in this case, hip arthroplasty.

Design/methodology/approach: The study was carried out on patients who had undergone scheduled hip arthroplasty included in CP during the years 1999 to 2004. Data on demographics, lengths of stay, complications, process and result variables were gathered, coverage was calculated and the evolution of the indicators was compared.

Findings: A total of 487 patients were enrolled, with five leaving the pathway and with unequal coverage, leading to a maximum peak of 77 per cent in 1999. A statistically significant decrease exists in the consumption of overall stays and in the pre-surgical stay, which dropped from a mean of 19.41 days in the pre-pathway situation to 10.12 days in 2004 and 4.5 days pre-surgery to 1.08 days. As a process indicator, the performance should be highlighted of post-operation check-up radiographies, which have been gaining high levels of compliance (p < 0.05) since 2001. The rate of complications has remained stable over the years.

Originality/value: Implementing the CP has meant a sustained saving of resources over the years and an improvement in the organization of work.

Purpose: This study aims to explore the construct validity and the sensitivity of a patient satisfaction questionnaire for the purpose of gaining a better understanding of the concept, and of issues surrounding its measurements.

Design/methodology/approach: Several statistical analyses were used to study the reliability, construct validity, and the sensitivity of a patient satisfaction questionnaire.

Findings: The study supported the construct validity, high internal consistency, and homogeneity of the instrument. Two factors were found; one consisted of negatively worded items and the other of positively worded items. The negatively worded items contributed more than the positively worded items to the sensitivity of the instrument. Items were identified that contribute little or nothing to the construct validity and/or the sensitivity of the questionnaire.

Research limitations/implications: The effect of wording on the variability and sensitivity of the instrument can be explained both as a consequence of response set bias and with regard to the theories against which two phenomena were being measured - patient satisfaction and patient dissatisfaction. The development of two kinds of instruments is proposed: those that measure patient dissatisfaction and are sensitive to minute changes in nursing care and those that measure both concepts and capture what patients find important in their care.

Originality/value: The paper demonstrates how an analysis of the construct validity and the sensitivity of patient satisfaction instrument, can enhance understanding of the concept. It contributes to the debate about whether patient satisfaction and dissatisfaction are opposite ends of the same continuum or two different phenomena that require two different definitions.

Purpose: Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG compliance among practitioners so far would aid the understanding of factors influencing CPG compliance. This study seeks to provide this.

Design/methodology/approach: A general review and discussion of CPGs in areas of their attributes, benefits and pitfalls were carried out. Articles concerning the assessment of CPG compliance were also reviewed to understand the kind of data collected for such assessments (qualitative vs quantitative), the methods used to collect data (objective versus subjective), and the assessment measures employed (process versus outcome).

Findings: A total of 57 CPG compliance assessment studies were reviewed. Almost two-thirds employed objective methods. Of the subjective assessments, 47 per cent analysed solely quantitative data, 32 per cent analysed solely qualitative information and 21 per cent analysed both. More than four-fifths of all studies used process measures to determine CPG compliance and only 5 per cent used solely outcome measures.

Practical implications: Depending on the methods used, assessments can help identify various factors influencing CPG compliance. Such factors may be related to the physician, guidelines, health system or patient. A good understanding of these factors and their role in influencing compliance behaviour will help health regulators and administrators plan better and more effective strategies to improve doctors' CPG compliance.

Originality/value: This review looks at the various aspects of CPGs to understand how these influence practitioners' compliance.

Purpose: The purpose of this descriptive and cross-sectional study is to explore the relationships between managers' leadership styles and employees' job satisfaction in Isfahan University Hospitals, Isfahan, Iran, 2004.

Design/methodology/approach: The data were collected through the distribution of two questionnaires among the 814 employees, first line, middle and senior managers of these hospitals through a stratified random sampling.

Findings: The dominant leadership style of managers was participative. The mean score of employee-oriented dimension of leadership style in first line, middle and senior managers were 52, 54, and 54 (from 75 credit) respectively. The mean score of task-oriented dimension of leadership style in first line, middle and senior managers were 68, 69, and 70 (from 100 credit) respectively. The mean score of employee's job satisfaction was 3.26 +/- 0.56 on a 6 scale (moderate satisfaction), 1.9, 26.1, 64.7, and 7.3 percent of hospital employees had respectively very low, low, moderate, and high satisfaction with their job. Employees demonstrated less satisfaction with salaries, benefits, work conditions, promotion and communication as satisfier factors and more satisfaction with factors such as the nature of the job, co-workers and supervision type factors. There was significant correlation (p < 0.001) between the use of leadership behaviors and employees and job satisfaction.

Research limitations/implications: Employee job satisfaction depends upon the leadership style of managers. Nevertheless, participative management is not always a good management style. Managers should select the best leadership style according to the organizational culture and employees' organizational maturity.

Originality/value: Although this study conducted in Iran, it is anticipated that the findings may have relevance on a broader scale. By replicating this study in different countries and contexts the results of could be very helpful for developing a new model of leadership with new implementation techniques that can be implemented easily and successfully in a cross cultural context.

Purpose: Quality of family planning services is now considered as a global concern and importance. The purpose of the present study is to assess quality of family planning services in the urbanhealth centers of Shahid Beheshti Medical Science University.

Design/methodology/approach: This was a descriptive study to assess structure, process and outcome of the family planning care services. A total of 15 health centers of Shahid Beheshti Medical Science University were randomized and the quality of provided care by 65 family planning care providers of these health centers were observed and assessed using checklists. A total of 75 family planning clients were interviewed to assess their knowledge about their selected family planning method all of whom completed the related forms of satisfaction with the services. The tools for data collection were two observational checklists, and two questionnaires with subsequent data analyzed using SPSS 11.5. In total 75 clients with an average age 24 (7 +/- 4) (mean +/- SD) participated in the study. The provision of family planning services by 65 providers was assessed by observation at three intervals. Of the providers, 60 (92.3 per cent) were midwives.

Findings: Mean satisfaction score of clients was 83.3 +/- 9.05 percent meaning clients were highly satisfied with the services. Mean knowledge score of clients about their family planning method of use was 59.1 +/- 18 percent, which shows their moderate knowledge about their method of use.

Originality/value: A more advanced tool to assess quality of care of family planning services with more focus on special care for the contraceptives was developed. Quality of care in family planning services of Shahid Beheshti Medical Science University health centers showed adequate facilities and equipment and to have trained personnel however their client's knowledge about the selected method was moderate. Therefore, interventional programs are needed to improve counseling and the educational process of clients, which should be considered in future research and planning of the programs.

Purpose: As part of its restructuring and commitment to collaboration and advances in healthcare, the author's organisation has recently adopted personal outcomes to ensure that services are aligned to meet patient needs more effectively. The purpose of this paper is to evaluate this advancement in healthcare in the light of recent research findings, changing policies and the author's own understanding. DESIGN/METHDODOLOGY/APPROACH: The paper introduces the concept of collaboration as a means of achieving personal outcomes. In addition, the paper puts forward suggestions as to how the nurse can foster interdisciplinary/multidisciplinary teamwork, utilising the core concepts of the advanced nurse practitioner, namely transformational leadership, in support of this.

Findings: While success stories of personal outcomes abound much of it anecdotal based. Therefore, the need to initiate research in this area is of paramount importance as the latter would be helpful in examining meaningful quality outcomes. Reform in structure, finance and policy will also be necessary, as these are vital ingredients to the success of personal outcomes. Despite the overlapping conflict of Irish government policy, the extra finance announced in the 2005 Budget can only serve to assist organisations in achieving accreditation through initiatives like personal outcomes. Central to the success of personal outcomes, is to engage in collaborative practice by way of fostering interdisciplinary/multidisciplinary team working.

Research limitations/implications: Further study of the impact on patient outcomes of collaboration is warranted.

Originality/value: The paper examines organisational, professional and interpersonal challenges.

Purpose: The purpose of this paper is to point out the dangers inherent in choosing schools or programs from the internet, particularly in the field of health services, which may not be accredited, and therefore not recognized either by other institutions or by employers.

Design/methodology/approach: The problem is described and some of the better known American accrediting agencies are listed.

Practical implications: The paper has practical implications in terms of providing useful steps for anyone interested in exploring a health services career through ongoing education.

Originality/value: The paper represents a viewpoint from the perspective of an American accreditation consultant who is familiar with the organizational and program accreditation system in the USA.

Purpose: The purpose of this article is to clarify the distinction between research and audit, and propose appropriate regulatory arrangements for audit and related activities.

Design/methodology/approach: The methods used were literature reviews and conceptual analysis.

Findings: Research and audit overlap in various ways, but differ in terms of their purposes and the risks likely to be encountered and distinguished, along with a third related category of activities called quality improvement.

Practical implications: Appropriate regulatory arrangements are proposed for audit and quality improvement activities. Using these should ensure appropriate ethical standards and risk management, while avoiding the time-consuming over-regulation that occurs when projects are unnecessarily submitted to the ethical scrutiny appropriate for research projects.

Originality/value: Gives suggestions and information that could be of great value in spreading service improvement.

Purpose: This paper seeks to present an analysis of the literature examining objective information concerning the subject of customer service, as it applies to the current medical practice. Hopefully, this information will be synthesized to generate a cogent approach to correlate customer service with quality.

Design/methodology/approach: Articles were obtained by an English language search of MEDLINE from January 1976 to July 2005. This computerized search was supplemented with literature from the author's personal collection of peer-reviewed articles on customer service in a medical setting. This information was presented in a qualitative fashion.

Findings: There is a significant lack of objective data correlating customer service objectives, patient satisfaction and quality of care. Patients present predominantly for the convenience of emergency department care. Specifics of satisfaction are directed to the timing, and amount of "caring". Demographic correlates including symptom presentation, practice style, location and physician issues directly impact on satisfaction. It is most helpful to develop a productive plan for the "difficult patient", emphasizing communication and empathy. Profiling of the customer satisfaction experience is best accomplished by examining the specifics of satisfaction, nature of the ED patient, demographic profile, symptom presentation and physician interventions emphasizing communication--especially with the difficult patient.

Originality/value: The current emergency medicine customer service dilemmas are a complex interaction of both patient and physician factors specifically targeting both efficiency and patient satisfaction. Awareness of these issues particular to the emergency patient can help to maximize efficiency, minimize subsequent medicolegal risk and improve patient care if a tailored management plan is formulated.

Purpose: The paper aims to explore the barriers that currently exist to patient-driven treatment within the field of mental health care and reform.

Design/methodology/approach: This study represents action learning research using grounded theory to explore a possible causal basis for recidivism related to non-compliance with medication. Interviews addressed concerns from the literature around perceived barriers to patient-driven treatment evidenced by non-compliance with medically recommended pharmaceutical treatment. Results were correlated to look for emergent themes that were used to form the basis for subsequent interview questions.

Findings: An analysis of the resulting emergent themes illustrated the importance of participatory treatment and coaching rather than medically applied paternalistic care, which is seen as encouraging learned helplessness on the part of patients. Similar helplessness was also revealed in clinicians themselves. Patients' awareness of their own needs and demands for more services place clients and the caregivers at odds over appropriate care in an environment of limited resources.

Research limitations/implications: The research was limited to only a small number of interviewees in one institution, all of whom were closely associated with mental illness in various capacities. The grounded theory nature of the research does, however, provide a framework for more research in other institutions to test and further explore some of the findings.

Practical implications: The study demonstrated a reinforcement of Maslow's theory of needs hierarchy. The study illustrated a step-wise approach to treatment to decrease the rate of failure and recidivism in mental health care. The provision of a stable living environment was viewed as instrumental in improving patients' compliance with pharmaceutical treatment. An action plan was therefore created to initiate the support of a transitional/emergency house by various community groups in partnership with pharmaceutical manufacturing companies.

Originality/value: Recidivism in mental health-created by non-compliance in pharmaceutical treatment, is a major issue in Canada's health care system. This study brings to the forefront issues from a number of perspectives in order to form a course of action in response to its findings.