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

Purpose: This paper sets out to analyse the use of the Six Sigma methodology to improve quality in healthcare. It looks at how Six Sigma grew out of the concept of Total Quality Management (TQM).

Design/methodology/approach: Six Sigma is a quality improvement methodology that has been widely adopted by companies since the early 1990s and has grown exponentially in the healthcare industry during the past five years. Some of the main tenets of Six Sigma have emerged from the principles of TQM, including the notion that the entire organization must support the quality effort; that there should be a vigorous education effort; and that a quality improvement process should emphasize root cause analysis.

Findings: In spite of its early success, TQM "crashed and burned" for several reasons including the fact that financial benefits were difficult to assign to TQM efforts, root cause was not always determined resulting in recurring errors, there was no common metric to measure the level of quality attained, and quality efforts were sometimes aimed at processes or operations that were not critical to the customer. Six Sigma filled the vacuums created by these TQM failures in several ways. Under the Six Sigma methodology, quality improvement projects are carefully defined so that they can be successfully completed within a relatively short time frame. Financials are applied to each completed project so that management knows how much the project saves the institution.

Originality/value: On each project, intense study is used to determine root cause analysis; and in the end, a metric known as "sigma level" can be assigned to signify the level of quality. Six Sigma has a "critical to quality" dimension that keeps the quality effort focused on improving only those things that really matter to the customer.

Purpose: With the three existing specialised paediatric liver centres working beyond bed capacity, this article aims to address the special problems arising from the tension between need for centralisation of skills, and advantages of decentralisation of care.

Design/methodology/approach: Three sessions using the appreciative inquiry method were conducted by the authors

Findings: This resulted in a new patient-centred set of priorities in developing a MCN and gave impetus to two regional MCNs and a National MCN movement for Paediatric Gastroenterology.

Originality/value: The authors describe the changes and how the AI method offers a powerful tool for positive change within the NHS. This article will be of special interest to those working within the paediatric liver services.

Purpose: Work-related musculoskeletal disorders following patient contact represent a major concern for health care workers. Unfortunately, research and prevention have been hampered by difficulties ascertaining true prevalence rates owing to under-reporting of these injuries. The purpose of this study is to determine the predictors for under-reporting work-related musculoskeletal injuries and their reasons.

Design/methodology/approach: Multivariate analysis using data obtained in a survey of Veterans Administration employees in the USA was used to determine underreporting patterns among registered nurses, licensed practical nurses and nursing assistants. Focus groups among health care workers were conducted at one of the largest Veterans Administration hospitals to determine reasons for under-reporting.

Findings: A significant number of workers reported work-related musculoskeletal pain, which was not reported as an injury but required rescheduling work such as changing shifts and taking sick leave to recuperate. The findings indicate that older health care workers and those with longer service were less likely to report as were those working in the evening and night shifts. Hispanic workers and personnel who had repetitive injuries were prone to under-reporting, as were workers in places that lack proper equipment to move and handle patients. Reasons for under-reporting include the time involved, peer pressure not to report and frustration with workers' compensation procedures.

Originality/value: This study provides insights into under-reporting musculoskeletal injuries in a major US government organization. The research indicates that current reporting procedures appear to be overtly cumbersome in time and effort. More flexible work assignments are needed to cover staff shortfalls owing to injuries. Health education on the detrimental long-term effects of ergonomic injuries and the need for prompt attention to injuries should prove useful in improving rates of reporting.

Purpose: The objective of this study is to shed some light on quality improvement practices of for-profit and not-for-profit hospitals

Design/methodology/approach: The scope and effectiveness of several quality improvement efforts are studied for a sample of 110 hospitals. Factor analysis was utilized to analyze the data collected.

Findings: The results of this study tended to suggest that for-profit and not-for-profit hospitals were more similar than different with the regard to the effective utilization of quality improvement initiatives, thus underscoring the utility of quality improvement efforts despite differences in operating characteristics, strategies and operating constraints.

Research limitations/implications: The sample used in this study is limited. Thus, the results should be interpreted accordingly.

Practical implications: This study offers decision-makers in healthcare operational settings empirical evidence of the operational and strategic effectiveness of different quality improvement efforts, thus justifying investments related to the initiation and implementation of such quality improvement efforts.

Originality/value: This study represents an important step toward understanding the effective implementation of quality improvement initiatives in different operational settings.

Purpose: The primary purpose of this study is to undertake a diagnostic investigation of the international health care logistical environment and determine whether regulatory policies or industry procedures have hindered the implementation of just-in-time (JIT) systems and then to recommend operational improvements to be achieved by implementing JIT Systems.

Design/methodology/approach: The analysis was conducted in a systematic manner and compared the anticipated benefits with benefits validated in other industries from the implementation of JIT. An extensive literature review was conducted.

Findings: In this particular study the cost and benefit outcomes achieved from a health care JIT implementation were compared with those achieved by the manufacturing, service, and retail industries. Chiefly, it was found that the health service market must be restructured to encourage greater price competition among priorities. A new standardization process should eliminate duplication of products and realize substantial savings.

Originality/value: The analysis was conducted in a systematic manner and compared the anticipated benefits with benefits validated in other industries from the implementation of JIT.

Purpose: This article aims to explore the relationship between technology and quality management for enhancing Thai hospital service quality.

Design/methodology/approach: The paper presents the findings of an exploratory study that investigates service quality from the customer and service provider perception. In-depth interviews were conducted with respondents in Thai hospitals. The interviews explored service-related factors that patients and service providers perceive to be important for hospital services. The first interview group consisted of professionals as internal customers in direct contact with external customers, while the second group consisted of external customers of the same hospitals.

Findings: The study's outcomes clearly suggest factors that make significant contribution to service quality. These factors can be categorized according to five SERVQUAL dimensions (reliability, responsiveness, assurance, empathy, and tangibility), although some factors required slightly different interpretation.

Originality/value: The findings suggest that hospitals can develop an appropriate approach to their advantage, which can yield sustainable improvement in service quality as perceived by patients and professionals. Hospitals can make better quality decisions based on structured measurement and knowledge. It is recommended that managers apply this knowledge for successful implementation of activities related to service quality in their organizations.

Purpose: There are many examples of consumer involvement in NHS research but few studies have examined the impact of this on service development or the research process. This study, involving service user and carer researchers working alongside professional researchers, aimed to examine the development of one service user and carer research group in a mental health Trust. DERSIGN/METHODOLOGY/APPROACH: The research involved a review of existing literature on consumer involvement in research, a review of user involvement in research in South West Yorkshire Mental Health NHS Trust, a survey of consumers and NHS staff in the Trust, and a skills audit and training needs analysis of consumers.

Findings: The study identified the range and extent of consumer involvement and the impact of this on consumers and the Trust. Service users and carers were involved in a range of projects, mainly on the level of consultation or collaboration. The benefits for consumers were principally on a personal level and included gaining knowledge and experience, improved sense of well-being, self esteem, and confidence. The benefit for the Trust was in having a service user perspective and focus. However, there is a tendency to omit service users from planning and setting priorities.

Practical implications: The study pointed to the need to build the evidence base on consumer involvement in research, particularly in terms of how consumers can impact on setting research priorities and selecting appropriate methods. It identifies the need for more training for consumers and for NHS staff and for a more coherent strategy.

Originality/value: This article will be of value to anyone who is at the start or in the early stages of their journey of consumer involvement. It identifies some of the practical issues faced by consumers and staff in working collaboratively, but also points to the benefits for all the stakeholders.

Purpose: The issues surrounding the measurement and provision of service quality in a health care setting are becoming increasingly important to nursing. This research study aims to apply the SERVQUAL measurement instrument in a Scottish colposcopy clinic.

Design/methodology/approach: The study involved adapting the SERVQUAL instrument to the colposcopy setting and asking a sample of patients to complete the questionnaire. Patient expectations of service were obtained on first attendance at the clinic. Patient perceptions of service received were obtained on completion of treatment. Perceptions and expectations are then compared to identify where the largest service gaps exist.

Findings: Although patient satisfaction with the overall service provided was generally high, the instrument provided evidence of where specific service improvements were needed. The largest service quality gap was for the reliability of service. The research also revealed the need for improved premises.

Research limitations/implications: Although the study has a limited sample size, it does appear that the SERVQUAL instrument has a useful diagnostic role to play in assessing and monitoring service quality in nursing, enabling nursing staff to identify where improvements are needed from the patients' perspective. The study has raised a number of issues which would form the basis for useful further research.

Practical implications: Service quality from the patients' perspective should be routinely monitored and assessed.

Originality/value: The findings should be useful to nursing staff seeking to assess, and improve, service quality.