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

Purpose: To review the experience of managing two patients with identical names in the same ward during a five-month period.

Design/methodology/approach: The records of the patients were reviewed to look for incorrect entries, errors in specimens sampling, administration of blood products and chemotherapy, and misplacement of clinical notes. Doctors and nurses involved were also invited to complete a questionnaire study to comment on the usefulness of the measures implemented for correct patient identification. A random sample of 60 patients was also selected to see if their full names were shared with other patients attending the same hospital.

Findings: Among the 1442 sheets of hospital records from the two patients, no errors pertaining to the clinical activities were found. However, 13 (0.9 per cent) sheets of the hospital records were misplaced. The 21 doctors and nurses participating in the questionnaire study gave positive support to all the additional measures implemented for safeguarding patient identification, of which the automated alerting feature in the electronic clinical management system received the highest scores. A total of 32 (53 per cent) of the 60 sampled patients shared a common full name with one to 101 other patients attending the same hospital.

Originality/value: Patients with identical names staying in the same ward present a unique challenge to acute health-care settings. The situation is especially relevant in communities where most people's names are not unique. Specific guidelines and measures are needed to prevent patient misidentification. Errors in filing of patient notes and laboratory reports to the hospital record deserve further attention.

Purpose: To compare patients' views on quality of care in different countries using a theory-based instrument, while at the same time controlling for the following potential confounders: type of care system (private vs public), type of care (kind of health problem), gender, age, and subjective wellbeing.

Design/methodology/approach: Patients capable of communicating in wards (medical and surgical departments) and day surgery departments in England, France, Norway, and Sweden were recruited consecutively, to participate in a programme run by the health-care company Capio. Ward patients: England (n=1236), France (n=1051), Norway (n=226), and Sweden (n=428). Day surgery patients: England (n=887), France (n=544), Norway (n=101), and Sweden (n=742). Average response rate across settings: approximately 75 per cent. Patients evaluated the quality of the care they actually received and the subjective importance they ascribed to different aspects of care. The questionnaire "Quality from the patient's perspective" (QPP) was used (modified short version).

Findings: Cross-national comparisons were made within each of the two care contexts (wards and day surgery) separately for men and women. Quality of care evaluations were adjusted for age and subjective wellbeing. English and French patients scored significantly higher than Norwegian and Swedish on both kinds of ratings (perceived reality and subjective importance), in both kinds of care contexts, and in both sexes.

Originality/value: Cross-national comparisons of patients' views on care can give meaningful guidance for practitioners only if they are context-specific and if well-known confounders are controlled for.

Purpose: To strengthen the middle manager role in a hospital quality improvement (QI) program, with a view to increasing and sustaining organisational QI implementation.

Design/methodology/approach: Case study based action research project, combining pre- and post-action quantitative and qualitative data collection, relating to a QI program intervention in an Australian metropolitan specialist teaching hospital. A model for enhancing the middle manager role in QI was developed and then implemented as the action over a 12-month period.

Findings: Middle manager understanding and ownership of the QI program and organisational QI implementation significantly increased, although their perceived enjoyment of being involved in QI decreased.

Research limitations/implications: This case-study based action research project was limited to one organisation of a specific type - a large specialist metropolitan teaching hospital. The composition of the middle manager group, therefore, is necessarily limited to particular specialties. It is acknowledged that findings from case study and action research methodologies are limited in their generalisability, but assist in the development of knowledge and principles that can be adapted to different settings.

Practical implications: This QI implementation model can increase levels of organisational QI implementation by effecting a positive change in middle manager attitude to and involvement in QI.

Originality/value: There are many theories regarding the importance of the middle manager role in QI, but little empirical research into exactly what this role may be and how it may be strengthened. This research adds to the knowledge base, and provides clear steps for achieving increased staff involvement and QI implementation.

Purpose: Business process reengineering has been touted in the literature as a dramatic improvement necessary for organization competitiveness, but in practice there are many unsuccessful cases. Thus, there is need for a more systematic and rigorous assessment of the factors deemed important to project success. The main objective of this study is to examine this issue.

Design/methodology/approach: For this research, success has been defined as the benefits the hospital has derived from the BPR project, according to top managers' opinions. A sample of 192 hospital administrators shared their organizations' experience with their last BPR project implementation, where the changes have been operational for at least one year.

Findings: Based on the results, recommendations are made for hospital managers to focus attention and resources on factors important to BPR project success. In general, hospitals are not emphasizing some of the most important activities and tasks recommended in the BPR literature, such as changes to customer/market-related business processes, the value-added element of every business activity, and applying the right innovative technology.

Originality/value: Based on the findings as a whole, it behoves top managers not to engage in BPR before ensuring the presence of the success factors found to be important.

Purpose: Given the enormous size of the health care industry, the problem of developing high-quality, cost-effective health care delivery systems is growing in importance. There is general consensus that health care systems require a continuous process of quality improvement (QI). Less agreement, however, surrounds the mechanisms to be implemented so that such a process is effective. This study aims to bring empirical evidence to support the hypothesis that a QI program in a general hospital - a special context of the health care delivery system - does not necessarily lead to better overall organizational performance results.

Design/methodology/approach: The study was done at the hospital level, and included all acute care hospitals in Israel. Data was collected in 16 of the country's 23 hospitals, a 70 percent response rate. The study compared hospital performance before and after the QI program implementation.

Findings: The study shows that QI creates meaningful improvement events. In addition, the research supports the hypothesis that increasing the number of QI activities (items) included in the QI program brings about more improvement events. The results do not support the hypothesis that high, rather than low, intensive implementation of QI activities leads to more improvement events.

Originality/value: The special context of general hospitals decreases the effects of a QI program on overall hospital performance, whereas QI activities function as triggers in initiating improvement events.

Purpose: Hidden camera television documentaries filmed in care home settings have shown evidence of the abuse of vulnerable adults, been widely discussed in the mass media and have brought the attention of the mass population to the importance of these issues. Governmental documents have also emphasised the need to protect vulnerable adults. It is therefore known that vulnerable adults exist and require protection from abuse in any shape or form. However, this paper aims to argue that protecting vulnerable adults and the current mechanisms for encouraging such individuals to make their views known to services are not mutually compatible. The main technique vulnerable adults may use, the complaints procedure, currently may not be sufficient to enable vulnerable adults to express themselves and their anxieties adequately.

Design/methodology/approach: The paper provides a case study which clearly demonstrates the nature of the problems, and then recognises and describes a number of levels which could be explored to learn more about these issues.

Research limitations/implications: Potential solutions are explored by the authors, who draw conclusions about the need for further research into this area.

Originality/value: This paper defines a gap between adult protection and complaints procedures, questioning both their efficacy and abilities to meet their stated aims. The paper also highlights that the nature of these may not sufficiently enable complaining vulnerable adults to express their views of services.

Purpose: To evaluate various designs for a quality assurance system to detect and control human errors in a national screening programme for diabetic retinopathy.

Design/methodology/approach: A computer simulation was performed of some possible ways of sampling the referral decisions made during grading and of different criteria for initiating more intensive QA investigations. The effectiveness of QA systems was assessed by the ability to detect a grader making occasional errors in referral.

Findings: Substantial QA sample sizes are needed to ensure against inappropriate failure to refer. Detection of a grader who failed to refer one in ten cases can be achieved with a probability of 0.58 using an annual sample size of 300 and 0.77 using a sample size of 500.

Originality/value: An unmasked verification of a sample of non-referrals by a specialist is the most effective method of internal QA for the diabetic retinopathy screening programme. Preferential sampling of those with some degree of disease may improve the efficiency of the system.

Purpose: To assess the relationship between quality management and employee commitment.

Design/methodology/approach: Analysis of the state of affairs with respect to (T)QM programs in The Netherlands based on the literature and interviews with key informants.

Findings: Description of an approach that tries to integrate employee commitment and quality management based on the concept of employees' psychological contracts with their organization (ideas about mutual obligations between them and their employer).

Research limitations/implications: The interviews with key informants provide limited information: the study is done in only one country. Research in a broader context and on a larger scale would give a more general overview.

Practical implications: The crucial factor in making quality management work can better be described by "quality fails when employees' psychological contracts are neglected" than by "quality fails when the system fails".

Originality/value: This paper highlights the essential relationship between quality management and employee commitment and offers suggestions on how to approach this issue.

Purpose: The objective of this paper is to present a model that uses multi-agent system (MAS) technology to assist doctors based at rural areas to receive timely expert opinions from specialist doctors working in medical institutions like the Postgraduate Institute of Medical Research, Chandigarh or the All India Institute of Medical Sciences, New Delhi.

Design/methodology/approach: A MAS is a software entity wherein agent metaphor is used to represent human-like intelligence and behavior. These agents are distributed over geographical areas and are part of software running at these sites. The foundation for this model lies in the fact that medical intelligence is distributed in nature and, if it is possible to bring this knowledge together, it could prove to be advantageous in providing improved health care to those people in rural areas. A few existing research works are included to demonstrate the usage of MAS in health care.

Findings: It has been observed that the health scenario in India is ranked poor world-wide by international organizations and, with the increasing population, this will worsen.

Research limitations/implications: Initially, the aim is to concentrate on a few medical departments only. It can be extended into more detailed framework.

Practical implications: Physical computing and networking infrastructure are required for practical implementation along with training for the doctors.

Originality/value: The primary beneficiaries of this system are likely to be those patients in the rural sector requiring expert medical opinion. The government health organizations will be able to provide quality medical facilities comparable with the medical facilities available in the developed nations. Currently this would seem to be a distant dream.

Purpose: This article aims to describe the research process, and the development of the instrument now employed in auditing patients' perceptions of quality improvement in a community health care trust in a coastal town in Essex, England.

Design/methodology/approach: The new instrument is currently being implemented and the findings thus far are described.

Findings: The instrument has measured health outcomes in terms of quality improvement from the users' perspective, and has also highlighted gaps between what the service offers in terms of quality and users' perceptions of what is delivered. The study demonstrates the importance of the professional role in quality improvement.

Originality/value: Patient-centred quality improvement audit should be undertaken regularly so that both non-clinical managers and health care professionals can establish whether or not they are providing services that are patient-friendly and effective from the user's viewpoint. In the course of their work, professionals and managers discuss patients and speak on their behalf in various forums, and knowing what patients actually expect and perceive before speaking on their behalf may be of great benefit in such instances.