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Hoogestraat F, Wild EM, Winter V. Factors driving differences in the adoption of quality management practices among hospitals: A two-phase, sequential mixed-methods analysis. Health Care Manage Rev 2024; 49:161-175. [PMID: 38709000 DOI: 10.1097/hmr.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Although all hospitals aim to deliver high-quality care, there is considerable variation in their adoption of quality management (QM) practices. Organizational and environmental factors are known to drive strategic decision-making in hospitals, but their impact on the adoption of QM practices remains unclear. PURPOSE Our study aims to identify multiple organizational and environmental factors that explain variation in the adoption of QM practices among hospitals and to explore mechanisms underlying these relationships. METHODOLOGY We conducted a two-phase, sequential mixed-methods study of German acute care hospitals. The quantitative phase used between-effects regressions to identify factors explaining variation in the number of QM practices adopted by hospitals from 2015 to 2019. The qualitative phase used semistructured interviews with quality managers to gain in-depth insights. RESULTS The number of QM practices adopted by a hospital was significantly associated with factors like hospital size and the presence of an emergency department or QM steering committee. Our qualitative findings highlighted potential mechanisms such as the presence of an emergency department serving as a proxy for organizational complexity or urgency of case-mix. CONCLUSION We provide an overview of factors driving QM adoption in hospitals, extending beyond the focus on single factors in previous research. Future studies could explore additional factors highlighted by our interviewees. PRACTICE IMPLICATIONS Our results can inform interventions to strengthen QM in hospitals and guide future research on this topic.
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Martin J, Khurshid Z, Moore G, Carton M, Fitzsimons JJ, Henry C, Flynn MA. Applying a new approach to the governance of healthcare quality at board level. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2023. [DOI: 10.1108/ijhg-10-2022-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PurposeThis paper describes a quality improvement project to improve oversight of quality at national board level using statistical process control (SPC) methods, complimented by a qualitative experience of patients and frontline staff. It demonstrates the application of the “Picture-Understanding-Action” approach and shares the lessons learnt.Design/methodology/approachUsing co-design and applying the “Picture-Understanding-Action” approach, the project team supported the directors of the Irish health system to identify and test a qualitative and quantitative picture of the quality of care across the health system. A “Quality Profile” consisting of quantitative indicators, analysed using SPC methods was used to provide an overview of the “critical few” indicators across health and social care. Patient and front-line staff experiences added depth and context to the data. These methods were tested and evolved over the course of six meetings, leading to quality of care being prioritised and interrogated at board level.FindingsThis project resulted in the integration of quality as a substantive and prioritised agenda item. Using best practice SPC methods with associated training produced better understanding of performance of the system. In addition, bringing patient and staff experiences of quality to the forefront “people-ised” the data.Originality/valueThe application of the “Picture-Understanding-Action” approach facilitated the development of a co-designed quality agenda item. This is a novel process that shifted the focus from “providing” information to co-designing fit-for-purpose information at board level.
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Hesselink G, Verhage R, Hoiting O, Verweij E, Janssen I, Westerhof B, Ambaum G, van der Horst ICC, de Jong P, Postma N, van der Hoeven JG, Zegers M. Time spent on documenting quality indicator data and associations between the perceived burden of documenting these data and joy in work among professionals in intensive care units in the Netherlands: a multicentre cross-sectional survey. BMJ Open 2023; 13:e062939. [PMID: 36878656 PMCID: PMC9990602 DOI: 10.1136/bmjopen-2022-062939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES The number of indicators used to monitor and improve the quality of care is debatable and may influence professionals' joy in work. We aimed to assess intensive care unit (ICU) professionals' perceived burden of documenting quality indicator data and its association with joy in work. DESIGN Cross-sectional survey. SETTING ICUs of eight hospitals in the Netherlands. PARTICIPANTS Health professionals (ie, medical specialists, residents and nurses) working in the ICU. MEASUREMENTS The survey included reported time spent on documenting quality indicator data and validated measures for documentation burden (ie, such documentation being unreasonable and unnecessary) and elements of joy in work (ie, intrinsic and extrinsic motivation, autonomy, relatedness and competence). Multivariable regression analysis was performed for each element of joy in work as a separate outcome. RESULTS In total, 448 ICU professionals responded to the survey (65% response rate). The overall median time spent on documenting quality data per working day is 60 min (IQR 30-90). Nurses spend more time documenting these data than physicians (medians of 60 min vs 35 min, p<0.01). Most professionals (n=259, 66%) often perceive such documentation tasks as unnecessary and a minority (n=71, 18%) perceive them as unreasonable. No associations between documentation burden and measures of joy in work were found, except for the negative association between unnecessary documentations and sense of autonomy (β=-0.11, 95% CI -0.21 to -0.01, p=0.03). CONCLUSIONS Dutch ICU professionals spend substantial time on documenting quality indicator data they often regard as unnecessary. Despite the lacking necessity, documentation burden had limited impact on joy in work. Future research should focus on which aspects of work are affected by documentation burden and whether diminishing the burden improves joy in work.
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Affiliation(s)
- Gijs Hesselink
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Rutger Verhage
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Oscar Hoiting
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Eva Verweij
- Department of Intensive Care Medicine, Bernhoven Hospital, Uden, The Netherlands
| | - Inge Janssen
- Department of Intensive Care Medicine, Maas Hospital Pantein, Boxmeer, The Netherlands
| | - Brigitte Westerhof
- Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Gilian Ambaum
- Department of Intensive Care Medicine, Rivierenland Hospital, Tiel, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
| | - Paul de Jong
- Department of Intensive Care Medicine, Slingeland Hospital, Doetinchem, The Netherlands
| | - Nynke Postma
- Department of Intensive Care Medicine, Streekziekenhuis koningin Beatrix, Winterswijk, The Netherlands
| | - Johannes G van der Hoeven
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke Zegers
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Gauld R, Horsburgh S. Did healthcare professional perspectives on the quality and safety environment in New Zealand public hospitals change from 2012 to 2017? J Health Organ Manag 2021; 34:775-788. [PMID: 32979044 DOI: 10.1108/jhom-11-2019-0331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The work environment is known to influence professional attitudes toward quality and safety. This study sought to measure these attitudes amongst health professionals working in New Zealand District Health Boards (DHBs), initially in 2012 and again in 2017. DESIGN/METHODOLOGY/APPROACH Three questions were included in a national New Zealand health professional workforce survey conducted in 2012 and again in 2017. All registered health professionals employed with DHBs were invited to participate in an online survey. Areas of interest included teamwork amongst professionals; involvement of patients and families in efforts to improve patient care and ease of speaking up when a problem with patient care is perceived. FINDINGS In 2012, 57% of respondents (58% in 2017) agreed health professionals worked as a team; 71% respondents (73% in 2017) agreed health professionals involved patients and families in efforts to improve patient care and 69% (65% in 2017) agreed it was easy to speak up in their clinical area, with none of these changes being statistically significant. There were some response differences by respondent characteristics. PRACTICAL IMPLICATIONS With no change over time, there is a demand for improvement. Also for leadership in policy, management and amongst health professionals if goals of improving quality and safety are to be delivered upon. ORIGINALITY/VALUE This study provides a simple three-question method of probing perceptions of quality and safety and an important set of insights into progress in New Zealand DHBs.
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Affiliation(s)
- Robin Gauld
- Dean's Office and Centre for Health Systems and Technology, School of Business, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Preventive and Social Medicine and Centre for Health Systems and Technology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Fayed AMS, Elshoura SMY, Mosallam RA. Governance structures and practices in for-profit and not-for profit hospitals in Egypt. Int J Health Plann Manage 2021; 36:1069-1080. [PMID: 33763915 DOI: 10.1002/hpm.3152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/15/2021] [Accepted: 03/02/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Governance is a system that ensures and promotes accountability and responsibility toward stakeholders. The present study aims to compare the governance structures and practices in for-profit and non-for profit hospitals in Alexandria, Egypt. METHODS The study is a descriptive cross sectional study in which Chief Executive officers (CEOs) in all hospitals in Alexandria Governorate were interviewed. A predesigned questionnaire was used in the interview that is composed of four section. The first section explored characteristics of study hospitals. The second section assessed the composition and the characteristics of boards. The third section assessed the functions of the board and the fourth section assessed boards' training and evaluation. RESULTS A centralized board existed in the Health Insurance, Ministry of Health and Population and University hospitals. As for private hospitals, board existed in only 72 hospitals (82.75 %). Almost all boards have CEO duality. Board members were as few as two members in some boards and up to twenty members in others. Some hospital boards did not have an orientation manual or program. CONCLUSION A proportion of study hospitals does not have a governing board. For the hospitals with governing boards, there were wide variation in governance structures and practices.
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Affiliation(s)
- AbdAlrahman Magdy Said Fayed
- Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, Alexandria Governorate, Egypt
| | - Shymaa Mahmoud Youssef Elshoura
- Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, Alexandria Governorate, Egypt
| | - Rasha Ali Mosallam
- Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, Alexandria Governorate, Egypt
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Pfaff H, Hammer A, Ballester M, Schubin K, Swora M, Sunol R. Social determinants of the impact of hospital management boards on quality management: a study of 109 European hospitals using a parsonian approach. BMC Health Serv Res 2021; 21:70. [PMID: 33468129 PMCID: PMC7814745 DOI: 10.1186/s12913-020-06053-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background The consolidated framework for implementation research states that personal leadership matters in quality management implementation. However, it remains to be answered which characteristics of plural leadership in hospital management boards make them impactful. The present study focuses on social determinants of implementation power of hospital boards using Talcott Parsons’ sociological concept of adaptation, goal attainment, integration, and latency (AGIL), focusing on the G (goal attainment) and I (integration) factors of this concept. The study aims to test the hypothesis that hospitals with management boards that are oriented toward the quality goal (G) and socially integrated (I) (GI boards) are better at implementing quality management than hospitals with boards lacking these characteristics (non-GI boards). Methods A cross-sectional mixed-method design was used for data collection in 109 randomly selected hospitals in seven European countries. Data is based on the study “Deepening our understanding of quality improvement in Europe” (DUQUE). We used responses from (a) hospitals’ chief executive officers to measure the variable social integration and the variable quality orientation of the board and (b) responses from quality managers to measure the degree of implementation of the quality management system. We developed the GI index measuring the combination of goal-orientation and integration. A multiple linear regression analysis was performed. Results Hospitals with management boards that are quality oriented and socially integrated (GI boards) had significantly higher scores on the quality management system index than hospitals with boards scoring low on these features, when controlled for several context factors. Conclusions Our findings suggest that the implementation power of hospital management boards is higher if there is a sense of unity and purpose within the boards. Thus, to improve quality management, it could be worthwhile to increase boards’ social capital and to increase time designated for quality management in board meetings.
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Affiliation(s)
- Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany.
| | - Antje Hammer
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), Universitat Autònoma de Barcelona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Kristina Schubin
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Michael Swora
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Universitat Autònoma de Barcelona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
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Georgiou MK, Merkouris A, Hadjibalassi M, Sarafis P. Contribution of Healthcare Professionals in Issues that Relate to Quality Management. Mater Sociomed 2021; 33:45-50. [PMID: 34012350 PMCID: PMC8116097 DOI: 10.5455/msm.2021.33.45-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The health sector should adopt integrated quality systems because of the need to survive and develop in a highly competitive environment. Inefficiency of mechanistic procedures, along with inadequate administrative infrastructure, impose innovative appoaches to improve operations and increase revenues by reducing quality feilures. Objective: A health system that relies on quality healthcare services can directly benefit the entire society, may reduce mortality, disease severity, and increase life expectancy. The following literature review constitutes an attempt to assess the contribution of healthcare professionals in issues that relate to quality management over the course of recent years. Methods: This systematic review took place between May 2019 and June 2020 in the databases PubMed, Cochrane Library, Wiley Online Library, Web of Science, Google Scholar and Scopus search engine databases. Study Selection and Data Extraction: This review includes articles written in English language, which contain quantitative and qualitative analysis of healthcare professionals’ involvement in quality activities. Correspondingly, the exclusion criteria were: languages other than English, secondary surveys (general and systematic reviews or post-analyses), letters to the publisher, and editorials or articles that did not illuminate the subject under study. After an extensive literature review, a standardised Excel spreadsheet was developed for data extraction from the included studies. The main characteristics of the studies were recorded (author’s name, place and time of work, the article under study and the methodology) so that all research articles corresponding to the review could be included. 31 articles were included. Results: Healthcare professionals are engaged in quality improvement activities and there is high association between quality management strategies and clinical processes. A systematic approach on healthcare activities based on the input of healthcare professionals can help increase business performance, reduce errors, improve patient safety, and contribute to a more proactive care. Conclusion: Health professionals’ contribution in the strategic planning of healthcare organisations that address quality activities can lead to better output, both in patient satisfaction and safety.
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Affiliation(s)
- Mary Kyriacou Georgiou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Cyprus
| | - Anastasios Merkouris
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Cyprus
| | - Maria Hadjibalassi
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Cyprus
| | - Pavlos Sarafis
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Cyprus
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Braithwaite J, Clay-Williams R, Taylor N, Ting HP, Winata T, Hogden E, Li Z, Selwood A, Warwick M, Hibbert P, Arnolda G. Deepening our Understanding of Quality in Australia (DUQuA): An overview of a nation-wide, multi-level analysis of relationships between quality management systems and patient factors in 32 hospitals. Int J Qual Health Care 2020; 32:8-21. [PMID: 31725882 DOI: 10.1093/intqhc/mzz103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/19/2019] [Accepted: 09/12/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The Deepening our Understanding of Quality in Australia (DUQuA) project is a multisite, multi-level, cross-sectional study of 32 of the largest hospitals in Australia. This overview examines relationships between (i) organization-level quality management systems and department-level quality management strategies and (ii) patient-level measures (clinical treatment processes, patient-reported perceptions of care and clinical outcomes) within Australian hospitals. DESIGN We examined hospital quality improvement structures, processes and outcomes, collecting data at organization, department and patient levels for acute myocardial infarction (AMI), hip fracture and stroke. Data sources included surveys of quality managers, clinicians and patients, hospital visits, medical record reviews and national databases. Outcomes data and patient admissions data were analysed. Relationships between measures were evaluated using multi-level models. We based the methods on the Deepening our Understanding of Quality Improvement in Europe (DUQuE) framework, extending that work in parts and customizing the design to Australian circumstances. SETTING, PARTICIPANTS AND OUTCOME MEASURES The 32 hospitals, containing 119 participating departments, provided wide representation across metropolitan, inner and outer regional Australia. We obtained 31 quality management, 1334 clinician and 857 patient questionnaires, and conducted 2401 medical record reviews and 151 external assessments. External data via a secondary source comprised 14 460 index patient admissions across 14 031 individual patients. Associations between hospital, Emergency Department (ED) and department-level systems and strategies and five patient-level outcomes were assessed: 19 of 165 associations (11.5%) were statistically significant, 12 of 79 positive associations (15.2%) and 7 of 85 negative associations (8.2%). RESULTS We did not find clear relationships between hospital-level quality management systems, ED or department quality strategies and patient-level outcomes. ED-level clinical reviews were related to adherence to clinical practice guidelines for AMI, hip fracture and stroke, but in different directions. The results, when considered alongside the DUQuE results, are suggestive that front line interventions may be more influential than department-level interventions when shaping quality of care and that multi-pronged strategies are needed. Benchmark reports were sent to each participating hospital, stimulating targeted quality improvement activities. CONCLUSIONS We found no compelling relationships between the way care is organized and the quality of care across three targeted patient-level outcome conditions. The study was cross-sectional, and thus we recommend that the relationships studied should be assessed for changes across time. Tracking care longitudinally so that quality improvement activities are monitored and fed back to participants is an important initiative that should be given priority as health systems strive to develop their capacity for quality improvement over time.
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Affiliation(s)
- Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Emily Hogden
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia
| | - Zhicheng Li
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Amanda Selwood
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Meagan Warwick
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia.,Australian Centre for Precision Health, Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, 101 Currie Street, Adelaide, SA 5000, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
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De Regge M, Eeckloo K. Balancing hospital governance: A systematic review of 15 years of empirical research. Soc Sci Med 2020; 262:113252. [PMID: 32771874 DOI: 10.1016/j.socscimed.2020.113252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/24/2020] [Accepted: 07/22/2020] [Indexed: 01/23/2023]
Abstract
It is crucial that we gain a deeper understanding of the features of organizational governance and how they contribute to hospital performance. Health care governance research has traditionally had a strong focus on the size and composition (i.e., the attributes) of the governing bodies, but less attention has been given to the dynamics, processes, and roles. Furthermore, evidence regarding the interconnection between the board and the executive management is lacking. This systematic literature review is thus intended to give a detailed summary of the attributes, the dynamics, and the processes, as well as the roles of governing bodies, by synthesizing the findings of published empirical studies. The framework of Kane et al. (2009) was used to position the results, taking into account external constraints and outputs/performance. Sixty-three studies were included in the systematic review. The majority of these studies deal with attributes (n = 34) and roles (n = 27); the smallest number of studies (n = 11) focus on dynamics and processes. There is a lack of consistency in the research findings on attributes and there is too little research into the dynamics and processes of hospital governance. However, it has been shown that clinical participation on the hospital board and the focus on quality in hospital board roles can have a beneficial effect. The studies do not provide sufficient direction on what best practice for governing hospitals should be. For this reason, we here provide a useful framework for understanding the aspects of governance and their impact on performance in hospitals and compare these with general corporate governance literature. Therefrom we propose avenues for further research.
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Affiliation(s)
- Melissa De Regge
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Marketing, Innovation and Organisation, Faculty of Economics and Business Administration, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium.
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel heymanslaan 10, 9000, Ghent, Belgium.
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Yıldız MS, Öztürk Z, Topal M, Khan MM. Effect of accreditation and certification on the quality management system: Analysis based on Turkish hospitals. Int J Health Plann Manage 2019; 34:e1675-e1687. [DOI: 10.1002/hpm.2880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Zekai Öztürk
- Sağlık Yönetimi Bölümü, İktisadi ve İdari Bilimler Fakültesi Hacı Bayram Veli Üniversitesi Ankara Turkey
| | - Mehmet Topal
- Tıp Fakültesi Kastamonu Üniversitesi Ankara Turkey
| | - M. Mahmud Khan
- Department of Health Services Policy and Management University of South Carolina Columbia South Carolina USA
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Carrasco-Peralta JA, Herrera-Usagre M, Reyes-Alcázar V, Torres-Olivera A. Healthcare accreditation as trigger of organisational change: The view of professionals. J Healthc Qual Res 2019; 34:59-65. [PMID: 30713136 DOI: 10.1016/j.jhqr.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Healthcare accreditation seeks to promote the organisational change in healthcare organisations from an approach that values the level of progress achieved through a validated reference framework. The aim of this paper is to analyse the role played by accreditation through the experience perceived by health professionals during the process of self-assessment and external evaluation, taking into account three dimensions of analysis: focus on the patient, internal organisation and leadership, and impact on the clinical aspects of healthcare. MATERIAL AND METHODS Design: Semi-structured interviews with key informants from clinical management units (CMU) within the Andalusian Health System (Spain). PARTICIPANTS The key informants in each CMU were the clinical leader, the head of nursing and two health professionals (doctors and nurses). A qualitative research protocol was employed to conduct the semi-structured interviews (n=52 interviews) with physicians and nurses, in order to analyse their experience with the accreditation process. RESULTS The analysis identified four main outcomes related to the accreditation process perceived by professionals: (1) A benchmarking conceptualisation of the process; (2) Improvements in patient-centred care, quality of clinical records, and organisational culture of the units; (3) Improvement of patient safety culture; (4) As negative outcomes, a slight perception of bureaucratisation and standardisation of the clinical practice. CONCLUSIONS The described initiative of accreditation process in Andalusia (Spain) is widely perceived as positive by health professionals since it fosters the organisational change, although it also has a slightly negative bureaucratisation effect on clinical practice.
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Affiliation(s)
- J A Carrasco-Peralta
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
| | - M Herrera-Usagre
- Andalusian Agency for Healthcare Quality/Pablo de Olavide University, Department of Sociology, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain.
| | - V Reyes-Alcázar
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
| | - A Torres-Olivera
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
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van Gelderen SC, Zegers M, Robben PB, Boeijen W, Westert GP, Wollersheim HC. Important factors for effective patient safety governance auditing: a questionnaire survey. BMC Health Serv Res 2018; 18:798. [PMID: 30342516 PMCID: PMC6195966 DOI: 10.1186/s12913-018-3577-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/27/2018] [Indexed: 11/29/2022] Open
Abstract
Background Audits are increasingly used for patient safety governance purposes. However, there is little insight into the factors that hinder or stimulate effective governance based on auditing. The aim of this study is to quantify the factors that influence effective auditing for hospital boards and executives. Methods A questionnaire of 32 factors was developed using influencing factors found in a qualitative study on effective auditing. Factors were divided into four categories. The questionnaire was sent to the board of directors, chief of medical staff, nursing officer, medical department head and director of the quality and safety department of 89 acute care hospitals in the Netherlands. Results We approached 522 people, of whom 211 responded. Of the 32 factors in the questionnaire, 30 factors had an agreement percentage higher than 50%. Important factors per category were ‘audit as an improvement tool as well as a control tool’, ‘department is aware of audit purpose’, ‘quality of auditors’ and ‘learning culture at department’. We found 14 factors with a significant difference in agreement between stakeholders of at least 20%. Amongst these were ‘medical specialist on the audit team’, ‘soft signals in the audit report’, ‘patients as auditors’ and ‘post-audit support’. Conclusion We found 30 factors for effective auditing, which we synthesised into eight recommendations to optimise audits. Hospitals can use these recommendations as a framework for audits that enable boards to become more in control of patient safety in their hospital. Electronic supplementary material The online version of this article (10.1186/s12913-018-3577-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saskia C van Gelderen
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Marieke Zegers
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Paul B Robben
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Wilma Boeijen
- Department of Quality and Safety, Radboud university medical center, Nijmegen, the Netherlands
| | - Gert P Westert
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Hub C Wollersheim
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
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13
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Abstract
Recent research has advanced understanding of corporate governance of healthcare quality, highlighting the need for future empirical work to develop beyond a focus on board composition to a more detailed exploration of the internal workings of governance that influence board engagement and activities. This paper proposes a conceptual framework to guide empirical research examining the work of board and senior management in governing healthcare quality. To generate this framework, existing conceptual approaches and key constructs influencing effectiveness are identified in the governance literature. Commonalities between governance and team effectiveness literature are mapped and suggest a number of key constructs in the team effectiveness literature are applicable to, but not yet fully explored, within the governance literature. From these we develop a healthcare governance conceptual framework encompassing both literatures, that outlines input and mediating factors influencing governance. The mapping process highlights gaps in research related to board dynamics and external influences that require further investigation. Organizing the multiple complex factors that influence governance of healthcare quality in a conceptual framework brings a new perspective to structuring theory-led research and informing future policy initiatives.
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14
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Lee R, Baeza JI, Fulop NJ. The use of patient feedback by hospital boards of directors: a qualitative study of two NHS hospitals in England. BMJ Qual Saf 2017; 27:103-109. [PMID: 28754814 PMCID: PMC5867437 DOI: 10.1136/bmjqs-2016-006312] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 05/11/2017] [Accepted: 06/26/2017] [Indexed: 11/24/2022]
Abstract
Background Although previous research suggests that different kinds of patient feedback are used in different ways to help improve the quality of hospital care, there have been no studies of the ways in which hospital boards of directors use feedback for this purpose. Objectives To examine whether and how boards of directors of hospitals use feedback from patients to formulate strategy and to assure and improve the quality of care. Methods We undertook an in-depth qualitative study in two acute hospital National Health Service foundation trusts in England, purposively selected as contrasting examples of the collection of different kinds of patient feedback. We collected and analysed data from interviews with directors and other managers, from observation of board meetings, and from board papers and other documents. Results The two boards used in-depth qualitative feedback and quantitative feedback from surveys in different ways to help develop strategies, set targets for quality improvement and design specific quality improvement initiatives; but both boards made less subsequent use of any kinds of feedback to monitor their strategies or explicitly to assure the quality of services. Discussion and conclusions We have identified limitations in the uses of patient feedback by hospital boards that suggest that boards should review their current practice to ensure that they use the different kinds of patient feedback that are available to them more effectively to improve, monitor and assure the quality of care.
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Affiliation(s)
- Robert Lee
- School of Management and Business, Faculty of Social Science and Public Policy, King's College London, London, UK
| | - Juan I Baeza
- School of Management and Business, Faculty of Social Science and Public Policy, King's College London, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
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15
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Manser T, Imhof M, Lessing C, Briner M. A cross-national comparison of incident reporting systems implemented in German and Swiss hospitals. Int J Qual Health Care 2017; 29:349-359. [PMID: 28340184 DOI: 10.1093/intqhc/mzx030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/22/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This study aimed to empirically compare incident reporting systems (IRS) in two European countries and to explore the relationship of IRS characteristics with context factors such as hospital characteristics and characteristics of clinical risk management (CRM). DESIGN We performed exploratory, secondary analyses of data on characteristics of IRS from nationwide surveys of CRM practices. SETTING The survey was originally sent to 2136 hospitals in Germany and Switzerland. PARTICIPANTS Persons responsible for CRM in 622 hospitals completed the survey (response rate 29%). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Differences between IRS in German and Swiss hospitals were assessed using Chi2, Fisher's Exact and Freeman-Halton-Tests, as appropriate. To explore interrelations between IRS characteristics and context factors (i.e. hospital and CRM characteristics) we computed Cramer's V. RESULTS Comparing participating hospitals across countries, Swiss hospitals had implemented IRS earlier, more frequently and more often provided introductory IRS training systematically. German hospitals had more frequently systematically implemented standardized procedures for event analyses. IRS characteristics were significantly associated with hospital characteristics such as hospital type as well as with CRM characteristics such as existence of strategic CRM objectives and of a dedicated position for central CRM coordination. CONCLUSIONS This study contributes to an improved understanding of differences in the way IRS are set up in two European countries and explores related context factors. This opens up new possibilities for empirically informed, strategic interventions to further improve dissemination of IRS and thus support hospitals in their efforts to move patient safety forward.
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Affiliation(s)
- Tanja Manser
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Michael Imhof
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | | | - Matthias Briner
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland.,Lucerne School of Business, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
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16
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Botje D, Ten Asbroek G, Plochg T, Anema H, Kringos DS, Fischer C, Wagner C, Klazinga NS. Are performance indicators used for hospital quality management: a qualitative interview study amongst health professionals and quality managers in The Netherlands. BMC Health Serv Res 2016; 16:574. [PMID: 27733194 PMCID: PMC5062914 DOI: 10.1186/s12913-016-1826-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 10/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitals are under increasing pressure to share indicator-based performance information. These indicators can also serve as a means to promote quality improvement and boost hospital performance. Our aim was to explore hospitals' use of performance indicators for internal quality management activities. METHODS We conducted a qualitative interview study among 72 health professionals and quality managers in 14 acute care hospitals in The Netherlands. Concentrating on orthopaedic and oncology departments, our goal was to gain insight into data collection and use of performance indicators for two conditions: knee and hip replacement surgery and breast cancer surgery. The semi-structured interviews were recorded and summarised. Based on the data, themes were synthesised and the analyses were executed systematically by two analysts independently. The findings were validated through comparison. RESULTS The hospitals we investigated collect data for performance indicators in different ways. Similarly, these hospitals have different ways of using such data to support their quality management, while some do not seem to use the data for this purpose at all. Factors like 'linking pin champions', pro-active quality managers and engaged medical specialists seem to make a difference. In addition, a comprehensive hospital data infrastructure with electronic patient records and robust data collection software appears to be a prerequisite to produce reliable external performance indicators for internal quality improvement. CONCLUSIONS Hospitals often fail to use performance indicators as a means to support internal quality management. Such data, then, are not used to its full potential. Hospitals are recommended to focus their human resource policy on 'linking pin champions', the engagement of professionals and a pro-active quality manager, and to invest in a comprehensive data infrastructure. Furthermore, the differences in data collection processes between Dutch hospitals make it difficult to draw comparisons between outcomes of performance indicators.
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Affiliation(s)
- Daan Botje
- Amphia Hospital, Langendijk 75, P.O. box 90157, 4800 RA, Breda, The Netherlands. .,NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
| | - Guus Ten Asbroek
- Ahti, Amsterdam Health & Technology Institute, Amsterdam, The Netherlands.,Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas Plochg
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Public Health Federation, Utrecht, The Netherlands
| | - Helen Anema
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dionne S Kringos
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Cordula Wagner
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Niek S Klazinga
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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17
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Manser T, Frings J, Heuser G, Mc Dermott F. The German clinical risk management survey for hospitals: Implementation levels and areas for improvement in 2015. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 114:28-38. [PMID: 27566267 DOI: 10.1016/j.zefq.2016.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Despite the growing recognition of the need to implement systematic approaches for managing the risks associated with healthcare, few studies have investigated the level of implementation for clinical risk management (CRM) at a national level. Therefore, this study aimed to assess the current level of CRM implementation in German hospitals and to explore differences across hospital types. METHODS From March to June 2015, persons responsible for CRM in 2,617 hospitals and rehabilitation clinics in Germany were invited to participate in a voluntary online survey assessing the level of implementation for various aspects of CRM: CRM strategy, structures and processes; risk assessment (risk identification, risk analysis, risk evaluation) with a focus on incident reporting systems; risk mitigation measures; and risk monitoring and reporting. RESULTS 572 hospitals participated in the survey (response rate 22 %). Most of these hospitals had a formalised, binding CRM strategy (72 %). 66 % had a centralised and 34 % a decentralised CRM structure. We also found that, despite a broad range of risk assessment methods being applied, there was a lack of integration of risk information from different data sources. Hospitals also reported a high level of implementation of critical incident reporting systems with a strong preference for local (74 %) over transorganisational systems. DISCUSSION AND CONCLUSION This study provides relevant data to inform targeted interventions concerning CRM implementation at a national level and to consider the specific context of different types of hospitals more carefully in this process. The approach to CRM assessment illustrated in this article could be the basis of a system for monitoring CRM over time and, thus, for evaluating the impact of strategy decisions at the policy level on CRM development.
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Affiliation(s)
- Tanja Manser
- University Hospital Bonn, Institute for Patient Safety, Bonn, Germany.
| | - Janina Frings
- University Hospital Bonn, Institute for Patient Safety, Bonn, Germany
| | - Gregory Heuser
- University Hospital Bonn, Institute for Patient Safety, Bonn, Germany
| | - Fiona Mc Dermott
- University Hospital Bonn, Institute for Patient Safety, Bonn, Germany
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18
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Rotar AM, van den Berg MJ, Kringos DS, Klazinga NS. Reporting and use of the OECD Health Care Quality Indicators at national and regional level in 15 countries. Int J Qual Health Care 2016; 28:398-404. [PMID: 26983686 DOI: 10.1093/intqhc/mzw027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 12/11/2022] Open
Abstract
QUALITY PROBLEM OR ISSUE OECD member states are involved since 2003 in a project coordinated by the OECD on Health Care Quality Indicators (HCQI). All OECD countries are biennially requested by the OECD to deliver national data on the quality indicators for international benchmarking purposes. INITIAL ASSESSMENT Currently, there is no knowledge whether the OECD HCQI information is used by the countries themselves for healthcare system accountability and improvement purposes. CHOICE OF SOLUTION The objective of the study is to explore the reporting and use of OECD HCQI in OECD member-states. IMPLEMENTATION Data were collected through a questionnaire sent to all OECD member-states containing factual questions on the reporting on all OECD HCQ-indicators. Responses were received between June and December 2014. In this timeframe, two reminders were sent to the participants. The work progress was presented during HCQI Meetings in November 2014 and May 2015. EVALUATION Fifteen countries reported to have a total of 163 reports in which one or more HCQIs were reported. One hundred and sixteen were national and 47 were regional reports. Forty-nine reports had a general system focus, 80 were disease specific, 10 referred to a specific type of care setting, 22 were thematic and 2 were a combination of two (disease specific for a particular type of care and thematic for a specific type of care). Most reports were from Canada: 49. All 15 countries use one or more OECD indicators. LESSONS LEARNED The OECD quality indicators have acquired a clear place in national and regional monitoring activities. Some indicators are reported more often than others. These differences partly reflect differences between healthcare systems. Whereas some indicators have become very common, such as cancer care indicators, others, such as mental healthcare and patient experience indicators are relatively new and require some more time to be adopted more widely.
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Affiliation(s)
- Alexandru M Rotar
- Department of Social Medicine, University of Amsterdam, Meibergdreef 9, 22660, 1100 DD, Amsterdam, The Netherlands
| | - Michael J van den Berg
- Department of Social Medicine, University of Amsterdam, Meibergdreef 9, 22660, 1100 DD, Amsterdam, The Netherlands National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Dionne S Kringos
- Department of Social Medicine, University of Amsterdam, Meibergdreef 9, 22660, 1100 DD, Amsterdam, The Netherlands
| | - Niek S Klazinga
- Department of Social Medicine, University of Amsterdam, Meibergdreef 9, 22660, 1100 DD, Amsterdam, The Netherlands
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19
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Howell AM, Burns EM, Hull L, Mayer E, Sevdalis N, Darzi A. International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process. BMJ Qual Saf 2016; 26:150-163. [PMID: 26902254 DOI: 10.1136/bmjqs-2015-004456] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 01/10/2016] [Accepted: 01/24/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patient safety incident reporting systems (PSRS) have been established for over a decade, but uncertainty remains regarding the role that they can and ought to play in quantifying healthcare-related harm and improving care. OBJECTIVE To establish international, expert consensus on the purpose of PSRS regarding monitoring and learning from incidents and developing recommendations for their future role. METHODS After a scoping review of the literature, semi-structured interviews with experts in PSRS were conducted. Based on these findings, a survey-based questionnaire was developed and subsequently completed by a larger expert panel. Using a Delphi approach, consensus was reached regarding the ideal role of PSRSs. Recommendations for best practice were devised. RESULTS Forty recommendations emerged from the Delphi procedure on the role and use of PSRS. Experts agreed reporting system should not be used as an epidemiological tool to monitor the rate of harm over time or to appraise the relative safety of hospitals. They agreed reporting is a valuable mechanism for identifying organisational safety needs. The benefit of a national system was clear with respect to medication error, device failures, hospital-acquired infections and never events as these problems often require solutions at a national level. Experts recommended training for senior healthcare professionals in incident investigation. Consensus recommendation was for hospitals to take responsibility for creating safety solutions locally that could be shared nationally. CONCLUSIONS We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally.
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Affiliation(s)
- Ann-Marie Howell
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Elaine M Burns
- Department of Biosurgery and Surgical Technology, Imperial College London, London, UK
| | - Louise Hull
- Division of Surgery, Imperial College London, London, UK
| | - Erik Mayer
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nick Sevdalis
- Department of Surgery and Cancer, Imperial College London, London, UK.,Health Service and Population Research, Centre for Implementation Science, King's College, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
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20
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Freeman T, Millar R, Mannion R, Davies H. Enacting corporate governance of healthcare safety and quality: a dramaturgy of hospital boards in England. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:233-251. [PMID: 26242565 PMCID: PMC5014173 DOI: 10.1111/1467-9566.12309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The governance of patient safety is a challenging concern for all health systems. Yet, while the role of executive boards receives increased scrutiny, the area remains theoretically and methodologically underdeveloped. Specifically, we lack a detailed understanding of the performative aspects at play: what board members say and do to discharge their accountabilities for patient safety. This article draws on qualitative data from overt non-participant observation of four NHS hospital Foundation Trust boards in England. Applying a dramaturgical framework to explore scripting, setting, staging and performance, we found important differences between case study sites in the performative dimensions of processing and interpretation of infection control data. We detail the practices associated with these differences--the legitimation of current performance, the querying of data classification, and the naming and shaming of executives--to consider their implications.
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Affiliation(s)
- Tim Freeman
- Leadership, Work and OrganisationMiddlesex UniversityUK
| | - Ross Millar
- Health Services Management CentreBirminghamUK
| | | | - Huw Davies
- School of ManagementUniversity of St. AndrewsUK
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21
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Weaver L, Bossé I, Sinclair D, Blais B, Pereira J. Making quality improvement stick and stay: Two lines of insurance. Healthc Manage Forum 2016; 29:28-32. [PMID: 26656388 DOI: 10.1177/0840470415616318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article examines issues related to sustaining Quality Improvement (QI) initiatives in a Canadian subacute care hospital and recommends strategies to address them. The authors define two levels of sustainability, the QI project and the corporate/organizational and how they influence a LEADS (Lead Self, Engage Others, Achieve Results, Develop Coalition and System Transformation) culture. The authors then reflect on the differing factors for QI sustainability and present them under five essential categories of accountability, education, communication, monitoring and reporting, and structure and processes.
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Affiliation(s)
- Lynda Weaver
- Bruyère Continuing Care, Ottawa, Ontario, Canada.
| | | | | | | | - José Pereira
- Bruyère Continuing Care, Ottawa, Ontario, Canada
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22
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Taylor N, Clay-Williams R, Hogden E, Pye V, Li Z, Groene O, Suñol R, Braithwaite J. Deepening our Understanding of Quality in Australia (DUQuA): a study protocol for a nationwide, multilevel analysis of relationships between hospital quality management systems and patient factors. BMJ Open 2015; 5:e010349. [PMID: 26644128 PMCID: PMC4679999 DOI: 10.1136/bmjopen-2015-010349] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite the growing body of research on quality and safety in healthcare, there is little evidence of the association between the way hospitals are organised for quality and patient factors, limiting our understanding of how to effect large-scale change. The 'Deepening our Understanding of Quality in Australia' (DUQuA) study aims to measure and examine relationships between (1) organisation and department-level quality management systems (QMS), clinician leadership and culture, and (2) clinical treatment processes, clinical outcomes and patient-reported perceptions of care within Australian hospitals. METHODS AND ANALYSIS The DUQuA project is a national, multilevel, cross-sectional study with data collection at organisation (hospital), department, professional and patient levels. Sample size calculations indicate a minimum of 43 hospitals are required to adequately power the study. To allow for rejection and attrition, 70 hospitals across all Australian jurisdictions that meet the inclusion criteria will be invited to participate. Participants will consist of hospital quality management professionals; clinicians; and patients with stroke, acute myocardial infarction and hip fracture. Organisation and department-level QMS, clinician leadership and culture, patient perceptions of safety, clinical treatment processes, and patient outcomes will be assessed using validated, evidence-based or consensus-based measurement tools. Data analysis will consist of simple correlations, linear and logistic regression and multilevel modelling. Multilevel modelling methods will enable identification of the amount of variation in outcomes attributed to the hospital and department levels, and the factors contributing to this variation. ETHICS AND DISSEMINATION Ethical approval has been obtained. Results will be disseminated to individual hospitals in de-identified national and international benchmarking reports with data-driven recommendations. This ground-breaking national study has the potential to influence decision-making on the implementation of quality and safety systems and processes in Australian and international hospitals.
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Affiliation(s)
- Natalie Taylor
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Emily Hogden
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Victoria Pye
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Zhicheng Li
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Oliver Groene
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rosa Suñol
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain
- Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, Barcelona, Spain
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
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23
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Rosen MA, Chima AM, Sampson JB, Jackson EV, Koka R, Marx MK, Kamara TB, Ogbuagu OU, Lee BH. Engaging staff to improve quality and safety in an austere medical environment: a case–control study in two Sierra Leonean hospitals. Int J Qual Health Care 2015; 27:320-7. [DOI: 10.1093/intqhc/mzv030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 12/14/2022] Open
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24
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Secanell M, Groene O, Arah OA, Lopez MA, Kutryba B, Pfaff H, Klazinga N, Wagner C, Kristensen S, Bartels PD, Garel P, Bruneau C, Escoval A, França M, Mora N, Suñol R. Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries. Int J Qual Health Care 2014; 26 Suppl 1:5-15. [PMID: 24671120 PMCID: PMC4001699 DOI: 10.1093/intqhc/mzu025] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction and Objective This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study. Design DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries. Setting and Participants We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30. Main outcome measures A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure). Results Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures. Conclusions This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers throughout the EU.
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Affiliation(s)
- Mariona Secanell
- Avedis Donabedian Reseach Institute, University Autonomous of Barcelona, C/Provenza 293, Pral. 08037 Barcelona, Spain.
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