Controlling healthcare associated infections (HAI) and the role of facilities management in achieving “quality” in healthcare: a three‐dimensional view

Prioritizing enablers for service quality in healthcare sector - a DEMATEL approach

PURPOSE

The Healthcare sector is one of the important sectors of the Service Industry. It is believed that in this sector, the customer server relationship is very critical, and even the slightest gap in the people quality may have a huge impact on the delivered service quality. Some of these enablers are doctors, nursing staff and support staff. Furthermore, the nonpeople quality enablers such as diagnostic services, facilities, hygiene levels and so on are also likely to impact the delivered service quality. It was also felt that the degree of impact each enabler has on the service quality could vary. Therefore there is a need for structured and deep analysis. The paper attempts to identify, analyze and prioritize the enablers that impact the delivered service quality.

DESIGN/METHODOLOGY/APPROACH

The enablers have been identified through literature review and inputs from experts in the healthcare fraternity. The authors have explored different decision-making tools such as analytic hierarchy process (AHP), analytic network process (ANP), stepwise weight assessment ratio analysis, Hybrid Model and DEMATEL (Decision-Making Trial and Evaluation Laboratory) for the analysis of data in this paper. Based on the strengths of the approach and careful considerations by focus group discussions, DEMATEL was chosen as the best option. It is simple, unique, sparingly used in the healthcare sector, effective in prioritizing and gives meaningful insights on importance, cause and effect factors. DEMATEL approach converts the complex problem with interrelated factors into a clear structure that makes simple interrelationships among factors in the form of cause and effects digraph, and hence, the authors chose to use it. A case study in one of the hospitals has also been conducted to demonstrate the applicability of the developed index. The case study very strongly validates the developed index.

FINDINGS

This research paper has found that there are people quality enablers such as the doctor, nursing staff, support staff and nonpeople quality enablers such as facilities, diagnostic services and hygiene levels maintenance, which impact the delivered service quality. It also concludes that the delivered service quality depends not only on the quality but also on the availability of these enablers. The inputs received from the experts have been run through the DEMATEL methodology and importance computed for each. The top five priority enablers are Quality of Doctor, Availability of Doctor, Quality of Support Staff, Quality of Nursing Staff and Availability of Support Staff.

RESEARCH LIMITATIONS/IMPLICATIONS

The weights of the enablers have been obtained using the DEMATEL tool. These weights have been calculated using the inputs from 22 experts, which meets the statistical requirement (Skulmoski, 2007). However, a larger group of experts can be reached, and based on the inputs received from them, the tool can be revalidated for repeatability and reproducibility. Using Fuzzy DEMATEL can also be explored for further analysis.

PRACTICAL IMPLICATIONS

The proposed framework to assess the service quality level of a healthcare organization is based on a sound approach of DEMATEL. The service index arrived, thereafter, can be used to rate the delivered service quality by any healthcare organization. It can be used to compare the similar type of healthcare organizations across locations. This Index can facilitate improvements in the healthcare organization through internal and external benchmarking. It also helps the organization to know the gaps, understand the root cause, improve upon them and become the best in class. This Index uses the inputs from the end customers to calculate the rating, which makes it more reliable and accurate. The overall scores obtained from the Index can provide the ranking to the healthcare providing organizations and options to customers to choose from best. The service quality index can be used by an organization to continuously monitor their delivered service quality scores and improve them to become the best in class. The research paper highlights the significant role played by the people quality and its strong impact/contribution on the delivered service quality. Hence, it is believed that it will encourage the healthcare organizations to prioritize the improvement and upgrade of the people quality over the nonpeople quality aspect.

ORIGINALITY/VALUE

Putting people and nonpeople quality enablers in one single model and assigning weights to them using the DEMATEL approach is a new application in healthcare. Developing an Index to measure the delivered service quality in the healthcare sector is also different and new.

Factors Impacting Patients' Willingness to Recommend: A Structural Equation Modeling Approach

Patient ratings of inpatient stay have been the focus of prior research since better patient satisfaction results in a financial benefit to hospitals and are associated with better patient health care outcomes. However, studies that simultaneously account for within- and between-hospital effects are uncommon. We constructed a multilevel structural equation model to identify predictors of patients’ willingness to recommend a hospital at both within-hospital and between-hospital levels. We used data from 60 U.S. general medical and surgical hospitals and 12,115 patients. Multilevel structural equation modeling reported that patient ratings on the overall quality of care significantly affect the willingness to recommend within hospitals. Also, patients’ perspectives on the hospital environment and nursing are the significant factors that predict the patient ratings on the overall quality of care. Overall patient satisfaction significantly predicts the willingness to recommend at the between-hospital level, whereas hospital size and location have marginal impacts.

Influence of Chinese geomancy on facilities operations and maintenance (FOM)

Purpose

There have recently been an increasing number of scientific studies exploring the effectiveness of practising Chinese geomancy or feng shui in the built environment. However, these are rather generic studies focusing mainly on urban planning, architecture and interior design. The impetus for this present research stems from the lack of understanding relating to the practice of feng shui in Facilities Management (FM). Bridging these two disciplines, this study examines the relevance of and relationship between feng shui and FM principles.

Design/methodology/approach

A questionnaire survey was conducted, the results of which affirm the validity of the assimilated relationships between the two disciplines. Interviews with three groups of experts – the feng shui practitioners, facilities managers and feng shui practitioners who are also building professionals – were also conducted to verify the assimilation of the two disciplines with a view to draw new perspectives for better understanding.

Findings

The principles of feng shui and FM were studied, and the validity of the relationships between 15 feng shui principles and three FM activities were examined. The latter relates specifically to building fabric cleaning, routine external site/lot cleaning and road and pavement cleaning. It was found that specific feng shui principles and scenarios appear to influence the three FM activities. The statistical analysis shows that the means of specific feng shui scenarios in relation to FM activities were consistently higher than those of the feng shui principles. The one-sample t-test indicates that all the feng shui principles were significant in affecting the three FM activities.

Research limitations/implications

This study provides a better understanding of the relevance of feng shui principles influencing FM principles. It also revealed the challenges and limitations in bridging the relationships between these two disciplines.

Originality/value

This study is the first investigation to examine the relevance and relationship between feng shui and FM practice. This serves to encourage further research to determine how feng shui design implementation will affect the ease of conducting FM activities. If the relationship is established, as is the case from this study, then the implementation of feng shui principles in building design can be encouraged to positively influence the ease of conducting FM activities downstream in the occupancy stage. This can serve to contribute to the improvement of sustainable building design. It can also contribute to the scientific investigation of feng shui, which has so far been largely overlooked in built environment studies. Such studies can help to demystify and provide logical and scientific interpretations of how feng shui principles actually work.

Reducing the risk of healthcare-associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy)

RATIONALE, AIMS, AND OBJECTIVES

Lean Six Sigma (LSS) has been recognized as an effective management tool for improving healthcare performance. Here, LSS was adopted to reduce the risk of healthcare-associated infections (HAIs), a critical quality parameter in the healthcare sector.

METHODS

Lean Six Sigma was applied to the areas of clinical medicine (including general medicine, pulmonology, oncology, nephrology, cardiology, neurology, gastroenterology, rheumatology, and diabetology), and data regarding HAIs were collected for 28,000 patients hospitalized between January 2011 and December 2016. Following the LSS define, measure, analyse, improve, and control cycle, the factors influencing the risk of HAI were identified by using typical LSS tools (statistical analyses, brainstorming sessions, and cause-effect diagrams). Finally, corrective measures to prevent HAIs were implemented and monitored for 1 year after implementation.

RESULTS

Lean Six Sigma proved to be a useful tool for identifying variables affecting the risk of HAIs and implementing corrective actions to improve the performance of the care process. A reduction in the number of patients colonized by sentinel bacteria was achieved after the improvement phase.

CONCLUSIONS

The implementation of an LSS approach could significantly decrease the percentage of patients with HAIs.

Organising in-house cleaning services in public FM

Purpose

This paper aims to describe and discuss in-house cleaning services in local authorities to gain a better understanding of current practices. These descriptions are intended to increase researchers’, practitioners’ and educators’ understanding of the studied issue, as there at present does not exist a solid understanding of in-house cleaning services in local authorities. Previous studies provide little detailed information regarding the internal environment of facility management (FM) organisations, in particular with regard to FM organisations’ individual services.

Design/methodology/approach

This research is based on two descriptive case studies, one from Norway and one from the UK. The case studies are based on semi-structured, face-to-face in-depth interviews and document reviews.

Findings

The cases demonstrate that in-house cleaning services can be structured and managed in different ways, particularly with respect to the split in services, the management of staff and customer contracts, the span of control, the chain of command, self-managed leadership, cleaners’ hours of duty and the use of outsourcing.

Research limitations/implications

Although the previous research on particular FM services is limited, this paper’s detailed descriptions may stimulate further development and research within the field. The knowledge brought forward is part of bridging a knowledge gap on cleaning in FM research. This knowledge can contribute to advancements in the way this service is discussed and measured across contexts by encouraging more rigour and specific studies on cleaning.

Originality/value

This paper constitutes one of the first detailed descriptions of in-house cleaning organisation in local authorities. This is a type of service supply that is common in certain contexts and identified as beneficial to cost-saving in other contexts.

Performance measurement tool (PMT) to control maintenance-associated infections

Purpose

Healthcare maintenance (HM) services have an important role in the control of hospital-acquired infections (HAIs). Notwithstanding, many HM managers still do not measure the performance of HM services in infection control (IC). This research, therefore, aims to establish the level of importance of critical success factors (CSFs) and performance measures in HM IC. A performance measurement tool (PMT) was also developed to improve the performance of the HM unit in IC.

Design/methodology/approach

The CSFs and performance measures identified in the literature were categorised into the four perspectives of balanced scorecard and analysed through Delphi. The Delphi participants were presented with 67 performance measures and asked to rate their level of importance in HM in IC. In total, they identified 53 important performance measures to control maintenance-associated HAIs. The results obtained from the Delphi study were used to categorise the performance measures into four means zones. The mean zones were assigned weights (1-4), and the level of importance of the CSFs was established through weighted average. Liaison and communication, IC practices and maintenance resource availability emerged as the most important CSFs in HM in IC. Conversely, customer satisfaction emerged as the least important. Information gathered about the CSFs and performance measures was used to develop a PMT in HM in IC.

Findings

The following CSFs, liaison and communication, IC practices and maintenance resource availability, emerged as the most important in HM in IC. Conversely, customer satisfaction emerged as the least important. Information gathered about the CSFs and performance measures was used to develop a PMT in HM in IC.

Originality/value

Through the application of the PMT, performance in IC can be estimated at different levels in the HM unit. The PMT allows managers to focus on the most crucial CSFs and performance measures that drive performance in HM in IC. The PMT could also be used for benchmarking purposes.

Knowledge Management for Healthcare: Investigating Practices that Drive Performance

Knowledge management (KM) is considered an important intervention in improving health care services. KM facilitates the transfer of existing knowledge and the development of new knowledge in hospitals. This research focuses on investigating the relationship between KM practices and performance in selected hospitals in Kuwait, exemplified by perceived productivity and quality. Survey data were collected from 277 doctors working in public and private hospitals in Kuwait. As predicted by previous studies, the doctors who responded to this research perceived good KM practices to have positive correlations with the productivity and quality of hospitals. Multiple regression analysis demonstrated a significant predictive power of knowledge capturing practices in predicting productivity and quality of hospitals. Knowledge sharing practices showed no significant predictive power in the model, and knowledge generating practices showed a slight prediction power.

A critical study of quality parameters in health care establishment: developing an integrated quality model

PURPOSE

The purpose of this article is to identify and critically analyze healthcare establishment (HCE) quality parameters described in the literature. It aims to propose an integrated quality model that includes technical quality and associated supportive quality parameters to achieve optimum patient satisfaction.

DESIGN/METHODOLOGY/APPROACH

The authors use an extensive in-depth healthcare quality literature review, discerning gaps via a critical analysis in relation to their overall impact on patient management, while identifying an integrated quality model acceptable to hospital staff.

FINDINGS

The article provides insights into contemporary HCE quality parameters by critically analyzing relevant literature. It also evolves and proposes an integrated HCE-quality model.

RESEARCH LIMITATIONS/IMPLICATIONS

Owing to HCE confidentiality, especially regarding patient data, information cannot be accessed.

PRACTICAL IMPLICATIONS

The integrated quality model parameters have practical utility for healthcare service managers. However, further studies may be required to refine and integrate newer parameters to ensure continuous quality improvement.

ORIGINALITY/VALUE

This article adds a new perspective to understanding quality parameters and suggests an integrated quality model that has practical value for maintaining HCE service quality to benefit many stakeholders.