Self-assessment of all the health centres of a public health service through the European Model of total quality management

Comeback workout: QM practices and the health and fitness industry

Purpose

The purpose of this paper is to provide a theoretical model for the relationship between quality management (QM) practices and the health and fitness industry through two competencies, including relational competence (RC) and technical competence (TC).

Design/methodology/approach

Drawing from the resource-based view and the relational competence theory, this paper seeks a further understanding of the conceptual link between QM practices and the health and fitness industry.

Findings

This paper proposes that RC and TC will positively mediate the relationship between QM practices and customers’ behavioral intentions to use the health and fitness service.

Research limitations/implications

This paper provides an integrated perspective to the health and fitness industry. More specifically, this paper suggests that QM practices can be applicable to customers’ behavioral intentions to use the health and fitness service. This paper also provides a solid conceptual foundation through which managers in the health and fitness industry put more effort in developing the relationship with customers. An empirical investigation might be needed for future study.

Practical implications

This paper suggests that managers and employees in the health and fitness industry need to provide a sustained and consistent effort into maintaining the interaction with customers. This paper also suggests that the use of QM practices can be related to customer perception (e.g. boosting behavioral intentions toward service providers) and can provide sustainable competitive advantage in the health and fitness industry.

Originality/value

This paper extends current understanding of QM practices and the health and fitness industry by providing a conceptual framework regarding how QM practices are related to the health and fitness industry through RC and TC.

Interrelationships among quality enablers, service quality, patients’ satisfaction and loyalty in hospitals

Purpose

The purpose of this paper is to clarify how enablers of quality management can secure the satisfaction and loyalty of patients through increasing service quality in hospitals.

Design/methodology/approach

The current study conducted a review of the existing literature to identify operational dimensions of the research variables. As a result of the review, 17 dimensions were identified; five European foundation for quality management enablers, five SERVQUAL service quality dimensions, four patients’ satisfaction elements and three patients’ loyalty components. To evaluate interrelationships among these 17 research dimensions, decision-making trial and evaluation laboratory technique was applied using experts’ opinions.

Findings

Several key relations were found among research dimensions. Research findings could provide a scientific insight for hospital managers to understand how they could increase the level of patients’ satisfaction and loyalty through high-quality services provided by quality management enablers.

Research limitations/implications

This study has been conducted based on the expert’s opinions from private hospitals located in Tehran and Alborz provinces, Iran. Although the results could be useful for hospital managers in different places and could provide them a valuable insight and knowledge, findings are limited to Iranian private hospitals.

Originality/value

It is taken for granted that patients’ satisfaction and loyalty could increase as a result of high-quality medical and treatment services in hospitals. On the other hand, offering excellent services meeting all the needs and expectations of customers could be consequence product of quality management enablers. Even though satisfaction and loyalty of customers, i.e. patients, is the primary target of quality management, there is little research in the literature as to how enablers of quality management can secure the satisfaction and loyalty through increasing service quality in hospitals. The gap is more critical because the specialized dimensions of four research variables have not been previously integrated into a coherent framework and interrelationships among them have not been studied and clarified in detail. The current study attempts to bridge this gap.

Is organizational progress in the EFQM model related to employee satisfaction?

BACKGROUND

To determine whether there is greater employee satisfaction in organisations that have made more progress in implementation of the European Foundation for Quality Management (EFQM) model.

METHODS

A series of cross-sectional studies (one for each assessment cycle) comparing staff satisfaction survey results between groups of healthcare organisations by degree of implementation of the EFQM model (assessed in terms of external recognition of management quality in each organisation).

SETTING

30 healthcare organisations including hospitals, primary care and mental health providers in Osakidetza, the Basque public health service.

PARTICIPANTS

Employees of 30 Osakidetza organisations.

INTERVENTION

Progress in implementation of EFQM model.

MAIN OUTCOME MEASURES

Scores in 9 dimensions of employee satisfaction from questionnaires administered in healthcare organisations in 4 assessment cycles between 2001 and 2010.

RESULTS

Comparing satisfaction results in organisations granted Gold or Silver Q Awards and those without this type of external recognition, we found statistically significant differences in the dimensions of training and internal communication. Then, comparing recipients of Gold Q Awards with those with no Q Certification, differences in leadership style and in policy and strategy also emerged as significant.

CONCLUSIONS

Progress of healthcare organisations in the implementation of the EFQM Excellence Model is associated with increases in their employee satisfaction in dimensions that can be managed at the level of each organisation, while dimensions in which no statistically significant differences were found represent common organisational elements with little scope for self-management.

[Catalonia's primary healthcare accreditation model: a valid model]

There are few experiences of accreditation models validated by primary care teams (EAP). The aim of this study was to detail the process of design, development, and subsequent validation of the consensus EAP accreditation model of Catalonia. An Operating Committee of the Health Department of Catalonia revised models proposed by the European Foundation for Quality Management, the Joint Commission International and the Institut Català de la Salut and proposed 628 essential standards to the technical group (25 experts in primary care and quality of care), to establish consensus standards. The consensus document was piloted in 30 EAP for the purpose of validating the contents, testing standards and identifying evidence. Finally, we did a survey to assess acceptance and validation of the document. The Technical Group agreed on a total of 414 essential standards. The pilot selected a total of 379. Mean compliance with the standards of the final document in the 30 EAP was 70.4%. The standards results were the worst fulfilment percentage. The survey target that 83% of the EAP found it useful and 78% found the content of the accreditation manual suitable as a tool to assess the quality of the EAP, and identify opportunities for improvement. On the downside they highlighted its complexity and laboriousness. We have a model that fits the reality of the EAP, and covers all relevant issues for the functioning of an excellent EAP. The model developed in Catalonia is a model for easy understanding.

Implementing quality initiatives in healthcare organizations: drivers and challenges

Purpose

– Various quality initiatives seem to have successful implementation in some healthcare organizations yet fail in others. This paper sets out to study the literature trying to understand drivers and challenges facing quality initiatives implementation in healthcare organizations then compare findings from literature with those of a structured questionnaire answered by 60 representatives from 18 hospitals. Finally it proposes a framework that mitigates challenges and utilizes drivers to ensure best implementation results.

Design/methodology/approach

– Literature regarding implementing various quality initiatives in the healthcare sector was reviewed. Representatives from several healthcare organizations were surveyed. Results from both approaches are compared to highlight the key challenges and drivers facing implementers.

Findings

– This research reveals that internal factors related to leadership and employees greatly affect quality initiative success or failure. Design and relevance play a major role in successful implementation.

Practical implications

– This research offers healthcare professionals greater success when implementing certain quality initiatives by taking success/failure factors into consideration. A general framework for successful implementation in the healthcare sector is provided.

Originality/value

– This article uncovers reasons behind success or failure in a comprehensive and practical way. It also explores how most popular quality initiatives are applied in hospitals.

European guidelines for quality assurance in cervical cancer screening: recommendations for cytology laboratories

The quality of a cervical cytology laboratory depends on adequate handling and staining of the samples, screening and interpretation of the slides and reporting of the results. These guidelines give an overview of procedures recommended in Europe to manage the balance between best patient care possible, laboratory quality assurance and cost effectiveness and will be published as a chapter 4 in the European Guidelines for Quality Assurance in Cervical Cancer Screening. The laboratory guidelines include protocols for personnel and organisation, material requirements, handling and analysing cervical samples, recording of results, quality management and communication. The section on quality management is comprehensive and includes protocols for all aspects of internal and external quality assurance. The guidelines are extensively referenced and as far as possible the recommendations are evidence-based.

A two‐level EFQM self‐assessment in an Italian hospital

PURPOSE

An assessment of the EFQM excellence model was carried out in Italy's Udine Hospital, aimed at evaluating how first and second-level managers perceived their hospital and individual departments. The study objectives also included identifying strengths and areas requiring improvement and stimulating a quality culture.

DESIGN/METHODOLOGY/APPROACH

Udine's S. Maria della Misericordia Hospital is a large specialised unit in North East Italy and similar to many regional hospitals throughout the country. The survey is a single case study of the hospital and its ten clinical departments. A 153-item questionnaire was completed by 201 experienced respondents.

FINDINGS

Leadership, policy and strategy, partnership and resources were rated highly, whereas people, society and customer results received lower ratings. Several improvement actions were planned, primarily with regard to the results criteria.

PRACTICAL IMPLICATIONS

A two-level self-assessment was successfully carried out in a hospital, giving insight into the organisation's strengths and areas requiring improvement. Through the study, a systemic approach was introduced and quality awareness was heightened.

ORIGINALITY/VALUE

The findings are useful for other hospitals conducting EFQM self-assessment.

Improving quality at the hospital psychiatric ward level through the use of the EFQM model

OBJECTIVE

To describe the implementation of the European Foundation for Quality Management (EFQM) model as a quality framework for improving a psychiatric hospital ward. METHODOGY: Two self-assessments were conducted using the EFQM model. The self-assessment methods combined two approaches proposed by the EFQM: the award simulation approach and the questionnaire approach. Work groups were set up to improve the areas for improvement identified on the self-assessment.

RESULTS

The EFQM was a useful framework for self-assessment at the ward level and a good system for identifying areas for improvement. Only one of the 32 sub-criteria did not apply at the ward level. The self-assessment score was 209 points in 2003 and 311 points 2 years later (an increase of 48.8% from the initial score).

DISCUSSION

The main difficulties were ensuring that clinical personnel understood the EFQM model, the extra effort demanded by the initial phase and the lack of decision-making capacity in certain relevant areas. Adapting the self-assessment methodology to the specific context facilitated the process, as did a high level of involvement of the part of manager and staff.

CONCLUSIONS

It is possible to implement the EFQM model at the hospital was level and it has a positive influence on staff communication and involvement. It is important, when working at this level, to adequately focus the scope of the project on improving quality in those areas where there is decision-making capacity.

Performance improvement based on integrated quality management models: what evidence do we have? A systematic literature review

PURPOSE

Health care organizations have to improve their performance for multiple stakeholders and organize integrated care. To facilitate this, various integrated quality management models can be used. This article reviews the literature on the Malcolm Baldrige Quality Award (MBQA) criteria, the European Foundation Quality Management (EFQM) Excellence model (Excellence award models) and the Chronic Care Model. The focus is on the empirical evidence for improved performance by the implementation of interventions based on these models.

DATA SOURCES

A systematic literature review from 1995 to May 2006 in the Pubmed, Cochrane, and ABI- databases was conducted.

STUDY SELECTION

After selection, 37 studies were included, 16 in the Excellence award model search and 21 in the Chronic Care Model search. DATA EXTRACTION AND RESULTS OF ANALYSIS: Data were retrieved about the main intervention elements, study design, evidence level, setting and context factors, data collection and analysis, principal results and performance dimensions. No Excellence Award model studies with controlled designs were found. For the Chronic Care Model, one systematic review, one meta analysis and six controlled studies were included. Seventeen studies (2 in Excellence award model, 15 in Chronic Care Model) reported one or more significant results.

CONCLUSION

There is some evidence that implementing interventions based on the 'evidence-based developed' Chronic Care Model may improve process or outcome performances. The evidence for performance improvement by interventions based on the 'expert-based developed' MBQA criteria and the EFQM Excellence model is more limited. Only a few studies include balanced measures on multiple performance dimensions. Considering the need for integrated care and chronic care improvement, the further development of these models for guiding improvements in integrated care settings and their specific context factors is suggested.

A proposed adaptation of the EFQM fundamental concepts of excellence to health care based on the PATH framework

OBJECTIVE

The use of the European Foundation for Quality Management (EFQM) Model in health care has found that this model is useful in promoting quality improvement, but its use in health care organizations is challenging because being a generic model, it does not cover the clinical aspects or the specifics of this field. For that reason, this article aims to bring the EFQM fundamental concepts of excellence closer to health care, using a specific model as a reference to this field: the Performance Assessment Tool for quality improvement in Hospitals (PATH) conceptual framework, developed by the WHO Regional Office for Europe.

METHOD

A content analysis was performed to independently identify the contents that defined the elements of both frameworks. Then, using defined criteria, two independent researchers compared the contents of the elements of both frameworks. The elements from both frameworks that were equivalent were aggregated. Several experts discussed the aspects with discrepancies between the two comparisons. Finally, the EFQM framework is adapted to health care by adding to those aggregated elements the aspects that were exclusive from one of the models.

RESULTS

The EFQM framework has many correspondences to a health care-specific framework. The EFQM-health care-adapted framework has eight quality dimensions, two of them (customer focus and safety) being overlapped with the other six (staff, results orientation, responsive governance, leadership and constancy of purpose, clinical effectiveness, and partnership development). This model also has two methodological dimensions (management by processes and facts and continuous learning; improvement and innovation).

CONCLUSION

This adapted model seems useful for health care organizations, but it needs to be further used to corroborate this preliminary finding.

A descriptive study of the implementation of the EFQM excellence model and underlying tools in the Basque Health Service

OBJECTIVE

To describe the implementation of the European Foundation for Quality Management (EFQM) excellence model as a common framework for quality management in a regional health care service.

DESIGN

Prospective, descriptive observational study.

SETTING

Thirty-one organizations (hospitals, primary care organizations, mental health institutions, and emergency services) of the Basque Health Service (serving a population of 2200000 inhabitants) in Basque Country, Spain.

METHODS

Since 1995, the experiences with the EFQM excellence model were initiated by training, the design of quality tools and application guidelines, and actions related to criteria of the EFQM model.

RESULTS

Four assessment cycles in which most of the organizations have participated were completed. Scores for most of the criteria improved, particularly in 'processes'. The overall patients' satisfaction was higher than 89% in all settings, in most of the cases higher than 95%. Ten organizations (32%) exceeded 400 points in an external evaluation with the EFQM excellence model, and 2 (6%) 500 points. Eighty-three percent of hospitals have some ISO-certified areas of activity. In the primary care setting, 40% of people were attended in a certified center.

CONCLUSIONS

Stimulating actions towards quality have resulted in progressive implementation of the EFQM model, this approach being possibly related to positive evolution of some outcomes. Key factors identified have been pursuing the objective of total quality management during several years and the assignment of the resources for training and implementation of quality systems.

Quality management in health care: a 20-year journey

In this article, the total quality programme in the Spanish healthcare system (1986-1992) and the subsequent quality improvement steps that have led to definition and implementation of such an integrated framework, seeking a quality management system and patient safety, are discussed.

La evaluación local de la calidad mediante instrumentos de medida genéricos

Performance measurement and accountability are the most frequently encountered concepts across healthcare systems, although the tools used to put these concepts into practice vary. The aim of the present article was to discuss the tools (e.g., indicators) and user expectations (e.g., quality versus performance) of these tools in fulfilling healthcare's accountability mandate. In particular, the developments within the Spanish health system are discussed to illustrate how Spain has addressed, in a stepwise manner, the determinants of a national accountability model. Finally, a multinational project, The Maryland Quality Indicator Project, is presented as a popular framework for measuring performance.

Quality management in German health care--the EFQM Excellence Model

A brief insight into the issues affecting German health care is given. Namely, upward pressure on costs leads to increasing expenditure within health care and downward pressure from economic recession and political unwillingness to increase taxes and budget spending. In the case of competing key stakeholder perspectives, a quality management framework is seen as a potential approach for addressing these issues. The framework is the European Foundation for Quality Management (EFQM) Excellence Model. The article briefly explains the pilot phase for utilising the EFQM Excellence Model within German health care organisations and the various implementation approaches recommended by EFQM. Specific details of an approach used by a health care organisation within Germany (providing social medicine, geriatric and elderly services) are described in detail. The benefits achieved from using the Model are a clear picture of where the gaps are in the organisation and a clear vision for concentrating future efforts towards total quality management.

The EFQM excellence model is useful for primary health care teams

BACKGROUND

Primary care teams are facing an increased need to develop quality programmes at local level. GPs must lead this process and promote a positive organizational culture if they want to achieve and maintain a continuous improvement of the service.

OBJECTIVE

The aim of the present study was to test the applicability and reliability of the European Foundation for Quality Management (EFQM) excellence model self-assessment questionnaire in a primary health care organization.

METHOD

A cross-sectional study was carried out of the EFQM questionnaire to compare the scores achieved by a primary health care team in Spain caring for 42 000 inhabitants using internal self-assessment with the scores achieved by professional management auditors through an external audit.

RESULTS

The scores of each criterion achieved by self-evaluation are similar to or lower than those assessed by the external evaluation. There is agreement in the areas suitable for improvement.

CONCLUSIONS

The experience proves the applicability of the EFQM excellence model for primary health care teams and its reliability, at least when the team undergoing self-assessment know they are going to be re-evaluated. There is high concordance in the identification of areas for improvement.