Quality management in healthcare and industry: A comparative review and emerging themes

Patient engagement behaviors in hospitals: the role of word of mouth and patient helping behaviors

Purpose

The purpose of this study is to investigate patient perceived value as a stimulus of patient engagement behaviors both from the conceptual and empirical perspectives.

Design/methodology/approach

Based on the stimulus–organism–response framework, the authors developed a model to determine the impact of patient perceived value on patient engagement behavior in health care. The data were collected from a sample of 391 patients hospitalized in private hospitals. Structural equation modeling technique was used to test the research hypotheses.

Findings

The findings confirmed relevance of the service quality dimensions reliability, tangibility, responsiveness and empathy as significant antecedents of patient perceived value. Perceived value plays a significant role in shaping word of mouth and patient helping behaviors.

Research limitations/implications

The findings of this study are relevant and applicable to patients in private hospitals.

Practical implications

This study contributes to the literature by providing new evidence on patient perceived value and engagement behaviors as a response to care quality. With adequate focus on perceived value and service quality, service providers can strengthen the relationship with patients and build a sustainable competitive advantage, by stimulating engagement behaviors in patients.

Originality/value

This study is of unique value to the health-care literature, both from the theoretical and managerial point of views. This study proposes a conceptual model of patient perceived value which can be used in the private health sector. Moreover, this study contributes to the health-care literature by introducing patient-helping behavior.

Machine Learning and Lean Six Sigma to Assess How COVID-19 Has Changed the Patient Management of the Complex Operative Unit of Neurology and Stroke Unit: A Single Center Study

Background: In health, it is important to promote the effectiveness, efficiency and adequacy of the services provided; these concepts become even more important in the era of the COVID-19 pandemic, where efforts to manage the disease have absorbed all hospital resources. The COVID-19 emergency led to a profound restructuring-in a very short time-of the Italian hospital system. Some factors that impose higher costs on hospitals are inappropriate hospitalization and length of stay (LOS). The length of stay (LOS) is a very useful parameter for the management of services within the hospital and is an index evaluated for the management of costs. Methods: This study analyzed how COVID-19 changed the activity of the Complex Operative Unit (COU) of the Neurology and Stroke Unit of the San Giovanni di Dio e Ruggi d'Aragona University Hospital of Salerno (Italy). The methodology used in this study was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC roadmap, characterized by five operational phases. To add even more value to the processing, a single clinical case, represented by stroke patients, was investigated to verify the specific impact of the pandemic. Results: The results obtained show a reduction in LOS for stroke patients and an increase in the value of the diagnosis related group relative weight. Conclusions: This work has shown how, thanks to the implementation of protocols for the management of the COU of the Neurology and Stroke Unit, the work of doctors has improved, and this is evident from the values of the parameters taken into consideration.

Discrete-Event Simulation Modeling in Healthcare: A Comprehensive Review

Discrete-event simulation (DES) is a stochastic modeling approach widely used to address dynamic and complex systems, such as healthcare. In this review, academic databases were systematically searched to identify 231 papers focused on DES modeling in healthcare. These studies were sorted by year, approach, healthcare setting, outcome, provenance, and software use. Among the surveys, conceptual/theoretical studies, reviews, and case studies, it was found that almost two-thirds of the theoretical articles discuss models that include DES along with other analytical techniques, such as optimization and lean/six sigma, and one-third of the applications were carried out in more than one healthcare setting, with emergency departments being the most popular. Moreover, half of the applications seek to improve time- and efficiency-related metrics, and one-third of all papers use hybrid models. Finally, the most popular DES software is Arena and Simul8. Overall, there is an increasing trend towards using DES in healthcare to address issues at an operational level, yet less than 10% of DES applications present actual implementations following the modeling stage. Thus, future research should focus on the implementation of the models to assess their impact on healthcare processes, patients, and, possibly, their clinical value. Other areas are DES studies that emphasize their methodological formulation, as well as the development of frameworks for hybrid models.

Integrating Quality Tools and Methods to Analyze and Improve a Hospital Sterilization Process

Healthcare facilities are facing major issues and challenges. Hospitals continuously search approaches to improve operations quality, optimize performance, and minimize costs. Specifically, an efficient hospital sterilization process (HSP) allows reusable medical devices (RMDs) to be more quickly available for healthcare activities. In this context, this paper describes an integrated approach developed to analyze HSP and to identify the most critical improvement actions. This proposed approach integrates four quality tools and techniques. Firstly, a structured analysis and design technique (SADT) methodology is applied to describe HSP as a hierarchy of activities and functions. Secondly, the failure modes and effects analysis (FMEA) method is used as a risk assessment step to determine which activity processes need careful attention. Thirdly, a cause–effect analysis technique is used as a tool to help identify all the possible improvement actions. Finally, priority improvement actions are proposed using the quality function deployment (QFD) method. To validate the proposed approach, a real sterilization process used at the maternity services of Hedi-Cheker Hospital in the governorate of Sfax, Tunisia, was fully studied. For this specific HSP, the proposed approach results showed that the two most critical activities were (1) improving the coordination between the sterilization service and the surgery block and (2) minimizing the average duration of the sterilization process to ensure the availability of RMDs in time.

Analyzing perceived healthcare service quality on patient related outcomes

Purpose

Through the lens of a total quality management approach, this paper aims to examine the effects of health-care service quality on patient satisfaction, repatronage intention (RI) and positive word-of mouth (PWOM) at a public hospital specialized in women and children’s diseases. The contribution is to measure and compare patient expectations and perceptions related to the public health service quality.

Design/methodology/approach

A structured questionnaire was distributed to in-patients who stayed at a public training and research hospital for at least three days. To analyze the relationship between variables, multiple regression analysis was used. To test the difference between expected and perceived service quality, the paired-sample t-test was used.

Findings

The findings provided empirical evidence that perceived service quality significantly influenced patient satisfaction, RI and PWOM. The “responsiveness and reliability” factor was found to be the most influential on patient RI and PWOM. The “tangibility” dimension had the strongest influence on patient satisfaction.

Practical implications

The results reveal that a reliable and responsive service, empathic personnel behaviors and appropriate tangibles are the outstanding factors for high levels of patient satisfaction, RI and PWOM.

Originality/value

Although the concepts of perceived service quality, patient satisfaction, RI and PWOM are explored frequently in service literature, there are few researches that focus on specialized health services for women and children’s diseases. By evaluating the service quality, it is hoped to provide an insight to health-care managers about the service quality dimensions and their relationship with patient satisfaction, RI and PWOM, specifically based on women patients.

Learning from the past to envision the future: a five-year review 2005-2009

Purpose

– The purpose of this paper is to identify and analyze the topics published in the journal in the five-year period from 2005 to 2009.

Design/methodology/approach

– A qualitative examination of content by year identifies prevalent themes.

Findings

– The beginning and ending of the time period demonstrate continued interest in major figures of our field and the context of their thinking. Quality, excellence and continuous improvement were recurrent topics as were those of business in society, ethics and social responsibility. The value of historical analysis with suggested methodologies for further study was included.

Research limitations/implications

– The paper is limited to the topical papers within this five-year timeframe and a qualitative analysis of themes. Fewer than expected papers were published on leadership and international subjects given their important to the field.

Practical implications

– Aspiring authors may find the historical background for the current topics of entrepreneurship, quality, ethics and social responsibility convenient. Helpful advice from experts about how to study management history is highlighted. Cross-cultural and international historical linkages on themes and concepts are identified as areas in need of additional research.

Social implications

– The social construction of studying and teaching history is discussed. The context in which major writers lived and events occurred is recognized as a major factor in interpreting situations.

Originality/value

– The paper reviews over 100 articles to categorize the historical origins of current and recurring topics into major themes. Papers are organized by topic, person or event into a chart by year.

Factors influencing the implementation of chronic care models: A systematic literature review

Background

The increasing prevalence of chronic disease faced by both developed and developing countries is of considerable concern to a number of international organisations. Many of the interventions to address this concern within primary healthcare settings are based on the chronic care model (CCM). The implementation of complex interventions such as CCMs requires careful consideration and planning. Success depends on a number of factors at the healthcare provider, team, organisation and system levels.

Methods

The aim of this systematic review was to systematically examine the scientific literature in order to understand the facilitators and barriers to implementing CCMs within a primary healthcare setting. This review focused on both quantitative and qualitative studies which included patients with chronic disease (cardiovascular disease, chronic kidney disease, chronic respiratory disease, type 2 diabetes mellitus, depression and HIV/AIDS) receiving care in primary healthcare settings, as well as primary healthcare providers such as doctors, nurses and administrators. Papers were limited to those published in English between 1998 and 2013.

Results

The search returned 3492 articles. The majority of these studies were subsequently excluded based on their title or abstract because they clearly did not meet the inclusion criteria for this review. A total of 226 full text articles were obtained and a further 188 were excluded as they did not meet the criteria. Thirty eight published peer-reviewed articles were ultimately included in this review. Five primary themes emerged. In addition to ensuring appropriate resources to support implementation and sustainability, the acceptability of the intervention for both patients and healthcare providers contributed to the success of the intervention. There was also a need to prepare healthcare providers for the implementation of a CCM, and to support patients as the way in which they receive care changes.

Conclusion

This systematic review demonstrated the importance of considering human factors including the influence that different stakeholders have on the success or otherwise of the implementing a CCM.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-015-0319-5) contains supplementary material, which is available to authorized users.

The rise and decline of TQM in the NHS

Purpose

– The purpose of this paper is to delineate the factors responsible for the decline of total quality management (TQM) in the National Health Service (NHS). It is suggested that if these factors were initially identified and eliminated prior to implementation, the decline of TQM as a strategy for improving the provision and delivery of quality patient care could have been prevented.

Design/methodology/approach

– The case study approach was chosen because it is the preferred method when “how” or “what” questions are being posed. It is applicable as is evident in this paper where the researcher has little control over events and when the focus is on a contemporary phenomenon within some real-life context. The case study enables the researcher to give an accurate rendition of actual events; it contributes uniquely to the knowledge of individual, organisational, social, and political phenomena. The semi-structured face-to-face interview constituted the main data collection technique of the research. Interviews were held with 23 quality management managers in the British NHS. The central focus of the interview was on “what” factors contributed to the rapid decline of TQM in the NHS. The respondents were chosen because they were directly involved with the implementation of TQM. They were in the vintage position to offer a full insight into the TQM initiative. The analysis of the case is based on Yin's analytic technique of explanation building.

Findings

– The decline of TQM in the NHS could have been prevented if top executives in hospitals had adopted the sequential steps to quality improvement: In the authors opinion, to land a man on the moon needed a belief in the possibility and breakthrough in the attitudes that viewed space travel as pure science fiction as opposed to a practical reality, and so it should have been with TQM in the NHS. However, the attitude of many NHS managers was that TQM was all right for “other institutions” because “they need it” whereas in the NHS, “we don’t”. This negative attitude should have been overcome if TQM was to be accepted as a corporate, all encompassing philosophy.

Research limitations/implications

– The limitation of the research may be the sample size of the respondents, which was limited to 23 quality managers that had hands-on experience and the leadership role to lead and implement TQM in the NHS. Future research may consider a broader sample size. It may also be considered for new research to use surveys to identify a broader set of reasons why TQM declined in the NHS.

Practical implications

– This paper is the first constructive insight to determine reasons for the decline of TQM in the NHS from the individuals who had the sole responsibility for implementation. Any other, group would have amounted to hearsay. Therefore, to constructively delineate the reasons for failure, it was pertinent to learn from the quality managers directly and to ensure that the reasons was representative of their experiences with TQM. The practical implication is to prepare future managers about how to avoid failure.

Originality/value

– The paper clearly suggests the systematic process required for effective implementation of TQM in a healthcare setting by identifying factors that must be avoided to ensure the successful and sustainable implementation of TQM.

Healthcare management education settings in the United States

Purpose

This paper aims to provide a history of graduate healthcare management education in the USA with an emphasis on the comparison of business schools and health science settings. It seeks to explain why different organizational cultures exist and how this affects education.

Design/methodology/approach

The approach relies on literature review and descriptive analysis using secondary data. Institutional economics helps provide perspective on different academic cultures and orientations.

Findings

Healthcare management education originated in the early twentieth century. Business schools at the University of Chicago and Northwestern were early pioneers. By mid‐century, schools of public health and medicine entered and came to dominate with strong graduate programs at Berkeley, Michigan and other leading universities. More recently, business schools have differentiated away from the generic MBA and expanded into this market. Advocates of health science settings commonly see healthcare as different from other forms of management. The externally funded model of medical education relying on patient and grant revenues dominates the health sciences. This can lead to preference for faculty who generate funds and a neglect of core academic areas that historically have not relied on grants and contracts.

Practical implications

This history of health management education provides insight for students, researchers, educators and administrators. It underscores comparative advantage of different academic settings.

Originality/value

This paper serves to fill a gap in the management literature. It provides history and perspective about academic settings not readily available.

Best practices of total quality management implementation in health care settings

Due to the growing prominence of total quality management (TQM) in health care, the present study was conducted to identify the set of TQM practices for its successful implementation in healthcare institutions through a systematic review of literature. A research strategy was performed on the selected papers published between 1995 and 2009. An appropriate database was chosen and 15 peer-reviewed research papers were identified through a screening process and were finally reviewed for this study. Eight supporting TQM practices, such as top-management commitment, teamwork and participation, process management, customer focus and satisfaction, resource management, organization behavior and culture, continuous improvement, and training and education were identified as best practices for TQM implementation in any health care setting. The article concludes with a set of recommendations for the future researchers to discuss, develop, and work upon in order to achieve better precision and generalizations.