Continuous quality improvement in a Maltese hospital using logical framework analysis

A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact

BACKGROUND

The growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts.

METHODS

This qualitative scoping review was conducted using Arksey and O'Malley's methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works.

RESULTS

A total of 87 articles, which covered 14 CQI models, were included in the review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI.

CONCLUSIONS

Implementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it's crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care.

An evaluation of Lean and Six Sigma methodologies in the national health service

Purpose

The purpose of this paper is to conduct an empirical study derived from the previous literature from the perspective of benefits, tools and techniques, continuous improvement (CI) and quality improvement (QI) methodologies and critical failure factors (CFFs) of Lean and Six Sigma (SS) in the national health service (NHS).

Design/methodology/approach

A literature review was carried out to identify previous findings, empirical data and critical variables concerning Lean and SS in healthcare for over ten years. Second, primary research in quantitative surveys and qualitative interviews was carried out with 110 participants who have experience using Lean and SS in the NHS.

Findings

Lean and SS have evolved into common practices within the NHS and now have an established list of tools and techniques frequently employed by staff. Lean and SS are considered robust CI methodologies capable of effectively delivering extensive benefits across many different categories. The NHS must overcome a sizable amount of highly important CFFs and divided organizational culture.

Originality/value

This paper has developed the most extensive empirical study ever produced on Lean and SS in the NHS and has expanded on previous works to create new and updated research. The findings produced in this paper will assist NHS medical directors and practitioners in obtaining up-to-date insight into Lean and SS status in the NHS. The paper will also guide the NHS to critically evaluate their current CI strategy to ensure long-term sustainability and deliver improved levels of service to patients.

What affects length of hospital stay? A case study from Malta

PURPOSE

Hospital length of stay (LOS) is not only a function of patient- and disease-related factors, but is also determined by other health system-wide variables. Managers and clinicians strive to achieve the best possible trade-off between patients' needs and efficient utilisation of hospital resources, while also embracing ethical decision making. The purpose of this paper is to explore the perceptions of the hospital's major stakeholders as to what affects the duration of LOS of inpatients.

DESIGN/METHODOLOGY/APPROACH

Using a data-triangulated case study approach, 50 semi-structured interviews were performed with management, doctors, nurses and patients. Additionally, the hospitals' standard operating procedures, which are pertinent to the subject, were also included in the thematic analysis.

FINDINGS

This study shows that LOS is a multi-dimensional construct, which results from a complex interplay of various inputs, processes and outcomes.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings emerging from a single case study approach cannot be generalised across settings and contexts, albeit being in line with the current literature.

PRACTICAL IMPLICATIONS

The study concludes that a robust hospital strategy, which addresses deficient organisational processes that may unnecessarily prolong LOS, is needed. Moreover, the hospital's strategy must be sustained by providing good primary care facilities within the community set-up, as well as by providing more long-term care and rehabilitation beds to support the hospital turnover.

ORIGINALITY/VALUE

The subject of LOS in hospitals has so far been tackled in a fragmented manner. This paper provides a comprehensive and triangulated account of the complexities surrounding the duration in which patients are kept in hospital by key stakeholders, most of whom were hands-on in the day-to-day running of the hospital under study.

An exploratory study into the use of Lean Six Sigma to reduce medication errors in the Norwegian public healthcare context

PURPOSE

Medication errors are a significant cause of injury in Norwegian hospitals. The purpose of this study is to explore how Lean Six Sigma (LSS) has been used in the Norwegian public health-care context to reduce medication errors.

DESIGN/METHODOLOGY/APPROACH

A mixed method approach was used to gather data from participants working in the four regions served by the Norway health authorities. A survey questionnaire was distributed to 38 health-care practitioners and semi-structured interviews were conducted with 12 health-care practitioners.

FINDINGS

The study finds that the implementation of LSS in the Norwegian public health-care context is still in its infancy. This is amidst several challenges faced by Norwegian hospitals such as the lack of top-management support, lack of LSS training and coaching and a lack of awareness around the benefits of LSS in health care.

RESEARCH LIMITATIONS/IMPLICATIONS

Because of the large geographical area, it was difficult to reach participants from all health regions in Norway. However, the study managed to assess the current status of LSS implementation through the participants' perspectives. This is a fruitful area for future research whereby an action research methodology could be used.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this is the first empirical study into the use of LSS methodology in reducing medication errors. In addition, this study is valuable for health-care practitioners and professionals as a guideline to achieve the optimal benefit of LSS implementation to reduce medication errors.

Bridging Sustainability and Corporate Social Responsibility: Culture of Monitoring and Evaluation of CSR Initiatives in India

This study examines the continuum of sustainability and corporate social responsibility (CSR) policies, and analyzes broad patterns that have emerged with respect to monitoring and evaluation practices in the CSR programs of Indian companies under new CSR regulations. Under these regulations, the Indian firms are mandated to spend at least 2% of their profits on social and development sectors. We specifically analyze (i) how Indian companies have conceptualized the idea of sustainability in their annual sustainability reports, and how these ideas get reflected in their CSR policies, and (ii) the monitoring and evaluation practices in CSR interventions. The study uses both primary and secondary data sources, and employs text network analysis and narratives-based content analysis to analyze the data. We find that the conceptualization of sustainability is a largely rhetoric and customary exercise that does not take into account variations in firms’ businesses. This approach toward sustainability initiatives presents serious challenges to sustainability, including social sustainability. The study also finds that there is lack of ‘willingness’ and ‘readiness’ among Indian companies to measure and monitor the outcomes of CSR interventions, which is arguably one of the most robust ways to signal their commitment toward corporate sustainability. Although mandatory CSR spending is a recent phenomenon in India, our study establishes that it is only through the design of effective CSR policies that the best practices for Indian business community can emerge in the near future.

Can Lean Six Sigma be used to reduce medication errors in the health-care sector?

Purpose The purpose of this paper is to present the implementation of Lean Six Sigma (LSS) to reduce medication errors, by using four case examples. The paper will also suggest appropriate Lean and Sigma tools to improve the medication process. Design/methodology/approach The authors critically analyze four case examples that used LSS projects, to demonstrate the approach, benefits, success factors and lessons learnt. Findings LSS is a powerful process improvement methodology that could be applied by health-care sectors to reduce medication errors, increase patient safety and reduce operational costs. Common Lean and Six Sigma tools play a significant role in improving and sustaining the medication process. Practical implications It is necessary for the project team to select the most appropriate LSS tools to address medication process problems. Adoption of a LSS roadmap could help health-care organizations in the successful implementation of LSS. Originality/value The paper is valuable for health-care professionals seeking to reduce errors in the medication process or other processes that need to be improved.