To improve quality, keep your eyes on the road

Organizational intervention to improve access to retinopathy screening for patients with diabetes mellitus: health care service improvement project in a tertiary public hospital

INTRODUCTION

The aim of this study was to improve the access to diabetic retinopathy (DR) screening with retinographies in a tertiary care center through a process conducted by an interdisciplinary group driven by a nurse.

MATERIALS AND METHODS

This is a quality improvement study that evaluated the flow for DR screening conducted by an interdisciplinary group using the Plan-Do-Study-Act methodology. As a result measure, we assessed the quantity of retinographies performed after the project implementation, the proportion of patients who presented abnormal retinographies, and the proportion of patients referred to a specialist.

RESULTS

The new patient screening flow and the reinforcement of available human resources led to an increase in the number of retinographies performed and screened patients. A total of 1184 retinographies were conducted, and it was possible to observe DR alterations in 37.8 % patients, of which only 6 % needed to be referred to the DR reference center.

CONCLUSIONS

This study showed a significant increase in the number of retinographies performed. The Plan-Do-Study-Act methodology was an important tool to improve the flow of patient access to fundus images, helping to consistently and continuously improve these processes.

Quality Improvement Metrics and Methods for Neurohospitalists

Measurement of clinical performance is largely driven by the requirements of the Centers for Medicare and Medicaid Services and accrediting bodies like The Joint Commission. Performance measures include length of stay, readmission rate, mortality rate, hospital-acquired complications, and stroke core measures. Hospital rankings also depend heavily on quality and patient safety indicators. Becoming facile with these measures can aid neurohospitalists in understanding their value and garnering resources to support improvement projects. Neurohospitalists can apply a structured A3-based method to define a clinical problem, perform systematic analysis, then design and test solutions to drive improved outcomes for patients with neurologic disease.

Hospital managers' perspectives with implementing quality improvement measures and a new regulatory framework: a qualitative case study

A new regulatory framework to support local quality and safety efforts in hospitals was introduced to the Norwegian healthcare system in 2017. This study aimed to investigate hospital managers' perspectives on implementation efforts and the resulting work practices, to understand if, and how, the new Quality Improvement Regulation influenced quality and safety improvement activities.

DESIGN

This article reports one study level (the perspectives of hospital managers), as part of a multilevel case study. Data were collected by interviews and analysed according to qualitative content analysis.

SETTING

Three hospitals retrieved from two regional health trusts in Norway.

PARTICIPANTS

20 hospital managers or quality advisers selected from different levels of hospital organisations.

RESULTS

Four themes were identified in response to the study aim: (1) adaptive capacity in hospital management and practice, (2) implementation efforts and challenges with quality improvement, (3) systemic changes and (4) the potential to learn. Recent structural and cultural changes to, and development of, quality improvement systems in hospitals were discovered (3). Participants however, revealed no change in their practice solely due to the new Quality Improvement Regulation (2). Findings indicated that hospital managers are legally responsible for quality improvement implementation and participants described several benefits with the new Quality Improvement Regulation (2). This related to adaptation and flexibility to local context, and clinical autonomy as an inevitable element in hospital practice (1). Trust and a safe work environment were described as key factors to achieve adverse event reporting and support learning processes (4).

CONCLUSIONS

This study suggests that a lack of time, competence and/or motivation, impacted hospitals' implementation of quality improvement efforts. Hospital managers' autonomy and adaptive capacity to tailor quality improvement efforts were key for the new Quality Improvement Regulation to have any relevant impact on hospital practice and for it to influence quality and safety improvement activities.