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Hanskamp-Sebregts M, van Gurp PJ, Braspenning J. Design and Validation of a Questionnaire to Measure Interprofessional Collaborative Practice for Auditing Integrated Hospital Care: Empirical Research. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00103. [PMID: 38015499 DOI: 10.1097/ceh.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Interprofessional teamwork is the key issue of delivering integrated hospital care; however, measuring interprofessional collaboration for auditing is fragmented. In this study, a questionnaire to measure InterProfessional collaborative Practice for Integrated Hospital care (IPPIH) has been developed and validated. METHODS A four-step iterative process was conducted: (1) literature search to find suitable questionnaires; (2) semistructured stakeholder interviews (individual and in focus groups) to discuss the topics and questions (face validity), (3) pretesting the prototype of the questionnaire in two different integrated care pathways for feasibility, usability, and internal consistency, and (4) testing (content and construct validity and responsiveness) of the revised questionnaire in eight integrated care pathways; the validation and responsiveness was tested by means of exploratory factor analysis, calculation of Cronbach alpha, item analysis, and linear mixed model analysis. RESULTS Based on six questionnaires and the opinion of direct stakeholders, the questionnaire IPPIH comprised 27 items. Five different domains could be distinguished: own skills, culture, coordination and collaboration, practical support, and appreciation with the Cronbach alpha varied from 0.91 to 0.48. The self-reported intensity of the collaboration within a specific care pathway significantly influenced the outcome ( P = .000). DISCUSSION The product is a questionnaire, IPPIH, which can measure the degree of interprofessional collaborative practice in integrated hospital care pathways. The IPPIH was initially developed for quality assurance. However, the IPPIH also seems to be suitable as a self-assessment tool for directors to monitor and improve the interprofessional collaboration and the quality of their integrated care pathway.
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Affiliation(s)
- Mirelle Hanskamp-Sebregts
- Dr. Hanskamp-Sebregts: Radboud University Medical Center, Institute of Quality Assurance and Patient Safety, Nijmegen, The Netherlands. Prof. van Gurp: Radboud University Medical Center, Institute of Quality Assurance and Patient Safety, Nijmegen, The Netherlands, and Department of General Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. Prof. Braspenning: IQ Healthcare, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
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Rockstroh J, Laut KG, Jakobsen SF, Raben D, Verluyten J, Behrens G, Martinez E, Noori T, Pharris A, Simões D, Sullivan A. An opinion piece on how we move towards common European standards of care for people with HIV. AIDS 2023; 37:1941-1948. [PMID: 37428204 DOI: 10.1097/qad.0000000000003652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
| | - Kamilla G Laut
- Centre of Excellence for Health, Immunity and Infections, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Stine F Jakobsen
- Centre of Excellence for Health, Immunity and Infections, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Dorthe Raben
- Centre of Excellence for Health, Immunity and Infections, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Georg Behrens
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Esteban Martinez
- Infectious Diseases Unit, Hospital Clínic/University of Barcelona, Spain
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Daniel Simões
- Coalition PLUS/GAT- Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Ann Sullivan
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Ji X, Gao L, Liu H, He S, Zhu B, Chow C, Chen J, Lu Z, Li L. Does public health policy quality foster state innovation capacity? Evidence from a global panel data. Front Public Health 2022; 10:952842. [PMID: 36438285 PMCID: PMC9686444 DOI: 10.3389/fpubh.2022.952842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
The design and implementation of public health policy may shape state innovation capacity with governance effectiveness, political stability, and government integrity. Previous studies, however, failed to incorporate these relationships simultaneously. This study aims to combine two distinct scholarships to examine whether the quality of policies in the public health sector contributes to state innovation capacity. We extracted data from the WHO international health regulatory dataset covering the WHO Member States between 2010 and 2017 to investigate the relationship (N = 145). Our fixed-effects models and regression discontinuity design (RDD) suggest a positive impact of public health policy quality on state innovation capacity. There are several contributions to the study of the relationship between public health and innovation in this study. Firstly, it fills a theoretical void concerning the relationship between policy development and implementation in the public health sector and country-specific innovations. Second, it provides an empirical quantitative analysis of policy quality in the public health sector. Third, this study contributes evidence that public health plays an important role in fostering state innovation beyond urbanization, investment in science and technology, and foreign trade. Furthermore, our quasi-experimental evidence found that this mechanism may be significant only between the more politically stable countries and the most politically stable countries. These contributions have empirical implications for governments across the world that seek to balance public health and innovation capacity in the context of the post-pandemic era.
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Affiliation(s)
- Xiaoyi Ji
- Faculty of Innovation and Entrepreneurship, Wenzhou University, Wenzhou, China
| | - Ling Gao
- Wang Yanan Institute for Studies in Economics, Xiamen University, Xiamen, China
| | - Huan Liu
- School of Business Administration, Zhejiang Gongshang University, Hangzhou, China
| | - Shengyu He
- School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Baoqing Zhu
- School of Marxism, Fudan University, Shanghai, China
| | - Cheng Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jieqiong Chen
- Department of Political Science, Party School of Zhejiang Provincial Committee of C.P.C, Hangzhou, China
| | - Zhipeng Lu
- School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Li Li
- School of Public Affairs, Zhejiang University, Hangzhou, China,*Correspondence: Li Li
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Rooke F, Burford J, Doorly A, Gush C, Brennan ML. Developing consensus for definitions of key veterinary-specific quality improvement (QI) terms using an eDelphi-study method. Vet Rec 2021; 191:e1174. [PMID: 34888878 DOI: 10.1002/vetr.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Quality improvement (QI) methods are a continuous process of iterative tests to improve the quality of a service or product. Using common language has been linked to the successful implementation of QI in human healthcare. This study aimed to assimilate and achieve consensus on veterinary-specific definitions for terms associated with quality care and QI methods in UK veterinary practice. METHODS A four-round modified eDelphi process with a panel of 50 UK veterinary practice stakeholders was used to generate consensus. The panel selected or suggested the definition they best felt 'fitted' each term. Consensus was reached if there was >70% agreement, and terms were eliminated if there was <15% selection. RESULTS Thirty-one panellists completed all three rounds of eDelphi; eight participants completed an optional feedback round. From 14 terms, 10 reached consensus, leaving four unresolved definitions. CONCLUSIONS A majority of terms reached consensus; 90% were new or amended definitions proposed by panel members. Utilising plain English refined by stakeholders will allow successful implementation of QI in veterinary healthcare. Not all terms achieved consensus, highlighting a need for further research to enable successful integration of QI principles as seen in human healthcare.
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Affiliation(s)
- Freya Rooke
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK.,Centre for Evidence-Based Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | - John Burford
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | | | | | - Marnie L Brennan
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK.,Centre for Evidence-Based Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
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Hut-Mossel L, Ahaus K, Welker G, Gans R. Understanding how and why audits work in improving the quality of hospital care: A systematic realist review. PLoS One 2021; 16:e0248677. [PMID: 33788894 PMCID: PMC8011742 DOI: 10.1371/journal.pone.0248677] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care. METHODS A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context-mechanism-outcome configurations (CMOcs). RESULTS From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration. CONCLUSIONS This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts. PROSPERO REGISTRATION CRD42016039882.
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Affiliation(s)
- Lisanne Hut-Mossel
- Centre of Expertise on Quality and Safety, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Kees Ahaus
- Department Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Gera Welker
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rijk Gans
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Sykes M, Thomson R, Kolehmainen N, Allan L, Finch T. Opportunities to enhance ward audit: a multi-site qualitative study. BMC Health Serv Res 2021; 21:226. [PMID: 33712006 PMCID: PMC7971099 DOI: 10.1186/s12913-021-06239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hospitals in many countries are encouraged to develop audits to assess and improve the quality of care. Ward audit is a specific form of audit and feedback that is commonly used but little studied. The aim of this study is to describe the content and application of hospital ward audit in order to identify potential enhancements to such audits. METHODS Multiple qualitative methods were used to study a diversity sample of four English National Health Service organisations over a 16-month period. We undertook semi-structured interviews (n = 32), documentary analysis (n = 44) and 25 h of observations of healthcare workers involved in the design and implementation of ward audit. Data were analysed using framework analysis. Findings were presented iteratively to stakeholders who used them to develop a description of the content and delivery of ward audit. RESULTS Ward audit consisted of seven stages: impetus; method; preparation of staff; assessing practice; analysis; feedback; and decide on action to improve. Two key stages were the monthly assessment of practice using case note data extraction, and the resulting feedback to clinical staff, ward managers, matrons and directors of nursing. At three organisations, the case note data were extracted by staff and there was evidence that this resulted in misrepresentation of the clinical performance audited. The misrepresentation appeared to be associated with the anticipation of punitive feedback from directors of nursing and matrons, as well as time pressures and a lack clarity about the method of audit data collection. Punitive feedback was reported to occur if no data were collected, if data demonstrated poor performance or if performance did not improve. CONCLUSIONS Organisations invest considerable clinical resources in ward audit, but such audits may have unintended, potentially negative, consequences due to the impacts from punitive feedback. We discuss potential enhancements to ward audit (e.g. providing feedback recipients with suggested actions for improvement) and discuss implications for theory. There is a need to reduce the use of punitive feedback.
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Affiliation(s)
- Michael Sykes
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK.
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
| | - Niina Kolehmainen
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
| | - Louise Allan
- South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Tracy Finch
- Coach Lane Campus West, Northumbria University, Newcastle upon Tyne, UK
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Vaagan A, Sandvin Olsson AB, Arntzen C, By Rise M, Grue J, Haugland T, Langeland E, Stenberg U, Koren Solvang P. Rethinking long-term condition management: An actor-level framework. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:392-407. [PMID: 33635559 DOI: 10.1111/1467-9566.13228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
To understand the complexities of managing long-term conditions and develop appropriate responses, micro-, meso- and macrolevels must be considered. However, these levels have not been combined in a single analytical framework of long-term condition management (LTCM). This article aims to describe a framework of LTCM practice and research that combines societal levels and key agents. The actor-level framework, based on the works of Abram De Swaan and Randall Collins, provides a broader understanding of LTCM as an interdisciplinary research field compared to previous contributions. The framework has three main advantages. First, it encourages knowledge production across levels and actors that address the complexity of long-term illness management. Second, it broadens the scope of LTCM as an interdisciplinary research field and practice field. Finally, it facilitates the integration of knowledge production from different disciplines and research traditions. The framework could stimulate interdisciplinary research collaboration to enhance knowledge of processes and interactions influencing the lives of individuals with long-term conditions.
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Affiliation(s)
- André Vaagan
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo, Norway
| | | | - Cathrine Arntzen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
| | - Marit By Rise
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Grue
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Trude Haugland
- Faculty of Health Studies, VID Specialized University, Norway and Inland Norway University of Applied Sciences, Hamar, Norway
| | - Eva Langeland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health and Frambu Competence Center of Rare Diagnosis, Oslo, Norway
| | - Per Koren Solvang
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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Georgiou MK, Merkouris A, Hadjibalassi M, Sarafis P. Contribution of Healthcare Professionals in Issues that Relate to Quality Management. Mater Sociomed 2021; 33:45-50. [PMID: 34012350 PMCID: PMC8116097 DOI: 10.5455/msm.2021.33.45-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The health sector should adopt integrated quality systems because of the need to survive and develop in a highly competitive environment. Inefficiency of mechanistic procedures, along with inadequate administrative infrastructure, impose innovative appoaches to improve operations and increase revenues by reducing quality feilures. Objective: A health system that relies on quality healthcare services can directly benefit the entire society, may reduce mortality, disease severity, and increase life expectancy. The following literature review constitutes an attempt to assess the contribution of healthcare professionals in issues that relate to quality management over the course of recent years. Methods: This systematic review took place between May 2019 and June 2020 in the databases PubMed, Cochrane Library, Wiley Online Library, Web of Science, Google Scholar and Scopus search engine databases. Study Selection and Data Extraction: This review includes articles written in English language, which contain quantitative and qualitative analysis of healthcare professionals’ involvement in quality activities. Correspondingly, the exclusion criteria were: languages other than English, secondary surveys (general and systematic reviews or post-analyses), letters to the publisher, and editorials or articles that did not illuminate the subject under study. After an extensive literature review, a standardised Excel spreadsheet was developed for data extraction from the included studies. The main characteristics of the studies were recorded (author’s name, place and time of work, the article under study and the methodology) so that all research articles corresponding to the review could be included. 31 articles were included. Results: Healthcare professionals are engaged in quality improvement activities and there is high association between quality management strategies and clinical processes. A systematic approach on healthcare activities based on the input of healthcare professionals can help increase business performance, reduce errors, improve patient safety, and contribute to a more proactive care. Conclusion: Health professionals’ contribution in the strategic planning of healthcare organisations that address quality activities can lead to better output, both in patient satisfaction and safety.
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Affiliation(s)
- Mary Kyriacou Georgiou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Cyprus
| | - Anastasios Merkouris
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Cyprus
| | - Maria Hadjibalassi
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Cyprus
| | - Pavlos Sarafis
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Cyprus
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Hamilton S, Jennings A, Forster AJ. Development and evaluation of a quality improvement framework for healthcare. Int J Qual Health Care 2020; 32:456-463. [PMID: 32696048 PMCID: PMC7654383 DOI: 10.1093/intqhc/mzaa075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/30/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Develop and evaluate a framework for quality improvement which will provide a common approach, terminology and greater likelihood of success in achieving demonstrable and sustained improvement. DESIGN Descriptive with mixed methods evaluation. SETTING Tertiary care academic hospital in Ottawa, Canada. PARTICIPANTS Students enrolled in the Quality and Patient Safety Leadership Executive Program at the local university. METHODS The quality improvement (QI) framework was developed though comparison and coding of key strengths across four commonly applied quality improvement frameworks. Effectiveness of the framework was evaluated through a satisfaction survey of students who were taught the framework, and independent assessment of student improvement initiatives that followed the QI Framework versus initiatives from a prior year who did not. MAIN OUTCOME MEASURES Acceptability and effectiveness of the QI Framework. RESULTS All participants found the QI Framework to be useful and easy to follow. Independent evaluation of improvement initiatives following the QI Framework, as compared to those that did not, scored higher (95% CI: 3.0 ± 0.49) than the projects completed without the QI Framework (95% CI: 2.2 ± 0.30), P value < 0.01. Scores were higher for cohort 2017/18 in all criteria except scaling and spreading, in which there was no change (2015/16 95% CI: 1.2 ± 0.24, 2017/18 95% CI: 1.2 ± 0.38). CONCLUSIONS The method we have developed is acceptable and helpful to users, and overall application resulted in higher quality initiatives. We believe this method, which we have branded as The Ottawa Hospital Innovation Framework, can be beneficial in healthcare settings for a variety of change initiatives.
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Affiliation(s)
- Samantha Hamilton
- Innovation & Quality, The Ottawa Hospital, Civic Campus, 1053 Carling Ave Ottawa, ON, K1Y 4E9
| | - Alison Jennings
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave., Ottawa, ON, K1Y 4E9
| | - Alan J Forster
- Innovation & Quality, The Ottawa Hospital, Civic Campus, 1053 Carling Ave Ottawa, ON, K1Y 4E9
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave., Ottawa, ON, K1Y 4E9
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Scholl I, Kobrin S, Elwyn G. "All about the money?" A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States. Implement Sci 2020; 15:81. [PMID: 32957962 PMCID: PMC7507661 DOI: 10.1186/s13012-020-01042-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/07/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite decades of ethical, empirical, and policy support, shared decision-making (SDM) has failed to become standard practice in US cancer care. Organizational and health system characteristics appear to contribute to the difficulties in implementing SDM in routine care. However, little is known about the relevance of the different characteristics in specific healthcare settings. The aim of the study was to explore how organizational and health system characteristics affect SDM implementation in US cancer care. METHODS We conducted semi-structured interviews with diverse cancer care stakeholders in the USA. Of the 36 invited, 30 (83%) participants consented to interview. We used conventional content analysis to analyze transcript content. RESULTS The dominant theme in the data obtained was that concerns regarding a lack of revenue generation, or indeed, the likely loss of revenue, were a major barrier preventing implementation of SDM. Many other factors were prominent as well, but the view that SDM might impair organizational or individual profit margins and reduce the income of some health professionals was widespread. On the organizational level, having leadership support for SDM and multidisciplinary teams were viewed as critical to implementation. On the health system level, views diverged on whether embedding tools into electronic health records (EHRs), making SDM a criterion for accreditation and certification, and enacting legislation could promote SDM implementation. CONCLUSION Cancer care in the USA has currently limited room for SDM and is prone to paying lip service to the idea. Implementation efforts in US cancer care need to go further than interventions that target only the clinician-patient level. On a policy level, SDM could be included in alternative payment models. However, its implementation would need to be thoroughly assessed in order to prevent further misdirected incentivization through box ticking.
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Affiliation(s)
- Isabelle Scholl
- Dartmouth College, The Dartmouth Institute for Health Policy & Clinical Practice, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany.
| | - Sarah Kobrin
- Healthcare Delivery Research Program, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Glyn Elwyn
- Dartmouth College, The Dartmouth Institute for Health Policy & Clinical Practice, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
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Allen P, Pilar M, Walsh-Bailey C, Hooley C, Mazzucca S, Lewis CC, Mettert KD, Dorsey CN, Purtle J, Kepper MM, Baumann AA, Brownson RC. Quantitative measures of health policy implementation determinants and outcomes: a systematic review. Implement Sci 2020; 15:47. [PMID: 32560661 PMCID: PMC7304175 DOI: 10.1186/s13012-020-01007-w] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/05/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Public policy has tremendous impacts on population health. While policy development has been extensively studied, policy implementation research is newer and relies largely on qualitative methods. Quantitative measures are needed to disentangle differential impacts of policy implementation determinants (i.e., barriers and facilitators) and outcomes to ensure intended benefits are realized. Implementation outcomes include acceptability, adoption, appropriateness, compliance/fidelity, feasibility, penetration, sustainability, and costs. This systematic review identified quantitative measures that are used to assess health policy implementation determinants and outcomes and evaluated the quality of these measures. METHODS Three frameworks guided the review: Implementation Outcomes Framework (Proctor et al.), Consolidated Framework for Implementation Research (Damschroder et al.), and Policy Implementation Determinants Framework (Bullock et al.). Six databases were searched: Medline, CINAHL Plus, PsycInfo, PAIS, ERIC, and Worldwide Political. Searches were limited to English language, peer-reviewed journal articles published January 1995 to April 2019. Search terms addressed four levels: health, public policy, implementation, and measurement. Empirical studies of public policies addressing physical or behavioral health with quantitative self-report or archival measures of policy implementation with at least two items assessing implementation outcomes or determinants were included. Consensus scoring of the Psychometric and Pragmatic Evidence Rating Scale assessed the quality of measures. RESULTS Database searches yielded 8417 non-duplicate studies, with 870 (10.3%) undergoing full-text screening, yielding 66 studies. From the included studies, 70 unique measures were identified to quantitatively assess implementation outcomes and/or determinants. Acceptability, feasibility, appropriateness, and compliance were the most commonly measured implementation outcomes. Common determinants in the identified measures were organizational culture, implementation climate, and readiness for implementation, each aspects of the internal setting. Pragmatic quality ranged from adequate to good, with most measures freely available, brief, and at high school reading level. Few psychometric properties were reported. CONCLUSIONS Well-tested quantitative measures of implementation internal settings were under-utilized in policy studies. Further development and testing of external context measures are warranted. This review is intended to stimulate measure development and high-quality assessment of health policy implementation outcomes and determinants to help practitioners and researchers spread evidence-informed policies to improve population health. REGISTRATION Not registered.
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Affiliation(s)
- Peg Allen
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Cole Hooley
- School of Social Work, Brigham Young University, 2190 FJSB, Provo, UT 84602 USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101 USA
| | - Kayne D. Mettert
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101 USA
| | - Caitlin N. Dorsey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101 USA
| | - Jonathan Purtle
- Department of Health Management & Policy, Drexel University Dornsife School of Public Health, Nesbitt Hall, 3215 Market St, Philadelphia, PA 19104 USA
| | - Maura M. Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Ana A. Baumann
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, 4921 Parkview Place, Saint Louis, MO 63110 USA
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Quality improvement in pediatric nephrology-a practical guide. Pediatr Nephrol 2020; 35:199-211. [PMID: 30612204 DOI: 10.1007/s00467-018-4175-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 12/16/2022]
Abstract
Improving quality of care delivery is an important focus for all practicing physicians. Frontline clinicians are in a great position to identify clinical problems and find innovative solutions. The current review describes the method used for quality improvement based on the Model for Improvement, a structural framework to guide improvement work. At its basis are three fundamental questions: What are we trying to accomplish? How will I know that a change will lead to improvement? And what changes could we make that will result in improvement? This preparation phase aims to identify and understand the problem, choose an intervention, and determine reliable measures to gauge improvement. The intervention is then tested using PLAN-DO-STUDY-ACT (PDSA) cycles, an iterative approach to systematically improve processes and outcomes. PLAN focuses on defining the goal of the cycle and describing in details what will be done. DO concentrates on the concrete application of the plan. STUDY focuses on data analyses as ACT identifies lessons learned from the cycle and orientate the goals of the following PDSA cycle. Learning from each cycle, developing an interdisciplinary team and repeated interventions are core principles involved in implementing a sustainable quality improvement program. The Model for Improvement will be illustrated by a common quality problem in pediatric nephrology.
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Tack J, Stanghellini V, Mearin F, Yiannakou Y, Layer P, Coffin B, Simren M, Mackinnon J, Wiseman G, Marciniak A. Economic burden of moderate to severe irritable bowel syndrome with constipation in six European countries. BMC Gastroenterol 2019; 19:69. [PMID: 31064345 PMCID: PMC6505116 DOI: 10.1186/s12876-019-0985-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/10/2019] [Indexed: 02/08/2023] Open
Abstract
Background Irritable bowel syndrome with predominant constipation (IBS-C) is a complex disorder with gastrointestinal and nervous system components. The study aim was to assess the economic burden of moderate to severe IBS-C in six European countries (France, Germany, Italy, Spain, Sweden and the UK). Methods An observational, one year retrospective-prospective (6 months each) study of patients diagnosed in the last five years with IBS-C (Rome III criteria) and moderate to severe disease at inclusion (IBS Symptom Severity Scale score ≥ 175). The primary objective was to assess the direct cost to European healthcare systems. Results Five hundred twenty-five patients were included, 60% (range: 43.1–78.8%) suffered from severe IBS-C. During follow-up 11.1–24.0% of patients had a hospitalisation/emergency room (ER) visit, median stay range: 1.5–12.0 days and 41.1–90.4% took prescription drugs for IBS-C. 21.4–50.8% of employed patients took sick leave (mean: 11.6–64.1 days). The mean annual direct cost to the healthcare systems was €937.1- €2108.0. The total direct cost (combined costs to healthcare systems and patient) for IBS-C was €1421.7–€2487.1. Conclusions IBS-C is not a life-threatening condition; however, it has large impact on healthcare systems and society. Direct and indirect costs for moderate to severe IBS-C were high with the largest direct cost driver being hospitalisations/ER visits.
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Affiliation(s)
- Jan Tack
- University Hospital Gasthuisberg, Leuven, Belgium. .,University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | | | | | | | | | - Benoit Coffin
- AP-HP Louis-Mourier Hospital, Colombes, and Paris Diderot University, Paris, France
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Mitchell P, Cribb A, Entwistle VA. Defining What is Good: Pluralism and Healthcare Quality. KENNEDY INSTITUTE OF ETHICS JOURNAL 2019; 29:367-388. [PMID: 31983698 PMCID: PMC7703364 DOI: 10.1353/ken.2019.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
'Quality' is a widely invoked concept in healthcare, which broadly captures how good or bad a healthcare service is. While quality has long been thought to be multidimensional, and thus constitutively plural, we suggest that quality is also plural in a further sense, namely that different conceptions of quality are appropriately invoked in different contexts, for different purposes. Conceptual diversity in the definition and specification of quality in healthcare is, we argue, not only inevitable but also valuable. To treat one conception of healthcare quality as universally definitive of good healthcare unjustifiably constrains the ways in which healthcare can be understood to be better or worse. This indicates that there are limits to the extent to which improvement activities should be coordinated or standardized across the healthcare sector. While there are good reasons to advocate greater coordination in healthcare improvement activities, harmonization efforts should not advance conceptual uniformity about quality.
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Brandrud AS, Nyen B, Hjortdahl P, Sandvik L, Helljesen Haldorsen GS, Bergli M, Nelson EC, Bretthauer M. Domains associated with successful quality improvement in healthcare - a nationwide case study. BMC Health Serv Res 2017; 17:648. [PMID: 28903723 PMCID: PMC5597987 DOI: 10.1186/s12913-017-2454-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 07/17/2017] [Indexed: 12/02/2022] Open
Abstract
Background There is a distinct difference between what we know and what we do in healthcare: a gap that is impairing the quality of the care and increasing the costs. Quality improvement efforts have been made worldwide by learning collaboratives, based on recognized continual improvement theory with limited scientific evidence. The present study of 132 quality improvement projects in Norway explores the conditions for improvement from the perspectives of the frontline healthcare professionals, and evaluates the effectiveness of the continual improvement method. Methods An instrument with 25 questions was developed on prior focus group interviews with improvement project members who identified features that may promote or inhibit improvement. The questionnaire was sent to 189 improvement projects initiated by the Norwegian Medical Association, and responded by 70% (132) of the improvement teams. A sub study of their final reports by a validated instrument, made us able to identify the successful projects and compare their assessments with the assessments of the other projects. A factor analysis with Varimax rotation of the 25 questions identified five domains. A multivariate regression analysis was used to evaluate the association with successful quality improvements. Results Two of the five domains were associated with success: Measurement and Guidance (p = 0.011), and Professional environment (p = 0.015). The organizational leadership domain was not associated with successful quality improvements (p = 0.26). Conclusion Our findings suggest that quality improvement projects with good guidance and focus on measurement for improvement have increased likelihood of success. The variables in these two domains are aligned with improvement theory and confirm the effectiveness of the continual improvement method provided by the learning collaborative. High performing professional environments successfully engaged in patient-centered quality improvement if they had access to: (a) knowledge of best practice provided by professional subject matter experts, (b) knowledge of current practice provided by simple measurement methods, assisted by (c) improvement knowledge experts who provided useful guidance on measurement, and made the team able to organize the improvement efforts well in spite of the difficult resource situation (time and personnel). Our findings may be used by healthcare organizations to develop effective infrastructure to support improvement and to create the conditions for making quality and safety improvement a part of everyone’s job. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2454-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aleidis Skard Brandrud
- Quality Department, Vestre Viken Health Trust, Wergelandsgate 10, Postbox 800, 3004, Drammen, Norway.
| | - Bjørnar Nyen
- Municipality of Porsgrunn, Porstbox 128, N-3901, Porsgrunn, Norway
| | - Per Hjortdahl
- Department of Family Medicine, Faculty of Medicine, University of Oslo, PO Box 1130, Blindern, NO-0318, Oslo, Norway
| | - Leiv Sandvik
- Oslo Center for Biostatistics and Epidemiology, Research support Services, Oslo University Hospital, Sogn Arena, Klaus Torgaards vei 3, 0372, Oslo, Norway
| | | | - Maria Bergli
- Quality Department, Vestre Viken Health Trust, Wergelandsgate 10, Postbox 800, 3004, Drammen, Norway
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 30 Lafayette Street, Lebanon, NH, USA
| | - Michael Bretthauer
- Department of Health and Society, Faculty of Medicine, University of Oslo, PO Box 1130, Blindern, NO-0318, Oslo, Norway
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El-Jardali F, Fadlallah R. A review of national policies and strategies to improve quality of health care and patient safety: a case study from Lebanon and Jordan. BMC Health Serv Res 2017; 17:568. [PMID: 28814341 PMCID: PMC5559834 DOI: 10.1186/s12913-017-2528-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background Improving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems. Methods We used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources. Results Both Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking. Importantly, incentive systems that link contractual agreement, regulations, accreditation, and performance indicators are underutilized in Lebanon and absent in Jordan. At the healthcare organizational level, there is a need to instill a culture of continuous quality improvement and promote professional training in quality improvement and patient safety. Conclusion Study findings highlight the importance of aligning policies, organizations, methods, capacities and resources in order to institutionalize quality improvement and patient safety practices in health systems. Gaps and dysfunctions identified can help inform national deliberations and dialogues among key stakeholders in each study country. Findings can also inform future quality improvement efforts in the EMR and beyond, with a particular emphasis on LMICs. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2528-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fadi El-Jardali
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon. .,Center for Systematic Review in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
| | - Racha Fadlallah
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon.,Center for Systematic Review in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
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Hut-Mossel L, Welker G, Ahaus K, Gans R. Understanding how and why audits work: protocol for a realist review of audit programmes to improve hospital care. BMJ Open 2017; 7:e015121. [PMID: 28615270 PMCID: PMC5541620 DOI: 10.1136/bmjopen-2016-015121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/24/2017] [Accepted: 03/01/2017] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Many types of audits are commonly used in hospital care to promote quality improvements. However, the evidence on the effectiveness of audits is mixed. The objectives of this proposed realist review are (1) to understand how and why audits might, or might not, work in terms of delivering the intended outcome of improved quality of hospital care and (2) to examine under what circumstances audits could potentially be effective. This protocol will provide the rationale for using a realist review approach and outline the method. METHODS AND ANALYSIS This review will be conducted using an iterative four-stage approach. The first and second steps have already been executed. The first step was to develop an initial programme theory based on the literature that explains how audits are supposed to work. Second, a systematic literature search was conducted using relevant databases. Third, data will be extracted and coded for concepts relating to context, outcomes and their interrelatedness. Finally, the data will be synthesised in a five-step process: (1) organising the extracted data into evidence tables, (2) theming, (3) formulating chains of inference from the identified themes, (4) linking the chains of inference and formulating CMO configurations and (5) refining the initial programme theory. The reporting of the review will follow the 'Realist and Meta-Review Evidence Synthesis: Evolving Standards' (RAMESES) publication standards. ETHICS AND DISSEMINATION This review does not require formal ethical approval. A better understanding of how and why these audits work, and how context impacts their effectiveness, will inform stakeholders in deciding how to tailor and implement audits within their local context. We will use a range of dissemination strategies to ensure that findings from this realist review are broadly disseminated to academic and non-academic audiences. PROSPERO REGISTRATION NUMBER CRD42016039882.
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Affiliation(s)
- Lisanne Hut-Mossel
- University of Groningen, University Medical Centre Groningen, Centre of Expertise on Quality and Safety, Groningen, The Netherlands
| | - Gera Welker
- University of Groningen, University Medical Centre Groningen, Centre of Expertise on Quality and Safety, Groningen, The Netherlands
| | - Kees Ahaus
- University of Groningen, University Medical Centre Groningen, Centre of Expertise on Quality and Safety, Groningen, The Netherlands
- Department Operations, University of Groningen, Faculty of Economics and Business, Groningen, The Netherlands
| | - Rijk Gans
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Manser T, Imhof M, Lessing C, Briner M. A cross-national comparison of incident reporting systems implemented in German and Swiss hospitals. Int J Qual Health Care 2017; 29:349-359. [PMID: 28340184 DOI: 10.1093/intqhc/mzx030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/22/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This study aimed to empirically compare incident reporting systems (IRS) in two European countries and to explore the relationship of IRS characteristics with context factors such as hospital characteristics and characteristics of clinical risk management (CRM). DESIGN We performed exploratory, secondary analyses of data on characteristics of IRS from nationwide surveys of CRM practices. SETTING The survey was originally sent to 2136 hospitals in Germany and Switzerland. PARTICIPANTS Persons responsible for CRM in 622 hospitals completed the survey (response rate 29%). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Differences between IRS in German and Swiss hospitals were assessed using Chi2, Fisher's Exact and Freeman-Halton-Tests, as appropriate. To explore interrelations between IRS characteristics and context factors (i.e. hospital and CRM characteristics) we computed Cramer's V. RESULTS Comparing participating hospitals across countries, Swiss hospitals had implemented IRS earlier, more frequently and more often provided introductory IRS training systematically. German hospitals had more frequently systematically implemented standardized procedures for event analyses. IRS characteristics were significantly associated with hospital characteristics such as hospital type as well as with CRM characteristics such as existence of strategic CRM objectives and of a dedicated position for central CRM coordination. CONCLUSIONS This study contributes to an improved understanding of differences in the way IRS are set up in two European countries and explores related context factors. This opens up new possibilities for empirically informed, strategic interventions to further improve dissemination of IRS and thus support hospitals in their efforts to move patient safety forward.
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Affiliation(s)
- Tanja Manser
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Michael Imhof
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | | | - Matthias Briner
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland.,Lucerne School of Business, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
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Søgaard R, Enemark U. The cost-quality relationship in European hospitals: a systematic review. J Health Serv Res Policy 2017; 22:126-133. [PMID: 28429978 DOI: 10.1177/1355819616682283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective To determine the relationship between cost and quality in European hospitals. Methods Juran's cost-quality curve served as a theoretical framework, linked to basic efficiency concepts. Based on systematic database searches, citation searches and cross-referencing, we identify 1093 empirical studies. After exclusion of studies from outside Europe (699), non-hospital settings (10 studies), lack of a cost parameter (194) or a quality parameter (27 studies), 22 studies (28 analyses) were assessed for direction of association and methodological heterogeneity. Results There was evidence of positive, negative, two-directional and no association between cost and quality. We examined whether diagnosis, procedure, type of quality measure and specification of the econometric model could explain the inconsistent evidence, but no clear explanation is identified. Despite the significant policy relevance, evidence on the relationship between costs and quality is limited. The literature is characterized by substantial methodological heterogeneity and lack of explicit definitions of the chosen cost and quality parameters, the econometric model and the underlying hypothesis for the cost-quality relationship. Conclusion It has been more than 60 years since Juran introduced the idea of failure costs, which implied that the marginal costs of quality could be non-constant. It seems imperative to acknowledge this idea in future studies.
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Affiliation(s)
- Rikke Søgaard
- 1 Department of Public Health and Department of Clinical Medicine, Aarhus University, Denmark
| | - Ulrika Enemark
- 2 Department of Public Health, Aarhus University, Denmark
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21
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Manser T, Frings J, Heuser G, Mc Dermott F. The German clinical risk management survey for hospitals: Implementation levels and areas for improvement in 2015. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 114:28-38. [PMID: 27566267 DOI: 10.1016/j.zefq.2016.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Despite the growing recognition of the need to implement systematic approaches for managing the risks associated with healthcare, few studies have investigated the level of implementation for clinical risk management (CRM) at a national level. Therefore, this study aimed to assess the current level of CRM implementation in German hospitals and to explore differences across hospital types. METHODS From March to June 2015, persons responsible for CRM in 2,617 hospitals and rehabilitation clinics in Germany were invited to participate in a voluntary online survey assessing the level of implementation for various aspects of CRM: CRM strategy, structures and processes; risk assessment (risk identification, risk analysis, risk evaluation) with a focus on incident reporting systems; risk mitigation measures; and risk monitoring and reporting. RESULTS 572 hospitals participated in the survey (response rate 22 %). Most of these hospitals had a formalised, binding CRM strategy (72 %). 66 % had a centralised and 34 % a decentralised CRM structure. We also found that, despite a broad range of risk assessment methods being applied, there was a lack of integration of risk information from different data sources. Hospitals also reported a high level of implementation of critical incident reporting systems with a strong preference for local (74 %) over transorganisational systems. DISCUSSION AND CONCLUSION This study provides relevant data to inform targeted interventions concerning CRM implementation at a national level and to consider the specific context of different types of hospitals more carefully in this process. The approach to CRM assessment illustrated in this article could be the basis of a system for monitoring CRM over time and, thus, for evaluating the impact of strategy decisions at the policy level on CRM development.
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Affiliation(s)
- Tanja Manser
- University Hospital Bonn, Institute for Patient Safety, Bonn, Germany.
| | - Janina Frings
- University Hospital Bonn, Institute for Patient Safety, Bonn, Germany
| | - Gregory Heuser
- University Hospital Bonn, Institute for Patient Safety, Bonn, Germany
| | - Fiona Mc Dermott
- University Hospital Bonn, Institute for Patient Safety, Bonn, Germany
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Janamian T, Upham SJ, Crossland L, Jackson CL. Quality tools and resources to support organisational improvement integral to high-quality primary care: a systematic review of published and grey literature. Med J Aust 2016; 204:S22-8. [PMID: 27078788 DOI: 10.5694/mja16.00113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/18/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To conduct a systematic review of the literature to identify existing online primary care quality improvement tools and resources to support organisational improvement related to the seven elements in the Primary Care Practice Improvement Tool (PC-PIT), with the identified tools and resources to progress to a Delphi study for further assessment of relevance and utility. STUDY DESIGN Systematic review of the international published and grey literature. DATA SOURCES CINAHL, Embase and PubMed databases were searched in March 2014 for articles published between January 2004 and December 2013. GreyNet International and other relevant websites and repositories were also searched in March-April 2014 for documents dated between 1992 and 2012. STUDY SELECTION All citations were imported into a bibliographic database. Published and unpublished tools and resources were included in the review if they were in English, related to primary care quality improvement and addressed any of the seven PC-PIT elements of a high-performing practice. Tools and resources that met the eligibility criteria were then evaluated for their accessibility, relevance, utility and comprehensiveness using a four-criteria appraisal framework. DATA EXTRACTION AND SYNTHESIS We used a data extraction template to systematically extract information from eligible tools and resources. A content analysis approach was used to explore the tools and resources and collate relevant information: name of the tool or resource, year and country of development, author, name of the organisation that provided access and its URL, accessibility information or problems, overview of each tool or resource and the quality improvement element(s) it addresses. If available, a copy of the tool or resource was downloaded into the bibliographic database, along with supporting evidence (published or unpublished) on its use in primary care. CONCLUSIONS This systematic review identified 53 tools and resources that can potentially be provided as part of a suite of tools and resources to support primary care practices in improving the quality of their practice, to achieve improved health outcomes.
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Affiliation(s)
- Tina Janamian
- Discipline of General Practice, Centre of Research Excellence – Building Primary Care Quality, Performance and Sustainability via Research Co-Creation, University of Queensland, Brisbane, QLD
| | - Susan J Upham
- Discipline of General Practice, Centre of Research Excellence – Building Primary Care Quality, Performance and Sustainability via Research Co-Creation, University of Queensland, Brisbane, QLD
| | - Lisa Crossland
- Discipline of General Practice, Centre of Research Excellence – Building Primary Care Quality, Performance and Sustainability via Research Co-Creation, University of Queensland, Brisbane, QLD
| | - Claire L Jackson
- Discipline of General Practice, Centre of Research Excellence – Building Primary Care Quality, Performance and Sustainability via Research Co-Creation, University of Queensland, Brisbane, QLD
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What do patients value in the hospital meal experience? Appetite 2016; 96:293-298. [DOI: 10.1016/j.appet.2015.09.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 11/20/2022]
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Abstract
PURPOSE The purpose of this paper is to explore regulation in India's healthcare sector and makes recommendations needed for enhancing the healthcare service. DESIGN/METHODOLOGY/APPROACH The literature was reviewed to understand healthcare's regulatory context. To understand the current healthcare system, qualitative data were collected from state-level officials, public and private hospital staff. A patient survey was performed to assess service quality (QoS). FINDINGS Regulation plays a central role in driving healthcare QoS. India needs to strengthen market and institutional co-production based approaches for steering its healthcare in which delivery processes are complex and pose different challenges. RESEARCH LIMITATIONS/IMPLICATIONS This study assesses current healthcare regulation in an Indian state and presents a framework for studying and strengthening regulation. Agile regulation should be based on service delivery issues (pull approach) rather than monitoring and sanctions based regulatory environment (push approach). PRACTICAL IMPLICATIONS Healthcare pitfalls across the world seem to follow similar follies. India's complexity and experience is useful for emerging and developed economies. ORIGINALITY/VALUE The author reviewed around 70 publications and synthesised them in healthcare regulatory contexts. Patient's perception of private providers could be a key input towards steering regulation. Identifying gaps across QoS dimensions would be useful in taking corrective measures.
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Affiliation(s)
- Gyan Prakash
- Department of Management, ABV - Indian Institute of Information Technology and Management, Gwalior, India
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Hungerford C, Kench P. Standards and Standardization. PROFESSIONAL AND PRACTICE-BASED LEARNING 2015. [DOI: 10.1007/978-94-017-9502-9_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Sax S, Marx M. Local perceptions on factors influencing the introduction of international healthcare accreditation in Pakistan. Health Policy Plan 2013; 29:1021-30. [PMID: 24226171 DOI: 10.1093/heapol/czt084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
One contributor to poor health outcomes in developing countries is weak health systems; key to strengthening them are interventions to improve quality of health services. Though the value of healthcare accreditation is increasingly recognized, there are few case studies exploring its adaptation in developing countries. The aim of our study in Pakistan was to identify perceived factors influencing the adaptation of international healthcare accreditation within a developing country context. We used qualitative methods including semi-structured interviews, a structured group discussion, focus groups and non-participant observation of management meetings. Data analysis used a grounded theory approach and a conceptual framework adapted from implementation science. Using our conceptual framework categories of 'inner' and 'outer' setting, we found six perceived inner health system factors that could influence the introduction of healthcare accreditation and two 'outer' setting factors, perceived as external to the health system but able to influence its introduction. Our research identified that there is no 'one size fits all' approach to introducing healthcare accreditation as a means to improve healthcare quality. Those planning to support healthcare accreditation, such as national and provincial ministries and international development partners, need to understand how the three components of healthcare accreditation fit into the local health system and into the broader political and social environment. In our setting this included moving to supportive and transparent external evaluation mechanisms, with a first step of using locally developed and agreed standards. In addition, sustainable implementation of the three components was seen as a major challenge, especially establishment of a well-managed, transparent accreditation agency able to lead processes such as training and support for peer surveyors. Consideration of local change mechanisms and cultural practices is important in designing a local accreditation approach. The results of our study are important for health systems strengthening in Pakistan and in other developing countries.
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Affiliation(s)
- Sylvia Sax
- Institute of Public Health, University of Heidelberg, INF 324 69120 Heidelberg, Germany
| | - Michael Marx
- Institute of Public Health, University of Heidelberg, INF 324 69120 Heidelberg, Germany
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The emerging EU quality of care policy: From sharing information to enforcement. Health Policy 2013; 111:226-33. [DOI: 10.1016/j.healthpol.2013.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 05/07/2013] [Accepted: 05/10/2013] [Indexed: 11/19/2022]
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Bell E, Seidel B. Understanding and benchmarking health service achievement of policy goals for chronic disease. BMC Health Serv Res 2012; 12:343. [PMID: 23020943 PMCID: PMC3536573 DOI: 10.1186/1472-6963-12-343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 09/21/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Key challenges in benchmarking health service achievement of policy goals in areas such as chronic disease are: 1) developing indicators and understanding how policy goals might work as indicators of service performance; 2) developing methods for economically collecting and reporting stakeholder perceptions; 3) combining and sharing data about the performance of organizations; 4) interpreting outcome measures; 5) obtaining actionable benchmarking information. This study aimed to explore how a new Boolean-based small-N method from the social sciences-Qualitative Comparative Analysis or QCA-could contribute to meeting these internationally shared challenges. METHODS A 'multi-value QCA' (MVQCA) analysis was conducted of data from 24 senior staff at 17 randomly selected services for chronic disease, who provided perceptions of 1) whether government health services were improving their achievement of a set of statewide policy goals for chronic disease and 2) the efficacy of state health office actions in influencing this improvement. The analysis produced summaries of configurations of perceived service improvements. RESULTS Most respondents observed improvements in most areas but uniformly good improvements across services were not perceived as happening (regardless of whether respondents identified a state health office contribution to that improvement). The sentinel policy goal of using evidence to develop service practice was not achieved at all in four services and appears to be reliant on other kinds of service improvements happening. CONCLUSIONS The QCA method suggested theoretically plausible findings and an approach that with further development could help meet the five benchmarking challenges. In particular, it suggests that achievement of one policy goal may be reliant on achievement of another goal in complex ways that the literature has not yet fully accommodated but which could help prioritize policy goals. The weaknesses of QCA can be found wherever traditional big-N statistical methods are needed and possible, and in its more complex and therefore difficult to empirically validate findings. It should be considered a potentially valuable adjunct method for benchmarking complex health policy goals such as those for chronic disease.
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Affiliation(s)
- Erica Bell
- University Department of Rural Health, University of Tasmania, Burnie, Tasmania, Australia
| | - Bastian Seidel
- Discipline of General Practice, University of Tasmania, Burnie, Tasmania, Australia
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Legido-Quigley H, Panteli D, Brusamento S, Knai C, Saliba V, Turk E, Solé M, Augustin U, Car J, McKee M, Busse R. Clinical guidelines in the European Union: mapping the regulatory basis, development, quality control, implementation and evaluation across member states. Health Policy 2012; 107:146-56. [PMID: 22939646 DOI: 10.1016/j.healthpol.2012.08.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 06/05/2012] [Accepted: 08/07/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Clinical guidelines are advocated to improve the quality of care, especially for chronic diseases. However, the regulatory basis of clinical guidelines, their development, quality control, implementation and use as well as evaluation within countries across the European Union is not systematically known. METHODS Using information collected from key informants in each country by means of a structured questionnaire, this mapping exercise illustrates the varied status of guideline production in European Union countries. RESULTS Most European Union countries have an established national, regional or local clinical guideline programme, and a substantial proportion have developed guidelines on the prevention and management of chronic diseases. Several countries have mechanisms in place to ensure the quality of scientific evidence used for the development of guidelines is high and that the process is consistent and transparent. Others are only now taking an interest in guideline development and are taking the first steps towards establishing ways of implementing them. The majority of countries have no legal basis for the development of guidelines and those that have well established systems mostly implement them on a voluntary basis. The process of guideline development varies in its degrees of decentralisation across countries with many different types of organisations taking on this responsibility. There is general acceptance of the value of the instrument developed by the AGREE collaboration for evaluating the methodological robustness of guidelines. However, the extent to which guidelines are implemented in Europe is unknown, as there is no systematic data collection and, in most countries, no structure to enable it. There are few examples of formal evaluations of the development, quality, implementation and use of guidelines. CONCLUSIONS Our findings call for renewed efforts to respond to the severe lack of standardized guideline terminology and accessibility as well as rigorous studies to evaluate the relationship between different ways to develop guidelines and their methodological quality, between their quality and the actual implementation and usage, and finally between implementation and health outcomes.
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Affiliation(s)
- Helena Legido-Quigley
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Baylina P, Moreira P. Healthcare-associated infections – on developing effective control systems under a renewed healthcare management debate. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2012. [DOI: 10.1179/2047970012z.00000000018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Elg M, Witell L, Poksinska B, Engström J, Mi Dahlgaard‐Park S, Kammerlind P. Solicited diaries as a means of involving patients in development of healthcare services. INTERNATIONAL JOURNAL OF QUALITY AND SERVICE SCIENCES 2011. [DOI: 10.1108/17566691111146050] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Donnelly LF, Anderson JM. Administrative Simplicity: An Important Component of Health Care Delivery. J Am Coll Radiol 2010; 7:364-8. [DOI: 10.1016/j.jacr.2009.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 11/10/2009] [Indexed: 10/19/2022]
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Suñol R, Vallejo P, Thompson A, Lombarts MJMH, Shaw CD, Klazinga N. Impact of quality strategies on hospital outputs. Qual Saf Health Care 2009; 18 Suppl 1:i62-8. [PMID: 19188464 PMCID: PMC2629927 DOI: 10.1136/qshc.2008.029439] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project on patients crossing borders, a study to investigate quality improvement strategies in healthcare systems across the European Union (EU). AIM To explore the association between the implementation of quality improvement strategies in hospitals and hospitals' success in meeting defined quality requirements that are considered intermediate outputs of the care process. METHODS Data regarding the implementation of seven quality improvement strategies (accreditation, organisational quality management programmes, audit and internal assessment of clinical standards, patient safety systems, clinical practice guidelines, performance indicators and systems for obtaining patients' views) and four dimensions of outputs (clinical, safety, patient-centredness and cross-border patient-centredness) were collected from 389 acute care hospitals in eight EU countries using a web-based questionnaire. In a second phase, 89 of these hospitals participated in an on-site audit by independent surveyors. Pearson correlation and linear regression models were used to explore associations and relations between quality improvement strategies and achievement of outputs. RESULTS Positive associations were found between six internal quality improvement strategies and hospital outputs. The quality improvement strategies could be reasonably subsumed under one latent index which explained about half of their variation. The analysis of outputs concluded that the outputs can also be considered part of a single construct. The findings indicate that the implementation of internal as well as external quality improvement strategies in hospitals has beneficial effects on the hospital outputs studied here. CONCLUSION The implementation of internal quality improvement strategies as well as external assessment systems should be promoted.
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Affiliation(s)
- R Suñol
- Avedis Donabedian Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona 08037, Spain.
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Suñol R, Garel P, Jacquerye A. Cross-border care and healthcare quality improvement in Europe: the MARQuIS research project. Qual Saf Health Care 2009; 18 Suppl 1:i3-7. [PMID: 19188459 PMCID: PMC2629851 DOI: 10.1136/qshc.2008.029678] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Citizens are increasingly crossing borders within the European Union (EU). Europeans have always been free to travel to receive care abroad, but if they wished to benefit from their statutory social protection scheme, they were subject to their local or national legislation on social protection. This changed in 1991 with the European Court of Justice defining healthcare as a service, starting a debate on the right balance between different principles in European treaties: movement of persons, goods and services, versus the responsibility of member states to organise their healthcare systems. Simultaneously, cross-border cooperation has developed between member states. In this context, patient mobility has become a relevant issue on the EU’s agenda. The EU funded a number of Scientific Support to Policies (SSP) activities within the Sixth Framework Programme, to provide the evidence needed by EU policy makers to deal with issues that European citizens face due to enhanced mobility in Europe. One SSP project “Methods of Assessing Response to Quality Improvement Strategies” (MARQuIS), focused on cross-border care. It aimed to assess the value of different quality strategies, and to provide information needed when: (1) countries contract care for patients moving across borders; and (2) individual hospitals review the design of their quality strategies. This article describes the European context related to healthcare, and its implications for cross-border healthcare in Europe. The background information demonstrates a need for further research and development in this area.
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Affiliation(s)
- R Suñol
- Avedis Donabedian Institute, Autonomous University of Barcelona, and CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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Vallejo P, Suñol R. MARQulS: quality improvement strategies for European cross-border healthcare. Qual Saf Health Care 2009; 18 Suppl 1:i1-2. [PMID: 19188455 PMCID: PMC2629852 DOI: 10.1136/qshc.2008.032110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P Vallejo
- Avedis Donabedian University Institute-Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Provença 2963, Barcelona, Spain.
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Groene O, Lombarts MJMH, Klazinga N, Alonso J, Thompson A, Suñol R. Is patient-centredness in European hospitals related to existing quality improvement strategies? Analysis of a cross-sectional survey (MARQuIS study). Qual Saf Health Care 2009; 18 Suppl 1:i44-50. [PMID: 19188461 PMCID: PMC2629879 DOI: 10.1136/qshc.2008.029397] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2008] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is growing recognition of patients' contributions to setting objectives for their own care, improving health outcomes and evaluating care. OBJECTIVE To quantify the extent to which European hospitals have implemented strategies to promote a patient-centred approach, and to assess whether these strategies are associated with hospital characteristics and the development of the hospital's quality improvement system. DESIGN Cross-sectional survey of 351 European hospital managers and professionals. MAIN OUTCOME MEASURES Patients' rights, patient information and empowerment, patient involvement in quality management, learning from patients, and patient hotel services at the hospital and ward level were assessed. The hypothesis that the implementation of strategies to improve patient-centredness is associated with hospital characteristics, including maturity of the hospital's quality management system, was tested using binary logistic regression. RESULTS In general, hospitals reported high implementation of policies for patients' rights (85.5%) and informed consent (93%), whereas strategies to involve patients (71%) and learn from their experience (66%) were less frequently implemented. For 13 out of 18 hospital strategies, institutions with a more developed quality improvement system consistently reported better results (percentage differences within maturity classification ranged from 12.4% to 46.6%). The strength of association between implementation of patient-centredness strategies and the quality improvement system, however, seemed lower at the ward than at the hospital level. Some associations (OR 2.1 to 5.1) disappeared or were weaker after adjustment for potential confounding variables (OR 2.2 to 3.7). CONCLUSIONS Although quality improvement systems seem to be effective with regard to the implementation of selected patient-centredness strategies, they seem to be insufficient to ensure widespread implementation of patient-centredness throughout the organisation.
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Affiliation(s)
- O Groene
- Avedis Donabedian University Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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Groene O, Klazinga N, Walshe K, Cucic C, Shaw CD, Suñol R. Learning from MARQuIS: future direction of quality and safety in hospital care in the European Union. Qual Saf Health Care 2009; 18 Suppl 1:i69-74. [PMID: 19188465 PMCID: PMC2629925 DOI: 10.1136/qshc.2008.029447] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This article summarises the significant lessons to be drawn from, and the policy implications of, the findings of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project--a part of the suite of research projects intended to support policy established by the European Commission through its Sixth Framework Programme. The article first reviews the findings of MARQuIS and their implications for healthcare providers (and particularly for hospitals), and then addresses the broader policy implications for member states of the European Union (EU) and for the commission itself. Against the background of the European Commission's Seventh Framework Programme, it then outlines a number of future areas for research to inform policy and practice in quality and safety in Europe. The article concludes that at this stage, a unique EU-wide quality improvement system for hospitals does not seem to be feasible or effective. Because of possible future community action in this field, attention should focus on the use of existing research on quality and safety strategies in healthcare, with the aim of combining soft measures to accelerate mutual learning. Concrete measures should be considered only in areas for which there is substantial evidence and effective implementation can be ensured.
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Affiliation(s)
- O Groene
- Avedis Donabedian University Institute, UAB, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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Lombarts MJMH, Rupp I, Vallejo P, Suñol R, Klazinga NS. Application of quality improvement strategies in 389 European hospitals: results of the MARQuIS project. Qual Saf Health Care 2009; 18 Suppl 1:i28-37. [PMID: 19188458 PMCID: PMC3269892 DOI: 10.1136/qshc.2008.029363] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2008] [Indexed: 11/03/2022]
Abstract
CONTEXT This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project investigating the impact of quality improvement strategies on hospital care in various countries of the European Union (EU), in relation to specific needs of cross-border patients. AIM This paper describes how EU hospitals have applied seven quality improvement strategies previously defined by the MARQuIS study: organisational quality management programmes; systems for obtaining patients' views; patient safety systems; audit and internal assessment of clinical standards; clinical and practice guidelines; performance indicators; and external assessment. METHODS A web-based questionnaire was used to survey acute care hospitals in eight EU countries. The reported findings were later validated via on-site survey and site visits in a sample of the participating hospitals. Data collection took place from April to August 2006. RESULTS 389 hospitals participated in the survey; response rates varied per country. All seven quality improvement strategies were widely used in European countries. Activities related to external assessment were the most broadly applied across Europe, and activities related to patient involvement were the least widely implemented. No one country implemented all quality strategies at all hospitals. There were no differences between participating hospitals in western and eastern European countries regarding the application of quality improvement strategies. CONCLUSIONS Implementation varied per country and per quality improvement strategy, leaving considerable scope for progress in quality improvements. The results may contribute to benchmarking activities in European countries, and point to further areas of research to explore the relationship between the application of quality improvement strategies and actual hospital performance.
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Affiliation(s)
- M J M H Lombarts
- Academic Medical Center, Department of Social Medicine, University of Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, the Netherlands.
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