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Cortellazzi P, Carini D, Bolzoni L, Cattadori E, Randi V. Emilia-Romagna Regional Blood System accreditation as an example of improvement through application of specific requirements: a retrospective analysis. BMJ Open Qual 2021; 10:bmjoq-2021-001408. [PMID: 34810202 PMCID: PMC8609938 DOI: 10.1136/bmjoq-2021-001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Institutional accreditation in Italy represents the license given by a region to a public or private facility to provide services in the name and on behalf of the National Health Service. This study aims to evaluate the improvement of the Emilia-Romagna Regional Blood System and to highlight its unresolved issues, analysing non-conformities observed during accreditation and maintenance inspections between 2013 and 2018. METHODS All the Emilia-Romagna Regional Blood facilities were invited to participate in this study voluntarily and anonymously. Participants had to access a web application that we developed specifically. For each of the three inspections evaluated in this study, they had to enter data about the state of their organisation branches and non-conformities observed by regional inspectors. All data entered were finally exported from the web application database and analysed with spreadsheets. Statistical analysis was performed using Wilcoxon signed-rank test with continuity correction. RESULTS 17 structures took part in the study, with a total of 174 organisation branches. The number of branches changed over the years because of new openings and closures due to reorganisations or non-conformities that were too difficult to correct. Inspectors observed 2381 non-conformities (291 structural, 611 technological and 1479 organisational). As a result of accreditation inspections and consequent improvement actions, non-conformities were reduced by 88%. The most frequent non-conformities concerned the management software and the transportation of blood and blood components. CONCLUSION An improvement in the Emilia-Romagna Regional Blood System over time is evident: institutional accreditation certainly pushed it to change and overcome its problems to comply with specific requirements. The remaining non-conformities after the three inspections were mostly organisational and management software was the most critical issue. Despite these non-conformities, all currently active structures are accredited and guarantee high standards of quality and safety of products and services.
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Affiliation(s)
| | - Davide Carini
- Immunohaematology and Transfusion Medicine Unit, Azienda USL di Piacenza, Piacenza, Italy
| | - Luana Bolzoni
- Quality and Research Unit, Azienda USL di Piacenza, Piacenza, Italy
| | | | - Vanda Randi
- Regional Blood Centre, Emilia-Romagna Region, Bologna, Italy
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Shaqura II, Gholami M, Sari AA. Evaluation of performance at Palestinian public hospitals using Pabón Lasso model. Int J Health Plann Manage 2021; 36:896-910. [PMID: 33657261 DOI: 10.1002/hpm.3124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/09/2020] [Accepted: 01/17/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hospitals have a paramount role in provision of health care services, which in turn significantly impacts the performance of any health system, especially in developing countries. AIM This study aimed to evaluate the performance of the Ministry of Health general hospitals in Gaza according to their surgical and internal medicine departments during a 3-year period (2016, 2017 and 2018) using Pabón Lasso model. METHOD This descriptive study includes the overall public general hospitals in Gaza Strip (7). Data have been collected from the officially disseminated reports, mainly about average length of stay, bed occupancy rate, and bed turnover ratio in the surgical and internal medicine departments for the study period. Pabón Lasso charts have been drawn using MS Excel 2013. RESULTS AND CONCLUSION For surgical departments, about 42.8% were efficient (zone 3) during the 3 years, while, 42.8% were inefficient (zone 1). Only one hospital was relatively efficient (zone 4) in 2017 and 2018. Regarding internal medicine departments, 28.6%-42.8% of hospitals were efficient during the study period, 14.3%-42.8% were inefficient, and 28.6%-42.8% were relatively efficient (zone 2 and 4). It is recommended to count on such type of analysis in decision-making and identify obstacles for best utilization of the available resources. Inefficiency in hospitals serves as a good opportunity for resources mobilization or innovation in demand-creating interventions, thereby, regular evaluation of resources' distribution. Further research is required by applying frontier techniques of efficiency measurement.
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Affiliation(s)
- Iyad Ibrahim Shaqura
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Gholami
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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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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4
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Johannesen DTS, Lindøe PH, Wiig S. Certification as support for resilience? Behind the curtains of a certification body - a qualitative study. BMC Health Serv Res 2020; 20:730. [PMID: 32771012 PMCID: PMC7414657 DOI: 10.1186/s12913-020-05608-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Certification in healthcare often involves independent private sector bodies performing legally required or voluntary external assurance activities. These certification practices are embedded in international standards founded in traditional beliefs about rational and predictable processes for quality and safety improvement. Certification can affect organizational and cultural changes, support collaboration and encourage improvement that may be conducive to resilient performance. This study explores whether ISO 9001 quality management system certification can support resilience in healthcare, by looking at characteristics in the objectives, methods, and practice of certification from a certification body's perspective. METHODS One of Norway's four certification bodies in healthcare was studied, using an explorative embedded single-case design. The study relies on document analysis of the international standards and associated guidances for the performance of certification bodies and thematic analyses of data from 60 h of observations of auditors in three certification processes and nine qualitative interviews with managers and personnel from the certification body. Results from the analyses were compared to identify discrepancies between the written and perceived certification approach and practice. RESULTS Standards and guidances for certification embed an elasticity between formal and consistent assessments of nonconformities in organizations and emphasize holistic approaches that brings added value. Auditors were then left with the latitude to navigate their auditing strategy during interaction with the auditees. Members of the certification body perceived and practiced a holistic and flexible auditing approach using opportunities to share knowledge, empower and make guidance for improvement. CONCLUSIONS ISO certification expects structures and systems to ensure consistent and objective certification processes. At the same time, it embodies a latitude to adopt flexible and context-specific certification approaches, as demonstrated by a certification body in this study, to give added value to the certified organizations. Such an ISO 9001 certification approach may support resilient performance in healthcare by nurturing the potential to respond and learn. These results are important for further development of methods that certification bodies use in the auditing encounter.
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Affiliation(s)
- Dag Tomas Sagen Johannesen
- Department of Media and Social Sciences, The Faculty of Social Sciences, University of Stavanger, 4036, Stavanger, Norway. .,Department of Health and Nursing Science, University of Agder, 4604, Kristiansand, Norway. .,SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
| | - Preben Hempel Lindøe
- Department of Safety, Economics and Planning, Faculty of Science and Technology, University of Stavanger, 4036, Stavanger, Norway
| | - Siri Wiig
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
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Johannesen DTS, Wiig S. Exploring hospital certification processes from the certification body's perspective - a qualitative study. BMC Health Serv Res 2020; 20:242. [PMID: 32293437 PMCID: PMC7092463 DOI: 10.1186/s12913-020-05093-w] [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: 01/04/2019] [Accepted: 03/09/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hospital certification is an external assessment mechanism to assure quality and safety systems. Auditors representing the certification body play a key role in certification processes, as they perform the assessment activities and interact with the involved healthcare organizations. There is limited knowledge about the approaches and methods that auditors use, such as role repertoire, conduct, and assessment practice. The purpose of this study was to explore auditors' practice in hospital certification processes, guided by the following research questions: What styles do auditors apply in hospital certification processes, and how do auditors perceive their role in hospital certification processes? METHODS The study was performed in two stages. In the first stage, non-participant observations (59 h) were conducted, to explore the professional practice of three lead auditors in certification processes of Norwegian hospitals. In the second stage, semi-structured interviews were conducted with these three observed lead auditors. The role repertoires and conducts identified were analyzed by using a deductive approach according to a surveyor (equivalent with auditor) styles typology framework. RESULTS Two distinct auditor styles ("explorer" and "discusser") were identified among the three studied auditors. Both styles were characterized by their preference for an opportunistic and less structured type of interview practice during certification audits. All three auditors embedded a guiding approach (reflections about findings, stimulate improvements, experience transfer from other industries) to their perception and practice of certification audits, interacting with the auditees. The use of group interviews instead of individual interviews during certification audits, was the rule of their professional practice. CONCLUSION The auditors' perceptions and styles demonstrated a multifaceted certification reality, in contrast to what is often presumed as consistent, stringent and independent practices. These findings may have implications for reliability judgements when developing hospital certification programs, and for the refinement of the current framework used here to study the different auditing practices.
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Affiliation(s)
- Dag Tomas Sagen Johannesen
- Department of Economic, risk management and planning, University of Stavanger, 4036 Stavanger, Norway
- Department of Health and Nursing Science, University of Agder, 4604 Kristiansand, Norway
- SHARE-Center for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Siri Wiig
- SHARE-Center for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
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Park JS, Ahn HK, Na J, Lee HH, Yoon YE, Yoon MG, Han WK. Cumulative sum analysis of learning curve for video-assisted mini-laparotomy partial nephrectomy in renal cell carcinoma. Medicine (Baltimore) 2019; 98:e15367. [PMID: 31027124 PMCID: PMC6831345 DOI: 10.1097/md.0000000000015367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Video-assisted mini-laparotomy surgery (VAMS), a hybrid of open and laparoscopic surgical techniques, is an important surgical approach in the field of partial nephrectomy. The learning curve for VAMS partial nephrectomy has not been studied to date; we therefore, evaluated this learning curve.We prospectively evaluated 20 consecutive patients who underwent VAMS partial nephrectomy performed by a single surgeon (YEY) between March 2015 and December 2016. The learning curve was evaluated using the cumulative sum method. The measure of surgical performance was composed of 3 parameters (total operation time [Op time], warm ischemic time [WIT], and estimated blood loss [EBL]).Among the 20 patients who underwent VAMS partial nephrectomy, the mean age was 54.6 years. The mean Op time and WIT were 172.5 and 28.8 minutes, respectively. The learning curve for the Op time, WIT, and EBL consisted of 3 unique phases: phase 1 (the first 7 cases), phase 2 (the next 5 to 7 cases), and phase 3 (all subsequent cases). Phase 1 represents the initial learning curve, and the phase 2 plateau represents the period of expert competency. Phase 3 represents when one is competent in VAMS partial nephrectomy.The learning curve for VAMS partial nephrectomy is relatively short and after a learning curve of approximately 7 cases, the surgeon became familiar with VAMS partial nephrectomy; after 12 to 14 cases, the surgeon became competent in this procedure.
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Affiliation(s)
- Jee Soo Park
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Kyu Ahn
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonchae Na
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung Ho Lee
- Department of Urology, National Health Insurance Service Ilsan Hospital
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine
| | - Min Gee Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 PLUS Project for Medical Science, Department of Urology, Yonsei University, Seoul, Republic of Korea
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Aimola L, Jasim S, Tripathi N, Bassett P, Quirk A, Worrall A, Tucker S, Holder S, Crawford MJ. Impact of a peer-review network on the quality of inpatient low secure mental health services: cluster randomised control trial. BMC Health Serv Res 2018; 18:994. [PMID: 30577847 PMCID: PMC6303937 DOI: 10.1186/s12913-018-3797-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peer-review networks aim to help services to improve the quality of care they provide, however, there is very little evidence about their impact. We conducted a cluster randomized controlled trial of a peer-review quality network for low-secure mental health services to examine the impact of network membership on the process and outcomes of care over a 12 month period. METHODS Thirty-eight low secure units were randomly allocated to either the active intervention (participation in the network n = 18) or the control arm (delayed participation in the network n = 20). A total of 75 wards were assessed at baseline and 8 wards dropped out the study before the data collection at 12 month follow up. The primary outcome measure was the quality of the physical environment and facilities of the services. The secondary outcomes included: safety of the ward, patient mental wellbeing and satisfaction with care, staff burnout, training and supervision. We hypothesised that, relative to control wards, the quality of the physical environment and facilities would be higher on wards in the active arm of the trial 12 months after randomization. RESULTS The difference in the primary outcome between the groups was not statistically significant (4.1; 95% CI [- 0.2, 8.3] p = 0.06). The median number of untoward incidents rose in control services and remained the same at the member of the network (Difference between members and non-members = 0.55; 95% IC [0.29, 1.07] p = 0.08). At follow up, a higher proportion of staff in the active arm of the trial indicated that they felt safe on the ward relative to those in the control services (p = 0.04), despite reporting more physical assaults (p = 0.04). Staff working in services in the active arm of the trial reported higher levels of burnout relative to those in the control group. No difference was seen in patient outcomes. CONCLUSIONS We did not find evidence that participation in a peer-review network led to marked changes in the quality of the physical environment of low secure mental health services at 12 months. Future research should explore the impact of accreditation schemes and examine longer term outcomes of participation in such networks. TRIAL REGISTRATION ISRCTN79614916 . Retrospectively registered 28 March 2014.
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Affiliation(s)
- Lina Aimola
- The Centre for Psychiatry, Imperial College London, London, W12 0NN 759 Q3Q4 UK
- The Royal College of Psychiatrists’ College Centre for Quality Improvement, 21 Prescot Street, London, E1 8BB UK
| | - Sarah Jasim
- The Royal College of Psychiatrists’ College Centre for Quality Improvement, 21 Prescot Street, London, E1 8BB UK
| | - Neeraj Tripathi
- Cygnet Hospital Stevenage, Graveley Road, Stevenage, SG1 4YS UK
| | | | - Alan Quirk
- The Royal College of Psychiatrists’ College Centre for Quality Improvement, 21 Prescot Street, London, E1 8BB UK
| | - Adrian Worrall
- The Royal College of Psychiatrists’ College Centre for Quality Improvement, 21 Prescot Street, London, E1 8BB UK
| | - Sarah Tucker
- Institute of Group Analysis, 1 Daleham Gardens, London, NW3 5BY UK
| | - Samantha Holder
- The Royal College of Psychiatrists’ College Centre for Quality Improvement, 21 Prescot Street, London, E1 8BB UK
| | - Mike J. Crawford
- The Centre for Psychiatry, Imperial College London, London, W12 0NN 759 Q3Q4 UK
- The Royal College of Psychiatrists’ College Centre for Quality Improvement, 21 Prescot Street, London, E1 8BB UK
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Quality Improvement Initiative to Improve Postoperative Pain with a Clinical Pathway and Nursing Education Program. Pain Manag Nurs 2018; 19:447-455. [PMID: 30057289 DOI: 10.1016/j.pmn.2018.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/04/2018] [Accepted: 06/26/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS We created a multicomponent intervention to improve pain management in the immediate postoperative period with the goal of improving the quality of patient recovery. DESIGN A multicomponent intervention to improve pain management in the immediate postoperative period with the goal of improving the quality of patient recovery. SETTINGS Pain management education of postanesthesia recovery room nurses through a practical intervention has the potential to improve patient pain experience, especially in those with a history of opioid tolerance. PARTICIPANTS/SUBJECTS Postanesthesia recovery nurses/postanesthesia patients. METHODS The intervention included two components: a clinical pain pathway on multimodal analgesia for both opioid-naïve and opioid-tolerant patients undergoing surgery and an educational program on pain management for frontline clinical nurses in the postanesthesia care unit (PACU). We measured the intervention's impact on time to pain relief, PACU length of stay, and patient satisfaction with pain management, as measured by self-report. RESULTS Patient PACU surveys indicated a decrease in the percent of patients with opioid tolerance who required more than 60 minutes to achieve adequate pain relief (from 32.7% preintervention to 21.3% postintervention). Additionally, after the intervention, the average time from a patient's PACU arrival to his or her discharge criteria being met decreased by 53 minutes and PACU stay prolongation as a result of uncontrolled pain for opioid-tolerant patients decreased from 45.2% to 25.7%. The sample size was underpowered to perform statistical analysis of this improvement. CONCLUSIONS After the combined intervention of a clinical pain pathway and interactive teaching workshop, we noted shortened PACU length of stay, reduced time to reach pain control, and improved overall patient satisfaction. Although we could not determine statistical significance, our findings suggest improved management of acute postoperative pain, especially for patients who are opioid tolerant. Because of the paucity of data, we were not able to conduct the analysis needed to evaluate quality improvement projects, as per SQUIRE 2.0. could be adopted by any institution.
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Park JS, Ahn HK, Na J, Lee HH, Yoon YE, Yoon MG, Han WK. Cumulative sum analysis of the learning curve for video-assisted minilaparotomy donor nephrectomy in healthy kidney donors. Medicine (Baltimore) 2018; 97:e0560. [PMID: 29703043 PMCID: PMC5944565 DOI: 10.1097/md.0000000000010560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/04/2018] [Indexed: 11/26/2022] Open
Abstract
Video-assisted minilaparotomy surgery (VAMS) is a hybrid of open and laparoscopic surgical techniques, so has advantages of both approaches. Here, we examined the learning curve for this procedure.We retrospectively evaluated 50 consecutive patients who underwent VAMS donor nephrectomy performed by a single surgeon (YEY) between March 2015 and March 2016. The learning curve was evaluated using the cumulative sum (CUSUM) method. Measures of surgical performance included total operation time, warm ischemic time, and estimated blood loss.The mean patient age, body mass index, and body surface area were 43.5 years, 23.8 kg/m, and 1.7 m, respectively. The mean operation time and warm ischemic time were 160.0 minutes and 124.4 seconds. The learning curve of total operation time was best modeled as a second-order polynomial with equation CUSUMOT (minutes) = -0.3802 × case number + 20.315 × case number - 41.333 (R = 0.7707). The curve included 3 unique phases: phase 1 (the initial 17 cases), which is the initial learning curve; phase 2 (the middle 23 cases), expert competence, and phase 3 (the subsequent cases), mastery. In terms of warm ischemic time and estimated blood loss, the initial learning was achieved after 16 cases and after 9 to 10 cases, one could achieve competency.The VAMS donor nephrectomy learning curve is shorter than for laparoscopic or robotic hand-assisted donor nephrectomy. Surgeons can become familiar with the procedure and perform it without complications after approximately 16 to 17 operations.
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Affiliation(s)
- Jee Soo Park
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Hyun Kyu Ahn
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Joonchae Na
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Hyung Ho Lee
- Department of Urology, National Health Insurance Service
Ilsan Hospital, Goyang, Gyeonggi-do
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of
Medicine
| | - Min Gee Yoon
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
- Brain Korea 21 PLUS Project for Medical Science, Department
of Urology, Yonsei University, Seoul, Republic of Korea
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Dombrádi V, Margitai B, Dózsa C, Bárdos-Csenteri OK, Sándor J, Gáll T, Gődény S. Investigation of the conditions affecting the joining of Hungarian hospitals to an accreditation programme: a cross-sectional study. BMJ Open 2018; 8:e019232. [PMID: 29391381 PMCID: PMC5829870 DOI: 10.1136/bmjopen-2017-019232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Quantitative studies have shown the various benefits for having accreditation in hospitals. However, neither of these explored the general conditions before applying for an accreditation. To close this gap, this study aimed to investigate the possible association between joining an accreditation programme with various hospital characteristics. DESIGN A cross-sectional study was implemented using the databases of the 2013 Hungarian hospital survey and of the Hungarian State Treasury. SETTING Public general hospitals in Hungary. PARTICIPANTS The analysis involved 44 public general hospitals, 14 of which joined the preparatory project for a newly developed accreditation programme. MAIN OUTCOME MEASURES The outcomes included the percentage of compliance in quality management, patient information and identification, internal professional regulation, safe surgery, pressure sore prevention, infection control, the opinions of the heads of quality management regarding the usefulness of quality management and clinical audits, and finally, the total debt of the hospital per bed and per discharged patient. RESULTS According to our findings, the general hospitals joining the preparatory project of the accreditation programme performed better in four of the six investigated activities, the head of quality management had a better opinion on the usefulness of quality management, and both the debt per bed number and the debt per discharged patient were lower than those who did not join. However, no statistically significant differences between the two groups were found in any of the examined outcomes. CONCLUSIONS The findings suggest that hospitals applying for an accreditation programme do not differ significantly in characteristics from those which did not apply. This means that if in the future the accredited hospitals become better than other hospitals, then the improvement could be solely contributed to the accreditation.
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Affiliation(s)
- Viktor Dombrádi
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Barnabás Margitai
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Csaba Dózsa
- Institute of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Miskolc, Hungary
| | | | - János Sándor
- Division of Biostatistics and Epidemiology, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tibor Gáll
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Sándor Gődény
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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Dombrádi V, Csenteri OK, Sándor J, Gődény S. Association between the application of ISO 9001:2008 alone or in combination with health-specific standards and quality-related activities in Hungarian hospitals. Int J Qual Health Care 2017; 29:283-289. [DOI: 10.1093/intqhc/mzx016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/07/2017] [Indexed: 11/14/2022] Open
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Weil G, Motamed C, Biau DJ, Guye ML. Learning curves for three specific procedures by anesthesiology residents using the learning curve cumulative sum (LC-CUSUM) test. Korean J Anesthesiol 2017; 70:196-202. [PMID: 28367291 PMCID: PMC5370306 DOI: 10.4097/kjae.2017.70.2.196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/25/2016] [Accepted: 11/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The learning curve cumulative sum (LC-CUSUM) test is an innovative tool that allows quantitative monitoring of individual medical performance during the learning process by determining when a predefined acceptable level of performance is reached. This study used the LC-CUSUM test to monitor the learning process and failure rate of anesthesia residents training for specific subspecialty anesthesia procedures. METHODS The study included 490 tracheal punctures (TP) for jet ventilation, 340 thoracic epidural analgesia (TEA) procedures, and 246 fiberoptic nasal intubations (FONI) performed by 18 residents during their single 6-month rotation. RESULTS Overall, 27 (14-52), 19 (5-41), and 14 (6-33) TP, TEA, and FONI procedures were performed, respectively, by each resident. In total, 2 of 18 residents achieved an acceptable failure rate for TEA according to the literature and 4 of 18 achieved an acceptable failure rate for FONI, while none of the residents attained an acceptable rate for TP. CONCLUSIONS A single 6-month rotation in a reference teaching center may not be sufficient to train residents to perform specific or sub-specialty procedures as required. A regional learning network may be useful. More patient-based data are necessary to conduct a risk adjustment analysis for such specific procedures.
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Affiliation(s)
- Gregoire Weil
- Department of Anesthesia, Institute Gustave Roussy, Villejuif, France
| | - Cyrus Motamed
- Department of Anesthesia, Institute Gustave Roussy, Villejuif, France
| | - David J Biau
- Department of Anesthesia, Institute Gustave Roussy, Villejuif, France
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Oliveira JLCD, Matsuda LM. DISQUALIFICATION OF CERTIFICATION BY HOSPITAL ACCREDITATION: PERCEPTIONS OF PROFESSIONAL STAFF. TEXTO & CONTEXTO ENFERMAGEM 2016. [DOI: 10.1590/0104-07072016004430014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Descriptive, exploratory, qualitative study that aimed to analyze the perceptions of professional certification disqualification by the Hospital Accreditation. A hospital was selectedthat lost the title of Accredited with Excellence. Twenty-three professionals participated who were working in care or hospital management who, in May 2014, answered a semi-structured interview, recorded and guided by the question: "Tell me about the disqualification of the certification of this hospital by the Accreditation". Based on the transcription and thematic analysis of the interviews, three categories emerged: disqualification of certification by Accreditation: grounds mentioned by workers; negative feelings related to the certification of the discredit and Accreditation; Certification disqualification: insufficient reason for abandoning principles of Accreditation. It was concluded that the loss of certification by the Accreditation caused a deep sense of regret among workers. Nevertheless, to favor the quality of care, participants signaled that the essential principles of Accreditation and some implemented actions remain at the service.
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Implementation of Departmental Quality Strategies Is Positively Associated with Clinical Practice: Results of a Multicenter Study in 73 Hospitals in 7 European Countries. PLoS One 2015; 10:e0141157. [PMID: 26588842 PMCID: PMC4654525 DOI: 10.1371/journal.pone.0141157] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/03/2015] [Indexed: 11/19/2022] Open
Abstract
Background Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness. Objective To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems. Design Multicenter, multilevel cross-sectional study. Setting and Participants Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries. Intervention None. Measures Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acyclic graph was used to encode relationships between predictors, outcomes, and covariates and to guide the choice of covariates to control for confounding. Results and Limitations Data were provided on 9021 clinical records by 276 departments in 73 hospitals. There were substantial variations in compliance with the 24 clinical practice indicators. Weak associations were observed between hospital quality systems and 4 of the 24 indicators, but on analyzing department-level quality systems, strong associations were observed for 8 of the 11 indicators for acute myocardial infarction and stroke. Clinical indicators supported by higher levels of evidence were more frequently associated with quality systems and activities. Conclusions There are significant gaps between recommended standards of care and clinical practice in a large sample of hospitals. Implementation of department-level quality strategies was significantly associated with good clinical practice. Further research should aim to develop clinically relevant quality standards for hospital departments, which appear to be more effective than generic hospital-wide quality systems.
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Groene O, Arah OA, Klazinga NS, Wagner C, Bartels PD, Kristensen S, Saillour F, Thompson A, Thompson CA, Pfaff H, DerSarkissian M, Sunol R. Patient Experience Shows Little Relationship with Hospital Quality Management Strategies. PLoS One 2015; 10:e0131805. [PMID: 26151864 PMCID: PMC4494712 DOI: 10.1371/journal.pone.0131805] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/07/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures. MATERIALS AND METHODS We employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level. RESULTS Overall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute myocardial infarction n = 1,379, hip fracture n = 1,503, deliveries n = 2,088, stroke n = 1,566). Patients admitted for hip fracture and stroke had the lowest scores across the four patient-reported experience measures throughout. Patients admitted after acute myocardial infarction reported highest scores on patient experience and hospital recommendation; women after delivery reported highest scores for patient involvement and health care transition. We found no substantial associations between hospital-wide quality management strategies, patient involvement in quality management, or patient-centered care strategies with any of the patient-reported experience measures. CONCLUSION This is the largest study so far to assess the complex relationship between quality management strategies and patient experience with care. Our findings suggest absence of and wide variations in the institutionalization of strategies to engage patients in quality management, or implement strategies to improve patient-centeredness of care. Seemingly counterintuitive inverse associations could be capturing a scenario where hospitals with poorer quality management were beginning to improve their patient experience. The former suggests that patient-centered care is not yet sufficiently integrated in quality management, while the latter warrants a nuanced assessment of the motivation and impact of involving patients in the design and assessment of services.
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Affiliation(s)
- Oliver Groene
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, Barcelona, Spain
| | - Onyebuchi A. Arah
- Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Niek S. Klazinga
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul D. Bartels
- Danish Clinical Registries, Aarhus, Denmark, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Solvejg Kristensen
- Danish Clinical Registries, Aarhus, Denmark, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Florence Saillour
- Unité Méthodes Evaluation en Santé, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Andrew Thompson
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Caroline A. Thompson
- Palo Alto Medical Foundation Research Institute (PAMFRI), Palo Alto, California, United States of America
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Maral DerSarkissian
- Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain
- Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, Barcelona, Spain
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Chabikuli ON, Gwarzo U, Olufunso A, Reidpath D, Allotey P, Ibrahim M, Hamelmann C. Closing the prevention of mother-to-child transmission gap in Nigeria: an evaluation of service improvement intervention in Nigeria. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2013.10874310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- ON Chabikuli
- Family Health International 360; Department of Family Medicine, Medunsa
| | - U Gwarzo
- Family Health International 360, Nigeria
| | - A Olufunso
- Monitoring and Evaluation, Family Health International 360, Nigeria
| | - D Reidpath
- Jeffrey Cheah School of Medicine and Health Services, Monash University, Malaysia
| | - P Allotey
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia
| | - M Ibrahim
- Family Health International 360, Nigeria
| | - C Hamelmann
- Regional Practice Leader HIV, Health and Development, Europe and Central Asia, United Nations Development Program
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Teixeira TCA, Cassiani SHDB. Análise de causa raiz de acidentes por quedas e erros de medicação em hospital. ACTA PAUL ENFERM 2014. [DOI: 10.1590/1982-0194201400019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivo: Identificar incidentes por queda e erros de medicação notificados em um hospital geral e privado e apresentar as categorias de fatores causais desses incidentes. Métodos: Trata-se de estudo transversal e exploratório realizado com 62 incidentes notificados no período de estudo. O instrumento de pesquisa foi elaborado para coletar dados dos formulários de notificação e dos prontuários dos pacientes. A validação de conteúdo do instrumento foi realizada por juízes. Foram constituídas duas equipes para análise da causa raiz dos incidentes e categorização dos fatores causais. Resultados: No período de estudo foram notificados 62 incidentes, sendo 11 quedas e 51 erros de medicação. A maior parte das quedas foi da própria altura, e os principais tipos de erros de medicação foram omissão e horário. Dos 19 incidentes analisados, um total de 118 fatores causais foram identificados, sendo a maioria relacionada às falhas sistêmicas, seguidas por falhas do indivíduo e do paciente. Conclusão: Erros de medicação ocorrem com maior frequência do que acidentes por quedas. A equipe de causa raiz analisou 14 erros de medicação com potencial para causar danos e cinco acidentes por queda, sendo identificados 83 e 35 fatores causais, respectivamente.
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Secanell M, Groene O, Arah OA, Lopez MA, Kutryba B, Pfaff H, Klazinga N, Wagner C, Kristensen S, Bartels PD, Garel P, Bruneau C, Escoval A, França M, Mora N, Suñol R. Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries. Int J Qual Health Care 2014; 26 Suppl 1:5-15. [PMID: 24671120 PMCID: PMC4001699 DOI: 10.1093/intqhc/mzu025] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction and Objective This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study. Design DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries. Setting and Participants We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30. Main outcome measures A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure). Results Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures. Conclusions This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers throughout the EU.
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Affiliation(s)
- Mariona Secanell
- Avedis Donabedian Reseach Institute, University Autonomous of Barcelona, C/Provenza 293, Pral. 08037 Barcelona, Spain.
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Botje D, Klazinga NS, Suñol R, Groene O, Pfaff H, Mannion R, Depaigne-Loth A, Arah OA, Dersarkissian M, Wagner C. Is having quality as an item on the executive board agenda associated with the implementation of quality management systems in European hospitals: a quantitative analysis. Int J Qual Health Care 2014; 26 Suppl 1:92-9. [PMID: 24550260 PMCID: PMC4001687 DOI: 10.1093/intqhc/mzu017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective To assess whether there is a relationship between having quality as an item on the board's agenda, perceived external pressure (PEP) and the implementation of quality management in European hospitals. Design A quantitative, mixed method, cross-sectional study in seven European countries in 2011 surveying CEOs and quality managers and data from onsite audits. Participants One hundred and fifty-five CEOs and 155 quality managers. Setting One hundred and fifty-five randomly selected acute care hospitals in seven European countries (Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Main outcome measure(s) Three constructs reflecting quality management based on questionnaire and audit data: (i) Quality Management System Index, (ii) Quality Management Compliance Index and (iii) Clinical Quality Implementation Index. The main predictor was whether quality performance was on the executive board's agenda. Results Discussing quality performance at executive board meetings more often was associated with a higher quality management system score (regression coefficient b = 2.53; SE = 1.16; P = 0.030). We found a trend in the associations of discussing quality performance with quality compliance and clinical quality implementation. PEP did not modify these relationships. Conclusions Having quality as an item on the executive board's agenda allows them to review and discuss quality performance more often in order to improve their hospital's quality management. Generally, and as this study found, having quality on the executive board's agenda matters.
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Affiliation(s)
- Daan Botje
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, PO Box 1568, 3500 BN Utrecht, The Netherlands.
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Hamdan M, Saleem AA. Assessment of patient safety culture in Palestinian public hospitals. Int J Qual Health Care 2013; 25:167-75. [PMID: 23382367 DOI: 10.1093/intqhc/mzt007] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the prevalent patient safety culture in Palestinian public hospitals. DESIGN A cross-sectional design, Arabic translated version of the Hospital Survey on Patient Safety Culture was used. SETTING All the 11 general public hospitals in the West Bank. PARTICIPANTS A total of 1460 clinical and non-clinical hospital staff. INTERVENTION(S) No. MAIN OUTCOME MEASURES Twelve patient safety culture composites and 2 outcome variables (patient safety grade and events reported in the past year) were measured. RESULTS Most of the participants were nurses and physicians (69.2%) with direct contact with patients (92%), mainly employed in medical/surgical units (55.1%). The patient safety composites with the highest positive scores were teamwork within units (71%), organizational learning and continuous improvement (62%) and supervisor/manager expectations and actions promoting patient safety (56%). The composites with the lowest scores were non-punitive response to error (17%), frequency of events reported (35%), communication openness (36%), hospital management support for patient safety (37%) and staffing (38%). Although 53.2% of the respondents did not report any event in the past year, 63.5% rated patient safety level as 'excellent/very good'. Significant differences in patient safety scores and outcome variables were found between hospitals of different size and in relation to staff positions and work hours. CONCLUSIONS This study highlights the existence of a punitive and blame culture, under-reporting of events, lack of communication openness and inadequate management support that are key challenges for patient safe hospital care. The baseline survey results are valuable for designing and implementing the patient safety program and for measuring future progress.
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Affiliation(s)
- Motasem Hamdan
- Faculty of Public Health, Al-Quds University, Jerusalem, occupied Palestinian territory. ;
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Hinchcliff R, Greenfield D, Moldovan M, Westbrook JI, Pawsey M, Mumford V, Braithwaite J. Narrative synthesis of health service accreditation literature. BMJ Qual Saf 2012; 21:979-91. [PMID: 23038406 DOI: 10.1136/bmjqs-2012-000852] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To systematically identify and synthesise health service accreditation literature. METHODS A systematic identification and narrative synthesis of health service accreditation literature published prior to 2012 were conducted. The search identified 122 empirical studies that examined either the processes or impacts of accreditation programmes. Study components were recorded, including: dates of publication; research settings; levels of study evidence and quality using established rating frameworks; and key results. A content analysis was conducted to determine the frequency of key themes and subthemes examined in the literature and identify knowledge-gaps requiring research attention. RESULTS The majority of studies (n=67) were published since 2006, occurred in the USA (n=60) and focused on acute care (n=79). Two thematic categories, that is, 'organisational impacts' and 'relationship to quality measures', were addressed 60 or more times in the literature. 'Financial impacts', 'consumer or patient satisfaction' and 'survey and surveyor issues' were each examined fewer than 15 times. The literature is limited in terms of the level of evidence and quality of studies, but highlights potential relationships among accreditation programmes, high quality organisational processes and safe clinical care. CONCLUSIONS Due to the limitations of the literature, it is not prudent to make strong claims about the effectiveness of health service accreditation. Nonetheless, several critical issues and knowledge-gaps were identified that may help stimulate and inform discussion among healthcare stakeholders. Ongoing effort is required to build upon the accreditation evidence-base by using high quality experimental study designs to examine the processes, effectiveness and financial value of accreditation programmes and their critical components in different healthcare domains.
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Affiliation(s)
- Reece Hinchcliff
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
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Hanna MN, González-Fernández M, Barrett AD, Williams KA, Pronovost P. Does Patient Perception of Pain Control Affect Patient Satisfaction Across Surgical Units in a Tertiary Teaching Hospital? Am J Med Qual 2012; 27:411-6. [DOI: 10.1177/1062860611427769] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Groene O, Mora N, Thompson A, Saez M, Casas M, Suñol R. Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety? BMC Health Serv Res 2011; 11:344. [PMID: 22185479 PMCID: PMC3267703 DOI: 10.1186/1472-6963-11-344] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 12/20/2011] [Indexed: 11/17/2022] Open
Abstract
Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes.
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Affiliation(s)
- Oliver Groene
- Avedis Donabedian University Institute, Autonomous University of Barcelona, Barcelona, Spain.
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Kliche T. [Structures and quality assurance of preventive care and health promotion in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:194-206. [PMID: 21290274 DOI: 10.1007/s00103-010-1210-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In order to identify requirements of quality assurance in this field, a general description of prevention, health promotion and education is outlined, based upon healthcare supply analyses and 158 interviews with experts. Prominent features are, among others, a distinctive heterogeneity and complexity of settings, suppliers, and interventions; supply of coverage is below public health criteria (needs); weak outcome evaluation; competition among suppliers, providers, and political agencies and decision makers; need for intra- and intersectoral coordination; the lack of evidence-based healthcare planning; and hurdles for quality assurance. A structural taxonomy of quality assurance systems is then developed, consisting of three dimensions: validity (quality of information), regularity, and degree of commitment and obligation. In terms of these dimensions, important systems of quality assurance in prevention, health promotion and education in Germany are analyzed. A number of different systems and approaches can be found. However, most of them share questionable validity, regularity, and degree of obligation. Increased commitment on behalf of providers, suppliers, and political institutions and decision makers for the quality of preventive interventions is inevitable in order to raise the performance of prevention and health promotion in Germany to their potential effectiveness.
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Affiliation(s)
- T Kliche
- Institut und Poliklinik für Medizinische Psychologie, Forschungsgruppe Versorgung und Qualität in der Prävention, Universitätsklinikum Eppendorf (UKE), Martinistrasse 52, Hamburg, Germany.
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Shaw C, Groene O, Mora N, Sunol R. Accreditation and ISO certification: do they explain differences in quality management in European hospitals? Int J Qual Health Care 2010; 22:445-51. [PMID: 20935006 DOI: 10.1093/intqhc/mzq054] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hospital accreditation and International Standardisation Organisation (ISO) certification offer alternative mechanisms for improving safety and quality, or as a mark of achievement. There is little published evidence on their relative merits. OBJECTIVE To identify systematic differences in quality management between hospitals that were accredited, or certificated, or neither. Research design ANALYSIS of compliance with measures of quality in 89 hospitals in six countries, as assessed by external auditors using a standardized tool, as part of the EC-funded METHODS of Assessing Response to Quality Improvement Strategies project. MAIN OUTCOME MEASURES Compliance scores in six dimensions of each hospital-grouped according to the achievement of accreditation, certification or neither. RESULTS Of the 89 hospitals selected for external audit, 34 were accredited (without ISO certification), 10 were certificated under ISO 9001 (without accreditation) and 27 had neither accreditation nor certification. Overall percentage scores for 229 criteria of quality and safety were 66.9, 60.0 and 51.2, respectively. Analysis confirmed statistically significant differences comparing mean scores by the type of external assessment (accreditation, certification or neither); however, it did not substantially differentiate between accreditation and certification only. Some of these associations with external assessments were confounded by the country in which the sample hospitals were located. CONCLUSIONS It appears that quality and safety structures and procedures are more evident in hospitals with either the type of external assessment and suggest that some differences exist between accredited versus certified hospitals. Interpretation of these results, however, is limited by the sample size and confounded by variations in the application of accreditation and certification within and between countries.
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Affiliation(s)
- Charles Shaw
- European Society for Quality in Healthcare, Limerick, Ireland.
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Groene O, Klazinga N, Wagner C, Arah OA, Thompson A, Bruneau C, Suñol R. Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE)' project. BMC Health Serv Res 2010; 10:281. [PMID: 20868470 PMCID: PMC2949856 DOI: 10.1186/1472-6963-10-281] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/24/2010] [Indexed: 11/16/2022] Open
Abstract
Background Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. Methods/Design We propose to study the relationships among organisational quality improvement systems, patient empowerment, organisational culture, professionals' involvement with the quality of hospital care, including clinical effectiveness, patient safety and patient involvement. We will employ a cross-sectional, multi-level study design in which patient-level measurements are nested in hospital departments, which are in turn nested in hospitals in different EU countries. Mixed methods will be used for data collection, measurement and analysis. Hospital/care pathway level constructs that will be assessed include external pressure, hospital governance, quality improvement system, patient empowerment in quality improvement, organisational culture and professional involvement. These constructs will be assessed using questionnaires. Patient-level constructs include clinical effectiveness, patient safety and patient involvement, and will be assessed using audit of patient records, routine data and patient surveys. For the assessment of hospital and pathway level constructs we will collect data from randomly selected hospitals in eight countries. For a sample of hospitals in each country we will carry out additional data collection at patient-level related to four conditions (stroke, acute myocardial infarction, hip fracture and delivery). In addition, structural components of quality improvement systems will be assessed using visits by experienced external assessors. Data analysis will include descriptive statistics and graphical representations and methods for data reduction, classification techniques and psychometric analysis, before moving to bi-variate and multivariate analysis. The latter will be conducted at hospital and multilevel. In addition, we will apply sophisticated methodological elements such as the use of causal diagrams, outcome modelling, double robust estimation and detailed sensitivity analysis or multiple bias analyses to assess the impact of the various sources of bias. Discussion Products of the project will include a catalogue of instruments and tools that can be used to build departmental or hospital quality and safety programme and an appraisal scheme to assess the maturity of the quality improvement system for use by hospitals and by purchasers to contract hospitals.
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Affiliation(s)
- Oliver Groene
- Avedis Donabedian University Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health, Barcelona, Spain.
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Groene O, Poletti P, Vallejo P, Cucic C, Klazinga N, Suñol R. Quality requirements for cross-border care in Europe: a qualitative study of patients', professionals' and healthcare financiers' views. Qual Saf Health Care 2009; 18 Suppl 1:i15-21. [PMID: 19188456 PMCID: PMC2629853 DOI: 10.1136/qshc.2008.028837] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the past decade the issue of patient mobility has emerged on the European health policy agenda. Although the volume of patients crossing borders to obtain healthcare is low, it is increasing continuously and, due to its legal, financial and medical implications, has generated considerable interest among health policy and other decision makers. However, there is little information available on the safety and patient-centredness of cross-border care and neither governments nor citizens have an explicit basis for comparing healthcare delivery in Europe. METHODS This study investigated the viewpoints of patients, professionals and healthcare financiers on the safety and patient-centredness of cross-border care. Qualitative interviews were carried out during 2005 and early 2006 with 40 patients, 30 professionals (doctors, nurses and managers) and 3 healthcare-financing bodies. RESULTS Although cross-border care has become a common issue in many European countries, there remain uncertainties on the side of each of the parties addressed--patients, professionals and financiers--with regard to the provision of cross-border care. One of the most striking results of this project is the current lack of research on systematic knowledge on the quality of cross-border care. CONCLUSION Many of the issues identified through this research may have a potential impact on the quality and safety of cross-border care and will support further investigation and help shape the health policy agenda on patients crossing borders in European Union countries.
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Affiliation(s)
- O Groene
- Avedis Donabedian Institute, Autonomous University of Barcelona, 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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Shaw C, Kutryba B, Crisp H, Vallejo P, Suñol R. Do European hospitals have quality and safety governance systems and structures in place? Qual Saf Health Care 2009; 18 Suppl 1:i51-6. [PMID: 19188462 PMCID: PMC2629926 DOI: 10.1136/qshc.2008.029306] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2008] [Indexed: 11/20/2022]
Abstract
Internal systems for quality and safety were assessed in 89 hospitals in six European states, by external teams using standardised criteria and procedures, as part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project. The assessments were made primarily to identify the current use of quality management systems in the sample hospitals, and also to demonstrate a potential tool for comparable assessment of hospitals in general. The large majority of the hospitals had a formal, documented infrastructure to manage quality and safety, but a significant minority had no designated mission, programme or coordination. In two-thirds of hospitals, the governing body was active in defining policy and programmes for improvement, and received reports on quality, safety and patient satisfaction at least once a year. The brief on-site assessments identified systematic variations, within and between countries, in structures and processes of governance and to document the uptake of best practice. Unacceptable variations in practice could be reduced, to the benefit of consumers and providers, by developing and publishing basic organisational standards relevant to all European states. The simple assessment criteria designed for this project could be developed into a practical tool for self-assessment, peer review or benchmarking of hospitals across national borders. This assessment, combined with explicit, relevant and achievable standards, could provide a vehicle to promote the voluntary uptake of best practice and consistency in quality and safety among hospitals in Europe.
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Affiliation(s)
- C Shaw
- European Society for Quality in Healthcare, Limerick, Ireland.
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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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