1
|
Akbaş KE, Hark BD. Evaluation of quantitative bias analysis in epidemiological research: A systematic review from 2010 to mid-2023. J Eval Clin Pract 2024; 30:1413-1421. [PMID: 39031561 DOI: 10.1111/jep.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/17/2024] [Accepted: 06/03/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE We aimed to demonstrate the use of quantitative bias analysis (QBA), which reveals the effects of systematic error, including confounding, misclassification and selection bias, on study results in epidemiological studies published in the period from 2010 to mid-23. METHOD The articles identified through a keyword search using Pubmed and Scopus were included in the study. The articles obtained from this search were eliminated according to the exclusion criteria, and the articles in which QBA analysis was applied were included in the detailed evaluation. RESULTS It can be said that the application of QBA analysis has gradually increased over the 13-year period. Accordingly, the number of articles in which simple is used as a method in QBA analysis is 9 (9.89%), the number of articles in which the multidimensional approach is used is 10 (10.99%), the number of articles in which the probabilistic approach is used is 60 (65.93%) and the number of articles in which the method is not specified is 12 (13.19%). The number of articles with misclassification bias model is 44 (48.35%), the number of articles with uncontrolled confounder(s) bias model is 32 (35.16%), the number of articles with selection bias model is 7 (7.69%) and the number of articles using more than one bias model is 8 (8.79%). Of the 49 (53.85%) articles in which the bias parameter source was specified, 19 (38.78%) used internal validation, 26 (53.06%) used external validation and 4 (8.16%) used educated guess, data constraints and hypothetical data. Probabilistic approach was used as a bias method in 60 (65.93%) of the articles, and mostly beta (8 [13.33%)], normal (9 [15.00%]) and uniform (8 [13.33%]) distributions were selected. CONCLUSION The application of QBA is rare in the literature but is increasing over time. Future researchers should include detailed analyzes such as QBA analysis to obtain inferences with higher evidence value, taking into account systematic errors.
Collapse
Affiliation(s)
- Kübra Elif Akbaş
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Betül Dağoğlu Hark
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Fırat University, Elazig, Turkey
| |
Collapse
|
2
|
Venugopal S, Patil RB, Thukral A, Koganti RA, Kumar Dl V, Sankar MJ, Agarwal R, Verma A, Deorari AK. Feasibility, Sustainability, and Effectiveness of the Implementation of "Facility-Team-Driven" Approach for Improving the Quality of Newborn Care in South India. Indian J Pediatr 2023; 90:974-981. [PMID: 37269503 DOI: 10.1007/s12098-023-04518-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/15/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The primary objective of the study was to assess the feasibility and sustainability of the implementation of the point of care quality improvement (POCQI) methodology for improving the quality of neonatal care at the level 2 special newborn care unit (SNCU). Additional objective was to evaluate the effectiveness of the quality improvement (QI) and preterm baby package training model. METHODS This study was conducted in a level-II SNCU. The study period was divided into baseline; intervention and sustenance phases. The primary outcome i.e., feasibility was defined as completion of training for 80% or more health care professionals (HCPs) through workshops, their attendance in subsequent review meetings and, successful accomplishment of at least two plan-do-study-act (PDSA) cycles in each project. RESULTS Of the total, 1217 neonates were enrolled during the 14 mo study period; 80 neonates in the baseline, 1019 in intervention and 118 in sustenance phases. Feasibility of training was achieved within a month of initiation of intervention phase; 22/24 (92%) nurses and 14/15 (93%) doctors attended the meetings. The outcomes of individual projects suggested an improvement in proportion of neonates being given exclusive breast milk on day 5 (22.8% to 78%); mean difference (95% CI) [55.2 (46.5 to 63.9)]. Neonates on any antibiotics declined, proportion of any enteral feeds on day one and duration of kangaroo mother care (KMC) increased. Proportion of neonates receiving intravenous fluids during phototherapy decreased. CONCLUSIONS The present study demonstrates the feasibility, sustainability, and effectiveness of a facility-team-driven QI approach augmented with capacity building and post-training supportive supervision.
Collapse
Affiliation(s)
- S Venugopal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra B Patil
- Department of Pediatrics, Shimoga Medical College, Shivamogga, Karnataka, India
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Ashok Koganti
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Vasanth Kumar Dl
- Department of Pediatrics, Shimoga Medical College, Shivamogga, Karnataka, India
| | - M Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Verma
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Deorari
- Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, Uttarakhand, India.
| |
Collapse
|
3
|
Engeltjes B, van Herk N, Visser M, van Wijk A, Cronie D, Rosman A, Scheele F, Wouters E. Patients' experiences with an obstetric telephone triage system: A qualitative study. PATIENT EDUCATION AND COUNSELING 2023; 108:107610. [PMID: 36584556 DOI: 10.1016/j.pec.2022.107610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Telephone Triage Systems aim to provide a uniform and practical system for healthcare professionals in order to prioritize urgency of care. A disadvantage of telephone triage system could be that the conversations are experienced as less personal, as it uses a uniform procedure for every patient. Therefore, aside from the clinical relevance, patient expectations, experiences and satisfaction were studied. OBJECTIVE The purpose of this study is to explore patients' experiences with obstetric telephone triage. METHODS A descriptive, qualitative design to explore experiences after triage with Dutch Obstetric Telephone Triage System. Participants, recruited from two Dutch hospitals, were pregnant women who received triage by telephone. Semi-structured interviews were held. The following topics were discussed: expectations before triage, experiences with triage, waiting time, information and communication, approach of healthcare professional, and quality of treatment. Data were analyzed using open, axial and selective coding. RESULTS Overall, the participants experienced the telephone conversation as satisfactory. This was due to the perceived professionalism with high accessibility and perceived reassurance. The approach of the professional was experienced as friendly and empathetic. Participants suggested that triage services could be improved by looking specifically at information provision. Explaining in advance how the service works can be helpful to create more awareness and to align better with expectations. CONCLUSION Participants reported that they could tell their own story and most participants realized that the professional asked extra questions in order to quantify the seriousness of the complaints. The level of involvement in the next steps of their care episode experienced by respondents lead us to conclude that the professional intended patient-centered care. PRACTICE IMPLICATIONS Improving the provision of information during waiting times and about the accessibility of the service can increase the quality of obstetric triage care. Patient involvement is necessary to increase trust and to meet the needs of the patient.
Collapse
Affiliation(s)
- Bernice Engeltjes
- Athena institute for transdisciplinary research, Faculty of science, VU University, Amsterdam, the Netherlands; Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands.
| | - Nikki van Herk
- Department of Obstetrics and Gynecology, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Maud Visser
- Department of Obstetrics and Gynecology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Astrid van Wijk
- Department of Healthcare Education, OLVG Teaching Hospital, Amsterdam, the Netherlands
| | - Doug Cronie
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Ageeth Rosman
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Fedde Scheele
- Athena institute for transdisciplinary research, Faculty of science, VU University, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Eveline Wouters
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| |
Collapse
|
4
|
Carrillo I, Tella S, Strametz R, Vanhaecht K, Panella M, Guerra-Paiva S, Knezevic B, Ungureanu MI, Srulovici E, Buttigieg S, Sousa P, Mira J. Studies on the second victim phenomenon and other related topics in the pan-European environment: The experience of ERNST Consortium members. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022. [DOI: 10.1177/25160435221076985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Patient safety is a priority worldwide. When things go wrong in the provision of patient care, the healthcare professionals involved can be psychologically affected (second victims, SVs). Recently, different initiatives have been launched to address this phenomenon. Aim To identify through the ERNST Pan-European Consortium the current study lines in Europe on SVs and other topics related to how the lack of well-being of healthcare professionals can affect the quality of care. Methods A cross-sectional study was conducted based on an ad hoc online survey. All 82 academics and clinicians who had formalized their membership to the COST Action 19113 by September 2020 and represented 27 European and one neighboring country were invited to participate. The survey consisted of 19 questions that explored the participants’ scientific profile, their interests, and previous experiences in the SVs’ topic, and related areas of work in Europe. Results Seventy (85.4%) COST Action members responded to the survey. Thirty-seven (37.1%) had conducted SV studies in the past or were doing so at the moment of the survey. Seventeen participants were involved in implementing interventions to support SVs. Future lines of study included legal issues, open disclosure, training programs, and patient safety curricula. Conclusions Studies have been conducted in Europe on the magnitude of the SV phenomenon and the usefulness of some techniques to promote resilience among healthcare professionals. New gaps have been identified. The COST Action 19113 aims to foster European collaboration to reinforce the healthcare professionals’ well-being and thus contribute to patient safety.
Collapse
Affiliation(s)
| | - Susanna Tella
- LAB University of Applied Sciences, Lahti, Lappeenranta, Finland
| | - Reinhard Strametz
- Wiesbaden Business School, Rhein Main University of Applied Science, Wiesbaden, Germany
| | | | - Massimiliano Panella
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Sofia Guerra-Paiva
- Public Health Research Centre, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | | | | | | | - Sandra Buttigieg
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Malta
| | - Paulo Sousa
- Public Health Research Centre, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Jose Mira
- Miguel Hernandez University, Elche, Spain
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Alicante, Spain
| |
Collapse
|
5
|
Pougheon Bertrand D, Fanchini A, Lombrail P, Rault G, Chansard A, Le Breton N, Frenod C, Milon F, Heymes-Royer C, Segretain D, Silber M, Therouanne S, Haesebaert J, Llerena C, Michel P, Reynaud Q. Collaborative research protocol to define patient-reported experience measures of the cystic fibrosis care pathway in France: the ExPaParM study. Orphanet J Rare Dis 2022; 17:73. [PMID: 35193621 PMCID: PMC8861995 DOI: 10.1186/s13023-022-02204-0] [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] [Received: 11/06/2021] [Accepted: 02/06/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction In France, the cystic fibrosis (CF) care pathway is coordinated by multidisciplinary teams from specialised CF centres or transplant centres. It includes the care provided at home or out of hospital, risk prevention in daily life and adjustments to social life, which together contribute to the person’s quality of life. Patient experience is used to describe and evaluate the care and life of patients living with the disease. Objectives Our collaborative research aims to identify the most significant areas and criteria that characterise the CF pathway. It will lead to the development of a questionnaire to collect patients' experience, which can be administered to all patients or parents of children registered and followed in the centres. The article describes the protocol developed in partnership with patients and parents of children living with the disease. Method A multidisciplinary research group brings together researchers, patients, parents of children with CF and health care professionals. The patient partnership is involved in the 4 phases of the protocol: (1) setting up the study, recruiting patient and parent co-researchers, training them in qualitative research methods, defining the situations and profiles of patients in the study population, elaborating the protocol; (2) selecting the study sites, recruiting participants, carrying out semi-structured interviews, analysing verbatims using the grounded theory approach; (3) co-elaborating Patient-Reported Experience Measures (PREM) questionnaires adapted to the 4 types of participants: parents, adolescents, non-transplanted adults and transplanted adults; (4) validating the construct with participants and professionals from the study centres. Results The protocol obtained a favourable opinion from the Ethics Evaluation Committee of INSERM (IRB00003888—no. 20-700). Training was provided to the 5 patients and 2 parent co-researchers to enable them to participate effectively in the research. Eleven centres participated in the recruitment of participants in mainland France and Reunion Island. Eighty hours of interviews were conducted. Discussion The PREM questionnaires to be elaborated will have to undergo psychometric validation before being used by the actors of the CF network to assess the impact on the care pathways of quality approaches or new therapies available in cystic fibrosis. Trial Registration Registry: IRB00003888 – no. 20-700. Issue date: 06/09/2020.
Collapse
Affiliation(s)
- D Pougheon Bertrand
- Laboratory of Education and Health Practices (LEPS) UR3412, Sorbonne Paris Nord University, Villetaneuse, France.
| | - A Fanchini
- Laboratory of Education and Health Practices (LEPS) UR3412, Sorbonne Paris Nord University, Villetaneuse, France
| | - P Lombrail
- Laboratory of Education and Health Practices (LEPS) UR3412, Sorbonne Paris Nord University, Villetaneuse, France
| | - G Rault
- Laboratory of Education and Health Practices (LEPS) UR3412, Sorbonne Paris Nord University, Villetaneuse, France
| | - A Chansard
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - N Le Breton
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - C Frenod
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - F Milon
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - C Heymes-Royer
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - D Segretain
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - M Silber
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - S Therouanne
- Centre de Ressources et de Compétences mucoviscidose, CHU Lille, Lille, France
| | - J Haesebaert
- Laboratory RESHAPE U. INSERM 1290, Claude Bernard Lyon 1 University, Villeurbanne, France
| | - C Llerena
- Centre de Ressources et de Compétences mucoviscidose, Hôpital Couple-Enfants, Grenoble, France
| | - P Michel
- Laboratory RESHAPE U. INSERM 1290, Claude Bernard Lyon 1 University, Villeurbanne, France.,Quality and Security Department, Hospices Civils de Lyon, Lyon, France
| | - Q Reynaud
- Laboratory RESHAPE U. INSERM 1290, Claude Bernard Lyon 1 University, Villeurbanne, France.,Centre de Ressources et de Compétences mucoviscidose, Hôpital Lyon Sud, Pierre-Bénite, France
| |
Collapse
|
6
|
Jarrar M, Al-Bsheish M, Aldhmadi BK, Albaker W, Meri A, Dauwed M, Minai MS. Effect of Practice Environment on Nurse Reported Quality and Patient Safety: The Mediation Role of Person-Centeredness. Healthcare (Basel) 2021; 9:healthcare9111578. [PMID: 34828624 PMCID: PMC8618501 DOI: 10.3390/healthcare9111578] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
This study aims to explore the potential mediation role of person-centeredness between the effects of the work environment and nurse reported quality and patient safety. A quantitative cross-sectional survey collected data from 1055 nurses, working in medical and surgical units, in twelve Malaysian private hospitals. The data collection used structured questionnaires. The Hayes macro explored the mediation effect of person-centeredness between the associations of work environment dimensions and care outcomes, controlling nurses’ demographics and practice characteristics. A total of 652 nurses responded completely to the survey (61.8% response rate). About 47.7% of nurses worked 7-h shifts, and 37.0% were assigned more than 15 patients. Higher workload was associated with unfavorable outcomes. Nurses working in 12-h shifts reported a lower work environment rating (3.46 ± 0.41, p < 0.01) and person-centered care (3.55 ± 0.35, p < 0.01). Nurses assigned to more than 15 patients were less likely to report a favorable practice environment (3.53 ± 0.41, p < 0.05), perceived lower person-centered care (3.61 ± 0.36, p < 0.01), and rated lower patient safety (3.54 ± 0.62, p < 0.05). Person-centeredness mediates the effect of nurse work environment dimensions on quality and patient safety. Medical and surgical nurses, working in a healthy environment, had a high level of person-centeredness, which, in turn, positively affected the reported outcomes. The function of person-centeredness was to complement the effects of the nurse work environment on care outcomes. Improving the nurse work environment (task-oriented) with a high level of person-centeredness (patient-oriented) was a mechanism through which future initiatives could improve nursing care and prevent patient harm.
Collapse
Affiliation(s)
- Mu’taman Jarrar
- Vice Deanship for Quality and Development, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Correspondence: or
| | - Mohammad Al-Bsheish
- Healthcare Administration Department, Batterjee Medical College, Jeddah 21442, Saudi Arabia;
| | - Badr K. Aldhmadi
- Department of Health Management, College of Public Health and Health Informatics, University of Ha’il, Ha’il 81451, Saudi Arabia;
| | - Waleed Albaker
- Department of Internal Medicine/Endocrinology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Ahmed Meri
- Department of Medical Instrumentation Techniques Engineering, Al-Hussain University College, Karbala 56001, Iraq;
| | - Mohammed Dauwed
- Department of Medical Instrumentation Techniques Engineering, Dijlah University College, Baghdad 10022, Iraq;
- Department of Computer Science, College of Science, University of Baghdad, Baghdad 10070, Iraq
| | - Mohd Sobri Minai
- College of Business, Universiti Utara Malaysia, Kedah 06010, Malaysia; or
| |
Collapse
|
7
|
Gabutti I. Filling the gap between theory and practice: A pilot study on parents' perceptions of integrated care for patients with borderline personality disorder. Int J Health Plann Manage 2021; 36:2366-2375. [PMID: 34460966 PMCID: PMC9291043 DOI: 10.1002/hpm.3307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 04/28/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022] Open
Abstract
Clinical pathways are known to be key in managing chronic conditions in an effective and sustainable way. This is particularly true in psychiatry, characterized by chronicity and managerial challenges. In particular, the borderline personality disorder is a highly complicated disorder to manage. Although numerous international guidelines converge on the urge of defining clinical pathways and a stepped-care model for its effective treatment, it is unknown to what extent these guidelines have been implemented into concrete changes in the provision of care. The objective of this study is to pursue a preliminary assessment of whether there exists coherence between the provision of formal health dispositions or guidelines and end-users' perception of the change they should imply. A pilot study investigating the perception of parents of patients with borderline disorder on continuity of care has been conducted in three Italian regions. Results suggest that pathways do exist and are partially able to reach their intended effects, although concrete accessibility is still a major issue. Future studies should build on these preliminary results through quantitative investigation and further explore their causes.
Collapse
Affiliation(s)
- Irene Gabutti
- Department of ManagementUniversità Cattolica del Sacro CuoreRomeItaly
| |
Collapse
|
8
|
Hammer A, Arah OA, Mannion R, Groene O, Sunol R, Pfaff H, Choi KE. Measuring social capital of hospital management boards in European hospitals: A validation study on psychometric properties of a questionnaire for Chief Executive Officers. BMC Health Serv Res 2021; 21:1036. [PMID: 34598708 PMCID: PMC8487123 DOI: 10.1186/s12913-021-07067-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background The commitment of hospital managers plays a key role in decisions regarding investments in quality improvement (QI) and the implementation of quality improvement systems (QIS). With regard to the concept of social capital, successful cooperation and coordination among hospital management board members is strongly influenced by commonly shared values and mutual trust. The purpose of this study is to investigate the reliability and validity of a survey scale designed to assess Social Capital within hospital management boards (SOCAPO-B) in European hospitals. Methods Data were collected as part of the EU funded mixed-method project “Deepening our understanding of quality improvement in Europe (DUQuE)” from 210 hospitals in 7 European countries (France, Poland, Czech Republic, Germany, Portugal, Spain, and Turkey). The Chief Executive Officers (CEOs) completed the SOCAPO-B scale (six-item survey, numeric scale, 1=‘strongly disagree’ to 4=‘strongly agree’) regarding their perceptions of social capital within the hospital management board. We investigated the factor structure of the social capital scale using exploratory and confirmatory factor analyses. Internal consistency was assessed using Cronbach’s alpha, while construct validity was assessed through Pearson’s correlation coefficients between the scale items. Results A total of 188 hospitals participated in the DUQuE-study. Of these, 177 CEOs completed the questionnaire(172 observations for social capital) Hospital CEOs perceive relatively high social capital among hospital management boards (average SOCAPO-B mean of 3.2, SD = 0.61). The exploratory factor analysis resulted in a 1-factor-model with Cronbach’s alpha of 0.91. Pearson’s correlation coefficients between the single scale items ranged from 0.48 to 0.68. Conclusions The SOCAPO-B−scale can be used to obtain reliable and valid measurements of social capital in European hospital management boards, at least from the CEO’s point of view. The brevity of the scale enables it to be a cost-effective and tool for measuring social capital in hospital management boards. Trial registration This validation study was not registered.
Collapse
Affiliation(s)
- Antje Hammer
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Onyebuchi A Arah
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, USA.,UCLA Center for Health Policy Research, Los Angeles, USA
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, United Kingdom
| | | | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), Donostia, Spain
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Kyung-Eun Choi
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Cologne, Germany. .,Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf b. Berlin/Neuruppin, Germany.
| |
Collapse
|
9
|
Cardinali F, Carzaniga S, Duranti G, Labella B, Lamanna A, Cerilli M, Caracci G, Carinci F. A nationwide participatory programme to measure person-centred hospital care in Italy: Results and implications for continuous improvement. Health Expect 2021; 24:1145-1157. [PMID: 34014021 PMCID: PMC8369125 DOI: 10.1111/hex.13231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/01/2021] [Accepted: 02/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patient-centredness has been targeted by the Italian government as a key theme for the future development of health services. OBJECTIVE Measuring patient-centred health services in partnership with citizens, health professionals and decision makers. DESIGN National participatory survey in a large test set of hospitals at national level. SETTING AND PARTICIPANTS A total of 387 hospital visits conducted in 16 Italian regions by over 1,500 citizens and health professionals during 2017-2018. MAIN VARIABLES AND OUTCOME MEASURES An ad hoc checklist was used to assess person-centredness in hospital care through 243 items, grouped in 4 main areas, 12 sub-areas and 29 person-centred criteria (scored 0-10). GEE linear multivariate regression was used to explore the relation between hospital characteristics and person-centredness. RESULTS Person-centred scores were moderately high, with substantial variation overall (median score: 7.0, range: 3.2-9.5) and by area (Care Processes: 6.8, 2.0-9.8; Access: 7.4, 2.7-9.7; Transparency: 6.7, 3.4-9.5 and Relationship: 7.3, 0.8-10.0). Multivariate regression found higher scores for increasing volumes of activity (quartile increase: +0.21; 95% CI: 0.13, 0.29) and lower scores in the south and islands (-1.03; -1.62,-0.45). DISCUSSION The checklist has been applied successfully by over 1,500 collaborators who assessed hospitals in 16 distinct Regions and Autonomous Provinces of Italy. Despite an overall positive mark, all scores were highly variable by location and hospital characteristics. CONCLUSION AND PATIENT OR PUBLIC CONTRIBUTION A national participatory programme to improve patient-centredness in Italian hospitals highlighted critical areas with the direct input of citizens.
Collapse
Affiliation(s)
- Flavia Cardinali
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | - Sara Carzaniga
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | - Giorgia Duranti
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | - Barbara Labella
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | | | - Micaela Cerilli
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | - Giovanni Caracci
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | - Fabrizio Carinci
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
- University of BolognaBolognaItaly
| |
Collapse
|
10
|
Datta V, Srivastava S, Garde R, Mehta R, Livesley N, Sawleshwarkar K, Pemde H, Patnaik SK, Sooden A, Singh M, John SS, Pradeep J, Vig A, Kumar A, Singh V, Bhatia V, Garg BS, Baswal D. Development of a framework of intervention strategies for point of care quality improvement at different levels of healthcare delivery system in India: initial lessons. BMJ Open Qual 2021; 10:e001449. [PMID: 34344739 PMCID: PMC8336183 DOI: 10.1136/bmjoq-2021-001449] [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: 03/02/2021] [Accepted: 05/22/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Inadequate quality of care has been identified as one of the most significant challenges to achieving universal health coverage in low-income and middle-income countries. To address this WHO-SEARO, the point of care quality improvement (POCQI) method has been developed. This paper describes developing a dynamic framework for the implementation of POCQI across India from 2015 to 2020. METHODS A total of 10 intervention strategies were designed as per the needs of the local health settings. These strategies were implemented across 10 states of India, using a modification of the 'translating research in practice' framework. Healthcare professionals and administrators were trained in POCQI using a combination of onsite and online training methods followed by coaching and mentoring support. The implementation strategy changed to a fully digital community of practice platform during the active phase of the COVID-19 pandemic. Dashboard process, outcome indicators and crude cost of implementation were collected and analysed across the implementation sites. RESULTS Three implementation frameworks were evolved over the study period. The combined population benefitting from these interventions was 103 million. A pool of QI teams from 131 facilities successfully undertook 165 QI projects supported by a pool of 240 mentors over the study period. A total of 21 QI resources and 6 publications in peer-reviewed journals were also developed. The average cost of implementing POCQI initiatives for a target population of one million was US$ 3219. A total of 100 online activities were conducted over 6 months by the digital community of practice. The framework has recently extended digitally across the South-East Asian region. CONCLUSION The development of an implementation framework for POCQI is an essential requirement for the initiative's successful country-wide scale. The implementation plan should be flexible to the healthcare system's needs, target population and the implementing agency's capacity and amenable to multiple iterative changes.
Collapse
Affiliation(s)
- Vikram Datta
- Neonatology, Kalawati Saran Children's Hospital, New Delhi, Delhi, India
- Neonatology, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Sushil Srivastava
- Pediatrics, University College of Medical Sciences, Delhi, Delhi, India
| | - Rahul Garde
- Quality Improvement, Nationwide Quality of Care Network, New Delhi, Delhi, India
| | - Rajesh Mehta
- Newborn, Child and Adolescent Health, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | | | | | - Harish Pemde
- Pediatrics, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Suprabha K Patnaik
- Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharastra, India
| | - Ankur Sooden
- QI, University Research Co LLC, Bethesda, Maryland, USA
- Technical Advisor Health Systems, Nationwide Quality of Care Network, Indora, Himachal Pradesh, India
| | - Mahtab Singh
- QI, Nationwide Quality Of Care Network India, New Delhi, Delhi, India
| | - Susy Sarah John
- College of Nursing, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Jeena Pradeep
- Department of Nursing, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Anupa Vig
- Telemedicine, Piramal Swasthya, Noida, NCR, India
- Obstetrics and Gynaecology, Piramal Swasthya, New Delhi, Delhi, India
| | - Achala Kumar
- Department of Nursing, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi, Delhi, India
| | | | | | - Bishan Singh Garg
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Dinesh Baswal
- Maternal Health Division, Ministry of Health and Family Welfare, Government of India, New Delhi, Delhi, India
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Braithwaite J, Clay-Williams R, Taylor N, Ting HP, Winata T, Hogden E, Li Z, Selwood A, Warwick M, Hibbert P, Arnolda G. Deepening our Understanding of Quality in Australia (DUQuA): An overview of a nation-wide, multi-level analysis of relationships between quality management systems and patient factors in 32 hospitals. Int J Qual Health Care 2020; 32:8-21. [PMID: 31725882 DOI: 10.1093/intqhc/mzz103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/19/2019] [Accepted: 09/12/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The Deepening our Understanding of Quality in Australia (DUQuA) project is a multisite, multi-level, cross-sectional study of 32 of the largest hospitals in Australia. This overview examines relationships between (i) organization-level quality management systems and department-level quality management strategies and (ii) patient-level measures (clinical treatment processes, patient-reported perceptions of care and clinical outcomes) within Australian hospitals. DESIGN We examined hospital quality improvement structures, processes and outcomes, collecting data at organization, department and patient levels for acute myocardial infarction (AMI), hip fracture and stroke. Data sources included surveys of quality managers, clinicians and patients, hospital visits, medical record reviews and national databases. Outcomes data and patient admissions data were analysed. Relationships between measures were evaluated using multi-level models. We based the methods on the Deepening our Understanding of Quality Improvement in Europe (DUQuE) framework, extending that work in parts and customizing the design to Australian circumstances. SETTING, PARTICIPANTS AND OUTCOME MEASURES The 32 hospitals, containing 119 participating departments, provided wide representation across metropolitan, inner and outer regional Australia. We obtained 31 quality management, 1334 clinician and 857 patient questionnaires, and conducted 2401 medical record reviews and 151 external assessments. External data via a secondary source comprised 14 460 index patient admissions across 14 031 individual patients. Associations between hospital, Emergency Department (ED) and department-level systems and strategies and five patient-level outcomes were assessed: 19 of 165 associations (11.5%) were statistically significant, 12 of 79 positive associations (15.2%) and 7 of 85 negative associations (8.2%). RESULTS We did not find clear relationships between hospital-level quality management systems, ED or department quality strategies and patient-level outcomes. ED-level clinical reviews were related to adherence to clinical practice guidelines for AMI, hip fracture and stroke, but in different directions. The results, when considered alongside the DUQuE results, are suggestive that front line interventions may be more influential than department-level interventions when shaping quality of care and that multi-pronged strategies are needed. Benchmark reports were sent to each participating hospital, stimulating targeted quality improvement activities. CONCLUSIONS We found no compelling relationships between the way care is organized and the quality of care across three targeted patient-level outcome conditions. The study was cross-sectional, and thus we recommend that the relationships studied should be assessed for changes across time. Tracking care longitudinally so that quality improvement activities are monitored and fed back to participants is an important initiative that should be given priority as health systems strive to develop their capacity for quality improvement over time.
Collapse
Affiliation(s)
- Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Emily Hogden
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia
| | - Zhicheng Li
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Amanda Selwood
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Meagan Warwick
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia.,Australian Centre for Precision Health, Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, 101 Currie Street, Adelaide, SA 5000, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| |
Collapse
|
13
|
Taylor N, Clay-Williams R, Ting HP, Winata T, Arnolda G, Hogden E, Lawton R, Braithwaite J. Validation of the patient measure of safety (PMOS) questionnaire in Australian public hospitals. Int J Qual Health Care 2019; 32:67-74. [DOI: 10.1093/intqhc/mzz097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/19/2019] [Accepted: 09/12/2019] [Indexed: 12/21/2022] Open
Abstract
Abstract
Objective
Patients can provide a unique perspective on the safety of care in hospitals. Understanding that the extent to which the way hospitals are organized for quality and safety is associated with patient perceptions of care is becoming increasingly valued and necessary for the direction of targeted interventions across healthcare systems. The UK-developed patient measure of safety (PMOS) assesses eight domains of ward safety from the patient point of view and has recently been adapted and piloted in Australia. The aim of this study is to test the psychometric properties of PMOS-Australia (PMOS-A) amongst a large cohort of hospitalized patients.
Design
Cross-sectional questionnaire validation assessment.
Setting and participants
As part of the DUQuA project, the PMOS-A survey was distributed within acute myocardial infarction, hip fracture and stroke departments across 32 large public hospitals in Australia. Patients could complete the PMOS-A independently, or request the assistance of a family member/guardian, or staff on the wards—space was included to record mode of completion.
Main outcome measures
Confirmatory factor analysis (CFA) was undertaken on a calibration sample to generate the model, and a validation sample was used to cross-validate the model. A subset of only those participants who received assistance for PMOS-A completion was also tested using CFA on a calibration and validation sample. Model fit indices (chi-square to degrees of freedom ratio [Chi-square:DF], root mean square error of approximation [RMSEA], comparative fit indices [CFI], standardized root mean squared residual [SRMR]), Cronbach’s α, average inter-item correlations, construct reliability and cross-loadings were examined with reference to recommended thresholds to establish the extent of convergent validity and discriminant validity. A marker of criterion validity was assessed through testing associations between the PMOS-A and adherence to clinical guidelines.
Results
Across the calibration and validation samples of the full (N = 911) and assisted completers only subset (N = 490), three (Chi-square:DF, SRMR, RMSEA) of the four indices consistently or almost always met thresholds for acceptable model fit. CFI indices did not meet the recommended limits (0.72–0.78, against a target > 0.9). Positive relationships were found for all tests between PMOS-A and adherence to clinical guidelines, and these were significant when assessed in the calibration datasets for the full and assisted completion samples.
Conclusion
A sufficiently reliable and valid measure of patient perceptions of safety has been developed. These findings should provide adequate support to justify the use of this measure to assess patient perceptions of safety in Australian hospitals and can be modified for use elsewhere.
Collapse
Affiliation(s)
- Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia
- Faculty of Health Sciences, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Emily Hogden
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds LS2 9JT, UK
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| |
Collapse
|
14
|
Corrêa JÉ, Turrioni JB, Mello CHP, Santos ACO, da Silva CES, de Almeida FA. Development of a System Measurement Model of the Brazilian Hospital Accreditation System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2520. [PMID: 30423866 PMCID: PMC6266958 DOI: 10.3390/ijerph15112520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 11/23/2022]
Abstract
The purpose of this study is to develop and validate a measurement model that evaluates the Brazilian hospital accreditation methodology (ONA), based on a multivariate model using structural equation modeling (SEM). The information used to develop the model was obtained from a questionnaire sent to all organizations accredited by the ONA methodology. A model was built based on the data obtained and tested through a structural equation modeling (SEM) technique using the LISREL® software (Scientific Software International, Inc., Skokie, IL, USA). Four different tests were performed: Initial, calibrated, simulated, and cross-validation models. By analyzing and validating the proposed measurement model, it can be verified that the selected factors satisfy the required criteria for the development of a structural model. The results show that leadership action is one of the most important factors in the process of health services accredited by ONA. Although, leadership, staff management, quality management, organizational culture, process orientation, and safety are strongly linked to the development of health organizations, and directly influence the accreditation process.
Collapse
Affiliation(s)
- João Éderson Corrêa
- Institute of Industrial Engineering and Management, Federal University of Itajubá, Av. BPS, 1303, Itajubá, Minas Gerais 37500-903, Brazil.
| | - João Batista Turrioni
- Institute of Industrial Engineering and Management, Federal University of Itajubá, Av. BPS, 1303, Itajubá, Minas Gerais 37500-903, Brazil.
| | - Carlos Henrique Pereira Mello
- Institute of Industrial Engineering and Management, Federal University of Itajubá, Av. BPS, 1303, Itajubá, Minas Gerais 37500-903, Brazil.
| | - Ana Carolina Oliveira Santos
- Institute of Integrated Engineering, Itabira Campus, Federal University of Itajubá, Rua Irmã Ivone Drumond, 200, Itabira, Minas Gerais 35903-087, Brazil.
| | - Carlos Eduardo Sanches da Silva
- Institute of Industrial Engineering and Management, Federal University of Itajubá, Av. BPS, 1303, Itajubá, Minas Gerais 37500-903, Brazil.
| | - Fabrício Alves de Almeida
- Institute of Industrial Engineering and Management, Federal University of Itajubá, Av. BPS, 1303, Itajubá, Minas Gerais 37500-903, Brazil.
| |
Collapse
|
15
|
The association between quality system development stage and the implementation of process-level patient safety themes in Dutch hospitals: an observational study. BMC Health Serv Res 2018; 18:189. [PMID: 29558932 PMCID: PMC5859445 DOI: 10.1186/s12913-018-2997-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
|
16
|
Villa S, Restuccia JD, Anessi-Pessina E, Rizzo MG, Cohen AB. Quality improvement strategies and tools: A comparative analysis between Italy and the United States. Health Serv Manage Res 2018; 31:205-217. [PMID: 29486603 DOI: 10.1177/0951484818755534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Italian and American hospitals, in two different periods, have been urged by external circumstances to extensively redesign their quality improvement strategies. This paper, through the use of a survey administered to chief quality officers in both countries, aims to identify commonalities and differences between the two systems and to understand which approaches are effective in improving quality of care. In both countries chief quality officers report quality improvement has become a strategic priority, clinical governance approaches, and tools-such as disease-specific quality improvement projects and clinical pathways-are commonly used, and there is widespread awareness that clinical decision making must be supported by protocols and guidelines. Furthermore, the study clearly outlines the critical importance of adopting a system-wide approach to quality improvement. To this extent Italy seems lagging behind compared to US in fact: (i) responsibilities for different dimensions of quality are spread across different organizational units; (ii) quality improvement strategies do not typically involve administrative staff; and (iii) quality performance measures are not disseminated widely within the organization but are reported primarily to top management. On the other hand, in Italy chief quality officers perceive that the typical hospital organizational structure, which is based on clinical directories, allows better coordination between clinical specialties than in the United States. In both countries, the results of the study show that it is not the single methodology/model that makes the difference but how the different quality improvement strategies and tools interact to each other and how they are coherently embedded with the overall organizational strategy.
Collapse
Affiliation(s)
- Stefano Villa
- 1 Department of Management, Università Cattolica del Sacro Cuore, Rome, Italy.,2 CERISMAS (Research Centre in Healthcare Management), Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Eugenio Anessi-Pessina
- 2 CERISMAS (Research Centre in Healthcare Management), Università Cattolica del Sacro Cuore, Milan, Italy.,4 Department of Management, Università Cattolica del Sacro Cuore, Milano, Italy
| | - Marco Giovanni Rizzo
- 1 Department of Management, Università Cattolica del Sacro Cuore, Rome, Italy.,2 CERISMAS (Research Centre in Healthcare Management), Università Cattolica del Sacro Cuore, Milan, Italy
| | - Alan B Cohen
- 3 Questrom School of Business, Boston University, Boston, MA, USA
| |
Collapse
|
17
|
Pougheon Bertrand D, Minguet G, Gagnayre R, Lombrail P. Lessons from patient and parent involvement (P&PI) in a quality improvement program in cystic fibrosis care in France. Orphanet J Rare Dis 2018; 13:19. [PMID: 29799378 PMCID: PMC6225648 DOI: 10.1186/s13023-017-0751-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Quality Improvement Programs (QIP) in cystic fibrosis (CF) care have emerged as strategies to reduce variability of care and of patient outcomes among centres facilitating the implementation of Best Practices in all centres. The US CF Foundation developed a Learning and Leadership Collaborative program which was transposed in France in 2011. Patient and parent involvement (P&PI) on the local quality teams (QTs) is one dimension of this complex intervention. The conditions and effects of this involvement needed to be evaluated. METHODS In all settings, patients and parents were recruited by their centre care team. They were trained to QI method and tools and contributed their own expertise to improve the process of care. This involvement has been analyzed in the frame of the whole process evaluation. Observations and interviews conducted during the course of the first training year explored the motivations of the patients and parents to participate and the vision of the health care teams. A research study was carried out after three years with the patients/parents and the professionals to assess the French QIP's effectiveness using a questionnaire to report their opinions on various components of the program, including their experience of P&PI. Responses were analyzed in view of identifying consensus and dissensus between the two groups. RESULTS At the introduction of the program, P&PI was an opportunity for healthcare providers to reflect on their conceptions of these individuals both as patients and as healthcare system users. Curiosity about the teams' functioning, the various center organizations and outcomes led patients to overcome their initial barriers to participation. Seventy-six people including 12 patients/parents from the 14 pilot centres responded to the questionnaire after 3 years. Consensus between professionals and patients/parents was high on most items characterizing the performance of the QIP, QT effectiveness and QT functioning. Patients, parents and professionals agreed on the main characteristics of care such as an optimized organization, multidisciplinary care and patient-centredness. Regarding the use of patient electronic records, the use of care guidelines or the organization of support in the patient community, responses were not consensual amongst patients/parents and a source of dissensus between the two groups. All agreed that the French QIP created good conditions for their involvement. In the end, both groups agreed that it was difficult to attribute the paternity of some changes specifically to any member in the team. DISCUSSION Perspectives such as an educational framework to develop the skills and behaviors of professionals engaged in collaborative practice with patients and families and large patient experience surveys could be used to capture patients' experience of care in the improvement work. CONCLUSION Success factors for patient/parent long-term involvement in QIPs have been identified. Answers to questions raised by the stakeholders about the feasibility, efficiency and usefulness of P&PI in this CF QIP could be given but new questions arose about the sustainability of continuous quality improvement over time.
Collapse
Affiliation(s)
| | | | - Rémi Gagnayre
- LEPS EA3412, Sorbonne Paris Cité University, Bobigny, France
| | - Pierre Lombrail
- LEPS EA3412, Sorbonne Paris Cité University, Bobigny, France
| |
Collapse
|
18
|
Jarrar M, Rahman HA, Minai MS, AbuMadini MS, Larbi M. The function of patient-centered care in mitigating the effect of nursing shortage on the outcomes of care. Int J Health Plann Manage 2018; 33:e464-e473. [PMID: 29380909 DOI: 10.1002/hpm.2491] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/14/2017] [Accepted: 01/03/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The shortage of nursing staff is a national and international issue. Inadequate number of hospital nurse staff leads to poor health care services. Yet the effects of patient-centeredness between the relationships of nursing shortage on the quality of care (QC) and patient safety (PS) have not been explored. The aim of this study was to examine the mediating effects of patient-centeredness on the relationship of nursing shortage on the QC and PS in the Medical and Surgical Wards, in Malaysian private hospitals. METHOD A descriptive, cross-sectional study was carried out on 12 private hospitals. Data was gathered, through a self- administered questionnaire, from 652 nurses, with a 61.8% response rate. Stratified simple random sampling was used to allow all nurses to participate in the study. Hayes PROCESS macro-regression analyses were conducted to explore the mediating effects of patient-centeredness on the relationships of hospital nurse staffing on the QC and PS. RESULTS Patient-centeredness mediated the relationships of hospital nurse staffing on both the QC (F = 52.73 and P = 0.000) and PS (F = 31.56 and P = 0.000). CONCLUSION Patient-centeredness helps to mitigate the negative associations of nursing shortage on the outcomes of care. The study provides a guide for hospital managers, leaders, decision-makers, risk managers, and policymakers to maintain adequate staffing level and instill the culture of patient-centeredness in order to deliver high quality and safer care.
Collapse
Affiliation(s)
- Mu'taman Jarrar
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | | | - Mahdi S AbuMadini
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mercy Larbi
- College of Applied Studies and Cummunity Services, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
19
|
Corrêa JÉ, Turrioni JB, de Paiva AP, Paes VDC, Balestrassi PP, Papandrea PJ, Gonçalves EDDC. The Influence of Accreditation on the Sustainability of Organizations with the Brazilian Accreditation Methodology. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:1393585. [PMID: 29599939 PMCID: PMC5823428 DOI: 10.1155/2018/1393585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 11/07/2017] [Indexed: 11/17/2022]
Abstract
This research evaluates the influence of the Brazilian accreditation methodology on the sustainability of the organizations. Critical factors for implementing accreditation were also examined, including measuring the relationships established between these factors in the organization sustainability. The present study was developed based on the survey methodology applied in the organizations accredited by ONA (National Accreditation Organization); 288 responses were received from the top level managers. The analysis of quantitative data of the measurement models was made with factorial analysis from principal components. The final model was evaluated from the confirmatory factorial analysis and structural equation modeling techniques. The results from the research are vital for the definition of factors that interfere in the accreditation processes, providing a better understanding for accredited organizations and for Brazilian accreditation.
Collapse
Affiliation(s)
- João Éderson Corrêa
- Industrial Engineering and Management Institute, Federal University of Itajuba, 1303 BPS Avenue, 37500-903 Itajubá, MG, Brazil
| | - João Batista Turrioni
- Industrial Engineering and Management Institute, Federal University of Itajuba, 1303 BPS Avenue, 37500-903 Itajubá, MG, Brazil
| | - Anderson Paulo de Paiva
- Industrial Engineering and Management Institute, Federal University of Itajuba, 1303 BPS Avenue, 37500-903 Itajubá, MG, Brazil
| | - Vinicius de Carvalho Paes
- Industrial Engineering and Management Institute, Federal University of Itajuba, 1303 BPS Avenue, 37500-903 Itajubá, MG, Brazil
| | - Pedro Paulo Balestrassi
- Vilanova i la Geltrú School of Engineering, Universitat Politècnica de Catalunya, Víctor Balaguer Avenue, 08800 Vilanova i la Geltrú, Barcelona, Spain
| | - Pedro José Papandrea
- Industrial Engineering and Management Institute, Federal University of Itajuba, 1303 BPS Avenue, 37500-903 Itajubá, MG, Brazil
| | | |
Collapse
|
20
|
Gabutti I, Mascia D, Cicchetti A. Exploring "patient-centered" hospitals: a systematic review to understand change. BMC Health Serv Res 2017; 17:364. [PMID: 28532463 PMCID: PMC5439229 DOI: 10.1186/s12913-017-2306-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/11/2017] [Indexed: 11/23/2022] Open
Abstract
Background The healthcare scenario in developed countries is changing deeply: patients, who are frequently affected by multi-pathological chronic conditions, have risen their expectations. Simultaneously, there exist dramatic financial pressures which require healthcare organizations to provide more and better services with equal (or decreasing) resources. In response to these challenges, hospitals are facing radical transformations by bridging, redesigning and engaging their organization and staff. Methods This study has the ambitious aim to shed light and clearly label the trends of change hospitals are enhancing in developed economies, in order to fully understand the presence of common trends and which organizational models and features are inspiring the most innovative organizations. The purpose is to make stock of what is known in the field of hospital organization about how hospitals are changing, as well as of how such change may be implemented effectively through managerial tools. To do so the methodology adopted integrates a systematic literature review to a wider engaged research approach. Results Evidence suggests that the three main pillars of change of the system are given by the progressive patient care model, the patient-centered approach and the lean approach. However, there emerge a number of gaps in what is known about how to exploit drivers of change and their effects. Conclusions This study confirms that efforts in literature are concentrated in analyzing circumscribed experiences in the implementation of new models and approaches, failing therefore to extend the analysis at the organizational and inter-organizational level in order to legitimately draw consequences to be generalized. There seem to be a number of “gaps” in what is known about how to exploit drivers of change and their effects, suggesting that the research approach privileged till now fails in providing a clear guidance to policy makers and to organizations’ management on how to concretely and effectively implement new organizational models. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2306-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Irene Gabutti
- Department of management, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | - Daniele Mascia
- Department of Management, University of Bologna, Bologna, Italy
| | - Americo Cicchetti
- Department of management, Università Cattolica del Sacro Cuore, Rome, 00168, RM, Italy
| |
Collapse
|
21
|
Fradgley EA, Paul CL, Bryant J, Collins N, Ackland SP, Bellamy D, Levi CR. Collaborative Patient-Centered Quality Improvement. Eval Health Prof 2016; 39:475-495. [DOI: 10.1177/0163278716659524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Identification of patients’ and health professionals’ quality improvement preferences is an essential first step in collaborative improvement models. This includes experience-based codesign (EBCD), where service change is strategically introduced following stakeholder consultation. This study compared the number and types of improvement initiatives selected by outpatients and health professionals. Using electronic surveys designed to inform EBCD studies, 541 outpatients (71.1% consent) and 124 professionals (47.1% response) selected up to 23 general initiatives. On average, outpatients selected 2.4 (median = 1, interquartile range = 1–3) initiatives and professionals selected 10.7 (median = 10; interquartile range = 6–15) initiatives. Outpatients demonstrated a strong preference for improvements to clinic organization, such as appointment scheduling and clinic contact. Outpatients selected relatively fewer initiatives potentially reducing the complexity of service change and resources required to address preferences. Comparatively, professionals indicated a greater degree of change is needed and selected initiatives related to communication with patients and other professionals, including coordinating multidisciplinary care. Improvements to information provision were commonly selected by both groups and offered a strategic opportunity to address patients’ and professionals’ preferences. By quantifying the ways in which preferences differed, this study emphasizes the need for collaborative approaches to health service change and may be used to initiate an informed discussion on patients’ and professionals’ quality improvement preferences in tertiary care.
Collapse
Affiliation(s)
- Elizabeth A. Fradgley
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christine L. Paul
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicolas Collins
- Department of Cardiovascular Medicine, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Stephen P. Ackland
- Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
- Department of Medical Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Douglas Bellamy
- Cancer Network, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Christopher R. Levi
- Department of Neurology, John Hunter Hospital and Research Support and Development Unit, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| |
Collapse
|
22
|
Rotar AM, Botje D, Klazinga NS, Lombarts KM, Groene O, Sunol R, Plochg T. The involvement of medical doctors in hospital governance and implications for quality management: a quick scan in 19 and an in depth study in 7 OECD countries. BMC Health Serv Res 2016; 16 Suppl 2:160. [PMID: 27228970 PMCID: PMC4896246 DOI: 10.1186/s12913-016-1396-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Hospital governance is broadening its orientation from cost and production controls towards ‘improving performance on clinical outcomes’. Given this new focus one might assume that doctors are drawn into hospital management across OECD countries. Hospital performance in terms of patient health, quality of care and efficiency outcomes is supposed to benefit from their involvement. However, international comparative evidence supporting this idea is limited. Just a few studies indicate that there may be a positive relationship between medical doctors being part of hospital boards, and overall hospital performance. More importantly, the assumed relationship between these so-called doctor managers and hospital performance has remained a ‘black-box’ thus far. However, there is an increasing literature on the implementation of quality management systems in hospitals and their relation with improved performance. It seems therefore fair to assume that the relation between the involvement of doctors in hospital management and improved hospital performance is partly mediated via quality management systems. The threefold aim of this paper is to 1) perform a quick scan of the current situation with regard to doctor managers in hospital management in 19 OECD countries, 2) explore the phenomenon of doctor managers in depth in 7 OECD countries, and 3) investigate whether doctor involvement in hospital management is associated with more advanced implementation of quality management systems. Methods This study draws both on a quick scan amongst country coordinators in OECD’s Health Care Quality Indicator program, and on the DUQuE project which focused on the implementation of quality management systems in European hospitals. Results This paper reports two main findings. First, medical doctors fulfil a broad scope of managerial roles at departmental and hospital level but only partly accompanied by formal decision making responsibilities. Second, doctor managers having more formal decision making responsibilities in strategic hospital management areas is positively associated with the level of implementation of quality management systems. Conclusions Our findings suggest that doctors are increasingly involved in hospital management in OECD countries, and that this may lead to better implemented quality management systems, when doctors take up managerial roles and are involved in strategic management decision making.
Collapse
Affiliation(s)
- A M Rotar
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands
| | - D Botje
- Berenschot BV, Europalaan 40, 3526 KS, Utrecht, The Netherlands
| | - N S Klazinga
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands
| | - K M Lombarts
- Professional Performance research group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - O Groene
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.,Optimedis AG, Hamburg, Germany
| | - R Sunol
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - T Plochg
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands.
| |
Collapse
|
23
|
Taylor N, Clay-Williams R, Hogden E, Pye V, Li Z, Groene O, Suñol R, Braithwaite J. Deepening our Understanding of Quality in Australia (DUQuA): a study protocol for a nationwide, multilevel analysis of relationships between hospital quality management systems and patient factors. BMJ Open 2015; 5:e010349. [PMID: 26644128 PMCID: PMC4679999 DOI: 10.1136/bmjopen-2015-010349] [Citation(s) in RCA: 16] [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: 11/24/2022] Open
Abstract
INTRODUCTION Despite the growing body of research on quality and safety in healthcare, there is little evidence of the association between the way hospitals are organised for quality and patient factors, limiting our understanding of how to effect large-scale change. The 'Deepening our Understanding of Quality in Australia' (DUQuA) study aims to measure and examine relationships between (1) organisation and department-level quality management systems (QMS), clinician leadership and culture, and (2) clinical treatment processes, clinical outcomes and patient-reported perceptions of care within Australian hospitals. METHODS AND ANALYSIS The DUQuA project is a national, multilevel, cross-sectional study with data collection at organisation (hospital), department, professional and patient levels. Sample size calculations indicate a minimum of 43 hospitals are required to adequately power the study. To allow for rejection and attrition, 70 hospitals across all Australian jurisdictions that meet the inclusion criteria will be invited to participate. Participants will consist of hospital quality management professionals; clinicians; and patients with stroke, acute myocardial infarction and hip fracture. Organisation and department-level QMS, clinician leadership and culture, patient perceptions of safety, clinical treatment processes, and patient outcomes will be assessed using validated, evidence-based or consensus-based measurement tools. Data analysis will consist of simple correlations, linear and logistic regression and multilevel modelling. Multilevel modelling methods will enable identification of the amount of variation in outcomes attributed to the hospital and department levels, and the factors contributing to this variation. ETHICS AND DISSEMINATION Ethical approval has been obtained. Results will be disseminated to individual hospitals in de-identified national and international benchmarking reports with data-driven recommendations. This ground-breaking national study has the potential to influence decision-making on the implementation of quality and safety systems and processes in Australian and international hospitals.
Collapse
Affiliation(s)
- Natalie Taylor
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Emily Hogden
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Victoria Pye
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Zhicheng Li
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Oliver Groene
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rosa Suñol
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain
- Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, Barcelona, Spain
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| |
Collapse
|
24
|
Sunol R, Wagner C, Arah OA, Kristensen S, Pfaff H, Klazinga N, Thompson CA, Wang A, DerSarkissian M, Bartels P, Michel P, Groene O. 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] [MESH Headings] [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.
Collapse
Affiliation(s)
- 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
| | - Cordula Wagner
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Public and Occupational Health,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Onyebuchi A. Arah
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Solvejg Kristensen
- Danish Clinical Registries, Aarhus, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
- Center for Health Services Research Cologne, University of Cologne, Cologne, Germany
| | - Niek Klazinga
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline A. Thompson
- Palo Alto Medical Foundation Research Institute (PAMFRI), Palo Alto, California, United States of America
| | - Aolin Wang
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Maral DerSarkissian
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Paul Bartels
- Danish Clinical Registries, Aarhus, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Philippe Michel
- Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Oliver Groene
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
25
|
Mumford V, Greenfield D, Hogden A, Forde K, Westbrook J, Braithwaite J. Counting the costs of accreditation in acute care: an activity-based costing approach. BMJ Open 2015; 5:e008850. [PMID: 26351190 PMCID: PMC4563236 DOI: 10.1136/bmjopen-2015-008850] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess the costs of hospital accreditation in Australia. DESIGN Mixed methods design incorporating: stakeholder analysis; survey design and implementation; activity-based costs analysis; and expert panel review. SETTING Acute care hospitals accredited by the Australian Council for Health Care Standards. PARTICIPANTS Six acute public hospitals across four States. RESULTS Accreditation costs varied from 0.03% to 0.60% of total hospital operating costs per year, averaged across the 4-year accreditation cycle. Relatively higher costs were associated with the surveys years and with smaller facilities. At a national level these costs translate to $A36.83 million, equivalent to 0.1% of acute public hospital recurrent expenditure in the 2012 fiscal year. CONCLUSIONS This is the first time accreditation costs have been independently evaluated across a wide range of hospitals and highlights the additional cost burden for smaller facilities. A better understanding of the costs allows policymakers to assess alternative accreditation and other quality improvement strategies, and understand their impact across a range of facilities. This methodology can be adapted to assess international accreditation programmes.
Collapse
Affiliation(s)
- Virginia Mumford
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Maquarie University, Sydney, New South Wales, Australia
| | - David Greenfield
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Maquarie University, Sydney, New South Wales, Australia
| | - Anne Hogden
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Maquarie University, Sydney, New South Wales, Australia
| | - Kevin Forde
- School of Public Health and Community Medicine, UNSW Medicine, UNSW, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Maquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Abstract
Purpose
– The purpose of this paper is to review how patient and public involvement (PPI) can contribute to quality improvement functions and describe the levels of PPI in quality improvement functions at hospital and departmental level in a sample of European hospitals.
Design/methodology/approach
– Literature review and cross-sectional study.
Findings
– PPI takes multiple forms in health care and there is not a single strategy or method that can be considered to reflect best practice. The literature reveals that PPI can serve important functions to support quality improvement efforts. In contrast, the assessment of actual PPI in quality improvement shows that PPI is low.
Research limitations/implications
– Findings are not representative of hospitals in the EU.
Practical implications
– A diverse set of methods and tools that can be employed to realize PPI. Service providers should consider PPI at all stages, in particular in setting quality standards and criteria and in evaluating the results.
Originality/value
– Contextualization of empirical findings with case studies from the literature that inform further practice and research on PPI.
Collapse
|
27
|
Cipolat Mis C, Truccolo I, Ravaioli V, Cocchi S, Gangeri L, Mosconi P, Drace C, Pomicino L, Paradiso A, De Paoli P. Making patient centered care a reality: a survey of patient educational programs in Italian Cancer Research and Care Institutes. BMC Health Serv Res 2015. [PMID: 26223861 PMCID: PMC4518580 DOI: 10.1186/s12913-015-0962-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Educational intervention represents an essential element of care for cancer patients; while several single institutions develop their own patient education (PE) programs on cancer, little information is available on the effective existence of PE programs at the level of research and care institutes. In Italy such institutes - Istituti di Ricovero e Cura a Carattere Scientifico - are appointed by the Ministry of Health, and 11 (Cancer Research & Care Istitute-CRCI) of the 48 are specific for cancer on the basis of specific requirements regarding cancer care, research and education. Therefore, they represent an ideal and homogeneous model through which to investigate PE policies and activities throughout the country. The objective of this study was to assess PE activities in Italian CRCI. Methods We carried out a survey on PE strategies and services through a questionnaire. Four key points were investigated: a) PE as a cancer care priority, b) activities that are routinely part of PE, c) real involvement of the patients, and d) involvement of healthcare workers in PE activities. Results Most CRCI (85 %) completed the survey. All reported having ongoing PE activities, and 4 of the 11 considered PE an institutional activity. More than 90 % of CRCI organize classes and prepare PE handouts, while other PE activities (e.g., Cancer Information Services, mutual support groups) are less frequently part of institutional PE programs. Patients are frequently involved in the organization and preparation of educational activities on the basis of their own needs. Various PE activities are carried out for caregivers in 8 (73 %) out of 11 institutes. Finally, health care workers have an active role in the organization of PE programs, although nurses take part in these activities in only half of CRCI and pharmacists are seldom included. Conclusions The information arising from our research constitutes a necessary framework to identify areas of development and to design new strategies and standards to disseminate the culture of PE. This may ultimately help and stimulate the establishment of institutional integrated PE programs, including policies and interventions that can benefit a significant proportion of cancer patients. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0962-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- C Cipolat Mis
- Scientific and Patients Library, CRO National Cancer Institute - IRCCS, Aviano (PN), Italy.
| | - I Truccolo
- Scientific and Patients Library, CRO National Cancer Institute - IRCCS, Aviano (PN), Italy.
| | - V Ravaioli
- Public Relations, Communication and Press Office, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) Srl IRCCS, Meldola, Italy.
| | - S Cocchi
- Medical Library, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - L Gangeri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - P Mosconi
- Laboratory for medical research and consumer involvement, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
| | - C Drace
- Familiar Cancer Clinic, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy.
| | - L Pomicino
- Department of Pediatrics, Institute of Maternal and Child Health, Burlo Garofolo, Trieste, Italy.
| | - A Paradiso
- Experimental Medical Oncology Unit, National Cancer Research Centre, Istituto Tumori'Giovanni Paolo II', Bari, Italy.
| | - P De Paoli
- Scientific Director, CRO National Cancer Institute - IRCCS, Aviano (PN), Italy.
| | | |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Atoof F, Eshraghian MR, Mahmoodi M, Mohammad K, Rangraz Jeddi F, Abootalebi F. Patients and Public Involvement in Patient Safety and Treatment Process in Hospitals Affiliated to Kashan University of Medical Sciences, Iran, 2013. Nurs Midwifery Stud 2015; 4:e24755. [PMID: 26339664 PMCID: PMC4557404 DOI: 10.17795/nmsjournal24755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 11/25/2022] Open
Abstract
Background: In the recent decades, healthcare providers had a perspective of benevolent paternalism. Nowadays, the patients’ role has changed and they have a significant obligation to participate in their caring decisions. Objectives: The current study aimed to investigate the involvement of patients and public in the patient safety and treatment process in hospitals affiliated to Kashan University of Medical Sciences, Kashan, Iran, 2013. Patients and Methods: A cross-sectional study was conducted in the hospitals affiliated to Kashan University of Medical Sciences in 2013. Subjects included all of the 18 chief managers, 10% of nurses in each hospital, and 375 patients. Data collection instruments included a questionnaire and a checklist designed according to the research objectives. Data analysis was performed using the SPSS ver. 13. Descriptive statistics, percentage and frequencies, were calculated for all variables and analyzed by Chi-square test. Results: In the treatment process, 81 patients (21.61%), 50 nurses (80.6%) and 15 chief managers (83.3%) had awareness about Patient Bill of Rights. In patient Safety, 19.73% of the patients stated that hospitals received their feedbacks. Management activities were weak in evaluation. All of the six hospitals (100%) had a defined process to perform satisfaction surveys’ quality improvement and patient authentication policy. Conclusions: Patient and public participation in Kashan hospitals are not adhered well. As the patient has an important role in improving the quality of services, more use of mass media especially local newspapers, hospital websites, and training programs are suggested to inform both the patients and public on their rights and roles in improving the healthcare services.
Collapse
Affiliation(s)
- Fatemeh Atoof
- Department of Epidemiology and Biostatistics, Faculty of Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Eshraghian
- Department of Epidemiology and Biostatistics, Faculty of Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mahmood Mahmoodi
- Department of Epidemiology and Biostatistics, Faculty of Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Kazem Mohammad
- Department of Epidemiology and Biostatistics, Faculty of Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Fatemeh Rangraz Jeddi
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Fatemeh Abootalebi
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| |
Collapse
|
30
|
Aghaei Hashjin A, Delgoshaei B, Kringos DS, Tabibi SJ, Manouchehri J, Klazinga NS. Implementing hospital quality assurance policies in Iran. Int J Health Care Qual Assur 2015; 28:343-55. [DOI: 10.1108/ijhcqa-03-2014-0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran.
Design/methodology/approach
– A mixed method (quantitative data and qualitative document analysis) study was carried out between 1996 and 2010.
Findings
– The QA policy cycle forms a tight monitoring system to assure hospital quality by combining mandatory and voluntary methods in Iran. The licensing, annual evaluation and grading, and regulatory inspections statutorily implemented by the government as a national package to assure and improve hospital care quality, while implementing quality management systems (QMS) was voluntary for hospitals. The government’s strong QA policy legislation role and support has been an important factor for successful QA implementation in Iran, though it may affected QA assessment independency and validity. Increased hospital evaluation independency and repositioning, updating standards, professional involvement and effectiveness studies could increase QA policy impact and maturity.
Practical implications
– The study highlights the current QA policy implementation cycle in Iranian hospitals. It provides a basis for further quality strategy development in Iranian hospitals and elsewhere. It also raises attention about finding the optimal balance between different QA policies, which is topical for many countries.
Originality/value
– This paper describes experiences when implementing a unique approach, combining mandatory and voluntary QA policies simultaneously in a developing country, which has invested considerably over time to improve hospital quality. The experiences with a mixed obligatory/voluntary approach and comprehensive policies in Iran may contain lessons for policy makers in developing and developed countries.
Collapse
|
31
|
Abdul Rahman H, Jarrar M, Don MS. Nurse Level of Education, Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-sectional Study. Glob J Health Sci 2015; 7:331-7. [PMID: 26153190 PMCID: PMC4803884 DOI: 10.5539/gjhs.v7n6p331] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/14/2015] [Indexed: 11/16/2022] Open
Abstract
Background and Objective: Nursing knowledge and skills are required to sustain quality of care and patient safety. The number of nurses with Bachelor degrees in Malaysia is very limited. This study aims to predict the impact of nurse level of education on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. Methodology: A cross-sectional survey by questionnaire was conducted. A total of 652 nurses working in the medical and surgical wards in 12 private hospitals participated in the study. Multistage stratified simple random sampling performed to invite nurses working in small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals to participate in the study. This allowed nurses from all shifts to participate in this study. Results: Nurses with higher education were not significantly associated with both quality of care and patient safety. However, a total 355 (60.9%) of respondents who participated in this study were working in teaching hospitals. Teaching hospitals offer training for all newly appointed staff. They also provide general orientation programs and training to outline the policies, procedures of the nurses’ roles and responsibilities. This made the variances between the Bachelor and Diploma nurses not significantly associated with the outcomes of care. Conclusions: Nursing educational level was not associated with the outcomes of care in Malaysian private hospitals. However, training programs and the general nursing orientation programs for nurses in Malaysia can help to upgrade the Diploma-level nurses. Training programs can increase their self confidence, knowledge, critical thinking ability and improve their interpersonal skills. So, it can be concluded that better education and training for a medical and surgical wards’ nurses is required for satisfying client expectations and sustaining the outcomes of patient care.
Collapse
|
32
|
Patient Empowerment and its neighbours: Clarifying the boundaries and their mutual relationships. Health Policy 2015; 119:384-94. [DOI: 10.1016/j.healthpol.2014.10.017] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/22/2014] [Accepted: 10/27/2014] [Indexed: 11/18/2022]
|
33
|
Lombarts KMJMH, Plochg T, Thompson CA, Arah OA. Measuring professionalism in medicine and nursing: results of a European survey. PLoS One 2014; 9:e97069. [PMID: 24849320 PMCID: PMC4029578 DOI: 10.1371/journal.pone.0097069] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/14/2014] [Indexed: 11/18/2022] Open
Abstract
Background Leveraging professionalism has been put forward as a strategy to drive improvement of patient care. We investigate professionalism as a factor influencing the uptake of quality improvement activities by physicians and nurses working in European hospitals. Objective To (i) investigate the reliability and validity of data yielded by using the self-developed professionalism measurement tool for physicians and nurses, (ii) describe their levels of professionalism displayed, and (iii) quantify the extent to which professional attitudes would predict professional behaviors. Methods and Materials We designed and deployed survey instruments amongst 5920 physicians and nurses working in European hospitals. This was conducted under the cross-sectional multilevel study “Deepening Our Understanding of Quality Improvement in Europe” (DUQuE). We used psychometric and generalized linear mixed modelling techniques to address the aforementioned objectives. Results In all, 2067 (response rate 69.8%) physicians and 2805 nurses (94.8%) representing 74 hospitals in 7 European countries participated. The professionalism instrument revealed five subscales of professional attitude and one scale for professional behaviour with moderate to high internal consistency and reliability. Physicians and nurses display equally high professional attitude sum scores (11.8 and 11.9 respectively out of 16) but seem to have different perceptions towards separate professionalism aspects. Lastly, professionals displaying higher levels of professional attitudes were more involved in quality improvement actions (physicians: b = 0.019, P<0.0001; nurses: b = 0.016, P<0.0001) and more inclined to report colleagues’ underperformance (physicians – odds ratio (OR) 1.12, 95% CI 1.01–1.24; nurses – OR 1.11, 95% CI 1.01–1.23) or medical errors (physicians – OR 1.14, 95% CI 1.01–1.23; nurses – OR 1.43, 95% CI 1.22–1.67). Involvement in QI actions was found to increase the odds of reporting incompetence or medical errors. Conclusion A tool that reliably and validly measures European physicians’ and nurses’ commitment to professionalism is now available. Collectively leveraging professionalism as a quality improvement strategy may be beneficial to patient care quality.
Collapse
Affiliation(s)
- Kiki M. J. M. H. Lombarts
- Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Thomas Plochg
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline A. Thompson
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, United States of America
| | - Onyebuchi A. Arah
- Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
- UCLA Center for Health Policy Research, Los Angeles, California, United States of America
| | | |
Collapse
|
34
|
Wagner C, Mannion R, Hammer A, Groene O, Arah OA, Dersarkissian M, Suñol R. The associations between organizational culture, organizational structure and quality management in European hospitals. Int J Qual Health Care 2014; 26 Suppl 1:74-80. [PMID: 24671119 PMCID: PMC4001695 DOI: 10.1093/intqhc/mzu027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2014] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals. DESIGN A multi-method, multi-level, cross-sectional observational study. SETTING AND PARTICIPANTS As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study (n = 158) included professional quality managers and hospital trustees. MAIN OUTCOME MEASURES Extent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities. RESULTS Among participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. Some structural characteristics were associated with the development of quality management systems. CONCLUSION The type of OC was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An OS that uses fewer protocols is associated with a less developed quality management system, whereas an OS which supports innovation in care is associated with a more developed quality management system.
Collapse
Affiliation(s)
- C Wagner
- * P.O. Box 1568, 3500 BN Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
35
|
Wagner C, Thompson CA, Arah OA, Groene O, Klazinga NS, Dersarkissian M, Suñol R. A checklist for patient safety rounds at the care pathway level. Int J Qual Health Care 2014; 26 Suppl 1:36-46. [PMID: 24615594 PMCID: PMC4001694 DOI: 10.1093/intqhc/mzu019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To define a checklist that can be used to assess the performance of a department and evaluate the implementation of quality management (QM) activities across departments or pathways in acute care hospitals. DESIGN We developed and tested a checklist for the assessment of QM activities at department level in a cross-sectional study using on-site visits by trained external auditors. SETTING AND PARTICIPANTS A sample of 292 hospital departments of 74 acute care hospitals across seven European countries. In every hospital, four departments for the conditions: acute myocardial infarction (AMI), stroke, hip fracture and deliveries participated. MAIN OUTCOME MEASURES Four measures of QM activities were evaluated at care pathway level focusing on specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies and clinical review (CR). RESULTS Participating departments attained mean values on the various scales between 1.2 and 3.7. The theoretical range was 0-4. Three of the four QM measures are identical for the four conditions, whereas one scale (EBOP) has condition-specific items. Correlations showed that every factor was related, but also distinct, and added to the overall picture of QM at pathway level. CONCLUSION The newly developed checklist can be used across various types of departments and pathways in acute care hospitals like AMI, deliveries, stroke and hip fracture. The anticipated users of the checklist are internal (e.g. peers within the hospital and hospital executive board) and external auditors (e.g. healthcare inspectorate, professional or patient organizations).
Collapse
|
36
|
Groene O, Sunol R. The investigators reflect: what we have learned from the Deepening our Understanding of Quality Improvement in Europe (DUQuE) study. Int J Qual Health Care 2014; 26 Suppl 1:2-4. [PMID: 24643959 PMCID: PMC4001690 DOI: 10.1093/intqhc/mzu024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
37
|
Groene O, Sunol R, Klazinga NS, Wang A, Dersarkissian M, Thompson CA, Thompson A, Arah OA. Involvement of patients or their representatives in quality management functions in EU hospitals: implementation and impact on patient-centred care strategies. Int J Qual Health Care 2014; 26 Suppl 1:81-91. [PMID: 24615596 PMCID: PMC4001693 DOI: 10.1093/intqhc/mzu022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies. DESIGN A cross-sectional, multilevel STUDY DESIGN that surveyed quality managers and department heads and data from an organizational audit. SETTING Randomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). PARTICIPANTS Hospital quality managers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012. MAIN OUTCOME MEASURES Four items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level. RESULTS Current levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies. CONCLUSIONS There is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect.
Collapse
Affiliation(s)
- Oliver Groene
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
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.
Collapse
Affiliation(s)
- Mariona Secanell
- Avedis Donabedian Reseach Institute, University Autonomous of Barcelona, C/Provenza 293, Pral. 08037 Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Wagner C, Groene O, Thompson CA, Klazinga NS, Dersarkissian M, Arah OA, Suñol R. Development and validation of an index to assess hospital quality management systems. Int J Qual Health Care 2014; 26 Suppl 1:16-26. [PMID: 24618212 PMCID: PMC4001698 DOI: 10.1093/intqhc/mzu021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objective The aim of this study was to develop and validate an index to assess the implementation of quality management systems (QMSs) in European countries. Design Questionnaire development was facilitated through expert opinion, literature review and earlier empirical research. A cross-sectional online survey utilizing the questionnaire was undertaken between May 2011 and February 2012. We used psychometric methods to explore the factor structure, reliability and validity of the instrument. Setting and participants As part of the Deepening our Understanding of Quality improvement in Europe (DUQuE) project, we invited a random sample of 188 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Main Outcome Measure The extent of implementation of QMSs. Results Factor analysis yielded nine scales, which were combined to build the Quality Management Systems Index. Cronbach's reliability coefficients were satisfactory (ranging from 0.72 to 0.82) for eight scales and low for one scale (0.48). Corrected item-total correlations provided adequate evidence of factor homogeneity. Inter-scale correlations showed that every factor was related, but also distinct, and added to the index. Construct validity testing showed that the index was related to recent measures of quality. Participating hospitals attained a mean value of 19.7 (standard deviation of 4.7) on the index that theoretically ranged from 0 to 27. Conclusion Assessing QMSs across Europe has the potential to help policy-makers and other stakeholders to compare hospitals and focus on the most important areas for improvement.
Collapse
Affiliation(s)
- C Wagner
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Plochg T, Arah OA, Botje D, Thompson CA, Klazinga NS, Wagner C, Mannion R, Lombarts K. Measuring clinical management by physicians and nurses in European hospitals: development and validation of two scales. Int J Qual Health Care 2014; 26 Suppl 1:56-65. [PMID: 24615595 PMCID: PMC4001689 DOI: 10.1093/intqhc/mzu014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective Clinical management is hypothesized to be critical for hospital management and hospital performance. The aims of this study were to develop and validate professional involvement scales for measuring the level of clinical management by physicians and nurses in European hospitals. Design Testing of validity and reliability of scales derived from a questionnaire of 21 items was developed on the basis of a previous study and expert opinion and administered in a cross-sectional seven-country research project ‘Deepening our Understanding of Quality improvement in Europe’ (DUQuE). Setting and Participants A sample of 3386 leading physicians and nurses working in 188 hospitals located in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Main Outcome Measures Validity and reliability of professional involvement scales and subscales. Results Psychometric analysis yielded four subscales for leading physicians: (i) Administration and budgeting, (ii) Managing medical practice, (iii) Strategic management and (iv) Managing nursing practice. Only the first three factors applied well to the nurses. Cronbach's alpha for internal consistency ranged from 0.74 to 0.86 for the physicians, and from 0.61 to 0.81 for the nurses. Except for the 0.74 correlation between ‘Administration and budgeting’ and ‘Managing medical practice’ among physicians, all inter-scale correlations were <0.70 (range 0.43–0.61). Under testing for construct validity, the subscales were positively correlated with ‘formal management roles’ of physicians and nurses. Conclusions The professional involvement scales appear to yield reliable and valid data in European hospital settings, but the scale ‘Managing medical practice’ for nurses needs further exploration. The measurement instrument can be used for international research on clinical management.
Collapse
Affiliation(s)
- Thomas Plochg
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Meibergdreef 9, 1100 DE Amsterdam J2-211, The Netherlands;
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Wagner C, Groene O, Thompson CA, Dersarkissian M, Klazinga NS, Arah OA, Suñol R. DUQuE quality management measures: associations between quality management at hospital and pathway levels. Int J Qual Health Care 2014; 26 Suppl 1:66-73. [PMID: 24615597 PMCID: PMC4001696 DOI: 10.1093/intqhc/mzu020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were developed. This study investigates the relationships between the various quality measures. Design It is a multi-level, cross-sectional, mixed-method study. Setting and Participants As part of the DUQuE project, we invited a random sample of 74 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Furthermore, data of site visits of external surveyors assessing the participating hospitals were used. Main Outcome Measures Three measures of QM at hospitals level focusing on integral systems (QMSI), compliance with the Plan-Do-Study-Act quality improvement cycle (QMCI) and implementation of clinical quality (CQII). Four measures of QM activities at care pathway level focusing on Specialized expertise and responsibility (SER), Evidence-based organization of pathways (EBOP), Patient safety strategies (PSS) and Clinical review (CR). Results Positive significant associations were found between the three hospitals level QM measures. Results of the relationships between levels were mixed and showed most associations between QMCI and department-level QM measures for all four types of departments. QMSI was associated with PSS in all types of departments. Conclusion By using the seven measures of QM, it is possible to get a more comprehensive picture of the maturity of QM in hospitals, with regard to the different levels and across various types of hospital departments.
Collapse
|
42
|
Shaw CD, Groene O, Botje D, Sunol R, Kutryba B, Klazinga N, Bruneau C, Hammer A, Wang A, Arah OA, Wagner C. The effect of certification and accreditation on quality management in 4 clinical services in 73 European hospitals. Int J Qual Health Care 2014; 26 Suppl 1:100-7. [PMID: 24615598 PMCID: PMC4001697 DOI: 10.1093/intqhc/mzu023] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals. DESIGN A mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management systems, illustrated by four clinical pathways. SETTING AND PARTICIPANTS Seventy-three acute care hospitals with a total of 291 services managing acute myocardial infarction (AMI), hip fracture, stroke and obstetric deliveries, in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. MAIN OUTCOME MEASURE Four composite measures of quality and safety [specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies (PSS) and clinical review (CR)] applied to four pathways. RESULTS Accreditation in isolation showed benefits in AMI and stroke more than in deliveries and hip fracture; the greatest significant association was with CR in stroke. Certification in isolation showed little benefit in AMI but had more positive association with the other conditions; greatest significant association was in PSS with stroke. The combination of accreditation and certification showed least benefit in EBOP, but significant benefits in SER (AMI), in PSS (AMI, hip fracture and stroke) and in CR (AMI and stroke). CONCLUSIONS Accreditation and certification are positively associated with clinical leadership, systems for patient safety and clinical review, but not with clinical practice. Both systems promote structures and processes, which support patient safety and clinical organization but have limited effect on the delivery of evidence-based patient care. Further analysis of DUQuE data will explore the association of certification and accreditation with clinical outcomes.
Collapse
Affiliation(s)
- Charles D Shaw
- * Centre for Clinical Governance Research, University of New South Wales, Sydney, Australia.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Groene O, Kristensen S, Arah OA, Thompson CA, Bartels P, Sunol R, Klazinga N. Feasibility of using administrative data to compare hospital performance in the EU. Int J Qual Health Care 2014; 26 Suppl 1:108-15. [PMID: 24554645 PMCID: PMC4001688 DOI: 10.1093/intqhc/mzu015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe hospitals' organizational arrangements relevant to the abstraction of administrative data, to report on the completeness of administrative data collected and to assess associations between organizational arrangements and completeness of data submission. DESIGN A cross-sectional STUDY DESIGN utilizing administrative data. SETTING AND PARTICIPANTS Randomly selected hospitals from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey). MAIN OUTCOME MEASURES Completeness of data submission for four quality indicators: mortality after acute myocardial infarction, stroke and hip fractures and complications after normal delivery. RESULTS In general, hospitals were able to produce data on the four indicators required for this research study. A substantial proportion had missing data on one or more data items. The proportion of hospitals that was able to produce more detailed indicators of relevance for quality monitoring and improvement was low and ranged from 40.1% for thrombolysis performed on patients with acute ischemic stroke to 63.8% for hip-fracture operations performed within 48 h after admission for patients aged 65 or older. National factors were strong predictors of data completeness on the studied indicators. CONCLUSIONS At present, hospital administrative databases do not seem to be an appropriate source of information for comparison of hospital performance across the countries of the EU. However, given that this is a dynamic field, changes to administrative databases may make this possible in the near future. Such changes could be accelerated by an in-depth comparative analysis of the issues of using administrative data for comparisons of hospital performances in EU countries.
Collapse
Affiliation(s)
- O Groene
- Health Services Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
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.
Collapse
Affiliation(s)
- Daan Botje
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, PO Box 1568, 3500 BN Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
The relationship between social capital and quality management systems in European hospitals: a quantitative study. PLoS One 2013; 8:e85662. [PMID: 24392027 PMCID: PMC3877377 DOI: 10.1371/journal.pone.0085662] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 12/02/2013] [Indexed: 11/24/2022] Open
Abstract
Background Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups. Objectives We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals. Methods We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering. Results The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029). Conclusion The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could have important implications for the work of hospital managers and the design and evaluation of hospital quality management systems.
Collapse
|
46
|
Uematsu H, Hashimoto H, Iwamoto T, Horiguchi H, Yasunaga H. Impact of guideline-concordant microbiological testing on outcomes of pneumonia. Int J Qual Health Care 2013; 26:100-7. [PMID: 24257160 DOI: 10.1093/intqhc/mzt078] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Clinical practice guidelines recommend standardized diagnostic microbiological testing for community-acquired pneumonia on hospital admission, although evidence of its impact on quality is limited. This study evaluated the relationship between guideline-concordant microbiological testing (GCMT) and both in-hospital mortality and length of stay. DESIGN /st> Retrospective cohort study using a multicenter claims-based inpatient database linked to a government hospital census database in Japan. SETTING AND PARTICIPANTS /st> Patients who were diagnosed with and treated for pneumonia, and were discharged between 1 July 2010 and 30 September 2011 (n = 65 145). METHODS and MAIN OUTCOME MEASURES /st> GCMT was defined to include sputum tests, blood cultures and urine antigen tests conducted on the first day of hospitalization. We examined the association between 30-day in-hospital mortality and both the performance of each test and the number of tests performed using multivariable logistic regression analysis, adjusting for patient demographics, pneumonia severity and hospital characteristics. Length of stay was analyzed using a Cox proportional hazards model. RESULTS /st> Simultaneous conduct of all three tests was significantly associated with reduced 30-day mortality (odds ratio: 0.64; 95% confidence interval (CI): 0.56-0.74) and with increased likelihood of discharge (hazard ratio: 1.04; 95% CI: 1.00-1.07), after adjusting for patient and hospital characteristics. The association was more marked as the level of disease severity increased. CONCLUSIONS /st> Performance of GCMT was significantly associated with lower mortality and shorter length of stay. These results suggest that hospitals should assure performance of GCMT in patients with severe community-acquired pneumonia.
Collapse
Affiliation(s)
- Hironori Uematsu
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | | | | | | | | |
Collapse
|
47
|
Tavakoli N, Abbasi S. External Evaluation of Four Hospitals According to Patient-centred Care Standards. Acta Inform Med 2013; 21:176-9. [PMID: 24167387 PMCID: PMC3804481 DOI: 10.5455/aim.2013.21.176-179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/28/2013] [Indexed: 12/03/2022] Open
Abstract
Introduction: Hospital accreditation is a multi-factorial issue. The aim of the current study was to accredit social security organization and university hospitals (that certificated by ISO 9001-2008) in Isfahan, the second largest city of Iran, based on Joint Commission International (JCI) accreditation standards. Methods: Accreditation of four hospitals was evaluated and compared in a cross-sectional study. Seven checklists were driven from patient-centered JCI accreditation standards to cover indices of access of patients to care and continuity of care (ACC), patients and families rights (PFR), patients and families education (PFE), assessment of patients (AOP), care of patients (COP), analgesic and surgical care (ASC), and medication management and use (MMU). They were filled out by seven inspectors. The findings were analyzed by SPSS 14 (SPSS Inc., Chicago, IL). Results: Beheshti and Zahra hospitals demonstrated the lowest and the highest mean levels preparation, respectively (60 vs. 68.5 percent, respectively). Also, Beheshti hospital revealed the lowest prepared levels in AOP, ASC, MMU and PFE among all evaluated hospitals; the corresponding mean amounts of preparation were 68, 82.5, 56 and 42 percent, respectively. Whereas Zahra hospital showed the highest prepared levels in AOP, COP, MMU and PFE among all evaluated hospitals; the mean amounts of preparation were 82, 61.5, 84 and 57 percent, respectively. No significant difference was found among the four hospitals in any of the seven indices. Discussion: The four evaluated hospitals were not fully prepared to present the best possible patient-centered care system.
Collapse
Affiliation(s)
- Nahid Tavakoli
- Department of Management and Health Information Technology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | |
Collapse
|
48
|
Groene O, Botje D, Sunol R, Lopez MA, Wagner C. A systematic review of instruments that assess the implementation of hospital quality management systems. Int J Qual Health Care 2013; 25:525-41. [DOI: 10.1093/intqhc/mzt058] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
49
|
Curry LA, Krumholz HM, O'Cathain A, Plano Clark VL, Cherlin E, Bradley EH. Mixed methods in biomedical and health services research. Circ Cardiovasc Qual Outcomes 2013; 6:119-23. [PMID: 23322807 DOI: 10.1161/circoutcomes.112.967885] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Leslie A Curry
- Section of Health Policy and Administration, Yale School of Public Health, New Haven, CT, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Kuhlmann E, Burau V, Correia T, Lewandowski R, Lionis C, Noordegraaf M, Repullo J. "A manager in the minds of doctors:" a comparison of new modes of control in European hospitals. BMC Health Serv Res 2013; 13:246. [PMID: 23819578 PMCID: PMC3702431 DOI: 10.1186/1472-6963-13-246] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 06/28/2013] [Indexed: 11/26/2022] Open
Abstract
Background Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals. Methods The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources. Results The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management. Conclusions Our comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective.
Collapse
Affiliation(s)
- Ellen Kuhlmann
- Institute of Economics, Labour and Culture, Goethe-University Frankfurt, Frankfurt, Germany.
| | | | | | | | | | | | | |
Collapse
|