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Dubas-Jakóbczyk K, Kocot E, Tambor M, Szetela P, Kostrzewska O, Siegrist Jr RB, Quentin W. The Association Between Hospital Financial Performance and the Quality of Care - A Scoping Literature Review. Int J Health Policy Manag 2022; 11:2816-2828. [PMID: 35988029 PMCID: PMC10105205 DOI: 10.34172/ijhpm.2022.6957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Improving the quality of hospital care is an important policy objective. Hospitals operate under pressure to contain costs and might face challenges related to financial deficits. The objective of this paper was to identify and map the available evidence on the association between hospital financial performance (FP) and quality of care (Q). METHODS A scoping review was performed. Searches were conducted in 7 databases: Medline via PubMed, EMBASE, Web of Science, Scopus, EconLit, ABI/INFORM, and Business Source Complete. The search strategy combined multiple terms from 3 topics: hospital AND FP AND Q. The collected data were analysed using both quantitative and qualitative methods. RESULTS 10 503 records were screened and 151 full text papers analysed. A total of 69 papers were included (60 empirical, 2 theoretical, 5 literature reviews, and 2 dissertations). The majority of identified studies were published within the last decade (2010-2021). Most empirical studies had been conducted in the United States (55/60), used cross-sectional approaches (32/60) and applied diverse regression models with FP measures as dependent variables, thus measuring the impact of Q on hospitals FP (34/60). The comparability of the studies' results is limited due to differences in applied methods and settings. Yet, the general overview shows that in almost half of the cases the association between hospital FP and Q was positive, while no study showed a clear negative association. CONCLUSION This scoping review provides an overview of the available literature on the association between hospital FP and Q. The results highlight numerous research gaps: (1) systematic reviews and meta-analyses of existing studies with similar measures of FP and Q are unavailable, (2) further methodological/conceptual work is needed on the metrics measuring hospital FP and Q, and (3) more empirical studies should analyse the association between FP and Q in non-US healthcare settings.
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Affiliation(s)
- Katarzyna Dubas-Jakóbczyk
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Kocot
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Marzena Tambor
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław Szetela
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Olga Kostrzewska
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, WHO European Centre for Health Policy Eurostation (Office 07C020), Brussels, Belgium
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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.
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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
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Dubas-Jakóbczyk K, Kocot E, Tambor M, Quentin W. The association between hospital financial performance and the quality of care-a scoping review protocol. Syst Rev 2021; 10:221. [PMID: 34380566 PMCID: PMC8359611 DOI: 10.1186/s13643-021-01778-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hospitals operate under constant pressure to contain costs and improve the quality of care. The literature suggests that there is an association between health care providers' financial performance and the quality of care. On the one hand, providers that are financially more stable might have better capacity to maintain reliable systems and resources for quality improvement. On the other hand, providing better quality of care might lead to financial gains in the form of increased revenues or achieved savings and, in consequence, a higher profitability. The general objective of this scoping review is to identify and map the available evidence on the association between hospital financial performance and the quality of care. It aims to (1) provide a broad overview of the topic and (2) indicate a more precise research question for a future systematic review. METHODS This scoping review will follow five stages: (1) defining the research question; (2) identifying relevant literature; (3) study selection; (4) data extraction; (5) collating, summarizing, and reporting the results; and (6) the consultation process and engagement of knowledge users. The following databases will be searched: MEDLINE via PubMed, (2) EMBASE, (3) Web of Science, (4) Scopus, (5) EconLit, (6) ABI/INFORM, and (7) Business Source Premier. The reference lists of relevant papers will be visually scanned with the aim of identifying further studies of interest. Also, a gray literature search will be conducted by screening the websites of diverse organizations dealing with hospital performance and/or quality of care. The review will not apply a publication date limit and will include both quantitative and qualitative empirical studies as well as theoretical papers, technical reports, books/chapters, and thesis. The reporting will utilize the PRISMA extension for a Scoping Review checklist. DISCUSSION This scoping review will provide an overview of the existing literature on the association between hospital financial performance and the quality of care. The review process will apply a rigorous methodological approach while broad inclusion criteria should assure comprehensive coverage of the available literature. The main limitation of the review is related to the general limitation of scoping reviews, i.e., the lack of a systematic quality and risk of bias assessment of included studies. In addition, the review will include only publications in English. SYSTEMATIC REVIEW REGISTRATION Open Science Framework osf.io/z25ag.
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Affiliation(s)
- Katarzyna Dubas-Jakóbczyk
- Health Economic and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska St., 31-066, Krakow, Poland
| | - Ewa Kocot
- Health Economic and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska St., 31-066, Krakow, Poland
| | - Marzena Tambor
- Health Economic and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska St., 31-066, Krakow, Poland
| | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni, 135 10623 Berlin, Germany
- European Observatory on Health Systems and Policies, WHO European Centre for Health Policy Eurostation (Office 07C020), Place Victor Horta/Victor Hortaplein, 40, /10 1060 Brussels, Belgium
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Tello JE, Barbazza E, Waddell K. Review of 128 quality of care mechanisms: A framework and mapping for health system stewards. Health Policy 2020; 124:12-24. [PMID: 31791717 PMCID: PMC6946442 DOI: 10.1016/j.healthpol.2019.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/29/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022]
Abstract
Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.
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Affiliation(s)
- Juan E Tello
- Integrated Prevention and Control of NCDs Programme, Division of NCDs and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - Erica Barbazza
- Academic UMC, Department of Public Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
| | - Kerry Waddell
- McMaster Health Forum, McMaster University, Hamilton, Canada; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
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Aslet M, Yates D, Wasawo S. Improving the day case rate for laparoscopic cholecystectomy via introduction of a dedicated clinical pathway. J Perioper Pract 2019; 30:156-162. [PMID: 31524067 DOI: 10.1177/1750458919862701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Day case laparoscopic cholecystectomy is a safe and economical procedure. However, successful discharge on the same day of the procedure has been difficult to achieve at our institution. This study introduced a standardised anaesthetic pathway aiming to increase same day discharges. This led to an overall increase in same day discharges from 42.0% to 54.1%. When the pathway was fully followed, 71% of patients were discharged on the same day. When the pathway was not followed at all, the same day discharge rate was 0%. Our study successfully demonstrates that small enhancements to perioperative care can accelerate patient recovery and improve same day discharges.
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Affiliation(s)
- Med Aslet
- Anaesthetics Department, York Teaching Hospitals NHS Foundation Trust, York, UK
| | - Dra Yates
- Anaesthesia and Intensive Care Medicine, York Teaching Hospitals NHS Foundation Trust, York, UK
| | - S Wasawo
- Anaesthesia and Intensive Care Medicine, York Teaching Hospitals NHS Foundation Trust, York, UK
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Humanization interventions in general pediatric wards: a systematic review. Eur J Pediatr 2019; 178:607-622. [PMID: 30949888 DOI: 10.1007/s00431-019-03370-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/23/2019] [Accepted: 03/20/2019] [Indexed: 02/07/2023]
Abstract
Humanization of care (HOC) interventions have rarely been evaluated and compared. We systematically reviewed the outcomes of published interventions aimed to improve the HOC for hospitalized children. PubMed and Scopus were used as data sources. Studies published between January 1, 2000, and February 28, 2018, were considered eligible if they reported analysis of results vs. either a control group or baseline, or if they measured patient/family/staff satisfaction. Neonatal age, emergency departments, and subspecialty settings were excluded. Data were extracted using a standardized data extraction form including study design, sample size, intervention, outcome/objective, and evaluation of results or pre- post-intervention satisfaction. Twenty-eight of the 12,012 retrieved articles met the inclusion criteria. Most studies were of moderate to low quality. Only six studies were of high quality. Areas of interest dealt with environment (n = 4), provider-patient relationship (n = 6), pet therapy (n = 5), technology (n = 5), family-centered rounds (n = 2), psychological support (n = 3), and staff training (n = 3). The overall trend of the results indicated that interventions were mostly effective and likely to have beneficial effects on several aspects of pediatric hospitalization.Conclusions: Pending further studies of better research quality, the findings of this review may have policy and practice implications for planning HOC interventions by pediatric healthcare professionals. What is Known: • In pediatrics, humanization of care (HOC) provides assistance focused not only on the child as a patient, but on the whole family. • HOC programs have been developed, but information on the overall outcome of local projects aiming to improve in a practical way the hospital taking charge of pediatric patients is still lacking. What is New: • Local HOC interventions are mostly effective and have beneficial effects on several aspects of hospitalization in general pediatrics wards. • The findings of this review may have practice implications for planning HOC interventions by pediatric healthcare professionals.
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González-Formoso C, Clavería A, Fernández-Domínguez MJ, Lago-Deibe FL, Hermida-Rial L, Rial A, Gude-Sampedro F, Pita-Fernández S, Martín-Miguel V. Effectiveness of an educational intervention to improve the safety culture in primary care: a randomized trial. BMC FAMILY PRACTICE 2019; 20:15. [PMID: 30657056 PMCID: PMC6337818 DOI: 10.1186/s12875-018-0901-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/28/2018] [Indexed: 11/10/2022]
Abstract
Background Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region. Methods Randomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported. We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants’ demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome. Results Trial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (− 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39–3.35), and by 13.75 (2.41–354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable. Conclusion A educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged. Trial registration It was retrospectively registered with (ISRCTN41911128, 31/12/2010). Electronic supplementary material The online version of this article (10.1186/s12875-018-0901-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clara González-Formoso
- Vigo Teaching Unit of Family and Community Medicine and Nursing, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Vigo, Spain
| | - Ana Clavería
- Quality and Research Unit, Primary Care, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Rosalía de Castro 21-23, 36201, Vigo, Spain.
| | - M J Fernández-Domínguez
- Ourense Health Center, EOXI Ourense, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Ourense, Spain
| | - F L Lago-Deibe
- Sárdoma Health Center, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Vigo, Spain
| | - Luis Hermida-Rial
- Fontenla-Maristany Health Center, EOXI Ferrol, Galician Health Service, Ferrol, Spain
| | - Antonio Rial
- Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Gude-Sampedro
- Epidemiology Department, EOXI Santiago de Compostela, Instituto de Investigación Sanitaria Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Victoria Martín-Miguel
- Vigo Teaching Unit of Family and Community Medicine and Nursing, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Vigo, Spain
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Kern M, Buia A, Tonus C, Weigel TF, Dittmar R, Hanisch E, Zapf D. [Psychological stressors, resources and well-being of surgeons in Germany : A cross-sectional study]. Chirurg 2019; 90:576-584. [PMID: 30610261 DOI: 10.1007/s00104-018-0780-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psychological stress at work is associated with detrimental and health-impairing consequences for employees. OBJECTIVE In this study major stress factors and the resource job control at the workplace of surgeons and facets of mental health were examined and compared to benchmark results of a large reference sample. METHOD Data were collected by a representative online survey among surgeons throughout Germany who were contacted via the Professional Association of German Surgeons. In total 643 surgeons from different organizations and different disciplines completed the questionnaire that was developed using well-validated instruments. RESULTS Time pressure was the most meaningful stress factor for surgeons. Moreover, the results for medical assistants showed adverse stress combinations of high goal uncertainty and low job control as well as high emotional exhaustion and low job satisfaction. In addition, the results indicated that surgeons in single and group practices as well as in outpatient healthcare centers have less stressors and more job resources. CONCLUSION The survey results suggest high levels of burnout risk for German surgeons, especially among medical assistants and medical specialists from large hospitals. In order to maintain a high quality in the surgical disciplines, a concerted effort by all players in the healthcare system is necessary.
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Affiliation(s)
- M Kern
- Abteilung Arbeits- und Organisationspsychologie, Goethe-Universität Frankfurt, PEG, Theodor-W.-Adorno-Platz 6, 63, 60629, Frankfurt am Main, Deutschland.
| | - A Buia
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Asklepios Klinik Langen, Langen, Deutschland
| | - C Tonus
- Klinik für Allgemein- und Viszeralchirurgie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - T F Weigel
- Klinik für Allgemein- und Viszeralchirurgie, Heilig-Geist-Hospital, Bingen, Deutschland
| | - R Dittmar
- Berufsverband der Deutschen Chirurgen, Berlin, Deutschland
| | - E Hanisch
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Asklepios Klinik Langen, Langen, Deutschland
| | - D Zapf
- Abteilung Arbeits- und Organisationspsychologie, Goethe-Universität Frankfurt, PEG, Theodor-W.-Adorno-Platz 6, 63, 60629, Frankfurt am Main, Deutschland
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van Melle MA, van Stel HF, Poldervaart JM, de Wit NJ, Zwart DLM. Measurement tools and outcome measures used in transitional patient safety; a systematic review. PLoS One 2018; 13:e0197312. [PMID: 29864119 PMCID: PMC5986135 DOI: 10.1371/journal.pone.0197312] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 04/29/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients are at risk for harm when treated simultaneously by healthcare providers from different healthcare organisations. To assess current practice and improvements of transitional patient safety, valid measurement tools are needed. AIM AND METHODS To identify and appraise all measurement tools and outcomes that measure aspects of transitional patient safety, PubMed, Cinahl, Embase and Psychinfo were systematically searched. Two researchers performed the title and abstract and full-text selection. First, publications about validation of measurement tools were appraised for quality following COSMIN criteria. Second, we inventoried all measurement tools and outcome measures found in our search that assessed current transitional patient safety or the effect of interventions targeting transitional patient safety. RESULTS The initial search yielded 8288 studies, of which 18 assessed validity of measurement tools of different aspects of transitional safety, and 191 assessed current transitional patient safety or effect of interventions. In the validated measurement tools, the overall quality of content and structural validity was acceptable; other COSMIN criteria, such as reliability, measurement error and responsiveness, were mostly poor or not reported. In our outcome inventory, the most frequently used validated outcome measure was the Care Transition Measure (n = 9). The most frequently used non-validated outcome measures were: medication discrepancies (n = 98), hospital readmissions (n = 55), adverse events (n = 34), emergency department visits (n = 33), (mental or physical) health status (n = 28), quality and timeliness of discharge summary, and patient satisfaction (n = 23). CONCLUSIONS Although no validated measures exist that assess all aspects of transitional patient safety, we found validated measurement tools on specific aspects. Reporting of validity of transitional measurement tools was incomplete. Numerous outcome measures with unknown measurement properties are used in current studies on safety of care transitions, which makes interpretation or comparison of their results uncertain.
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Affiliation(s)
- Marije A van Melle
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Henk F van Stel
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Judith M Poldervaart
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dorien L M Zwart
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
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Tessema GA, Laurence CO, Mahmood MA, Gomersall JS. Factors determining quality of care in family planning services in Africa: a systematic review protocol. ACTA ACUST UNITED AC 2018; 14:103-14. [PMID: 27635750 DOI: 10.11124/jbisrir-2016-003056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW OBJECTIVE AND QUESTIONS The objective of this systematic review is to identify and synthesize the best available quantitative and qualitative evidence to understand the factors determining quality of care in family planning services in Africa.The review question for the quantitative component of the review is:What factors, including facility, provider and client characteristics, are associated with quality of care in family planning services in Africa?The review question for the qualitative component of the review is:What are client and provider experiences and/or perceptions of factors that affect quality of care in family planning services in Africa?
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Affiliation(s)
- Gizachew Assefa Tessema
- 1School of Public Health, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia 2Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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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.
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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
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12
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van C, McInerney P, Cooke R. Patients' involvement in improvement initiatives: a qualitative systematic review. ACTA ACUST UNITED AC 2018; 13:232-90. [PMID: 26571293 DOI: 10.11124/jbisrir-2015-1452] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Over the last 20 years, quality improvement in health has become an important strategy in health services in many countries. With the emphasis on quality health care, there has been a shift in social paradigms towards including service users in their own health on different levels. There is growing evidence in literature on the positive impact on health outcomes where patients are active participants in their personal care. There is however less information available on the broader influence of users on improvement in systems. OBJECTIVES The objective of this review was to identify the barriers and enablers to patients being involved in quality improvement efforts directed towards their own health care. INCLUSION CRITERIA This review considered studies that included adults and children of any age experiencing any health problem.The review considered studies that explored patient or user participation in quality improvement and the factors enabling and hindering this processThe qualitative component of this review considered studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Other texts such as opinion papers and reports were also considered. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. The searches using all identified keywords and index terms included the databases PubMed, PsycINFO, Medline, Scopus, EBSCOhost and CINAHL.Qualitative, text and opinion papers were considered for inclusion in this review.Closely related concepts like community involvement, family involvement, patients' involvement in their own care (for example, in the case of shared decision making), and patient centeredness in the context of a consultation were excluded. METHODOLOGICAL QUALITY Qualitative and textual papers selected for retrieval were assessed by two independent reviewers for authenticity prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION Qualitative and textual data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS The above findings were pooled and through the identification of categories, a final meta-synthesis was formulated. RESULTS Two synthesized findings were created from the included papers. Firstly, there are barriers to patients' participation in quality improvement in health and in spite of policy support for user involvement in quality improvement, it is a difficult strategy to implement. The second synthesized finding was that there are enablers to patients' involvement in quality improvement: when patients are involved in quality improvement efforts in health care, there are innovative, often unexpected, outcomes at different levels of the process, and sustaining these efforts is possible with ongoing individual or group support.Five categories which supported the synthesized findings were created through the meta-aggregative process. CONCLUSIONS There are enablers and barriers to involving patients in quality improvement in health care that need to be considered when planning such interventions.Relationships and roles will need to be very clear from the outset. A developmental approach needs to be considered where support and training is part of the project. Where patients are truly engaged in service improvement, unexpected innovation occurs.There are many more reports and opinion papers published regarding this topic than there are rigorous research studies. This leaves the field open to the development of good methodological studies related to quality improvement and in particular to the participation of patients.
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Affiliation(s)
- Claire van
- 1Department of Family Medicine, University of the Witwatersrand, Johannesburg, South Africa2The Witwatersrand Center for Evidence Based Practice: an Affiliate Center of the Joanna Briggs Institute3Center for Health Science Education, Faculty of Health Science Education, University of the Witwatersrand.4Center for Rural Health, University of the Witwatersrand, Johannesburg, South Africa
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Dickinson H, Bismark M, Phelps G, Loh E. Future of medical engagement. AUST HEALTH REV 2018; 40:443-446. [PMID: 26386780 DOI: 10.1071/ah14204] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 08/17/2014] [Indexed: 11/23/2022]
Abstract
Although it has long been recognised that doctors play a crucial role in the effectiveness and efficiency of health organisations, patient experience and clinical outcomes, over the past 20 years the topic of medical engagement has started to garner significant international attention. Australia currently lags behind other countries in its heedfulness to, and evidence base for, medical engagement. This Perspective piece explores the link between medical engagement and health system performance and identifies some key questions that need to be addressed in Australia if we are to drive more effective engagement.
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Affiliation(s)
- Helen Dickinson
- Melbourne School of Government, The University of Melbourne, Vic. 3052, Australia
| | - Marie Bismark
- School of Population and Global Health, The University of Melbourne, Rm 442, Level 4, 207 Bouverie Street, Carlton, Vic. 3010, Australia. Email
| | - Grant Phelps
- Department of Health Victoria, 50 Lonsdale Street, Melbourne, Vic. 3350, Australia. Email
| | - Erwin Loh
- School of Public Health and Preventive Medicine/School of Clinical Sciences at Monash Health, Monash University, 246 Clayton Road, Clayton, Vic. 3168, Australia. Email
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Marshall BG, Assef MS, Pitney RB, Macco MC, Tschoeke BM, Oksa MA, Yeatman A. Introduction of a Surgical Navigator in the Perioperative Process Improves Patient Satisfaction. J Patient Exp 2017; 4:10-16. [PMID: 28725855 PMCID: PMC5513665 DOI: 10.1177/2374373517692916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Patients who had received surgical services at Bellin Hospital reported anxiety with the surgical flow. This study tested the hypothesis that the introduction of a surgical navigator, someone who guided the patient and their accompanying others throughout the surgical process, would improve patient satisfaction. Methods: Ambulatory surgical patients were randomized to control and study groups. The study group patients were assigned a surgical navigator. Prior to discharge from the hospital, patients were asked to complete a patient satisfaction survey. Results: The study group had significantly higher mean scores (P value ≤ 0.026), top box scores (P value ≤ 0.021), and positive comments. Conclusion: The addition of a surgical navigator to the perioperative process significantly enhanced patient satisfaction in ambulatory surgical patients.
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Affiliation(s)
| | | | - Ryan B Pitney
- University of Wisconsin-La Crosse located in La Crosse Wisconsin
| | - Maria Cj Macco
- University of Wisconsin-Madison located in Madison, Wisconsin
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Dickinson H, Phelps G, Loh E, Bismark M. Medical management and leadership: a time of transition? Intern Med J 2017; 47:818-820. [DOI: 10.1111/imj.13479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 11/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Helen Dickinson
- Public Service Research Group; The University of New South Wales; Sydney New South Wales Australia
| | - Grant Phelps
- Department of Internal Medicine; Ballarat Health Services; Ballarat Victoria Australia
| | - Erwin Loh
- Department of Medical Administration; Monash Health; Victoria Australia
| | - Marie Bismark
- School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
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Villiers-Tuthill A, Doulougeri K, McGee H, Montgomery A, Panagopoulou E, Morgan K. Development and Validation of a Cross-Country Hospital Patient Quality of Care Assessment Tool in Europe. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:753-761. [PMID: 28523465 DOI: 10.1007/s40271-017-0246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient perceptions of quality of care (QoC) are directly linked with patient safety and clinical effectiveness. We need patient-designed QoC instruments that work across languages and countries to optimise studies across systems in this area. Few QoC measurement tools exist that assess all aspects of QoC from the patient perspective. This paper describes the development and validation of a comprehensive measure to assess patient perceptions of QoC that incorporates technical and interpersonal aspects of care and is grounded in the established Institute of Medicine (IOM) QoC framework. DESIGN We conducted a multi-country cross-sectional study. METHODS Following a literature review and patient focus groups, an expert panel generated questionnaire items. Following a pilot study, item numbers were reduced. The final questionnaire consisted of three sections: demographics, perceived QoC and one open-ended question. Data was collected from patients (n = 531) discharged from hospitals across seven countries in South East Europe (languages: Turkish, Greek, Portuguese, Romanian, Croatian, Macedonian and Bulgarian). Reliability and validity of the measure were assessed. RESULTS Confirmatory factor analysis was used to compare various factor models of patient-perceived QoC. Good model fit was demonstrated for a two-factor model: communication and interpersonal care, and hospital facilities. CONCLUSIONS The ORCAB (Improving quality and safety in the hospital: The link between organisational culture, burnout and quality of care) Patient QoC questionnaire has been collaboratively and exhaustively developed between healthcare professionals and patients. It enables patient QoC data to be assessed in the context of the IOM pillars of quality, considering both technical and interpersonal dimensions of care. It represents an important first step in including the patient perspective.
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Affiliation(s)
- Amanda Villiers-Tuthill
- Division of Population Health Sciences, Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Karolina Doulougeri
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Hannah McGee
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anthony Montgomery
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | | | - Karen Morgan
- Division of Population Health Sciences, Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland.
- PU-RCSI School of Medicine, Perdana University, Kuala Lumpur, Malaysia.
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Skela-Savič B, Macrae R, Lillo-Crespo M, Rooney KD. The development of a consensus definition for healthcare improvement science (HIS) in seven European countries: A consensus methods approach. Zdr Varst 2017; 56:82-90. [PMID: 28289467 PMCID: PMC5329771 DOI: 10.1515/sjph-2017-0011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 08/29/2016] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION There is a limited body of research in the field of healthcare improvement science (HIS). Quality improvement and 'change making' should become an intrinsic part of everyone's job, every day in all parts of the healthcare system. The lack of theoretical grounding may partly explain the minimal transfer of health research into health policy. METHODS This article seeks to present the development of the definition for healthcare improvement science. A consensus method approach was adopted with a two-stage Delphi process, expert panel and consensus group techniques. A total of 18 participants were involved in the expert panel and consensus group, and 153 answers were analysed as a part of the Delphi survey. Participants were researchers, educators and healthcare professionals from Scotland, Slovenia, Spain, Italy, England, Poland, and Romania. RESULTS A high level of consensus was achieved for the broad definition in the 2nd Delphi iteration (86%). The final definition was agreed on by the consensus group: 'Healthcare improvement science is the generation of knowledge to cultivate change and deliver person-centred care that is safe, effective, efficient, equitable and timely. It improves patient outcomes, health system performance and population health.' CONCLUSIONS The process of developing a consensus definition revealed different understandings of healthcare improvement science between the participants. Having a shared consensus definition of healthcare improvement science is an important step forward, bringing about a common understanding in order to advance the professional education and practice of healthcare improvement science.
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Affiliation(s)
| | - Rhoda Macrae
- Institute of Care and Practice Improvement, School of Health, Nursing and Midwifery, University of the West of Scotland, Hamilton, ML3OBA, Scotland
| | - Manuel Lillo-Crespo
- Faculty of Health Sciences, University of Alicante, Spain, Carretera de San Vicente del Raspeig s/n 03690 San Vicente del Raspeig, Alicante, Spain
| | - Kevin D Rooney
- Institute of Care and Practice Improvement, School of Health, Nursing and Midwifery, University of the West of Scotland, Hamilton, ML3OBA, Scotland; Anaesthesia & Intensive Care Medicine, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, Scotland
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Tessema GA, Streak Gomersall J, Mahmood MA, Laurence CO. Factors Determining Quality of Care in Family Planning Services in Africa: A Systematic Review of Mixed Evidence. PLoS One 2016; 11:e0165627. [PMID: 27812124 PMCID: PMC5094662 DOI: 10.1371/journal.pone.0165627] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/15/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Improving use of family planning services is key to improving maternal health in Africa, and provision of quality of care in family planning services is critical to support higher levels of contraceptive uptake. The objective of this systematic review was to synthesize the available evidence on factors determining the quality of care in family planning services in Africa. METHODS Quantitative and qualitative studies undertaken in Africa, published in English, in grey and commercial literature, between 1990 and 2015 were considered. Methodological quality of included studies was assessed using standardized tools. Findings from the quantitative studies were summarized using narrative and tables. Client satisfaction was used to assess the quality of care in family planning services in the quantitative component of the review. Meta-aggregation was used to synthesize the qualitative study findings. RESULTS From 4334 records, 11 studies (eight quantitative, three qualitative) met the review eligibility criteria. The review found that quality of care was influenced by client, provider and facility factors, and structural and process aspects of the facilities. Client's waiting time, provider competency, provision/prescription of injectable methods, maintaining privacy and confidentiality were the most commonly identified process factors. The quality of stock inventory was the most commonly identified structural factor. The quality of care was also positively associated with privately-owned facilities. The qualitative synthesis revealed additional factors including access related factors such as 'pre-requisites to be fulfilled by the clients and cost of services, provider workload, and providers' behaviour. CONCLUSION There is limited evidence on factors determining quality of care in family planning services in Africa that shows quality of care is influenced by multiple factors. The evidence suggests that lowering access barriers and avoiding unnecessary pre-requisites for taking contraceptive methods are important to improve the quality of care in family planning services. Strategies to improve provider behavior and competency are important. Moreover, strategies that minimize client waiting time and ensure client confidentiality should be implemented to ensure quality of care in family planning services. However, no strong evidence based conclusions and recommendations may be drawn from the evidence. Future studies are needed to identify the most important factors associated with quality of care in family planning services in a wider range of African countries.
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Affiliation(s)
- Gizachew Assefa Tessema
- School of Public Health, The University of Adelaide, Adelaide, Australia
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Waelli M, Gomez ML, Sicotte C, Zicari A, Bonnefond JY, Lorino P, Minvielle E. Keys to successful implementation of a French national quality indicator in health care organizations: a qualitative study. BMC Health Serv Res 2016; 16:553. [PMID: 27716193 PMCID: PMC5053143 DOI: 10.1186/s12913-016-1794-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 09/24/2016] [Indexed: 12/30/2022] Open
Abstract
Background Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice. Method Seven ethnographic case studies in French HCOs combining in situ observations and 37 semi-structured interviews. Results A significant proportion of potential QAF users, such as anesthetists or other health professionals were often unaware of quality data. They were, however, involved in improvement actions to meet the QAF criteria. In fact, three intertwined factors influenced QAF appropriation by anesthesia teams and impacted practice. The first factor was the action of clinical managers (chief anesthetists and head of department) who helped translate public policy into local practice largely by providing legitimacy by highlighting the scientific evidence underlying QAF, achieving consensus among team members, and pointing out the value of QAF as a means of work recognition. The two other factors related to the socio-material context, namely the coherence of information systems and the quality of interpersonal ties within the department. Conclusions Public policy tends to focus on the metrological validity of QIs and on ranking methods and overlooks QI implementation. However, effective QI implementation depends on local managerial activity that is often invisible, in interaction with socio-material factors. When developing national quality improvement programs, health authorities might do well to specifically target these clinical managers who act as invaluable mediators. Their key role should be acknowledged and they ought to be provided with adequate resources.
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Affiliation(s)
- Mathias Waelli
- EA 7438 MOS, EHESP (French School of Public Health), Rennes, France. .,EHESP, 8 rue Maria Helena Vieira Da Silva - 75014, Paris, France.
| | | | - Claude Sicotte
- EA 7438 MOS, EHESP (French School of Public Health), Rennes, France.,Montreal University, Montreal, Canada
| | | | | | | | - Etienne Minvielle
- EA 7438 MOS, EHESP (French School of Public Health), Rennes, France.,Gustave Roussy Institute, Villejuif, France
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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.
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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
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Sánchez-Casado M, Hostigüela-Martín V, Raigal-Caño A, Labajo L, Gómez-Tello V, Alonso-Gómez G, Aguilera-Cerna F. Escalas pronósticas en la disfunción multiorgánica: estudio de cohortes. Med Intensiva 2016; 40:145-53. [DOI: 10.1016/j.medin.2015.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 02/03/2015] [Accepted: 03/29/2015] [Indexed: 10/23/2022]
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Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial. Br J Gen Pract 2015; 65:e319-29. [PMID: 25918337 DOI: 10.3399/bjgp15x684853] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND A constructive safety culture is essential for the successful implementation of patient safety improvements. AIM To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture. DESIGN AND SETTING A three-arm cluster randomised trial was conducted in a mixed method study, studying the effect of administering a patient safety culture questionnaire (intervention I), the questionnaire complemented with a practice-based workshop (intervention II) and no intervention (control) in 30 general practices in the Netherlands. METHOD The primary outcome, the number of reported incidents, was measured with a questionnaire at baseline and a year after. Analysis was performed using a negative binomial model. Secondary outcomes were quality and safety indicators and safety culture. Mixed effects linear regression was used to analyse the culture questionnaires. RESULTS The number of incidents increased in both intervention groups, to 82 and 224 in intervention I and II respectively. Adjusted for baseline number of incidents, practice size and accreditation status, the study showed that practices that additionally participated in the workshop reported 42 (95% confidence interval [CI] = 9.81 to 177.50) times more incidents compared to the control group. Practices that only completed the questionnaire reported 5 (95% CI = 1.17 to 25.49) times more incidents. There were no statistically significant differences in staff perception of patient safety culture at follow-up between the three study groups. CONCLUSION Educating staff and facilitating discussion about patient safety culture in their own practice leads to increased reporting of incidents. It is beneficial to invest in a team-wise effort to improve patient safety.
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Kringos DS, Sunol R, Wagner C, Mannion R, Michel P, Klazinga NS, Groene O. The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews. BMC Health Serv Res 2015. [PMID: 26199147 PMCID: PMC4508989 DOI: 10.1186/s12913-015-0906-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual factors in the literature on the effectiveness of quality improvement strategies, (ii) assess the relationship between effectiveness and contextual factors, and (iii) analyse the importance of contextual factors. Methods We conducted an umbrella review of systematic reviews searching the following databases: PubMed, Cochrane Database of Systematic Reviews, Embase and CINAHL. The search focused on quality improvement strategies included in the Cochrane Effective Practice and Organisation of Care Group taxonomy. We extracted data on quality improvement effectiveness and context factors. The latter were categorized according to the Model for Understanding Success in Quality tool. Results We included 56 systematic reviews in this study of which only 35 described contextual factors related with the effectiveness of quality improvement interventions. The most frequently reported contextual factors were: quality improvement team (n = 12), quality improvement support and capacity (n = 11), organization (n = 9), micro-system (n = 8), and external environment (n = 4). Overall, context factors were poorly reported. Where they were reported, they seem to explain differences in quality improvement effectiveness; however, publication bias may contribute to the observed differences. Conclusions Contextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system. Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0906-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dionne S Kringos
- Department of Public Health, Academic Medical Center (AMC) - University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Rosa Sunol
- Avedis Donabedian Research Institute, University Autonomous of Barcelona, C/Provenza 293, Pral. 08037, Barcelona, Spain. .,Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, ᅟ, Spain. .,Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, ᅟ, Spain.
| | - Cordula Wagner
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, B15 2RT, UK.
| | - Philippe Michel
- Quality and Safety Department, Lyon University, Hospital Network, Lyon, France.
| | - Niek S Klazinga
- Department of Public Health, Academic Medical Center (AMC) - University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Oliver Groene
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Schermuly CC, Draheim M, Glasberg R, Stantchev V, Tamm G, Hartmann M, Hessel F. Human resource crises in German hospitals--an explorative study. HUMAN RESOURCES FOR HEALTH 2015; 13:40. [PMID: 26016562 PMCID: PMC4453019 DOI: 10.1186/s12960-015-0032-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 05/14/2015] [Indexed: 05/23/2023]
Abstract
BACKGROUND The complexity of providing medical care in a high-tech environment with a highly specialized, limited labour force makes hospitals more crisis-prone than other industries. An effective defence against crises is only possible if the organizational resilience and the capacity to handle crises become part of the hospitals' organizational culture. To become more resilient to crises, a raised awareness--especially in the area of human resource (HR)--is necessary. The aim of this paper is to contribute to the process robustness against crises through the identification and evaluation of relevant HR crises and their causations in hospitals. METHODS Qualitative and quantitative methods were combined to identify and evaluate crises in hospitals in the HR sector. A structured workshop with experts was conducted to identify HR crises and their descriptions, as well as causes and consequences for patients and hospitals. To evaluate the findings, an online survey was carried out to rate the occurrence (past, future) and dangerousness of each crisis. RESULTS Six HR crises were identified in this study: staff shortages, acute loss of personnel following a pandemic, damage to reputation, insufficient communication during restructuring, bullying, and misuse of drugs. The highest occurrence probability in the future was seen in staff shortages, followed by acute loss of personnel following a pandemic. Staff shortages, damage to reputation, and acute loss of personnel following a pandemic were seen as the most dangerous crises. CONCLUSIONS The study concludes that coping with HR crises in hospitals is existential for hospitals and requires increased awareness. The six HR crises identified occurred regularly in German hospitals in the past, and their occurrence probability for the future was rated as high.
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Affiliation(s)
| | - Michael Draheim
- SRH Hochschule Berlin, Ernst Reuter Platz 10, 10587, Berlin, Germany.
| | - Ronald Glasberg
- SRH Hochschule Berlin, Ernst Reuter Platz 10, 10587, Berlin, Germany.
| | | | - Gerrit Tamm
- SRH Hochschule Berlin, Ernst Reuter Platz 10, 10587, Berlin, Germany.
| | - Michael Hartmann
- SRH Hochschule Berlin, Ernst Reuter Platz 10, 10587, Berlin, Germany.
| | - Franz Hessel
- SRH Hochschule Berlin, Ernst Reuter Platz 10, 10587, Berlin, Germany.
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Abstract
PURPOSE OF REVIEW To describe why the prediction of ICU outcomes is essential to underpin critical care quality improvement programmes. RECENT FINDINGS Recent literature demonstrates that risk-adjusted mortality is a widely used and well-accepted quality indicator for benchmarking ICU performance. Ongoing research continues to address the best ways to present the results of benchmarking through either direct comparison among institutions (e.g., by funnel plots) or indirect comparison against the risk predictions from a risk model (e.g., by process control charts). There is also ongoing research and debate regarding event-based outcomes (e.g., hospital mortality) versus time-based outcomes (e.g., 30-day mortality). Beyond benchmarking, ICU outcome prediction models have a role in risk adjustment and risk stratification in randomized controlled trials, and adjusting for confounding in nonrandomized, observational research. Recent examples include comparing risk-adjusted outcomes according to 'capacity strain' on the ICU and extending propensity matching methods to evaluate outcomes of patients managed with a pulmonary artery catheter, among others. Risk models may have a role in communicating risk, but their utility for individual patient decision-making is limited. SUMMARY Risk-adjusted mortality has strong support from the critical care community as a quality indicator for benchmarking ICU performance but is dependent on up-to-date, accurate risk models. ICU outcome prediction can also contribute to both randomized and nonrandomized research and potentially contribute to individual patient management, although generic risk models should not be used to guide individual treatment decisions.
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Renedo A, Marston C. Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement. BMC Health Serv Res 2015; 15:122. [PMID: 25903663 PMCID: PMC4407290 DOI: 10.1186/s12913-015-0770-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 02/27/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Understanding quality improvement from a patient perspective is important for delivering patient-centred care. Yet the ways patients define quality improvement remains unexplored with patients often excluded from improvement work. We examine how patients construct ideas of 'quality improvement' when collaborating with healthcare professionals in improvement work, and how they use these understandings when attempting to improve the quality of their local services. METHODS We used in-depth interviews with 23 'patient participants' (patients involved in quality improvement work) and observations in several sites in London as part of a four-year ethnographic study of patient and public involvement (PPI) activities run by Collaborations for Leadership in Applied Health Research and Care for Northwest London. We took an iterative, thematic and discursive analytical approach. RESULTS When patient participants tried to influence quality improvement or discussed different dimensions of quality improvement their accounts and actions frequently started with talk about improvement as dependent on collective action (e.g. multidisciplinary healthcare professionals and the public), but usually quickly shifted away from that towards a neoliberal discourse emphasising the role of individual patients. Neoliberal ideals about individual responsibility were taken up in their accounts moving them away from the idea of state and healthcare providers being held accountable for upholding patients' rights to quality care, and towards the idea of citizens needing to work on self-improvement. Participants portrayed themselves as governed by self-discipline and personal effort in their PPI work, and in doing so provided examples of how neoliberal appeals for self-regulation and self-determination also permeated their own identity positions. CONCLUSIONS When including patient voices in measuring and defining 'quality', governments and public health practitioners should be aware of how neoliberal rationalities at the heart of policy and services may discourage consumers from claiming rights to quality care by contributing to public unwillingness to challenge the status quo in service provision. If the democratic potential of patient and public involvement initiatives is to be realised, it will be crucial to help citizens to engage critically with how neoliberal rationalities can undermine their abilities to demand quality care.
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Affiliation(s)
- Alicia Renedo
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Cicely Marston
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Doyle KE. Australian Aboriginal peoples and evidence-based policies: closing the gap in social interventions. JOURNAL OF EVIDENCE-INFORMED SOCIAL WORK 2015; 12:166-74. [PMID: 25661890 DOI: 10.1080/15433714.2013.777005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Australian Aboriginal people are some of the most researched people on earth, yet their life expectancy and other well-being indices lag significantly behind non-Aboriginal Australians. The reach of evidence-based practice (EBP) in social interventions has not yet informed Aboriginal policy even though it is based on clinical expertise and systematic research. This is due to criticism of the processes of EBP, most commonly its supposed limitations and misperceptions, which are easily refuted. EBP continues to be a tool that is needed to inform practice across all disciplines of human service, and needs to be the core value of any intervention with indigenous peoples.
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Affiliation(s)
- Kerrie E Doyle
- a Indigenous Health, School of Health Sciences, RMIT , Bundoora , Australia
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Lagrew DC, Jenkins TR. The future of obstetrics/gynecology in 2020: a clearer vision. Why is change needed? Am J Obstet Gynecol 2014; 211:470-474.e1. [PMID: 25173188 DOI: 10.1016/j.ajog.2014.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/30/2014] [Accepted: 08/19/2014] [Indexed: 11/26/2022]
Abstract
External and internal pressures are causing rapid changes to the delivery of health care that markedly will influence the practice of obstetrics and gynecology. These changes can be divided into broad categories: (1) Burden of the high cost of current health care on society; (2) demographic changes in women that include aging, obesity, diversity, and chronic medical conditions; and (3) workforce changes that include growing provider shortages, inexperience, and desires for improved lifestyles. The combination of these factors has brought health care to a strategic inflection point where current practice methods will lead to an inability to meet the demand for health care because of increasing volume while simultaneously controlling costs and improving quality. This necessitates providing women's health care in a redesigned fashion for it to flourish in the new world of medicine.
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Haugum M, Danielsen K, Iversen HH, Bjertnaes O. The use of data from national and other large-scale user experience surveys in local quality work: a systematic review. Int J Qual Health Care 2014; 26:592-605. [DOI: 10.1093/intqhc/mzu077] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Changes in Transformational Leadership and Empirical Quality Outcomes in a Finnish Hospital over a Two-Year Period: A Longitudinal Study. Nurs Res Pract 2014; 2014:218069. [PMID: 25009744 PMCID: PMC4070428 DOI: 10.1155/2014/218069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 05/16/2014] [Indexed: 11/23/2022] Open
Abstract
This paper describes the changes in transformational leadership and quality outcomes that occurred between 2008 and 2011 in a Finnish university hospital that is aiming to meet the Magnet standards. Measurements were conducted in 2008-2009 and subsequently in 2010-2011 by surveying nursing staff and patients. Nursing staff were surveyed using web-based surveys to collect data on transformational leadership (n1 = 499, n2 = 498) and patient safety culture (n1 = 234, n2 = 512) and using both postal and web-based surveys to gather information on job satisfaction (n1 = 1176, n2 = 779). Questionnaires were used to collect data on care satisfaction from patients (n1 = 678, n2 = 867). Transformational leadership was measured using the 54-item TLS, job satisfaction with the 37-item KUHJSS, patient safety culture with the 42-item HSPSC, and patient satisfaction using the 42-item RHCS questionnaire. Transformational leadership, which was the weakest area, was at the same level between the two measurement occasions. Job satisfaction scores increased between 2008 and 2010, although they were generally excellent in 2008. The scores for nonpunitive responses to errors and events reported were also higher in the 2010-2011 surveys. The highest empirical outcome scores related to patient satisfaction. The project and the development initiatives undertaken since 2008 seem to have had positive effects on empirical quality outcomes.
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Montgomery A. The inevitability of physician burnout: Implications for interventions. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.burn.2014.04.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Costantini M, Romoli V, Leo SD, Beccaro M, Bono L, Pilastri P, Miccinesi G, Valenti D, Peruselli C, Bulli F, Franceschini C, Grubich S, Brunelli C, Martini C, Pellegrini F, Higginson IJ. Liverpool Care Pathway for patients with cancer in hospital: a cluster randomised trial. Lancet 2014; 383:226-37. [PMID: 24139708 DOI: 10.1016/s0140-6736(13)61725-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The quality of care provided to patients with cancer who are dying in hospital and their families is suboptimum. The UK Liverpool Care Pathway (LCP) for patients who are dying was developed with the aim of transferring the best practice of hospices to hospitals. We therefore assessed the effectiveness of LCP in the Italian context (LCP-I) in improving the quality of end-of-life care for patients with cancer in hospitals and for their family. METHODS In this pragmatic cluster randomised trial, 16 Italian general medicine hospital wards were randomly assigned to implement the LCP-I programme or standard health-care practice. For each ward, we identified all patients who died from cancer in the 3 months before randomisation (preintervention) and in the 6 months after the completion of the LCP-I training programme. The primary endpoint was the overall quality of care toolkit scale. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01081899. FINDINGS During the postintervention assessment, data were gathered for 308 patients who died from cancer (147 in LCP-I programme wards and 161 in control wards). 232 (75%) of 308 family members were interviewed, 119 (81%) of 147 with relatives cared for in the LCP-I wards (mean cluster size 14·9 [range eight to 22]) and 113 (70%) of 161 in the control wards (14·1 [eight to 22]). After implementation of the LCP-I programme, no significant difference was noted in the distribution of the overall quality of care toolkit scores between the wards in which the LCP-I programme was implemented and the control wards (score 70·5 of 100 vs 63·0 of 100; cluster-adjusted mean difference 7·6 [95% CI -3·6 to 18·7]; p=0·186). INTERPRETATION The effect of the LCP-I programme in our study is less than the effects noted in earlier phase 2 trials. However, if the programme is implemented well it has the potential to reduce the gap in quality of care between hospices and hospitals. Further research is needed to ascertain what components of the LCP-I programme might be effective and to develop and assess a wider range of approaches to quality improvement in hospital care for people at the end of their lives and for their families. FUNDING Italian Ministry of Health and Maruzza Lefebvre D'Ovidio Foundation-Onlus.
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Affiliation(s)
- Massimo Costantini
- Palliative Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Arcispedale S Maria Nuova, Reggio Emilia, Italy.
| | - Vittoria Romoli
- Regional Palliative Care Network, IRCCS Azienda Ospedaliera Universitaria San Martino-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Silvia Di Leo
- Regional Palliative Care Network, IRCCS Azienda Ospedaliera Universitaria San Martino-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Monica Beccaro
- Regional Palliative Care Network, IRCCS Azienda Ospedaliera Universitaria San Martino-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Laura Bono
- Regional Palliative Care Network, IRCCS Azienda Ospedaliera Universitaria San Martino-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Paola Pilastri
- Hospice Maria Chighine, IRCCS Azienda Ospedaliera Universitaria San Martino-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
| | - Danila Valenti
- Palliative Care Network, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy
| | | | - Francesco Bulli
- Clinical and Descriptive Epidemiology Unit, Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
| | | | | | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; European Palliative Care Research Centre, Norwegian University of Science and Technology, Faculty of Medicine, Trondheim, Norway
| | - Cinzia Martini
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Pellegrini
- Mario Negri Sud Institute, Mario Negri Sud Consortium, Chieti, Italy
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
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Khan C, Ollenschläger G. Wirksamkeit von Qualitätsprogrammen in der stationären Versorgung in Deutschland – eine Literaturanalyse. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108:576-86. [DOI: 10.1016/j.zefq.2014.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Recommendations for evaluation of health care improvement initiatives. Acad Pediatr 2013; 13:S23-30. [PMID: 24268081 DOI: 10.1016/j.acap.2013.04.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 04/03/2013] [Accepted: 04/12/2013] [Indexed: 11/22/2022]
Abstract
Intensive efforts are underway across the world to improve the quality of health care. It is important to use evaluation methods to identify improvement efforts that work well before they are replicated across a broad range of contexts. Evaluation methods need to provide an understanding of why an improvement initiative has or has not worked and how it can be improved in the future. However, improvement initiatives are complex, and evaluation is not always well aligned with the intent and maturity of the intervention, thus limiting the applicability of the results. We describe how initiatives can be grouped into 1 of 3 improvement phases-innovation, testing, and scale-up and spread-depending on the degree of belief in the associated interventions. We describe how many evaluation approaches often lead to a finding of no effect, consistent with what has been termed Rossi's Iron Law of Evaluation. Alternatively, we recommend that the guiding question of evaluation in health care improvement be, "How and in what contexts does a new model work or can be amended to work?" To answer this, we argue for the adoption of formative, theory-driven evaluation. Specifically, evaluations start by identifying a program theory that comprises execution and content theories. These theories should be revised as the initiative develops by applying a rapid-cycle evaluation approach, in which evaluation findings are fed back to the initiative leaders on a regular basis. We describe such evaluation strategies, accounting for the phase of improvement as well as the context and setting in which the improvement concept is being deployed. Finally, we challenge the improvement and evaluation communities to come together to refine the specific methods required so as to avoid the trap of Rossi's Iron Law.
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New utility for an old tool: can a simple gait speed test predict ambulatory surgical discharge outcomes? Am J Phys Med Rehabil 2013; 92:849-63. [PMID: 24051992 DOI: 10.1097/phm.0b013e3182a51ac5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary aims of this study were to design prediction models based on a functional marker (preoperative gait speed) to predict readiness for home discharge time of 90 mins or less and to identify those at risk for unplanned admissions after elective ambulatory surgery. DESIGN This prospective observational cohort study evaluated all patients scheduled for elective ambulatory surgery. Home discharge readiness and unplanned admissions were the primary outcomes. Independent variables included preoperative gait speed, heart rate, and total anesthesia time. The relationship between all predictors and each primary outcome was determined in separate multivariable logistic regression models. RESULTS After adjustment for covariates, gait speed with adjusted odds ratio of 3.71 (95% confidence interval, 1.21-11.26), P = 0.02, was independently associated with early home discharge readiness of 90 mins or less. Importantly, gait speed dichotomized as greater or less than 1 m/sec predicted unplanned admissions, with odds ratio of 0.35 (95% confidence interval, 0.16-0.76, P = 0.008) for those with speeds 1 m/sec or greater in comparison with those with speeds less than 1 m/sec. In a separate model, history of cardiac surgery with adjusted odds ratio of 7.5 (95% confidence interval, 2.34-24.41; P = 0.001) was independently associated with unplanned admissions after elective ambulatory surgery, when other covariates were held constant. CONCLUSIONS This study demonstrates the use of novel prediction models based on gait speed testing to predict early home discharge and to identify those patients at risk for unplanned admissions after elective ambulatory surgery.
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Reeves R, West E, Barron D. Facilitated patient experience feedback can improve nursing care: a pilot study for a phase III cluster randomised controlled trial. BMC Health Serv Res 2013; 13:259. [PMID: 23826970 PMCID: PMC3711856 DOI: 10.1186/1472-6963-13-259] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 07/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND England's extensive NHS patient survey programme has not fulfilled government promises of widespread improvements in patients' experiences, and media reports of poor nursing care in NHS hospitals are increasingly common. Impediments to the surveys' impact on the quality of nursing care may include: the fact that they are not ward-specific, so nurses claim "that doesn't happen on my ward"; nurses' scepticism about the relevance of patient feedback to their practice; and lack of prompt communication of results. The surveys' impact could be increased by: conducting ward-specific surveys; returning results to ward staff more quickly; including patients' written comments in reports; and offering nurses an opportunity to discuss the feedback. Very few randomised trials have been conducted to test the effectiveness of patient feedback on quality improvement and there have been few, if any, published trials of ward-specific patient surveys. METHODS Over two years, postal surveys of recent inpatients were conducted at four-monthly intervals in 18 wards in two NHS Trusts in England. Wards were randomly allocated to Basic Feedback (ward-specific printed patient survey results including patients' written comments sent to nurses by letter); Feedback Plus (in addition to printed results, ward meetings to discuss results and plan improvements) or Control (no active feedback of survey results). Patient survey responses to questions about nursing care were used to compute wards' average Nursing Care Scores at each interval. Nurses' reactions to the patient feedback were recorded. RESULTS Conducting ward-level surveys and delivering ward-specific results was feasible. Ward meetings were effective for engaging nurses and challenging scepticism and patients' written comments stimulated interest. 4,236 (47%) patients returned questionnaires. Nursing Care Scores improved more for Feedback Plus than Basic Feedback or Control (difference between Control and Feedback Plus=8.28±7.2 (p=0.02)). CONCLUSIONS This study provides preliminary evidence that facilitated patient feedback can improve patients' experiences such that a full trial is justified. These findings suggest that merely informing nurses of patient survey results in writing does not stimulate improvements, even if results are disaggregated by ward, but the addition of ward meetings had an important and significant impact.
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Affiliation(s)
- Rachel Reeves
- School of Health and Social Care, University of Greenwich, London SE9 2UG, UK.
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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.
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Affiliation(s)
- Ellen Kuhlmann
- Institute of Economics, Labour and Culture, Goethe-University Frankfurt, Frankfurt, Germany.
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Montgomery A, Todorova I, Baban A, Panagopoulou E. Improving quality and safety in the hospital: The link between organizational culture, burnout, and quality of care. Br J Health Psychol 2013; 18:656-62. [DOI: 10.1111/bjhp.12045] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/13/2013] [Indexed: 11/30/2022]
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