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Vanhaecht K, Lachman P, Van der Auwera C, Seys D, Claessens F, Panella M, De Ridder D. The "House of Trust". A framework for quality healthcare and leadership. F1000Res 2024; 13:503. [PMID: 38881947 PMCID: PMC11179047 DOI: 10.12688/f1000research.149711.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/18/2024] Open
Abstract
In healthcare, improvement leaders have been inspired by the frameworks from industry which have been adapted into control systems and certifications to improve quality of care for people. To address the challenge to regain trust in healthcare design and delivery, we propose a conceptual framework, i.e. the "House of Trust". This House brings together the Juran Trilogy, the emerging concept of co-production in quality management and the multidimensional definition of quality, which describes core values as an integral part of the system to deliver person- and kin-centered care. In the "House of Trust" patients, their kin, healthcare providers, executives and managers feel at home, with a sense of belonging. If we want to build a care organization that inspires and radiates confidence to all stakeholders, highlighting the basic interactions between front- and back-office is required. An organization with both well-organized back- and front-offices can enable all to benefit from the trust each of them needs and deserves. A quality system does not depend on government inspection and regulations nor on external accreditation to develop itself into a House of Trust. Success will only be achieved if all involved continuously question themselves about the technical dimensions of quality and their core values during the "moment of truth".
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Affiliation(s)
- Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, KU Leuven University of Leuven, Leuven, Flanders, Belgium
- Department of Quality, University Hospitals of Leuven, Leuven, 3000, Belgium
| | - Peter Lachman
- Royal College of Physicians of Ireland, Dublin, Leinster, Ireland
| | - Charlotte Van der Auwera
- Leuven Institute for Healthcare Policy, KU Leuven, KU Leuven University of Leuven, Leuven, Flanders, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven, KU Leuven University of Leuven, Leuven, Flanders, Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy, KU Leuven, KU Leuven University of Leuven, Leuven, Flanders, Belgium
| | - Massimiliano Panella
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven, KU Leuven University of Leuven, Leuven, Flanders, Belgium
- Department of Quality, University Hospitals of Leuven, Leuven, 3000, Belgium
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Karakusevic S, Yearsley L, Maddocks-Brown L. Networks, the clear blue water of change or the "wave tops" on the sea? Healthc Manage Forum 2024; 37:164-167. [PMID: 37971279 DOI: 10.1177/08404704231211163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
In this short article, we consider leadership in the context of managing increasingly complex networks. Our approach draws on multiple perspectives that support the use of collective approaches to leadership and the processes that underpin them. We highlight the importance of creating spaces for co-productive work and the use of rapid insight generation to accelerate learning and impact based on our experience of working on complex change programs.
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Claessens F, Van der Auwera C, Seys D, De Ridder D, Van Wilder A, Vanhaecht K, Research Group ATF. A multiphase, multicentre development and validation of two maturity tools assessing the implementation of the FlaQuM co-creation roadmap. Int J Qual Health Care 2024; 36:mzae035. [PMID: 38619125 DOI: 10.1093/intqhc/mzae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/19/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024] Open
Abstract
As part of the new Flanders Quality Model (FlaQuM) towards sustainable quality management systems, a co-creation roadmap with 6 primary drivers and 19 building blocks that guides healthcare organizations has been developed. Currently, no assessment tool is available to monitor hospitals' quality management systems implementation according to this co-creation roadmap. Therefore, we aimed to measure the maturity of the implementation of the FlaQuM co-creation roadmap in hospitals. A three-phase approach in co-design with 19 hospitals started with defining the scope, followed by establishing content validity through a literature review, involvement of content experts (n = 47), 20 focus groups with content experts (n = 79), and a Delphi round with healthcare quality managers (n = 19) to test the content validity index. Construct validity was assessed by confirmatory factor analyses and convergent validity by Spearman's ρ correlation coefficients. Based on 17 included existing maturity instruments and subcomponents of content experts, two maturity tools were developed according to the implementation of the FlaQuM co-creation roadmap: (i) a maturity matrix with 52 subcomponents and (ii) a co-creation scan with 19 statements. The overall scale-content validity index varied between 93.3% and 90.0% in terms of relevance and clarity, respectively. In a sample of 119 healthcare professionals, factor analyses revealed a six-factor structure and 16 (84.2%) of the 19 hypothesis for testing convergent validity between both maturity tools were statistically significant. Measuring the implementation of the FlaQuM co-creation roadmap and monitoring its maturity over time should be feasible by using these comprehensive maturity tools in hospitals. Results of both tools should be able to describe the current state of hospitals' implementation of the co-creation roadmap as basis for strategic improvement plans and next steps.
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Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy-Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 7, Leuven 3000, Belgium
| | - Charlotte Van der Auwera
- Leuven Institute for Healthcare Policy-Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 7, Leuven 3000, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy-Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 7, Leuven 3000, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy-Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 7, Leuven 3000, Belgium
- Department of Quality Management, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy-Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 7, Leuven 3000, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy-Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 7, Leuven 3000, Belgium
- Department of Quality Management, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
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Miller JP, Hutton J, Doherty C, Vallesi S, Currie J, Rushworth K, Larkin M, Scott M, Morrow J, Wood L. A scoping review examining patient experience and what matters to people experiencing homelessness when seeking healthcare. BMC Health Serv Res 2024; 24:492. [PMID: 38643146 PMCID: PMC11031864 DOI: 10.1186/s12913-024-10971-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/09/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Homelessness is associated with significant health disparities. Conventional health services often fail to address the unique needs and lived experience of homeless individuals and fail to include participatory design when planning health services. This scoping review aimed to examine areas of patient experience that are most frequently reported by people experiencing homelessness when seeking and receiving healthcare, and to identify existing surveys used to measure patient experience for this cohort. METHODS A scoping review was undertaken reported according to the PRISMA-ScR 2020 Statement. Databases were searched on 1 December 2022: MEDLINE, EMBASE, APA PsychINFO and CINAHL. Included studies focused on people experiencing homelessness, healthcare services and patient experience, primary research, published in English from 2010. Qualitative papers and findings were extracted and synthesized against a modified framework based on the National Institute for Health and Care Excellence guidelines for care for people experiencing homelessness, the Institute of Medicine Framework and Lachman's multidimensional quality model. People with lived experience of homelessness were employed as part of the research team. RESULTS Thirty-two studies were included. Of these, 22 were qualitative, seven quantitative and three mixed methods, from the United States of America (n = 17), United Kingdom (n = 5), Australia (n = 5) and Canada (n = 4). Health services ranged from primary healthcare to outpatient management, acute care, emergency care and hospital based healthcare. In qualitative papers, the domains of 'accessible and timely', 'person-centred', and values of 'dignity and respect' and 'kindness with compassion' were most prevalent. Among the three patient experience surveys identified, 'accessible and timely' and 'person-centred' were the most frequent domains. The least frequently highlighted domains and values were 'equitable' and 'holistic'. No questions addressed the 'safety' domain. CONCLUSIONS The Primary Care Quality-Homeless questionnaire best reflected the priorities for healthcare provision that were highlighted in the qualitative studies of people experiencing homelessness. The most frequently cited domains and values that people experiencing homelessness expressed as important when seeking healthcare were reflected in each of the three survey tools to varying degrees. Findings suggest that the principles of 'Kindness and compassion' require further emphasis when seeking feedback on healthcare experiences and the domains of 'safety', 'equitable', and 'efficiency' are not adequately represented in existing patient experience surveys.
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Affiliation(s)
| | - Jennie Hutton
- St Vincent's Hospital Melbourne, Melbourne, Australia.
- The University of Melbourne, Melbourne, Australia.
- Victorian Virtual Emergency Department, Northern Hospital, Melbourne, Australia.
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | | | | | - Jane Currie
- Queensland University of Technology, Brisbane, Australia
| | | | | | - Matthew Scott
- St Vincent's Hospital Melbourne, Melbourne, Australia
- Lived Experience Representative, Melbourne, Australia
| | - James Morrow
- Lived Experience Representative, Melbourne, Australia
| | - Lisa Wood
- The University of Notre Dame Australia, Perth, Australia
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Chan A, Hickey L, Finucane K, Brennan J. Assessing care quality in general practice: a qualitative study of GPs in Ireland. BJGP Open 2024; 8:BJGPO.2023.0104. [PMID: 37813473 PMCID: PMC11169978 DOI: 10.3399/bjgpo.2023.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/15/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND It is estimated that each year in Ireland, approximately 29 million consultations occur in general practice with a patient satisfaction level of 90%. To date, research has been lacking on how GPs assess the quality of care. AIM To examine how GPs assess care quality during routine practice with respect to the following pillars of quality improvement: effectiveness, safety, timeliness, equity, efficiency, sustainability, and person-centredness. DESIGN & SETTING Qualitative study of GPs in Ireland. METHOD In this qualitative study, semi-structured interviews were conducted with 10 GPs who were recruited via a snowball sampling strategy. Interviews were recorded, transcribed, and analysed. Quality 'assessment points' were identified and themes were synthesised to produce a theoretical framework. RESULTS Five female and five male GPs practising in a variety of settings were interviewed. The age range was 33-68 years. In total, 122 assessment points emerged from the data and were collated into the following eight themes: the GP as a professional person factors; the patient and coproduction factors; care team factors; direct care factors; outcome factors; practice environment and organisation factors; external environment factors; and improvement approach factors. CONCLUSION This is the first study to examine how GPs in Ireland assess care quality as a holistic construct during daily care. The qualitative approach applied yielded rich and diverse insights into the many assessment points that GPs use to inform their approach and actions as clinicians, managers, collaborators, and leaders to maximise patient care. The theory produced is likely useful and applicable for practising GPs, healthcare administration, policymakers, and funders in planning and executing changes for quality improvement.
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Affiliation(s)
- Aaron Chan
- University College Dublin School of Medicine, Dublin, Republic of Ireland
| | | | | | - John Brennan
- Quality Improvement Faculty, Royal College of Physicians of Ireland, Dublin, Republic of Ireland
- Gowran Medical Centre, Co. Kilkenny, Dublin, Republic of Ireland
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Coeckelberghs E, Bislenghi G, Wolthuis A, Teunkens A, Dewinter G, Coppens S, Vanhaecht K, D'Hoore A. Quality indicators for ambulatory colectomy: literature search and expert consensus. Surg Endosc 2024; 38:1894-1901. [PMID: 38316661 PMCID: PMC10978605 DOI: 10.1007/s00464-023-10660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/22/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Care for patients undergoing elective colectomy has become increasingly standardized using Enhanced Recovery Programs (ERP). ERP, encorporating minimally invasive surgery (MIS), decreased postoperative morbidity and length of stay (LOS). However, disruptive changes are needed to safely introduce colectomy in an ambulatory or same-day discharge (SDD) setting. Few research groups showed the feasibility of ambulatory colectomy. So far, no minimum standards for the quality of care of this procedure have been defined. This study aims to identify quality indicators (QIs) that assess the quality of care for ambulatory colectomy. METHODS A literature search was performed to identify recommendations for ambulatory colectomy. Based on that search, a set of QIs was identified and categorized into seven domains: preparation of the patient (pre-admission), anesthesia, surgery, in-hospital monitoring, home monitoring, feasibility, and clinical outcomes. This list was presented to a panel of international experts (surgeons and anesthesiologists) in a 1 round Delphi to assess the relevance of the proposed indicators. RESULTS Based on the literature search (2010-2021), 3841 results were screened on title and abstract for relevant information. Nine papers were withheld to identify the first set of QIs (n = 155). After excluding duplicates and outdated QIs, this longlist was narrowed down to 88 indicators. Afterward, consensus was reached in a 1 round Delphi on a final list of 32 QIs, aiming to be a comprehensive set to evaluate the quality of ambulatory colectomy care. CONCLUSION We propose a list of 32 QI to guide and evaluate the implementation of ambulatory colectomy.
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Affiliation(s)
- Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - An Teunkens
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Geertrui Dewinter
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Steve Coppens
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - André D'Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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Claessens F, Seys D, Van der Auwera C, Castro EM, Jans A, Schoenmakers B, De Ridder D, Bruyneel L, Van Wilder A, Vanhaecht K. The FlaQuM-Quickscan: A starting point to include primary care professionals' perspectives in the evaluation of hospital quality priorities. J Healthc Qual Res 2024; 39:89-99. [PMID: 38195377 DOI: 10.1016/j.jhqr.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Today, primary care professionals' (PCPs) perspectives on hospital quality are unknown when evaluating hospital quality priorities. The aims of the present study were to identify key healthcare quality attributes from PCPs' perspective, to validate an instrument that measures PCPs' experiences of healthcare quality multidimensionally and to define hospital quality priorities based on PCPs' experiences. MATERIAL AND METHODS Focus groups with PCPs were conducted to identify quality attributes through a qualitative in-depth analysis. A multicentre study of 18 hospitals was used to quantitatively assess construct, discriminant and criterion validity of the FlaQuM-Quickscan, an instrument that measures 'Healthcare quality for patients and kin' (part 1) and 'Healthcare quality for professionals' (part 2). To set quality priorities, scores on quality domains were analyzed descriptively and between-hospital variation was examined by evaluating differences in hospitals' mean scores on the quality domains using one-way Analysis of Variance (ANOVA). RESULTS Identified key attributes largely corresponded with Lachman's multidimensional quality model. Including 'Communication' as a new quality domain was recommended. The FlaQuM-Quickscan was completed by 550 PCPs. Confirmatory factor analyses showed reasonable to good fit, except for the Root Mean Square Error of Approximation (RMSEA) in part 2. The 'Equity' domain scored the highest in parts 1 and 2. Domains 'Kin-centred care' and 'Accessibility and timeliness' scored the lowest in part 1 and 'Resilience' and 'Partnership and co-production' in part 2. Significant variation in hospitals' mean scores was observed for eleven domains in part 1 and sixteen domains in part 2. CONCLUSIONS The results gained a better understanding of PCPs' perspective on quality. The FlaQuM-Quickscan is a valid instrument to measure PCPs' experiences of hospital quality. Identified priorities indicate that hospital management should focus on multifaceted quality strategies, including technical domains, person-and kin-centredness, core values and catalysts.
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Affiliation(s)
- F Claessens
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium.
| | - D Seys
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - C Van der Auwera
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - E M Castro
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - A Jans
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - B Schoenmakers
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - D De Ridder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - L Bruyneel
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - A Van Wilder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Claessens F, Seys D, Van der Auwera C, Jans A, Castro EM, Jacobs L, De Ridder D, Bruyneel L, Leenaerts Z, Van Wilder A, Brouwers J, Lachman P, Vanhaecht K. Measuring in-hospital quality multidimensionally by integrating patients', kin's and healthcare professionals' perspectives: development and validation of the FlaQuM-Quickscan. BMC Health Serv Res 2023; 23:1426. [PMID: 38104060 PMCID: PMC10725024 DOI: 10.1186/s12913-023-10349-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Measuring quality is essential to drive improvement initiatives in hospitals. An instrument that measures healthcare quality multidimensionally and integrates patients', kin's and professionals' perspectives is lacking. We aimed to develop and validate an instrument to measure healthcare quality multidimensionally from a multistakeholder perspective. METHODS A multi-method approach started by establishing content and face validity, followed by a multi-centre study in 17 Flemish (Belgian) hospitals to assess construct validity through confirmatory factor analysis, criterion validity through determining Pearson's correlations and reliability through Cronbach's alpha measurement. The instrument FlaQuM-Quickscan measures 'Healthcare quality for patients and kin' (part 1) and 'Healthcare quality for professionals' (part 2). This bipartite instrument mirrors 15 quality items and 3 general items (the overall quality score, recommendation score and intention-to-stay score). A process evaluation was organised to identify effective strategies in instrument distribution by conducting semi-structured interviews with quality managers. RESULTS By involving experts in the development of quality items and through pilot testing by a multi-stakeholder group, the content and face validity of instrument items was ensured. In total, 13,615 respondents (5,891 Patients/kin and 7,724 Professionals) completed the FlaQuM-Quickscan. Confirmatory factor analyses showed good to very good fit and correlations supported the associations between the quality items and general items for both instrument parts. Cronbach's alphas supported the internal consistency. The process evaluation revealed that supportive technical structures and approaching respondents individually were effective strategies to distribute the instrument. CONCLUSIONS The FlaQuM-Quickscan is a valid instrument to measure healthcare quality experiences multidimensionally from an integrated multistakeholder perspective. This new instrument offers unique and detailed data to design sustainable quality management systems in hospitals. Based on these data, hospital management and policymakers can set quality priorities for patients', kin's and professionals' care. Future research should investigate the transferability to other healthcare systems and examine between-stakeholders and between-hospitals variation.
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Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Charlotte Van der Auwera
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anneke Jans
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - Eva Marie Castro
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - Laura Jacobs
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Zita Leenaerts
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Peter Lachman
- Lead Faculty Quality Improvement Programme- Royal College of Physicians of Ireland, Dublin, Ireland
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Claessens F, Castro EM, Seys D, Brouwers J, Van Wilder A, Jans A, De Ridder D, Vanhaecht K. Sustainable quality management in hospitals: The experiences of healthcare quality managers. Health Serv Manage Res 2023:9514848231218631. [PMID: 38001556 DOI: 10.1177/09514848231218631] [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: 11/26/2023]
Abstract
BACKGROUND Quality management systems are essential in hospitals, but evidence shows a real literature gap on the sustainable implementation of quality. PURPOSE This study aimed to explore and identify enablers towards sustainable quality management in hospitals. Research design and Study Sample: Interviews were conducted with 23 healthcare quality managers from 20 hospitals. Data collection and/or Analysis: Data collection and analysis were conducted simultaneously by using the Qualitative Analysis Guide of Leuven and following the COREQ Guidelines. Thematic analysis from interview transcripts was performed in NVivo 12. RESULTS The results reveal two categories: (1) quality in the organisation's DNA and (2) quality in the professional's DNA. The first category consists of: bottom-up and top-down management, the organisation-wide integration of quality and an organisational culture shift. The second one consists of: quality awareness, understanding the added value, the encouragement and engagement, the accountability and ownership for quality. Moving towards sustainable quality management systems in hospitals requires a good interaction between a bottom-up approach and leadership to ensure continuous support from healthcare stakeholders. CONCLUSIONS This study contributes to existing conceptual and theoretical foundations with practical insights into sustainable quality management. The findings can guide quality departments and hospital management to regain professionals' commitment to quality and to establish a sustainable quality management system.
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Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Eva Marie Castro
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anneke Jans
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Gartner JB, Côté A. Optimization of Care Pathways Through Technological, Clinical, Organizational and Social Innovations: A Qualitative Study. Health Serv Insights 2023; 16:11786329231211096. [PMID: 37953914 PMCID: PMC10637140 DOI: 10.1177/11786329231211096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Numerous calls at national and international level are leading some countries to seek to redesign the provision of healthcare and services. Care pathways have the potential to improve outcomes by providing a mechanism to coordinate care and reduce fragmentation and ultimately costs. However, their implementation still shows variable results, resulting in them being considered as complex interventions in complex systems. By mobilizing an emerging approach combining action research and grounded theory methodology, we conducted a pilot project on care pathways. We used a strongly inductive process, to mobilize comparison and continuous theoretical sampling to produce theories. Forty-two interviews were conducted, and participant observations were made throughout the project, including 60 participant observations at meetings, workshops and field observations. The investigators kept logbooks and recorded field notes. Thematic analysis was used with an inductive approach. The present model explains the factors that positively or negatively influence the implementation of innovations in care pathways. The model represents interactions between facilitating factors, favourable conditions for the emergence of innovation adoption, implementation process enablers and challenges or barriers including those related specifically to the local context. What seems to be totally new is the embodiment of the mobilizing shared objective of active patient-partner participation in decision-making, data collection and analysis and solution building. This allows, in our opinion, to transcend professional perspectives for the benefit of patient-oriented results. Finally, the pilot project has created expectations in terms of spread and scaling. Future research on care pathway implementation should go further in the evaluation of the multifactorial impacts and develop a methodological framework of care pathway implementation, as the only existing proposition seems limited. Furthermore, from a social science perspective, it would be interesting to analyse the modes of social valuation of the different actors to understand what allows the transformation of collective action.
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Affiliation(s)
- Jean-Baptiste Gartner
- Département de management, Faculté des sciences de l’administration, Université Laval, Québec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- Centre de recherche du CISSS de Chaudière-Appalaches, Québec, QC, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Centre de recherche de l’Institut Universitaire de Cardio-Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - André Côté
- Département de management, Faculté des sciences de l’administration, Université Laval, Québec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- Centre de recherche du CISSS de Chaudière-Appalaches, Québec, QC, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Centre de recherche de l’Institut Universitaire de Cardio-Pneumologie de Québec, Université Laval, Québec, QC, Canada
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Gartner JB, Benharbit B, Layani G, Sasseville M, Lemaire C, Bergeron F, Wilhelmy C, Menear M, Côté A. Implementation model for a national learning health system (IMPLEMENT-National LHS): a concept analysis and systematic review protocol. BMJ Open 2023; 13:e073767. [PMID: 37907296 PMCID: PMC10619008 DOI: 10.1136/bmjopen-2023-073767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Despite efforts and repeated calls to improve the organisation and quality of healthcare and services, and in view of the many challenges facing health systems, the results and capacity to adapt and integrate innovations and new knowledge remain suboptimal. Learning health systems (LHS) may be an effective model to accelerate the application of research for real quality improvement in healthcare. However, while recognising the enormous potential of LHS, the literature suggests the model remains more of an aspiration than a reality. METHODS AND ANALYSIS To reach a fine understanding of the implementation of the concepts involved in LHS, we will use a hybrid method which combines concept analyses with systematic review methodology. We will use a two-step analysis, a content analysis to analyse the definitions, uses and attributes of the concept and a systematic review to analyse the concept's implementation mechanisms. We will search eight databases and grey literature and present a broad synthesis of the available evidence regarding design, implementation and evaluation of LHS in a multilevel perspective. We will follow the latest Preferred Reporting Items for Systematic Review and Meta-Analysis statement for conducting and reporting a systematic review. Two reviewers will independently screen the titles and abstracts against the eligibility criteria followed by full-text screening of potentially relevant articles for final inclusion decision. Conflicts will be resolved with a senior author. We will include published primary studies that use qualitative, quantitative or mixed methods. The assessment of risk of bias will be made using the Mixed-Methods Appraisal Tool. ETHICS AND DISSEMINATION This systematic review is exempt from ethics approval. The results formulated will highlight evidence-based interventions that support the implementation of a national LHS. They will be of particular interest to decision makers, researchers, managers, clinicians and patients allowing finally to implement the promising proposal of LHSs at national scale. PROSPERO REGISTRATION NUMBER CRD42023393565.
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Affiliation(s)
- Jean-Baptiste Gartner
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
- Centre de recherche de l'Institut Universitaire de Cardio-Pneumologie de Québec, Université Laval, Québec, QC, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- Centre de recherche du CISSS de Chaudière-Appalaches, Université Laval, Québec, QC, Canada
| | - Boutheina Benharbit
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
| | - Géraldine Layani
- Département de Médecine de famille et médecine d'urgence, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du CHUM, Montreal, QC, Canada
| | - Maxime Sasseville
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Faculté des sciences infirmières, Université Laval, Quebec, QC, Canada
| | - Célia Lemaire
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
- iaelyon, Université Jean Moulin Lyon 3 iaelyon School of Management, Lyon, France
| | - Frédéric Bergeron
- Bibliothèque-Direction des services-conseils, Université Laval, Québec, QC, Canada
| | - Catherine Wilhelmy
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Matthew Menear
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Quebec, Canada
| | - André Côté
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
- Centre de recherche de l'Institut Universitaire de Cardio-Pneumologie de Québec, Université Laval, Québec, QC, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- Centre de recherche du CISSS de Chaudière-Appalaches, Université Laval, Québec, QC, Canada
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Brînzac MG, Kuhlmann E, Dussault G, Ungureanu MI, Cherecheș RM, Baba CO. Defining medical deserts-an international consensus-building exercise. Eur J Public Health 2023; 33:785-788. [PMID: 37421651 PMCID: PMC10567127 DOI: 10.1093/eurpub/ckad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Medical deserts represent a pressing public health and health systems challenge. The COVID-19 pandemic further exacerbated the gap between people and health services, yet a commonly agreed definition of medical deserts was lacking. This study aims to define medical deserts through a consensus-building exercise, explaining the phenomenon to its full extent, in a manner that can apply to countries and health systems across the globe. METHODS We used a standard Delphi exercise for the consensus-building process. The first phase consisted of one round of individual online meetings with selected key informants; the second phase comprised two rounds of surveys when a consensus was reached in January 2023. The first phase-the in-depth individual meetings-was organized online. The dimensions to include in the definition of medical deserts were identified, ranked and selected based on their recurrence and importance. The second phase-the surveys-was organized online. Finally, external validation was obtained from stakeholders via email. RESULTS The agreed definition highlight five major dimensions: 'Medical deserts are areas where population healthcare needs are unmet partially or totally due to lack of adequate access or improper quality of healthcare services caused by (i) insufficient human resources in health or (ii) facilities, (iii) long waiting times, (iv) disproportionate high costs of services or (v) other socio-cultural barriers'. CONCLUSIONS The five dimensions of access to healthcare: (i) insufficient human resources in health or (ii) facilities, (iii) long waiting times, (iv) disproportionate high costs of services and (v) other socio-cultural barriers-ought to be addressed to mitigate medical deserts.
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Affiliation(s)
- Monica G Brînzac
- Department of Public Health, Faculty of Political, Administrative, and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- EUPHAnxt, European Public Health Association, Utrecht, The Netherlands
- Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Ellen Kuhlmann
- Institute of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
- Health and Health Systems, Faculty I, University of Siegen, Siegen, Germany
| | - Gilles Dussault
- Institute of Hygiene and Tropical Medicine, Lisbon, Portugal
- World Health Organization Collaborating Centre for Health Workforce Policy and Planning, Lisbon, Portugal
| | - Marius I Ungureanu
- Department of Public Health, Faculty of Political, Administrative, and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Răzvan M Cherecheș
- Department of Public Health, Faculty of Political, Administrative, and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Cătălin O Baba
- Department of Public Health, Faculty of Political, Administrative, and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
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Datta V, Srivastava S, Lalwani K, Garde R, Patnaik SK, Venkatagiri P, Pradeep J, Bangal V, Pemde H, Kumar A, Sooden A, Vijayan S, Sawleshwarkar K, Mehta R, Raina N, Khanna R, Singh V, Singh P, Saha K, Sharma C, Jain S. Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic. BMJ Open Qual 2023; 12:e002370. [PMID: 37863508 PMCID: PMC10603542 DOI: 10.1136/bmjoq-2023-002370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/11/2023] [Indexed: 10/22/2023] Open
Abstract
INTRODUCTION Ensuring quality of care in Low and Middle Income countries (LMICs) is challenging. Despite the implementation of various quality improvement (QI) initiatives in public and private sectors, the sustenance of improvements continues to be a major challenge. A team of healthcare professionals in India developed a digital community of practice (dCoP) focusing on QI which now has global footprints. METHODOLOGY The dCoP was conceptualised as a multitiered structure and is operational online at www.nqocncop.org from August 2020 onwards. The platform hosts various activities related to the quality of care, including the development of new products, and involves different cadres of healthcare professionals from primary to tertiary care settings. The platform uses tracking indicators, including the cost of sustaining the dCoP to monitor the performance of the dCoP. RESULT Since its launch in 2020, dCoP has conducted over 130 activities using 13 tools with 25 940 registration and 13 681 participants. From April 2021, it has expanded to countries across the South-East Asia region and currently has participants from 53 countries across five continents. It has developed 20 products in four thematic areas for a targeted audience. dCoP is supporting mentoring of healthcare professionals from five countries in the South-East Asia region in their improvement journey. Acquiring new knowledge and improvement in their daily clinical practice has been reported by 93% and 80% of participants, respectively. The dCoP and its partners have facilitated the publication of nearly 40 articles in international journals. CONCLUSION This dCoP platform has become a repository of knowledge for healthcare professionals in the South-East Asia region. The current paper summarises the journey of this innovative dCoP in an LMIC setting for a wider global audience.
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Affiliation(s)
- Vikram Datta
- Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Sushil Srivastava
- Pediatrics, University College of Medical Sciences, New Delhi, Delhi, India
| | | | - Rahul Garde
- Quality Improvement, NQOCN, New Delhi, Delhi, India
| | - Suprabha K Patnaik
- Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharastra, India
| | | | - Jeena Pradeep
- Nursing, Ministry of Health and Family Welfare, India, New Delhi, Delhi, India
- Pediatrics, Kalawati Saran Children's Hospital, New Delhi, Delhi, India
| | - Vidhyadhar Bangal
- Obstetrics and Gynaecology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
- Centre for Social Medicine, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Harish Pemde
- Paediatrics, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Achala Kumar
- Nursing, Ministry of Health and Family Welfare, India, New Delhi, Delhi, India
| | - Ankur Sooden
- Private Sector Engagement, JSI India, New Delhi, Delhi, India
| | - Shreeja Vijayan
- Child Health Nursing, Choithram College of Nursing and Choithram Hospital & Research Centre, Indore, Madhya Pradesh, India
| | | | | | - Neena Raina
- World Health Organization - South East Asia Regional Office, New Delhi, Delhi, India
| | - Rajesh Khanna
- World Health Organization - South East Asia Regional Office, New Delhi, Delhi, India
| | - Vivek Singh
- Health Section, UNICEF India, New Delhi, Delhi, India
| | | | - Khushboo Saha
- The University of Texas Southwestern Medical Center at Dallas Library, Dallas, Texas, USA
| | - Chhavi Sharma
- Pediatrics, Kalawati Saran Children's Hospital, New Delhi, Delhi, India
| | - Sonam Jain
- Quality Improvement, NQOCN, New Delhi, Delhi, India
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Vackerberg N, Andersson AC, Peterson A, Karltun A. What is best for Esther? A simple question that moves mindsets and improves care. BMC Health Serv Res 2023; 23:873. [PMID: 37592279 PMCID: PMC10433680 DOI: 10.1186/s12913-023-09870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Persons in need of services from different care providers in the health and welfare system often struggle when navigating between them. Connecting and coordinating different health and welfare providers is a common challenge for all involved. This study presents a long-term regional empirical example from Sweden-ESTHER, which has lasted for more than two decades-to show how some of those challenges could be met. The purpose of the study was to increase the understanding of how several care providers together could succeed in improving care by transforming a concept into daily practice, thus contributing with practical implications for other health and welfare contexts. METHODS The study is a retrospective longitudinal case study with a qualitative mixed-methods approach. Individual interviews and focus groups were performed with staff members and persons in need of care, and document analyses were conducted. The data covers experiences from 1995 to 2020, analyzed using an open inductive thematic analysis. RESULTS This study shows how co-production and person-centeredness could improve care for persons with multiple care needs involving more than one care provider through a well-established Quality Improvement strategy. Perseverance from a project to a mindset was shaped by promoting systems thinking in daily work and embracing the psychology of change during multidisciplinary, boundary-spanning improvement dialogues. Important areas were Incentives, Work in practice, and Integration, expressed through trust in frontline staff, simple rules, and continuous support from senior managers. A continuous learning approach including the development of local improvement coaches and co-production of care consolidated the integration in daily work. CONCLUSIONS The development was facilitated by a simple question: "What is best for Esther?" This question unified people, flattened the hierarchy, and reminded all care providers why they needed to improve together. Continuously focusing on and co-producing with the person in need of care strengthened the concept. Important was engaging the people who know the most-frontline staff and persons in need of care-in combination with permissive leadership and embracing quality improvement dimensions. Those insights can be useful in other health and welfare settings wanting to improve care involving several care providers.
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Affiliation(s)
- Nicoline Vackerberg
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
- Region Jönköping County, Jönköping, Sweden.
| | - Ann- Christine Andersson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anette Peterson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Region Jönköping County, Jönköping, Sweden
| | - Anette Karltun
- Department of Supply Chain and Operations Management, School of Engineering, Jönköping University, Jönköping, Sweden
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de Kok K, van der Scheer W, Ketelaars C, Leistikow I. Organizational attributes that contribute to the learning & improvement capabilities of healthcare organizations: a scoping review. BMC Health Serv Res 2023; 23:585. [PMID: 37286994 DOI: 10.1186/s12913-023-09562-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/16/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND This study aims to explore and identify the organizational attributes that contribute to learning and improvement capabilities (L&IC) in healthcare organizations. The authors define learning as a structured update of system properties based on new information, and improvement as a closer correspondence between actual and desired standards. They highlight the importance of learning and improvement capabilities in maintaining high-quality care, and emphasize the need for empirical research on organizational attributes that contribute to these capabilities. The study has implications for healthcare organizations, professionals, and regulators in understanding how to assess and enhance learning and improvement capabilities. METHODS A systematic search of peer-reviewed articles published between January 2010 and April 2020 was carried out in the PubMed, Embase, CINAHL, and APA PsycINFO databases. Two reviewers independently screened the titles and abstracts and conducted a full-text review of potentially relevant articles, eventually adding five more studies identified through reference scanning. Finally, a total of 32 articles were included in this review. We extracted the data about organizational attributes that contribute to learning and improvement, categorized them and grouped the findings step-by-step into higher, more general-level categories using an interpretive approach until categories emerged that were sufficiently different from each other while also being internally consistent. This synthesis has been discussed by the authors. RESULTS We identified five attributes that contribute to the L&IC of healthcare organizations: perceived leadership commitment, open culture, room for team development, initiating and monitoring change, and strategic client focus, each consisting of multiple facilitating aspects. We also found some hindering aspects. CONCLUSIONS We have identified five attributes that contribute to L&IC, mainly related to organizational software elements. Only a few are identified as organizational hardware elements. The use of qualitative methods seems most appropriate to understand or assess these organizational attributes. We feel it is also important for healthcare organisations to look more closely at how clients can be involved in L&IC. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Kees de Kok
- Dutch Health and Youth Care Inspectorate (IGJ), Stadsplateau 1, 3521 AZ, Utrecht, The Netherlands.
| | - Wilma van der Scheer
- Health Care Governance, Erasmus School of Health Policy & Management, Erasmus University, Burgemeester Oudlaan 50, Rotterdam, The Netherlands
| | - Corry Ketelaars
- Dutch Health and Youth Care Inspectorate (IGJ), Stadsplateau 1, 3521 AZ, Utrecht, The Netherlands
| | - Ian Leistikow
- Dutch Health and Youth Care Inspectorate (IGJ), Stadsplateau 1, 3521 AZ, Utrecht, The Netherlands
- Health Care Governance, Erasmus School of Health Policy & Management, Erasmus University, Burgemeester Oudlaan 50, Rotterdam, The Netherlands
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Vohoumani R, Le R, Agustines D. A Holistic Approach to Cardiopulmonary Concerns in a Schizophrenic Patient and Ensuring Quality Care. Cureus 2023; 15:e37303. [PMID: 37168212 PMCID: PMC10166599 DOI: 10.7759/cureus.37303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
"Holistic approach" and "Quality Care" have been trending topics in the medical community for several decades, with holistic practice advocating for meeting patients' emotional, physiologic, psychological, and spiritual needs. In comparison, the quality care model highlights patient care metrics of equity, safety, and timeliness in medical treatment. Both converge on the concept of medical care centered around patients, with countless papers discussing their benefits in various healthcare settings. However, there is a gap in the literature regarding using both models to manage the mentally ill. Adopting the healthcare quality approach and incorporating a holistic perspective in managing psychiatric conditions can improve patient satisfaction and reduce societal and healthcare costs, making it an important area of further investigation. This paper will discuss the case of a 59-year-old male with schizophrenia who developed cardiopulmonary symptoms during his prolonged hospital stay, leading to extensive yet inefficient workup, in which his symptoms improved after implementing measures that uplifted his psyche. It will carefully examine holistic care's emotional and psychological aspects and the quality care domains for mentally ill patients. The case report aims to endorse integrating both models into the management of the psychiatric population to promote patient-centered and optimal quality of care.
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Affiliation(s)
- Rostam Vohoumani
- Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA
| | - Raymond Le
- Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA
| | - Davin Agustines
- Psychiatry, Olive View - University of California Los Angeles Medical Center, Los Angeles, USA
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van Engen V, Bonfrer I, Ahaus K, Buljac-Samardzic M. Identifying consensus on activities that underpin value-based healthcare in outpatient specialty consultations, among clinicians. PATIENT EDUCATION AND COUNSELING 2023; 109:107642. [PMID: 36696878 DOI: 10.1016/j.pec.2023.107642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To find a consensus on clinicians' and patients' activities that underpin an ideal value-based outpatient specialty consultation, among clinicians. METHODS A three-round online Delphi study was conducted. A purposive sample of nineteen clinicians from a Dutch university hospital judged activities on importance. Consensus was defined at 80% agreement. Activities were thematically analyzed to derive conceptual themes. RESULTS The expert panel agreed on 63 activities as being important for an ideal value-based outpatient specialty consultation and two activities as being unimportant. They failed to reach a consensus on 11 activities. Conceptual themes for activities that were considered important regard: 1) empowerment, 2) patient-reported biopsychosocial outcomes, 3) the patient as a person, 4) the patient's kin, 5) shared power and responsibility, 6) optimization, 7) coordination, 8) therapeutic relationships, and 9) resource-consciousness. CONCLUSION A value-based outpatient specialty consultation requires contextual decision-making, is person-centered, and focusses attention on care optimization and intelligent resource allocation. No importance is attributed to healthcare's societal burden and climate footprint. Disparities existed in various areas including the role of patient reported experience measures, "patient-like-me" data, and healthcare costs. PRACTICE IMPLICATIONS This study contributes a toolbox to guide and evaluate clinicians' and patients' behaviors in value-based outpatient specialty consultations and reveals opportunities to enhance facilitation.
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Affiliation(s)
- Veerle van Engen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, the Netherlands.
| | - Igna Bonfrer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, the Netherlands.
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, the Netherlands.
| | - Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, the Netherlands.
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Adu-Bonsaffoh K, Tamma E, Nwameme A, Dako-Gyeke P, Srofenyoh E, Ansah EK, Grobbee DE, Franx A, Browne JL. Provision and experience of care among women with hypertension in pregnancy: a multi-center qualitative study in Ghana. Reprod Health 2023; 20:49. [PMID: 36966326 PMCID: PMC10039538 DOI: 10.1186/s12978-023-01593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/05/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) remain a leading global health problem with complex clinical presentations and potentially grim birth outcomes for both mother and fetus. Improvement in the quality of maternal care provision and positive women's experiences are indispensable measures to reduce maternal and perinatal adverse outcomes. OBJECTIVE To explore the perspectives and lived experiences of healthcare provision among women with HDP and the associated challenges. METHODS A multi-center qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in five major referral hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Women between 26 and 34 weeks' gestation with confirmed HDP who received maternity care services were eligible to participate. Thematic content analysis was performed using the inductive analytic framework approach. RESULTS Fifty IDIs and three FGDs (with 22 participants) were conducted. Most women were between 20 and 30 years, Akans (ethnicity), married/cohabiting, self-employed and secondary school graduates. Women reported mixed (positive and negative) experiences of maternal care. Positive experiences reported include receiving optimal quality of care, satisfaction with care and good counselling and reassurance from the health professionals. Negative experiences of care comprised ineffective provider-client communication, inappropriate attitudes by the health professionals and disrespectful treatment including verbal and physical abuse. Major health system factors influencing women's experiences of care included lack of logistics, substandard professionalism, inefficient national health insurance system and unexplained delays at health facilities. Patient-related factors that influenced provision of care enumerated were financial limitations, chronic psychosocial stress and inadequate awareness about HDP. CONCLUSION Women with HDP reported both positive and negative experiences of care stemming from the healthcare system, health providers and individual factors. Given the importance of positive women's experiences and respectful maternal care, dedicated multidisciplinary women-centered care is recommended to optimize the care for pregnant women with HDP.
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Affiliation(s)
- Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu, P.O. Box 77, Accra, Ghana.
- Holy Care Specialist Hospital, Accra, Ghana.
| | | | - Adanna Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Emmanuel Srofenyoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital (Ridge), Accra, Ghana
| | - Evelyn K Ansah
- Institute for Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Claessens F, Castro EM, Jans A, Jacobs L, Seys D, Van Wilder A, Brouwers J, Van der Auwera C, De Ridder D, Vanhaecht K. Patients' and kin's perspective on healthcare quality compared to Lachman's multidimensional quality model: Focus group interviews. PATIENT EDUCATION AND COUNSELING 2022; 105:3151-3159. [PMID: 35843847 DOI: 10.1016/j.pec.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To identify key attributes of healthcare quality relevant to patients and kin and to compare them to Lachman's multidimensional quality model. METHODS Four focus groups with patients and kin were conducted using a semi-structured interview guide and a purposive sampling method. Classical content analysis and constant comparison method were used to focus data analysis on individual and group level. RESULTS Communication with patients, kin and professionals emerged as a new dimension from interview transcripts. Other identified key attributes largely corresponded with Lachman's multidimensional quality model. They were mainly classified in dimensions: 'Partnership and Co-Production', 'Dignity and Respect' and 'Effectiveness'. Technical quality dimensions were linked to organisational aspects of care in terms of staffing levels and time. The dimension 'Eco-friendly' was not addressed by patients or kin. CONCLUSIONS The results enhance the comprehension of healthcare quality and contribute to its academic understanding by validating Lachman's multidimensional quality model from patients' and kin's perspective. The model robustness is increased by including communication as a quality dimension surrounding technical domains and core values. PRACTICE IMPLICATIONS The key attributes can serve as a holistic framework for healthcare organisations to design their quality management system. An instrument can be developed to measure key attributes.
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Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Eva Marie Castro
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - Anneke Jans
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - Laura Jacobs
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Charlotte Van der Auwera
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium.
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20
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Putnis N, Neilson M. Environmental Sustainability and Quality Care: Not One without the Other. Int J Qual Health Care 2022; 34:6677181. [PMID: 36018042 DOI: 10.1093/intqhc/mzac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/12/2022] [Accepted: 08/26/2022] [Indexed: 11/15/2022] Open
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21
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Claessens F, Seys D, Brouwers J, Van Wilder A, Jans A, Castro EM, Bruyneel L, De Ridder D, Vanhaecht K. A co-creation roadmap towards sustainable quality of care: A multi-method study. PLoS One 2022; 17:e0269364. [PMID: 35771777 PMCID: PMC9246114 DOI: 10.1371/journal.pone.0269364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Hospitals demonstrated increased efforts into quality improvement over the past years. Their growing commitment to quality combined with a heterogeneity in perceptions among healthcare stakeholders cause concerns on the sustainable incorporation of quality into the daily workflow. Questions are raised on the drivers for a sustainable hospital quality policy. We aimed to identify drivers and incorporate them into a new, unique roadmap towards sustainable quality of care in hospitals. Design A multi-method design guided by an eight-phase approach to develop a conceptual framework consists of multiple, iterative phases of data collection, synthesis and validation. Starting with a narrative review followed by a qualitative in-depth analysis and including feedback of national and international healthcare stakeholders. Setting Hospitals. Results The narrative review included 59 relevant papers focusing on quality improvement and the sustainability of these improved quality results. By integrating, synthesising and resynthesizing concepts during thematic and content analysis, the narrative review evolved to an integrated, co-creation roadmap. The Flanders Quality Model (FlaQuM) is presented as a driver diagram that features six primary drivers for a sustainable quality policy: (1) Quality Design and Planning, (2) Quality Control, (3) Quality Improvement, (4) Quality Leadership, (5) Quality Culture and (6) Quality Context. Six primary drivers are described in 19 building blocks (secondary drivers) and 104 evidence-based action fields. Conclusions The framework suggests that a manageable number of drivers, building blocks and action fields may support the sustainable incorporation of quality into the daily workflow. Therefore, FlaQuM can serve as a useful roadmap for future sustainable quality policies in hospitals and for future empirical and theoretical work in sustainable quality management.
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Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- * E-mail:
| | - Deborah Seys
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
| | - Anneke Jans
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Flanders, Belgium
| | - Eva Marie Castro
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Flanders, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Flanders, Belgium
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O'Brien N, Durkin M, Lachman P. Lessons post-COVID from national and international approaches to safety and quality in healthcare. Future Healthc J 2021; 8:e602-e608. [PMID: 34888449 PMCID: PMC8651324 DOI: 10.7861/fhj.2021-0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic has been a challenge as well as an opportunity for healthcare. The pandemic has exposed the inherent weaknesses in health systems globally while, at the same time, revealing strengths on which post-pandemic health systems can be built. We propose lessons on improving quality and safety post-pandemic from a global perspective based on recent policy publications and our global experience. Nine possible lessons are discussed. These lessons can ensure that healthcare does not return to the old normal, but rather builds on what we have learnt as we deliver on the Sustainable Development Goals and universal health coverage. Quality and safety are an essential component of healthcare strategy. Post-pandemic systems require a transparent compassionate culture, with integration of care at its core. The workforce must be trained in the skills to improve care, and patient and healthcare worker protection (both physically and psychologically) needs to be a given. Any development of systems will best be co-produced with the people who receive and deliver care in an equal partnership. Finally, the new systems need to be conscious of emerging threats (such as the challenge of climate change), building sustainable health systems that also address the structural inequities that currently exist.
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Affiliation(s)
- Niki O'Brien
- Institute of Global Health Innovation, London, UK and Imperial College London, London, UK
| | - Mike Durkin
- and academic lead, Global Patient Safety Collaborative, London, UK
| | - Peter Lachman
- Royal College of Physicians of Ireland, Dublin, Ireland
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Vanhaecht K, De Ridder D, Seys D, Brouwers J, Claessens F, Van Wilder A, Panella M, Batalden P, Lachman P. The History of Quality: From an Eye for an Eye, Through Love, and Towards a Multidimensional Concept for Patients, Kin, and Professionals. Eur Urol Focus 2021; 7:937-939. [PMID: 34538749 DOI: 10.1016/j.euf.2021.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
In ancient civilizations, poor quality was dealt with according to the principle of "an eye for an eye." In the modern era we have learned from industry what quality really is. Quality includes standards, protocols, system thinking, and an understanding of variation to ensure good outcomes. In the post-COVID era, quality is not all about predefined specifications but rather about relationships and even love. Quality can now be defined as multidimensional, including person-centered care for patients, kin, and providers. Care should be safe, efficient, effective, timely, equitable, and eco-friendly. High quality is only possible if we include core values of dignity and respect, holistic care, partnership, and kindness with compassion in our daily practice for every stakeholder at every managerial and policy level. PATIENT SUMMARY: Quality of care is a multidimensional concept in which person-centered care is central. The care a patient receives should be safe, efficient, effective, timely, equitable, and eco-friendly. Attention should be given to dignity, respect, kindness, and compassion. There should be a holistic approach that includes partnership with all stakeholders. The only acceptable level of quality a professional should provide is the level they would accept if their loved one were to be the next patient.
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Affiliation(s)
- Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium; Department of Quality Improvement, University Hospitals Leuven, Leuven, Belgium.
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium; Department of Quality Improvement, University Hospitals Leuven, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | | | - Massimiliano Panella
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy
| | - Paul Batalden
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Peter Lachman
- Royal College of Physicians Ireland, Dublin, Ireland
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24
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A decade of commitment to hospital quality of care: overview of and perceptions on multicomponent quality improvement policies involving accreditation, public reporting, inspection and pay-for-performance. BMC Health Serv Res 2021; 21:990. [PMID: 34544408 PMCID: PMC8450175 DOI: 10.1186/s12913-021-07007-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/07/2021] [Indexed: 01/02/2023] Open
Abstract
Background Quality improvement (QI) initiatives such as accreditation, public reporting, inspection and pay-for-performance are increasingly being implemented globally. In Flanders, Belgium, a government policy for acute-care hospitals incorporates aforementioned initiatives. Currently, questions are raised on the sustainability of the present policy. Objective First, to summarise the various initiatives hospitals have adopted under government encouragement between 2008 and 2019. Second, to study the perspectives of healthcare stakeholders on current government policy. Methods In this multi-method study, we collected data on QI initiative implementation from governmental and institutional sources and through an online survey among hospital quality managers. We compiled an overview of QI initiative implementation for all Flemish acute-care hospitals between 2008 (n = 62) and 2019 (n = 53 after hospital mergers). Stakeholder perspectives were assessed via a second survey available to all healthcare employees and a focus group with healthcare policy experts was consulted. Variation between professions was assessed. Results QI initiatives have been increasingly implemented, especially from 2016 onwards, with the majority (87%) of hospitals having obtained a first accreditation label and all hospitals publicly reporting performance indicators, receiving regular inspections and having entered the pay-for-performance initiative. On the topic of external international accreditation, overall attitudes within the survey were predominantly neutral (36.2%), while 34.5% expressed positive and 29.3% negative views towards accreditation. In examining specific professional groups in-depth, we learned 58% of doctors regarded accreditation negatively, while doctors were judged to be the largest contributors to quality according to the majority of respondents. Conclusions Hospitals have demonstrated increased efforts into QI, especially since 2016, while perceptions on currently implemented QI initiatives among healthcare stakeholders are heterogeneous. To assure quality of care remains a top-priority for acute-care hospitals, we recommend a revision of the current multicomponent quality policy where the adoption of all initiatives is streamlined and co-created bottom-up. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07007-w.
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McCarthy SE, Jabakhanji SB, Martin J, Flynn MA, Sørensen J. Reporting standards, outcomes and costs of quality improvement studies in Ireland: a scoping review. BMJ Open Qual 2021; 10:bmjoq-2020-001319. [PMID: 34341016 PMCID: PMC8330587 DOI: 10.1136/bmjoq-2020-001319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/08/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To profile the aims and characteristics of quality improvement (QI) initiatives conducted in Ireland, to review the quality of their reporting and to assess outcomes and costs. DESIGN Scoping review. DATA SOURCES Systematic searches were conducted in PubMed, Web of Science, Embase, Google Scholar, Lenus and rian.ie. Two researchers independently screened abstracts (n=379) and separately reviewed 43 studies identified for inclusion using a 70-item critique tool. The tool was based on the Quality Improvement Minimum Quality Criteria Set (QI-MQCS), an appraisal instrument for QI intervention publications, and health economics reporting criteria. After reaching consensus, the final dataset was analysed using descriptive statistics. To support interpretations, findings were presented at a national stakeholder workshop. ELIGIBILITY CRITERIA QI studies implemented and evaluated in Ireland and published between January 2015 and April 2020. RESULTS The 43 studies represented various QI interventions. Most studies were peer-reviewed publications (n=37), conducted in hospitals (n=38). Studies mainly aimed to improve the 'effectiveness' (65%), 'efficiency' (53%), 'timeliness' (47%) and 'safety' (44%) of care. Fewer aimed to improve 'patient-centredness' (30%), 'value for money' (23%) or 'staff well-being' (9%). No study aimed to increase 'equity'. Seventy per cent of studies described 14 of 16 QI-MQCS dimensions. Least often studies reported the 'penetration/reach' of an initiative and only 35% reported health outcomes. While 53% of studies expressed awareness of costs, only eight provided at least one quantifiable figure for costs or savings. No studies assessed the cost-effectiveness of the QI. CONCLUSION Irish QI studies included in our review demonstrate varied aims and high reporting standards. Strategies are needed to support greater stimulation and dissemination of QI beyond the hospital sector and awareness of equity issues as QI work. Systematic measurement and reporting of costs and outcomes can be facilitated by integrating principles of health economics in QI education and guidelines.
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Affiliation(s)
- Siobhán Eithne McCarthy
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Samira Barbara Jabakhanji
- Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer Martin
- National Quality Improvement Team, Health Service Executive, Dublin, Ireland
| | - Maureen Alice Flynn
- National Quality Improvement Team, Health Service Executive, Dublin, Ireland
| | - Jan Sørensen
- Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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26
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Lachman P, Nelson EC. Policy, accreditation and leadership: Creating the conditions for effective coproduction of health, healthcare and science. Int J Qual Health Care 2021; 33:ii1-ii3. [PMID: 33822945 DOI: 10.1093/intqhc/mzab065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth; The Health Assessment Lab/Medical Outcomes Trust
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