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Preview: International Journal for Quality in Health Care - current issue

International Journal for Quality in Health Care Current Issue





Published: Tue, 19 Dec 2017 00:00:00 GMT

Last Build Date: Wed, 20 Dec 2017 07:50:32 GMT

 






Examining influences on speaking up among critical care healthcare providers in the United Arab Emirates

Thu, 23 Nov 2017 00:00:00 GMT

Abstract
Objective
Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses.
Design, setting, participants, intervention
A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort.
Main outcome measures
Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority. Qualitative thematic analyses were conducted for open-ended questions.
Results
A total of 1171 participants were invited to complete the survey and 639 responded (response rate = 54.6%). Compared to other stakeholders (e.g. the media, public), a larger proportion of respondents ‘agreed/strongly agreed’ that corporate health system leadership and the health regulatory authority encouraged and supported error reporting (83%; 75%), and had the most influence on their decisions to report (81%; 74%). 29.5% of respondents cited fear of repercussion as a barrier, and 21.3% of respondents indicated no barriers to reporting. Barriers included perceptions of a culture of blame and issues with reporting procedures. Recommendations to establish patient safety as an organizational priority included creating supportive environments to discuss errors, hiring staff to advocate for patient safety, and implementing policies to standardize clinical practices and streamline reporting procedures.
Conclusions
Influences on reporting perceived by providers in the UAE were similar to those in the US and other countries. These findings highlight the roles of corporate leadership and regulators in developing non-punitive environments where reporting is a valuable and safe activity.



Organizing and implementing a multidisciplinary fast track oncology clinic

Tue, 21 Nov 2017 00:00:00 GMT

Abstract
Quality problem
Patients with gastrointestinal malignancies often need multiple appointments with different medical specialists, causing waiting times to accrue.
Initial assessment
In our hospital, care is organized in a sequential manner, causing long waiting times. To reduce this, a fast track outpatient clinic (FTC) was implemented.
Choice of solution
The FTC was organized within the hospital’s existing structure. Patient centered care was achieved by ensuring that the medical specialists visit the patient, implementing nurse coordinators and considering patient wishes and co-morbidities when formulating a treatment plan.
Implementation
A mandate from the board (Top-down), ensured cooperation between different medical departments and a change in resource allocation (i.e. medical staff); a horizontal clinic across a vertical departmental structure. Brainstorm sessions between the departments led by two physicians who were going to work at the FTC (Bottom-up), assured a swift implementation of the FTC.
Evaluation
Since implementation in 2009, patient influx has tripled. Waiting time for an appointment and start of treatment was reduced from 2–4 weeks to 6 working days and from 12–14 weeks to 17 working days, respectively. This was achieved by re-allocating recourses, but without increasing existing resources.
Lessons learned
The combination of a top-down and bottom-up strategy ensured participation from all involved departments, a strong foundation and a shared vision on patient centered care. The FTC facilitates sharing information between different medical specialists through both proximity and a shared electronic patient record. The implementation of the FTC comprises a change in organization, but not a change in structure.



Using Value Stream Mapping to improve quality of care in low-resource facility settings

Thu, 09 Nov 2017 00:00:00 GMT

Abstract
Quality problem or issue
Jacaranda Health (JH) is a Kenya-based organization that attempts to provide affordable, high-quality maternal and newborn healthcare through a chain of private health facilities in Nairobi.
Initial assessment
JH needed to adopted quality improvement as an organization-wide strategy to optimize effectiveness and efficiency.
Choice of solution
Value Stream Mapping, a Lean Management tool, was used to engage staff in prioritizing opportunities to improve clinical outcomes and patient-centered quality of care.
Implementation
Implementation was accomplished through a five-step process: (i) leadership engagement and commitment; (ii) staff training; (iii) team formation; (iv) process walkthrough; and (v) construction and validation.
Evaluation
The Value Stream Map allowed the organization to come together and develop an end-to-end view of the process of care at JH and to select improvement opportunities for the entire system.
Lessons learned
The Value Stream Map is a simple visual tool that allows organizations to engage staff at all levels to gain commitment around quality improvement efforts.



Barriers to effective, safe communication and workflow between nurses and non-consultant hospital doctors during out-of-hours

Thu, 26 Oct 2017 00:00:00 GMT

Abstract
Objective
This study aimed to evaluate the nature and type of communication and workflow arrangements between nurses and doctors out-of-hours (OOH). Effective communication and workflow arrangements between nurses and doctors are essential to minimize risk in hospital settings, particularly in the out-of-hour’s period. Timely patient flow is a priority for all healthcare organizations and the quality of communication and workflow arrangements influences patient safety.
Design
Qualitative descriptive design and data collection methods included focus groups and individual interviews
Setting
A 500 bed tertiary referral acute hospital in Ireland.
Participants
Junior and senior Non-Consultant Hospital Doctors, staff nurses and nurse managers.
Results
Both nurses and doctors acknowledged the importance of good interdisciplinary communication and collaborative working, in sustaining effective workflow and enabling a supportive working environment and patient safety. Indeed, issues of safety and missed care OOH were found to be primarily due to difficulties of communication and workflow. Medical workflow OOH is often dependent on cues and communication to/from nursing. However, communication systems and, in particular the bleep system, considered central to the process of communication between doctors and nurses OOH, can contribute to workflow challenges and increased staff stress. It was reported as commonplace for routine work, that should be completed during normal hours, to fall into OOH when resources were most limited, further compounding risk to patient safety.
Conclusion
Enhancement of communication strategies between nurses and doctors has the potential to remove barriers to effective decision-making and patient flow.



Patient–clinician relationship seems to affect adherence to analgesic use in cancer patients: a cross sectional study in a Taiwanese population

Thu, 26 Oct 2017 00:00:00 GMT

Abstract
Objectives
Patient satisfaction can provide a measure of service quality and serve as a predictor of health-related behaviors. Little is known about how patients’ satisfaction with clinician–patient interactions affects their adherence to taking analgesics. The purposes of this study were to (1) investigate the predictors of patients’ satisfaction with clinicians, and (2) examine whether patients’ satisfaction with their clinicians can improve adherence to analgesic use.
Design
A cross-sectional and descriptive design was used.
Setting
Outpatient oncology clinic at a medical center in Taiwan.
Participants
A convenience sample (N = 309) was recruited.
Main outcome measures
The Medical Interview Satisfaction Scale 21 – Chinese Version, Short Version of the Barriers Questionnaire – Taiwan Form, Taiwanese version of the Morisky Medication Adherence Measure, and Interpersonal Physician Trust Scale – Chinese version, and Brief Pain Inventory Chinese Version.
Results
Variables that could significantly predict patients’ satisfaction were patient age and trust in clinicians, which together accounted for 33% of the total variance. Patients’ satisfaction with their clinicians significantly predicted patients’ adherence to medication use (OR = 3.10, P < 0.05). There was an interactive effect (OR = 0.12, P < 0.05) between patients’ satisfaction and barriers to analgesic use. Correlation coefficients between barriers to analgesic use and patients’ adherence are −0.52 (P < 0.001) and −0.13 (P = 0.20) in the higher satisfaction and lower satisfaction patients, respectively.
Conclusions
Patients’ satisfaction with their clinicians can have a positive effect on changing analgesics adherence behaviors when patients hold incorrect beliefs about analgesics. Patients’ satisfaction has an important role in enhancement of analgesics adherence behaviors.



Enhancing patients’ autonomy by involving them in research ethics committees

Wed, 25 Oct 2017 00:00:00 GMT

Abstract
Objective
Although clinical trial participants are the most affected by research ethics committee’s decisions, they are not formally represented on Swiss committees. We aimed to find out what patients think about the idea of being members of such committees.
Design
Latent thematic analysis was used to analyse the interviews.
Setting
Patients were recruited in a Swiss university hospital.
Participants
The study involved 26 patients suffering from diabetes or gout.
Interventions
We conducted semi-structured interviews.
Main Outcome Measures
We explored what patients think of being established members of research ethics committees.
Results
We identified three different attitudes among our participants regarding participation in research ethics committees: (i) positive attitude regarding the idea of being members of such committees, (ii) ambivalent attitude and (iii) negative attitude. Patients belonging to the first group (i) often mentioned that they wanted their health condition to be more visible. Patients from the second group (ii) mentioned positive as well as negative aspects. Patients from the third group (iii) said that patients in general did not have enough background knowledge to be able to gain an overview of a whole clinical trial.
Conclusions
Our study adds important knowledge about the idea of patients becoming research ethics committee members by exploring their perceptions of being members. Stable patients tended to be interested in the idea of participation and some specific recommendations could be derived (patients could have an advisory instead of a decision-making role on committees). However, further studies with more patients and further quantitative research are needed.



Are data from national quality registries used in quality improvement at Swedish hospital clinics?

Wed, 25 Oct 2017 00:00:00 GMT

Abstract
Objective
To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden.
Design
Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level).
Setting and Participants
Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR).
Main Outcome Measure(s)
Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation.
Results
Riksstroke data were reported as most extensively used at individual and unit levels (x̅ 17.97 of 24 and x̅ 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs (x̅ 19.86 for Riksstroke and x̅ 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks (x̅ 12.90 and x̅ 13.28 of 20) while the least developed registry, the NLCR, had lower estimates (x̅ 10.32). In Riksstroke, the managers requested registry data more often (x̅ 15.17 of 20).
Conclusions
While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry’s level of development and factors important for routinization of innovations such as NQRs needs investigation.



Seen through the patients’ eyes: Safety of chronic illness care

Wed, 25 Oct 2017 00:00:00 GMT

Abstract
Objective
Due to the increasing burden of chronic diseases, a considerable part of care delivery will continue to shift from secondary to primary care, and home care settings. Despite the growing importance of primary care, concerns about the safety of patients in hospitals have thus far driven most research in the field. Therefore, the present study sought to explore patients’ perceptions and experiences of the safety of primary chronic care.
Design
An observational, cross-sectional study design was applied.
Participants
Participants were recruited from the Flemish Patients’ Platform, an independent organization that defends patients’ rights and strives for more care quality.
Main Outcome Measure(s)
An online questionnaire was designed to assess: socio-demographic characteristics, medical consumption and patients’ perspectives of the quality and safety of chronic care.
Results
Respondents (n = 339) had positive perceptions of the safety of primary chronic care as they indicated to receive safe care at home (68.1%), receive enough care support at home (70.8%) and experience good communication between their healthcare professionals (51.6%). Almost one quarter of respondents experienced an incident, mainly related to self-reported fall incidents (50.4%), wrong diagnoses or treatments (37.8%) and adverse drug events (11.8%). Also, more than half of respondents who experienced an incident (64.9%) indicated that poor communication between their healthcare professionals was the main cause.
Conclusions
Information on patients’ experiences is critical to identify patient safety incidents and to ultimately reduce patient harm. More research is needed to fully understand patient safety in primary chronic care to further improve patient safety.



Factors associated with malnutrition among children <5 years old in Burkina Faso: evidence from the Demographic and Health Surveys IV 2010

Tue, 17 Oct 2017 00:00:00 GMT

Abstract
Objective
To assess the factors associated with malnutrition among children <5 years in Burkina Faso.
Design
This study was based on secondary analysis of cross-sectional population-based data from Burkina-Faso Demographic Health Surveys 2010.
Setting
This study was carried out in Burkina Faso, West Africa.
Participants
The participants were 6337 children <5 years and their mothers.
Main outcome measures
Demographic characteristics, child nutrition and health status, and maternal and household information were collected. Survey-specific SAS procedures for weighting, clustering and stratification in the survey design were used. The distribution of different nutritional status, such as underweight, stunting and wasting and the effects of risk factors on malnutrition was analyzed.
Results
Out of 6337 children <5 years, 51.0% of children were male and 57.8% of children had an average size at birth. There were 15.6, 21.5 and 10.6% of children who recently suffered from diarrhea, fever and acute respiratory infection, respectively. Child sex, age, size at birth, child morbidity, mother's education and body mass index and household wealth index were significantly associated with undernutrition among children <5 years in Burkina Faso.
Conclusions
In addition to the improvement of household wealth index, more health and nutritional education for mothers should be implemented by the government to improve health and nutritional status of children <5 years in Burkina Faso.



A quality improvement project to reduce hypothermia in preterm infants on admission to the neonatal intensive care unit

Tue, 17 Oct 2017 00:00:00 GMT

Abstract
Objective
To study effectiveness of quality improvement interventions in reducing hypothermia in preterm infants on admission to neonatal intensive care unit.
Design
Quality improvement methodologies including multidisciplinary planning and implementation of evidence-based interventions. Data during and post-implementation were collected.
Setting and participants
In total, 84 preterm infants with birth weights ≤ 1500 g delivered during implementation period (October 2008–April 2009) were compared with 168 historical controls and 947 infants in the subsequent 4 years.
Intervention(s)
In addition to routine interventions, delivery room temperatures were increased, and use of full-body polyethylene wraps and woollen caps were implemented during initial stabilization. Education and training were provided to reinforce the new interventions.
Main Outcome Measure(s)
Primary outcome was incidence of hypothermia and mean admission temperature. Secondary outcomes were rates of intraventricular haemorrhage and mortality.
Results
Incidence of admission hypothermia decreased from 79.4 to 40.5% (P < 0.001), constituting a 49% improvement (OR = 0.177, 95% CI: 0.099–0.316). Mean admission temperature increased from 35.8 ± 0.8°C to 36.5 ± 0.7°C (P < 0.001). Hyperthermia incidence was higher at 6% compared to baseline of 1.3% (P = 0.049). The incidence of admission hypothermia remained stable at 47.4% in the 4 years post-implementation. Rates of intraventricular haemorrhage and mortality remained unchanged. Small for gestation, low 5-min Apgar score and singleton delivery were factors found to be associated with admission hypothermia.
Conclusion
The implementation of evidence-based best practices resulted in significant reduction in admission hypothermia in preterm infants, which persisted for 4 years post-implementation. The practices have since become standard of care in our institution.



Understanding the impact of accreditation on quality in healthcare: A grounded theory approach

Tue, 17 Oct 2017 00:00:00 GMT

Abstract
Objective
To explore how organizations respond to and interact with the accreditation process and the actual and potential mechanisms through which accreditation may influence quality.
Design
Qualitative grounded theory study.
Setting
Organizations who had participated in Accreditation Canada’s Qmentum program during January 2014–June 2016.
Participants
Individuals who had coordinated the accreditation process or were involved in managing or promoting quality.
Results
The accreditation process is largely viewed as a quality assurance process, which often feeds in to quality improvement activities if the feedback aligns with organizational priorities. Three key stages are required for accreditation to impact quality: coherence, organizational buy-in and organizational action. These stages map to constructs outlined in Normalization Process Theory. Coherence is established when an organization and its staff perceive that accreditation aligns with the organization’s beliefs, context and model of service delivery. Organizational buy-in is established when there is both a conceptual champion and an operational champion, and is influenced by both internal and external contextual factors. Quality improvement action occurs when organizations take purposeful action in response to observations, feedback or self-reflection resulting from the accreditation process.
Conclusions
The accreditation process has the potential to influence quality through a series of three mechanisms: coherence, organizational buy-in and collective quality improvement action. Internal and external contextual factors, including individual characteristics, influence an organization’s experience of accreditation.



Lean Management to support Choosing Wisely in healthcare: the first evidence from a systematic literature review

Tue, 17 Oct 2017 00:00:00 GMT

Abstract
Purpose
Choosing Wisely (CW) is an emergent approach to identify and reduce unnecessary care, such as tests and treatments that do not add value for patients and may even cause harm. The purpose of this paper is to investigate whether and how Lean Healthcare Management (LHM) can support CW objectives, focusing on customer needs and on waste elimination.
Data sources
A systematic literature review has been performed in Scopus, PubMed and Web of Science.
Study selection
Peer reviewed articles published in English language have been selected. Papers were considered if they regarded LHM and its possible support for achieving CW objectives.Data extraction. The links between the LHM purposes of adoption and the pursued CW objectives were investigated. Moreover, LHM tools, practices and interventions to support CW were grasped.
Results of data synthesis
Sixteen articles were included in the analysis. Links between the identified LHM purposes of adoption and CW objectives were discovered: through process understanding, optimization, evaluation and control, LHM contributes to the reduction of overuses in healthcare, but also to the delivery of a more effective and evidence-based care (EBC). Moreover, it provides an objective approach useful for choosing the most cost-effective solution among different alternatives.
Conclusions
Results highlight how LHM, and with which tools and practices, can be adopted to enhance the healthcare appropriateness pursued by CW, paving the way for interesting future research about this emerging topic.