Editorial

Keith Hurst (Independent Research and Analysis)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 8 February 2016

310

Citation

Hurst, K. (2016), "Editorial", International Journal of Health Care Quality Assurance, Vol. 29 No. 1. https://doi.org/10.1108/IJHCQA-09-2015-0112

Publisher

:

Emerald Group Publishing Limited


Editorial

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 29, Issue 1.

Using QA methods to eliminate waste in healthcare services

Efficiency (doing things right) and effectiveness (doing the right things) are less commonly used but equally meaningful quality assurance definitions. If submissions to IJHCQA are a proxy measure then the efficiency-effectiveness definition deserves more limelight because service waste and lower quality are strongly tethered and evidence about their importance is growing. However, despite compelling evidence, expecting staff to comply; i.e., leading a horse to water and making it drink could be a book title about implementing evidence-based practice (EBP), which we can see from Praveen Rajasekhar et al.’s paper, poses several challenges for managers and practitioners. The authors use qualitative approaches to explore the reasons why practitioners did/did not implement one particular EBP. Knowing the reasons for successful implementation (e.g. using prominent posters that explain new policy and practice) and failure; i.e., staff not complying with the new practice (i.e. sceptical practitioners) helped the Quality Improvement in colonoscopy project managers to improve compliance, which also could be useful for related studies elsewhere.

The time, money and effort that Preethy Nayar and colleagues placed into evaluating and improving medications management in one Veteran Health Administration’s pharmacy service is justified. Their Lean Six Sigma project mapped several inefficiencies that significantly affected clinic staff and patients. In the project’s unique context (veterans using two or more service providers), the care team did well to reduce pharmacy service bottle necks and errors caused by, for example, having to check that prescribed medicines had not been changed by other providers. The research team’s findings and recommendations should go some way to removing waste in an important service for deserving clientele (i.e. ex-soldiers). There are tips and lessons in this paper for managers faced with similar problems in other healthcare services.

Staff must get frustrated and families disillusioned and concerned when patients leave hospital against medical advice (DAMA). Money is wasted in the hospital the patient leaves and unnecessary costs incurred in another hospital where the patient seeks attention because diagnostic tests may be repeated. Surprisingly, Azar Hadadi and colleagues found DAMA poorly investigated, especially in emergency departments where DAMA led to significant waste. Consequently, their study and findings add valuable methodological and practical insights into the topic. The authors’ findings will surprise readers; notably the reasons why patients leave with completing their treatment and care. Nevertheless, ED managers were able to use the study’s outcomes to improve services and boost patient satisfaction. Clearly, the next step is an economics analysis to see what financial savings can be made by preventing DAMA.

You would forgive patients who stop consulting practitioners that they do not trust; i.e., we would expect patients to vote with their feet (indeed one reason given in Khashayar and colleagues’ DAMA study). However, trust in physicians, as Arttu Olavi Saarinen and colleagues explain in this issue, is a complex behaviour and difficult to unravel, but an important behaviour to unravel because treatment compliance has significant effects on healthcare outcomes and costs. Their comprehensive 22 OECD country study, focusing on two main issues – particularised and generalised trust, attempts to systematically explore the effect that personal and socio-economic characteristics have on patient trust. Although the authors’ robust statistical analysis (which can be adopted by researchers working in similar fields) produces useful and important insights; they have only scraped the surface. At a minimum, the authors spotlight an important research topic worthy of deeper and wider exploration.

Despite their ubiquity, there are services and domains where patient satisfaction studies have not been attempted or do not encroach that often, especially when family members are asked to contribute their perceptions. Elisabetta Angelino and colleagues in this issue develop and test a family and patient-oriented satisfaction questionnaire to improve inpatient rehabilitation services. After thorough testing and refinement, the authors were satisfied that service managers now have another useful patient satisfaction questionnaire in their armoury. The authors’ robust psychometric testing approach could be adopted by researchers working in other disciplines.

There have been alarming reports recently that some patients leave hospital malnourished. These reports are incongruous because service users usually give positive reviews about hospital food quality and quantity when surveyed; i.e., in one recent service quality study, 89 per cent (SD=0.06 per cent) said hospital food was good. So what is going wrong among patients leaving hospital poorly nourished? Ensuring patients eat and drink appropriately, you would have thought, is straightforward basic care, but patient nutrition is a growing issue and submissions to IJHQA are gaining momentum, which can only shed more light on hospital catering and patient meals. In this issue, for example, Ella Ottrey and Judi Porter summarise a systematic literature review that focused on hospital menus. Readers unused to hospital catering will be surprised at the menu options available to patients. However, the authors were disappointed about evidence quantity and quality. Owing to the time, effort and money hospital staff inject into patient food and drink, patient nutrition research is a deserving topic especially when the effect that malnourished patients can have on community care and readmission rates is considered.

What effect does consumerism have on service efficiency and effectiveness? Do service users spot but keep mum about the inefficiencies they observe? Can they help managers and practitioners reduce service waste. James Demetri Sideras explores trans-disciplinary groups in mental health and learning disability services, a relatively inexpensive quality improvement technique in which patients take the lead. Although the initiative clearly benefitted service quality, the author unearthed some surprising, negative findings after studying trans-disciplinary group structures, processes and outcomes; notably how professionals undermine consumer-oriented quality initiatives, but the author is satisfied that the initiative’s benefits outweigh downsides.

A significant waste issue not often considered in the literature is caused by researchers exploring their topic using ill-prepared data collection instruments. If a job is worth doing then it is worth doing well. This maxim is especially true in patient satisfaction studies in which researchers spend significant tax payers’ money carefully reviewing the literature, developing and testing data collection instruments, surveying respondents, analysing and presenting their findings. High-quality patient satisfaction research instruments are an imperative R&D component because patients contribute significant time and thought when completing questionnaires. It’s unlikely that readers will find a finer psychometric testing example than Shelley Beatty et al.’s maternity satisfaction study, which is reported in this issue. Readers will be right to think that quality assurance journal editor’s job exposes him/her to consumer oriented research from every conceivable angle. However, processing this paper led me to learn new and valuable psychometric knowledge and skills, which are transferrable to all patient satisfaction studies.

Keith Hurst

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