International Journal of Health Care Quality Assurance

The design and implementation of an audit study of intensive care data in Australia and New Zealand: a pilot study : Table of Contents

Sun Jul 05 14:15:04 BST 2009

Abstract:
Purpose - A pilot study was designed to trial an audit process to investigate and describe the completeness and reliability of the data collected in the ANZICS Adult Patient Database (APD).Design/methodology/approach - A database was created to audit 50 records per site to determine the degree of correctness. The audited records were randomly selected from the calendar year 2004 and 4 sites participated in the pilot audit study. Forty one data elements were assessed for data quality, being those elements required for APACHE II scoring system.Findings - The results showed that the audit was feasible; missing audit data was an unplanned problem; the analysis was complicated due to the way the APACHE calculations are performed and that 50 records per site was too time-consuming. Initial results suggest particular fields were shown to be more prone to error and this will be further examined in the full audit study. From this pilot study, the audit database has been modified to ensure streamlined capture of data and comparison reports between the original and audited data.Research limitations/implications - Practical implications - The audit study is feasible to conduct throughout Australia and New Zealand; however, the number of records audited per site will be reduced to 25 for logistic reasons.Originality/value - This is the first audit study of intensive care data within the ANZICS APD and demonstrates how to determine the data quality in a large database containing individual patient records. This is an important process as the data held within the APD is used for quality assurance and outcome measurement in intensive care.

Does daily nurses’ staffing matches ward workload variability? three hospitals experience : Table of Contents

Dr. Uri Gabbay, Mr. Michael Bukchin — Sun Jul 05 14:15:04 BST 2009

Abstract:
Purpose - Nurses’ shortage and healthcare resource burden enforcing appropriate manpower utilization. The paper aims on a methodology and ongoing monitoring to evaluate whether daily nursing staffing meets ward workload needs in a given resources.Design/methodology/approach - We evaluated workload, nurse attendance and daily nurse’s workload capacity in 3 hospitals underwent efficiency intervention. We used statistic process control (SPC) methodology to evaluate intra ward nurse’s workload capacity day to day variations. SPC is a statistical based method for process monitoring that used charts with predefined target measure and control limits. Standardization was performed to enable inter ward analysis by converting ward specific crude measures to ward specific relative measures by dividing observed/expected (which is the monthly based daily average). We defined two charts; acceptable and tolerable daily nurse’s workload intensity (control limits of 90-110% and 80-120% respectively). Appropriate staffing indicators were defined by exceeding predefined rates of days within acceptable and tolerable limits (50% and 80% respectively). Findings - 42% of the overall days comply within acceptable control limits and 71% within tolerable control limits. Appropriate staffing indicators met only by 33% of wards regarding acceptable nurse’s workload intensity and only by 45% regarding tolerable respectively. Research limitations/implications - Our work did not differ nursing type as it utilized crude nurse attendance and it did not take into account patient severity as it utilize crude patient occupancy. Our methodology using double SPC charts and staffing appropriateness indicators definitions may be debated. Practical implications - The rates of wards that met appropriate staffing indicators prove our methodology feasibility. The higher rates of wards that not met appropriate staffing indicators prove the importance and the need for process evaluations and monitoring. The methods we presented for monitoring daily staffing appropriateness are simple to implement either for intra ward day to day variation by using nurse’s workload capacity SPC charts, and for inter ward evaluation using standardized measure of nurse’s workload intensity. The real challenge will be in developing planning systems and implementing correction interventions such as dynamic and flexible daily staffing that will face difficulties and barriers.Originality/value - This paper fulfils the need for manpower utilization evaluation. We presented a simple methodology utilizing available data for daily staffing appropriateness evaluation which is easy to implement and operate. The methodology of SPC enable intra ward evaluation, while the standardization by converting crude into relative measures enables inter ward analysis. The definitions of appropriateness staffing indicators enable performance evaluation. Our study is original in utilizing SPC develop simple standardization method and applying simple statistical tools. Our methodology is not limited to utilized crude measures as we had presented but rather may utilize weighted workload measures such as nursing acuity or weighted nurses’ type.

What do websites tell us about Quality management in Belgian Hospitals? : Table of Contents

Dr. Gauthier R Desuter, Mrs. Valerie Dujeu, Mr. hugues michel — Sun Jul 05 14:15:04 BST 2009

Abstract:
Purpose - Purpose – Following the launching of the "Patient Quality and Safety Contract" by the Belgian Federal Authorities, authors placed Belgian hospital websites under scrutiny. This study is aimed to assess the presence of some sort of quality management strategy within Belgian Acute Care Hospital digital external communications. Design/methodology/approach - Method - Digital communications were assessed thanks to a pre-established grid focusing on direct quality improvement testimonies, like the presence of a quality manager, a quality committee, a specific strategy, etc.Findings - Findings - Authors come up with two hypotheses to explain the poor results: (i) structured quality improvement exists in organizations but senior managers don’t feel the need to transparently communicate the subject; and (ii) quality improvement does not exist in a sufficiently structured way to allow open communication.Practical implications - Originality/value - Value - Underlines the urgent need for Belgian healthcare executives to be aware of structured quality management strategy’s importance and be eager to openly communicate the strategy.

Relationship between Stress and Performance in a Japanese Nursing Organization : Table of Contents

Mr. Hiromasa Ida — Sun Jul 05 14:15:04 BST 2009

Abstract:
Purpose - The article aims to describe the relationship between job stress factor, coping ability and performance among Japanese nurses.Design/methodology/approach - Health risk and organization environment as job stress factors, Sense of Coherence as stress coping ability and medical risk indicator and sick absence days as performance, were used to investigate the relationship between stress and performance. Length of professional experience was included in the investigation.Findings - The present study suggests a possibility that enriching nurses?f professional experiences contributes to reducing medical risk. There is also a possibility that raising Sense of Coherence and improving organization environment contribute to reducing sickness absence.Research limitations/implications - A cross-sectional study of nurses in a single institution was used. In order to generalize the study?fs results, it will be necessary to conduct multi-institutional longitudinal studies.Originality/value - The present study shows key factors affecting medical risk and sickness absence that lead to a reduction in nursing performance.

ASIAN INDIAN PHYSICIAN’S EXPERIENCE WITH MANAGED CARE ORGANIZATIONS : Table of Contents

Dr. Ranjita Misra, Dr. Arvind Modawal, Dr. Bhagaban Panigrahy — Sun Jul 05 14:15:04 BST 2009

Abstract:
Purpose - To determine ethnic Asian-Indian physician experience of managed care organizations (MCO) and their satisfaction with medical practice in the United States by age, gender, region of practice in the US.Design/methodology/approach - A random (nationwide) mail survey of 254 physicians who are members of American Association of Physicians of Indian Origin (AAPI), during the period 1998 to 2000. The information on MCO was categorized into physician satisfaction; rating of plan for quality of care; limitations in delivery of care to the enrollees; difficulties, if any, in acquisition and maintenance of managed care contracts; and financial impact. Findings - Physicians in solo and group practice relied heavily on patients enrolled in MCO. Physicians in solo, and group-based practices reported acquisition and termination of contracts, and limitations on providing care to patients was more serious problem than did physicians in staff-model HMO and hospital /clinic based practices. Physician satisfaction was not significantly related to board certification, type of practice, region of practice, and participation in MCO. However, practices participating in MCO had the highest number of board certificated physicians. Research limitations/implications - Low response rate (37%); data collected through survey questionnaire.Practical implications - This paper has implications for ethnic minority physician’s capability to get managed care contracts. Originality/value - This is the first national study of Asian Indian physicians and their experience with managed care organization. Asian-Indian physicians are over-represented in the medical profession and hence this paper will be of special interest to those working and dealing with managed care organization/patients.

Patients’ views on quality of care and attitudes towards visiting the same provider again : Table of Contents

Prof. Bodil Wilde-Larsson, Prof. Gerry Larsson — Sun Jul 05 14:15:04 BST 2009

Abstract:
Purpose - To explore the relationship between patients’ quality of care experiences and their attitudes towards visiting the same health care provider again. Design/methodology/approach - All patients who visited one of the 121 primary health care centres (public health care) in a Swedish region between January and March 2005, who were 16 years or older and capable of communicating, were invited to participate. Responses were obtained from 22,170 patients (75% response rate). Patients evaluated care quality using the "Quality from the Patient’s Perspective" (QPP; modified short version) questionnaire. Potentially confounding variables such as age, sex, educational level and self-reported health condition were also assessed. Data were analysed through logistic regression analysis using both individual- and organisational- level (primary health care centres’) data. Findings - Approximately ten per cent reported various degrees of hesitation about continuing to visit the same care provider. Favourable quality of care evaluations made a statistically significant contribution to the odds of reporting no hesitation about visiting the same primary health care centre again. Organisational-level data were less clear. Research limitations/implications - No data are available on actual hesitation and avoidance later in time when a new need for care arises. Similarly, there were no data on the availability of alternative care providers, which, particularly in rural areas, may be limited or non-existent. Practical implications - The main theoretical conclusion is that patients’ quality of care experiences appear to have an effect on outcome variables like hesitation about continuing to visit the same care provider. This kind of care-proximal aspect may serve as a link to more distal outcomes such as general health status and deserve further research attention. A practical recommendation is the use theory-based instruments when monitoring patients’ opinions on care and follow-up of the results on later visits.Originality/value - Patients’ care experiences appear to have an effect on post-care-episode attitudes (and possibly behaviours). It is suggested that effects on care-proximal aspects, such as hesitation about visiting the same provider again, could be an important link to more distal phenomena such as general health status.