International Journal of Health Care Quality Assurance

Certifying a university ENT clinic using the ISO 9001:2000 International Standard : Table of Contents

Mon Feb 22 02:05:17 GMT 2010

Abstract:
Purpose - Against the setting of statutory duties in various countries to introduce a quality management system, the increased importance of this subject leads to numerous activities in various public health system institutions. Following the International Standardization Organization (ISO 9001:2000) prerequisites, University of Frankfurt ENT clinic staff introduced a quality management system. Design/methodology/approach - Design, planning and implementing the quality management system is described. Under the supervision of an executive quality management board, clinic quality goals were defined. Thereafter, several quality management teams performed an actual state analysis as well as developing and realizing improvement proposals. Finally a quality management manual containing binding standards and working instructions concerning all aspects of patient care, research and teaching was written.Findings - Successful certification of this system by a neutral body ascertains that the quality management system conforms to current national and international standards while restructuring and reform improved procedural efficiency. Originality/value - Implementing the quality management system requires considerable effort but patients as well as staff profited considerably from the innovation. On the whole, the positive impact on structure and work flow in a specialist clinic predominates. Therefore, implementing a quality management system in all the clinic’s wards and departments is recommended.

Medication error prevalence : Table of Contents

Mon Feb 22 02:05:17 GMT 2010

Abstract:
Purpose - Healthcare risk epidemiology identifies medication error as the commonest cause of adverse effects on patients. Medication error (MEs) can occur at any phase of the complex medication process so prevalence rates need to be estimated at each drug treatment phase: prescription, transcription and administration along with their clinical repercussions.Design/methodology/approach - Medication errors were recorded on an ad hoc sheet and staff were observed. Recorded errors were later classified and their clinical repercussions determined by experts.Findings - 757 inpatients 5,466 drug prescriptions were studied. The prescription error rate was 4.79% (95% CI 4.21-5.36). The most frequent error in this phase was failing to observe international prescribing standards. The highest error rate was found in transcription (14.61% 95% CI, 13.67-15.54). Almost 1900 dose administrations were observed. There was a 9.32% error rate (95% CI 7.98-10.67). The commonest error in this phase was omission. Most errors were in transcription, which were detected before harm was doneResearch limitations/implications - The dispensation phase is absent. Practical implications - Errors can be reduced if they are understood.Originality/value - Education and training based on the study’s findings can reduce MEs.

Developing Severity Adjusted Quality Measures for Intensive Care Units : Table of Contents

Mon Feb 22 02:05:17 GMT 2010

Abstract:
Purpose - Intensive care unit performance evaluation is usually affected by variations in the severity of inpatients’ health status. The authors aim, therefore, to standardize two performance measures: intensive care unit survival and length of stay using the Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of illness score. Design/methodology/approach - A records study in three Ain Shams University hospital intensive care units, from January 1st to December 31st 2003, was carried out to examine illness severity effect using APACHE II on the length of stay and the survival. Retrospective data were used to model length of stay in days and the survival using the APACHE II score as a predictor. This was followed by a prospective study to monitor the standardized measures in two intensive care units for one year. Findings - APACHE II severity scoring system predicted length of stay of those who were discharged and control charts for severity-adjusted length of stay were drawn up. The APACHE II score predicted survival for those with APACHE II score >16. The model is significant with specificity of 89.9% while sensitivity was 25%. Control charts for severity-adjusted mortality were drawn up to monitor mortality.Research limitations/implications - Only 60% of the files examined in the retrospective part of the study had enough data to calculate APACHE II scores. Practical implications - Standardized APACHE II severity of illness score can monitor intensive care unit length of stay and mortality.Originality/value - Underlines the need to implement a standardized measurement system to evaluate intensive care patient outcomes.

A comprehensive approach to quality management of intensive care services : Table of Contents

Dr. Seetharaman Hariharan, Dr. Prasanta Kumar Dey — Mon Feb 22 02:05:17 GMT 2010

Abstract:
Purpose - The main purpose is to develop a comprehensive framework for improving intensive care unit performance.Design/methodology/approach - This study introduces a quality management framework by combining a cause and effect diagram and a logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a ‘cause and effect’ diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated for improving performance. Findings - Stakeholders identified various intensive care unit issues. Intensive care unit management, hospital management, organizational processes, and insufficient human resources were considered major issues. A logical framework was developed to plan an improvement project to resolve the issues raised by clinicians and patients. Improved infrastructure, state-of-the-art equipment, well maintained facilities, IT-based communication tools and equipment, motivated doctors, nurses and support staff, improved patient care and appropriate drugs availability were considered as the main project outputs in order to improve performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a framework for planning, implementing, monitoring and evaluating the quality improvement measures on a sustainable basis. Originality/value - The combined cause and effect diagram and the logical framework analysis is a novel and effective framework for improving intensive care services performance. Similar approach could be adopted in any intensive care unit.

Factors Influencing the Pathways in Response to Complaints : Table of Contents

Dr. Sophie Yahui Hsieh — Mon Feb 22 02:05:17 GMT 2010

Abstract:
Purpose - This article explores hospital staff response to patient complaints and the factors influencing the complaint pathway in responseDesign/methodology/approach - The article describes an exploratory study in a large Taiwanese hospital purposefully chosen as a case study. The study applied the Critical Incident Technique (CIT), using a questionnaire along with non-participant observations, in which the results have been triangulated. A total of 59 cases were collected.Findings - The study found when facing ¯humaneness? complaints, hospital staff attempted to investigate the complaint event and then explain the facts to the complainant or empathise with the complainant and then refer the problem to the relevant unit. In response to complaints about ¯communication? and ¯care/treatment and humaneness? simultaneously, staff tended to investigate the event?s details and then directly explain them to the complainant. When complaints involved ¯care/treatment?, staff tended to empathise with the complainant, investigate the facts, and explain them to the complainant. Additionally, the organisational response to complaints was influenced by who made complaints; complaint type, severity and complaining method and patient?s status.Research limitations/implications - The literature has revealed that the case study is most common in organisational studies. However, the case study approach has been frequently criticised for not offering findings that can be generalised in different contexts.Practical implications - The complaint?s nature is the major factor influencing the response pathway. If healthcare managers intend to reduce complaint rates then they need to carefully classify the complaint?s nature. Different complaints have different handling procedures and guidelines to help managers resolve complaints in the first place.Originality/value - There are extensive studies focusing on investigating complaint nature and resolution. Nevertheless, these studies did not demonstrate the various means of handling patient complaints. Neither did they describe how different complaints might lead to a different outcome. Therefore, this study aims to explore hospital staff response to patient complaints and the factors influencing the pathways in response to complaints.

Evolution and outcomes of a quality improvement program : Table of Contents

Mon Feb 22 02:05:17 GMT 2010

Abstract:
Purpose - To examine the outcomes and evolution over a five-year period of a quality improvement program in a Swedish university hospital, in light of the enduring uncertainty regarding the effectiveness of such programs in healthcare, and how best to evaluate it.Design/methodology/approach - Case study with data collected as part of the program, including quality indicators from clinical improvement projects, and participants’ evaluations of the program.Findings - Overall, 58 % of the program’s projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 %, n=11) than projects led by male doctors (51 %, n=55). Facilitators at the hospital continuously adapted the improvement methodology to the local context. A lack of dedicated time for improvement efforts was the participants’ biggest difficulty. The dominant benefits included an increased ability to see the "bigger picture" and the improvements achieved for patients and employees.Research limitations/implications - The measurement of quality indicators was weak with limited reliability. Reliable measurement is important for the ability to conduct, and evaluate, improvement efforts. Nevertheless, the present study adds to the evidence base for the effectiveness of improvement programs in healthcare. Gender differences in improvement team leadership merit further study. Evaluations of improvement program effectiveness should assess the extent to which improvement methods are locally adapted and applied.Originality/value - This case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five-year period and provides in-depth insight into the changeable nature of an improvement program.