Doing more with the same resources

Citation

Hurst, K. (2015), "Doing more with the same resources", International Journal of Health Care Quality Assurance, Vol. 28 No. 5. https://doi.org/10.1108/IJHCQA-04-2015-0043

Doing more with the same resources

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 28, Issue 5.

Emergency departments (ED) are attracting attention from service improvement specialists as patient attendances grow. Overburdened primary care services, causing inappropriate ED attendance and a growing/ageing population combine to ensure that ED attendances will increase. That leaves ED managers with three choices: (i) discourage inappropriate attendances – stopping the anything and everything (A&E) phenomenon; (ii) expand ED services and increase resources; (iii) improves existing service efficiency and effectiveness. Janet Sandler and Tedd Karr in the issue describe a project that addresses option (iii). Their focus is unusual – reducing specimen turnaround time (TA) in their ED. Readers will be surprised about ED blood specimen activity and what can be achieved using Lean techniques. It’s clear in the paper that Lean techniques can reduce waste other ED service treatment and care steps.

Abdlehakim Abdelhadi in this issue also applies Lean metrics to EDs. They use the TaktTime metric to fine tooth comb ED processes. The differences between two ED sub departments are staggering, which weren’t apparent until the TaktTime metrics were applied. It’s clear that the ED’s managers have serious process anomalies to address. However, the old maxim applies – you can’t change services without measuring first.

Sara Tolf et al. in this issue also take Lean methods one step further by introducing a more agile and flexible approach to service efficiency and effectiveness in an uncertain and changing health service. Some discussion in the paper is controversial; i.e. creating flexible healthcare workforces is a challenge; i.e. unlike a production line, health service managers can’t send healthcare staff home when bed occupancy and patient dependency/acuity fall. Calling in temporary staff (e.g. agency workers) is expensive and may be unpalatable. Nevertheless, having an expensive workforce working inefficiently can’t be ignored.

Screening to detect disease complications makes sense for several reasons: it improves the patient’s quality of life; a stitch-in-time (spotting disease and complications early) saves nine; and data are collected that contribute to research and development. But what happens if we’re faced with reluctant patients? Ibrahim Abdulhamid et al. in this issue describe the challenges when screening cystic fibrosis children at risk of developing diabetes mellitus. The low cystic fibrosis complication screening take-up rates will surprise readers. Analysing the screening process steps, the authors were able to identify the elements that are likely to cause screening no shows; e.g. expecting a fasting child to travel several hours to a testing service. Tracking children and multidisciplinary team working turned out to be an important factor, which when addressed markedly improved screening take-up rates.

The relationship between patient satisfaction and customer loyalty is a popular topic among our authors and readers. Understanding the relationship in private healthcare adds a new dimension. Although Rama Koteswara Rao Kondasani and Rajeev Kumar Panda’s paper in this issue probably doesn’t tell us much more about private healthcare, it does indicate the areas where public healthcare services may be falling down and those service elements that need improving if patient satisfaction and customer loyalty are to be improved.

Patient complexity (usually measured using dependency and acuity scales) has a significant impact on health and social care professional workloads. Adjusting resources (e.g. staffing) to reflect rising and falling workloads is major challenge for healthcare managers. However, according to Mustafa Ozkaynak et al. in this issue, there seems to be theoretical and practical layer below simple dependency/acuity scores. The authors show that understanding these sub processes (qualitatively) may improve service efficiency and effectiveness without additional resources and possibly predicting clinic workloads.

The jury’s been out for some time deciding whether contracting out healthcare services improves healthcare efficiency and effectiveness. Contracting out administrative services and it benefits and weaknesses is regularly covered in IJHCQA, but rarely do we get paper that summarise studies into contracting out clinical services. In the issue, Fauziah Rabbani et al. methodically explore and evaluate contracting out maternal and new-born healthcare. The researchers’ balanced-scorecard based metrics unearthed many expected and a few unexpected differences between contracted-out and centrally administered maternal and new-born healthcare services in rural India. A major finding was the patients’ preferences for contracted-out services.

If researchers expect their quality assessment instruments to be rolled out then they have a duty explain their instruments’ theoretical framework and psychometric properties. Menala Glarcher et al. may surprise readers in this issue about the extent to which quality assurance instruments meet these criteria. The instruments reviewed, claiming to measure nursing quality, conceptually, varied markedly and three measures fell down on not adequately reporting psychometric properties. The papers’ main value lies in its guidelines for critiquing instruments purporting to measure nursing quality from patient and nurse perspectives.

Keith Hurst