Service evaluation and improvement methods

Citation

Hurst, K. (2013), "Service evaluation and improvement methods", International Journal of Health Care Quality Assurance, Vol. 26 No. 7. https://doi.org/10.1108/IJHCQA-06-2013-0075

Service evaluation and improvement methods

Article Type:

Editorial

From:

International Journal of Health Care Quality Assurance, Volume 26, Issue 7

Does increased healthcare spending improve service quality and stabilise or lower costs – the CQI professional’s Holy Grail? These are important questions, so options for evaluating and healthcare CQI approaches (i.e. the quality spiral) are crucial, and that’s why they’re aired regularly by our authors. We add considerable intelligence to CQI methodology in this issue. We kick-off with Francesca Garrard and colleagues’ article on evaluating a reconfigured antenatal-service using SERVQUAL; heavily involving service users (patient and public involvement is a powerful movement in the UK NHS). The arguments are well rehearsed in the literature. On one hand, shouldn’t we tailor services to customer expectations? On the other, can patients judge technical care? Garrard et al., at least show that women undergoing ante-natal care can easily judge service tangibles (e.g. cleanliness); although there is a spill-over into technical competence; i.e. women were concerned about staff hand-washing. Clearly, the media’s MRSA and C diff coverage has heightened patients’ awareness, so we may need to rethink our perceptions that patients cannot judge technical care. The authors raise a peripheral but important SERVQUAL issues; they found it hard to meta-analyse patient expectation and satisfaction studies underpinned by SERVQUAL owing to researcher/author methodological permutations.

Six Sigma (SS), commonly applied to manufacturing, seems an appropriate method for improving health services and evaluating quality improvement (QI) initiatives. Matthew Liberatore summarises a mammoth Six Sigma literature review in this issue. He describes SS variations including blending SS with Toyota’s Lean system. The author provides readers with the same information in two formats: the usual systematic review (as a commentary) and the same publications in tabular format that neatly summarises each publication’s application, structure, process, outputs and outcomes. The author carefully considers SS’s short and long-term effects, notably revenue generation and cost savings prompted by SS evaluations; however, Dr Liberatore underlines how some authors fail to report their project methods and outcomes. He wonders if SS and its variations have peaked since these and similar techniques seem to have been famous for 15 minutes in the health service.

We publish two articles by authors in this issue that use PDSA as an alternative (to SS) quality-project evaluation and improvement techniques. Pamela Moule and colleagues, were commissioned to evaluate the English NHS Pacesetter project, which is designed to remove health inequalities. The authors use an action-learning design and involve the projects’ main stakeholders including patients and public. Four case studies underline the challenges facing researchers implementing complex evaluations in the real-world. The PDSA method’s effect on project structures, processes and outcomes are clearly described, which generates valuable insights for researchers working on similar projects. Consequently, clear policy and practice recommendations emerge. The second PDSA-based commentary in this issue, written by Pow-li Chia and colleagues, clearly shows how PDSA improves clinical procedures. The authors focus on unplanned endotracheal tube extubation (UE) among CCU patients. Intubation is an invasive, life-saving and frightening clinical procedure, and dangerous especially if a disoriented patient prematurely removes his or her inflated endo-tracheal tube. The authors show, through a robust study in one large CCU, that intubated patient care requires stringent clinical protocols. The reasons (emerging from the study) why UE occurs may surprise readers, especially when they are preventable. The authors use their preliminary findings to strengthen local clinical guidelines, which they test over one year. Their results are remarkable – reducing UEs from 5.9 per cent to 0.9 per cent. Their new guidelines exude efficiency and effectiveness and should be implemented widely.

If healthcare professionals are formally taught QI methods then does implementing QI projects make a difference in the workplace, especially if projects are costly to organise and run? Jill Daugherty and colleagues, in this issue, describe a study that evaluates one extensive QI education and training programme’s structure, process, outputs and outcomes. Their QI programme’s value is assessed by asking course participants to implement a QI project in their workplace. Consequently, their qualitative study generates valuable insights into QI course curricula. The authors’ warts-and-all report ends with valuable QI education and training policy/practice recommendations.

We’ve all slipped, tripped and fallen – at least an unpleasant and often a painful experience that can have significant socio-economic effects. If an older person falls then there are additional problems such as faller losing confidence, immobility and potential isolation. Caroline Hollins-Martin and colleagues’ article in this issue shows that reducing risk and improving patient safety needn’t be complicated; i.e. simply addressing older peoples’ footwear can significantly reduce fall risks, improve quality of life and reduce healthcare costs. Their simple, qualitative survey into healthcare professionals’ footwear knowledge is remarkably revealing. What’s even more surprising is that guidelines for professionals about appropriate footwear and fall prevention in the elderly do not exist. Consequently, the authors: suggest an education and training programme for nurses and support staff; and draft safe-footwear and fall-prevention guidelines that could be broadly adopted.

Udechukwu Ojiako and colleagues in this issue look in detail at Chile’s publicly supported and private health insurance policy schemes. Using their expertise and the literature, they remind us about government supported and private policy provision’s strengths (cheap, universal coverage, risk pooling) and weaknesses (poor governance and market manipulation) before modelling 250,000 policy holder records (using high-level inferential statistics) for profiling purposes. Their analyses show how segmenting (profiling) policy holders can improve risk pooling for insurers and introduce targeted public health education for health service professionals.

Keith Hurst