Editorial

Citation

Downey-Ennis, K. (2011), "Editorial", International Journal of Health Care Quality Assurance, Vol. 24 No. 5. https://doi.org/10.1108/ijhcqa.2011.06224eaa.001

Editorial

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 24, Issue 5

Gaining efficiency, improving patient outcomes and the involvement of all stakeholders are core activities that all healthcare organizations should strive and aim to achieve. The papers in this issue give the readers substantial information and knowledge on how to apply various tools and techniques to achieve this aim. However, lack of interest and resistance appears to be a common problem when implementing quality improvement in healthcare internationally and it is important that the implementers of new initiatives prepare and plan implementation thoroughly in order to avoid such resistance and would be well advised to utilize Deming’s PDCA cycle for any improvement activity.

Kumar et al. aimed to research the quality and efficiency of the US healthcare services which they indicate is characterized as the world’s most expensive yet least effective and one which is very diverse compared with other nations. After pin-pointing the major cost drivers, the authors determined that the focus of decision and policy makers should be on various important measures of the system’s performance, such as treatment cost, access to healthcare, health and wellbeing, responsiveness, fairness in financing, and consumer satisfaction. They further suggest several steps that could be taken to revitalize the system by reducing the costs and increasing the quality and efficiency. Computerized medical records, active promotion of primary care physician services, pay for performance paradigm shift, universal healthcare coverage and many other solutions can be applied to reform the system and suggest to government policy makers, corporate strategists and public welfare committee representatives that they should work jointly to give a new lease of life to the US healthcare system. This is an interesting paper. Even though the US system may differ from others there are many valuable lessons for managers internationally to adapt and implement in their own organizations.

Hogan and colleagues in their paper describe the implementation of integrated care pathways as a quality improvement method aimed at optimizing patient outcomes and maximizing clinical efficiency in the Irish healthcare acute system. A qualitative phenomenological approach was utilized which explored healthcare professionals’ experiences of the implementation of integrated care pathways. Their findings indicate resistance was encountered and that lip service only was forthcoming. In some instances, however, with some effort and resilience on the part of the implementers some success was evident. The authors suggest that to implement pathways requires changes in existing institutional structures and cultures and that these changes will not be driven by one person alone, but by management and senior staff throughout the setting, as the input of senior management is essential to achieve buy-in from all disciplines. The main lesson from this paper is that implementing new techniques in healthcare requires certain specific skill on the part of the implementers such as communications, interpersonal skills to gain the involvement and commitment of all relevant stakeholders.

Knowledge management (KM) is the topic studied by Ying-Ying Chang in the Twain healthcare sector. Using a mixed methodology the study aimed to gain a deeper insight into policy-makers’ perceptions and the relationship between KM cognition and demand and the activities of KM enablers within the hospital. The findings indicate that the cognition and demand for KM in subordinates is close to the expectations of policy-makers. The policy-makers expect subordinates working in the hospital to be brave in taking on new responsibilities and complying with hospital operation norms. KM is emphasized as a powerful and positive asset and, moreover, understanding KM predicts good performance in an organization. A major benefit of this study is that it can be generalized to other local community hospitals and the findings may be applied to a wider population.

Roberts and colleagues from Ireland wonder if non-attendance at clinical appointments in acute hospitals could possibly be in the DNA of Irish citizens. On a more serious note patients who do not attend represent a significant drain on public hospital resources particularly for administration staff. But as the authors argue more importantly unused appointments mean other patients remain on waiting lists for an unnecessarily longer period in their assessment and treatment. This has become more acute recently with the current austerity measures being implemented in the Irish public sector. The research undertaken aimed to determine the reasons why patients miss clinic appointments in a neurology service and to ascertain patients’ views on the implementation of reminder systems and penalty fees to reduce non-attendees. The most common reason for non-attendance among our out-patients was simply that the patient had forgotten their appointment. Other reasons cited included clerical errors, feeling better and fear of being seen by a junior doctor. The issue of clerical error is something that requires attention by the hospital, but an interesting finding from the study was that nearly half of the study participants would be willing to pay a fee on booking that could be refunded on attending and lost if they missed their appointment. The authors conclude that, even though drastic, perhaps the most logical thing to do is to hit non- attendees where it hurts the most, their back-pocket … this might just be the most powerful deterrent. Without doubt charging patients will be controversial; nonetheless it may be worth a try to improve the attendance in various clinical settings to gain efficiencies.

Holder and Berndt from South Africa give the readers an interesting paper on service quality. The authors argue that physical evidence (tangibles) is critical in services as it is used as a cue to provide the client with an indication of the service offered, while it also impacts on the way in which the service is positioned and differentiated. Their study was to examine the effect of changes in the servicescape and service quality perceptions in a maternity unit with the main objective to ascertain the effects that a change in physical evidence had on the perceptions of service quality and to determine the significance of these changes. The term servicescape refers to both exterior attributes such as building exterior, signage, parking, waiting areas, admission office, and landscape and interior attributes such as design, layout, equipment and décor. The findings identified indeed that the servicescape had an influence on the perception of service quality in a maternity unit setting with the authors concluding that the importance of physical evidence in the management of a service facility is important and they firmly place the responsibility on management to ensure that the physical evidence receives the necessary attention. A limitation of this study is that the research was undertaken in two private facilities.

Kay Downey-EnnisCo-Editor