Editorial

Citation

Downey-Ennis, K. (2012), "Editorial", International Journal of Health Care Quality Assurance, Vol. 25 No. 2. https://doi.org/10.1108/ijhcqa.2012.06225baa.001

Editorial

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 25, Issue 2

It is my pleasure that I develop this editorial for the 2nd issue of the 25th volume of IJHCQA. The papers within this issue span across a wide range of topics and are not restricted to the traditional quality assurance systems that previously dominated the quality world, and while quality assurance is still an important topic we are now very firmly into the realm of quality improvement. The contents of this issue offer to the readers interesting topics for professionals (clinicians and managers) to enhance the care environment so that patients can experience improvements in the quality of care received through a myriad of topics.

Taylor and colleagues study examined perceptions of local service change and concepts of change amongst participants in a UK nationwide randomised controlled trial to promote quality improvement.

The authors suggest that in the UK with the move to community care, healthcare planning and commissioning controlled by primary care trusts and practices with competition between providers on the basis of quality and service require good collaboration across many interfaces, sectors and organizations within the NHS. The study reported NCROP, a quality improvement initiative to ascertain whether peer review accelerated change to reduce variability in COPD (revealed in a clinical audit) care was developed through a coalition composed of the leading society for respiratory clinicians with a long standing interest in clinical audit and peer review to improve care in the UK across the discipline of respiratory medicine. The findings revealed that while peer review was associated with positive changes however change can be perceived in a variety of ways by individuals with little consensus apparent. While differences in perceptions of change has already been noted through previous research the data from this study adds to current knowledge by illustrating how different perceptions exist between clinicians in similar posts treating the same condition and that generic change i.e. changes to culture etc. were often not perceived as change but on the other hand technical change was more likely to be recognised.

From Spain Una and colleagues researched an interesting topic on how to engage nursing staff in the decision-making-process in an oncology setting. The main aim was to ensure that the implementation of new strategies and integration of basic aspects of health management into daily clinical practice was achieved. Essentially the authors wished to take into account the voice of the nurses in developing new protocols to enhance the quality and safety of patient care in conjunction with medical colleagues. This type of intervention is pivotal and critical for any quality initiative to be sustainable and has been a central theme of quality management gurus for many years in the implementation of TQM where employee involvement is one of the critical success factors for implementation. These authors quite rightly indicate that satisfaction is not easy to define and that excellence in healthcare is impossible without professional/patient satisfaction. While their study was a pilot and small in nature the findings are quite striking and very promising in terms of agreement reached among the professionals involved and suggest that the methodology used is very applicable to other units and that satisfaction of nursing staff with improvements being implemented improves both the safety and quality of care delivered to patients. This manuscript indicates to the reader that with good clinical leadership and employee involvement real improvements can be made for the benefit of patient care.

Löfgren and colleagues research paper describes a program of change to improve hip fracture care and outcomes in a Swedish university hospital by a clinician group. This study was against the backdrop that since 2003 national guidelines requiring that hip fracture patients (when in need of surgery) should be operated on within 24 hours of admission were in place but the fact was clear that just 25 per cent of patients within the study site were operated on within 24 hours indicating that the guidelines in place were not adhered to. Throughout the research evidence revealed that nursing staff recognised the patients were a “forgotten group”, and that little attention was paid to the requirement to treat the patients within 24 hours but on the other hand there was skepticism and resistance to the national guidelines as expressed by orthopaedic surgeons which was in the context of little top management commitment. However some minimal changes were made. The authors conclude that a clear vision why change is needed and that is well communicated by a respected clinical leader can motivate personnel, but other influences are also needed to bring about change. Without a plan agreed and supported by top management, changes are likely to be limited to parts of the process and improvements to patient care may be minimal. These and other findings may be applicable to similar situations in other services.

Process flow and overall hospital performance is the topic explored by Zhu who argue that performance can be affected by the lack of intensive care beds resulting in cancellation of surgery and undoubtly a waste of precious resources within the Singapore healthcare system. The authors developed an interesting a discrete event simulation (DES) model, which aimed to predict ICU bed capacity, one, which would strike a balance between service levels and cost effectiveness. One cannot argue that the overall patient flow of a surgical ICU is indeed complex. In this study the patient flow was examined which as expected identified two sources of inflow namely: firstly the critically injured or ill patient from the emergency department, secondly those patients that come from the operating theatres. As expected several variations in the system were identified which the writers arguing that the DES model developed accurately captures the variations in the system and they claim that the model is flexible enough to simulate various what-if scenarios. Specifically they studied two what-if scenarios: the proper number of the ICU beds in service to meet the target rejection rate and the extra ICU beds in service needed to meet the demand growth. Their results indicate that the proposed DES model accurately describes the actual situation and is flexible enough to test the different what-if scenarios which will be useful to many practitioners interested in coming to grips with the complex flow of patients within this environment.

Trinidade’s paper examined the clinical follow up pathway regimes for patients suffering from neck cancer in the UK arguing that the current follow up process may be too prescriptive and did not take into consideration the account of the patient perspective. Thus they set out to ascertain what patients thought of the system of follow up with just under 45 per cent of patients indicating that their preferred first point of contact is a clinical nurse specialist which suggests the need to develop a more patient focused individualized approach in this disease cohort of patients. The patients indicated that being seen intensively for the first year would be beneficial following which visits could be tapered off over the next two years and finally being seen according to symptoms thereafter to be appropriate and felt that this represented an overall better system. The results of this research are really important for clinicians as they provide an insight into the patients’ perspective of the current follow-up regime. An interesting point the authors make is that research suggests that the incidence of patient’s under-reporting symptoms and signs is far increased with more frequent follow-up which indeed is quite perplexing as one could assume that with frequent visits symptoms would be picked up. However most of the participants in this study felt that overall, visits were too frequent and intensive and felt that different aspects of the MDT clinic needed to communicate better to avoid replication which indicates that the communication within the differing disciplines requires attention to avoid the replication and duplication that many patients feel while visiting a hospital. The data from this research suggests that follow up approaches maybe too prescriptive in their approach and one, which does not take the patient perspective into consideration. Thus what is required is a more patient-focused, individualised approach to follow-up in head and neck cancer which may result in less over-subscribed clinics and better-informed, less anxious patients with individually tailored follow-up plans and greater clinic access if needed.

The paper by Pobkeeree and colleagues trace back the origins of quality in Thailand where the government implemented policies on the quality of public healthcare as a result of inappropriate treatment, negligence and malpractice of health care personnel which the public becoming more aware of their rights when seeking healthcare. The government obviously keen to assure quality focused on several quality issues resulting in quality in laboratories being a crucial component of care and treatment in public health services. This paper outlines to the reader an overview of the system of public health laboratory quality management systems in Thailand and produces a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis. Their findings indicate that various quality management systems were identified however the number of laboratories that met both international and national quality management requirements was different. The SWOT analysis found the Opportunities and Strengths factors offered the best chance to improve laboratory quality management. The factors derived from the analysis can help improve laboratory quality management and provides several viewpoints and evidence-based approaches for the development of best possible practice of services in public health laboratories in Thailand. The findings are not specific to Thailand and many other laboratories can benefit from the results of this study.

Kay Downey-EnnisCo-Editor