Editorial

Citation

Downey-Ennis, K. (2012), "Editorial", International Journal of Health Care Quality Assurance, Vol. 25 No. 6. https://doi.org/10.1108/ijhcqa.2012.06225faa.001

Editorial

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 25, Issue 6

In this issue of the IJHCQA the papers outlined span a variety of areas topics all important to healthcare providers and organizations who wish to improve patient safety and processes within their environments. Thus readers of this issue will be exposed to many new and novel areas and gain an in depth insight into differing methods for improvement and ways to enhance quality from an individual and organisational perspective. I hope that the papers contained within this issue will be both insightful and useful to the readers.

Lovell et al. bring to the readers an interesting empirical study carried out in the Canadian healthcare sector which focuses on and includes physician input on potential latent errors that may occur from their interpersonal communications with patients. It is well known that patient safety is a high priority of all healthcare organizations and the authors argue that communication errors are a major contributor to adverse events and medical error – with some studies indicating that over 90 percent of events stem from the communication process. The results of this study indicate that a high percentage of physicians cited several difficulties in relation to communication with patients with an interesting feature emerging that the specialties of psychiatry and pediatrics having significantly more difficulty than other specialties. A further salient finding which makes the communication process problematic is that patients in the age group 41-60 years age bracket were least likely to buy into and adhere to treatment plans coupled with difficulties understanding implications for lifestyle and behaviour change. Interestingly experienced physicians cited significant difficulties discussing complimentary alternative therapies, explaining the diagnosis, and reconciling patients conflicting views about diagnosis which the authors argue is as a result of sparse training for these cohort of physicians in communication skills. However of note the female physician-female patient interaction led to fewer difficulties in nearly all communication statements which one can argue can be attributable to the fact that female physicians use more emotional communication in their interactions resulting in being more amenable to female populations in general. This paper unearths a possible latent problem leading to errors in relation to the communication process and is one which requires action to ensure that all physicians experienced or not receive training to improve their communication skills.

The following paper in this issue comes from Eales-Reynolds and Clarke from an NHS perspective which examining a novel training program aimed at instilling and engendering a customer care culture in a large hospital trust. The study utilized a case study methodology to investigate the impact of an educational intervention on the participants’ knowledge and understanding of customer care and their ability to transfer their learning into the workplace in order to implement change. The approach adopted was effective in raising awareness of the customer care framework and in enhancing participant’s self-efficacy in relation to the principles of customer care. However transference to the workplace was dependent on personality and departments having sufficient numbers of staff participating. A weakness in this study for the authors is that fact that very few medical doctors participated and they argue that it is difficult to know whether or not the presence of more doctors might have improved transference given their leadership roles within the clinical setting. Notably medical doctors have been identified as a highly influential group that need to be involved if change is to occur effectively but which are difficult to engage in new initiatives. A further limitation for the authors was the fact that the project was somewhat limited in both time and resources for follow up interviews designed to explore if, and to what extent, the learning had had a lasting impact on participants and if it had enabled transference to the workplace. Despite these limitations the study has shown that training in the form of interactive workshops with high fidelity simulation, can engender a customer focused culture within an NHS organisation.

From Spain Rodríguez Cerrillo and colleagues report on the implementation of ISO 9001 applied in a hospital in the home (HIH) which is an alternative to conventional hospitalization but remains part of a hospital The paper is unique in describing the implementation of the ISO standard in such a setting and while the importance of physician patient contact is important there are other factors that require management such as ensuring that medical equipment works correctly to the establishment of protocols that lead to a reduction in variability among staff. Core processes and protocols required to attain the standard are outlined from the perspective of the HIH ranging from patient eligibility and satisfaction, patient care management, equipment maintenance and infrastructure were developed. Following implementation many areas of quality were increased, an increase in patient satisfaction was recorded, percentage of patients requiring to return to hospital decreased, performance of external suppliers improved, compliance to documented processes was high, the number of admitting physicians also increased. The authors clearly demonstrate that the hospital at home project enabled patients to receive high quality as one may expect if treatment was being received in a hospital environment.

The following paper comes from Israel where Gabbi et al. argue that while the developing generic market has advantages of availability and affordability of therapy questions are asked whether therapeutic equivalent substitute under unfamiliar name(s) may cause confusion that lead to medical errors and that this particular facet has not been sufficiently studied. The impetus for the study was triggered following sporadic reports according which patients mistakenly consider therapeutic equivalents as unrelated medications rather than substitutes. A quantitative methodology using a questionnaire to gain recall was utilized in one of Israel’s largest healthcare provider and had a good response rate. The study was original as the authors indicate that a literature search revealed no studies evaluating potential medications errors attributed to the switch between therapeutic equivalents. The results recall uncertainty, confusion, misidentification, and mainly cases of medication errors in which patients consumed both therapeutic equivalents simultaneously as was reported by 81 per cent of physicians and 70 per cent of pharmacists. The conclusion drawn from this study is that therapeutic equivalent substitutes that are new or unfamiliar to the individual patient may cause confusion and misidentification which may result in unique and serious medication errors. The authors give several suggestions on how to improve the management of therapeutic equivalents however they caution and indicate that the steps outlined by them are expected to face huge difficulties including legislative barrier, commercial objections, professional concern, and political involvement but otherwise medication errors caused by switching between therapeutic equivalents will be inevitable. Patient safety must be to the fore of all professionals, thus this study is a valuable resource for all involved in the prescribing of such medication therapeutic equivalents.

Hofer and colleagues paper is both novel and interesting where they look at the laundry process undertaken during commercial laundry in the health sector with emphasis on using a bacteriophage-charged bioindicator (MS2) for the testing of low-temperature disinfecting laundry processing on efficacy against viruses related to practice. Their study was undertaken under practical conditions at several differing temperature ranges and found that the MS2 bioindicators prove to be suitable as a tool to determine the performance of disinfection procedures against viruses in practice. The value of their paper is that phage charged bio indicators may be a tool to provide further insights into the reliability of antiviral laundry processes for the health care quality management and for infection control.

The final paper in this issue comes from Australia with West and Gullick suggesting that while the quality improvement focus within healthcare institutions is increasing and in Australia, as in many other developed countries, a formal framework of quality assessment is now tied to a government-driven accreditation process and that such trends are compelling clinicians to find rigorous methods to evaluate current clinical practice. Thus their study aimed to evaluate the quality of the services clinicians provide for both service planning and improvement to generate new knowledge for the development of their clinical practice. The Picker Dimensions of experience and Heideggerian phenomenology was utilized within a qualitative methodology with their findings indicating that well-conducted qualitative interviews can provide common ground for service improvement initiatives and rigorous research analysis. The access that qualitative data provides to the patient and family’s perspective is becoming increasingly valued in processes of ongoing quality improvement, clinical redesign and evaluation for hospital accreditation. The intrinsic rewards of deep qualitative analysis for the staff involved are extraordinary; clinicians were humbled by new understandings, which surprised them despite their long clinical experience.

Kay Downey-EnnisCo-Editor