Emerald | Leadership in Health Services | Table of Contents

QFD application using SERVQUAL for private hospitals: A case study

Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - Purpose - This paper employed Quality Function Deployment methodology for translating customer needs and expectations into the quality characteristics in a private healthcare setting. This case study illustrates how an existing approach of SERVQUAL and QFD integration can be applied for quality improvement. Design/methodology/approach - Design/methodology/approach – Integrating SERVQUAL into QFD to set the success factors to improve quality in the healthcare industry is the main aim of this paper. A privately-held university hospital within the city of Istanbul in Turkey was selected as the sampling frame. A SERVQUAL-type of questionnaire was used and a total of 250 questionnaires were distributed and 210 of them were received. Usable responses were 170, comprising a response rate of 68 percent. Findings - Findings - From the results of the QFD application it is seen that behavior and attitude of staff has the highest weight score meaning that when behavior and attitude of staff is improved there will be almost 25% of improvement in the hospital. Another finding was that there is strong relationship among skills of physician, behavior and attitude of staff, and having enough modern equipment with the customer requirement of modern equipment used in hospital. Research limitations/implications - Research limitations/implications - Quality function deployment (QFD) technique is able to provide hospitals with a better understanding of customers’ expectations to translate these expectations into appropriate service specifications and perform existing process assessment. Originality/value - The case study was a first attempt to apply this integrative approach to a service sector and thus offers practical and applied information that are useful to both academicians and practitioners.

Healthcare quality costs based on an ISO 9000 model

literatinetwork@emeraldinsight.com (Leonardo Sedevich-Fons) — Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - The objective of this paper is to put forward a quality cost management model for healthcare organizations, which is based on the Quality Management Systems proposed in ISO 9000 international standards. Design/methodology/approach - The model suggested here arose from the individual study of quality in healthcare, quality management systems and quality cost theories; and the analysis of problems emerging when these tools are combined in practice. Findings - The traditional quality cost model, usually implemented in manufacturing companies, can also be applied to healthcare organizations that manage their processes according to ISO 9000 Quality Management Systems. Research limitations/implications - This document is a general description of the model proposed and, therefore, just presents overall guidelines to managing quality costs in healthcare organizations. Originality/value - Since most healthcare organizations are still stuck in the quality assurance stage, there has been little research conducted on quality cost specifically focused on this industry.

Applying systems engineering to create a population-centered sleep disorders program

Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - This paper is a case study of a healthcare service redesign. In 2005 sleep disorder diagnostic assessments for patients in the Province of Manitoba was conducted at two independent sites. Referrals had accumulated, creating a waiting list of over 3400 patients while only 1200 patients were studied annually. Wait times for diagnosis and treatment increased dramatically. No managed patient database existed, nor were there standards to measure the effectiveness of the services. Design/methodology/approach - A systems analysis approach was used which including population demand analysis, value stream mapping and refining the clinical service objectives. The current and desired state of the system was defined and a gap analysis became the foundation of a change management plan.Findings - A system redesign resulted in tripling the throughput with a 35% increase in operating budget, evaluation metrics, elimination of diagnostic handling and treatment start delays, and an increase in treatment rates for positively diagnosed patients from 55% to 70%.Originality/value - This paper provides an example of how healthcare services can be envisioned using a systems analysis approach.

Deming’s systems thinking and quality of healthcare services: A case study

literatinetwork@emeraldinsight.com (Robert M. Gerst) — Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - This paper examines the large negative impact command and control thinking has had on the Alberta provincial healthcare system. The assumptions of this thinking and devastating consequences for health services delivery in Alberta and across Canada, are contrasted with Deming's system thinking.Design/methodology/approach - The author has been following and writing about the use of the command & control management model in Alberta healthcare for 20 years, treating its expanding use in the system as an experiment in the effectiveness of this model in improving system performance. Findings - The assumptions of command and control thinking combined with a limited enumerative, as opposed to analytic understanding of the system, has largely manufactured the present crisis. Equally important, systemic issues continue to worsen the system until the command & control model will get replaced.Originality/value - There is a comparison of two distinct models of management, management style, and the linking of Deming's' enumerative and analytic studies to these models. An analysis of healthcare system evolution over two decades is detailed on how the command & control model of professional management has failed and why.

Time to care: a patient-centered quality improvement strategy

Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - The purpose of the paper is to describe the processes and results of implementing and evaluating the Releasing Time to Care™ (RTC™) model in a 45 bed Neurosciences unit in a tertiary care hospital in Saskatchewan province of western Canada.Design/methodology/approach - Organizational restructuring in healthcare systems has impacted the ability of CRNs in participation and in influencing the decision making that affect the delivery and outcomes of patient-centered care. At the same time, CRNs work has intensified because of increases in patient acuity, technological advances, complexity of care provided to patient families and communities, in addition to the intensifying demands put on by aging population and dwindling resources. The work reported in this paper shows that over 6,300 improvements have been made based on the current needs and the change is forever imminent. Establishing solid people connections and networking opportunities proved valuable for current and future exchange of information and knowledge translation. Findings - Model implementation resulted in positive narrative and empirical data including: improved patient safety, staff engagement, leadership opportunities and an affirmative shift in organizational culture. Improved patient safety was evidenced by a reduction in falls and decreased medication errors. Originality/value – The paper focuses on including the clinical nurse in organizational and system change towards improving patient-centered quality care. Neurosciences 6300 at Royal University Hospital (RUH) in Saskatoon, was viewed as an RTC™ champion and one of the first to implement and complete the eleven module toolkit. Practical implications - Implementing transformational methodologies require methodical dedication by all healthcare stakeholders. Engaging clinical nurses and other healthcare workers is a significant recipe for successful implementation. Decision making involving these basic principles allowed the staff to deliver quality outcomes and increase time at the patient bedside. This practical application increased patient and staff satisfaction. Organizations must recgonize that fostering a culture of excellence, must also include recognizing and respecting CRNs role in the decision making process. Ultimately this is essential towards recruitment, retention and sustainability. Originality/value - Quality patient care resonates with CRNs professionalism which is clearly relevant to safe patient care. Implementing transformational methodoligies in this original context can positively impact individuals, groups and organizations both locally and nationally. Therefore, efforts taken to introduce change utilizing quality initiatives must incorporate the expertise of appropriate healthcare workers; including CRNs in the decision making processes is a necessity. Finally, involving and providing accountability to CRNs in decision making and implementation of RTC™ model show positive results concerning the patient-centered care in hospitals.

Development and implementation of a regional intensive care health service model

Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - We present a case study of a healthcare service redesign. Before 1998, five community hospitals in Winnipeg each managed their intensive care units (ICUs) independently providing virtually no access to patients in rural and remote regions of the province of Manitoba. Two tertiary university affiliated hospitals were left with insufficient intensive care beds to service the rest of the provincial population in addition to their tertiary service responsibilities. We resolved to create a city-wide integrated critical care services model in order to improve patient access, quality of care and cost effectiveness. Design/methodology/approach - A population demand analysis was performed and service objectives were defined. A gap analysis became the basis of an integrated service model design and an implementation plan was formulated.Findings - Beds were redistributed among community hospital Intensive Care units to match available nursing resources. A credentialing process was developed to establish medical competency for attending physicians. A central bed registry and a referral triage system were implemented to ensure that any Manitoban requiring an ICU admission acquired an appropriate bed in a timely manner. A regional computerized critical care database was introduced to all ICUs. The total number of beds was reduced from 92 to 84 and total occupancy fell from 65 to 58. The new model was entirely funded from bed reductions. Originality/value - This paper describes the integration of a group of hospital based intensive care units into a regional service delivery model developed to meet the needs of a provincial population.

Quality Leadership in Healthcare Services: Selected Papers from 4th Canadian Quality Congress

literatinetwork@emeraldinsight.com (Madhav Sinha) — Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Not available.

News And Views

literatinetwork@emeraldinsight.com (Jo L Lamb) — Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Not available.