Emerald | International Journal of Health Care Quality Assurance

Assessment of quality of prenatal care in Shahid Beheshti Medical Science University Centers

Masoumeh Simbar, Fatemeh Nahidi, Alireza Akbarzadeh — 2012-03-16 00:00:00.0

Abstract

Purpose - Purpose – Improving access to hospital services and care are suggested to be the best approaches for decreasing maternal mortality. This study aims to evaluate prenatal care (PNC) to improve Shahid Beheshti University (SBMU) hospital and health canter service qualityDesign/methodology/approach - This was a cross sectional descriptive study to evaluate prenatal care services status in three domains: service structure, care process and outcomes. Using nonrandomized quota sampling, 600 PNC clients were assessed in 12 prenatal SBMU clinics. Two checklists were used to assess facilities and equipment. A care process checklist and a questionnaire used to assess services were developed Ministry of Health maternal care guidelines. Validity and reliability were assessed and confirmed. Data were analyzed using SPSS 16.Findings - Findings: 600 subjects with average pregnancy duration of 29.32±9.42 weeks were assessed in the study. Assessment of different care procedures demonstrated the following percentages of conformity with standards: counseling procedures 55.49±21.24 percent, history-taking procedure 48.71±11.36, vital signs assessment 53.41±10.55, general examination for first-time-attended clients 30.22±13.23, obstetrical examination 91.77±27.01, blood tests 93.83±21.89, urinary tests 86.85±26.29 and sonograhic assessment 95.7±4.3, clients' education about individual health 6.54±17.10 and the education on perinatal-risk 39.67±27.09 percent. The results demonstrated 73.76±15.04 percent of clients’ satisfaction with the structure of PNC services and 70.54±13.13 percent of satisfaction with the care procedures.Research limitations/implications - Implications for research, practice and/or society – The methodology and results of the study could be utilized by the managers of maternal care services for evaluation and improvement of PNC services.Practical implications - Originality/value - Value - This is the first time that Iranian PNC service structures, processes and outcomes have been studied. Developing care standards and interventional programs are necessary to improve counseling, physical examination, client education, waiting time and privacy to develop Iranian PNC services.

Quality from the Patient’s Perspective – a one-year trial

Liselotte Jakobsson, Leif Holmberg — 2012-03-16 00:00:00.0

Abstract

Purpose - Purpose - To study how changing information routines might influence patients’ service quality perceptions. A secondary aim was to test an instrument’s everyday feasibility for healthcare quality assessment.Design/methodology/approach - Patients often show high grade satisfaction with general care although they display dissatisfaction with information they receive. A questionnaire survey is used to establish pa-tients’ satisfaction with an intervention consisting of introducing standardized guidelines for nursing performance and information provision. Patient satisfaction was assessed through a standardized questionnaire: ‘Quality from the Patient’s Perspective’ (QPP). A cross sectional interventional survey was applied to patients from gynaecological and haematological wards (n=71). A comparison group was used (n=67). Patients were given the questionnaire when their diagnosis was confirmed, after six months and 12 months. Data were collected succes-sively over 36-months.Findings - Findings - The study group showed an increased satisfaction with information from nurses (p=0.001) but not physicians. However, patients tended to put greater emphasis on socio-cultural issues than information and some kind of cooperation seemed to represent high qual-ity from the patient’s perspective. Research limitations/implications - Limitations – Successively lower response rate, mainly owing to cancer patients’ deteriorating medical conditions.Practical implications - Implications for research, practice and/or society –The study seems to verify the concor-dance model’s relative merits and that the softer side of care appears to be more important to patients than specific improvements regarding informationOriginality/value - Value - Result confirm that patients’ satisfaction with information had implications for overall quality; but social issues seemed more important and enhancing quality is best achieved through participation and cooperation.

Place of morbidity and mortality conferences in quality assessments

Elodie Sellier, Sandra David-Tchouda, Gaëlle Bal, Patrice Francois — 2012-03-16 00:00:00.0

Abstract

Purpose - To analyze morbidity and mortality conferences (M&MCs) in a university-affiliated hospital, notably their format and progression since the 1990’sDesign/methodology/approach - A cross-sectional study was conducted in a university-affiliated hospital, June 2007. Past M&MC characteristics were collected using three methods: a survey to all department heads to identify past M&MCs; semi-directive interviews with each M&MC leader; and when available, meeting reports were analyzed.Findings - Of 189 questionnaires sent to department heads, 105 were completed and returned (55.3%). Twenty-seven M&MCs were indentified; five times more than in 1994. The M&MC format varied greatly between departments. In surgical units, cases per conference tended to be higher than ICUs or medical units and paramedical staff were invited less often. Compared with 1998, head nurses (27.3 vs 70.4%, p=0.03) and paramedical staff (18.2 vs 63.0%, p=0.03) attendance increased significantly. Physicians considered M&MCs an important tool for improving service quality, patient safety and enhancing team cohesion.Research limitations/implications - Patient outcomes were not assessed in this study. Practical implications - Although their less-well defined format allowed staff leaders to conduct M&MCs according to their objectives, how these conferences are conducted should impact healthcare quality and safety.Originality/value - Results indicate that M&MCs have evolved over the past 20 years, showing that this tool is a particularly valuable quality and safety improvement method.

Planning for Avian Flu Disruptions on Global Operations – a DMAIC case study

Sameer Kumar — 2012-03-16 00:00:00.0

Abstract

Purpose - This study assesses the spread of avian flu, its impact on businesses operating in the United States (US) and overseas and measures required for corporate preparedness. Design/methodology/approach - Six Sigma DMAIC process is used to analyze avian flu’s impact and how an epidemic could affect large US business operations worldwide. Wal-Mart and Dell Computers were chosen as one specializes in retail and the other manufacturing.Findings - The study identifies avian flu pandemic risk including failure modes on Wal-Mart and Dell Computers’ global operations. It reveals the sequence of factors that reinforce avian-flu pandemic’s negative impact on companies’ global supply chains. It also uncovers a sequence of factors that balance avian-flu pandemic’s impact on their global supply chains.Research limitations/implications - The nature of the avian flu and its irregularity affects the research because its spread could fluctuate based on so many factors that could come into play. However, this randomness not withstanding should be a cause for great concern for any business. Further, the potential cost to manufacturers and other supply chain partners is relatively unknown. As a relatively new happening, quantitative data was not available to determine immediate costs. Originality/value - The study provides guidance on what global business operation managers can do to prepare for such events, as well as how avian flu progression to a pandemic can disrupt such operations. This study raises awareness about avian flu’s impact on businesses and humans and also highlights the need to create contingency plans for corporate preparedness to avoid incurring losses.

Healthcare provision in rural India- does micro health insurance help or hinder?

David J Forbes — 2012-03-16 00:00:00.0

Abstract

Purpose - Healthcare provision changes need not be sudden or damaging. When making changes, many valuable services may be lost. This article considers dramatic change's negative effects on Indian rural healthcare provision. Design/methodology/approach - A case study is used to evaluate importing and developing rural India's private health insurance, combined with evidence from other micro health insurance effectiveness studies. Findings - Rural health insurance schemes are financially and culturally precarious. Enthusiastically importing these ventures into rural scenarios further fragments vulnerable healthcare systems that have served and survived many other threats. The new services may fail if not subsidised and the experiment might undermine what was already in place. Is it improvement or just change? Research limitations/implications - The absence of an Association of rural health providers means data are not regularly available.Practical implications - As more western healthcare concepts are parachuted into developing areas, understanding and appreciating what already exists has to be planned. New healthcare schemes must be critically evaluated, including the damage they could do to other healthcare provision. Originality/value - Unlike other published research on private health insurance introduced in India and Africa, this study critically reviews the effect in rural areas from the perspective of vital hospital services.

Quality assuring adult anti-microbial treatment guidelines

Husayn Al Mahdy — 2012-03-16 00:00:00.0

Abstract

Purpose - Guidelines have been produced in nearly all hospitals of the developed countries to provide cost-effective hospital care. The study's purpose was to determine whether an anti-microbial guideline document developed in a London hospital conforms to this principle.Design/methodology/approach - Literature search to determine anti-microbial therapy for certain diseases and comparing outcomes with what hospital guidelines recommend.Findings - There are significant discrepancies in the hospital anti-microbial guidelines and what is recommended in the literature.Research limitations/implications - Local microbial patterns for these diseases was not studied as they were not formally available, and these could have had an impact on the recommendations of the hospital guidelines.Practical implications - These guidelines influence day to day hospital clinical practice and the robustness of their recommendations is important. Extensive discussion of the clinical issues presented needs to take place within these guidelines. Such an approach would be rewarding for the training of medical students and junior doctors who use these guidelines.Originality/value - The study provides an important contribution to the development of clinical guidelines in hospital practice.