Editorial

Citation

Downey-Ennis, K. (2012), "Editorial", International Journal of Health Care Quality Assurance, Vol. 25 No. 4. https://doi.org/10.1108/ijhcqa.2012.06225daa.001

Editorial

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 25, Issue 4

The main focus of attention in this fourth issue of the 25th volume of IJHCQA is mainly on streamlining process within organizations through a myriad of approaches including Lean, Six Sigma and Process Management all of which have the potential to assist organizations in the current stringent fiscal environment that most healthcare organizations are experiencing. Others authors to this issue contribute to both the physical health of patients with severe mental illness and to improving service quality through branding.

The first paper from Morrow and colleagues describes a large-scale quality improvement project spanning 96 different healthcare organisations in the UK. The aim of the reported research was to use the case of The Productive Ward program to gain insights into areas of challenges identified from the current research literature on innovations, focusing on the use of lean thinking in health care. The challenges are staff receptivity, the complexity of adoption, evidence of the innovation, and embedding change. The authors report that the project was well received and widely supported when Lean was framed in terms of “releasing time to care” which created an emotional connection between healthcare practitioners that align with their professional values. The findings of this study of The Productive Ward in English hospitals shows stakeholders at different levels of the health system have experienced a range of challenges and facilitating factors to implementation. Key issues for all stakeholders were staff time to work on the programme and showing evidence of the impact on staff, patients and ward environments. Taken together this research shows that Lean initiatives are well received when they are connected with establishing lasting improvements to healthcare services that align with the professional values of staff who work within them.

Following this paper Celano and colleagues present to the readers a theoretical framework based on a “roadmap” facilitating the process of embedding discrete-event simulation as a decision tool within a Six Sigma quality-improvement project in the Italian healthcare sector. The “roadmap” is built as a structured and hierarchical procedure to achieve quality improvement in a general setting. A key factor in the implementation of the roadmap to the in-hospital case study allowed some strength points of the proposed theoretical framework to be experienced. Getting a precise definition of the cross-functional process maps and the value-added stream analysis at the early steps of the project was a key factor in stating the problem correctly and successfully developing the project. The dissemination of the results inside and outside the hospital during meetings and seminars received a positive feedback from operators, especially in terms of interest to the roadmap implementation to other healthcare settings.

Taner and colleagues paper is the application of the Six Sigma methodology to improve workflow by eliminating potential risks associated with radological service in the medical imaging department of a private Turkish hospital. While the limiation of this study is that data was collected over a limited period and in one location the data measurement and improvement methdology of Six Sigma proves an an impetus for healthcare facilities to rethink their workforce and reduce malpractice as it involves measuring, recording and reporting data on a regular basis which enables management to continuously monitor the workflow of a given department or indeed the organisation as a whole. The paper reported in this issue supports the need to apply Six Sigma and identifies that its adoption can have a measurable impact on cost and quality of services in that several processes were evaluated with subsequent risks identified which were corrected before any adverse events took place. Without doubt taking into consideration the improvements made within the reported paper any program which will deflect adverse events is worth reproducing in healthcare facilities.

Using a similar methodology Kumar and his colleagues in the US developed a business model to generate quantitative evidence of the benefits of implementing radio frequency identification (RFID) technology limiting the scope to outpatient surgical processes in hospitals. Their analysis identified significant estimated annual cost and time savings in carrying out patients’ surgical procedures with RFID technology implementation for the outpatient surgery processes in a hospital. This is largely due to elimination of both the non-value added activities of locating supplies and equipment and also the elimination of the “return” loop created by preventable post operative infections. Several poka-yokes developed using RFID technology were identified to eliminate those two issues, as well as, for improving the safety of the patient and cost effectiveness of the operation to ensure the success of the outpatient surgical process. The suggestion is that computations of costs and savings will help decision makers understand the benefits and implications of the technology in the hospital environment. However a word of caution from the reported research is that it may be necessary to more fully study the mindset and attitudes of managers supporting various parts of the healthcare supply chain so that incorporating RFID technology in various healthcare delivery processes can be effectively planned

From Australia Al-Hakim and colleague’s research was to ascertain how long preventable disruption prolonged a patient’s journey within the surgical domain of healthcare. Similar delays and flaws within processes occur within this hemisphere as the other papers outlined in this issue and of interest here is that the researchers themselves were from an engineering/work design background. Process management was employed within the research methodology and examined disruption affecting the start and the end of the surgical flow process. The results demonstrated that preventable disruption caused an increase in the patient journey and forced surgeons and patients to endure an unnecessary average delay of almost 25 per cent of the total surgery session time. The majority of disruptions were due to a myriad of inefficiencies stemming from sources such as information, work design and communication with 10 per cent of the patient journey disruption which could be eliminated or considerably reduced by further training and doing the work correctly and cooperatively. This study outlines clearly and will inform management of hospitals regarding the magnitude and causes of preventable disruption affecting surgical flow with a major benefit of the study is the possible improvement in the patient journey and that such improvements would have the potential to free resources to deal with emergency cases and to shorten waiting lists for elective surgery.

Chahal and Bala suggest that branding plays a special role in service firms as it increases customers trust, enables customers to better visualize the service products, acts as a means of differentiation among competitive products and delivers value to the customers. This describes a comprehensive account of service quality which has the potential to be of assistance for healthcare to achieve a state of excellence for customers and is interesting to ascertain how it can be latched onto healthcare especially those in the Indian sector who are legally not permitted to run any commercial advertising. The authors inform us that brand equity is considered as the power of the brand that is built in the minds of the consumers on the basis of what they have learnt, seen, felt, and heard about the brand. The study reported only included three aspects of branding – that is brand loyalty/patient loyalty, perceived quality, and brand image which are considered as significant components of service brand equity in healthcare. The findings revealed that brand loyalty and perceived quality are important components that have a dominating effect on service brand equity. Certain significant outcomes were revealed relating to brand loyalty and perceived quality. That is, a service provider through enhancing brand loyalty can build organizational image and work for the development of service brand equity. Overall, the study concludes that brand loyalty and perceived quality are the two major components that contribute to the development of service brand equity in the healthcare sector. More importantly, organizations with a high degree of service brand equity will be efficient in sustaining competitive performance.

The final paper by Vasudev and colleagues in the UK who studied patients with severe mental illness being treated with antipsychotic medication and who they identify as being at increased risk of metabolic side-effects like weight gain, diabetes mellitus and dyslipidaemia. Given that physical health problems are common in patients with schizophrenia, among which cardiovascular events contribute most strongly to the excess mortality observed in schizophrenia, followed by other factors including obesity, metabolic aberrations, smoking, alcohol, lack of exercise and poor diet the purpose of this study is admirable. The authors looked at the feasibility of maintaining a physical health monitoring sheet in patients’ records and its impact on physical health of patients with severe mental illness over a 12 month period was studied. The method used was the placing of a physical health monitoring sheet in patients records in a male medium secure forensic psychiatric rehabilitation unit, as a prompt to regularly monitor physical health parameters. Their findings identified that the serum lipids and cardiovascular risk over the next ten years reduced over time leading to an increased prescribing of hypolipidaemic agents. However there was no significant change noted on the parameters including BMI, central obesity, high blood pressure and smoking status.

Kay Downey-Ennis