Quality management in health care
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Qual Manag Health Care · Jul 2011
Multicenter StudyThe best period for mortality rates associated with hospital stay: hospital mortality performs well for nonsurgical diagnostic groups.
Mortality is widely used to assess quality of hospital care. Inpatient mortality is easily available in administrative data. The use of periods other than length of stay is questionable. We compared different overlapping and disjunctive periods for the calculation of mortality associated with hospital care. ⋯ For nonsurgical tracers, hospital stay is the best period to assess mortality associated with hospital stay. The courses (sequences of 4 mortality rates for one tracer in a hospital) for surgical tracers, in particular colorectal carcinoma, appear as a harvesting effect with an association of high in-hospital mortality with low mortality in the medium term.
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Qual Manag Health Care · Jul 2011
Multicenter StudyFacilitators and barriers to the implementation of patient flow improvement strategies.
Patient flow improvement strategies have been effective in reducing emergency department (ED) crowding, but little guidance is available on the implementation process. By using a qualitative research design, our objective was to identify common facilitators and barriers to the implementation of patient flow improvement strategies and successful approaches for mitigating barriers. Six hospitals participated in an 18-month Urgent Matters learning network launched in October 2008. ⋯ Some of the challenges were mitigated through approaches such as staff education and department leaders' constant reinforcement. Our findings indicate that several facilitators and barriers are common to the implementation of different strategies. Leveraging facilitators and developing a strategy to address common barriers may leave hospital and ED leaders better prepared to implement patient flow improvement strategies.
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Qual Manag Health Care · Jul 2011
"The people not the policy": quality improvement, junior doctors, and cultural change.
Health care is a highly regulated environment. This has driven what could be characterized as a paper-safe approach, whereby organizations are required to demonstrate to a multiplicity of regulators, inspectorates, and accrediting bodies that they are paper safe. However, for many organizations, this has not produced a system that is actually patient safe; rather, it has in practice operated as a parallel system that does not reflect the true state of safety. This project looks at a quality improvement and patient safety program and critically asks the question of whether it is flawed because of failure to address issues surrounding doctors and cultural change. ⋯ Unless the cultural differences are adequately addressed, transformational change projects such as "Best & Safest Care" are unlikely to succeed. A better understanding of the organizational context allows for more appropriate change interventions to be developed.