Quality management in health care
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Qual Manag Health Care · Oct 2011
Effect of surgical safety checklists on postoperative morbidity and mortality rates, Shiraz, Faghihy Hospital, a 1-year study.
The study intent was to (1) encourage the use of surgical safety checklists and (2) measure the effect checklists have in reducing surgical complications. ⋯ Complications decreased by 57% after intervention. Both high patient information detection and elevated levels of cooperation by surgical personnel were observed. Compliance likely helped prevent some adverse effects associated with surgery.
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Qual Manag Health Care · Oct 2011
A system for using patient complaints as a trigger to improve quality.
This study aims to explore how hospital organizations can use complaints to drive quality improvement. A teaching hospital in Taiwan was purposefully selected as a case study. Data were collected from a variety of sources, including interview with key managers and social workers, questionnaire survey of managers (n = 53), interview with government organizations (n = 4) and nongovernment organizations (n = 3), document collection and review, and the Critical Incident Technique using a questionnaire and nonparticipant observation (n = 59). ⋯ But it did not act on these complaints as a collective group to identify systemic problems and deficiencies. This approach provides single-loop learning, which may be sufficient to handle the problem on hand but is not enough to prevent such problems occurring again in the future. This study suggests some implications in regard to a best practice system for using complaints to improve quality.
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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.