Win-win QA processes

Citation

Hurst, K. (2016), "Win-win QA processes", International Journal of Health Care Quality Assurance, Vol. 29 No. 5. https://doi.org/10.1108/IJHCQA-04-2016-0046

Win-win QA processes

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 29, Issue 5.

Laboratory services, along with clinical examination, are the diagnostic phase’s most critical elements. Developed country medical education and training quality assurance programmes are well established. Assuring laboratory service quality structures and processes, on the other hand, are perhaps less-well understood, and therefore, warrants the attention that Graham Lee and colleagues describe in sequential articles in this issue. Their detailed and highly relevant literature review will surprise readers, notably that international and international guidelines are not fool-proof even when laboratory staff fully implement laboratory quality assurance programmes. The authors can be forgiven for going what seems to be an extra marathon in their laboratory QA programme. The detail in which they set measurement parameters and methods, and safety checks is impressive, especially their laboratory QA process flow charts. The authors appear to have found and disengaged most if not all the bear traps facing laboratory quality assurance managers. There is more than strong element of crystal-ball gazing also, intended to warn readers about what QA issues are round the corner. The authors are modest in their assertions; their recommendations do far more than enhance laboratory QA systems – they seem to plug current QA structure and process gaps, and fool-proof the whole process. In short, the two articles form a definitive guide for laboratory staff.

As our American colleagues might say, short waiting times for cancer patients is a no-brainer! But is it that simple? Do we really understand the treatment and care plans that our patients prefer? Dr Tytgat and colleagues, in this issue, generate some remarkable insights into cancer patient expectation and satisfaction in a fast track clinic (where diagnostic and treatment waiting times are short by any standards). Consequently, the authors (rightly) conclude that the waiting time between referral and treatment should be tailored to each patients’ preferences according to the diagnostic and treatment phase they are in. I am sure most healthcare professionals structure diagnostic, treatment and care phases informally, but best-practice guidelines do not address person-centred requirements in this detail, so the authors’ longitudinal research and development breaks new ground. Clearly, here is a patient group that can benefit immeasurably from individual care planning – moreover, a relatively inexpensive option.

When reading Fildelma Fitzpatrick and colleagues’ article, readers will wonder why their elegantly simple notion; i.e., combining quality improvement (QI) projects with continuous professional development (CPD) has not been implemented globally, especially when the authors created a system that cost nothing extra and yet contributes significantly to healthcare structures, processes and outcomes. What makes the authors’ article even more special and impressive, however, is how they use Twitter-based communication and PDSA cycles to monitor on-site QI/CPD session efficiency and effectiveness; notably how they strived to determine the optimum educational approach. Readers will not be surprised about which teaching sessions and styles did well. Consequently, the authors were able to tailor their interdisciplinary education/training sessions to healthcare professionals’ needs.

Unless immersed in the process, it is hard to conceive how much potentially harmful clinical waste is generated each day in a large hospital. Gloves, syringes, laboratory specimens, food waste, etc., items in the millions are collected and processed daily. Moreover, as Thakur and Ramesh point out in this issue, if hazardous and non-hazardous waste is not separated, then it is likely that all waste becomes contaminated, placing staff, patients and public at risk. Multiplying contaminated and routine daily waste by total hospitals in a country brings the full problem into sharp focus. The authors, using a triangulation and statistical modelling, identify the barriers to efficient and effective clinical waste management in a developing country. The authors, helpfully, classify these barriers into low and high priority. The traps and pitfalls are nightmarish and unfortunately, can be costly to rectify, which may mean that some healthcare staff cut corners. However, some solutions are easy to implement – simply raising staff awareness and moving clinical waste management issues up the management decision hierarchy are effective. Other preventive and curative clinical waste structures and processes; e.g., microwaving waste before transferring it to landfills are more challenging and costly especially in cash-strapped countries.

If, as intended, cheaper primary care is to replace secondary care; i.e., minimising hospital admissions whenever possible, then: first, are resources allocated to primary care appropriate; second, are primary care professionals using the most effective and efficient procedures; and third, can primary care staff in one country learn from best practice elsewhere? John Øvretveit and colleagues address these and other questions in a longitudinal (2006-2014) and comprehensive two-country (USA and Sweden) chronic disease study. Although primary care services are different in the two countries (i.e. they reflect Sweden and US healthcare structures and processes), there are excellent health information and technology service features in both countries (e.g. e-prescribing) that seem to have been kept under wraps and can be relatively easily implemented by primary care centre heads fairly cheaply, which can improve chronic disease sufferer’s quality of life and lower healthcare costs.

Keith Hurst