Editorial

Citation

Hurst, K. (2015), "Editorial", International Journal of Health Care Quality Assurance, Vol. 28 No. 7. https://doi.org/10.1108/IJHCQA-06-2015-0075

Editorial

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 28, Issue 7.

Equitable and inequitable healthcare

Most seasoned healthcare researchers know that Julian Tudor Hart’s inverse care law (those with the greatest need receive the fewest resources), postulated 40 years ago, is alive and kicking. It’s encouraging, therefore, that Jonesmus Wambua and colleagues in this issue, not only explore slum residents’ healthcare needs and services but also recommend ways for managers to improve slum area services. Slum resident service users were asked for their perceptions about treatment and care they received and data were exposed to rigorous statistical analysis. Factors that influence patient satisfaction, unearthed by the authors, may surprise our readers. Nevertheless, customer feedback based solutions; e.g., more resources to reduce waiting times and better public transport, are unfortunately costly but essential to improve welfare among a deserving population.

In a second equality-related paper in this issue, changing health service policies are shown to have remarkable knock-on effects on healthcare efficiency and effectiveness. Augustine Adomah-Afari, also from an equality stance, looks at how Ghana’s changing healthcare system (now a mutual and health insurance based provision) is negatively affecting provider reimbursement and how providers are re-cutting their cloth accordingly. Although providers are desperately trying to maintain high-quality services, they appear to be swimming against the tide.

The haves, on the other hand, with sufficient money, can expand their options and choose, for example, medical tourism (travelling to another country for healthcare), which is big business. Unsurprisingly, healthcare managers see the monetary value in attracting patients from other countries. They also believe that overseas customers receive a superior service not least because providers often have the most recent technology for treatment and care. However, there are concerns that patients developing complications, or requiring complex follow-up care after receiving planned treatment in another country, leave healthcare staff in the patient’s home country to correct mistakes and treat complications that might not have happened had the patient been treated at home. Consequently, medical tourism is a ripe research-topic and Tieh-Min Yen and colleagues in this issue add significant intelligence to what we know about Taiwanese medical tourism. Their article has added value: they tell us more about medical tourism structures, processes, outputs and outcomes; and they adapt SERVQUAL and fuzzy analysis as a medical tourism performance measure. There probably aren’t many surprises in their results, but at least they are generating evidence-based medical-tourism oriented guidance.

Pia Jansson von Vultée’s article on sickness-absence rates in this issue is startling – not only the high sickness rates in her country but also its economic impact. Understanding the reasons behind sickness absence from work and more importantly, offering solutions to improve attendance, seem fundamental. Readers may be surprised by the main issues identified by the author (who used rigorous statistical techniques) – but they make sense. More importantly, they offer tangible challenges that employers must address.

Keeping the workforce’s knowledge and skills fresh is crucial if patients are to receive the most efficient and effective care. Education is also a variable that indirectly affects sickness absence – vis-à-vis Pia Jansson von Vultée’s article. However, around one in five healthcare professionals are away from the “bedside” at any time owing to holidays, sickness, maternity, compassionate and study leave – a significant drain on the workforce. Study leave contributes a significant amount to time out from the service. Elements explored by Farhan Vakani in this issue, therefore, include making continuing medical education programmes efficient for provider and effective for the recipient. The author describes some interesting structures and processes, which, otherwise, may not be immediately apparent to the reader.

Dental service article submissions to IJHCQA are growing – clearly an active research field. Authors seem to be interested in two main dental service quality assurance issues: developing measures and highlighting the services that improve patient satisfaction. In this issue, Mohammadkarim Bahadori and colleagues report a large and novel dental service quality study in Tehran. Using rigorous statistical techniques, they revise Parasuraman et al.’s well-tried and tested patient expectation and satisfaction method. The authors’ belief that understanding patient perceptions and improving dental services using patient views will give them a marketing advantage in a competitive industry, is well argued.

Alarming situations involving antibiotic resistant microbes forced healthcare staff to focus on preventing rather than treating hospital acquired infections. The contamination’s impact on patients’ quality of life and the economic costs that infections generate makes the topic among the most important healthcare agenda items today. It seems odd, therefore, not to broaden the hospital infection control team to include facilities management staff who, for example, are responsible for controlling infection laden dust during building maintenance. Stanley Njuangang and colleagues, in this issue, take a multidisciplinary approach to defining infection control criteria and related performance measures. The infection control specification’s breadth and depth will surprise subject ignorant readers like me. They also may be surprised about the weak consensus among staff in different teams. Nevertheless, using Delphi exercises to achieve a consensus, the authors construct an infection control specification that managers and clinicians elsewhere will find valuable. Their carefully described Delphi approach is amenable to like-minded quality assurance topics.

Improving healthcare efficiency by screening depressed patients (a common reason for seeking medical help) using a two-stage process, has merit according to Sohaib Aleem and colleagues in this issue. Owing to growing demand for depression treatment and care, and the multidisciplinary teams involved, however, depression screening processes needed to be more efficient and effective. The authors, using Lean and Six Sigma methods, rigorously identified the flaws in their existing screening service before redesigning the structures and processes and re-measuring depression screening outputs. The next logical step, therefore, is to assess the new screening service’s effect on outcomes.

Keith Hurst