Hurst, K. (2014), "Learning from our internal and external customers", International Journal of Health Care Quality Assurance, Vol. 27 No. 5. https://doi.org/10.1108/IJHCQA-12-2013-0143Download as .RIS
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Learning from our internal and external customers
Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 27, Issue 5
Do patients and relatives have different service-quality perceptions? And if they do, what can we learn and use to improve service quality? Sometimes we’re on thin ice when we ask patients to rate healthcare experiences because not all patients (owing to illness) are compos mentis during their healthcare, so relatives’ views can add significant insights. Panchapakesan Padma and colleagues in this issue explore Indian patient and family perceptions when they experience the same hospital treatment and care. The authors describe how patients and families have unique wants and needs and consequently view services differently. Indian families have extended healthcare roles when relatives are inpatients, compared to their western counterparts, so the authors’ findings may not be generalisable. Nevertheless, the study's methodological issues have currently in other countries.
Education and training (for extended role procedures) is underlined in an article we feature in this issue. As background, about one in five UK nurses is way from work at any time owing to sick, holiday, maternity, education, leave, etc. However, only about 2 per cent is study leave (e.g. post-basic education). Similarly, in-service education (e.g. in the ward) consumes only about 1.5 per cent of all ward staff time. These staff education and training processes and outputs are worryingly low considering the technological pace that healthcare practitioners face, epitomised in Panutsaya Tientadakul and colleagues’ paper on Thai nurses’ compliance with remote testing guidelines. Their observational study showed that nurses (doctors aren’t thought to be much different) point-of-care glucose testing techniques were flawed, with potentially harmful consequences for patients. Ward staff were also let down by poorly performing remote-testing equipment. Practice improved after experts helped and guided bed-side professionals and service managers to resolve the issues.
We were assured two decades ago that the paperless office was around the corner, but as I look at my office files, it's a myth; however, let's not give up, especially in healthcare. Sun Cheng Hung and colleagues grasped the nettle in their hospital by building pathology test results into their existing electronic patient records (EPR). The authors designed and implemented electronic reporting, which: forced clinicians to review test results and alert staff when results were being overlooked. Healthcare service efficiency and effectiveness improved markedly and were sustainable. Their paper is remarkably informative about engaging and learning from clinicians when introducing major change such as the new EPR modules; noting that merely imposing change upon frontline staff is doomed.
Learning from wasted time and resources, which drains healthcare budgets world wide, is another valuable teaching and learning strategy. Lean thinking (an efficiency and effectiveness improvement method drawn from the automotive industry) attempts to boost staff and patient value-added time. Kristin Thomas and colleagues in this issue evaluate how Lean thinking is practised in Sweden and compares Sweden's with UK and Denmark approaches. Lean approaches in the three countries, like diabetic retinopathy care in de-Kort's two-country study (précised above), were different and context sensitive. Nevertheless, standardised Lean thinking methods applied in different countries generate valuable teaching and learning opportunities, so sharing experiences nationally and internationally is valuable.
Developing services without “hearing patients’ voices” is increasingly passé in modern healthcare. Brandon Vachirasudlekha and colleagues underline growing consumer involvement practices when they evaluated an American HIV service, which was shifting steadily to multi-disciplinary care. Although patients rated their hospital's multidisciplinary HIV service highly and patients felt that medical and paramedical professionals contributed equally to their care, patients also highlighted service deficiencies that perhaps weren’t immediately obvious to service managers and practitioners. Continuing education for healthcare managers and practitioners, therefore, should include empirical evidence from consumer studies.
Susanne Maria Kristina Gustavsson's paper, in this issue, also features service users’ voices, but in an unusual context – mothers’ and fathers’ neonatal care perceptions. She triangulates neonatal service data gathered during observations, interviews and reflective accounts. A simple but effective R&D framework emerges, tempered by patients’ views – how neonatal service problems fall into simple, complicated and complex. Feedback to staff revealed that professionals were ignorant about their patients’ perceptions and recognised these studies’ contribution to service development.
Trends analysis is another valuable basic and post-basic teaching and learning exercise. José Labarère and colleagues, regular contributors to IJHCQA, re-worked a decades’ French patient satisfaction data – notably how patient perceptions change over time – presumably a response to service changes based on previous surveys. Unsurprisingly, hospital tangibles (e.g. meals and drinks) attract most attention although the patients’ technical-care views (e.g. staff-patient communication) also fluctuated over time. The authors’ paper is methodologically valuable – how data from almost 11,000 patients gathered over 11 years can be meta-analysed to generate new insights; notably, how confounding variables over time have to be controlled.
Many readers will have spotted how health service leadership has overtaken healthcare management as a key service-quality driver. Luis Mendes and Mabuildria Fradique in this issue build on what we know about leadership's general and specific influence on (Portuguese) nursing care – the largest healthcare staff group. The authors’ high-level statistical analysis underlines leaderships’ influence on nursing services, which justifies including the topic in under- and post-graduate education.