Keith Hurst (Independent Research and Analysis)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 9 March 2015


Hurst, K. (2015), "Editorial", International Journal of Health Care Quality Assurance, Vol. 28 No. 2. https://doi.org/10.1108/IJHCQA-12-2014-0116



Emerald Group Publishing Limited


Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 28, Issue 2.

Internal and external customers – the health service's heart

Dismissing patients' perceptions because they lack professional knowledge is a lost argument and the authoritative-submissive provider-user healthcare model dissolved years ago. So, as acceptance grows, it's inevitable that patient and public involvement (PPI) in health policy and practice will expand. For example, Katherine Pollard and colleagues, in this issue, explore how experienced service users can be involved in research management, which is now expected in the English NHS to the extent that it's likely that a grant application without a significant PPI element will be rejected. But what education, training and support do patients as co-investigators, advisors and collaborators need? The authors explored and evaluated existing PPI guidelines. They found out that PPI guidance is meagre and set out to determine, empirically, what patient support and training is needed. In a second, related, article Williamson and Hitchen (which follows-up an earlier IJHCQA article) examine in significant detail what it means for a service user to be co-researchers. The authors describe the (significant) contribution that service-user co-researchers make to research projects and also the strain/toll these roles have on all service collaborators. The implications for research staff emerge clearly. Indeed both PPI articles in this issue generate new insights into an important health and social care research development.

Delivering services to agreed standards as promised is common place in industry and commerce. Increasingly, key promises often appear in healthcare organisation banner statements - usually beneath their logos. Devolving this approach to department level, on the other hand, is a new venture or at least poorly investigated and reported. It's obvious that macro and micro customer promises have important roles. In this issue, Mohammed and colleagues concentrate on micro approaches. They describe how customer promises can feature in a department's quality assurance strategy, which, usefully, become a measurable standard. But what customer promises are most appropriate and how can they be measured? The authors show how easily department staff can be set up to fail if an unrealistic customer promise (i.e. seeing all patients on all arrival) is established. Consequently, the authors use an ISO standard to help formulate, implement and measure their customer promises - a fresh if not unique approach.

One way health service providers can be properly reimbursed for their services is basing payment on results (PbR) seems appropriate; possibly a win-win situation. However, measuring outcomes can be challenging. Barry Speak and colleagues take apart one outcome measure - the Health of the Nation Outcomes scales (HoNOS) in a mental health service context. Their deep analyses reveal worrying psychometric issues for HoNOS and its variants. Consequently, using high-level statistics, they construct a new variant deemed to be more robust. The authors are attempting to develop, refine and improve their new scale so that it can be extrapolated to PbR in other countries.

Pia Polsa and colleagues expand the variables known to influence healthcare quality by exploring hospital atmosphere (e.g. building fabric and working styles) in a multi-national settings. Their detailed statistical results reveal a relationship between hospital atmosphere and patient outcomes. Interestingly, their findings are relevant to developed and developing countries. Gathering and responding to patient perceptions is so important today that it is folly to ignore them, even though some analysts believe that patients don't have the knowledge and skills to judge treatment and care's technical side. But as Polsa et al., show, the patients' hospital atmosphere perceptions are a powerful service-quality driver and an important angle from which to measure and improve service quality.

How should a major health service redesign be planned and monitored? Are their quality assurance models on the shelf that can be adopted? These issues are IJHCQA's bread and butter, testified by several macro accounts that we have published in IJHCQA over the years. In this issue, we add to the portfolio by publishing Emanuelle Torri and colleague's article, which describes a large system-wide service review underpinned by the EFQM excellence model. The model helped the authors to locate relevant service redesign elements and the metrics for monitoring progress. The elements and metrics Torri et al., describe aren't probably the ones that immediately leap to mind, but they work. It's clear that the authors have embedded a robust and sustainable QA method; one that can easily be rolled out to other localities and countries. Torri and colleagues use a bottom-up approach to governance; a preferred method since service providers partly or wholly own and direct the product. But should we dismiss top-down methods as ways to improve service quality? That is, should being done to rather than done by be discouraged? Gyan Prakash in this issue examines a top-down approach to regulating India's rapidly expanding and evolving healthcare services. The author calls top-down and bottom-up the pull and push approach, which offers a different but useful perspective especially when they're examined from state and private healthcare angles. Dr Prakash underlines many healthcare service strengths and shortcomings in India that may only be resolved by a push approach.

Academic healthcare science networks are relatively new phenomenon (in the UK at least). It has always made sense for neighbouring hospital and university staff work together. Training placements for healthcare professionals, for example, is one collaboration that is well established in most countries and without doubt a win-win situation; so extending collaboration to joint research projects, sharing financial, personnel and IT resources is logical. But there are downsides; e.g., being burdened with a partner's hidden financial deficit. We know surprisingly little about hospital-university collaboration strengths and weaknesses - a gap that Mário Franco and colleagues help to fill in this issue. Their qualitative study unearths many positive aspects regarding hospital and university collaboration and few downsides. However, collaborating institution managers are highly sensitive to the partnership's upsides and downsides, and are remarkably less guarded and wary than readers might imagine.

Kay Downey Ennis

It's my sad duty to report that Kay, a former IJHCQA co-editor, died earlier this year after a lengthy illness. Kay was a long-standing peer reviewer for IJHCQA before joining the Editorial Advisory Board in the 1990s. Indeed, her hard work, dedication and contributions to the journal were so impressive that she was appointed co-editor in 2006 - a role she fulfilled until illness prevented her from continuing in 2013. Authors who Kay "looked after" and those professionals who collaborated with Kay will remember her as a charming, approachable and highly supportive publishing expert. She will be sorely missed by all IJHCQA staff and our condolences go to her family and friends.

Keith Hurst