Needs-led QA publications

Citation

Hurst, K. (2005), "Needs-led QA publications", International Journal of Health Care Quality Assurance, Vol. 18 No. 4. https://doi.org/10.1108/ijhcqa.2005.06218daa.001

Needs-led QA publications

One of the benefits of my triple role as researcher, lecturer and journal editor is the level of immersion in QA theory and practice that I am fortunate to experience. A recent experience drove home this point, when a group of senior health and social care managers undertook a QA module forming part of their Master’s programme at Leeds University. I have written before about their wide and deep perceptions of health and social care quality issues (IJHCQA, Vol. 15 No. 1, 2002, pp. 5-6), but this time, however, there seemed to be a shift in their learning needs. It was clear that these managers and practitioners at the coalface are looking for two main features in QA publications. First, they are interested in expositions of seminal QA models (such as Donabedian, EFQM, etc.) from different perspectives, ideally exploring a QA model’s practical application to health and social care. Second, they want to know what is round the corner. Their self-preservation is unsurprising since they do not want to be caught unawares by the numerous statutory assessors who visit them in their workplaces. For example, the Balanced Score Card (BSC), despite being “sold” heavily in the UK and in other countries, for example, was not universally understood by the Master’s students even though important health care quality “accreditation” processes are BSC-based. Clearly, there are important messages for IJHCQA and related journal authors and editors. Reassuringly, it is good to see from a content analysis of several hundred recent QA publications that a wide-ranging set of QA models underpinned the articles. Incidentally, the front-runner QA model was TQM/CQI, followed closely by EFQM and BSC.

So how do articles in this journal issue meet the students’ needs? Björkman and her colleagues in Sweden write about a topic that is not often encountered in QA journals – drugs and therapeutics committee members’ perceptions of patient centred services and their relationship to drug prescribing efficiency and effectiveness. Unusually also, they employ a powerful but little used qualitative research design (phenomenography) to interpret informants’ perceptions. Naveh and Stern, in their article, revisit an intractable QA issue – healthcare cost and quality. Their underpinning theoretical framework (CQI) is the natural choice, which is explored using a robustly constructed before-and-after experimental research design. Balding’s longitudinal Australian survey-based study also explores the impact of CQI on hospital processes and outcomes. Her unique selling point is the extent to which middle managers sustain their quality improvement programmes. Balding’s analysis generates fascinating insights into a professional group who are (unfairly) criticised in the British media (and possibly in Australia too) as a less relevant NHS workforce (Health Service Journal, 2004). Grone and his WHO colleagues set the scene for other articles in this issue as they revisit another QA stalwart – quality standards and their pride of place in the quality spiral. However, this time the topic (health promotion in a pan-European context), if not unique, is rarely tackled in the QA literature. The writers show that careful quality standards preparation and testing pays dividends. Hughes clarifies the difference between clinical/organisational audit and research and development – both highly relevant QA activities. The reasons why audit is weaker than R&D, owing to psychometric flaws and other limitations, are set out before he recommends ways of strengthening this important second step in the quality spiral. Hsieh and her Australian colleagues take a close look at patient complaints and how Taiwanese hospital managers and practitioners respond and learn from them. Not only are long-standing problems underlined but also new insights are generated. Finally, Juul et al., researching and writing about Danish health care, explore a quality assurance technique (care pathways) that was expected to take off a few years ago. Specifically, variance analyses, incorporated into pathways, are an inbuilt and efficient mechanism that underline why and when patient care deviated from “best practice” interventions set down in the pathway. In the case of post-operative patients with diabetes mellitus, the authors’ multi-centre randomised controlled trial shows, among other things, the relationship between care pathways, quality improvement and accreditation, and vice versa.

Returning to our postgraduate students – clearly these authors have at least addressed one of the students’ needs and in some cases both. Moreover, analysis and synthesis by our readers should allow them to extrapolate from the writer’s context to their work setting.

Keith HurstNuffield Health and Social Care Policy Group, Health Sciences and Public Health Research Institute, Leeds University, Leeds, UK