Downey-Ennis, K. (2008), "Editorial", International Journal of Health Care Quality Assurance, Vol. 21 No. 4. https://doi.org/10.1108/ijhcqa.2008.06221daa.001
Emerald Group Publishing Limited
Copyright © 2008, Emerald Group Publishing Limited
Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 21, Issue 4
In this issue we are privileged to publish papers from an international perspective that address different aspects of healthcare that affect and influence the patient care delivery process and the outcome of care.
Bakar et al. inform readers of a methodology used on a widespread scale in the marketing discipline, SERVQUAL, which was adapted for use within a network of hospital environments on specific service dimensions and who conclude that the instrument was extremely useful in measuring the functional quality of the hospitals assessed. The perceived scores of the patients were higher than expected for an ordinary hospital; however, they were lower than expected for a high-quality hospital. The authors found that, in fact, young patients had a high expected service score gap and a low adequate service score difference while highly educated patients had a high expected service score difference, and uninsured patients had a low adequate service score difference. This paper clearly informs the reader(s) that the patient of the future will be more discerning when it comes to quality measured from service level dimensions.
Abor and Bouwer examine empirically the controversial topic of waste management practices within a South African hospital. This paper was developed as a consequence of mounting problems in respect of medical waste being disposed incorrectly resulting in the accidental exposure of innocent children to potential danger. The study concluded that a major hospital does not first, quantify medical waste or segregate infections and non-infectious materials; however, it is of interest that the authors note that separation of municipal and medical waste is satisfactorily performed. The authors give several recommendations for hospitals to employ in respect of best practice waste management. The strategies outlined can be used by healthcare institutions internationally and will assist organisation to ensure that they uphold their “duty of care” in respect of waste management practices. This paper is timely given the impetus the World Health Organization has given to the management of healthcare waste in that it requires increased attention and diligence to avoid the substantial disease burden associated with poor practice, including exposure to infectious agents and toxic substances.
Sajid describes health related quality of life tools (HR-QOL) to measure and assess the changes in the health status of patients. This paper concludes that using these tools has now become the most desirable evaluation tool to quantify the real impact and success of surgical or medical interventions and the author suggests and argues that like tools should be developed for each ailment for accurate estimation of the overall success of an intervention. Given the multidimensional construct of these tools referring to the patient’s perceptions of the impact of disease and treatment on their physical, psychological and social function and wellbeing is indeed a crucial element in the overall evaluation of all healthcare interventions. A further important element is the incorporation of HR-QOL in both the medical school curriculum and in the continuous professional development programme for clinicians.
Vivay et al. describe a useful method to improve the patient journey when being admitted for elective surgery and which has the potential to reduce costs overall to the hospital. While not novel the concept is described from the experience of a dedicated unit for elective surgery with same day admissions. This paper gives an example of the efficiency that a dedicated unit can attain in respect of timely discharges.
Renshaw et al. challenge the impact that incident reporting has had on improving patient safety and suggest that incident reporting will fail to bring any tangible benefits and that the reliability of health care processes remains low. The authors conclude that the reliability of health care processes would need to substantially improve before an incident reporting system can have a meaningful impact on patient safety. The authors argue that the quantum leap will not be facilitated by incident reporting alone but will only occur through the systematic application of process redesign and quality improvement. This proposition would suggest that the newer methodologies transferring from the business world would be more than an appropriate tool to use to ensure that patient safety is improved for example, Six Sigma.
Parke and McCusker demonstrate the benefits and results of a consensus development activity for Emergency Departmental care and services of older adults which reflect the consensus of an interdisciplinary, international panel of 20 experts in Emergency Department care and service for older adults, validated by an external review panel.
These policy recommendations echo themes previously reported in the literature, but which have lacked evidence-based support. The authors strongly recommend that there is a need for further research to extend the evidence-based support for policy recommendations, which in turn may lead to policy change or a change in the recommendations if research does not support the hypothesized benefits of the proposed interventions.
Finally, Fecho et al. describe the results of a one-year study of the incidence of, and risk factors for, peri-operative adverse events during in-patient and out-patient anaesthesia-assisted procedures. They conclude that in-patient and out-patient surgical procedures differ in the incidence of peri-operative adverse events, and in risk factors, suggesting a need to develop separate monitoring strategies. Their results add to the sparse literature on the incidence of peri-operative adverse events amongst in-patient surgical procedures. The findings of this study extend earlier studies by determining rates of adverse events amongst out-patient procedures as well. While their results point out that rates of peri-operative adverse events are generally lower for out-patient procedures, they suggest the need to maintain close out-patient patient monitoring and to be especially aware of the potential for airway complications.