Synthesising the QA literature

Citation

Hurst, K. (2012), "Synthesising the QA literature", International Journal of Health Care Quality Assurance, Vol. 25 No. 5. https://doi.org/10.1108/ijhcqa.2012.06225eaa.001

Synthesising the QA literature

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 25, Issue 5

Criminal justice policy makers and operational staff go to some lengths to help ensure patients are fairly treated. In the European Community, where cross-border treatment and care is increasing, it is even more important that patient services are transparent and fair. However, single-country, let alone European-Community, legal systems are complex and as Diego Fornaciari and Stefan Callens explain (and help to unravel) in this issue – statute and case law are not complete. What does the law say, for example, about health service competition and markets – especially important when patients, unlike the commercial-sector choices they make, are handling life and death decisions often with less technical knowledge about treatment and care in their own country let alone another? So does healthcare require unique competition and marketing laws? For example, if healthcare providers want to merge, do they need approval from the competition authorities. It is clear from the authors’ arguments that systematic and transparent multi-country guidance and regulation is needed.

The IJHCQA, with other QA-oriented journals, generate significant outputs each year, which mean that the QA literature is growing and changing. Unsurprisingly, new QA models are emerging and it is harder for health and social care professionals to remain up-to-date. Consequently, what is needed is QA-oriented researchers and authors to periodically and systematically review new QA publications before synthesising their essence into single articles. In this issue, Mohammed Azam and colleagues: unravel recent QA publications; bounce emerging points off the old literature; generate an integrated service-quality model; before validating the new model among coal-face staff, which theoretically, should improve the model’s applicability. Their aim is laudable – to use a homogeneous model for improving service quality and maintaining or lowering costs. The authors make an important point – that business and commerce quality parameters are not suited to welfare services and should be applied carefully. A bonus is that the authors provide neatly summarised tables, which complement their commentary, so that readers can quickly locate relevant publications.

Quality assurance research and development (R&D) is resource intensive. Researchers are acutely aware that QA R&D data collection by health and social care professionals is burdensome especially when they may not have enough time for patient care. It’s important, therefore, that researchers and authors like Oscar Firbank in this issue explore QA methodological efficiency and effectiveness to help relieve health and social care professionals’ data collection burden. He chooses to evaluate an important (and growing) service, for vulnerable, older people, who deserve the best care we can offer. Readers will find the author’s substantive and methodological literature review helpful if they are contemplating setting up QA reviews. Surprisingly, the author and his research team opted for a qualitative approach, which is more expensive and time consuming. However, looking at user insights (as quotations) in the article is incredibly helpful – the “data mining” argument However, the author reminds us that smaller agencies are likely to need significant external support if focus-group interviews are the recommended method for QA work in the residential- and home-care sector.

Developed countries’ healthcare expenditure is eye-wateringly high and growing, so transparent performance indicators (PIs) are crucial for keeping stakeholders informed about value for money. Artie Ng and Peter Yuens in this issue, therefore, explore how Hong Kong Health Authority (HKHA) managers developed and used their PIs. The authors review the PI best-practice literature and they use the balanced score card (BSC) as an operating framework for reviewing performance evaluation systems. After scrutinising the HA’s official documents they conclude that finance-oriented PIs predominate and that service quality occupies a poor second place despite serious service quality criticisms in the media and that service quality targets were absent. Interestingly, they suggest that the HKHA management structure and governance systems may also be to blame. They conclude that HKHA health service efficiency and effectiveness can best be monitored and improved if an integrated, BSC-driven PI system is built. Their ideas about balancing lead and lag PIs (defined in the article) has merit.

Despite hard, strenuous and demanding work faced by most healthcare professionals, it seems that little attention is paid to healthcare ergonomics. Nurses, for example, face challenging work 24 hours a day, 365 days a year and in some environments walk up to seven miles a day, a distance that could be lowered if equipment they need is conveniently placed. Consequently, the literature on healthcare building design is growing. Staff welfare is important but if working environments lead to treatment and care errors then the topic deserves more attention. Consequently, Habib Chaudhury and colleagues take a comprehensive look at nurses’ working environments and medication errors. The authors focus on residential and care homes, which arguably are more prone to medication errors owing to prescription complexity. Their literature review shows how complex variables inter-twine to create the working environment “perfect storm”. They triangulate three vital data sets to generate the most important medication error issues. Unsurprisingly, poor medication-room design and interruptions by staff, patients and relatives are big factors that heighten risk. Consequently, it seems that optimum room design is unlikely to resolve medication-error risks, so the authors make several policy and practice recommendations, which are not always expensive to implement.

Significant time, effort and money go into educating and training our clinicians. But considering healthcare workforce cost and quality, do we put enough effort into selecting and appointing them the right clinicians? Christopher Chan and his colleagues in this issue explore medical selection and appointment structures, processes and outcomes. Appointing doctors fit for purpose and capable of working in a team, for example, is not an easy process; moreover, owing to the clinician’s pivotal management and leadership role, finding a clinical leader with vision is vital. The authors point out that implications falling out of poor appointments can hit the headlines, while good appointees just get on with the job. The authors’ experiences and literature review clearly show the problems and pitfalls facing appointing panels. Fortunately, they provide clear and helpful guidance to help panel members short-list the right people and test all the attributes required by the job holder. Moreover, their policy and practice recommendations suit all clinical appointments, not just medical practitioners.

Fortunately, patient complaints have moved from something feared and sometimes reviled or brushed under the carpet to more positive stances where complaints are handled like treasures, and used to improve service quality. A tough challenge though is developing systems for handling complaints; for example, do we appoint a dedicated officer for handling them, with its related costs, for what may be only a few incidents each year (in smaller organisations). Sophie Hsieh (a regular contributor to IJHCQA on this topic) looks at complaints handling systems. Her literature review leads to a three-dimensional model to help us think and act on patient complaints so that services are improved. Each dimension is described, explored and applied to health services. We have come to learn that service quality policy and practice are complex, several inter-twining variables are addressed by the author. One intriguing and important finding emerging from her review is that any strategy has to be patient- and staff-focused; concentrating on one side is likely to fail.

Keith Hurst