Editorial

Citation

Downey-Ennis, K. (2012), "Editorial", International Journal of Health Care Quality Assurance, Vol. 25 No. 8. https://doi.org/10.1108/ijhcqa.2012.06225haa.001

Editorial

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 25, Issue 8

It is with pleasure that I contribute to this issue of the IJHCQA and bring to the readers several diverse papers all of which have potential learning for readers and a means to transfer that learning within their own organisations. The papers span across a wide area of healthcare from safety to the development of guidelines and the means by which to garner patient satisfaction within healthcare systems. I hope the readers of this issue will pick up many new and novel ideas to use within their work environment.

A retrospective medical record review was undertaken by Verelst and colleagues from the Belgium healthcare sector with the overall aim being to assess the reliability of an in-depth analysis carried out by two separate review teams on five selected adverse events in acute hospitals. The teams reviewed the five selected indicators, which include pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator-associated pneumonia and postoperative wound infection. Differences between the two teams were evident with team 1 concluding that a high probability for healthcare management causation was responsible in 95.5 per cent of adverse events, which is in contrast to team 2 who concluded that the figure for this variable was in fact 38.9 per cent. Likewise, high-preventability was concluded in 83.1 per cent of cases by team 1 versus 51.7 per cent by team 2. Other significant differences between the two teams determining the degree of disability were also found for pressure ulcers, postoperative pulmonary embolism or deep vein thrombosis and postoperative wound infection, but no significant differences between the two teams were found for postoperative sepsis and ventilator-associated pneumonia. Clearly from the findings, and which the authors conclude that judgment of adverse events on causation, preventability, and disability may be susceptible to considerable variation in interpretation due to the implicit method of evaluation. Furthermore, incomplete medical records and heterogeneity in the background of reviewers can also influence the medical record review process therefore such evaluations should be interpreted with caution. Thus, the findings of this paper really highlight the importance of ensuring objective transparent comparability when attempting to review healthcare records.

The paper from Chaiter et al. inform the reader about a unique computerized control system that is being introduced to assess and manage medical processes of the medical committees in the Israel Defense Forces. The system consists of three main components: a specific status indicating the processes in each file, an appointment system, and an internal computerized system that uses a magnetic card for the regulation of the local waiting lists. The authors conclude that the combined computerized system improves the control and management of the medical processes and informatics, from the point-of-view of both the patients and system operators. The computerized system allows efficient follow-up and management of medical processes and informatics, led to a better utilisation of human and medical resources, and becomes a component of the decision making by the system operators and the administrative staff. Such system could be used with success in clinics, hospitals, and other medical facilities. Implementation and automation of medical regulations and procedures within the computerized system make the latter play a key role and serve as a control tool during the decision-making process.

Seeking to improve patient satisfaction in an outpatient setting is the topic under review by Aggarwal et al. from North India. Their aim was to monitor both the quality of care and patient satisfaction with a view to implementing continuous quality improvement. They utilized a cross-sectional hospital-based study comprising of doctor-patient interactions and exit interviews. They found that at exit almost 90 per cent of patients were satisfied with the care received, over 90 per cent of patients indicated that they were satisfied with the facilities offered and with the doctor-patient interaction process, a smaller percentage 76 per cent were satisfied with the quality of their prescriptions, however, significantly lower numbers 43 per cent indicated their satisfaction with the signage within the facility under study. The methods and tools used were found to be simple and extensive enough to capture information at multiple service points, but a salient point and limitation of the study is that the authors did not use the Likert scale, which is identified as the standard practice to measure patient satisfaction. However, the items used within this study were useful and the survey methodology was comprehensive, replicable and simple to use, and were on topics identified within the existing literature.

Lovaglio et al. give the readers the findings of a complex review, which aims to furnish international data on the occurrence of clinical errors by type and consequence to patients in the Lombardy region of Italy, and to use claims data and clinical administrative data as a risk management strategy to highlight problematic, error-prone health structures in the region. The impetus for their review came from a reported increase in claims against health structures within Italy during a ten-year period, with a notable increment in the trend towards physician responsibility for claims resulting in a trend in the insurance market, introducing increasingly stringent practices regarding structural and managerial risk, leading to the need to develop instruments to drastically reduce the occurrence of errors of an organisational/medical nature. The authors used regression tree-based techniques and report two salient findings, first, that empirical evidence supports the connection between context indicators and the incidence of clinical errors, and second, that surgical errors occur more frequently in unspecialized health structures hosting low percentages of patients with oncologic or cardiologic diagnosis. Two practical implications arise from these empirical findings, there is little evidence that claims related to surgical type or errors resulting in patient lesion were sufficiently concentrated to permit negligence reduction strategies targeted at health structures, and the evidence of significant causal relationships between error occurrence and accreditation-type measures suggests that available administrative data may be effective in prospectively determining situations in which clinical errors typically occur in the regional context, consequently aiding in the identification of priority intervention areas. While there appears to the need for systematic improvement in the measurement of patents safety the authors argue that the approach utilised provides a cost-effective method of receiving timely, relevant information, offering regional stakeholders the opportunity to gain a deeper understanding of the problematic areas in clinical risk assessment.

Blozik reports on a worldwide study of the simultaneous development of guidelines and quality indicators. The aim was to examine how official bodies, health care organisations, and professional associations deal with the absence of a methodological gold standard for the development of clinical practice guidelines and quality indicators and to ascertain what procedures were used. The methodology used was a-web based survey among 90 organisational members of the Guidelines International Network (G-I-N) representing 34 countries. While a response rate of 59 per cent was achieved just 24 organisations were included in the final analysis. It is disconcerting that 41 per cent of this international network did not respond. The results indicated that there was a broad variability in the approaches and methods used to develop quality indicators and guidelines. While various strengths were found of concern from the results is that piloting or evaluation of the procedures is almost completely missing and furthermore respondents reported that indeed the procedure utilised could be more rigourous.

The last paper in this issue is quite interesting and a very topical subject, which is presented by Ezzat on obesity among adult females in Egypt. The aim of the study, which was undertaken through a random sampling methodology, was to investigate the use of anti-obesity drugs, and is reported by the author as being the first report of the pattern of using anti-obesity drugs in Egypt. The findings indicate that almost 20 per cent take medication while dieting and that physicians were the main source of advice on anti-obesity medication, which in the main, are those that stimulate metabolism. Various side effects were noted, however the findings indicate that not all comply, but those that did comply, almost 50 per cent experienced weight loss. Of note, older females and those with BMI>35 were more keen to seek advice from the physician, were more likely to comply fully and reported the highest rate of weight loss. The use of anti-obesity drugs was highest (44 per cent) among university graduates compared to 24.8 per cent among females with limited education.

Kay Downey-EnnisCo-Editor