Evidence-based healthcare policy and practice

Citation

Hurst, K. (2013), "Evidence-based healthcare policy and practice", International Journal of Health Care Quality Assurance, Vol. 26 No. 5. https://doi.org/10.1108/ijhcqa.2013.06226eaa.001

Evidence-based healthcare policy and practice

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 26, Issue 5

Pharmacy service staff have moved-on from their stereotypical role – merely dispensing medications. They are now integral community-based healthcare service providers by advising patients about illness and treatment options. Hospital outpatient based pharmacies also are the shop window, so it seems logical that we understand pharmacy service users’ expectation and satisfaction. It’s possible that satisfied pharmacy-service users are more likely to comply with medication regimes. In this issue, therefore, Syed Asif Raza and colleagues explore middle-east pharmacy service structures, processes and outcomes in considerable detail. They treat us to a thorough literature review that covers substantive and methodological pharmacy service issues. Their data reduction techniques identify five pharmacy service issues that are important to patients and generate results that service managers need to address and monitor.

Separately, Swee Goh et al., and Kathleen Abrahamson and colleagues in this issue explain that patient safety is a fast-growing research topic and among the top service-quality issues facing healthcare professionals. Quite worrying US and UK research shows to what extent untoward incidents harmed and in some cases killed patients. Monitoring, reporting and preventing untoward incidents needs to take priority because healthcare is probably lagging behind other safety-conscious industries such as aviation. However, Swee Goh et al., point out, that empirical literature is lacking partly owing to weak understanding about what patient safety culture structure, processes and outcomes and outputs mean. Despite patient safety’s importance, we do not appear to have much empirical data about issues that shift organisation culture from a blame- to a learning-oriented one. The authors therefore offer a conceptual framework based on patient safety and learning organisation literature in which patient safety theorists and practitioners may act. In the second, related article, Kathleen Abrahamson et al., focus on nurses (the largest healthcare-professional group) who also have the most bedside contact of all healthcare professionals. Their service perceptions, therefore, are a useful barometer and perhaps provide the strongest hints where improvement efforts should lie. The authors generate new insights into what variables influence nurses’ perceptions and what drives them to maintain patient safety. Their literature review clearly underlines the topic’s complexity; so to increase our understanding and insights, the authors surveyed experienced nurses in several hospitals using an established questionnaire before comparing nursing perceptions within and between-units. The authors note that nurses’ perceptions vary between more so than within hospitals, which implies that broader organisational structures and processes are the bedrock. Nurses’ work experience is a major influencer since there is probably a feedback loop among workers in the same team regarding experience, staff retention and safety commitments.

The “global village”, brought about by readily available and cheap international transport means that more discerning patients look beyond their country’s boundaries for healthcare. Medical tourism therefore is gaining momentum – data, especially service providers’ opportunity costs, summarised by Michael Guiry and colleagues in this issue are staggering. However, the extent to which overseas services meet medical tourist expectations is unknown. There seems merit and value therefore measuring actual and potential medical tourists’ views. The authors summarise a comprehensive literature-review before adopting SERVQUAL as their main evaluation method. Readers may not be surprised to learn that actual tourists’ perceptions are different from potential tourist’s and there are differences between actual tourists’ expectations and satisfaction. Consequently, the authors generate a useful framework that helps managers and practitioners explore medical tourism. The authors’ preliminary findings have major marketing implications for out-of-country service providers.

Evidence-based practice (EBP) has gained a significant hold in the last 25 years. The guidelines that expert groups produce have significant service efficiency and effectiveness implications. Linking EBP to sophisticated web-based software further strengthens EBP’s value to busy practitioners. Eric Bloomfield and colleagues, in this issue, describe an evidenced-based clinical decision support system (CDSS) for an important, life-saving, expensive and risky treatment – internal cardiac defibrillators (ICD). Their rationale for creating the software is easily justified by the volume of patients who could benefit from ICDs and indeed those would not, and the staggering cost implications for getting the decision right. Internal cardiac defibrillators treatment outcomes are not well known, although up to 20 per cent of implanted devices may fail, so the area is ripe for research. The authors describe a comprehensive and well thought-out protocol to set up and monitor an ICD CDSS. Moreover, their project, if successful, could easily be rolled out to other treatments – a promising developmental area.

Readers will know from IJHCQA’s content that articles covering the customers’ voice are gaining importance. In this issue, Margareta Johansson and colleagues, take the notion further by exploring new and repeat fathers’ post-natal care perceptions – a topic, they remind us, that is not commonly explored in the literature. There is a risk, therefore, that fathers may be sidelined during the birth, which, conceivably, could have detrimental effects on the family. Using a large and representative sample, and a strong design, the authors noted that while most fathers were satisfied with post-natal care, there were significant service-deficiencies, which did not always agree with dissatisfying factors the authors found in the literature. Communication, follow-up care and the SERVQUAL “tangibles”, for example, fell down. However, respondents’ perceptions were birth-type and care-context sensitive. The authors also highlight some important methodological considerations; for example, their longitudinal study (lasting one year) meant there is a risk that follow-up questionnaires could be sent to parents experiencing miscarriages or premature death – at least distressing and possibly inflammatory. Consequently, several, strong policy and practice recommendations emerge from the study.

We are always pleased to receive manuscripts where authors “take stock”; in this case, the main patient satisfaction variables that we should measure. In this issue, Roger Atinga and Aaron Abuosi do several important things in Ghana’s developing health services. First, they remind us about the burgeoning patient-perception articles in the literature. Second, they compare Ghana’s hospital patient expectations and satisfaction before they use inferential techniques to reduce patient satisfaction concepts similar to those found in the SERVQUAL approach. Unlike SERVQUAL, the authors reduced their data to four main components. The authors note that Ghana’s health services are erratic and that the dimensions they generate will help monitor the country’s health service quality improvement initiatives.

Keith Hurst