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The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A & E) unit of a Maltese hospital.

The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients’ requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A & E unit of the hospital.

The major and related problems being faced by the hospital under study were overcrowding at A & E and shortage of beds, respectively. The combined framework ensures better A & E services and patient flow. QFD identifies and analyses the issues and challenges of A & E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A & E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A & E unit.

The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives.

Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A & E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.

The purpose of the paper is to develop an integrated quality management model, which identifies problems, suggests solutions, develops a framework for implementation and helps evaluate performance of health care services dynamically.

This paper uses logical framework analysis (LFA), a matrix approach to project planning for managing quality. This has been applied to three acute healthcare services (Operating room utilization, Accident and emergency, and Intensive care) in order to demonstrate its effectiveness.

The paper finds that LFA is an effective method of quality management of hospital‐based healthcare services.

This paper shows LFA application in three service processes in one hospital. However, ideally this is required to be tested in several hospitals and other services as well.

In the paper the proposed model can be practised in hospital‐based healthcare services for improving performance.

The paper shows that quality improvement in healthcare services is a complex and multi‐dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in health care delivery and corrective measures are taken for superior performance, there is an absence of an integrated approach, which can identify and analyze issues, provide solutions to resolve those issues, develop a project management framework (planning, monitoring, and evaluating) to implement those solutions in order to improve process performance. This study introduces an integrated and uniform quality management tool. It integrates operations with organizational strategies.

The purpose of this paper is to develop an integrated quality management model that identifies problems, suggests solutions, develops a framework for implementation and helps to evaluate dynamically healthcare service performance.

This study used the logical framework analysis (LFA) to improve the performance of healthcare service processes. LFA has three major steps – problems identification, solution derivation, and formation of a planning matrix for implementation. LFA has been applied in a case‐study environment to three acute healthcare services (Operating Room utilisation, Accident and Emergency, and Intensive Care) in order to demonstrate its effectiveness.

The paper finds that LFA is an effective method of quality management of hospital‐based healthcare services.

This study shows LFA application in three service processes in one hospital. This very limited population sample needs to be extended.

The proposed model can be implemented in hospital‐based healthcare services in order to improve performance. It may also be applied to other services.

Quality improvement in healthcare services is a complex and multi‐dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in healthcare delivery, they are not without flaws. There is an absence of an integrated approach, which can identify and analyse issues, provide solutions to resolve those issues, develop a project management framework to implement those solutions. This study introduces an integrated and uniform quality management tool for healthcare services.

The issue of “out of hours” provision of primary care services by family doctors has excited particularly marked debate in the UK. This article considers the implications for this debate of results from a project designed to elicit the views of users of out of hours primary care provision. Focus groups were used to gauge definitions of “out of hours” services, factors governing the use of some services rather than others and influences on the evaluation of different options. The centrality accorded by patients to the social dimensions of a more “traditional” relationship with family doctors was central to the selection and evaluation of alternative provision. Any significant initiative in the reconfiguration of local health care services might thus be regarded as much a social enterprise as a technical challenge based on the most equitable and efficient application of resources.

Key‐safes have become a backbone of community care, enabling formal carers to access the homes of people receiving routine homecare services or emergency services such as telecare. People need to have confidence in their security features if they are to wholeheartedly accept the need for keeping a key available in a safe at all times. A project was undertaken to compare the features of a number of popular key‐safes on the market in the UK, considering security as the most important factor but also including the subjective opinions of a panel of relevant stakeholders on issues such as aesthetics, value for money and usability. It was found that the newest device on the market, the Supra C500, was significantly more secure than its rivals, and was the only model in our trial to satisfy domestic security standards for front doors. It is proposed that all key‐safes should be required to achieve a national standard for resistance to forced entry before they can be considered for use as part of a homecare or telecare package in the UK.

Owing to NHS managers’ preponderance with financial issues, the present Government made improving the quality of health services a statutory requirement in 1997. In this article, one means of improving the quality of health services, clinical governance, is examined in detail before some issues related to its implementation are described. The Trust’s A&E services, the context for interpreting and applying clinical governance, are briefly described before introducing a force‐field analysis that demonstrates the different elements when changing services broadly and clinical governance specifically. The final section concentrates on implementing and improving clinical governance in A&E departments.

The purpose of this paper is to describe and explain a clinician‐led improvement of a hip fracture care process in a university hospital, and to assess the results and factors helping and hindering change implementation.

The paper has a mixed methods case study design. Data collection was guided by a framework directing attention to the content and process of the change, its context and outcomes.

Using a multiprofessional project team, beneficial changes in the early parts of the care process were achieved, but inability to change surgical staff work practices meant that the original goal of operating patients within 24 hours was not reached. After three years, top management introduced a hospital‐wide process improvement programme, which “took over” the responsibility for improving hip fracture care.

A clear vision why change is needed and what needs to be done, which is well communicated by a respected clinical leader, can motivate personnel, but other influences are also needed to bring about change. Without a plan agreed and supported by top management, changes are likely to be limited to parts of the process and improvements to patient care may be minimal. These and other findings may be applicable to similar situations in other services.

This case study is an illustration of both the strengths and the weaknesses of a “bottom‐up, clinician‐champion‐led improvement initiative” in a complex university hospital.

Forensic nursing is a term applied to nurses working in many different areas of clinical practice, such as high security hospitals, medium secure units, low secure units, acute mental health wards, specialised private hospitals, psychiatric intensive care units, court liaison schemes, and outpatient, community and rehabilitation services. Rarely is the term defined in the general literature and as a concept it is multifaceted. Concept analysis is a method for exploring and evaluating the meaning of words. It gives precise definitions, both theoretical and operational, for use in theory, clinical practice and research. A concept analysis provides a logical basis for defining terms and helps us to refine and define a concept that derives from practice, research and theory. This paper uses the strategy of concept analysis to explore the term ‘forensic nursing’ and finds a working definition of forensic mental health nursing. The historical background and literature are reviewed using concept analysis to bring the term into focus and to define it more clearly. Forensic nursing is found to derive from forensic practice. A proposed definition of forensic nursing is given.

In this paper I will analyse the nature of the relationship between area and health in cities. Although it has long been known that mortality and morbidity are unevenly distributed within urban environments (Stamp, 1964; Learmonth, 1988) it remains problematic as to how these differences should be explained. In the present paper I will present detailed information on the spatial distibution of mortality, morbidity, and health services in cities and consider the explanations which have been put forward to account for them. Research which has considered this topic covers various fields; medical geography, medical ecology, epidemiology, and sociology, and has utilised numerous methodological approaches, from straightforward mapping techniques to complex multi‐variate analysis. Research has also been carried out across the world. However, because differences in the political and social organisation of cities can have an effect on health, and these structural differences vary from country to country, I have restricted the current review to work carried out in the cities of the developed world as studies are more comparable.

This paper critically reviews the motivations for introducing different connected healthcare to support Assisted Living in older and other vulnerable groups. The aim is to develop a new approach that will be sustainable in the future.

The methodology involves a consideration of assessment criteria currently being employed and the resulting costs and limitations in providing a person centred approach. The implications of introducing new technologies such as plesiocare and mCare are then considered.

It was found that one of the most cost‐effective applications of technology is in the support of informal carers but the telecare equipment that they are offered may not be the most appropriate.

The findings are limited by a lack of formal risk assessments that are person centred. The implications include the need for improved training in assessment processes and access to a wider inventory of technologies.

Existing telecare services will need to change in order to adopt more plesiocare and self‐care approaches and to engage more actively in the development of models based on mcare.

Governments and health ministries may achieve better and lower cost support for their ageing population by adopting a model that includes multiple layers of technology, including easier access to self‐care and mCare technologies.

This paper includes the first discussion on plesiocare and its relative advantages over telecare in supporting informal carers.