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Article
Publication date: 23 March 2010

Johan Thor, Bo Herrlin, Karin Wittlöv, John Øvretveit and Mats Brommels

The purpose of this paper is to examine the outcomes and evolution over a five‐year period of a Swedish university hospital quality improvement program in light of…

Abstract

Purpose

The purpose of this paper is to examine the outcomes and evolution over a five‐year period of a Swedish university hospital quality improvement program in light of enduring uncertainty regarding the effectiveness of such programs in healthcare and how best to evaluate it.

Design/methodology/approach

The paper takes the form of a case study, using data collected as part of the program, including quality indicators from clinical improvement projects and participants' program evaluations.

Findings

Overall, 58 percent of the program's projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 percent, n=11) than projects led by male doctors (51 percent, n=55). Facilitators at the hospital continuously adapted the improvement methods to the local context. A lack of dedicated time for improvement efforts was the participants' biggest difficulty. The dominant benefits included an increased ability to see the “bigger picture” and the improvements achieved for patients and employees.

Research limitations/implications

Quality measurement, which is important for conducting and evaluating improvement efforts, was weak with limited reliability. Nevertheless, the present study adds evidence about the effectiveness of healthcare improvement programs. Gender differences in improvement team leadership merit further study. Improvement program evaluation should assess the extent to which improvement methods are locally adapted and applied.

Originality/value

This case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five‐year period and provides in‐depth insight into an improvement program's changeable nature.

Details

International Journal of Health Care Quality Assurance, vol. 23 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 12 June 2009

Denis R. Towill

The purpose of this article is to look at method study, as devised by the Gilbreths at the beginning of the twentieth century, which found early application in hospital…

Abstract

Purpose

The purpose of this article is to look at method study, as devised by the Gilbreths at the beginning of the twentieth century, which found early application in hospital quality assurance and surgical “best practice”. It has since become a core activity in all modern methods, as applied to healthcare delivery improvement programmes.

Design/methodology/approach

The article traces the origin of what is now currently and variously called “business process re‐engineering”, “business process improvement” and “lean healthcare” etc., by different management gurus back to the century‐old pioneering work of Frank Gilbreth. The outcome is a consistent framework involving “width”, “length” and “depth” dimensions within which healthcare delivery systems can be analysed, designed and successfully implemented to achieve better and more consistent performance.

Findings

Healthcare method (saving time plus saving motion) study is best practised as co‐joint action learning activity “owned” by all “players” involved in the re‐engineering process. However, although process mapping is a key step forward, in itself it is no guarantee of effective re‐engineering. It is not even the beginning of the end of the change challenge, although it should be the end of the beginning. What is needed is innovative exploitation of method study within a healthcare organisational learning culture accelerated via the Gilbreth Knowledge Flywheel.

Research limitations/implications

It is shown that effective healthcare delivery pipeline improvement is anchored into a team approach involving all “players” in the system especially physicians. A comprehensive process study, constructive dialogue, proper and highly professional re‐engineering plus managed implementation are essential components. Experience suggests “learning” is thereby achieved via “natural groups” actively involved in healthcare processes.

Originality/value

The article provides a proven method for exploiting Gilbreths' outputs and their many successors in enabling more productive evidence‐based healthcare delivery as summarised in the “learn‐do‐learn‐do” feedback loop in the Gilbreth Knowledge Flywheel.

Details

International Journal of Health Care Quality Assurance, vol. 22 no. 4
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 14 March 2016

Paul Jon Greenwood and David Edward Shiers

The purpose of this paper is to improve the quality of monitoring of risk factors that predict the likelihood of people with severe mental illness (SMI) developing…

Abstract

Purpose

The purpose of this paper is to improve the quality of monitoring of risk factors that predict the likelihood of people with severe mental illness (SMI) developing cardiovascular disease (CVD), diabetes and obesity, major contributors to poor physical health and risk of premature mortality.

Design/methodology/approach

The first phase of the AQuA “Don’t just screen-intervene” initiative supported five specialised community-based Early Intervention for Psychosis services in North West England to assess the effectiveness of monitoring of cardiometabolic risk in their patients using standards derived from the Lester Positive Cardiometabolic Health Resource, a nationally acknowledged framework for people with psychosis receiving antipsychotic medication. The initial findings formed the basis for a quality improvement programme which ran from November 2012 until May 2013.

Findings

By the end of a six month quality improvement programme the likelihood of a patient receiving a comprehensive cardiometabolic risk screening (evidenced by recorded measurement of body mass index or waist circumference, blood pressure, blood glucose and lipid profile, assessment of smoking status and enquiry of relevant family history) had increased from 10 to between 63 and 80 per cent.

Research limitations/implications

Cardiometabolic risk monitoring from the onset of psychosis and its treatment can be improved utilising quality improvement methodology in real-world specialist mental health services. Earlier identification and treatment of risk factors that predict higher rates of obesity, diabetes and SMI may help people with SMI avoid life-restricting and life-shortening physical disorders.

Practical implications

Given the National Audit of Schizophrenia findings of inadequate screening in those with established SMI alongside evidence that CVD risk can emerge early in the course of psychosis, a group of early intervention in psychosis services in North West England decided to examine this aspect of their routine clinical practice. This service evaluation describes the effectiveness of a quality improvement programme based on the Lester Positive Cardiometabolic Health Resource (referred to as Lester resource henceforth) to improve the effectiveness of monitoring of risk factors that predict the likelihood of people experiencing psychosis and schizophrenia developing CVD diabetes and obesity.

Social implications

A combination of social disadvantage and unhealthy lifestyles, adverse cardiometabolic impacts of antipsychotic medication and inequitable access to physical healthcare combine to put people with SMI at particular risk from CVD, the single biggest cause of premature death, and much more common than suicide (Brown et al., 2010). Despite higher rates of potentially modifiable CVD risk factors (De Hert et al., 2009) people with SMI appear to be missing out on opportunities to actively prevent conditions like CVD and diabetes compared to the general population.

Originality/value

People with SMI such as schizophrenia die 15-20 years earlier on average than the general population. Around 20 per cent of premature deaths can be explained by suicide and injury, but the remainder arise from a variety of natural causes such as CVD, chronic obstructive pulmonary disorder and certain cancers and infections (Nordentoft et al., 2013). The authors worked with five mental health trusts in the North West of England covering a sample of over 500 cases within early intervention services.

Details

Mental Health Review Journal, vol. 21 no. 1
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 6 June 2016

Matloub Hussain, Mohsin Malik and Hamda S. Al Neyadi

The purpose of this paper is to introduce lean concept to the field of healthcare management, expands the conceptualization of lean management beyond the manufacturing…

Abstract

Purpose

The purpose of this paper is to introduce lean concept to the field of healthcare management, expands the conceptualization of lean management beyond the manufacturing companies to consider key waste reduction opportunities which are posited to be requisites to lean practices and implements the proposed framework in the three public hospitals in Abu Dhabi.

Design/methodology/approach

This research is designed by decomposing complex and unstructured issue into a set of components organized in a multi-level hierarchical form. To deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research.

Findings

AHP framework for this study resulted in a ranking of 21 healthcare wastes based on the evaluations of local situations by experienced healthcare professionals. It has been found that management in healthcare systems of Abu Dhabi is putting more emphasis on the inventory waste.

Research limitations/implications

The future directions of the research would be to apply a lean set of tools for the value stream optimization of the prioritized key improvement areas.

Practical implications

This is a contribution to the continuing research into lean management, giving practitioners and designers a practical way for measuring and implementing lean practices across health organizations.

Originality/value

The contribution of this research, through successive stages of data collection, measurement analysis and refinement, is a set of reliable and valid framework that can be subsequently used in conceptualization, prioritization of the waste reduction strategies in healthcare management.

Details

Business Process Management Journal, vol. 22 no. 3
Type: Research Article
ISSN: 1463-7154

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Article
Publication date: 13 April 2021

Antoinette Pavithra

The key aim of this narrative literature review, therefore, is to identify the key conceptual categories that inform the construction of positive person-centred culture…

Abstract

Purpose

The key aim of this narrative literature review, therefore, is to identify the key conceptual categories that inform the construction of positive person-centred culture within hospitals, and how these frameworks are brought to bear upon organisational culture within healthcare systems in Australia.

Design/methodology/approach

This narrative review presents a thematic synthesis of literature identified through a systematic search protocol undertaken across 19 academic databases and Google Scholar as an additional search tool. Thematic qualitative analysis was performed on the research results to determine the common themes within the diverse literature presented within this study.

Findings

Culture change interventions in hospitals attempt to address the problem of widespread unprofessional behaviour within healthcare systems. However, diverse definitions and seemingly fragmented approaches to understanding and enacting organisational culture change present a significant hurdle in achieving cohesive and sustainable healthcare reform. This narrative literature review offers a comprehensive conceptual view of the key approaches that inform positive person-centred culture within hospital settings. In total, three primary dimensions, belonging, behaving and being, aligned against organisational goals, individual behaviours and worker as well as organisational identity were identified. Other individual and group interactional dynamics that give rise to negative organisational culture are further analysed to understand the fault lines along which existing culture change interventions are typically operationalised.

Research limitations/implications

This review is not exhaustive and is limited in its methodological scope. The central values and themes identified within the literature are integral to designing humanised healthcare systems. However, owing to the qualitative nature and contextual variability of these factors, these themes do not lend themselves to replicable quantification.

Social implications

This analysis contributes to foundational research efforts towards transforming healthcare practice to be more aligned with humanised and equitable values within increasingly complex healthcare organisational settings. Designing culture change interventions that align more suitably with the values-driven categories identified in this literature review may increase the effectiveness and sustainability of these interventions and reform efforts at organisational and systemic levels.

Originality/value

This article presents a comprehensive framework to approach healthcare organisational reform through shared and equitable models of operation, management and governance rather than continuing to promote narrowly defined outcomes derived from commodified models of healthcare practice.

Details

Journal of Health Organization and Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 18 April 2020

Nick J. Reed, Natalie Wilson and Kathryn J. Hayes

A method to engage salient organisational stakeholders in identifying and ranking measures of healthcare improvement programs is described. The method is illustrated using…

Abstract

Purpose

A method to engage salient organisational stakeholders in identifying and ranking measures of healthcare improvement programs is described. The method is illustrated using Executive WalkRounds (EWRs) in a multi-site Australian Health District.

Design/methodology/approach

Subject matter experts (SMEs) conducted document analysis, identified potential EWRs measures, created driver diagrams and then eliminated weak measures. Next, a panel of executives skilled in EWRs ranked and ratified the potential measures using a modified Delphi technique.

Findings

EWRs measurement selection demonstrated the feasibility of the method. Of the total time to complete the method 79% was contributed by SMEs, 14% by administration personnel and 7% by executives. Document analysis revealed three main EWRs aims. Ten of 28 potential measures were eliminated by the SME review. After repeated Delphi rounds the executive panel achieved consensus (75% cut-off) on seven measures. One outcome, one process and one implementation fidelity metric were selected to measure and monitor the impact of EWRs in the health district.

Practical implications

Perceptions of weak relationships between measures and intended improvements can lead to practitioner scepticism. This work offers a structured method to combine the technical expertise of SMEs with the practical knowledge of healthcare staff in selecting improvement measures.

Originality/value

This research describes and demonstrates a novel method to systematically leverage formal and practical types of expertise to select measures that are strongly linked to local quality improvement goals. The method can be applied in diverse healthcare settings.

Details

International Journal of Health Care Quality Assurance, vol. 33 no. 4/5
Type: Research Article
ISSN: 0952-6862

Keywords

Content available
Article
Publication date: 28 September 2012

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 8
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 April 2006

Ken Black and Lee Revere

This paper sets out to analyse the use of the Six Sigma methodology to improve quality in healthcare. It looks at how Six Sigma grew out of the concept of Total Quality…

Abstract

Purpose

This paper sets out to analyse the use of the Six Sigma methodology to improve quality in healthcare. It looks at how Six Sigma grew out of the concept of Total Quality Management (TQM).

Design/methodology/approach

Six Sigma is a quality improvement methodology that has been widely adopted by companies since the early 1990s and has grown exponentially in the healthcare industry during the past five years. Some of the main tenets of Six Sigma have emerged from the principles of TQM, including the notion that the entire organization must support the quality effort; that there should be a vigorous education effort; and that a quality improvement process should emphasize root cause analysis.

Findings

In spite of its early success, TQM “crashed and burned” for several reasons including the fact that financial benefits were difficult to assign to TQM efforts, root cause was not always determined resulting in recurring errors, there was no common metric to measure the level of quality attained, and quality efforts were sometimes aimed at processes or operations that were not critical to the customer. Six Sigma filled the vacuums created by these TQM failures in several ways. Under the Six Sigma methodology, quality improvement projects are carefully defined so that they can be successfully completed within a relatively short time frame. Financials are applied to each completed project so that management knows how much the project saves the institution.

Originality/value

On each project, intense study is used to determine root cause analysis; and in the end, a metric known as “sigma level” can be assigned to signify the level of quality. Six Sigma has a “critical to quality” dimension that keeps the quality effort focused on improving only those things that really matter to the customer.

Details

International Journal of Health Care Quality Assurance, vol. 19 no. 3
Type: Research Article
ISSN: 0952-6862

Keywords

Content available

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 24 no. 8
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 November 2006

R. Nat Natarajan

The purpose of this paper is to analyze the opportunities and challenges in the healthcare sector for learning and transferring from other sectors the concepts, best…

Abstract

Purpose

The purpose of this paper is to analyze the opportunities and challenges in the healthcare sector for learning and transferring from other sectors the concepts, best practices, and tools for improving quality, safety, and productivity. Design/methodology/approach – In this paper, the various approaches for improving quality, safety, and productivity are considered. How these approaches are being used in healthcare are analyzed. The obstacles to their successful implementation in healthcare are discussed. Findings – The paper finds that there are many approaches, best practices, tools, and technologies for improving quality and safety – which have proved their worth in other industries – that are relevant for the healthcare sector. There are some characteristics of the healthcare industry that distinguish it from other industries. Although the managerial processes in the healthcare industry are similar to those of other industries, the prevalent norms, culture, practices, and the regulatory framework can promote or hinder efforts to improve performance. These characteristics influence the extent to which the best practices in other industries are relevant and transferable to the healthcare sector. Originality/value – In this paper, prospects for utilizing the opportunities are assessed. The paper identifies a number of obstacles to the transfer of best practices to the healthcare sector. Insights are provided into factors that are critical to addressing those obstacles. These are of value to the practitioners in healthcare and to the academics, who want to pursue further research on this topic.

Details

The TQM Magazine, vol. 18 no. 6
Type: Research Article
ISSN: 0954-478X

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