Search results

Quality improvement is imperative for healthcare organisations. Despite the importance of the topic, many efforts have been wasted on failed improvement programs. Various studies have tried to identify the failure factors in improvement programs, but the divergences in the results hamper this research field’s evolution. This study reviews scientific activity from 2000 to 2019 on failure factors in Healthcare Quality Improvement Programs (HCQIP) to help academics and managers understand the field’s evolution better. This research intends to answer four questions on failure factors in HCQIP: Who are the most active authors in this field?; Which journals have been used as diffusion channels?; What are the themes addressed the most in this field?; and What are the themes considered to be emerging?

The authors conducted a bibliometric-based literature review on a sample of 5,137 articles, and 104 studies were included in this review, covering a longitudinal analysis in two periods (P1: 2000–2010 and P2: 2011–2019). Performance analysis, citation, co-citation, co-words analysis and network mapping identified the authors in this scientific field, the journals, the number of articles, along with the current and emerging themes that reveal the latent structure of the factors associated with failures in HCQIP.

The number of articles in P2 (83 studies) is almost four times higher than in P1 (21 studies). The results reveal a dynamic field attracting more authors since 2013, expanding from 5 to 42 journals that publish on the topic. Furthermore, research has evolved from comprehensive manufacturing programs to more theory-based and contextualised health care. In this sense, the recent literature (P2) suggests that failure factors related to quality improvement programs can be minimised if these initiatives align with the human centrality paradigm.

Analysing the evolution of failure factors in HCQIP helps redesign research and management for better quality health outcomes. Knowledge of the scientific community trajectory over nearly 20 years enables better planning from the patient's perspective and contributes to reducing failures in quality programs.

This study contributes to developing the field of failure factors in HCQIP by providing researchers and managers with an evolutionary, systematic and pioneering view of the theme.

In this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes.

Our recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature.

ROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised.

This article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as “agents”, “stewards” or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems.

The article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance.

This paper aims to highlight the factors influencing the conceptualisation of return on investment (ROI) from healthcare quality improvement (QI) programmes.

In their previous work, the authors found that the concept of ROI from QI is broad and includes numerous internal and external benefits for organisations. In this paper, the authors developed a framework outlining the factors that influence this conceptualisation of QI-ROI from an institutional theory perspective. The framework is based on the synthesis of their serial studies on the determinants of the concept of ROI from QI. The research was performed from 2020–2023 and involved a global multidisciplinary systematic literature review (N = 68), qualitative interviews (N = 16) and a Delphi study (N = 23). The qualitative and Delphi studies were based on the publicly-funded mental healthcare in UK. Participants included board members, clinical and service directors, as well as QI leaders.

The authors outline a framework of internal and external institutional forces that influence the conceptualisation of ROI from QI programmes in mental healthcare and similar organisations. Based on these factors, the authors state several conjectures. In doing this, the authors highlight the ambiguities and uncertainties surrounding QI-ROI conceptualisation. These challenge leaders to balance various monetary and non-monetary benefits for organisations and health systems. This explains the broadness of the QI-ROI concept.

The authors developed a framework highlighting the forces underpinning the broad, ambiguous and sometimes uncertain nature of the QI-ROI concept. They raise awareness about dilemmas to be confronted in developing or applying any tool to evaluate the value for money of QI programmes. Specifically, the work highlights the limitations of the ROI methodology as a primary tool in the QI context and the need for a more comprehensive tool.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.