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Article
Publication date: 14 February 2020

Alison Brown

The importance of hospital board engagement in the work of governing healthcare quality has been demonstrated in the literature. Research into influences on effective…

Abstract

Purpose

The importance of hospital board engagement in the work of governing healthcare quality has been demonstrated in the literature. Research into influences on effective corporate governance has traditionally focused on board architecture. Emerging research is bringing to light the importance of governance dynamics. This paper contributes to emerging research through highlighting how communication and leadership underpin effective engagement in governing healthcare quality.

Design/methodology/approach

A comparative case study of eight Australian public hospitals was undertaken involving document review, interviews and observations. Case studies were allocated into high- or low-engagement categories based on evidence of governance processes being undertaken, in order to compare and contrast influencing factors. Thematic analysis was undertaken to explore how communication and leadership influence healthcare governance.

Findings

Several key components of communication and leadership are shown to influence healthcare quality governance. Clear logical narratives in reporting, open communication, effective questioning and challenge from board members are important elements of communication found to influence engagement. Leadership that has a focus on healthcare excellence and quality improvement are aligned and promote effective meeting processes is also found to foster governance engagement. Effective engagement in these communication and leadership processes facilitate valuable reflexivity at the governance level.

Practical implications

The findings highlight the way in which boards and senior managers can strengthen governance effectiveness through attention to key aspects of communication and leadership.

Originality/value

The case study approach allows the exploration of communication and leadership in greater depth than previously undertaken at the corporate governance level in the healthcare setting.

Details

Journal of Health Organization and Management, vol. 34 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 10 June 2019

Ashley Jill Shepherd, Julie Cowie and Michelle Beattie

The purpose of this paper is to determine the relative influence of the different domains of healthcare quality from the Care Experience Feedback Improvement Tool (CEFIT…

Abstract

Purpose

The purpose of this paper is to determine the relative influence of the different domains of healthcare quality from the Care Experience Feedback Improvement Tool (CEFIT) and identify key predictors of healthcare quality from the patients’ perspective. Measurement is necessary to determine whether the quality of healthcare is improving. The CEFIT was developed as a brief measure of patient experience. It is important to determine the relative influence of the different domains of healthcare quality to further clarify how the CEFIT can be used and identify key predictors of healthcare quality from the patients’ perspective.

Design/methodology/approach

In sum, 802 people with a healthcare experience during the previous 12 months were telephoned to complete the CEFIT questions and an additional 11-point global rating of patient experience. To estimate the influence of different domains of healthcare quality on patient overall ratings of quality of healthcare experience, the authors regressed the overall rating of patient experience with each component of quality (safety, effectiveness, timely, caring, enables system navigation and person-centred).

Findings

The authors found that all of the domains of the CEFIT influenced patient experience ratings of healthcare quality. Specifically, results show the degree of influence, the impact of demographics and how high scores for overall rating of patient experience can be predicted.

Originality/value

The findings suggest that all of the CEFIT domains are important in terms of capturing the wholeness of the patient experience of healthcare quality to direct local quality improvement.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 5
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 12 June 2009

Masood A. Badri, Samaa Attia and Abdulla M. Ustadi

The purpose of this article is to present a comprehensive structural equation based service quality and patient satisfaction model taking into account the patient's…

Abstract

Purpose

The purpose of this article is to present a comprehensive structural equation based service quality and patient satisfaction model taking into account the patient's condition before and after discharge. The authors aim to test for causality in a sample of patients from United Arab Emirates public hospitals.

Design/methodology/approach

Data were collected using questionnaires completed by adults discharged (n=244) from UAE public hospitals. The proposed model consists of five main constructs. Three represent service quality: quality of care (four variables); process and administration (four variables) and information (four variables). There is also one construct that represents patient's status (two variables – health status before admission and after discharge). Finally, there is one construct that represents patient's satisfaction with care (two variables – general and relative satisfaction). Structural equation modeling and LISREL using maximum likelihood estimation was used to test hypothesized model(s)/parameters(s) derived deductively from the literature.

Findings

The structural equation modeling representation provides a comprehensive picture that allows healthcare constructs and patient satisfaction causality to be tested. The goodness‐of‐fit statistics supported the healthcare quality‐patient status‐satisfaction model.

Originality/value

The model has been found to capture attributes that characterize healthcare quality in a developing country and could represent other modern healthcare systems. Also, it can be used to evaluate other healthcare practices from patients' viewpoints. The study highlights the importance of healthcare quality as patient satisfaction predictors by capturing other effects such as patient status.

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: 12 June 2009

Aditi Naidu

The aim of this paper is to build a comprehensive conceptual model to understand and measure variables affecting patient satisfaction‐based healthcare quality.

Abstract

Purpose

The aim of this paper is to build a comprehensive conceptual model to understand and measure variables affecting patient satisfaction‐based healthcare quality.

Design/methodology/approach

A total of 24 articles from international journals were systematically reviewed for factors determining patient satisfaction and healthcare quality.

Findings

Patient satisfaction is a multi‐dimensional healthcare construct affected by many variables. Healthcare quality affects patient satisfaction, which in turn influences positive patient behaviours such as loyalty. Patient satisfaction and healthcare service quality, though difficult to measure, can be operationalized using a multi‐disciplinary approach that combines patient inputs as well as expert judgement.

Research limitations/implications

The paper develops a conceptual model that needs to be confirmed empirically. Also, most research pertains to developed countries. Findings are presented that may not be generalized to developing nations, which may be quite different culturally.

Practical implications

The paper has direct implications for health service providers. They are encouraged to regularly monitor healthcare quality and accordingly initiate service delivery improvements to maintain high levels of patient satisfaction.

Originality/value

The paper collates and examines recent healthcare quality study findings. It presents a comprehensive, conceptual model encompassing research work and a holistic view of various aspects affecting patient satisfaction and healthcare quality. Although a large amount of healthcare quality research has been done, each studying a particular service, this paper comprehensively brings together various research findings.

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: 15 March 2013

Ali Mohammad Mosadeghrad

The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying…

Abstract

Purpose

The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying definitions for clients, professionals, managers, policy makers and payers.

Design/methodology/approach

This study represents an exploratory effort to understand healthcare quality in an Iranian context. In‐depth individual and focus group interviews were conducted with key healthcare stakeholders.

Findings

Quality healthcare is defined as “consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient's needs and satisfies providers”. Healthcare quality definitions common to all stakeholders involve offering effective care that contributes to the patient well‐being and satisfaction.

Practical implications

This study helps us to understand quality healthcare, highlighting its complex nature, which has direct implications for healthcare providers who are encouraged to regularly monitor healthcare quality using the attributes identified in this study. Accordingly, they can initiate continuous quality improvement programmes to maintain high patient‐satisfaction levels.

Originality/value

This is the first time a comprehensive healthcare quality definition has been developed using various healthcare stakeholder perceptions and expectations.

Details

International Journal of Health Care Quality Assurance, vol. 26 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 15 March 2013

Jaap van den Heuvel, Gerard C. Niemeijer and Ronald J.M.M. Does

Current health care quality performance indicators appear to be inadequate to inform the public to make the right choices. The aim of this paper is to define a framework…

Abstract

Purpose

Current health care quality performance indicators appear to be inadequate to inform the public to make the right choices. The aim of this paper is to define a framework and an organizational setting in which valid and reliable healthcare information can be produced to inform the general public about healthcare quality.

Design/methodology/approach

To improve health care quality information, the paper explores the analogy between financial accounting, which aims to produce valid and reliable information to support companies informing their shareholders and stakeholders, and healthcare aiming to inform future patients about healthcare quality. Based on this analogy, the authors suggest a measurement framework and an organizational setting to produce healthcare information.

Findings

The authors suggest a five‐quality element framework to structure quality reporting. The authors also indicate the best way to report each type of quality, comparing performance indicators with certification/accreditation. Health gain is the most relevant quality indicator to inform the public, but this information is the most difficult to obtain. Finally, the organizational setting, comparable to financial accounting, required to provide valid, reliable and objective information on healthcare quality is described.

Practical implications

Framework elements should be tested in quantitative studies or case studies, such as a performance indicator's relative value compared to accreditation/ certification. There are, however, elements that can be implemented right away such as third party validation of healthcare information produced by healthcare institutions.

Originality/value

Given the money spent on healthcare worldwide, valid and reliable healthcare quality information's value can never be overestimated. It can justify delivering “expensive” healthcare, but also points the way to savings by stopping useless healthcare. Valid and reliable information puts the patient in the driver's seat and enables him or her to make the right decision when choosing their healthcare provider.

Details

International Journal of Health Care Quality Assurance, vol. 26 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 13 July 2015

Mohammad Shafiqul Islam

Quantitative indicators show that Bangladeshi maternal and child healthcare is progressing satisfactorily. However, healthcare quality is still inadequate. It is…

Abstract

Purpose

Quantitative indicators show that Bangladeshi maternal and child healthcare is progressing satisfactorily. However, healthcare quality is still inadequate. It is hypothesised that modern technology enhances healthcare quality. Therefore, the purpose of this paper is to investigate how modern technology such as electronic record keeping and the internet can contribute to enhancing Bangladeshi healthcare quality. This study also explores how socio-economic and political factors affect the healthcare quality.

Design/methodology/approach

This paper is based on a qualitative case study involving 68 in-depth interviews with healthcare professionals, elected representatives, local informants and five focus group discussions with healthcare service users to understand technology’s effect on health service quality. The study has been conducted in one rural and one urban service organisations to understand how various factors contribute differently to healthcare quality.

Findings

The findings show that modern technology, such as the internet and electronic devices for record keeping, contribute significantly to enhancing health service transparency, which in turn leads to quality health and family planning services. The findings also show that information and communication technology (ICT) is an effective mechanism for reducing corruption and promoting transparency. However, resource constraints impact adversely on the introduction of technology, which leads to less transparent healthcare. Progress in education and general socio-economic conditions makes it suitable to enhance ICT usage, which could lead to healthcare transparency, but political and bureaucratic factors pose a major challenge to ensure transparency.

Practical implications

This paper can be a useful guide for promoting governance and healthcare quality in developing countries including Bangladesh. It analyses the ICT challenges that healthcare staff face when promoting transparent healthcare.

Originality/value

This paper provides a deeper understanding of transparency and healthcare quality in an ICT context using empirical data, which has not been explored in Bangladesh. This critical thinking is useful for policy makers and healthcare practitioners for promoting health service quality.

Details

International Journal of Health Care Quality Assurance, vol. 28 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 10 July 2009

Víctor Reyes‐Alcázar, Belén Sotillos‐González and Antonio Torres‐Olivera

The purpose of this paper is to develop and describe the symbolic value of quality awards as a key indicator of recognition that public organizations have reached in the…

Abstract

Purpose

The purpose of this paper is to develop and describe the symbolic value of quality awards as a key indicator of recognition that public organizations have reached in the scope of quality management and continuous improvement.

Design/methodology/approach

The paper provides a description of the evolution of the three series of healthcare quality awards that have been held to‐date in one of the biggest regions of Europe: Andalusia.

Findings

Theoretical analysis of an instrument conceived as an institutionalised way of recognizing quality assurance initiatives in the Andalusian Public Health System. At the same time, the article focuses on the importance of using a reference model to ensure that the process of assessing the projects is systematic and rigorous and therefore stands as a guarantee of transparency within a public administration.

Research limitations/implications

The ultimate outcome is dependent of the geographical context and the behaviours and perceptions of people that have participated as assessment panels.

Practical implications

The conceptual framework provides guidance on what methodology is used to assess the quality projects (process to allocate projects to assessment panels and assessment criteria required) in a complex healthcare system. It serves as a managerial framework to enhance the continuous improvement in all health‐related services.

Originality/value

The paper contributes to create a structured debate between researchers and healthcare leaders regarding the assessment criteria to evaluate healthcare quality projects.

Details

Leadership & Organization Development Journal, vol. 30 no. 5
Type: Research Article
ISSN: 0143-7739

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Article
Publication date: 21 March 2008

Masood A. Badri, Samaa Taher Attia and Abdulla M. Ustadi

The purpose of this paper is to show that, although there has been some research to identify the dimensions on which healthcare quality and in‐patient satisfaction should…

Abstract

Purpose

The purpose of this paper is to show that, although there has been some research to identify the dimensions on which healthcare quality and in‐patient satisfaction should be measured, the confirmation of constructs and indicators that constitute an overall care quality and satisfaction remains unclear. The objective is to present several models of service quality and satisfaction in healthcare for discharged patients; and to test those models in a sample of discharged patients in public hospitals in the United Arab Emirates.

Design/methodology/approach

A detailed in‐patient survey (using interviews) was used. Data were collected with questionnaires from adult discharges (n=244) in public hospitals in the UAE. Several structures are proposed and tested. Confirmatory Factor Analysis (CFA) and LISREL SIMPLIS using maximum likelihood estimation were used to estimate and test the parameters of the hypothesized models derived deductively from the previous literature.

Findings

Several models (with one, two, three and four constructs) with different structures were tested using CFA. The final recommended model is based on three constructs – quality of care, process and administration, and information. The goodness‐of‐fit statistics supported the basic solution of the healthcare quality‐satisfaction model.

Originality/value

The model has been found to capture attributes that characterize healthcare quality in a developing country such as the UAE and could represent other modern healthcare systems. It can be used as a basis for evaluation in healthcare practices from discharges (in‐patients) point of view. The study highlights the importance of patients' satisfaction with care as predictors of quality of care. The results also confirm the construct validity of the previously discussed healthcare quality scales.

Details

International Journal of Health Care Quality Assurance, vol. 21 no. 2
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 21 March 2019

Sue S. Feldman, Scott Buchalter, Dawn Zink, Donna J. Slovensky and Leslie Wynn Hayes

The purpose of this paper is to understand the degree to which a quality and safety culture exists after healthcare workers in an academic medical center complete a…

Abstract

Purpose

The purpose of this paper is to understand the degree to which a quality and safety culture exists after healthcare workers in an academic medical center complete a quality improvement and patient safety education program focused on developing leaders to change the future of healthcare quality and safety.

Design/methodology/approach

The safety attitudes questionnaire (SAQ) short-form was used for measuring the culture of quality and safety among healthcare workers who were graduates of an academic medical center’s healthcare quality and safety program. A 53 percent response rate from program alumni resulted in 54 usable responses.

Findings

This study found that 42 (78 percent) of the respondents report that they are currently working in a healthcare quality and safety culture, with 25 (59 percent) reporting promotion into a leadership role after completion of the quality improvement education program. This compares favorably to AHRQ culture of safety survey results obtained by the same academic medical center within the year prior revealing only 63 percent of all inpatient employees surveyed reported working in a quality and safety culture.

Research limitations/implications

The study design precluded knowing to what degree a quality and safety culture, as measured by the SAQ, existed prior to attending the healthcare quality and safety program.

Originality/value

This study has practical value for other organizations considering a quality and safety education program. For organizations seeking to build capacity in quality and safety, training future leaders through a robust curriculum is essential. This may be achieved through development of an internal training program or through attending an outside organization for education.

Details

Leadership in Health Services, vol. 32 no. 2
Type: Research Article
ISSN: 1751-1879

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