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Article
Publication date: 1 April 1990

Paul B. Batalden and Eugene C. Nelson

A conceptual model of health care, a theory of quality improvement in health care and the role of patient, physician and employee judgements as part of organisation‐wide…

Abstract

A conceptual model of health care, a theory of quality improvement in health care and the role of patient, physician and employee judgements as part of organisation‐wide improvement are introduced. The conceptual model of health care shows how the practitioner, the locus of care‐giving and the social context interact to meet the needs of patients and highlights potential sources of unwanted variation in outcomes. This theory of quality improvement stresses the continuous improvement of processes throughout the entire organisation to meet the needs and expectations of customers. Basic building blocks for continuous improvement ‐ knowledge of customers, knowledge of work as processes, and statistical and scientific thinking ‐ are discussed along with the need to transform the entire organisation. A method for gaining customer knowledge and for monitoring hospital quality, based on measuring quality from patients′, physicians′, and employees′ judgements of quality, is introduced. The method, called the Hospital Quality Trend (HQT) family of quality measures, is described and its uses to promote organisation‐wide quality improvement are illustrated. Health care work is complex and unique. Careful analysis of the way that work is done and knowledge of the customers in defining and improving quality is essential for achieving better quality and value from the health care system.

Details

International Journal of Health Care Quality Assurance, vol. 3 no. 4
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 9 October 2017

Rachel Canaway, Marie Bismark, David Dunt and Margaret Kelaher

The purpose of this paper is to understand the concerns and factors that impact on hospital quality and safety, particularly related to use of performance data, within a…

Abstract

Purpose

The purpose of this paper is to understand the concerns and factors that impact on hospital quality and safety, particularly related to use of performance data, within a setting of devolved governance.

Design/methodology/approach

This qualitative study used thematic analysis of interviews with public hospital medical directors. For additional context, findings were framed by themes from a review of hospital safety and quality in the same jurisdiction.

Findings

Varying approaches and levels of complexity were described about what and how performance data are reviewed, prioritised, and quality improvements implemented. Although no consistent narrative emerged, facilitators of improvement were suggested relating to organisational culture, governance, resources, education, and technologies. These hospital-level perspectives articulate with and expand on the system-level themes in a state-wide review of hospital safety and quality.

Research limitations/implications

The findings are not generalisable, but point to an underlying absence of system-wide agreement on how to perceive, retrieve, analyse, prioritise and action hospital performance data.

Practical implications

Lack of electronic medical records and an inefficient incident reporting system limits the extent to which performance and incident data can be analysed, linked and shared, thus limiting hospital performance improvement, oversight and learning.

Social implications

Variable approaches to quality and safety, standards of care, and hospital record keeping and reporting, mean that healthcare consumers might expect inconsistency across Victorian hospitals.

Originality/value

The views of medical directors have been little researched. This work uses their voice to better understand contextual factors that situate and impact on hospital quality and safety towards understanding the mixed effectiveness of hospital quality improvement strategies.

Details

Journal of Health Organization and Management, vol. 31 no. 7/8
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 20 July 2010

Raed Ismail Ababaneh

This study seeks to investigate empirically the impact of organizational culture (bureaucratic, innovative, and supportive) and quality improvement practices.

Abstract

Purpose

This study seeks to investigate empirically the impact of organizational culture (bureaucratic, innovative, and supportive) and quality improvement practices.

Design/methodology/approach

Data used in this study were obtained through a questionnaire by random sampling, which took place in four large public hospitals, located in Irbid Governorate, Jordan, involving 271 managers, physicians, and nurses.

Findings

Quality improvement practices were measured by 16 statements on a five‐point rating scale. Each of the three types of organizational culture was measured using five items on a five‐point rating scale.

Practical implications

The three types of culture have a significantly positive influence on quality improvement practices, and account for 62 per cent of the variation of quality improvement practices. Compared with bureaucratic and supportive cultures, innovative culture appears to play a stronger role in quality improvement practices. Contrary to expectations, the analysis shows that bureaucratic actions enhance rather than hinder quality improvement practices. Respondents with a bachelor or a higher degree and participating in a training course related to quality reported higher prevalence of each culture and a higher level of quality improvement practices.

Originality/value

Innovative culture has a crucial role in quality improvement practices compared with bureaucratic and supportive cultures.

Details

Leadership in Health Services, vol. 23 no. 3
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 1 September 2000

Clare Chow‐Chua and Mark Goh

Presents an exploratory field research on all hospitals in Singapore, highlighting the different routes hospitals have adopted in pursuing their corporate quality journey…

Abstract

Presents an exploratory field research on all hospitals in Singapore, highlighting the different routes hospitals have adopted in pursuing their corporate quality journey for the new millennium. In general, both continuous improvement and innovation‐based approaches have generated cost and time savings and helped to streamline work processes. However, the initial survey results show that innovation‐based programs require a longer time frame for implementation, are more prone to resistance to change and suffer from program failure. Also, large hospitals and public hospitals are more inclined to implement innovation based approaches while medium‐sized hospitals tend to use continuous improvement as a medium for quality improvement.

Details

International Journal of Health Care Quality Assurance, vol. 13 no. 5
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 24 July 2007

Russell Linwood, Gary Day, Gerrard FitzGerald and Brian Oldenburg

The purpose of this article to review the literature relating to improving paramedic care in an Australian context.

Abstract

Purpose

The purpose of this article to review the literature relating to improving paramedic care in an Australian context.

Design/methodology/approach

The paper presents changes and challenges that have occurred in the ambulance services in terms of improving care and measuring performance, exploring the literature on quality improvement initiatives and their application to pre‐hospital care.

Findings

While hospitals and health services have moved well down the quality improvement pathway, the application of these processes to pre‐hospital care has been a relatively recent phenomenon. Ambulance services have taken a variety of approaches to measuring and improving pre‐hospital care. This article questions the transferability of lessons learned in hospitals to ambulance services. Arguably, the quality improvement approach is dependent upon health control and funding models and where ambulance is categorised in terms of health or emergency services.

Originality/value

The quality improvement approach by Australian paramedics and ambulance services is in its infancy. This article provides insights into the quality improvement approach taken by ambulance staff in Australia compared to other countries, as well as highlighting useful information on the future direction and research into the area.

Details

International Journal of Health Care Quality Assurance, vol. 20 no. 5
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 May 2009

Yahui Sophie Hsieh

This study aims to explore whether and how patient voices had been taken into account within quality management systems in Hospital A in Britain and Hospital B in Taiwan.

Abstract

Purpose

This study aims to explore whether and how patient voices had been taken into account within quality management systems in Hospital A in Britain and Hospital B in Taiwan.

Design/methodology/approach

The two hospitals were purposefully selected and the data were collected over six months, via documents, interviews, and a semi‐structured questionnaire. A mixed method strategy within an overall qualitative framework (i.e. managerial‐operational‐technical) was used to make comparisons between them.

Findings

A number of strategies were developed by both Hospital A and Hospital B to take patients' voice into account within quality systems. In an attempt to improve quality standards of services, both hospitals used patient satisfaction surveys relating to specific services to understand patients' opinions about care in outpatient services, inpatient services, or emergency services. They also set up patient suggestion boxes and managed complaints data to understand what patients needed and wanted.

Originality/value

There is very limited literature related to the comparison of quality systems. In particular, this study explores the mechanisms to take patients' voices into account within quality systems. The most important distinction between the two hospitals is that in Hospital A, complaints are managed by a quality manager, while in Hospital B the Social Work Department (SWD) is responsible for dealing with patient complaints. In practice, it is more effective for quality officers to take care of complaints management than social workers, in terms of using complaints to improve quality.

Details

International Journal of Health Care Quality Assurance, vol. 22 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 19 October 2012

Charles R. Gowen, Kathleen L. McFadden and Sriranjita Settaluri

Rapidly rising healthcare costs, partially due to preventable medical errors, have led hospitals to redouble their process improvement (PI) efforts. The purpose of this…

Abstract

Purpose

Rapidly rising healthcare costs, partially due to preventable medical errors, have led hospitals to redouble their process improvement (PI) efforts. The purpose of this paper is to examine how PI initiatives mediate the effect of medical error sources to enhance three hospital outcomes (patient safety, operational effectiveness, and competitiveness).

Design/methodology/approach

Drawing from Dynamic Capabilities Theory, the authors develop a framework to explore three PI initiatives: Continuous Quality Improvement (CQI), Six Sigma Initiatives (SSI), and Lean Management Initiatives (LMI). Hierarchical regression analysis is employed to test the proposed model, using data from a nationwide survey of 210 US hospitals.

Findings

For enhancing patient safety outcomes, it was found that CQI and LMI were significant in mediating hospital error sources; however, SSI was not significant after accounting for the other two PI types. For improving organizational effectiveness, CQI and SSI were significant; whereas LMI was not significant over and above the other two PI types. Finally, only SSI was significant for superior sustainable competitive advantage.

Research limitations/implications

The paper provides insight into which PI initiatives were most effective for various hospital outcomes. The findings can benefit healthcare practitioners as they select among different PI programs for enhancing healthcare results. Limitations of the study include the use of perceptual measures, relatively small sample size, and potential alternate relationships relevant to the outcome variables.

Originality/value

This is the first study to explore the mediating effects of three PI programs for the impact of medical errors on each of three hospital outcomes.

Details

American Journal of Business, vol. 27 no. 2
Type: Research Article
ISSN: 1935-5181

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Article
Publication date: 1 February 2002

Clare Chow‐Chua and Mark Goh

Based on the research so far on quality improvement and performance measurement on hospitals and the health‐care sector, there appears to be a need to combine the various…

Abstract

Based on the research so far on quality improvement and performance measurement on hospitals and the health‐care sector, there appears to be a need to combine the various models or approaches to performance and quality improvement. This paper presents a knowledge‐based framework for evaluating the performance of a hospital using a model based on the Singapore Quality Award (SQA) criteria and the balanced scorecard (BSC) approach. A specific case study of a public sector hospital in Singapore is provided to illustrate how the SQA and the BSC can be integrated to help a public sector hospital implement and manage performance‐based programs. Overall, while limitations and implementation challenges exist, the preliminary results suggest that hospitals can also use this approach to their advantage, yielding sustainable improvement in patient satisfaction and better inter‐departmental communication. Through this framework, hospitals can make better quality decisions based on structured measurement and knowledge.

Details

Managing Service Quality: An International Journal, vol. 12 no. 1
Type: Research Article
ISSN: 0960-4529

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Article
Publication date: 1 November 2006

Prasanta Kumar Dey and Seetharaman Hariharan

The purpose of the paper is to develop an integrated quality management model, which identifies problems, suggests solutions, develops a framework for implementation and…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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

Research limitations/implications

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.

Practical implications

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

Originality/value

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.

Details

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

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Book part
Publication date: 26 October 2020

Resat Aydin, Ferhat D. Zengul, Jose Quintana and Bunyamin Ozaydin

Purpose – The numbers of health care transparency initiatives are increasing. Despite the growing availability of quality data, there seems to be a shortage of evidence…

Abstract

Purpose – The numbers of health care transparency initiatives are increasing. Despite the growing availability of quality data, there seems to be a shortage of evidence about the effects and effectiveness of such initiatives. The aim of this systematic review is to document the effects of transparency, defined as the public release of quality performance data, on hospital care outcomes.

Design/methodology/approach – Through a review of the literature, we chose 46 keywords to use in our searches and focused on empirical studies published in English between 2010 and 2015. The use of combinations of these keywords in searches of four databases (PubMed, Scopus, Web of Science, and the Cochrane Library) generated 13,849 publications. The removal of duplicates and exclusion of studies that were not empirical or not relevant to transparency and quality resulted in 39 studies to be reviewed.

Findings – Our review of the literature confirmed the growth of health care transparency efforts, led by the United States, and found mixed results regarding the effects of transparency on hospital care outcomes. For example, mortality, the most frequently researched performance measure (n = 15), exhibited this mixed pattern by having studies showing a reduction (n = 4), increase (n = 1), mixed findings (n = 4), and no significant relationship (n = 6) as a result of public release. We also found a limited number of articles related to unintended consequences of public reporting. When compared with earlier systematic reviews, there seems to be a trend in the reduction of unintended consequences. Therefore, we recommend exploration of this potential trend in future studies empirically.

Practical Implications – The research findings summarized in this systematic review can be used to understand the results of existing transparency efforts and to develop future transparency initiatives that may better enhance hospital quality performance.

Originality/value – This is the latest and most comprehensive systematic review summarizing the effects of transparency of quality metrics on hospital care outcomes.

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