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Abstract

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Mental Health Review Journal, vol. 9 no. 3
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 15 September 2020

Brahim Zaadoud, Youness Chbab and Aziz Chaouch

The purpose of this article is to analyze and compare between the frameworks of performance measurement in primary health care in the world. The subject of search is to…

Abstract

Purpose

The purpose of this article is to analyze and compare between the frameworks of performance measurement in primary health care in the world. The subject of search is to compare if the frameworks of performance measurement in primary health care have an influence on performances of health centers.

Design/methodology/approach

We conducted a systematic review of the literature to (1) identify the conceptual framework for measuring quality management systems, (2) assess the effects of conceptual framework on quality improvement and quality of care outcomes. We opted for the frameworks that are more cited in the literature and we analyzed and compared between these frameworks.

Findings

Eight dimensions were identified for assessing performance in Primary Health Care Facilities “PHCF” in more than 50% frameworks: Effectiveness, Safety, Accessibility, Equity, Efficiency, Acceptability, Patient Centeredness and Timeliness.

Research limitations/implications

The limits of this study can be represented by the following elements: (1) lack of exhaustiveness with regard to the current Frameworks. (2) The evaluation of reliability and validity of the qualitative studies remains difficult to appreciate. (3) Most of the evaluation tools of the primary health care are not validated yet. (4) The difference in performance levels between countries, especially for the developed countries and the multitude of the frames of measure of performance, limits the comparability of the results.

Practical implications

This study provides a conceptual and descriptive literature on the different conceptual frameworks for performance measurement in primary health care, and a practical and useful tool for comparison between the different conceptual frameworks. Several organisations of accreditation or certification introduced, developed, incorporated and checked the indicators of clinical quality in the organizations of health care. Some studies revealed links with the governance, the access, the continuity, the coordination, the efficiency and the strength primary care (Dionne Kringos, 2018). Improvements in the quality of care have been observed in the results of accreditation and certification bodies regarding hospital infection control infrastructure, organization and performance.

Originality/value

Even if the links are not established within the framework of a scientific research, quality approaches are generally recognized as an essential tool to help establishments to improve the quality and the safety of the patients. Until now, it is not still common to make evaluation of the quality of care in the “PHCF” to obtain the relevant information. The necessity of having performance measurement tools, which puts in coherence the piloting of the operational level with the strategy, to integrate the organizational objectives into the measures of operational performances and make estimate its structures towards a real management by the quality.

Details

International Journal of Health Governance, vol. 25 no. 4
Type: Research Article
ISSN: 2059-4631

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Article
Publication date: 4 December 2017

Ben Pearson

Providers of health and social care services aim to deliver personalised care that is safe, effective, caring, responsive and well led. Multidisciplinary teams often have…

Abstract

Purpose

Providers of health and social care services aim to deliver personalised care that is safe, effective, caring, responsive and well led. Multidisciplinary teams often have to work together, either within or across multiple provider organisations in order to achieve this aim. It is valuable to have a framework of clinical governance for such circumstances that enables a shared assurance of quality. To achieve these aims, the purpose of this paper is to present a clinical governance matrix framework developed by the author’s experiences in clinical practice, in service change and in management and leadership.

Design/methodology/approach

There are seven pillars of clinical governance; patient and public involvement, staffing and staff management, clinical effectiveness and research, using information and IT, education and training, risk management and audit. These seven pillars of clinical governance can be mapped against the five quality domains of safe, effective, caring, responsive and well led to create a matrix that in turn describes the framework we need for quality assurance.

Findings

The matrix is populated with outcome measures and these are monitored to achieve balance across the framework. The tool can be used at the level of an individual practitioner all the way up to multiple organisations in collaboration. The detail in each cell of the matrix will change accordingly and critically should be developed and owned by the subject of the framework.

Originality/value

This clinical governance matrix is presented as a methodology to monitor quality assurance in the settings of health and social care.

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Article
Publication date: 1 July 2014

Nikunj Agarwal and M.P. Sebastian

The purpose of this paper is to evaluate the utility of clinical processes in healthcare institutions of different sizes. The implications of adoption rate of computerized…

Abstract

Purpose

The purpose of this paper is to evaluate the utility of clinical processes in healthcare institutions of different sizes. The implications of adoption rate of computerized physicians order entry (CPOE) and electronic medical/health records (EMRs/EHRs) in different sized healthcare institutions in the USA were studied in terms of understanding its impact on enhancement of quality of patient care.

Design/methodology/approach

This study has used secondary data to obtain insights on the processes and technologies used in hospitals of different sizes in the USA and enlighten those in the developing countries to adopt a strategy that would be most appropriate for them. The Dorenfest Institute for H.I.T. Research and Education Analytics database (The Dorenfest Institute, 2011) provided the data for 5,038 US hospitals. Logistic regression was performed to study the impact of the different types of processes and technologies on institutions of different sizes, classified based on the number of beds, physicians, and nurses.

Findings

The findings show that small sized hospitals had a positive relationship with drug dosing interactions process and nursing and clinician content process. On the contrary, medium sized hospitals had a negative relationship with the usage of CPOE for entering medical records, i.e. <25 percent (p<0.05). In order to be effective, these institutions should increase the usage of EMRs by more than 25 percent to get positive outcomes. Large hospitals showed a positive relationship with the usage of >75 percent of CPOE to enter medical records and usage of medical records >75 percent.

Practical implications

The authors demonstrate the need for an evaluation of utility of acute care hospitals based on hospital size in terms of number of physicians, and nurses, which have not been dealt earlier by the past studies. Moreover, there is also a need for an evaluation of utility of acute care hospitals for implementation of CPOEs and EMRs that are integrated with clinical decision support systems.

Originality/value

Although the data are US-centric, the insights provided by the results are very much relevant to the Indian scenario to support the improvement of the quality of care. The findings may help those implementing processes in healthcare institutions in India. No study has addressed the measurement of the positive and negative outcomes arising due to the implementation of different percentages of CPOEs and EMRs in different sized institutions. Further the number of physicians and nurses have not been considered earlier. Therefore, the authors have classified the hospitals based on physicians and nurses and studied their impact on the adoption of CPOEs, clinical decision support systems, and EMRs.

Details

Clinical Governance: An International Journal, vol. 19 no. 3
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 1 April 2014

Julia Ellershaw, Peter Steane, John McWilliams and Yvon Dufour

Job satisfaction, mental health and organisational commitment are important for clinician retention. Psychological contracts, organisational justice and negative…

Abstract

Purpose

Job satisfaction, mental health and organisational commitment are important for clinician retention. Psychological contracts, organisational justice and negative affectivity (NA) have been linked with these outcomes but there is limited research examining these concepts in combination, particularly for clinicians. The aim of this paper is to examine the relationships between psychological contract breach, organisational justice and NA, on the outcomes of organisational commitment, psychological distress and job satisfaction, in a medical context.

Design/methodology/approach

Surveys were distributed to Australian hospital clinicians through their internal mail and 81 completed surveys were returned (response rate=24 per cent).

Findings

Multiple regression analyses revealed that organisational commitment was related to NA, psychological contract obligation and the interaction between psychological contract breach and distributive justice. Psychological distress was related to NA and procedural justice. Job satisfaction was related to the interaction between psychological contract breach and informational justice, however, the overall model for job satisfaction was not significant.

Practical implications

By implementing innovative social exchange processes, healthcare organisations can ensure distributive justice is maintained in the culture in event of contract breach, and by so doing build safety mechanisms into sustaining commitment from clinicians.

Originality/value

This paper contributes to the literature on clinical governance in managing the psychological contract to sustain commitment from clinical staff. The findings provide new insights into the factors effecting employee outcomes for clinicians.

Details

Clinical Governance: An International Journal, vol. 19 no. 2
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 7 August 2018

Alexandra Khoury, Mark Jones, Christopher Buckle, Mark Williamson and Guy Slater

Weekend surgery carries higher mortality than weekday surgery, with complications most commonly arising within the first 48 hours. There is a reduced ability to identify…

Abstract

Purpose

Weekend surgery carries higher mortality than weekday surgery, with complications most commonly arising within the first 48 hours. There is a reduced ability to identify complications at the weekend, with early signs going undetected in the absence of thorough early patient review, particularly in the elderly with multiple co-morbidities. Weekend working practices vary amongst UK hospitals and specialties. The weekend effect has been a prominent feature in the literature over the past decade. The purpose of this paper is to identify the number of patients undergoing weekend surgery who receive a Day 1 post-operative review and improve this outcome by implementing an effective change.

Design/methodology/approach

It was observed that not all patients undergoing surgery on a Friday or Saturday at the authors’ District General Hospital were receiving Day 1 post-operative review by a clinician. A retrospective audit was carried out to identify percentage of patients reviewed on post-operative Day 1 at the weekend. A change in handover practice was implemented before re-audit.

Findings

In Phase 1, 54 per cent of patients received Day 1 post-operative reviews at the weekend against a set standard of 100 per cent. A simple change to handover practice was implemented to improve patient safety in the immediate post-operative period resulting in 96 per cent of patients reviewed on Day 1 post-operatively at re-audit.

Originality/value

This study confirms that simple changes in handover practices can produce effective and translatable improvements to weekend working. This further contributes to the body of literature that acknowledges the existence of a weekend effect, but aims to evolve weekend working practices to accommodate improvement within current staffing and resource availability by maximising efficiency and communication.

Details

International Journal of Health Governance, vol. 23 no. 4
Type: Research Article
ISSN: 2059-4631

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Article
Publication date: 24 August 2018

Emmanuel Anongeba Anaba and Aaron Asibi Abuosi

Adolescents are more exposed to risky health behaviors. However, many adolescents do not seek health care due to the poor quality of care. The purpose of this paper is to…

Abstract

Purpose

Adolescents are more exposed to risky health behaviors. However, many adolescents do not seek health care due to the poor quality of care. The purpose of this paper is to assess health care quality in adolescent clinics in Tema, a suburb of Ghana.

Design/methodology/approach

Cross-sectional survey design was adopted to collect data from 365 adolescent respondents. Data were analyzed with the aid of Statistical Package for Social Science (version 20) using descriptive statistics and multiple linear regression.

Findings

The results demonstrate that adolescents perceived quality of care in adolescent clinics to be good. The significant predictors of adolescents’ overall perceptions of quality of care were provider competencies (β=0.311, p<0.01), adolescent’s health literacy (β=0.359, p<0.01), appropriate package of services (β=0.093, p<0.05), and equity and non-discrimination (β=0.162, p<0.01).

Research limitations/implications

The study was conducted in an urban setting. Therefore, the generalization of findings must be done with caution.

Originality/value

Adolescent health care quality in Ghana is below expectation. However, it has received little attention from researchers. This study provides empirical evidence for adolescent health care quality improvement in developing countries like Ghana.

Details

International Journal of Health Governance, vol. 23 no. 4
Type: Research Article
ISSN: 2059-4631

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Book part
Publication date: 1 January 2008

Yee-Ching Lilian Chan and Alfred Seaman

This article looks at the alignment of performance management system with the strategy, structure, and organizational outcome in Canadian health care organizations. In…

Abstract

This article looks at the alignment of performance management system with the strategy, structure, and organizational outcome in Canadian health care organizations. In this study, balanced scorecard is the framework adopted for assessing the health care organization's performance management system (PMS) and outcome. CEO and clinical unit managers were surveyed for their perceptions on their organization's strategy, autonomy structure, PMS, and organizational performance. Path analysis was the methodology used in examining the relationship about the above organizational variables. The results indicate that patient satisfaction is the primary and most significant perspective of the depicted balanced scorecard in organizational performance. Patient satisfaction and research criteria, on the other hand, are the significant perspectives of a balanced scorecard in an organization's PMS, which are linked to strategy, autonomy structure, and organizational performance. Moreover, the results show that the strategy/structure links operated as suggested. Surprisingly, strategy on service innovation has a negative impact on the organizational outcome of patient satisfaction. Uncertainty from continuous development and organizational change in pursuing service innovation and cost-cutting measures in response to fiscal constraints are plausible explanations of the adverse impact reported.

Details

Advances in Management Accounting
Type: Book
ISBN: 978-1-84855-267-8

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Article
Publication date: 14 May 2018

Simone Fanelli, Gianluca Lanza and Antonello Zangrandi

The purpose of this paper is to describe the design and construction of a privilege mapping system (clinical and organizational competences) of the medical staff of the…

Abstract

Purpose

The purpose of this paper is to describe the design and construction of a privilege mapping system (clinical and organizational competences) of the medical staff of the Niguarda Hospital in Milan, Italy. The second aim is to measure and assess the impact of implementing an evaluation process of clinical competences at the same hospital.

Design/methodology/approach

The paper retraces the development and implementation of the evaluation of the privilege system, highlighting the subjects involved, the phases and outputs. Moreover, a questionnaire was distributed to 50 heads of unit involved in the planning, building and implementation of competences mapping. Five areas were investigated: competences evaluation for professional development; the impact on work organization and professional roles; professional collaboration; its impact according to context (hospital or unit) and time scale (short or long term); and ability to evaluate clinical outcome.

Findings

Results reveal success factors for the development and implementation of a privilege mapping system. Furthermore, the survey revealed that clinical leaders are aware of the importance of competences evaluation. In particular, they consider it as a management tool useful for professional development, for identifying excellence and planning operational activities.

Originality/value

Literature and practical evidence recognize the need to assess the clinical and organizational competences in order to assign tasks and responsibilities. However, there are no studies that describe the construction of systems of evaluation of privileges, as it has never been investigated as professionals perceive these tools.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 4
Type: Research Article
ISSN: 0952-6862

Keywords

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Article
Publication date: 5 October 2020

Alberto Sardi, Enrico Sorano, Anna Guerrieri and Umberto Fiandra

To improve the performance both in terms of patient safety and quality of treatments, this research studies one of the most delicate processes of health organizations…

Abstract

Purpose

To improve the performance both in terms of patient safety and quality of treatments, this research studies one of the most delicate processes of health organizations, that is to say, the clinical risk management in maternal and child pathway. This paper aims to analyze the accidents that occurred in a complex health facility through the standard mapping of this pathway included in the CartoRisk, i.e. a risk assessment tool for the a priori analysis.

Design/methodology/approach

The research uses the case study methodology, as it explores a complex process in which a lot of variables and actors are involved. It analyzes the accidents occurred in the largest health facility at national and European level.

Findings

After a presentation of the regulatory framework and the studied health organization, the research analyzes the accidents occurred in maternal and child pathway from 2014 to 2018. It showed the main risks according to the standard mapping of the maternal and child pathway. Furthermore, it identified 11 new risks mainly associated with physiologic birth and Caesarean birth.

Originality/value

This study presents the regulatory framework, the health facility and the accidents of a health organization. Moreover, besides the accident analysis, the research integrates further risks into the standard mapping adopted to carry out this study and proposes a risk management approach. Therefore, the value of the research for operators will consist of the integration of the standard mapping used for a priori analysis to be reused in the hospitals where they work, while for researchers it will represent a deep knowledge of a real case.

Details

Measuring Business Excellence, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1368-3047

Keywords

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