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Article
Publication date: 14 January 2021

Marc Sales and Rodolfo De Castro

This paper aims to present a method for strategic planning and implementation processes in health care based on lean management.

Abstract

Purpose

This paper aims to present a method for strategic planning and implementation processes in health care based on lean management.

Design/methodology/approach

Within the framework of the action research methodology, the authors present the ten steps of a kaizen project, which enable lean transformation over a period of time. The study is underpinned by a literature review of enablers and barriers and an implementation case in a tertiary care hospital.

Findings

Key points and possible contingency issues are presented for each of the steps, and a successful lean tools intervention is illustrated by examples of improvement projects of the surgical process. Conclusions of the implementation establish a roadmap for improvement projects in hospital environments based on lean management, thus bridging the existing gap between the large number of theoretical projects (much of the projects described are not sustainable over time as the hospital sector is very particular) that have failed to be implemented, or been paused mid-term, and the self-sustaining projects developed by improvement teams in the hospital.

Originality/value

The study details knowledge gleaned from a three-year project entailing various stages: forming improvement teams; training health-care professionals in lean management; drawing up a process map to identify value stream mapping improvement opportunities; implanting projects and verifying the results obtained; and finally, laying the cornerstones, which would make the project self-sustaining and open to long-term continuous improvement.

Details

The TQM Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1754-2731

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Article
Publication date: 2 October 2009

Anjali Patwardhan and Prakash Patwardhan

In the recent climate of consumerism and consumer focused care, health and social care needs to be more responsive than ever before. Consumer needs and preferences can be…

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1571

Abstract

Purpose

In the recent climate of consumerism and consumer focused care, health and social care needs to be more responsive than ever before. Consumer needs and preferences can be elicited with accepted validity and reliability only by strict methodological control, customerisation of the questionnaire and skilled interpretation. To construct, conduct, interpret and implement improved service provision, requires a trained work force and infrastructure. This article aims to appraise various aspects of consumer surveys and to assess their value as effective service improvement tools.

Design/methodology/approach

The customer is the sole reason organisations exist. Consumer surveys are used worldwide as service and quality of care improvement tools by all types of service providers including health service providers. The article critically appraises the value of consumer surveys as service improvement tools in health services tool and its future applications.

Findings

No one type of survey is the best or ideal. The key is the selection of the correct survey methodology, unique and customised for the particular type/aspect of care being evaluated. The method used should reflect the importance of the information required.

Research limitations/implications

Methodological rigor is essential for the effectiveness of consumer surveys as service improvement tools. Unfortunately so far there is no universal consensus on superiority of one particular methodology over another or any benefit of one specific methodology in a given situation. More training and some dedicated resource allocation is required to develop consumer surveys. More research is needed to develop specific survey methodology and evaluation techniques for improved validity and reliability of the surveys as service improvement tools. Measurement of consumer preferences/priorities, evaluation of services and key performance scores, is not easy.

Practical implications

Consumer surveys seem impressive tools as they provide the customer a voice for change or modification. However, from a scientific point‐of‐view their credibility in service improvement in terms of reproducibility, reliability and validity, has remained debatable.

Originality/value

This artcile is a critical appraisal of the value of consumer surveys as a service improvement tool in health services – a lesson which needs to be learnt.

Details

International Journal of Health Care Quality Assurance, vol. 22 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 3 August 2012

Helen Tucker and Mark Burgis

This paper aims to demonstrate the approach taken in Norfolk, UK, to engage patients and staff to develop and improve services by stimulating improvements in integrated…

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152

Abstract

Purpose

This paper aims to demonstrate the approach taken in Norfolk, UK, to engage patients and staff to develop and improve services by stimulating improvements in integrated working. The two year programme focused on making specific improvements that patients said they wanted to see by working with staff who volunteered to take part in the programme.

Design/methodology/approach

The “Integrating Care in Norfolk” pilot (ICN) was one of 16 national pilots. GPs from 32 practices worked with local community staff to redesign services to meet “patient pledges”. The impact of changes on patients, staff and services were evaluated locally using questionnaires and by analysing data combined in a performance dashboard. The ICN was subject to both national and local evaluations, which provided a basis for comparison.

Findings

The local evaluation showed that progress had been made towards meeting objectives, including patients and staff satisfaction and reducing unplanned admissions. GPs recorded improvements to joint working, and all staff concerned chose to continue the project beyond the pilot period.

Research limitations/implications

The findings of the local evaluation contrasted with those of the national evaluation. The Norfolk study demonstrated the positive impact of integrating care on patients, staff and services. The national study concluded that there were minimal or negative impacts of integrating care, although the study amalgamated all 16 pilots, with very different clients, services and objectives.

Originality/value

The ICN was novel in the way that patients and staff were engaged. Patients were invited to set an agenda for change, and provided a mandate to staff from each organisation to redesign their services. This approach may provide a solution to sustainable integrated working. The ICN was evaluated locally as well as nationally as part of the DH ICP programme, enabling respective findings to be compared and validated.

Details

Journal of Integrated Care, vol. 20 no. 4
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 1 July 2002

Sarah Fraser, Tim Wilson, Ken Burch, Mary‐Ann Osborne and Martin Knightley

Improvements were delivered in the care of patients on anti‐coagulants through a collaborative improvement methodology within one primary care organisation. Although a key…

Abstract

Improvements were delivered in the care of patients on anti‐coagulants through a collaborative improvement methodology within one primary care organisation. Although a key clinical governance priority, the project was conducted in a low‐key manner with minimal support. Practice teams were encouraged to apply evidence through small‐scale testing of changes, using measurements to monitor improvement and to share what they learned amongst themselves. No specific model of care was pursued and instead the emphasis was on demonstrating an improvement at the practice level, by whatever means worked best. The methodology used was similar to that applied in major national and regional collaborative programmes. This project demonstrates how it can be simplified and implemented within one primary care organisation to deliver improvements in care as well as to support the building of teams and learning about measurement and quality improvement.

Details

International Journal of Health Care Quality Assurance, vol. 15 no. 4
Type: Research Article
ISSN: 0952-6862

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Book part
Publication date: 28 September 2020

Maureen Walsh Koricke and Teresa L. Scheid

PurposePatient safety and adverse events continue to present significant challenges to the US health care delivery system. Mandated reporting of adverse events can be a…

Abstract

PurposePatient safety and adverse events continue to present significant challenges to the US health care delivery system. Mandated reporting of adverse events can be a mechanism to “coerce” hospitals to identify, evaluate, and ultimately improve the quality and safety of patient care. The objective of this study is to determine if the coercion of mandated reporting impacts hospital patient safety scores.

Methods – We utilize the US News and World Report 2012–2013 Best Hospital Rankings which includes patient safety data from US teaching hospitals. The dependent variable is a composite measure of six indicators of patient safety during and after surgery. The independent variable is state mandated reporting of hospital adverse events. Three control variables are included: Magnet accreditation status, surgical volume, and the percentage of surgical admissions.

Findings – Using ordered logistic regression (n = 670 hospitals) we find a positive, but not significant, relationship between state mandated reporting and better patient safety scores.

Implications – This finding suggests that regulatory policy may not actually prompt performance improvement, and our data point to the need for further study of both formal and informal processes to manage patient safety within the hospital.

Originality – While increased reporting of adverse events has been linked to hospitals providing safer care, no research to date has examined whether or not state-level mandates actually lead to improvements in patient safety.

Details

Race, Ethnicity, Gender and Other Social Characteristics as Factors in Health and Health Care Disparities
Type: Book
ISBN: 978-1-83982-798-3

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Article
Publication date: 12 August 2019

Jitendra Singh, Brandi Sillerud and Marah Omar

The purpose of this paper is to explore and examine attitudes and perceptions of leaders on application of quality improvement (QI) strategies in a palliative and hospice…

Abstract

Purpose

The purpose of this paper is to explore and examine attitudes and perceptions of leaders on application of quality improvement (QI) strategies in a palliative and hospice care organization.

Design/methodology/approach

This study employed qualitative research methodology where leaders working in a hospice and palliative care organization were invited to participate in 45–60-min-long semi-structured interview. Interviews were recorded and transcribed verbatim. Qualitative content analysis was utilized to analyze the data collected during participant interviews.

Findings

Seven leaders participated in the interviews. Five themes were developed from data analysis: patient-centered care; continuous QI; leadership involvement and commitment; communication as a foundation for QI; and perceived barriers. Data analysis suggests that use of QI approach in palliative and hospice care enhances the quality of care provided for patients, and can help improve patient satisfaction.

Practical implications

Because there is a paucity of research on implementation of QI strategies in hospice and palliative care settings, this research can have wide practical implications. This research can provide useful practical tips to leaders as they work on implementing QI projects in their organization.

Originality/value

This manuscript can be of value to leaders, administrators and academicians who are interested in applying QI principles to healthcare processes especially in palliative and hospice care settings. Ability to work with others, solid communication and involvement of employees from all levels can help in streamlining current systems of care.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 3 February 2012

Susanne Löfgren, Johan Hansson, John Øvretveit and Mats Brommels

The purpose of this paper is to describe and explain a clinician‐led improvement of a hip fracture care process in a university hospital, and to assess the results and…

Abstract

Purpose

The purpose of this paper is to describe and explain a clinician‐led improvement of a hip fracture care process in a university hospital, and to assess the results and factors helping and hindering change implementation.

Design/methodology/approach

The paper has a mixed methods case study design. Data collection was guided by a framework directing attention to the content and process of the change, its context and outcomes.

Findings

Using a multiprofessional project team, beneficial changes in the early parts of the care process were achieved, but inability to change surgical staff work practices meant that the original goal of operating patients within 24 hours was not reached. After three years, top management introduced a hospital‐wide process improvement programme, which “took over” the responsibility for improving hip fracture care.

Research implications/limitations

A clear vision why change is needed and what needs to be done, which is well communicated by a respected clinical leader, can motivate personnel, but other influences are also needed to bring about change. Without a plan agreed and supported by top management, changes are likely to be limited to parts of the process and improvements to patient care may be minimal. These and other findings may be applicable to similar situations in other services.

Originality/value

This case study is an illustration of both the strengths and the weaknesses of a “bottom‐up, clinician‐champion‐led improvement initiative” in a complex university hospital.

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 2
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 11 May 2015

Annelie Khatami and Kristina Rosengren

– The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones.

Abstract

Purpose

The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones.

Design/methodology/approach

A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months.

Findings

The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes.

Research limitations/implications

This study includes one team (six members, different health professionals) within the same urology department.

Practical implications

Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work.

Social implications

Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work.

Originality/value

Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

Details

International Journal of Health Care Quality Assurance, vol. 28 no. 4
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 18 October 2011

Nicola Shaw, Victoria Aceti, Denise Campbell‐Scherer, Marg Leyland, Victoria Mozgala, Lisa Patterson, Shanna Sunley, Donna Manca and Eva Grunfeld

This paper aims to explore the perceptions of facilitators and barriers to their using electronic medical records (EMRs) for these functions and contributes baseline data…

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2074

Abstract

Purpose

This paper aims to explore the perceptions of facilitators and barriers to their using electronic medical records (EMRs) for these functions and contributes baseline data about the use of EMRs for chronic disease management. The sub‐study reported here is a baseline process evaluation of EMRs and their current use, preliminary to a larger, pragmatic, randomized controlled trial. Its purpose is to understand how EMRs are currently being used by primary care physicians to facilitate chronic disease prevention and screening in their practices.

Design/methodology/approach

This is a qualitative case study where the lead physician at each of eight primary care clinics (four in Alberta, four in Ontario) participated in semi‐structured interviews. Data were analyzed using thematic content analysis.

Findings

Although EMRs are being used in a limited fashion for chronic disease prevention and screening, clinicians identified few current benefits. Participants noted some instances in which paper charts were preferred and that the lack of human and financial resources is inhibiting the use of chronic disease applications already incorporated in EMRs.

Research limitations/implications

To understand fully how EMRs can best be used in the logistical management of chronic disease prevention and screening requires research efforts towards improvement of the data structures they contain.

Practical implications

Data extraction needs to be easier so that screening of patients, at risk or living with chronic disease, can be facilitated.

Social implications

Evaluation of the benefits, for the content of care and care relationships, conferred by this new method of communicating, needs to be complemented by a parallel exploration of the risks.

Originality/value

The paper illustrates that with the tremendous investments in EMRs it is important to learn how changes in their design could facilitate improvements in patient care in this important area.

Details

Clinical Governance: An International Journal, vol. 16 no. 4
Type: Research Article
ISSN: 1477-7274

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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.

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2003

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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