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The aim of this study was to assess whether clinical guidelines complied with the instructions for writing structured care management tools in a French university hospital. A cross‐sectional study of guidelines for appropriate antimicrobial agent use in the authors’ institution was carried out. A total of 221 guidelines were retrieved in 62 hospital units. The number of guidelines by unit ranged from one to 22 and 198 guidelines (90 per cent) had been developed at the local level. None of the guidelines fully complied with the ten criteria of the instructions. Each guideline met, on average, 4.2 criteria (3.9‐4.5). The partial compliance rate was 75 per cent (68‐80). In two‐level multivariate analysis, factors associated with partial compliance were: dissemination of guidelines after implementation of the instructions (odds ratio=6.25 (2.41‐16.21)), existence of more than one storage site for guidelines in each unit (OR=3.26 (1.03‐10.32)), and hospital unit (variance of the intercept=1.54).

The objective of this study was to check psychometric properties of a French‐language in‐patient experience questionnaire in a test sample different from the development sample. The questionnaire was sent out to 5,736 in‐patients, within two to four weeks of discharge from a teaching hospital of 2,200 beds. Overall 4,095 questionnaires (71.4 per cent) were returned. Of these, 3,879 questionnaires were analyzed. In principal component analysis, seven principal components accounted for 62.4 per cent of the total variance. Cronbach’s alpha coefficient ranged from 0.62 to 0.90, with the exception of the seventh scale (convenience scale, two items, Cronbach=0.39). The overall patient experience score increased with increasing patient age (except for patients older than 65), male sex, low education level, use of a single room, and prior stay in the department. It also differed with respect to patients’ behavioral intentions, answers to an overall satisfaction item, and open‐ended comments.

This paper aims to evaluate the effectiveness of a program designed to improve the quality of drug prescription‐writing at a university hospital in France. Improvement actions included feed‐back from yearly audits and the dissemination of recommendations on how best to write the prescriptions. A random sample of 30 stays was selected from among the hospitalizations for the year 1996. From each patient, medical records were searched for the first prescription order of the stay and its quality was assessed according to standards. A total of 872 records were relevant and included 3,289 medications. The results were compared to those obtained for the two previous years. Actions to sensitize prescribers resulted in an insufficient improvement of most indicators of prescription‐writing quality with results remaining well below ideal standards. The hospital staff concerned had a positive opinion of the program which led to an awareness of prescription problems. This assessment showed that the program had a moderate impact on prescribers’ practice and efforts must be continued.

Examines the dynamics of change that operated following preparations for accreditation. The study was conducted from May 1995 to October 2001 in a university hospital center in France after the introduction in 1996 of mandatory accreditation. An embedded explanatory case study sought to explore the organizational changes: a theoretical framework for analyzing change was developed; semi‐structured interviews, focus groups, and questionnaires addressed to the hospital's professionals were used and documents were collected; and qualitative and quantitative analyses were carried out. Professionals from clinical and medico‐technical departments participated most. Preparations for accreditation provided an opportunity to reflect non‐hierarchically on the treatment of patients and on the hospital's operational modalities by creating a locus for exchanges and collegial decision making. These preparations also led to giving greater consideration to results of exit surveys and to committing procedures to paper, and were a key opportunity for introducing a continuous quality program.

Development and implementation of guidelines constitutes the basis of quality management systems for any organization. The authors have studied the internal documentation produced by professionals on 88 functional units of a university hospital. Reveals the existence of many documents concerning quality of care with an average of 102 available procedures or protocols per unit. However, this documentation is badly organized, making it difficult to consult and to put into practice. The results of this study were provided to other professionals at our hospital in order to make them aware of the necessity of rigorous document management. We have also written and sent recommendations for drawing up procedures and implementing an efficient documentary management system. This effort complements development of the hospital quality assurance plan.

This article aims to analyze morbidity and mortality conferences (M&MCs) in a university‐affiliated hospital, notably their format and progression since the 1990s.

A cross‐sectional study was conducted and M&MC characteristics were collected using three methods: a questionnaire to all department heads to identify past M&MCs; semi‐structured interviews with each M&MC leader; and when available, meeting reports were analyzed.

Of 189 questionnaires sent to department heads, 105 were completed and returned (55.6 per cent). A total of 27 M&MCs were identified; five times more than in 1994. The M&MC format varied greatly between departments. In surgical units, cases per conference tended to be higher than in intensive care or medical units and paramedical staff were invited less often. Compared with 1998, head nurses (70.4 vs 27.3 percent, p=0.03) and paramedical staff (63.0 vs 18.2 percent, p=0.03) attendance increased significantly. Physicians considered M&MCs important for improving service quality, patient safety and enhancing team cohesion.

Patient outcomes were not assessed.

Although undefined formats allowed leaders to conduct M&MCs according to their objectives, how these conferences are conducted should impact healthcare quality and safety.

Results indicate that M&MCs have evolved over the past 20 years, showing them to be valuable quality and safety improvement methods.

The purpose of this paper is to assess the impact of five type II diabetes managed care programmes (MCPs) in clinical and economic terms at the community level in which these programmes function in the Provence‐Alpes‐Côte d'Azur region of France.

A prospective, controlled, before‐and‐after study (2001‐2004) compared diabetic patients who lived in departments (localities) with (the experimental group) and without a MCP (the control group). Quality of care was estimated by the conformity of health care professionals' practices when following‐up type II diabetes. Costs are compared from a health service perspective.

The study finds that of 626 patients enrolled, 529 lived in departments with an MCP and 97 patients in departments without. Type II diabetes follow‐up globally improved between the two study periods (2001 and 2004), but the study did not show significant differences between the two groups, except for the proportion of creatinine and ophthalmologic examinations, which were higher for the control group. The study did not find significant differences in the increase of costs between the two groups from 2001 to 2004.

This type of study could constitute a methodological model to assess the MCP's population impact.

MCPs probably did not reach a critical size in terms of patient recruitment and healthcare professional adhesion to have a significant impact at a population level.

The study highlights a number of points to consider for future MCPs in France.

Medical record represents the main information support used by healthcare providers. The purpose of this paper is to examine whether patient perception of hospital care quality related to compliance with medical-record keeping.

The authors merged the original data collected as part of a nationwide audit of medical records with overall and subscale perception scores (range 0-100, with higher scores denoting better rating) computed for 191 respondents to a cross-sectional survey of patients discharged from a university hospital.

The median overall patient perception score was 77 (25th-75th percentiles, 68-87) and differed according to the presence of discharge summary completed within eight days of discharge (81 v. 75, p=0.03 after adjusting for baseline patient and hospital stay characteristics). No independent associations were found between patient perception scores and the documentation of pain assessment and nutritional disorder screening. Yet, medical record-keeping quality was independently associated with higher patient perception scores for the nurses’ interpersonal and technical skills component.

First, this was a single-center study conducted in a large full-teaching hospital and the findings may not apply to other facilities. Second, the analysis might be underpowered to detect small but clinically significant differences in patient perception scores according to compliance with recording standards. Third, the authors could not investigate whether electronic medical record contributed to better compliance with recording standards and eventually higher patient perception scores.

Because of the potential consequences of poor recording for patient safety, further efforts are warranted to improve the accuracy and completeness of documentation in medical records.

A modest relationship exists between the quality of medical-record keeping and patient perception of hospital care.

The purpose of this paper is to investigate trends in patient hospital quality perceptions between 1999 and 2010.

Original data from 11 cross-sectional surveys carried out in a French single university hospital were analyzed. Based on responses to a 29-item survey instrument, overall and subscale perception scores (range 0-10) were computed covering six key hospital care quality dimensions.

Of 16,516 surveyed patients, 10,704 (64.8 percent) participated in the study. The median overall patient perception score decreased from 7.86 (25th-75th percentiles, 6.67-8.85) in 1999 to 7.82 (25th-75th percentiles, 6.67-8.74) in 2010 (p for trend <0.001). A decreasing trend was observed for the living arrangement subscale score (from 7.78 in 1999 to 7.50 in 2010, p for trend <0.001). Food service and room comfort perceptions deteriorated over the study period while patients increasingly reported better explanations before being examined.

Patient perception scores may disguise divergent judgments on different care aspect while individual items highlight specific areas with room for improvement.

Despite growing pressure on healthcare expenditure, this single-center study showed only modest reduction in patients’ hospital-care perceptions in the 2000s.

The purpose of this paper is to examine the effect of brand experience on hospital brand equity; also to assess the effects of different brand equity dimensions on overall customer‐based hospital brand equity.

Measurement items for each variable are developed by integrating existing literature and qualitative in‐depth interviews with patients who have either used, or are using hospital services in India. Face‐to‐face interviews with patients were conducted to obtain 902 usable data points. Psychometric properties of the measurement instrument were satisfactory. Data were analyzed using structural equation modelling to test the influences of different dimensions of brand experience on brand equity dimensions and on overall hospital brand equity.

The study found that brand experience is an important factor influencing hospital brand equity. The study provides evidence that the brand experience dimensions (sensory, affective, behavioural and intellectual) positively influence the five brand equity dimensions (brand awareness, brand association, perceived quality, brand trust and brand loyalty). The study also confirms the influence of brand equity dimensions (brand awareness, brand association, perceived quality, brand trust and brand loyalty) on customer‐based hospital brand equity.

The distinctive contribution of this research is that it examines the effect of brand experience on customer‐based brand equity in the context of a credence‐based service in an emerging economy. Such a work is essential in understanding the importance of experiential marketing in an emerging economy for building a strong service brand.