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This paper aims to gain insights about information management practices in public health-care organizations in Kuwait and offer recommendations to improve these practices.
Abstract
Purpose
This paper aims to gain insights about information management practices in public health-care organizations in Kuwait and offer recommendations to improve these practices.
Design/methodology/approach
This study involves secondary analysis of quantitative and qualitative accreditation-related data pertaining to the compliance with the Information Management standard at seven public tertiary health-care facilities over two accreditation cycles.
Findings
Overall, organizations improved their compliance with the Information Management standard. However, issues exist with effectively and efficiently transmitting data, aggregating clinical and administrative data and using the information for both strategic planning and quality improvement initiatives.
Research limitations/implications
The analysed data set does not provide information about the improvements done between the accreditation cycles. Caution should be applied before assuming generalizability of the results, considering the context and social constructs around the health-care system is essential.
Practical implications
Compliance with predetermined criteria through accreditation can improve information management practices. Without proper management of information at health-care facilities, achieving safe and effective patient care is futile. The role of health information technology (IT) should not be sidelined; robust health IT solutions can help support good information management practices thereby improving care quality and aiding health-care reform.
Originality/value
Concerning information management, health-care organizations providing focused services have clear advantages over organizations providing general care services. Considering the type of care organization (general vs specialized) can provide insights into how information management practices can affect the operations of the organization.
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Neelu Puri, Anil Gupta, Arun K. Aggarwal and Vipin Kaushal
Outpatient departments (OPDs) need to monitor the quality of care and patient satisfaction for continuous quality improvement. Additionally, there is a need for an increase in…
Abstract
Purpose
Outpatient departments (OPDs) need to monitor the quality of care and patient satisfaction for continuous quality improvement. Additionally, there is a need for an increase in focused literature on patient satisfaction and quality of health care at a tertiary care level. The purpose of this paper is to attempt to fulfil this need.
Design/methodology/approach
A cross‐sectional hospital‐based study among OPD patients was undertaken, where investigators conducted interviews with 120 patients at entry (registration), 120 patients at the OPD clinic (60 doctor‐patient interactions and 60 exit interviews), and a further 120 patients at investigation facilities. Patient satisfaction, client convenience facilities, prescription quality, doctor‐patient interaction and other quality elements as described in the study were given score of 0 or 1.
Findings
At exit, 52 (86.6 percent) patients were satisfied with the OPD care. The mean total quality score was 80.9 percent of the total scores. It was above 90 percent of the total score for patient convenience facilities and for doctor‐patient interaction, 76 percent for the prescription quality of the doctors and 43.3 percent for signage display. The mean score for patient‐doctor interaction was found to be significantly lower (3.6/5) among dissatisfied patients compared to the satisfied patients (4.7/5). Satisfied patients reported a significantly higher consultation time (12.4 minutes) with a doctor compared to dissatisfied patients (8.5 minutes) (p=0.04).
Research limitations/implications
Not using a Likert scale to measure patient satisfaction could be considered a limitation. However, the authors also arrived at similar conclusions with their tools as with the use of Likert scales in other studies. Furthermore, findings are limited to medicine and surgery general OPDs in a tertiary care setting. Any interpretation beyond this frame may be done with caution.
Practical implications
Hospitals should encourage good patient‐doctor interaction as it has emerged as the key factor associated with patient satisfaction.
Social implications
Quality improvements in public sector health institutes can lead to better utilization of health care by the poor and compromised sections of society and can lead to a reduction in the inequity associated with health care.
Originality/value
This paper fulfils the need to evaluate quality of hospital care in public sector hospitals at the tertiary care level. The methods and tools used are simple and extensive enough to capture information at multiple service points.
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Priscilla Anaba, Emmanuel Anongeba Anaba and Aaron Asibi Abuosi
Promoting patient satisfaction is crucial for healthcare quality improvement. However, literature on patient satisfaction with nursing care in Ghana is limited. The aim of this…
Abstract
Purpose
Promoting patient satisfaction is crucial for healthcare quality improvement. However, literature on patient satisfaction with nursing care in Ghana is limited. The aim of this study was to assess patient satisfaction with perioperative nursing care in Korle-Bu Teaching Hospital, the largest tertiary hospital in Ghana.
Design/methodology/approach
The study was a cross-sectional study. A sample of one hundred (n = 100) in-patients in the surgical department were interviewed. Statistical Package for Social Science (SPSS), version 22, was used to analyze the data. The results were presented using univariate, bivariate and multivariate analyses.
Findings
It was found that majority of the respondents were males (53%), employed (56%) and insured (85%). It was also found that eight in ten respondents were satisfied with the perioperative nursing care. Overall patient satisfaction with perioperative nursing care was significantly associated with information provision (p < 0.001), nurse–patient relationship (p < 0.001), fear and concern (p < 0.05) and discomfort and need (p < 0.05). At the multivariate level, overall patient satisfaction was significantly influenced by nurse–patient relationship (β = 0.430, p = 0.002).
Originality/value
There is limited literature on nursing care in surgical departments and rarely are patients' views considered in assessing quality of perioperative care, especially in Low- and Middle- Income Countries (LMICs). This study is a modest contribution to the literature on patient satisfaction with perioperative nursing care in Ghana.
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Lorraine Abela, Adriana Pace and Sandra C. Buttigieg
Hospital length of stay (LOS) is not only a function of patient- and disease-related factors, but is also determined by other health system-wide variables. Managers and clinicians…
Abstract
Purpose
Hospital length of stay (LOS) is not only a function of patient- and disease-related factors, but is also determined by other health system-wide variables. Managers and clinicians strive to achieve the best possible trade-off between patients’ needs and efficient utilisation of hospital resources, while also embracing ethical decision making. The purpose of this paper is to explore the perceptions of the hospital’s major stakeholders as to what affects the duration of LOS of inpatients.
Design/methodology/approach
Using a data-triangulated case study approach, 50 semi-structured interviews were performed with management, doctors, nurses and patients. Additionally, the hospitals’ standard operating procedures, which are pertinent to the subject, were also included in the thematic analysis.
Findings
This study shows that LOS is a multi-dimensional construct, which results from a complex interplay of various inputs, processes and outcomes.
Research limitations/implications
The findings emerging from a single case study approach cannot be generalised across settings and contexts, albeit being in line with the current literature.
Practical implications
The study concludes that a robust hospital strategy, which addresses deficient organisational processes that may unnecessarily prolong LOS, is needed. Moreover, the hospital’s strategy must be sustained by providing good primary care facilities within the community set-up, as well as by providing more long-term care and rehabilitation beds to support the hospital turnover.
Originality/value
The subject of LOS in hospitals has so far been tackled in a fragmented manner. This paper provides a comprehensive and triangulated account of the complexities surrounding the duration in which patients are kept in hospital by key stakeholders, most of whom were hands-on in the day-to-day running of the hospital under study.
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Waleed M. S. Al‐Shaqha and Mohamed Zairi
Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk…
Abstract
Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk preparation and distribution of drug products to one centred on ensuring optimal drug therapy. Whereas hospital pharmacists were charged with maintaining large drug stock on nursing units, many of them now provide individualised patient therapies. The practice of hospital pharmacy has therefore become one encompassing all aspects of drug therapy, from the procurement of drugs and drug delivery devices, their preparation and distribution, to their most appropriate selection and use for each patient. Hospital pharmacy services have traditionally had little involvement at the key stages in patients’ hospital care. This leads to the conclusion that the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today’s health‐care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health‐care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians.
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Alok Kumar Samanta, Varaprasad G. and Anand Gurumurthy
Health care organisations implement lean six sigma (LSS) methodology to achieve improved performance in terms of cost, quality and productivity. However, the way it gets…
Abstract
Purpose
Health care organisations implement lean six sigma (LSS) methodology to achieve improved performance in terms of cost, quality and productivity. However, the way it gets implemented differs between organisations. Hence, this paper deal with a review of case studies describing the implementation of LSS in health care organisations to understand the nuances of implementation and identify future research directions.
Design/methodology/approach
The journal articles indexed in the Web of Science and Scopus database were filtered out. In total, 154 articles were evaluated using specific structural dimensions to categorise the literature into various groups, and content analysis was performed to synthesise the same.
Findings
This review revealed that the number of articles publishing the application of LSS in health care has been increasing in the last five years. Academic hospitals play a pivotal role to bridge the gap between LSS theory and practice. Despite this fact, certain themes remain unexplored. Not many studies are available that document the application of LSS in non-clinical areas such as pharmacy, internal logistics, maintenance and medical records. Only 20% of articles mentioned the post-intervention data up to three years, thus questioning the sustainability aspect of the achieved improvements.
Research limitations/implications
Various research gaps were identified, which can be used by the researchers to build the body of knowledge in the domain of LSS in health care.
Practical implications
This review provides a diversified view regarding the utility of LSS in the health care scenario. The findings will provide valuable insights for the health care practitioners regarding tools, techniques, drivers and performance measures.
Originality/value
To the best of the authors’ knowledge, this is the first study to review only the case studies that describe the implementation of LSS in the health care sector.
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Daniela Fishbein, Siddhartha Nambiar, Kendall McKenzie, Maria Mayorga, Kristen Miller, Kevin Tran, Laura Schubel, Joseph Agor, Tracy Kim and Muge Capan
Workload is a critical concept in the evaluation of performance and quality in healthcare systems, but its definition relies on the perspective (e.g. individual clinician-level vs…
Abstract
Purpose
Workload is a critical concept in the evaluation of performance and quality in healthcare systems, but its definition relies on the perspective (e.g. individual clinician-level vs unit-level workload) and type of available metrics (e.g. objective vs subjective measures). The purpose of this paper is to provide an overview of objective measures of workload associated with direct care delivery in tertiary healthcare settings, with a focus on measures that can be obtained from electronic records to inform operationalization of workload measurement.
Design/methodology/approach
Relevant papers published between January 2008 and July 2018 were identified through a search in Pubmed and Compendex databases using the Sample, Phenomenon of Interest, Design, Evaluation, Research Type framework. Identified measures were classified into four levels of workload: task, patient, clinician and unit.
Findings
Of 30 papers reviewed, 9 used task-level metrics, 14 used patient-level metrics, 7 used clinician-level metrics and 20 used unit-level metrics. Key objective measures of workload include: patient turnover (n=9), volume of patients (n=6), acuity (n=6), nurse-to-patient ratios (n=5) and direct care time (n=5). Several methods for operationalization of these metrics into measurement tools were identified.
Originality/value
This review highlights the key objective workload measures available in electronic records that can be utilized to develop an operational approach for quantifying workload. Insights gained from this review can inform the design of processes to track workload and mitigate the effects of increased workload on patient outcomes and clinician performance.
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Sharmin Majumder, Zannatul Najnin, Shamim Ahmed and Shafi Ullah Bhuiyan
Neonatal mortality rate is 24 deaths per 1,000 live births in Bangladesh and most of them die during early neonatal period. The purpose of this paper is to assess the knowledge…
Abstract
Purpose
Neonatal mortality rate is 24 deaths per 1,000 live births in Bangladesh and most of them die during early neonatal period. The purpose of this paper is to assess the knowledge and attitude of neonatal care practices among postnatal mothers in a tertiary care hospital in order to provide a basis for the development of strategies to improve further.
Design/methodology/approach
A cross-sectional study was carried out in the Dhaka Medical College Hospital, Bangladesh using a convenient sampling technique. In total 211 postnatal mothers were interviewed using a structured questionnaire and χ2 test was used to analyze the data.
Findings
Among mothers, 37.9 percent were aged between 16–20 years; 16.1 percent had no institutional education; 55 percent were primipara and only 26.5 percent had attended antenatal visit for more than four times. Mothers had apparently good knowledge and attitude about thermoregulation, early initiation of breast-feeding, importance of providing colostrum to the newborn, exclusive breast-feeding (EBF) up to six months of age and immunization at birth. However, this study identified knowledge gap about cord care, eye care, first bathing and hygiene practices. Overall, only a small proportion of respondents had good level of knowledge (37 percent) and attitude (47.4 percent) on newborn care. Highly significant statistical association was found between the knowledge, attitude level and socio-demographic characteristics of respondents. Knowledge and attitude were strongly associated as well.
Research limitations/implications
There is scope for improvement by providing health education to antenatal and postnatal mothers. Therefore, implementation of the guidelines outlined in the Maternal and Child Handbook (MCH) is highly recommended.
Originality/value
There is scope for improvement by providing health education to antenatal and postnatal mothers. Therefore, implementation of the guidelines outlined in the MCH is highly recommended to enhance the knowledge and attitude on newborn care among postnatal mothers.
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Richa Tripathi, Shalini Singh, Siddharth Sarkar, Rakesh Lal and Yatan Pal Singh Balhara
There is a paucity of comparative literature on pathway to care among patients with co-occurring disorders and those with only substance use disorders. This paper aims to compare…
Abstract
Purpose
There is a paucity of comparative literature on pathway to care among patients with co-occurring disorders and those with only substance use disorders. This paper aims to compare the pathways to care among patients with co-occurring disorder and those with only substance use disorders.
Design/methodology/approach
A cross-sectional observational study was carried out on male treatment seekers at a tertiary care substance use disorder treatment center in India. Participants were recruited in two groups, those with co-occurring psychiatric and substance use disorders and those with only substance use disorders. The two groups were matched for age and socio-economic status.
Findings
A total of 189 subjects with co-occurring psychiatric and substance use disorders and 197 subjects with substance use disorders only were recruited. Psychiatric services were the most common first point of care. However, a larger proportion of the subjects in the co-occurring disorder group received the first care from faith healers, while a greater proportion received first care from the therapeutic communities in substance use disorder only group. Initial care was sought mostly following suggestion from the family members in both the groups. The time to treatment for substance use disorders did not differ between the two groups, though the treatment seeking for substance use disorder was more delayed than that of psychiatric disorder in the co-occurring disorder group.
Research limitations/implications
The findings shed light on the pathway of care followed in India and is a matter of further research.
Practical implications
Expansion of services and dissemination of information about psychiatric disorders and substance use disorders can provide timely care to patients with substance use disorders and co-occurring disorders.
Social implications
The findings have a social implication as well. More awareness is needed currently in India for timely treatment of dual disorders.
Originality/value
The paper is an original research by the authors. The data were collected from the participants who reported to the dual diagnosis clinic. The findings are important as they tell us about the current understanding of dual diagnosis by the general public.
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Fauziah Rabbani, Farah Naz Hashmani, Aftab A Ali Mukhi, Xaher Gul, Nousheen Pradhan, Peter Hatcher, Mounir Farag and Farhat Abbas
The WHO Eastern Mediterranean Regional Office has emphasized health system strengthening among the top five strategic priorities. One of the integral elements of health systems…
Abstract
Purpose
The WHO Eastern Mediterranean Regional Office has emphasized health system strengthening among the top five strategic priorities. One of the integral elements of health systems are the hospitals. The purpose of this paper is to review the need for formalized training in hospital management to improve the quality of care.
Design/methodology/approach
Literature review and hands on experience of conducting a regional training in hospital management for Eastern Mediterranean Region (EMR) countries.
Findings
Majority of patients in EMR bypass Primary Health Care facilities due to inadequate quality of services and prefer seeking specialized care at a tertiary level. There is mounting evidence of mediocre to poor patient satisfaction due to inefficient health care practices in hospitals of EMR. Strengthening the management capacity of the hospitals through a formal training programme is therefore necessary for improving the performance of health care delivery and the overall health system. Hospital management encompasses hospital planning and operational activities including development and implementation of organizational strategies to ensure adequate numbers and quality of trained human resources and effective financial management, disaster management, health management information system utilization, support services, biomedical engineering, transport and waste management. Such training will prepare health care professionals with leadership skills to deliver quality hospital services.
Originality/value
This is one of the first papers emphasizing the need for a formal structured regional training in hospital management for the countries of EMR. A modular incremental training approach developing an EMR Credit Transfer and Accumulation system is proposed.
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