Continuous Service Improvement Research Articles

Development of an accreditation model for health education and promotion programs in the Iranian primary healthcare system: a Delphi study.

Background: Considering the lack of accreditation models for health education and promotion(HEP) activities in the Iranian primary health care (PHC) system we conducted the present study to develop a national accreditation model for HEP actions in the Iranian PHC system.Methods: After a comprehensive review on the accreditation models in PHC field, especially those concentrated on the HEP programs, an initial HEP accreditation model was developed.Then, applying the Delphi technique, 18 experts in the Iranian PHC system with field experience in HEP programs were invited to assess the initial model. In the two-round Delphi study,aggregation was provided on the opinions and the standards and indicators were finalized.Conventional content analysis was applied to make sense of the data collected in the study.Results: The developed HEP accreditation model encompassed 62 indicators and five standards.The standards were as follow: "resources for HEP programs", "educational needs assessment of the target groups", "methods of providing a community with education", "management of health volunteers’ actions" and "evaluation of HEP programs".Conclusion: The standards and indicators found in the present study may serve as an educational rationale for health educators while designing high-quality health education/promotion programs. This model may be helpful for health policy-makers and stakeholders while planning to assess the continuous quality improvement of HEP services delivered in the PHC systems.

Development of a method of continuous improvement of services using the Business Intelligence tools

The purpose of the study was to develop a method of continuous improvement of services using the Business Intelligence tools. Materials and methods: the materials are used on the concept of the Deming Cycle, methods and Business Intelligence technologies, Agile methodology and SCRUM. Results: the article considers the problem of continuous improvement of services and offers solutions using methods and technologies of Business Intelligence. In this case, the purpose of this technology is to solve and make the final decision regarding what needs to be improved in the current organization of services. In other words, Business Intelligence helps the product manager to see what is hidden from the “human eye” on the basis of received and processed data. Development of a method based on the concept of the Deming Cycle and Agile methodologies, and SCRUM. The article describes the main stages of development of method based on activity of the enterprise. It is necessary to fully build the Business Intelligence system in the enterprise to identify bottlenecks and justify the need for their elimination and, in general, for continuous improvement of the services. This process is represented in the notation of DFD. The article presents a scheme for the selection of suitable agile methodologies. The proposed concept of the solution of the stated objectives, including methods of identification of problems through Business Intelligence technology, development of the system for troubleshooting and analysis of results of the introduced changes. The technical description of the project is given. Conclusion: following the work of the authors there was formed the concept of the method for the continuous improvement of the services, using the Business Intelligence technology with the specifics of the enterprises, offering SaaS solutions. It was also found that when using this method, the recommended development methodology is SCRUM. The result of this scientific research is the continuous improvement of IT services, using Business Intelligence for enterprises, offering SaaS solutions, which solves the problems, identified in the existing methods of continuous improvement. Proposed method consists of the following steps: – analysis of the current status of the service and identification of bottlenecks; – analysis of possible causes of problems; – formation of requirements to improve services; – development of the part of the system, including troubleshooting; – analysis of the results of the implemented changes; – definition of new measurable criteria and data collection. The developed method was used at the enterprise Ltd “Solomoto”. In the course of practical testing of this method the identified problem of tutorials in SaaS platform Solomoto was eliminated. In addition, they identified several positive effects from the implementation of this method in the enterprise. They include the following: – increase in the quality of requirements’ formation; – improving response to business needs; – reduce costs and negative impact on the implementation of changes; – improving the quality of information on the state of services and the improvement of various metrics; – improving the quality of work of staff; – improving the competitiveness of enterprises through continuous improvement and maintaining the service up to date.

Factors influencing E-HRM implementation in government organisations

PurposeThe purpose of this paper is to investigate the factors influencing the implementation of electronic human resource management (e-HRM) in Bangladesh government organisations. Recent research evidence has shown that e-HRM played a significant role in enhancing the performance of human resource (HR) departments in private sector organisations. While similar practices are expected from government domain, there is no empirical research evidence to support this proposition. Given the significant technological advancements today, e-HRM as a strategic tool has grown to encompass seamless functionality to support organisations in providing tactical capability, reducing cost and continuous service improvement as well as the quality of service delivery. Although several private and public sector organisations have implemented e-HRM, its application within government domain in developing regions is limited. This can be attributed to the bureaucratic nature of public sector organisation, which are often slow to adopt changes.Design/methodology/approachThe study adopts a qualitative and multiple case study research approach.FindingsThe findings provide insights into the myth surrounding the lack of and slow implementation of e-HRM among public sector organisation in developing economies but also serve as empirical data for further research.Research limitations/implicationsThe low level in the number of public organisations that have implemented e-HRM applications in developing countries may be responsible for the dearth of empirical studies in this area. The dearth of empirical studies and the need to understand the factors that influence the implementation of e-HRM in public sector organisations led the authors to investigate the factors influencing the implementation of e-HRM in public sector organisation.Practical implicationsFindings from two case organisations exhibit that such an approach contributes towards more healthy and robust decisions for e-HRM implementation and specifies that it is acceptable by the case study organisations. The findings from this research can serve as a source of understanding the particular context in which the study was undertaken. Moreover, it should serve as a catalyst for understanding organisations in similar socio-politico and economic context.Originality/valueThis research advances and contributes to the body of knowledge as it examines factors influencing the implementation of e-HRM in Bangladesh public sector organisations and proposes a model for e-HRM implementation in government organisations in developing economies. The e-HRM implementation research presented in this paper extends recognised standards for e-HRM implementation, by bringing together influential factors – benefits, barriers and risks, thus, enabling government organisations in developing nations to produce more vigorous proposals for e-HRM implementation.

The impact of TQM practices on key performance indicators: empirical evidence from automotive dealerships

The After-Sales (AS) service is becoming a strategic business driver to maintain longterm customer retention, customer satisfaction and capital revenue in such a manner that it guarantees the continuous improvement of products and services offered to customers; AS market is up to five times larger than the new product market (Bundschuh & Dezvane, 2003), whilst it is widely agreed that the turnover of the original purchase can be tripled during the product lifespan by investing in AS services. Consequently, performance of the after-sales department should be well measured and monitored to achieve a balance between the business and the operational goals on the one hand, and their assessed values on the other (Cavalieri et al., 2007).

Measuring the service quality of luxury hotel chains in the USA

In the hospitality industry, quality of services rendered to customers determines the level of business success. To sustain and improve the high level of service quality continuously, hotel management should assess how well they have served their customers and how competitive they become as a result of continuous service improvements. Such assessment begins with the identification of key service attributes that shape up the customer's perceived service quality and influence the customer's level of satisfaction with hotel services. In particular, to achieve full customer satisfaction and stay ahead of industry rivals, hotel management should gain the knowledge of a hotel's competitive position in the dynamically changing marketplace and create the opportunity for continuous service improvement. With this in mind, this paper develops service standards that help hotel managers monitor their service delivery process, identify performance gaps, and take corrective actions. Based on the exploratory study of customers who have stayed at luxury hotels in the USA, this paper identifies key success factors for luxury hotel franchises and develops service improvement plans for practising hotel managers.

Introduction

Introduction

Modelación con teoría de grafos para la unidimensionalidad de un instrumento de evaluación

Modelación con teoría de grafos para la unidimensionalidad de un instrumento de evaluación

The consultant practitioner: an evolving role to meet changing NHS needs.

This article reflects on the relevance of the consultant practitioner role and the impact of an action learning set in hastening its evolution in one NHS foundation trust. From a process of collective critical reflection on their practice, six consultant practitioners analysed the impact they have had on influencing services and empowerment of their patients. Additionally, they have analysed the impact of an externally facilitated action learning set as a catalyst for change. All six consultant practitioners recognised that working together through the learning set enabled them to be more influential and effective. It encouraged them to share their experiences of continuous service improvement and crystalised their views on the impact they have had in delivering the organisation's vision. From their critical reflection, the six consultant practitioners acknowledged the influence of the action learning set on accelerating their confidence and competence to lead, and evaluating new models of care delivery at scale and pace. They recognised how far they have travelled in achieving the four dimensions of the role and ultimately their impact on their local sustainability and transformation plan (STP) and their trust's vision.

"My Health" - A new coaching approach for empowering people to health activities in an integrated care setting

Introduction: Gesundes Kinzigtal offers a broad range of activities and services within their integrated care model for all ages in the region. These are for example lecture series or seminars about health topics, nutrition consultation, education programes, training courses for different needs of activity, equipment training. Since the start of Gesundes Kinzigtal 2006 those services were composed into special care programes covering different chronic diseases. Starting point for these care programes is the physician´s practice, who enrols the patient and initiates care pathway including rigid procedure structure. Practice change, theory, current status and timeline: Providing the right care at the right time and a continuous improvement of care services are guiding principles of the GK model, which is about empowerment and vertical and horizontal integration of the healthcare services. Mainly huge workload for practice staff in the enrolling procedure as well as patient´s wish being more empowered was reason of developing a new care approach named “My Health” in the beginning of 2016. Final Implementation for region Kinzigtal is planned during 2017. The overall aim of “MY Health” lies in the ability to adapt the existing programmes to the specific needs, wishes of people living in Kinzigtal region and get much closer to the subject of multi-morbidity. With regard to the new developments Gesundes Kinzigtal is about breaking down the rigid structures of the programmes and to give the patient the opportunity to individually put its elements of former programmes together. These kind of modules are very clear topics, such as medicine, therapy, medication, exercise, relaxation. Every module has a huge bunch of health offers that could be either a training module, a self-management module, a psychotherapeutic brief intervention or a particular module where the physician assistant regularly. To handle this procedure a new profession called “Consultant – My Health” will be responsible for the consultation and planning of those individual offers. All the physician practice has to do is to prescribe the consultation with his recommended modules and makes an appointment for their patients. The consultation takes place in during define opening hours at different locations (office Gesundes Kinzigtal, citizen office, practice) with respect to multi-morbid persons with limited mobility. Innovativeness, impacts, sustainability, and transferability: Within the scope of the planned care approach “My Health” the introduction of a new professions lowers the barriers for patients to enter in health activities and improves cost effectiveness of the integrated care model in the long term. Tasks of this new profession, which doesn´t exists so far in the german health care system will incorporate mainly the arrangement of the new care modules and health care services based on physician´s recommendation and the individual preferences of the patient. The physicians can be relieved from their burocratic workload for enrolment and giving detailed information about care services. But still they are up to date of the care treatment process by looking in to their electronic patient record, where the consultant puts the results that were agreed with the patient directly after the consultation appointment. Consultants will be qualified and trained to be prepared for this kind of tasks. But there is no need for extensive medical knowledge because ultimately the direction is already determined by the physician and by the modules and contraindications. Therefore, this approach can be easily transferred to other regions in Germany. My Health is currently tested in 7 GP practices and provides relevant lessons to optimize the approach and the transferability.

Service quality and users’ satisfaction assessment in the health context in Mexico

Service Quality and the users’ satisfaction are seen as substantial challenges for the health system in Mexico. The new reforms in the area of health have turned these issues into areas of interest for the population and the institutions within the sector. The principal aim of this research is to analyze the service’s quality, users’ satisfaction, and the relationship between these two variables of study. The analysis is performed under a quantitative approach through the application of 876 questionnaires in eight public hospitals in the state of Tamaulipas, Mexico. Multiple linear regressions are used for data processing and descriptive statistics for the valuation each one of the variables. The results have shown a positive and significant relationship between the service’s quality and the satisfaction of the users, taking this as an important part for the continuous improvement of health services and the creation of recommendations that promote or improve the patient’s satisfaction.

The Effect of Medical Recording Training on Quantity and Quality of Recording in Gynecology Residents of Tabriz University of Medical Sciences.

Introduction: Medical records contain valuable information about a patient's medical history and treatment. Patient safety is one of the most important dimensions of health care quality assurance and performance improvement. Completing the process of documentation is necessary to continue patient care and continuous quality improvement of basic services. The aim of the present study was to evaluate the effect of medical recording education on the quantity and quality of recording in gynecology residents of Tabriz University of Medical Sciences. Methods: This study is a quasi-experimental study and was conducted at Al-Zahra Teaching Hospital, Tabriz, Iran, in 2016. Thirty-two second through fourth year gynecologic residents of Tabriz University of Medical Sciences who were willing to participate in the study were included by census sampling and participated in training workshop. Three evaluators reviewed the residents’ records before and after training course by a checklist. Statistical analyses were performed using SPSS 13 software. P-values less than 0.05 were considered statistically significant. Results: The results showed that before the intervention, there were significant differences in the quantity of information status among the evaluators and no significant difference was observed in the recording of qualitative status. After the workshop, among the 3 evaluators, there were also significant differences in the quantity of data recording status; however, no significant change was observed in recording of qualitative status. Conclusion: The study findings revealed that a sectional training course of correct and standardized medical records has no effect on reforming the process of recording.

South Island Well Child Tamariki Ora Quality Improvement Project

The Well Child Tamariki Ora (WCTO) Quality Improvement project is a national two year project that has been funded by the Ministry of Health. The aim of this project is to improve the quality of the WCTO programme and health outcomes for children aged 0-5 years. The Model for Improvement and the WCTO quality improvement framework have been used as tools to support each level of the sector to achieve family-centred, high quality, equitable and effective child health services that deliver the best possible health outcomes for all New Zealand children and their families/whanau. Childhood health care services in New Zealand, primary maternity services, the WCTO programme and primary health services are all interrelated and require an integrative approach to service provision, Strengthening the connections/links between Lead Maternity Carer’s, WCTO provider, B4School Check nurses, Oral Health services, hearing screening, breastfeeding services, primary health organisations and immunisation services has been achieved through quality improvement training and education, establishing multi-agency advisory/strategic groups to oversee facilitate the improved integration, coverage and coordination of WCTO services. The desired outcomes of the WCTO project is based upon the WCTO quality improvement triple aim framework which includes • All children living in New Zealand aged 0-5 years of age have equitable access to the WCTO programme • Best value for the health system resource is achieved • All WCTO service providers have access to high quality and effective quality improvement tools and training Initiatives that aligned with either an access, outcome or quality child health indicator focus were selected. These included quality Improvement workshops offered to the wider Child health and Maternity sector. Establishing District Health Board WCTO forums across the region to provide a more collaborative and integrated approach to achieving child health outcomes.Developing referral pathways to improve enrolment into all universal child health services. Distribution of newsletters and webpage to share learning and provide quality improvement resources. Enabling equity and access: Quality improvement indicator dashboards have been developed as a tool to plan and design services and to underpin the culture of continuous service improvement. The WCTO quality indicator dashboards enable the impact of the project to be measured against the desired outcomes. The South Island region has demonstrated an overall improvement in children receiving core contacts in the first 12 months and greater number of children being referred from their Lead Maternity Carer into the WCTO programme. Engaging children, families and communities: The journey of navigating and staying connected with health services from consumers’ perspectives has been explored. Families were invited to share their experience of the Well Child service as well as suggest ideas for improvement through a group or individual discussion session. Stories were filmed to inform practice and training/ education sessions. All improvement requires change but not all change will result in improvement. Thus, the Model for Improvement methodology has ensured all change ideas are sustainable, measureable and result in beneficial change in the provision of health care for all children living in New Zealand.

How to conduct a clinical audit and quality improvement project.

Audits and quality improvement projects are vital aspects of clinical governance and continual service improvement in medicine. In this article we describe the process of clinical audit and quality improvement project. Guidance is also provided on how to design an effective audit and bypass barriers encountered during the process.

Facteurs associés à la satisfaction des prescripteurs de produits sanguins labiles au Burkina Faso

BackgroundThe National Blood Transfusion Centre, unique operator of blood transfusion in Burkina Faso is engaged into the quality process according to ISO 9001. Therefore, the assessment of customer satisfaction is a main part of its system. Our study conceives “customer satisfaction” as dependant to the perceived service quality based on SERVQUAL model. ObjectivesTo identify factors associated with the satisfaction of blood products prescribers in order to help decision-makers for continuous improvement of services. Material and methodsWe conducted a cross-sectional survey among prescribers of blood components in Ouagadougou, between February 27 and April 30, 2015. We used an anonymous self-administered questionnaire, including 13 items associated to the 5 dimensions of SERVQUAL model. The different satisfaction gaps were calculated and linear regression was used to determine statistical associations with a significance level of 5%. ResultsThe return rate was 94.5% about the 256 questionnaires distributed. A total of 30% of respondents were satisfied to very satisfied. The overall global gap of satisfaction was −5.74. The product delivery time, the efficacy and safety of blood products, the medical and clinical support, the pro-activity of the communication, the management of blood products reservation and the satisfaction of needs in blood products were the factors associated with the prescribers’ satisfaction. ConclusionThis first study in blood transfusion services in our context was been useful to assess customer satisfaction and identify the main axes on which targeting priority actions in order to effectively use available resources.

Humanization in a Hospital

Concern with humanization in hospitals has been an increasingly common feature in debates related to healthcare, public policies and hospital management. However, in most Brazilian hospitals, humanization has not gone beyond the stage of ‘politically correct’ discourse and has not resulted in substantive changes in organizational behaviour. These changes mean a greater challenge especially in hospital organizations, as these are renowned for their complexity, pluralism and knowledge-based work. From an ethnographic experience guided by intervention in the implementation of a humanization programme at a hospital, we analyzed the resulting cultural change, highlighting the obstacles that were encountered and the main actions taken to overcome them. The results of this initiative reveals important lessons: (i) it represents an organizational commitment to the continuous improvement of health services by focusing on one of the most critical elements: human beings; (ii) to implement the initiative, it was necessary to develop social actions such as relationships with the government, market and society; (iii) it was necessary to hold a scientific, albeit incipient, debate concerning the role and relevance of clinical psychology in hospitals. Results were grouped as individual, social and organizational dimensions reflecting substantive aspects of the change process in complex setting.

A fuzzy superiority and inferiority ranking based approach for IT service management software selection

PurposeInformation technology service management (ITSM) has become a major IT department management system in organizations. Successful implementation of ITSM depends on select adequate ITSM software. Evaluation and selection of the ITSM solution or software packages is complicated and time-consuming decision-making problem. This paper aims to present an approach for dealing with such a problem.Design/methodology/approachThis approach introduces functional, non-functional requirements and novel fuzzy out-ranking evaluation method for ITSM software selection. The presented approach breaks down ITSM software selection criteria into two broad categories, namely, functional (service strategy, service design, service transition, service operation, continual service improvement according to Information Technology Infrastructure Library V3) and non-functional requirements (quality, technical, vendor, implementation) including totally 46 selection criteria. A novel fuzzy superiority and inferiority ranking (FSIR) was developed and made applicable for ITSM software selection based on identified criteria.FindingsThe proposed approach is applied to IT services company to select and acquire ITSM software, and the provided numerical example illustrates the applicability of the approach for this choice. The approach can facilitate firms to achieve suitable ITSM software and have a precise acquisition decision; however, the limitation of dependency on experts’ competence and proficiency in the both ITSM field and IT technical issues exists.Research limitations/implicationsThe approach can facilitate firms to achieve suitable ITSM software and have a precise acquisition decision; however, the limitation of dependency on experts’ competence and proficiency in the both ITSM field and IT technical issues exists.Practical implicationsFacilitating of ITSM implementation through its handy software selection is the major impact of current research.Originality/valueA facile FSIR-based approach for software selection has been customized to contribute to the current literature in the ITSM field. Facilitating of ITSM implementation through its handy software selection is the major impact of current research.

The Environmental Management System in a Health Structure: The Case study of ORC-Aviano (Italy)

The Oncology Reference Center (ORC) of Aviano (Italy) organization principles are based on the criteria of effectiveness efficiency and cost-effectiveness in compliance to clinical autonomy leading to the continuous improvement of services provided and the research activities in order to ensure maximum level of safety for patients and operators. Within these values the adoption of environmental sustainable management voluntary systems such as ISO 14000 and EMAS has been evaluated and proposed. To this note the Initial Environmental Analysis (IEA) is presented allowing basic targets for improvement and implementation of environmental management programs as well as highlighting the effectiveness of the adoption of sustainable management of voluntary EMAS instrument. Phases to define and evaluate the environmental factors were analysed and the relationship between the site and the surrounding zone was performed according to the characteristics of “sensitivity” and “vulnerability” of the affected area. Specifying different degrees of priority which the problems must be managed to a medium priority rating was found for short term interventions Some improvements in the hospital waste management were identified among these the preparation of guidelines applicable to current operational practices are the most reliable.

Factors Affecting Quality of Health Service and Patient Satisfaction in Community Health Centers in North Lampung, Sumatera

Background: Quality of health service and patient satisfaction are an important element in providing a health service. Assessing and evaluating a health service based on user perceptions are important for continuous improvement of health services. This study aimed to examine the factors affecting the quality of health service and patient satisfaction in community health centers in North Lampung, Sumatera, Indonesia. Subjects and Method: This was an analytic observational study with a cross-sectional design. This study was conducted in 25 community health centers in North Lampung, Sumatera, in January 2017. A total sample of 200 out-patients was selected for this study by simple random sampling and stratified random sampling for community health center. The dependent variables were quality of service and patient satisfaction. The independent variables were education, income, a frequency of visit, and accreditation status of community health center. The contextual effect was measured by accreditation status of community health center. The data were collected by questionnaire and analyzed by linear regression multilevel model. Results: Factors affecting quality of health service were income (b= -1.09, 95% CI= -5.71 to 3.52, p = 0.641), education (b = -11.48, 95% CI= -16.07 to -6.88, p< 0.001), and frequency of visits (b=6.88, 95% CI= 2.53 to 11.23, p=0.002). Intraclass correlation= 6%. Factors affecting patient satisfaction were income (b= -1.07, 95% CI= -1.58 to -0.56, p<0.001), education (b= -0.77, 95% CI= -1.31 to -0.23, p=0.005), frequency of visits (b= 0.88, 95% CI= 0.39 to 1.38, p<0.001), and quality of service (b=0.04, 95% CI= 0.02 to 0.06, p<0.001). Intraclass corelation= 13.79% indicating considerable contextual effect of accreditation status of community health center. Conclusion: Quality of service is affected by income, education, and frequency of visits in community health center. Patient satisfaction is affected by income, education, a frequency of visits, and quality of service. Accreditation status of community health center has a considerable contextual effect on patient satisfaction. Keywords: quality of service, patient satisfaction, accreditation status, community health center, multilevel analysis Correspondence: Mulia Yuli Widayati. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A Surakarta. Email: muliayuli@yahoo.co.id Journal of Health Policy and Management (2017), 2(2): 165-175 https://doi.org/10.26911/thejhpm.2017.02.02.08

Promoting health workers' ownership of infection prevention and control: using Normalization Process Theory as an interpretive framework

All health workers should take responsibility for infection prevention and control (IPC). Recent reduction in key reported healthcare-associated infections in the UK is impressive, but the determinants of success are unknown. It is imperative to understand how IPC strategies operate as new challenges arise and threats of antimicrobial resistance increase. The authors undertook a retrospective, independent evaluation of an action plan to enhance IPC and 'ownership' (individual accountability) for IPC introduced throughout a healthcare organization. Twenty purposively selected informants were interviewed. Data were analysed inductively. Normalization Process Theory (NPT) was applied to interpret the findings and explain how the action plan was operating. Six themes emerged through inductive analysis. Theme 1: 'Ability to make sense of ownership' provided evidence of the first element of NPT (coherence). Regardless of occupational group or seniority, informants understood the importance of IPC ownership and described what it entailed. They identified three prerequisites: 'Always being vigilant' (Theme 2), 'Importance of access to information' (Theme 3) and 'Being able to learn together in a no-blame culture' (Theme 4). Data relating to each theme provided evidence of the other elements of NPT that are required to embed change: planning implementation (cognitive participation), undertaking the work necessary to achieve change (collective action), and reflection on what else is needed to promote change as part of continuous quality improvement (reflexive monitoring). Informants identified barriers (e.g. workload) and facilitators (clear lines of communication and expectations for IPC). Eighteen months after implementing the action plan incorporating IPC ownership, there was evidence of continuous service improvement and significant reduction in infection rates. Applying a theory that identifies factors that promote/inhibit routine incorporation ('normalization') of IPC into everyday health care can help explain the success of IPC initiatives and inform implementation.

An examination of competitiveness of rural destinations from the supply side perspective

Tourist destinations are now faced with increased competition at the market and holders of tourist policy and offers have realized that understanding the factors that contribute to a better positioning in the market place, and therefore the competitiveness, is of crucial importance for further development. The aim of this paper is to determine how much Vojvodina is competitive as a rural tourism destination, and to assess the current state of all the factors that affect/could affect the competitiveness of rural tourism destinations in Vojvodina Province (Northern Serbia). The total of 136 tourism experts were interviewed, and we concluded that the key resources and attraction of rural areas in Vojvodina are rated better than the macro and industry-related factors. This suggests that a rural development strategy should have a special bond with resources and attractions of the destination, that priority should be given to maintaining all aspects of safety and security, continuous improvement of services, diversity of culinary products, as well as the application of the principles of sustainability in environmental management. The work of national and provincial institutions should have the aim to ensure that the destination has a clear idea of where it is going and what it takes to become successful in the long term.