Healthcare Quality Professionals Research Articles

Enhancing Strategic Learning Through the Implementation of Robust Process Improvement in a Specialized Tertiary Care Hospital.

Performance improvement (PI) in healthcare is essential to improve health, patient experience, and reduce costs. PI projects became low, inconsistent and weakly-sustained in our hospital. The low number and low sustainability were scarcely in alignment with our strategic goal to become a high reliability organization (HRO). This was due to lack of standardized knowledge and ability to initiate and sustain PI projects. Therefore, a structured framework was developed, followed by the building of capacity and capability in the use of robust process improvement (RPI) amidst the COVID-19 pandemic. A team of healthcare quality professionals collaborated with Hospital Performance Improvement-Press Ganey for hospital-wide quality improvement project. The team received training on RPI from Press Ganey and created the framework to use . This framework is based on the Institute for Healthcare Improvement Model for Improvement, Lean, Six Sigma, and FOCUS-PDSA (Find-Organize-Clarify-Understand-Select-Plan-Do-Study-Act). Thereafter, the team of internal coaches organized an RPI training course that consisted of 6 sessions, for clinical and nonclinical staff , using classroom and virtual sessions during the pandemic. This course was increased to eight sessions to avoid information overload. Process measures were collected using a survey to obtain feedback, whereas outcome measures were from the number of completed projects and their effects related to costs, access to care, waiting time, number of harms, and compliance. Participation and submission improved after three PDSA (Plan-Do-Study-Act) cycles. This resulted in an increased number of completed and sustained projects from 50 in 2019 to 94 in 2020 and continued to rise to 109 in 2021. There were 140 and 122 certified RPI coaches in 2020 and 2021, respectively. Although there was a decrease in the number of certified coaches in 2021, the number of completed projects was higher than in 2020. The overall effect of these completed projects by the third quarter of 2021 showed improvement in access to care by 39%, compliance to standards of care by 48%, satisfaction by 8%, and reduction in costs by 47,010 SAR, in waiting time of 170 hours, and in the number of harms by 89. This quality improvement project led to enhanced capacity of staff as seen in the increased number of certified RPI coaches, thereby increasing the submission and completion of projects in 1 year. Its sustainability during the 2 succeeding years continued to enhance project completion and maintenance, bringing quality improvement benefits to the organization and the patients.

Utilization of Improvement Methodologies by Healthcare Quality Professionals During the COVID-19 Pandemic.

This study describes the work of healthcare quality professionals during the COVID-19 pandemic, highlighting the successes and challenges they faced when applying their expertise in performance and process improvement (PPI) to help manage the crisis. The researchers performed a descriptive analysis of anonymous survey data collected from members of the National Association for Healthcare Quality professional community who were asked about their improvement work during the pandemic response. Most survey respondents used improvement methods to a great or moderate extent to measure what was happening (83%), rapidly review processes and practice (81%), and decide where to focus effort (81%). Fewer respondents used PPI methods to engage with patients and families (58% to a great or moderate extent). Looking to the future, respondents indicated that embedding systematic approaches to improvement within healthcare organizations (59%) and working in a more integrated way across teams (48%) should be prioritized in the post-pandemic recovery. The results from this study demonstrate why healthcare leaders should recognize the value that performance improvement approaches provide to everyday operations. They must empower PPI experts to lead this critical work and continue building workforce capacity in PPI methods to strengthen staff engagement and achieve better outcomes.

Why Competency Standardization Matters for Improvement: An Assessment of the Healthcare Quality Workforce.

Healthcare transformation requires a healthcare quality workforce with the requisite expertise to lead, oversee, and implement positive change within healthcare organizations. The National Association for Healthcare Quality (NAHQ) Competency Framework, which spans 29 competencies across 8 domains of healthcare quality, outlines the specific knowledge and skills needed to advance personal and organizational quality goals. This study describes 1,671 responses to the NAHQ Professional Assessment survey from a diverse group of healthcare quality professionals representative of NAHQ's professional community. Results show that two-thirds of respondents indicated they are working in 4 or more competency domains, with 85% reporting working in Performance and Process Improvement. Results also indicate that individuals who hold the Certified Professional in Healthcare Quality (CPHQ) certification perform work at more advanced levels across all eight domains of the competency framework. This was statistically significant for 13 of the 29 competencies including all three competency statements within the Performance and Process Improvement domain. Healthcare organizations need a workforce with specialized quality and safety expertise to advance quality goals, and this study suggests that those who invest in continued professional development by attaining the CPHQ certification may be better positioned to contribute meaningfully to advance these goals and improve organizational outcomes.

A Study to See the Effect of Social Media Usage Among Healthcare Providers.

PurposeThis study aimed to assess how healthcare professionals (HCPs) use social media to determine how it influences the quality of patient care.Materials and methodsThis is a cross-sectional study conducted over eight months, between August 2020 and March 2021 using a questionnaire and checked amongst investigators.ResultsOne hundred fifty-eight participants had electronic devices and 145 (91.9%) used social media at work. 26.6% of these HCPs said they spent less than an hour on social media forums, 31% said they spent one to two hours, 28.5% said two to three hours, and 13.9% said they spent more than four hours. As compared to nurses (46%), consultants and pharmacists use social media at a much lower rate (1% for each group). Compared to junior doctors, a higher percentage of nurses (40%) said they were aware of a social media policy at their hospital (8%). A quarter of healthcare employees (20%) were unaware of their workplace policy, potentially exposing sensitive medical details to the public. More research is needed to assess the particular effects of these results on patient care quality and can help in providing literature informing applications encrypted and secure patient data.ConclusionAccording to our results, a large percentage of healthcare quality professionals used social media networks. A significant proportion of doctors and nurses use it to visit online medical forums for improving education. A large portion of surveyed sample was unaware of hospital policy on social media usage. Further education is required to improve the right use of social media in the hospital setting.

Medication errors reported in a tertiary care private hospital in Eastern India: a three years experience

Background: Medication errors (MEs) can cause significant harm to patients. The MEs identified through reporting processes currently report only a fraction of the actual number of MEs. Data about MEs is limited in India, especially from eastern and north-eastern parts of India. The objective of this study was to analyse the various types of Medication errors reported in a tertiary care private hospital in Eastern India. The aim was to determine the various factors associated with these errors and steps to be taken to reduce the MEs in this healthcare setup.Methods: We carried out a prospective passive surveillance study over the course of 3 years (2016-2018) on 50,822 admitted patients after obtaining approval from the Institutional Ethics Committee. A detailed root-cause analysis was performed for every reported error by a team of healthcare quality professionals and clinical pharmacists along with a clinical pharmacologist followed by appropriate preventive and corrective actions.Results: In our study, a total number of 88 medication errors were reported from a sample size of 50,822 (0.0017%). 61 of the reported MEs were administration errors (69.3%). Higher preponderance of medication errors was seen in male patients (53.1%) in comparison to female patients (46.9%).Conclusions: In this study gross under-reporting of MEs were observed which is in line with previously published studies in India. The reasons reported for gross under-reporting can function as an effective tool to ensure improved reporting of MEs and implementation of mitigation strategies.

Statistical Methods Useful in Clinical Simulation and Medical Education Scholarship

The objective of this paper is to introduce selected statistical and epidemiologic topics that are of interest to interdisciplinary teams of healthcare quality professionals, educators, technical staff, and researchers who participate in clinical simulation scholarship. Four research vignettes in the setting of a hypothetical clinical simulation training workshop are presented. The first vignette illustrates the utility of exact logistic regression when analyzing a small dataset. The second underscores the importance of using an appropriate method to account for the repeated measurement of an outcome. The third illustrates the use of the intraclass correlation coefficient to measure inter-rater reliability. The final vignette demonstrates the benefits of creating a causal diagram known as a directed acyclic graph.

Workforce Competencies for Healthcare Quality Professionals: Leading Quality-Driven Healthcare.

As healthcare delivery systems increasingly adopt models designed to reward cost-efficient and high-quality care, the demand for expertise in healthcare quality continues to grow. There has been wide variation and limited conformity in the definition of the quality competencies that are essential for healthcare professionals. To address the need for a standard, widely accepted, comprehensive definition of the competencies required for healthcare quality, the National Association for Healthcare Quality (NAHQ) made a strategic commitment to develop a comprehensive healthcare quality competency framework applicable to all practice settings across the care continuum. In this article, the authors describe the development of NAHQ's Healthcare Quality Competency Framework depicting eight competency dimensions required for success in current and future healthcare quality positions. In addition, they discuss a self-assessment survey tool to identify individual and organizational gaps in the workforce competencies of Healthcare Quality Professionals.

Letters

Letters

Integration of the e-Learning into the medical university curricula

The aim of this contribution was to present the e-Learning introduction in the Slovak Medical University (SMU) with a focus on the implementation phase of the two blended courses - Healthcare Quality and Healthcare Professionals' Ethics. The introduction of the e-Learning was realized during the period 2008-2009 in the partnership of SMU and IBM Company, following strictly the project management approach. The development of the e-module beta-versions was evaluated by the modules' authors using a structured interview. In a consequent pilot testing, the blended courses were evaluated by 23 students of the bachelor program in Rescue health care, and by 61 public health students at the master level program, respectively, using the standardized questionnaires. The tangible results included the documented SMU strategy for the e-Learning integration, six e-Learning modules and evaluation results. The authors' evaluation showed high scores for the experience in collaboration with IBM, as well as for the experience with the LMS environment. The students' evaluation showed a high acceptance of the e-Learning by both part-time and full-time students. The access to Internet was not recognized as a serious barrier. The first experience with the integration of the e-Learning into the curricula of the Slovak Medical University showed the advantage of the systematic approach. The experience with developing the strategy in an interdisciplinary/ intercultural team, the knowledge about specific characteristics of distance learning by the involved SMU staff, and the know-how and skills represented the important benefits. It was demonstrated that the blended learning is recommended as optimal for the education in medical environment (Tab. 4, Fig. 1, Ref. 22).

Identification and prioritization of quality indicators in clinical genetics: An international survey

The range and demand for clinical genetic services will continue to grow, and now is an ideal time to assess current service quality. Based on the previous work of quality professional organizations such as the Institute of Medicine (IOM) and The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) which is now known as The Joint Commission (TJC), an independent group of genetic and healthcare quality professionals (InheritQual) drafted and defined a list of potential quality indicators for clinical genetics. Perspectives on the appropriateness and the practicality of each indicator were surveyed and analyzed. The Quality Special Interest Group of the American College of Medical Genetics (ACMG) chartered the survey results. After measuring the degree of consensus, an expert panel was selected to review the quality indicators based on practicality and applicability. This expert panel comprised of members of the ACMG Quality Sig workgroup met for final consensus and developed a methodology to pilot these indicators.

Quality Improvement, Research, and the Institutional Review Board

Is an activity quality improvement (QI), or is it research? And why does the distinction make a difference? While national leaders deliberate on how to answer these questions, healthcare organizations must act to ensure patient safety in both QI and research activities. The current system used by researchers for more than 30 years has not always protected human subjects. The result has been patient injuries and even death. Could QI activities result in patient injuries and death? This article offers healthcare quality professionals information that will better equip them to ensure safe practice and protect human subjects.

The Business Role of Healthcare Quality Professionals

1Daniel H. van Leeuwen, MPH RN CPHQ, is a manager in information technology at St. Peter's Hospital in Albany, NY, and has more than 30 years' experience in healthcare delivery, management, and research. He is coeditor of the Journal for Healthcare Quality Quality NETwork column and was a contributing author of Q Solutions: Essential Resources for the Healthcare Quality Professional.

What Is Quality? Do We Agree, and Does It Matter?

The definition of quality is complex, elusive, and ambiguous. Cross-disciplinary definitions, usually assumed to be identical, vary in significant and subtle ways. Clear definition of a problem is the first step in correcting or improving it. Therefore, identification and increased understanding of disciplinary definitions of quality healthcare are needed. Development of a universal definition would be the ideal solution and would support quality improvement and patient safety efforts and programs. This article compares and contrasts definitions of quality in four selected healthcare disciplines and offers recommendations for how healthcare quality professionals might address and mitigate the ambiguity.

Beyond Interviewing: A 21st-century Recruitment Process for Healthcare Quality Professionals

Interview techniques have evolved to include objective testing and situational assessment methods, and an applicant for a quality leadership role in today's market may encounter these new techniques. For an organization, the use of an updated interview process provides greater insight into an applicant's knowledge, skills, and abilities. This article offers an overview of these processes, insights for organizations and leaders to consider in developing assessment strategies, and tips for quality leaders who encounter testing and situational assessment methods during a career search. A case study is provided on the use of job simulations for recruitment of both a senior director for quality and performance improvement and a data management administrator in a regional medical center.

Can't miss: conquer any number task by making important statistics simple. Part 6. Tests of statistical significance (z test statistic, rejecting the null hypothesis, p value), t test, z test for proportions, statistical significance versus meaningful difference.

Healthcare quality professionals need to understand and use inferential statistics to interpret sample data from their organizations. Since in quality improvement and healthcare research studies all the data from a population often are not available, investigators take samples and make inferences about that population using inferential statistics. This series of six articles will give readers an understanding of the concepts of inferential statistics as well as the specific tools for calculating confidence intervals and tests of statistical significance for samples of data. This article, Part 6, merges the four concepts of the (1) standard error of the difference between sample means, (2) the z test statistic, (3) rejecting the null hypothesis, and (4) the p value to provide a comprehensive view of tests of statistical significance. This is followed by a description of t tests, statistical tests for comparing two sample proportions, and Type I and Type II errors. The series of articles concludes with a description of statistical significance versus meaningful difference.

Can't miss: conquer any number task by making important statistics simple. Part 4. Confidence intervals with t distributions, standard error, and confidence intervals for proportions.

Healthcare quality professionals need to understand and use inferential statistics to interpret sample data from their organizations. Since in quality improvement and healthcare research studies, all the data from a population often are not available, investigators take samples and make inferences about that population using inferential statistics. This series of six articles will give readers an understanding of the concepts of inferential statistics, as well as the specific tools for calculating confidence intervals and tests of statistical significance for samples of data. The statistical principles are equally applicable to quality improvement and healthcare research studies. This article, Part 4, starts with a review of the information contained in Parts 1, 2, and 3, which appeared in the July/August 2003 issue of the Journal for Healthcare Quality. This article describes t distributions and how these are used to calculate confidence intervals for estimating a population mean based on a sample mean of a continuous variable. Part 4 concludes with a discussion of standard error, margin of error, and confidence intervals for estimating a population proportion based on a sample proportion from a binomial variable.

Tips for teaching quality concepts to international audiences.

Healthcare quality professionals in the United States have opportunities to teach healthcare providers in other countries how to measure and monitor quality. Special preparation is required to effectively teach an international audience. This article offers tips for teaching basic quality concepts based upon the authors' experiences in the People's Republic of China. Working with health professionals in other countries is exciting and challenging for everyone involved. Approaching the opportunity with systematic preparation may be the key to success.

The relationship between continuous quality improvement and research.

The adoption of new care processes can take years despite high-quality research findings that support the change in clinical practice. Healthcare quality professionals, with their leadership and continuous quality improvement (CQI) skills, are critical champions in accelerating and supporting the change toward evidence-based practice. Heightened attention to the relationship between CQI, research, and research utilization is vital. This article addresses CQI strategies and research activities that can help organizations advance quality of care and patient outcomes. By broadening their repertoire of CQI methods, healthcare quality professionals can provide more value to their organizations and expand the complex problems and projects that CQI teams can manage.

Quantitative study designs used in quality improvement and assessment.

This article describes common quantitative design techniques that can be used to collect and analyze quality data. An understanding of the differences between these design techniques can help healthcare quality professionals make the most efficient use of their time, energies, and resources. To evaluate the advantages and disadvantages of these various study designs, it is necessary to assess factors that threaten the degree with which quality professionals may infer a cause-and-effect relationship from the data collected. Processes, the conduits of organizational function, often can be assessed by methods that do not take into account confounding and compromising circumstances that affect the outcomes of their analyses. An assumption that the implementation of process improvements may cause real change is incomplete without a consideration of other factors that might also have caused the same result. It is only through the identification, assessment, and exclusion of these alternative factors that administrators and healthcare quality professionals can assess the degree to which true process improvement or compliance has occurred. This article describes the advantages and disadvantages of common quantitative design techniques and reviews the corresponding threats to the interpretability of data obtained from their use.

A conceptual framework for achieving high-quality care in nursing homes.

Nursing home care accounts for 12% of healthcare expenditures in the United States, yet serious concerns remain about the quality of care provided in these settings. This article describes a comprehensive systems model that views organizational environments as consisting of four interacting dimensions: organizing arrangements, social factors, technology, and physical setting. This model is then used as a conceptual framework (vis-à-vis an extensive literature review) to identify factors that contribute to poor-quality care in nursing homes and to highlight previous research efforts. The literature review also provides a useful framework to guide nursing home administrators and healthcare quality professionals in their implementation of quality improvement processes and serves to help direct future research in this very important arena.