Impact Of Quality Improvement Initiative Research Articles

The data quality and applicability of a Danish prehospital electronic health record: A mixed-methods study.

Without accurate documentation, it can be difficult to assess the quality of care and the impact of quality improvement initiatives. Prehospital lack of documentation of the basic measurements is associated with a twofold risk of mortality. The aim of this study was to investigate data quality in the electronic prehospital patient record (ePPR) system in the Region of Southern Denmark. In addition, we investigated ambulance professionals' attitudes toward the use of ePPR and identified barriers and facilitators to its use. We used an explanatory sequential mixed-methods design. Phase one consisted of a retrospective assessment of the data quality of ePPR information, and phase two included semi-structured interviews with ambulance professionals combined with observations. We included patients who were acutely transported to an emergency department by ambulance in the Region of Southern Denmark from 2016 to 2020. Data completeness was calculated for each vital sign using a two-way table of frequency. Vital signs were summarised to calculate data correctness. Interviews and observations were analysed using thematic analysis. Overall, an improvement in data completeness and correctness was observed from 2016-2020. When stratified by age group, children (<12 years) accounted for the majority of missing vital sign registrations. In the thematic analysis, we identified four themes; ambulance professionals' attitudes, emergency setting, training and guidelines, and tablet and software. We found high data quality, but there is room for improvement. The ambulance professionals' attitudes toward the ePPR, working in an emergency setting, a notion of insufficient training in completing the ePPR, and challenges related to the tablet and software could be barriers to data completeness and correctness. It would be beneficial to include the end-user when developing an ePPR system and to consider that the tablet should be used in emergency situations.

Making the Business Case for Quality: Monetizing Quality

Surviving in the current and anticipated healthcare operating environment requires leaders to consistently demonstrate comparatively higher quality at the lowest possible cost to payers and patients alike. To accomplish this, leaders must take a deliberate and systematic approach to identifying, measuring, and reporting both the cost of waste and the anticipated financial impact of quality improvement initiatives.

Impact of quality improvement initiatives to improve CKD referral patterns: a systematic review protocol

IntroductionChronic kidney disease (CKD) is a global-health problem. A significant proportion of referrals to nephrologists for CKD management are early and guideline-discordant, which may lead to an excess number of...

Surveillance Strategies for Tracking Sepsis Incidence and Outcomes.

Sepsis is a leading cause of death and the target of intense efforts to improve recognition, management and outcomes. Accurate sepsis surveillance is essential to properly interpreting the impact of quality improvement initiatives, making meaningful comparisons across hospitals and geographic regions, and guiding future research and resource investments. However, it is challenging to reliably track sepsis incidence and outcomes because sepsis is a heterogeneous clinical syndrome without a pathologic reference standard, allowing for subjectivity and broad discretion in assigning diagnoses. Most epidemiologic studies of sepsis to date have used hospital discharge codes and have suggested dramatic increases in sepsis incidence and decreases in mortality rates over time. However, diagnosis and coding practices vary widely between hospitals and are changing over time, complicating the interpretation of absolute rates and trends. Other surveillance approaches include death records, prospective clinical registries, retrospective medical record reviews, and analyses of the usual care arms of randomized controlled trials. Each of these strategies, however, has substantial limitations. Recently, the US Centers for Disease Control and Prevention released an "Adult Sepsis Event" definition that uses objective clinical indicators of infection and organ dysfunction that can be extracted from most hospitals' electronic health record systems. Emerging data suggest that electronic health record-based clinical surveillance, such as surveillance of Adult Sepsis Event, is accurate, can be applied uniformly across diverse hospitals, and generates more credible estimates of sepsis trends than administrative data. In this review, we discuss the advantages and limitations of different sepsis surveillance strategies and consider future directions.

A COMBINED MULTI-OBJECTIVE SIMULATION-OPTIMIZATION AND AHP APPROACH: A HEALTHCARE CASE STUDY

Quality of care is crucial for patients' satisfaction and safety in healthcare centers. The majority of hospitals attempt to implement facility-wide improvements to ensure high-quality care delivery. This study aims to propose a combined Simulation-Optimization and MCDM approach to accurately assess the impact of quality improvement initiatives on different facets of healthcare systems. In this framework, first, the importance (weights) of the different healthcare criteria is determined by health providers’ using an AHP approach. Then, the weights provided by AHP are applied in a simulation-optimization environment to determine the most efficient action with the most desirable quality of care. Simulation provides a platform to examine the effectiveness of different improvement efforts and calculate their impact on the system performance measures.

What can we learn from the last 20 years: A review of litigation trends in otolaryngology

IntroductionLitigation in healthcare is a large financial burden to the NHS and can be a cause of great stress to clinicians. The overall number of claims across specialities, from the years 1995–2017 have increased. Despite being one of the smaller surgical specialities, litigation costs are still significant within Otolaryngology. In this piece we sought to analyse the available data to identify trends within litigation and therefore which areas of practise could be improved. MethodsA freedom of information request was submitted to NHS Resolution for summarised data on claims coded under ‘Otolaryngology’ or ‘ENT’ between 1996 and 2017. Information was collected on the total number of claims, the number of successful claims and details on the reasons for making claims. ResultsThe total number of claims made against Otolaryngology departments from 1996/97 to 2016/17 was 1952. The overall number of claims have increased during this time period. The total amount of money paid out between 1996 and 2017 was £108, 240, 323. The top causes of claim by injury were unnecessary pain and unnecessary operations. The highest number of claims by cause were for failure or delay in diagnosis and intraoperative problems. ConclusionThese results highlight areas that local units can focus on to reduce their litigation burden. Targeted initiatives aimed at improving patient-clinician communication, the consent process and improving local organisational efficiency will address a significant proportion of claims. Re-examination of this data on a regular basis can serve as a useful adjunct in assessing the impact of quality improvement initiatives and implementation of best practiseswithin the speciality.

PS02.156: IMPROVING COMPLIANCE WITH ENHANCED RECOVERY PROTOCOLS IN OESOPHAGO-GASTRIC CANCER SURGERY: A COLLABORATIVE QUALITY IMPROVEMENT PROJECT

Abstract Background Compliance with enhanced recovery programmes (ERPs) in oesophago-gastric (OG) surgery is challenging due to high rates of complications. Higher compliance is associated with better outcomes; however compliance is difficult to assess due to variable reporting and lack of standardisation of descriptors within an ERP. This study aims to understand variability in ERPs across two OG cancer centres and analyse impact of cross-site engagement and collaborative quality improvement (QI) on ERP compliance. Methods The collaborative QI project consisted of workshops and meetings that involved presentations and assessment of variations across ERPs, with prospective recording of ERP compliance at each site and cross-site feedback of results. Compliance and outcomes for 2016 were compared with 2017 to assess impact of QI initiative. Results At site A, overall mobilisation improved from 25% to 28% (P = 0.448) and oral intake from 19% to 56% (P = 0.002). There were no improvements in NGT (65% to 54%) and drain removal (69% to 53%). At site B, mobilisation improved from 51% to 68% (P = 0.097), NGT removal from 37% to 51% (P = 0.196), and drain removal from 15% to 32% (P = 0.412). There was no improvement in oral intake (47% to 34%). At site A, all complications reduced from 56% to 46% (P = 0.401), pneumonia from 47% to 22% (P = 0.024), and grade 3 complications from 22% to 15% (P = 0.605). At site B, all complications reduced from 58% to 54% (P = 0.697), pneumonia from 46% to 37% (P = 0.353), and grade 3 complications from 23% to 20% (P = 0.678). At site A, the median length of hospital stay reduced from 11 days to 9 days (P = 0.024), with no improvement at site B (12 to 14 days). Conclusion Engagement between clinical teams across the two sites resulted in improvement in postoperative outcomes. Compliance with individual ERP elements was observed across a few domains. Challenges encountered in this project included a lack of standardised definitions of ERP descriptors, variability in measures and variations in the individual elements within each ERP. Disclosure All authors have declared no conflicts of interest.

The EXpert PANel Decision (EXPAND) method: a way to measure the impact of diverse quality improvement activities of clinical networks.

A retrospective cross-sectional study of 19 clinical networks using multiple methods of data collection including the EXpert PANel Decision (EXPAND) method. Network impacts were identified through interviews with network managers (n = 19) and co-chairs (n = 32), and document review. The EXPAND method brought together five independent experts who provided initial individual ratings of overall network impact. After attendance at an in-person moderated meeting where aggregate scores were discussed, the experts provided a final rating. Median scores of postmeeting ratings were the final measures of network impact. Among the 19 clinical networks, experts rated 47% (n = 9) as having a limited impact on improving quality of care, 37% (n = 7) as having a moderate impact and 16% (n = 3) as having a high impact. The experts rated 26% (n = 5) of clinical networks as having a limited impact on facilitating system-wide change, 37% (n = 7) as having a moderate impact and 37% (n = 7) as having a high impact. The EXPAND method enabled appraisal of diverse clinical networks in the absence of primary data that could directly evaluate network impacts. The EXPAND method can be applied to assess the impact of quality improvement initiatives across diverse clinical areas to inform healthcare planning, delivery and performance. Further research is needed to assess its reliability and validity.

Using Quality Tools and Methodologies to Improve a Hospital's Quality Position

ABSTRACTThe authors identify the quality tools and methodologies most frequently used by quality-positioned hospitals versus nonquality hospitals. Northeastern U.S. hospitals in both groups received a brief, 12-question survey. The authors found that 93.75% of the quality hospitals and 81.25% of the nonquality hospitals used some form of process improvement methodologies. However, there were significant differences between the groups regarding the impact of quality improvement initiatives on patients. The findings indicate that in quality hospitals the use of quality improvement initiatives had a significantly greater positive impact on patient satisfaction and patient outcomes when compared to nonquality hospitals.

Assessing the risk: Scoring systems for outcome prediction in emergency laparotomies.

Emergency laparotomy is the commonest emergency surgical procedure in most hospitals and includes over 400 diverse surgical procedures. Despite the evolution of medicine and surgical practices, the mortality in patients needing emergency laparotomy remains abnormally high. Although surgical risk assessment first started with the ASA Physical Status score in 1941, efforts to find an ideal scoring system that accurately estimates the risk of mortality, continues till today. While many scoring systems have been developed, no single scoring system has been validated across multiple centers and geographical locations. While some scoring systems can predict the risk merely based upon preoperative findings and parameters, some rely on intra-operative assessment and histopathology reports to accurately stratify the risk of mortality. Although most scoring systems can potentially be used to compare risk-adjusted mortality across hospitals and amongst surgeons, only those which are based on preoperative findings can be used for risk prognostication and identify high-risk patients before surgery for an aggressive treatment. The recognition of the fact, that in the absence of outcome data in these patients, it would be impossible to evaluate the impact of quality improvement initiatives on risk-adjusted mortality, hospital groups and surgical societies have got together and started to pool data and analyze it. Appropriate scoring systems for emergency laparotomies would help in risk prognostication, risk-adjusted audit and assess the impact of quality improvement initiative in patient care across hospitals. Large multi-centric studies across varied geographic locations and surgical practices need to assess and validate the ideal and most apt scoring system for emergency laparotomies. While APACHE-II and P-POSSUM continue to be the most commonly used scoring system in emergency laparotomies,studies need to compare them in their ability to predict mortality and explore if either has a higher sensitivity and specificity than the other.

Communication in healthcare: a narrative review of the literature and practical recommendations.

SummaryObjectivesEffective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialised and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare.DesignNarrative literature review.MethodsA search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (MeSH)terms ‘communication’, ‘primary health care’, ‘correspondence’, ‘patient safety’, ‘patient handoff’ and ‘continuity of patient care’. Reviewers screened 4609 records and 462 full texts were checked according following inclusion criteria: (1) publication between January 1985 and March 2014, (2) availability as full text in English, (3) categorisation as original research, reviews, meta‐analyses or letters to the editor.ResultsA total of 69 articles were included in this review. It was found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences.ConclusionThere is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Peer review, process indicators and follow‐up tools are required to measure the impact of quality improvement initiatives. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver.

Radiation dose benchmarks during cardiac catheterization for congenital heart disease in the United States.

The aim of this study was to define age-stratified, procedure-specific benchmark radiation dose levels during interventional catheterization for congenital heart disease. There is a paucity of published literature with regard to radiation dose levels during catheterization for congenital heart disease. Obtaining benchmark radiation data is essential for assessing the impact of quality improvement initiatives for radiation safety. Data were obtained retrospectively from 7 laboratories participating in the Congenital Cardiac Catheterization Project on Outcomes collaborative. Total air kerma, dose area product, and total fluoroscopy time were obtained for the following procedures: 1) patent ductus arteriosus closure; 2) atrial septal defect closure; 3) pulmonary valvuloplasty; 4) aortic valvuloplasty; 5) treatment of coarctation of aorta; and 6) transcatheter pulmonary valve placement. Between January 2009 and July 2013, 2,713 cases were identified. Radiation dose benchmarks are presented including median, 75th percentile, and 95th percentile. Radiation doses varied widely between age groups and procedure types. Radiation exposure was lowest in patent ductus arteriosus closure and highest in transcatheter pulmonary valve placement. Total fluoroscopy time was a poor marker of radiation exposure and did not correlate well with total air kerma and dose area product. This study presents age-stratified radiation dose values for 6 common congenital heart interventional catheterization procedures. Fluoroscopy time alone is not an adequate measure for monitoring radiation exposure. Thesevalues will be used as baseline for measuring the effectiveness of future quality improvement activities by theCongenital Cardiac Catheterization Project on Outcomes collaborative.

Clinical and economic impact of a quality improvement initiative to enhance early recognition and treatment of sepsis.

Studies evaluating the clinical effectiveness of sepsis screening tools and methods to improve the time from diagnosis to antibiotic administration are needed to improve sepsis-related outcomes. To evaluate the clinical and economic impact of a sepsis quality improvement initiative to improve early recognition and treatment of sepsis. A retrospective observational study of adults with sepsis was performed in a 433-bed tertiary medical center. Baseline data were collected for 181 patients with sepsis diagnosis-related group (DRG) coding assignments from July through September 2013. The intervnetion group included 216 patients from October through December 2013. A First-Dose STAT Antibiotic policy was developed, and nurses were instructed to complete an electronic sepsis screening tool once per shift. Primary outcomes included in-hospital mortality and intensive care unit (ICU) length of stay (LOS). Secondary outcomes included overall LOS and cost per case. Nonsignificant decreases in overall LOS (7.43 ± 5.68 days vs 6.77 ± 5 days; P = 0.138) and in-hospital mortality (13.8% vs 8.8%; P = 0.113) were observed in patients with sepsis DRGs. Early recognition and treatment contributed to significant reductions in ICU LOS (5.85 ± 4.38 days vs 4.21 ± 3.64 days; P = 0.003) and total cost per case ($14 378 vs $12 311; P = 0.033). The percentage of highest disease-severity DRG coding assignments decreased from 7.9% to 0%. Strategies to improve early recognition and treatment of sepsis, including routine use of an electronic sepsis screening tool and implementation of a First-Dose STAT Antibiotic policy, contributed to significant reductions in ICU LOS and cost per case.

RADIATION DOSE BENCHMARKS DURING CARDIAC CATHETERIZATION FOR CONGENITAL HEART DISEASE IN THE UNITED STATES

Abstract Objectives The aim of this study was to define age-stratified, procedure-specific benchmark radiation dose levels during interventional catheterization for congenital heart disease. Background There is a paucity of published literature with regard to radiation dose levels during catheterization for congenital heart disease. Obtaining benchmark radiation data is essential for assessing the impact of quality improvement initiatives for radiation safety. Methods Data were obtained retrospectively from 7 laboratories participating in the Congenital Cardiac Catheterization Project on Outcomes collaborative. Total air kerma, dose area product, and total fluoroscopy time were obtained for the following procedures: 1) patent ductus arteriosus closure; 2) atrial septal defect closure; 3) pulmonary valvuloplasty; 4) aortic valvuloplasty; 5) treatment of coarctation of aorta; and 6) transcatheter pulmonary valve placement. Results Between January 2009 and July 2013, 2,713 cases were identified. Radiation dose benchmarks are presented including median, 75th percentile, and 95th percentile. Radiation doses varied widely between age groups and procedure types. Radiation exposure was lowest in patent ductus arteriosus closure and highest in transcatheter pulmonary valve placement. Total fluoroscopy time was a poor marker of radiation exposure and did not correlate well with total air kerma and dose area product. Conclusions This study presents age-stratified radiation dose values for 6 common congenital heart interventional catheterization procedures. Fluoroscopy time alone is not an adequate measure for monitoring radiation exposure. These values will be used as baseline for measuring the effectiveness of future quality improvement activities by the Congenital Cardiac Catheterization Project on Outcomes collaborative.

Explaining variation in perceived team effectiveness: results from eleven quality improvement collaboratives

Explore effectiveness of 11 collaboratives focusing on 11 different topics, as perceived by local improvement teams and to explore associations with collaborative-, organisational- and team-level factors. Evidence underlying the effectiveness of quality improvement collaboratives is inconclusive and few studies investigated determinants of implementation success. Moreover, most evaluation studies on quality improvement collaboratives are based on one specific topic or quality problem, making it hard to compare across collaboratives addressing different topics. A multiple-case cross-sectional study. Quality improvement teams in 11 quality improvement collaboratives focusing on 11 different topics. Team members received a postal questionnaire at the end of each collaborative. Of the 283 improvement teams, 151 project leaders and 362 team members returned the questionnaire. Analysis of variance revealed that teams varied widely on perceived effectiveness. Especially, members in the Prevention of Malnutrition and Prevention of Medication Errors collaboratives perceived a higher effectiveness than other groups. Multilevel regression analyses showed that educational level of professionals, innovation attributes, organisational support, innovative culture and commitment to change were all significant predictors of perceived effectiveness. In total, 27·9% of the individual-level variance, 57·6% of the team-level variance and 80% of the collaborative-level variance could be explained. The innovation's attributes, organisational support, an innovative team culture and professionals' commitment to change are instrumental to perceived effectiveness. The results support the notion that a layered approach is necessary to achieve improvements in quality of care and provides further insight in the determinants of success of quality improvement collaboratives. Understanding which factors enhance the impact of quality improvement initiatives can help professionals to achieve breakthrough improvement in care delivery to patients on a wide variety of quality problems.

Abstract P147: Impact of Quality Improvement Initiatives on Core Measures Performance and Short-Term Mortality in Patients With Acute Myocardial Infarction

Background: Impact of compliance with process of care measures on acute myocardial infarction (AMI) outcomes is ambiguous. Baylor Health Care System, Dallas, TX (BHCS) invested substantial resources in measuring and improving performance on the Centers for Medicare and Medicaid Services (CMS) Core Measures, and sought to determine the changes in both compliance and short-term mortality over a 6-year period. Methods: CMS AMI core measure compliance and mortality were assessed in consecutive encounters eligible for at least one measure from July 2002 to June 2008 at 8 BHCS hospitals (n= 6,826). Adjusted odds ratios for in-hospital and 30-day post-admission mortality and rate ratios for core measure compliance were calculated using marginal structural models to assess differences over time. Results: Core measures compliance improved significantly. Adjusted odds ratios [95% confidence intervals] revealed significant decreases in in-hospital mortality in cohorts eligible for: aspirin at arrival (Year 5 versus baseline: 0.46 [0.27, 0.78]; Year 6 versus baseline: 0.37 [0.22, 0.65]), beta-blockers at arrival (Year 5 versus baseline: 0.38 [0.19, 0.74]; Year 6 versus baseline: 0.24 [0.11, 0.52]) and a bundle measure comprising aspirin at arrival, beta-blockers at arrival and timely reperfusion (Year 5 versus baseline: 0.46 [0.28, 0.78]; Year 6 versus baseline: 0.41 [0.24, 0.69]). Significant decreases in 30-day post-admission mortality followed the same pattern. Conclusion: AMI Core Measures compliance improved significantly and short-term mortality decreased significantly in patients eligible for 3 of the admission measures. Further research is needed to elucidate any causal relationship between the improved compliance and short-term survival.

Ethnic disparities in diabetes management: a 10-year population-based repeated cross-sectional study in UK primary care

There has been little research on the impact of quality improvement initiatives on ethnic disparities in diabetes management in the UK. Population-based, repeated cross-sectional survey of recorded measurements, prescribing and achievement of treatment targets among 4309 patients with diabetes mellitus using electronic medical records from 26 general practices in North-West London from 1997 to 2006. Proportions of patients having their blood pressure (BP), cholesterol and HbA1c measured and recorded increased over the study period [from 50.6% to 87.0% (P < 0.0001), 17.0% to 76.7% (P < 0.0001) and 32.9% to 74.1% (P < 0.0001), respectively]. However, some ethnic differences remained. Black patients with diabetes were less likely to achieve target BP (<140/80 mmHg) than the white group [2006 age-sex adjusted odds ratio (AOR), 0.65; 95% confidence interval (CI), 0.51-0.83]. South Asians were found to have better lipid target control (2006 AOR, 1.57; CI, 1.23-2.00), were more likely to receive oral hypoglycaemic agents (2006 AOR, 2.27; CI, 1.79-2.86) but less likely to receive insulin (2006 AOR, 0.54; CI, 0.42-0.69) than the white group. Although ethnic disparities persist in diabetes management in this study population, these are starting to be addressed, particularly in the South Asian group. All ethnic groups have benefited from recent quality initiatives in the UK.

Hospital Standardized Mortality Ratio: The Way Forward in Ontario

Variations in quality of care persist despite an increased understanding of optimal practice and an improved ability to monitor outcomes. The reporting of hospital standardized mortality ratios (HSMRs) is an important step in highlighting the need to improve quality; but, as with most measures, the HSMR is not without flaws. Intense debate in the United Kingdom and the United States, and now here in Canada, has focused too much on the shortcomings of this measure and not enough on the issue at hand. The Ontario Ministry of Health and Long-Term Care--assuming our commitment to steward the healthcare system--embraces the themes of transparency and accountability as key tools in focusing attention on system performance and quality. The analysis of HSMRs in Ontario has indicated limitations to its interpretation, similar to those observed in the Winnipeg Regional Health Authority. The HSMR may not be a specific measure of adverse events, but this does not negate its usefulness in tracking the impact of quality improvement initiatives over time; it may be considered a valuable tool among a suite of indicators. In light of this, there is an opportunity to develop better statistics, including better data and measurement frameworks, and to educate the public to facilitate accurate interpretation, which will drive improvements in practice, quality and patients' experiences.

The role of quality improvement initiatives in healthcare operational environments

The purpose of this paper is to shed some light on the utilization of quality improvement initiatives in healthcare operational environments. In the process, environmental changes and strategic responses are examined for a sample of healthcare organizations. A survey-based research methodology is utilized in this study. Factor analysis is used to extract relevant factors representing environmental changes and strategic options relevant to healthcare organizations. In addition, simple percentages are utilized to assess the extent of implementation and effectiveness of quality improvement initiatives. In general, the findings appear to indicate that the studied organizations have achieved both operational and strategic benefits due to the effective implementation of quality improvement initiatives. The implementation of quality improvement initiatives appears to be in response to environmental changes and challenges faced by healthcare organizations. Based on the findings of this study, decision-makers are encouraged to commit organizational resources toward the effective implementation of quality improvement initiatives. Investing in quality improvement not only is justified, but also appears to be very much needed in a changing competitive environment. This study contributes to enhancing one's practical and theoretical understanding of the competitive impact of quality improvement initiatives in different operational settings.

Baldrige Award Announcement and Long Memory in Shareholder Wealth

In a competitive global market environment, the successful institution and implementa-tion of a comprehensive quality improvement programme is pivotal in attaining and sustaining business excellence. Tangible evidence of a company's level of excellence can be demonstrated by winning a prestigious quality award like the Malcolm Baldrige National Quality Award (MBNQA). While the intention to raise the level of competitiveness in all business sectors is lauded, two pertinent issues arise. Firstly, do investors or stock market participants share the belief that quality leads to business excellence. This implies that the stock market participants may have limited knowledge and experience in assessing the impact of quality improvement initiatives on performance (Easton & Jarrell, 1998). Secondly, if investors do believe and are able to assess the benefits quality improvement initiatives bring, would they acknowledge the benefits these quality awards bring in terms of sustained returns? This paper, an extension from studies by Przasnyski & Tai (2002) and Ramasesh (1998), attempts to investigate the long run sustainability of returns by recipient companies of the MBNQA from 1988 to 1996. Using long memory models commonly used in the financial econometrics literature, it was found that most recipient companies do not display long memory or, in short, recipient companies cannot sustain the previously generated significant abnormal returns on the day of announcement of winning the award.