Health Service Quality Improvement Research Articles

The Experiences of Stakeholders Using Social Media as a Tool for Health Service Design and Quality Improvement: A Scoping Review.

Health organisations and stakeholders use social media for a range of functions, including engaging stakeholders in the design and quality improvement (QI) of services. Social media may help overcome some of the limitations of traditional stakeholder engagement methods. This scoping review explores the benefits, risks, barriers and enablers for using social media as a tool for stakeholder engagement in health service design and QI. The searches were conducted on 16 August 2022. Inclusion criteria were: studies of any health service stakeholders, in any health setting, where social media was used as a tool for service design or QI. Data was analysed using deductive content analysis. A committee of stakeholders provided input on research questions, data analysis and key findings. 61 studies were included. Benefits included improved organisational communication and relationship building. Risks/limitations included low quality of engagement and harms to users. Limited access and familiarity with social media were frequently reported barriers. Making discussions safe and facilitating access were common enablers. The benefits, risks, barriers and enablers identified highlight the complexity of social media as an engagement tool for health service design and QI. Understanding these experiences may help implementers design more effective social media-based engagement activities.

Implementation of Google Forms as Alternative for Quality Indicator Recording and Reporting Systems in the Time of Covid-19 Pandemic

Recording and reporting are parts of health services aiming to create administrative discipline to improve health service quality. Covid-19 pandemic prevalence has impeded unit quality indicator recording and reporting, causing suboptimal quality measurements. This study aimed to see the implementation of Google Forms as a solution to overcome obstacles in unit quality indicator recording and reporting. This study was a one-group pre-experimental with a pre-and post-intervention design without control. The sample was seven people who were Laboratory Unit staff of a Private Hospital in Batu City. The results showed that applying Google Forms can provide staff's ability and timeliness in measuring unit quality indicators. A good quality measurement method can increase the effectiveness of monitoring and evaluation related to patient-centered quality improvement.

Improving Health Service Quality Management in Hospitals (Literature Study)

Hospitals as the main goal of overcoming public health complaints should try to provide best quality services to patients from all walks of life. For this reason, it is necessary to have service quality management as a process of optimizing the implementation of health activities according to established health service standards. The research method used is a literature study method related to a series of activities related to the collection of library data regarding improving the quality management of health services in hospitals that are sourced from research journals that will be read, writtten, and then the datas will be processed. Quality management of health services in hospitals can be improved by paying attention to aspects of fulfilling hospital accreditation according to established standards, fulfilling hospital minimum service standards, implementing management functions in health programs such as BPJS Kesehatan, as well as analysing integrated quality management (TQM) and based on ISO 9001:2015

Child and adolescent mental health services in the Western Cape Province of South Africa: the perspectives of service providers

BackgroundCurrent work in the field point to the need to strengthen child and adolescent mental health services (CAMHS) globally, and especially in low- and middle-income countries (LMICs). Policy development, planning and service provision must be relevant to the needs of stakeholders at grassroots level, and should include their perspectives. This study set out to explore the perspectives and lived experiences of service providers, including their recommendations to strengthen CAMHS in South Africa.MethodsUsing focus group discussions (FGDs) and semi-structured individual interviews (SSIIs), qualitative data were collected from 46 purposefully selected multidisciplinary health service providers across the Western Cape, one of the nine provinces of South Africa. Audio-recorded data were entered into NVivo 11 (QSR), and thematic analysis was performed by two independent raters.ResultsResults highlighted a significant lack of CAMH resources, poor intersectoral collaboration, limited access to training, absence of consistency and uniformity in service delivery, weak support for staff, and high rates of negative attitudes of staff. External factors contributing to poor CAMHS identified by service providers included poor socioeconomic circumstances, high rates of HIV/AIDS, substance use and stigma. The eight recommendations to strengthen CAMHS included a need to (1) increase CAMH staffing, (2) provide dedicated CAMHS at secondary care and child-friendly infrastructure at primary care, (3) review current service focus on number of patients seen versus quality of care provided to children, (4) formalise intersectoral collaborations, (5) increase learning opportunities for trainees, (6) employ a lead professional for CAMHS in the province, (7) increase support for staff, and (8) acknowledge staff initiatives.ConclusionsFindings underlined the need for quality improvement, standardisation and scale-up of mental health services for children and adolescents in South Africa. Whilst we used the Western Cape as a ‘case study’, we propose that our findings may also be relevant to other LMICs. We recommend that the perspectives of service users, including children and adolescents, be sought to inform service transformation.

LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS (LOCOMOTION): protocol for a mixed-methods study in the UK.

IntroductionLong COVID, a new condition whose origins and natural history are not yet fully established, currently affects 1.5 million people in the UK. Most do not have access to specialist long COVID services. We seek to optimise long COVID care both within and outside specialist clinics, including improving access, reducing inequalities, helping self-management and providing guidance and decision support for primary care. We aim to establish a ‘gold standard’ of care by systematically analysing current practices, iteratively improving pathways and systems of care.Methods and analysisThis mixed-methods, multisite study is informed by the principles of applied health services research, quality improvement, co-design, outcome measurement and learning health systems. It was developed in close partnership with patients (whose stated priorities are prompt clinical assessment; evidence-based advice and treatment and help with returning to work and other roles) and with front-line clinicians. Workstreams and tasks to optimise assessment, treatment and monitoring are based in three contrasting settings: workstream 1 (qualitative research, up to 100 participants), specialist management in 10 long COVID clinics across the UK, via a quality improvement collaborative, experience-based co-design and targeted efforts to reduce inequalities of access, return to work and peer support; workstream 2 (quantitative research, up to 5000 participants), patient self-management at home, technology-supported monitoring and validation of condition-specific outcome measures and workstream 3 (quantitative research, up to 5000 participants), generalist management in primary care, harnessing electronic record data to study population phenotypes and develop evidence-based decision support, referral pathways and analysis of costs. Study governance includes an active patient advisory group.Ethics and disseminationLOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS study is sponsored by the University of Leeds and approved by Yorkshire & The Humber—Bradford Leeds Research Ethics Committee (ref: 21/YH/0276). Participants will provide informed consent. Dissemination plans include academic and lay publications, and partnerships with national and regional policymakers.Trial registration number NCT05057260, ISRCTN15022307.

Impact of health system engagement on the health and well-being of people who use drugs: a realist review protocol

BackgroundAlthough community-level benefits of health system engagement (i.e., health service planning, delivery, and quality improvement, engaged research and evaluation, and collaborative advocacy) are well established, individual-level impacts on the health and well-being of community members are less explored, in particular for people who use or have used illegal drugs (PWUD). Capacity building, personal growth, reduced/safer drug use, and other positive outcomes may or may not be experienced by PWUD involved in engagement activities. Indeed, PWUD may also encounter stigma and harm when interacting with healthcare and academic structures. Our objective is to uncover why, how, and under what circumstances positive and negative health outcomes occur during health system engagement by PWUD.MethodsWe propose a realist review approach due to its explanatory lens. Through preliminary exploration of literature, lived experience input, and consideration of formal theories, an explanatory model was drafted. The model describes contexts, mechanisms, and health outcomes (e.g., mental health, stable/safer drug use) involved in health system engagement. The explanatory model will be tested against the literature and iteratively refined against formal theories. A participatory lens will also be used, wherein PWUD with lived experience of health system engagement will contribute throughout all stages of the review.DiscussionWe believe this is the first realist review to explore the contextual factors and underlying mechanisms of health outcomes for PWUD who participate in health system engagement. A thorough understanding of the relevant literature and theoretical underpinnings of this process will offer insights and recommendations to improve the engagement processes of PWUD.

Scaling up community-based health insurance in Ethiopia: a qualitative study of the benefits and challenges

BackgroundEthiopia has achieved impressive improvements in health outcomes and economic growth in the last decade but its total health spending is among the lowest in Africa. Ethiopia launched a Community-Based Health Insurance (CBHI) scheme in 2011 with a vision of reaching 80% of districts and 80% of its population by 2020. This study aimed to identify early achievements in scaling up CBHI and the challenges of such scale-up.MethodsWe interviewed 18 stakeholders working on health financing and health insurance in Ethiopia, using a semi-structured interview guide. All interviews were conducted in English and transcribed for analysis. We performed direct content analysis of the interview transcripts to identify key informants’ views on the achievements of, and challenges in, the scale-up of CBHI.ResultsImplementation of CBHI in Ethiopia took advantage of two key “policy windows”—global efforts towards universal health coverage and domestic resource mobilization to prepare countries for their transition away from donor assistance for health. CBHI received strong political support and early pilots helped to inform the process of scaling up the scheme. CBHI has helped to mobilize community engagement and resources, improve access to and use of health services, provide financial protection, and empower women.ConclusionGradually increasing risk pooling would improve the financial sustainability of CBHI. Improving health service quality and the availability of medicines should be the priority to increase and sustain population coverage. Engaging different stakeholders, including healthcare providers, lower level policy makers, and the private sector, would mobilize more resources for the development of CBHI. Training for operational staff and a strong health information system would improve the implementation of CBHI and provide evidence to inform better decision-making.

Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia

BackgroundAchieving universal health coverage (UHC) is a global priority and a keystone element of the 2030 Sustainable Development Goals. However, COVID-19 is causing serious impacts on tax revenue and many countries are facing constraints to new investment in health. To advance UHC progress, countries can also focus on improving health system technical efficiency to maximize the service outputs given the current health financing levels.MethodsThis study assesses Cambodia’s public health services technical efficiency, unit costs, and utilization rates to quantify the extent to which current health financing can accommodate the expansion of social health protection coverage. This study employs Data Envelopment Analysis (DEA), truncated regression, and pioneers the application of DEA Aumann-Shapley applied cost allocation to the health sector, enabling unit cost estimation for the major social health insurance payment categories.ResultsOverall, for the public health system to be fully efficient output would need to increase by 34 and 73% for hospitals and health centers, respectively. We find public sector service quality, private sector providers, and non-discretionary financing to be statistically significant factors affecting technical efficiency. We estimate there is potential supply-side ‘service space’ to expand population coverage to an additional 4.69 million social health insurance beneficiaries with existing financing if the public health system were fully efficient.ConclusionsPublic health service efficiency in Cambodia can be improved by increasing utilization of cost-effective services. This can be achieved by enrolling more beneficiaries into the social health insurance schemes with current supply-side financing levels. Other factors that can lead to increased efficiency are improving health service quality, regulating private sector providers, focusing on discretionary health financing, and incentivizing a referral system.

Quality improvement of health services in primary care centers

Quality improvement of health services in primary care centers

The Impact of Total Quality Management on Health Services Improvement, Sana’a Hospitals, Yemen (2017-2020)

Background: Total quality management (TQM) plays a major role in quality health services improvement. The aims of the study are to identify the concepts of total quality management in health institutions to know the nature of the relationship between the application of TQM and improving the quality of health services in Sana’a Governorate. Method: This applied research is a descriptive cross-sectional study in which the TQM of 13 affiliated Sana’a Governorate hospitals during “2017-2020”, were evaluated based on self-administered questionnaires. Data were collected by questionnaires including demographical variables, TQM dimensions variables. Data were analyzed by using SPSS version 16. Results: A total of 281 users 98.6% had responded. The employee’s responses for sixth study dimensions were the top manager’s commitment (TMC) 80.46%, customers focusing CF 81.55%, continuous improvement (CI) 82.32%, training (T) 71.51%, and strategic planning of the quality (SPQ) 74.76%, health services quality improvement (HSQI) 74.25%. There is a strong relationship between TQM and HSQI. There is no relationship between demographic factors gender, profession, years of experience, except age with TMC, T, HSQI, qualification with the TMC, CI, T, HSQI and job with all study variables. Conclusion: The application of TQM at hospitals in quality of health services improvement has several challenges, lacking staff experience and lacking leadership support, weakness of the training, customers focusing, continuous improvement, and strategic planning of the quality. Therefore, benefiting from the experiences of leading hospitals in implementing total quality management programs by sending some cadres to these hospitals for training and gaining experience or by hosting experienced cadres to conduct training courses is recommended.

Perceptions of service quality in Victorian public dental clinics using Google patient reviews.

Objectives Using Google online reviews, this study investigated why patients were satisfied or dissatisfied with their public dental clinic in Victoria, Australia. Methods This mixed methods study gathered Google reviews published by users pre-March, 2021. The reviews were coded and subthemes and major themes were identified. The most common reasons why patients gave reviews were tabulated and stratified according to star rating, remoteness and accessibility index classification, and socio-economic status. Results Of the 522 reviews included in this study, in 317 (60.7%) satisfaction was expressed. Compliments and complaints were documented. A total of 53 subthemes were identified. Major themes included Treatment, Staff, Communication and Professionalism, Patient Factors and Non-Clinical Reasons. From the reviews, more patients were satisfied with general unspecified treatment (n = 195; 14.7%) and dissatisfied with reception staff (n = 64; 4.8%). More reviews were generated by patients who visited clinics in major cities and lower socio-economic areas. Conclusion This study found that most patients expressed satisfaction and identified reasons why patients were satisfied or dissatisfied. Consumer feedback, including compliments and complaints, is an integral aspect of monitoring and improving health service quality. It is important to continue seeking feedback and improve accordingly.

Abstract IA-03: Making progress, together: An inclusive, broad-based approach to reducing excess burden of breast cancer among African American women in St Louis - with lessons for national implementation

Abstract Breast cancer deaths in Missouri are among the highest in the Nation. In St Louis City and North County late-stage diagnosis and mortality have remained high. Cancer disparities can be driven by behavioral risk factors, by health systems, and by biology. Research on all these aspects must be rewarded in academic promotion and tenure review. Siteman created the Program for the Elimination of Cancer Disparities (PECaD) to build community partnerships and develop outreach and education; conduct quality improvement and research in breast health services; and train community members in public health research principles. We developed a breast cancer community partnership in 2007 and identified priorities for the community and the partnership. These included improve awareness of prevention and breast health services, build trust, develop strategies to help patients keep appointments, support adherence to routine screening. We partnered with the African American newspaper (The St Louis American), public library, and federally qualified health centers. In collaboration with FQHCs, we evaluated referral patterns and identified strategies to improve communication between providers. Using the collective impact model to sustain change, for over a decade PECaD supports the St Louis Regional Breast Navigator workgroup. Diagnoses of breast cancer among Black women were 32% stage III/IV in 2000. By 2019, Siteman had expanded services and partnerships to reduce late-stage diagnosis to 16.4% of incident cancers among Black women, still higher than 9.8% observed among white women. To ensure access to clinical trials we implemented system changes for monitoring trial protocols, defining eligibility targets by race, and monitored accruals by race, integrating the process into PRMC and Siteman leadership review. We reported breast cacner outcomes from SEER and Missouri cancer registries by race and engaged bench researchers to study pathways that may drive disparities. They now study pathways that may drive triple negative breast cancer in African American women and DNA repair pathways that may modify response to treatment. This includes research by Dr. Weber (breast program) on adenosine deaminase acting on RNA (ADAR1, encoded by ADAR) and by Dr. Shao on repair of double strand DNA breaks that may counteract therapy for TNBC. We have expanded community service aspects of promotion review traditionally framed as service to medical center, university, and community. We now specifically call out service to Siteman through our Research Programs or Community Outreach and Engagement activities. Thus, faculty can make explicit their contributions to diversity, equity, and inclusion, and their disparities focused research. By working at multiple levels, we have improved access to screening and breast health services, improving stage at diagnosis among African American women. We have engaged bench scientists to address excess risk of TNBC in African American women, and have used the promotion criteria to reward disparities and community engaged research. Citation Format: Graham A. Colditz. Making progress, together: An inclusive, broad-based approach to reducing excess burden of breast cancer among African American women in St Louis - with lessons for national implementation [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-03.

Large Scale Survey Research with Older Adults/Persons with Disabilities in a Public Health Crisis

Best practice for measuring quality improvement and consumer satisfaction of health and human services for older adults and people with disabilities relies on in-person survey administration. This poster highlights adaptation strategies undertaken across three large-scale evaluation studies of program/service delivery conducted during the COVID-19 pandemic, necessitating a departure from in-person techniques: 1) Integrated Satisfaction Measurement for the Program of All-Inclusive Care for the Elderly (I-SAT-PACE), 2) National Core Indicators- Aging and Disabilities/Intellectual and Developmental Disabilities (NCI-AD/IDD), and 3) Assisted Living Resident Quality of Life (AL-QOL). Data collection for these projects occurred from September 2020 to August 2021, providing an opportunity to showcase project adaptation over the course of the pandemic. Using project implementation examples across 15 states and approximately 10,100 participants, we discuss implications for successful survey coordination, interviewer training, data collection, and participant/stakeholder engagement during a public health emergency. Strategies included pivoting to phone, Zoom, and paper-based data collection and increasing technical assistance for field staff and participants. Project teams were able to increase access to participation by implementing multimodal survey delivery, mitigate coronavirus exposure, continue collecting older adults and people with disabilities’ experiences, and compare results based on method of delivery. Technology barriers, field staff dropout, need for larger sample sizes, and inclusion of participants with dementia, hearing, and speech impairments present important tradeoffs to consider. These examples indicate it is possible to administer hybrid data collection methods across populations with varying cognitive and physical abilities without compromising data quality.

What can we learn from the SARS-COV-2 pandemic about the value of specific radiological examinations?

BackgroundThe SARS-COV-2 pandemic provides a natural intervention to assess practical priority setting and internal evaluation of specific health services, such as radiological services. Norway makes an excellent case as it had a very low infection rate and very few cases of COVID-19. Accordingly, the objective of this study is to use the changes in performed outpatient radiological examinations during the first stages of the SARS-COV-2 pandemic to assess the practical evaluation of specific radiological examinations in Norway.MethodsData was collected retrospectively from the Norwegian Health Economics Administration (HELFO) in the years 2015–2020. Data included the number of performed outpatient imaging examinations at public hospitals and private imaging centers in Norway and was divided in to three periods based on the level of restrictions on elective health services. Results were analyzed with descriptive statistics.ResultsIn the first period there was a 45% reduction in outpatient radiology compared to the same time period in 2015–2019 while in period 2 and 3 there was a 25 and 6% reduction respectively. The study identified a list of specific potential low-value radiological examinations. While some of these are covered by the Choosing Wisely campaign, others are not.ConclusionBy studying the priority setting practice during the initial phases of the pandemic this study identifies a set of potential low value radiological examinations during the initial phases of the SARS-COV-2 pandemic. These examinations are candidates for closer assessments for health services quality improvement.

Data Quality Improvement and Internal Data Audit of the Chinese Neonatal Network Data Collection System.

Background: The Chinese Neonatal Network (CHNN) is a nationwide neonatal network that aims to improve clinical neonatal care quality and short- and long-term health outcomes of infants. This study aims to assess the quality of the Chinese Neonatal Network database by conducting an internal audit of data extraction.Methods: A data audit was performed by independently replicating the data collection and entry process in all 58 tertiary neonatal intensive care units (NICU) participating in the CHNN. Eighty-eight data elements selected for re-abstraction were classified into three categories (critical, important, less important), and agreement rates for original and re-abstracted data were predefined. Three to five records were randomly selected at each site for re-abstraction, including one short- (0–7 days), two medium- (8–28 days), and two long-stay (more than 28 days) cases. Agreement rates for each data item were calculated for individual NICUs and across the network, respectively.Results: A total of 283 cases and 24,904 data fields were re-abstracted. The agreement rates for original and re-abstracted data elements were 96.1% overall, and 97.2, 94.3, and 96.6% for critical, important, and less important data elements, respectively. Individual site variation for discrepancies ranged between 0.0 and 18.4% for all collected data elements.Conclusion: The completeness, precision, and quality of data in the CHNN database are high, providing assurance for multipurpose use, including health service evaluation, quality improvement, clinical trials, and other research.

Quality of Health Service: Issues and Measures to Improve

Health service is considered fundamental right of every citizen in the Constitution of Nepal, so it obviously becomes obligation of the State. Service quality has many dimensions, among them responsiveness towards patients is an indispensable one. Service quality and health service quality are defined differently by different writers. To improve health service quality, some measures are deemed necessary to be taken immediately. Among them, ingraining a culture of quality and use of technology are primary ones. This article focuses on the problems in health quality and some measures to be adopted in order to improve the service quality.

Literature Review: Strategy Analysis of Pharmaceutical Service Quality Improvement

Hospitals are individual health service facilities and part of health resources that are indispensable in supporting the implementation of health efforts. Quality improvement in health services is not only oriented to quality service processes but also the results of the quality of health services following the wishes of customers or patients. One type of hospital service that must be provided is pharmacy services. Pharmacy services must be carried out according to predetermined service standards. Problems that are still encountered in Indonesian hospital pharmacy installations are: speed of service time is not optimal, service friendliness is still not optimal, and limited drug availability. This study aims to determine the strategy for improving the service quality of hospital pharmacy installations in Indonesia. This research is a literature review by searching electronic databases published in 2017-2022 and meeting the inclusion criteria. Articles were taken from the Scopus, Science Direct, ProQuest, Springer Link, Google Scholar, Nature, JSTOR, and Emerald Insight databases with a total of 20 articles used. Twenty articles show that to improve the service quality of hospital pharmacy installations in Indonesia is to pay attention to several aspects of indicators including, service friendliness, service speed, service accuracy, product completeness, workforce professionalism, and service convenience

Are user fees in health care always evil? Evidence from family planning, maternal, and child health services

The effect of introducing or increasing user fees for health services in low- and middle-income countries is controversial. While user fees are advocated as an effective means of generating revenue and enabling health service quality improvement, they constitute a financial barrier to access health services for the poorer. This paper contributes to the literature on the demand-side financing in health by providing evidence on the medium-term effects of introducing user fees on the utilisation of family planning, antenatal care, and delivery care services, women’s access to health care, and child health status in a middle-income country setting. Using a difference-in-differences identification strategy to establish causality, we find that the introduction of user fees in Egypt had no negative effect on the utilisation of family planning and delivery care services. Further, fees did not hinder women’s access to care and did not harm child health outcomes. Positive effects were even observed with respect to the utilisation of antenatal care services. Our findings are compatible with the hypothesis that the potential decrease in demand due to the user fee imposition might have been offset by an increased willingness to pay for a quality of health care that could be, at least partly, perceived as higher.

Co-produced capability framework for successful patient and staff partnerships in healthcare quality improvement: results of a scoping review

BackgroundInternationally, patient and public involvement (PPI) is core policy for health service quality improvement (QI). However, authentic QI partnerships are not commonplace. A lack of patient and staff capability to...

A quasi-experimental study to improve health service quality: implementing communication and self-efficacy skills training to primary healthcare workers in two counties in Iran

BackgroundService satisfaction ratings from clients are a good indicator of service quality. The present study aimed to investigate the impact of communication skills and self-efficacy training for healthcare workers on clients’ satisfaction.MethodsA quasi-experimental study was conducted in health centers of Saveh University of Medical Science in Iran. Primary Healthcare (PHC; N = 105) workers and service recipients (N = 364) were randomly assigned to intervention and control groups. The intervention group received four 90-min training sessions consisting of lecture, film screening, role-playing, and discussion group. Before and 3 months after the intervention, a multi-part questionnaire (including demographics, self-efficacy and communication skills in PHC workers; and satisfaction questionnaire in service recipients) was completed by participants in both intervention and control groups.ResultsPHC worker mean scores of self-efficacy and communication skills after the educational program were increased in the intervention group compared to the control group (p < 0.05). Also, mean satisfaction scores for service recipients of the intervention group (PHC workers) generally significantly increased compared to the control group (p < 0.001).ConclusionsThe educational program improved the self-efficacy, and communication skills in health workers and improved client satisfaction overall. Our results support the application of self-efficacy and communication skills training for other medical groups who wish to improve clients satisfaction as an important health services outcome.