Involvement In Quality Improvement Research Articles

A comparative study of quality management practices between Vietnamese and Japanese manufacturing plants

This study aims to investigate impact of quality management practices on operational capabilities in Vietnamese and Japanese manufacturers, and then, compare the impact between two countries. Statistical techniques are applied to analyse data collected from 25 Vietnamese and 22 Japanese manufacturing plants through an international joint research called high performance manufacturing (HPM) - round 4 in 2014-2015. Analytical results indicate positive impact from supplier involvement in quality improvement and process control but negative impact from feedback and continuous improvement and learning on operational capabilities. The impacts of supplier involvement in quality improvement and feedback practices are significantly different between Japanese and Vietnamese manufacturing companies. The results provide empirical evidence on the implementation quality management practices in different countries, and offer some insights into performance improvement in both developed and developing countries.

Identification of Quality Improvement Projects from AUA White Papers.

Health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. Following a review of the recently published AUA (American Urological Association) white papers on "Optimizing Outcomes in Urologic Surgery" a detailed list of potential quality improvement projects was created as our AUA Leadership Program project. In this article we familiarize the reader with basic tools used in quality improvement project development and the components of quality initiative planning required for implementation of a sample of the identified projects in clinical practice. The projects identified are derived from the areas highlighted in the AUA white papers addressing preoperative, intraoperative and postoperative considerations for quality and safety. We anticipate that this information will be useful for students, residents and practicing urologists to expand their involvement in quality improvement and build multidisciplinary projects based on the work the AUA has already done in this area.

Nurses+QI=better hospital performance? A critical review of the literature.

NHS regulators, such as NHS Improvement and the Care Quality Commission, promote staff involvement in quality improvement (QI), while national nursing leaders and the Nursing and Midwifery Council advocate nurses' involvement in improving services. This article critically explores the evidence base for a national nursing strategy to involve nurses in QI using a literature review. A thematic analysis shows that nurse involvement in QI has several positive outcomes, which are also included in the NHS Improvement's Single Oversight Framework for NHS Providers. The article concludes that nurse involvement in QI helps improve hospital performance.

How is patient involvement measured in patient centeredness scales for health professionals? A systematic review of their measurement properties and content

BackgroundPatient centeredness is an important component of patient care and healthcare quality. Several scales exist to measure patient centeredness, and previous literature provides a critical appraisal of their measurement properties. However, limited knowledge exists regarding the content of the various scales in terms of what type of patient centeredness they represent and how they can be used for quality improvement. The aim of this study was to explore the measurement properties of patient centeredness scales and their content with a special focus on patient involvement, and assess whether and how they can be used for quality improvement.MethodsA systematic review of patient centeredness scales was conducted in Medline, CINAHL, Embase, and SCOPUS in April and May 2017. Inclusion criteria were limited to articles written in English published from 2005 to 2017. Eligible studies were critically appraised in terms of internal consistency and reliability, as well as their content, structural, and cross-cultural validity. Type of studies included were scale-development articles and validation studies of relevant scales, with healthcare personnel as respondents. We used directed content analysis to categorize the scales and items according to Tritter’s conceptual framework for patient and public involvement.ResultsEleven scales reported in 22 articles were included. Most scales represented individual, indirect, and reactive patient involvement. Most scales included items that did not reflect patient centeredness directly, but rather organizational preconditions for patient centered practices. None of the scales included items explicitly reflecting the use of patient experiences of quality improvement.ConclusionsThere is a lack of patient centeredness scales focusing on direct and proactive involvement of patients in quality improvement. It would be useful to develop such instruments to further study the role of patient involvement in quality improvement in healthcare. Furthermore, they could be used as important tools in quality improvement interventions.

Exploring the phase for highest impact on radicality: a cross-sectional study of patient involvement in quality improvement in Swedish healthcare

ObjectivesInvolving patients in quality improvement is often suggested as a critical step for improving healthcare processes. However, this comes with challenges related to resources, tokenism, validity and competence. Therefore, to...

2242 Evaluation of a clinical investigation curriculum: Post-graduate outcomes

OBJECTIVES/SPECIFIC AIMS: Many CTSA programs have implemented curricula leading to clinical investigation master’s degrees. Evaluation of long-term outcomes for graduates can support curriculum improvement. METHODS/STUDY POPULATION: We evaluated graduates 1–3 years post completion of an MS in Clinical Investigation at the University of Utah. We administered the 12-item Clinical Research Appraisal Inventory (CRAI-12) describing confidence in ability to perform research tasks; we derived 6 CRAI sub-scales. Additional questionnaire items assessed current engagement in research, including percent of effort devoted to research and level of involvement in research projects using specific research methods. RESULTS/ANTICIPATED RESULTS: Graduates reported high confidence for the CRAI domain of reporting, interpreting, and presenting (on a scale of 0–20, mean 17.9±SD 1.9) and the domain of conceptualizing and collaborating (16.5±2.2) on research projects; confidence was somewhat lower in the domains of planning (14.6±3.3) and funding (14.9±2.8) projects. Graduates’ estimated current professional effort devoted to research had a median of 32%, interquartile range (IQR) 20%–70%; among graduates with clinical responsibilities, median effort devoted to research was 23%, IQR 15%–45%. In total, 74% of graduates reported moderate or high involvement in research using existing large databases, 46% reported moderate or high involvement in comparative effectiveness research, and 54% reported moderate or high involvement in quality improvement. DISCUSSION/SIGNIFICANCE OF IMPACT: A majority of clinical investigation graduates remain engaged in research but most are able to devote less than one-third of professional effort to research. Evaluation of clinical investigation graduates who have moved into their research careers can inform program directors about domains of research expertise and methodological areas that may merit additional emphasis in the curriculum.

Patient Engagement in Community Health Center Leadership: How Does it Happen?

Patient engagement in primary care leadership is an important means to involve community voices at community health centers. Federally qualified health centers (FQHCs) are mandated to have patient representation within their governing boards, while practices seeking patient-centered medical home certification receive credit for implementing patient advisory councils (PACs). Our objective was to compare and contrast how community health centers engage patients in clinic management, decision-making and planning within governing boards versus PACs. Qualitative study conducted from August 2016 to June 2017 at community health centers in California, Arizona and Hawaii. We interviewed practice leaders of patient engagement programs at their site. Eligible clinics had patient representatives within their governing board, PAC, or both. We assessed patient demographics, roles and responsibilities of patients participating, and extent of involvement in quality improvement among governing boards versus PACs. We interviewed 19 sites, of which 17 were FQHCs that had governing boards. Of the 17 FQHCs, 11 had also implemented PACs. Two non-FQHC safety-net sites had PACs but did not have governing boards. Governing board members had formal, structured membership responsibilities such as finances and hiring personnel. PAC roles were more flexible, focusing on day-to-day clinic operations. Clinics tended to recruit governing board patient members for their skill set and professional experience; PAC member recruitment focused more on demographic representation of the clinic's patient population. Both groups worked on quality improvement, but governing boards tended to review clinic performance metrics, while PAC members were involved in specific project planning and implementation to improve clinical outcomes and patient experience. Patient involvement in clinic improvement in CHCs includes higher-level decision-making and governance through mechanisms such as governing boards, as well as engagement in day-to-day practice improvement through PACs. These roles offer differing, but valuable insights to clinic programs and policies.

Cultural Change of Applying User Involvement for Improving Healthcare Quality: A Review of the Impact on Attitudes, Values and Assumptions among Healthcare Professionals and Users

Purpose: The purpose of this study is to provide a review of the impact on culture (attitudes, values and assumptions) among both healthcare professionals, as well as users, when involving users for improving quality in healthcare.Methodology/Approach: The paper is based on an extensive, narrative literature review considering studies that included professional’s and users experiences of user involvement in quality improvement. The included articles were analyzed using an interpretive, along with a deductive, approach according to a theoretical framework.Findings: The results indicate that there is currently limited research focusing on the impact of user involvement in quality improvement processes regarding professionals’ and users’ attitudes, values and/or assumptions. The articles identified during the study provides situations and statements, during the process of development, which can be interpreted as change in the culture. Although few articles specifically draw conclusions on user involvement as a “tool” for cultural change, the authors interpret several findings which strengthens that theory.Research Limitation/implication: Research published in other databases could have been missed. The authors have tried to avoid this by using a snowball method reading references in identified articles.Originality/Value of paper: The review provides a platform for both future research and the development of current practice within the area. There have been literature reviews showing obstacles and enablers when using patients, users and relatives in quality improvement work, but few which investigates cultural change.

Quality Improvement in Nursing Homes: Alignment Among Leaders Across the Organizational Chart.

This article describes nursing home (NH) leaders' involvement in quality improvement (QI) decisions, with an emphasis on the concept of alignment in QI decisions across leaders. We used a qualitative approach and semistructured interviews to collect data from a convenience sample of 39 NH leaders, including corporate/executive-level leaders and facility-level leaders. Thematic analysis was used to inductively capture key patterns in data. Variations in alignment emerged as a major theme to describe the interface and interaction among facility- and corporate/executive-level leaders around QI decision making and implementation of QI decisions. For this study, alignment refers to the extent of shared understanding, beliefs, motivations, and implied or explicit agreement among leaders in regards to: (a) goals, values, priorities, and expectations for quality or QI (and/or applicable resources); and (b) expectations for leaders to carry out QI decisions made by other leaders. This study offers new insights into the complexities associated with leadership alignment toward improving NH quality. The findings provide a glimpse into leaders' involvement in QI based on their position on the facility's organizational chart and extend our understanding of the centrality of the concept of alignment in promoting QI. These findings may inform future research on facility- and corporate/executive-level leader interactions and how these interactions impact quality outcomes.

Rheumatologists' perception of systemic lupus erythematosus quality indicators: significant interest and perceived barriers.

Differences in quality of care may contribute to health disparities in systemic lupus erythematosus (SLE). Studies show low physician adherence rates to the SLE quality indicators but do not assess physician perception of SLE quality indicators or quality improvement. Using a cross-sectional survey of rheumatologists in the southeastern USA, we assessed the perception and involvement of rheumatologists in quality improvement and the SLE quality indicators. Using electronic mail, an online survey of 32 questions was delivered to 568 rheumatologists. With a response rate of 19% (n=106), the majority of participants were male, Caucasian, with over 20years of experience, and seeing adult patients in an academic setting. Participants had a positive perception toward quality improvement (81%) with a majority responding that the SLE quality indicators would significantly impact quality of care (54%). While 66% of respondents were familiar with the SLE quality indicators, only 18% of respondents reported using them in everyday practice. The most commonly reported barrier to involvement in quality improvement and the SLE quality indicators was time. Rheumatologists had a positive perception of the SLE quality indicators and agreed that use of the quality indicators could improve quality of care in SLE; however, they identified time as a barrier to implementation. Future studies should investigate methods to increase use of the SLE quality indicators.

Patients' involvement in improvement initiatives: a qualitative systematic review.

Over the last 20 years, quality improvement in health has become an important strategy in health services in many countries. With the emphasis on quality health care, there has been a shift in social paradigms towards including service users in their own health on different levels. There is growing evidence in literature on the positive impact on health outcomes where patients are active participants in their personal care. There is however less information available on the broader influence of users on improvement in systems. The objective of this review was to identify the barriers and enablers to patients being involved in quality improvement efforts directed towards their own health care. This review considered studies that included adults and children of any age experiencing any health problem.The review considered studies that explored patient or user participation in quality improvement and the factors enabling and hindering this processThe qualitative component of this review considered studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Other texts such as opinion papers and reports were also considered. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. The searches using all identified keywords and index terms included the databases PubMed, PsycINFO, Medline, Scopus, EBSCOhost and CINAHL.Qualitative, text and opinion papers were considered for inclusion in this review.Closely related concepts like community involvement, family involvement, patients' involvement in their own care (for example, in the case of shared decision making), and patient centeredness in the context of a consultation were excluded. Qualitative and textual papers selected for retrieval were assessed by two independent reviewers for authenticity prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute. Qualitative and textual data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute. The above findings were pooled and through the identification of categories, a final meta-synthesis was formulated. Two synthesized findings were created from the included papers. Firstly, there are barriers to patients' participation in quality improvement in health and in spite of policy support for user involvement in quality improvement, it is a difficult strategy to implement. The second synthesized finding was that there are enablers to patients' involvement in quality improvement: when patients are involved in quality improvement efforts in health care, there are innovative, often unexpected, outcomes at different levels of the process, and sustaining these efforts is possible with ongoing individual or group support.Five categories which supported the synthesized findings were created through the meta-aggregative process. There are enablers and barriers to involving patients in quality improvement in health care that need to be considered when planning such interventions.Relationships and roles will need to be very clear from the outset. A developmental approach needs to be considered where support and training is part of the project. Where patients are truly engaged in service improvement, unexpected innovation occurs.There are many more reports and opinion papers published regarding this topic than there are rigorous research studies. This leaves the field open to the development of good methodological studies related to quality improvement and in particular to the participation of patients.

The quality of cardiovascular disease prevention in rural primary care.

ObjectiveTo measure the differences in the recording of risk factors and lifestyle advice between those at high risk of cardiovascular disease and those diagnosed with cardiovascular disease, and to identify the practice characteristics associated with such recording in rural primary care.DesignA cross‐sectional observation study of 14 general practices. Medical records were audited to measure recording of risk factors and lifestyle advice for those at high risk of and those diagnosed with cardiovascular disease. Practice characteristics were collected, with logistic regression used to test for an association with the recording of risk factors.SettingGeneral practices in rural Australia.ParticipantsEach practice was asked to identify 20 patients; 10 at high risk and 10 diagnosed with cardiovascular disease.Main outcome measuresThe recording of risk factors and lifestyle advice in patient records and practice characteristics.Results282 records were audited with 142 being high risk and 140 diagnosed with cardiovascular disease.Measures recorded significantly less in the high‐risk group were: blood pressure (94% versus 99%; P = 0.019); physical activity (24% versus 56%; P = 0.000); dietary advice (32% versus 51%; P = 0.001); and physical activity advice (34% versus 56%; P = 0.000).Recording of risk factors was positively associated with practice involvement in quality improvement (P < 0.001), continuing education (P < 0.001), and greater percentage of general practitioners (P < 0.05) and practice nurses (P < 0.001).ConclusionsThere is substantial room for enhanced cardiovascular disease prevention through rural primary care in Australia, particularly for high‐risk patients. This study has demonstrated an association between practice factors (including targeted education, quality improvement activities and appropriate workforce) and improved preventive activities.

Strategies for Aligning Physicians to System Redesign Goals at Eight Safety-Net Systems

Facing recent economic and regulatory pressures, safety-net systems (SNSs) are redesigning their organizations to improve care delivery, remain financially viable, and maintain competitive positions. Aligning physicians with redesign goals is a priority, particularly as many SNSs shift toward patient-centered, population health-focused models. No previous work has examined efforts to align physicians to safety net redesign efforts. This qualitative study, conducted at eight SNSs, examined challenges faced in a changing health care environment, as well as strategies and resources to address them. Strategies clustered in two categories: physician role definition and organizational infrastructure. Physician role definition strategies were (1) changing payment and employment arrangements, (2) changing clinical roles, (3) increasing physician involvement in quality improvement, and (4) strengthening physician leadership in clinical and quality roles. Organizational infrastructure strategies were (1) ensuring medical center leadership support and integration, (2) utilizing data to drive physician behavior, and (3) addressing competing allegiances with academia. All sites reported multifaceted approaches but differed in specific strategies employed, facilitators noted, and challenges encountered. The findings highlight the need to implement multiple strategies to align physicians in redesign efforts. They suggest that all health systems, whether SNSs or not, can capitalize on qualities of physicians and existing infrastructural and leadership elements to achieve physician alignment. However, they must contend with and address challenges of competing allegiance (for example, academic, physician organization, hospital), as well as resistance to changing clinical roles and payment structures.

Participation of National Medical Associations in quality improvement activities - International comparison and the Israeli case.

BackgroundMany countries have devoted considerable efforts in an attempt to improve the performance of their health care systems. National Medical Associations (NMAs), along with other stakeholders, play a part in the promotion of such activities. The purpose of this paper is to explore the nature and level of participation of NMAs in activities of quality improvement in medicine, with a specific emphasis on Israel.MethodsThe authors conducted a survey among NMAs around the world inquiring as to their involvement in three central aspects of quality improvement: clinical guidelines, quality measurement and continuing medical education (CME). In addition, they conducted a review of the literature in order to gather more information and complete the data collected in the survey. The findings were processed and analyzed comparatively.ResultsMost of the NMAs surveyed participate in quality improvement activities at least to some extent. NMAs' main involvement is in the regulation of CME and they are involved to a much lesser extent in the preparation of clinical guidelines and in quality measurement. In Israel, the Israeli Medical Association (IMA) has a dominant role in both the preparation of clinical guidelines and the regulation of CME credits.DiscussionIt is possible that the expertise maintained by the profession, coupled with the organizational power of the NMA as a union, is viewed as beneficial for regulating educational activities in medicine such as CME. Conversely, the issuing of clinical guidelines is usually regarded as a typical scientific activity, and therefore often rests in the hands of professional medical societies. Quality measurement is regarded as a distinctive administrative tool and is usually found in the province of governments. Based on the typology that we introduced in our previous paper, we discovered that the extent of NMAs’ involvement in quality improvement coincides with the mode of governance of the health care system.ConclusionsThe nature and level of participation of NMAs in activities of quality improvement varies widely. Collaboration of NMAs in this field with other stakeholders is not uncommon, and may contribute to the further development of quality improvement in medicine.

Patient involvement in quality improvement: is it time we let children, young people and families take the lead?

It is vital to involve children, young people and families in the design, delivery and improvement of their care. Their involvement can range from individuals giving feedback, such as patient...

Optimizing patient involvement in quality improvement

IntroductionPatient and public involvement in healthcare planning, service development and health‐related research has received significant attention. However, evidence about the role of patient involvement in quality improvement work is more limited. We aimed to characterize patient involvement in three improvement projects and to identify strengths and weaknesses of contrasting approaches.MethodsThree case study quality improvement projects were purposively sampled from a broader programme. We used an ethnographic approach involving 126 in‐depth interviews, 12 weeks of non‐participant observations and documentary analysis. Data analysis was based on the constant comparative method.ResultsThe three projects differed in the ways they involved patients in their quality improvement work, including their rationales for including patients. We characterized three very different models of patient involvement, which were each influenced by project context. Patients played distinctive roles across the three projects, acting in some cases as intermediaries between the wider patient community and clinicians, and sometimes undertaking persuasive work to convince clinicians of the need for change. We identified specific strategies that can be used to help ensure that patient involvement works most effectively and that the enthusiasm of patients to make a difference is not dissipated.ConclusionPatient involvement in quality improvement work needs careful management to realize its full potential.

Public reporting outcomes of multidisciplinary cancer care: Conceptual issues.

280 Background: Patient outcomes are the most valid measures of quality of care. Public reporting makes them available to patients, referring physicians and payers. Our institution has committed to reporting all cancer patient outcomes. In carrying out that objective, we encountered novel analytical issues arising from differences between the usually reported treatments, surgical procedures, and multidisciplinary cancer care. We present important conceptual issues we identified. Methods: Analytic description of methodological issues encountered in publishing cancer patient outcomes. Results: Issues include: (1) Assigning responsibility. Patient outcomes of multidisciplinary cancer care can be influenced by multiple oncology specialties and institutions. While providers directly control only the treatment they provide, providers share collective responsibility for executing the treatment plan, coordinating care and vouching for the quality of collaborating providers. Therefore, reporting outcomes of one element of multidisciplinary care is incomplete and inadequate. (2) Claiming responsibility. Providers with institutional affiliations but no involvement in quality improvement or reporting processes should be excluded from public reporting. Minimum requirements to qualify for public institutional affiliation should be enforced and “free riders” identified. (3) Defining and presenting valid comparison populations. Treatment trials’ eligibility criteria and recruitment practices exclude poorer prognosis patients, producing biased comparisons to complete “registry” populations that distort patient expectations. Publishing outcomes of well-characterized subpopulations improves valid results and provides more individualized information. Conclusions: Reporting patient outcomes after multidisciplinary cancer care raises novel conceptual issues. We discuss our response to three important issues.

Public Health Nursing Job Descriptions

The American Nurses' Association (ANA) 2007 Public Health Nursing: Scope and Standards of Practice along with the Quad Council's PHN competencies frame the practice of public health nurses (PHNs). The preface for ANA's PHN Scope and Standards encourages using the standards as the basis of PHN job descriptions. This study sought to assess the extent to which PHN job descriptions are aligned with the ANA's PHN Scope and Standards and the Quad Council competencies. We obtained PHN job descriptions from 3 local health departments in Illinois and 3 in Washington. Statements from the job descriptions were content analyzed, categorizing statements into the 16 ANA PHN Scope and Standards and using Quad Council competencies as additional definitions of each category. To code all job statements related to PHN practice, 2 categories were added which were MPH competencies from the Associations of Schools of Public Health. Interrater reliability was established. All 18 PHN job descriptions had statements related to Standard 5 Implementation, followed by 94% of the job descriptions having statements related to assessment, planning, coordination of services, health education/health promotion, and collaboration. The least frequently (22%) included standard was outcome identification. Attention to human resource management is necessary to align job descriptions with current professional scope and standards for basic and advanced PHN practice. The lack of statements regarding Outcome Identification has serious implications for PHN involvement in quality improvement and health planning.

Determinants of Rehabilitation Services Staffs' Job Satisfaction (By Effort Reward Imbalance) and Variations in Teaching, Profit Making and Non Profit Hospitals

To evaluate the level of work satisfaction based on the Effort-Reward Imbalance Model of staff working in rehabilitation services of different categories (in teaching, profit making and non-profit making hospitals). Participants were 166 therapists and assistants working in the Departments of Physical, Occupational and Respiratory Therapy from 10 hospital centers classified per three different categories in the Jeddah area. Effort-Reward Imbalance and staff satisfaction with intrinsic and extrinsic variables were measured by a self-administered questionnaire. There is a significant difference of level of job satisfaction measured by effort and reward imbalance between the therapists and assistant therapists working in the teaching, private or non-profit making health care facilities. In comparison by hospital type, the surveyed rehabilitation staffs presented a higher mean effort-reward imbalance in the teaching hospitals but higher job satisfaction with their salary, their perception of salary comparatively to others, yearly performance appraisal grading and affective commitment. In the rehabilitation services of non-profit making hospitals, the surveyed therapists and assistant therapists had the lowest mean Effort-Reward Imbalance ratio explained by their satisfaction with the variables of patient/staff ratio and emotional attachment to the organization. In the profit making healthcare facilities, the surveyed staffs are comparatively more satisfied with the variables of doctors' respect, involvement in quality improvement or educational lectures and transportation to/from work. Rehabilitation services staffs working in teaching hospitals and profit making hospitals had in general a higher effort-reward imbalance ratio with work stress and low satisfaction in work compared to the non-profit hospital facilities. Job satisfaction of rehabilitation staff varies per hospital type and mission of the health care facility. © Medwell Journals, 2012.

Supply quality management with wholesale price and revenue-sharing contracts under horizontal competition

In a number of industries (e.g., the airplane industry, aerospace industry, auto industry, or computer industry), certain suppliers essentially have a monopoly on the production technology for key components, and inevitably manufacturers in these industries have common suppliers. A key part of manufacturers’ work with suppliers concerns improving the quality of their respective products, which gives rise to a collaborative activity usually termed as “supply quality management”. When the manufacturers are competitors, they do not wish to see a common supplier dividing his involvement in quality improvement unequally between themselves and their rivals. However, as the suppliers collaborate with several manufacturers, it is highly questionable whether their efforts will be strictly equivalent for each manufacturer. In this paper, a non-cooperative dynamic game is formulated in which a single supplier collaborates with two manufacturers on design quality improvements for their respective products. The manufacturers compete for market demand both on price and design quality. The paper analyzes how each party should allocate resources for quality improvement over time. In order to take into account the potential coordinating power of the compensation scheme adopted in this type of decentralized setting, we compare the possible outcomes under a wholesale price contract and a revenue-sharing contract.