Key Areas For Quality Improvement Research Articles

"Cultural Security Is an On-Going Journey…" Exploring Views from Staff Members on the Quality and Cultural Security of Services for Aboriginal Families in Western Australia.

Cultural security is a key element of accessible services for Indigenous peoples globally, although few studies have examined this empirically. We explored the scope, reach, quality, and cultural security of health and social services available to Aboriginal and/or Torres Strait Islander families in Western Australia (WA), from the point of view of staff from the services. We recruited staff from health and social services for Aboriginal people in the Perth, Kalgoorlie, Great Southern, and South West regions of WA between December 2015 and September 2017 to complete online surveys. We examined the proportions of participants that responded saying the service was culturally secure, the reasons for the response, and perceived factors related to a high-quality service. Sixty participants from 21 services responded to the survey. Seventy-three percent stated the service was culturally secure; however, only 36% stated that the staff employed at the service had sufficient knowledge on cultural security. Participants suggested having Aboriginal staff and better cultural awareness training as methods to improve cultural security within the service. Participants highlighted that staffing, funding for resources, and patient financial difficulties in accessing care as key areas for quality improvement. Much greater effort is required in improving knowledge through on-going training of staff in the practice of culturally safe care. Organisations must also be required to meet specific standards in cultural safety.

Improving the paediatric surgery patient experience: an 8-year analysis of narrative quality data.

BackgroundNarrative data about the patient experience of surgery can help healthcare professionals and administrators better understand the needs of patients and their families as well as provide a foundation for improvement of procedures, processes and services. However, units often lack a methodological framework to analyse these data empirically and derive key areas for improvement. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is aimed at improving the quality of surgical care by collecting patient data and reporting risk-adjusted surgical outcomes for each participant hospital in the programme. Though qualitative data about patient experience are captured as part of the NSQIP database, to date no framework or methodology has been proposed, or reported on, to analyse these data for the purposes of quality improvement. The goal of this study was to demonstrate the feasibility of using content analysis to empirically derive key areas for quality improvement from a sample of 3601 narrative comments about paediatric surgery from patients and families at British Columbia Children’s Hospital.Study designThematic content analysis conducted on a total of 3601 patient and family narratives received between 2011 and 2018.ResultsOverall satisfaction with care was high and experiences with healthcare providers at the hospital were positive. Areas for improvement were identified in the themes of health outcomes, communication and surgery timelines. Results informed follow-up interprofessional quality improvement initiatives.ConclusionsRecording and analysing patient experience data as part of validated quality improvement programmes such as ACS NSQIP can provide valuable and actionable information to improve quality of care.

Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis

ObjectivesThe Assessment of SpondyloArthritis International Society (ASAS) aimed to develop a set of quality standards (QS) to help improve the quality of healthcare provided to adult patients affected by axial...

IDENTIFYING CONSTRAINTS FOR HOSPITAL INFECTION CONTROL MANAGEMENT VIA MCKINSEY 7S FRAMEWORK IN PAKISTAN

Background: In Pakistan, structured guidelines for hospital infection control and prevention are deficient in most public sector facilities. There is dearth of literature available on management of hospital-care acquired infections and related issues. This study aims to understand infection control management as a proxy measure for quality of health care provided at a public sector tertiary care hospital in Karachi, Pakistan. In this study, we identify barriers to implementation of infection control measures and highlight key areas for quality improvement. Methods: A cross sectional study was carried out in 2008 using qualitative research methods. In-depth interviews were conducted with hospital staff belonging to three different management tiers. Results: There was lack of a centralized documented infection control policy, structure or management hierarchy in the hospital. The infection control mechanisms were managed at the individual ward level depending upon the interest of the individual Head of the Department. Lack of well-defined systems for human resource and financial management, resource allocation, documentation, communication, monitoring and evaluation for infection control further augmented the problem. Conclusion: Based on the results of this study, it is evident that quality infection control mechanisms must be organized and controlled at the hospital level not at the individual ward level. Human resource recruitment and training, budgetary allocation and designing of communication channels specific to infection control are needed at this tertiary care hospital. This is the first study to understand the management perspective for hospital infection control using 7S McKinsey framework of management in the largest tertiary care public sector hospital in Sindh.

Antimicrobial-related medication safety incidents: a regional retrospective study in West of Scotland hospitals

Medication-related incidents are an important consideration in enhancing patient safety in hospital care. The wide use of antimicrobial therapy in this population renders these medications particularly vulnerable to errors and adverse events. To analyse the characteristics of antimicrobial-related incident reports across a group of secondary care hospitals. Reports for antimicrobial-related incidents from April 2010 to December 2013 were obtained from a regional area of hospitals in National Health Service Scotland. Reports were analysed as a full set, and with subset analyses of incidents resulting in patient harm/injury and those included in a multi-variable regression adjusted by occupied bed-days and defined daily doses to better ascertain areas to target for antimicrobial safety. In total, 1345 incidents were reported at a crude rate of 0.98 reports/day [95% confidence interval (CI) 0.93-1.03 reports/day]. Penicillins (371 reports; 27.6%), aminoglycosides (358; 26.6%) and glycopeptides (210; 15.6%) were the most commonly involved classes of medications. Most incidents involved no injury/harm (514; 38.2%), but 72 reports (5.4%) did result in patient harm. The rehabilitation/assessment [relative rate (RR) 2.61, 95% CI 1.70-4.03] and women/childrens (RR 2.04, 95% CI 1.39-2.99) directorates had higher incident reporting rates compared with other directorates, likely as a function of at-risk patient populations. Among the types of incidents reported, those involving issues with administration/supply were most common (RR 2.07, 95% CI 1.51-2.84). Incident reporting for antimicrobials identified several key areas for quality improvement in the hospital setting, which can guide safety efforts.

P135 Using Current Practice Information to Identify Areas Of Variation

BackgroundQuality standards describe high-priority areas for quality improvement in a defined area.ObjectivesTo describe the processes by which areas for quality improvement are identified for quality standards.MethodsA topic overview, which describes...

Quality improvement in paediatric palliative care: multidisciplinary stage 1 service evaluation at a tertiary children's hospital

Aims A stakeholder survey was performed in order to evaluate practice against the Association for Children9s Palliative Care (ACT) Integrated Palliative Care Pathways Standards and provide a baseline for service development. Methods A multidisciplinary subcommittee of staff adapted the ACT Service Self Assessment Tool for use in an online survey of hospital professionals. Stakeholder inclusion criteria were defined by seniority, speciality and profession (n=104). Sixty questions evaluated how well current care provision meets ACT standards by scaled and free text responses. Anonymised data were analysed using SPSS Statistics v17.0, graphs prepared with Excel v8.0 and a thematic analysis of free-text responses was completed. Results Subgroup analysis by specialty shows both variation in response rate (table 1) and in percentage of caseload/time spent on palliative care (figure 1). Figure 2 summarises overall aspects of good practice and those in need of further development. Blue ovals in figures 3–5 highlight a selection of specific ACT Standards for improvement. Theme-based analysis reveals: (A) Strengths (1) Good experience and communication within/between professional groups. (2) PICU/NICU expertise in end-of-life care. (3) Holistic family-centred care/support and child-friendly environment. (4) Dedicated pain management and bereavement counselling services. (B) Challenges (1) Lack of shared definition/framework/structure for paediatric palliative care. (2) Poor linkage with community services: discharge planning/out of hours care. (3) Emotive communication: end-of-life discussions; debriefing after child9s death. (4) Barriers preventing families accessing timely spiritual/pastoral/psychological care. (5) Practical limitations: privacy/space on ward; accommodation; interpreters. (C) Wish list (1) Dedicated paediatric palliative care team: consultant-led with regional outreach. (2) Holistic palliative care education, training and supervision for staff. (3) Greater access to psychological support: same day/out of hours and for siblings. (4) Specific written guidance/information resources for staff, children and families. (5) Clearer pathways of care linking hospital and community services: hospices/respite. Conclusions This is the largest service evaluation of palliative care in a tertiary children9s hospital, using ACT9s Service Self Assessment Tool to highlight key areas for quality improvement. Senior multidisciplinary stakeholders have identified their strengths, challenges and necessary resources, processes and outcomes for service development. Stage 2 service user evaluation proposed: to explore children and families9 priorities.