Quality Agenda Research Articles

Reclaiming user leadership in peer support practice

Purpose – The purpose of this paper is to explore user leadership in peer support practice by reviewing existing evidence and models of delivery, investigating the recently developed term of “authentic” peer support and reflecting on challenges and opportunities for the future. Design/methodology/approach – The paper presents and discusses views and evidence on peer support policy and practice, found in the current literature, grass roots peer support experts’ presentations and contributions to conferences, a national peer support network, key policy documents and the work of Together for Mental Wellbeing. Findings – Peer support benefits are widely documented as is its history, rooted in user leadership. More recently, peer support is acknowledged in a number of key mental health policy documents as seen to be key in the response to current quality and cost agendas. There has been a simultaneous increase of “formal” peer support as practiced by large service providers and a gradual shift away from its “user led” origins. Against the background of the current economic climate and implications for mental health services, there seems to be a need to pause and reflect on current peer support practice and rethink the way forward. Originality/value – This paper's emphasis on the authenticity of peer support covers new ground in relation to an important topical debate.

Communicating for Quality in School Age Care Services

SCHOOL AGE CARE (SAC) services have existed in Australia for over 100 years but they have tended to take a back seat when compared with provision for school-aged children and those under school age using early childhood education and care (ECEC) services. Many SAC services are housed in shared premises and many children attending preparatory or preschool use SAC. Reforms introduced by the Australian Government have included a National Quality Standard for school age care (COAG, 2009b). Like the National Quality Standard for early childhood education and care settings (COAG, 2009b), this quality agenda has prompted a greater focus on the ability of services to provide environments that support the wellbeing and development of school age children and meet the quality standards. SAC is one of the fastest growing ECEC services provided for children and families (DEEWR, 2013). This article makes the case that skilful communication is needed among stakeholders in early education and care settings, schools and SAC in order to provide high-quality services.

Work–life balance – work intensification and job insecurity as job stressors

What does it mean to have good work–life balance? Public debate has grown around the importance of work–life balance in contributing to quality of life, yet the debate remains quite narrowly conceived. In particular, ‘work’ is conceived as negative, especially long hours, and ‘life’ is centred around (typically women’s) caring responsibilities, especially childcare. However, a number of studies have challenged these dichotomies and suggested that work–life balance is influenced by other variables. Using Australia at Work survey data on over 4000 individuals, this study considers the factors that determine satisfaction with work–life balance. An ordered probit framework is used to take advantage of a data set that is rich in variables capturing objective and subjective measures of the labour contract and workplace characteristics. The results show that while long hours and caring responsibilities do indeed affect work–life balance outcomes, the presence of job insecurity and work intensification have measurably larger effects. The implications of the analysis are that wider interpretations of work–life balance are needed, which move beyond seeing work–life balance as an issue only of relevance to women with childcaring responsibilities and focus on a broader job quality agenda.

Lost in translation? ‘Evidence’ and the articulation of institutional logics in integrated care pathways: from positive to negative boundary object?

This article examines the translation of a clinical governance concept - integrated care pathways (ICPs)--into an infrastructural technology. Building on previous work, the application of boundary object theory is extended in this article to argue that stakeholder enrolment in pathway methodology may be less thoroughgoing than originally assumed. Pathways have effectively aligned management and nursing interests around a quality agenda and nurses have emerged as the leaders in this field, but doctors have rather lower levels of engagement. It is suggested that the contradictory logics inherent in pathway philosophy (primarily as these relate to 'evidence') and the social organisation of ICP development foster a transformation of the concept when this is translated into the technology, creating a negative boundary object from the perspective of doctors. Medicine is a powerful actor in health care, which is consequential for whether pathways, as designated boundary objects, become boundary objects-in-use. It also has implications for the diffusion of the concept as a mechanism of clinical governance and the credibility of nurses as emergent leaders in this field. Qualitative case studies of ICP development processes undertaken in the UK National Health Service and ethnographic research on the ICP community provide the empirical foundations for the analysis.

Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas

Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas

The Development of a New Master’s of Science in Healthcare Quality Program

With a goal to advance the healthcare quality agenda and in response to an identified need within both the educational and healthcare sector, Queen’s University established a Master’s degree in Healthcare Quality. The unique interdisciplinary Master of Science in Healthcare Quality program offers a mix of both theoretical and practical underpinnings. This program has been built on solid educational pedagogy and offers both synchronous and asynchronous delivery via a distance learning platform and three face to face encounters. Further, this program will offer Canadian and international perspectives on quality, risk, and safety in healthcare.

Improving the efficiency of a hospital pharmacy service: the journey of one hospital pharmacy

ObjectivesThis article describes key changes made within one hospital pharmacy department in the UK during on-going work to improve services and meet the aims of the National Health Service (NHS)...

The Casual Approach to Teacher Education: What Effect Does Casualisation Have for Australian University Teaching?

Abstract: Universities in many countries are struggling to adapt to the competing forces of globalisation, new managerialism, entrepreneurialism and new technologies and quality agenda demands. Diminishing resources caused by restricted funding and an aging and diminishing academic workforce pose barriers. One solution to staffing shortages is the casualisation of academic teachers increasing causal or sessional teaching staff who take on significantly increased teaching responsibilities. This article explores the casualisation of university academics and reports on preliminary findings of a small scale sessional teacher development program that used data from a questionnaire on demographics of a small group of 22 sessional teaching staff employed at an Australian university. Results indicated that sessional staff believed they were effective university teachers yet their ongoing development was hampered by heavy teaching workloads, other employment and lack of time. The article concludes that universities, to provide quality outcomes for students, must address these factors.

Anesthesia Quality and Safety

Anesthesia Quality and Safety

An Overview of the National Quality Strategy: Where Do Nurses Fit?

The definition of quality healthcare, its accurate measurement, and its effective management is nebulous and constantly evolving. Even the most respected and knowledgeable experts cannot come to consensus on exactly what quality means. Levels of measurement, as well as questions of whom, how, and when to measure are topics of continual deliberation. These discussions occur at multiple levels through councils, committees, workgroups, task forces, and expert panels. Many policy-related decisions these groups make affect nurses and nursing care. All of them affect how patients receive or engage in healthcare. This article discusses the National Quality Strategy by offering a description and history of the quality conversation, including federal advisory committees and quality measurement data standards. There are several gaps in the quality conversation to which nurses could contribute valuable insights. The authors describe ways that nurses can engage in the national quality agenda. The article concludes with a call to action to encourage nurses to take a larger role in driving the National Quality Strategy.

Applying the Triple Aim to the Quality Agenda for Anticoagulation Care

The Institute for Healthcare Improvement's Triple Aim Framework has been gaining ground since its launch in 2008 as an innovative vision for health system reform. The framework articulates a set of goals in which health system costs and healthcare quality must be balanced against the needs of the

Medical Specialty Society–Sponsored Data Registries

Clinical data registries are commonly used worldwide and are implemented for a variety of purposes ranging from physician or facility clinic logs for tracking patients, to collecting outcomes data, to measuring quality improvement or safety of medical devices. In the United States, the U.S. Food and Drug Administration has used data collected through registries to facilitate the drug and device regulatory process, for ongoing surveillance during the product life cycle, and for disease appraisals. Furthermore, the Centers for Medicare and Medicaid Services, in certain instances, bases registry participation and submitting data to registries as factors for reimbursement decisions. The purpose of this article is to discuss the use of clinical data registries; the role that medical specialty societies, in particular, the American Society of Plastic Surgeons and The Plastic Surgery Foundation, can have in the development and management of registries; and the opportunities for registry use in plastic surgery. As outcomes data are becoming essential measures of quality health care delivery, participation in registry development and centralized data collection has become a critical task for plastic surgery to engage in to proactively participate in the national quality and performance measurement agenda.

How a targeted reduction in spend on wound care dressings was achieved without compromising quality of care and outcomes?

It was the aim of this study to investigate whether targeted wound dressings education and training could deliver the objectives of the quality, innovation productivity and prevention (QIPP) agenda, compared to simply having a strictly controlled products list. The programme, which was aimed at 3500 community nurses, covering a population of 1.2m treating in the region of around 45,000 wounds per year, included targeted correct usage of products education and training within policy guidelines. In 2009 the spend on dressings was estimated to be around £5m, equated to about 18% of the total spend on wound care. It showed that product usage education and training could be used to deliver productivity objectives. A programme of education and training delivered locally showed that it is an efficient and effective way of ensuring that not only productivity is improved but also quality of wound management is further enhanced. However, it is essential that arrangements to deliver change in behaviour are well thought-out and clearly communicated to achieve maximum engagement to minimise resistance. In conclusion, the project has succeeded to deliver a reduction in the spend on dressings without compromising quality. Furthermore, there is evidence of growing awareness among product user to ensure that quality outcomes are achievable by correct usage of products which in turn can only be achieved through product usage education and training. Indication management and case management are an integral part of the process and require special training.

PTH-076 University Hospital Southampton IBD Portal Pilot– An Innovative it Tool to Promote Patient Self-Care

IntroductionChronic disease management represents a big challenge to the NHS. The IBD standards specify the use of IT to support patient care and to optimise clinical management through data collection...

The assessment and management of falls in residential care settings

Care of the older person has become more specialised in Ireland particularly since the introduction of national and international healthcare standards. In this regard, older people are receiving more evidence-based quality care when living in long-term healthcare facilities in Ireland. Assessment and management of falls is currently high on the quality agenda in terms of measuring quality outcomes. Clinical practice is being standardised using evidence-based practice and research. Residential care nurses caring for older people in Ireland are required to demonstrate clinical competence when assessing and managing falls in the residential care setting. Healthcare legislation, policy and in-service education, occurring in both the public and private sector, require a multidisciplinary-team approach. This article addresses the nursing priorities regarding falls assessment and management strategies that residential nurses should consider when caring for the older person at risk of falling.

Patient safety management in the health services- what do patients want?

Patient safety management in the health services- what do patients want?

What is clinical leadership and why might it be important in dentistry?

The concept of leadership means different things to different people. At present there is no single definition of leadership nor an established theoretical approach. Despite this, leadership in the clinical environment is becoming increasingly cited as an important component in the transition of the National Health Service (NHS) and in the development of clinician led services. In medicine, clinical commissioning groups (CCGs) will soon be operational and the Department of Health (DH) seeks to establish a similar approach in dentistry, where local clinicians drive forward a quality agenda with a focus on patient outcomes. To facilitate this, the NHS Commissioning Board (NHSCB) are in the process of developing Local Professional Networks (LPNs) for dentistry. Given this shift towards localism and clinician led services it would appear that leadership will have a significant role in both medicine and dentistry. This paper explores what leadership is, before determining why it might be important in providing a clinician-led, patient-based and outcomes-focused service.

Moving the Discourse on Quality in Pediatrics: Recent Contributions of Robert Wood Johnson Foundation Clinical Scholars

* Abbreviations: RWJF — : Robert Wood Johnson Foundation UCLA — : University of California, Los Angeles This issue links together a broad construct (quality) in a defined population (children) with alumni from a specific training program. In so doing, it is both a celebration and a challenge. The supplement celebrates the contributions of Robert Wood Johnson Foundation (RWJF) Clinical Scholars to the national discourse regarding the measurement and improvement of quality; it acknowledges the increasing prominence of child health work as part of the national quality agenda and the hope for filling the many gaps regarding our understanding of how to measure and improve children’s health care. Children’s health care quality has become a major part on the research agenda of pediatric participants in the RWJF Clinical Scholars Program. Alumni of this program have in turn nurtured additional health services research and quality fellowships at other institutions and have helped build this area of inquiry in pediatrics. The Clinical Scholars Program marks its 40th anniversary this year. This is a remarkable milestone of sustained support for any US philanthropy but even more so when the outlines of the history of the RWJF are filled in. As the story goes, in the late 1960s, physicians from a handful of prominent institutions were gathered (whether it was in a bar was not recorded) after a national meeting and chatting with leaders of The Commonwealth Fund and the Carnegie Corporation about the need for advanced training in the nonbiological sciences to create a career development path for clinicians who were intellectually inclined and humanistic but not inclined to laboratory training. Out of this conversation came an invitation to submit a proposal; that proposal evolved into a postresidency academic fellowship in the nonbiological sciences that would be national in scope and local in character. It was first funded in 1969 and built on institutional strengths (at Johns Hopkins University, University … Address correspondence to Lawrence C. Kleinman, MD, MPH, Department of Health Evidence and Policy, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1077, New York, NY 10029. E-mail: lawrence.kleinman{at}mountsinai.org

3 Quality of life: patient safety and satisfaction

The UK has an ageing population with the fastest population increase being in those individuals aged 85 years and over; by 2035, it is projected that the number of people aged 85 years and over will reach 3.5 million. With the increasing population, we can assume that the number of acute, chronic and infected wounds will also increase. The Department of Health has been clear that patients should be kept at the heart of everything we do and as such, should be actively involved in the decision-making process relating to their care plans. It is vital that all practitioners are aware of the quality agenda and how to successfully engage patients in the decision-making process that will ultimately improve patient wellbeing.

Leadership, a Central Ingredient for a Successful Quality Agenda: A Qualitative Study of Canadian Leaders' Perspectives

Leadership, a Central Ingredient for a Successful Quality Agenda: A Qualitative Study of Canadian Leaders' Perspectives