Quality Assurance Of Health Services Research Articles

Situación actual y perspectiva de la metrología en el sector salud de la provincia Matanzas

La Metrología es importante en los procesos que se desarrollan en la atención médica, así como en la docencia y la investigación para elevar la calidad en los resultados de los servicios de salud. El objetivo de esta investigación es caracterizar la actividad de metrología en la provincia de Matanzas durante el período de enero del 2013 a septiembre del 2016 como parte de la garantía de la calidad en los servicios de salud. Para ello se realizó un estudio descriptivo retrospectivo donde se revisaron todos los informes semestrales y anuales de la actividad que realiza el departamento de investigaciones y envía al Ministerio de salud pública y la dirección provincial de salud. La selección y capacitación del personal permitió durante este periodo que la ejecución de la contratación del servicio de verificación y calibración por parte de las unidades tanto de atención primaria como secundaria esté al 100 %. La participación en los cursos no es elevada, debido a la estabilidad del personal en las unidades de salud municipales y hospitalarias. El desarrollo de la actividad permitió una mejor preparación de los profesionales y técnicos vinculados a la tecnología biomédica. Además de cumplir con la estrategia del Ministerio de Salud Pública a fin de garantizar el uso correcto de los instrumentos de medición, la exactitud de las mediciones y resalta la importancia que tiene la metrología en los equipos biomédicos, y como este impacta en las actividades orientadas a la confiablidad de los resultados.

Assessment of patient satisfaction of certified and non-certified private dental clinics in Athens

Background: In recent years, the issue of quality assurance in health services has emerged in the forefront, with strong research and practical interest. In addition, there is a number of changes to health service users who nowadays have higher expectations of satisfaction, efficiency and quality of health services.Aim: The aim of the present study is to assess the satisfaction of patients and, by extension, the quality of the services provided both in certified and non-certified private dental practices in Athens, to highlight the difference in the services provided and the areas in which it appears.Methods: This is a quantitative study of dental patients’ satisfaction in Athens using an anonymous and self-completed questionnaire. The aggregate sample collected is 317 patients within three months of the questionnaire being shared. In particular, the sample for certified dental places was 176 patients, while the sample of non-certified dental places was 141 patients. For the statistical analysis, the SPSS program for Windows version 25 was used, and the tables were created with Microsoft Excel 2010 based on the SPSS analysis data.Results: The results showed differences between the social level of patients, the permanent residence of the participants as well as differences in the reason for choice and visit to each dental place, while on the questions about the satisfaction of the services the differences were little. The questions with the most shared responses were those in the financial basis. Correlation coefficients did not show any statistically significant relationship between demographic characteristics and satisfaction, with the exception of the level of education of patients in certified dental clinics.Conclusions: Although the results of the research showed little differences in the satisfaction of the patients between certified and non-certified dental clinics, these results are quite limited due to the small number of certified dental clinics in Greece. Further research is needed to produce safer conclusions.

Pengembangan Sistem Informasi Pemantauan Alat Kesehatan Untuk Mendukung Penjaminan Mutu Pelayanan Kesehatan Di Balai Kesehatan Indera Masyarakat (BKIM) Provinsi Jawa Tengah

An information system of monitoring health equipment at Balai Kesehatan Indera Masyarakat (BKIM) in Province of Central Java was very simple. The available system had not resulted complete, accurate, and well-timed information in accordance with the needs of management to monitor health equipment in all health service rooms. The aim of this study was to develop an information system of monitoring health equipment to support quality assurance of health services at BKIM in the Province of Central Java. This was a qualitative-quantitative study using Pre-Experimental design with one group pretest-posttest approach. Data were collected using methods of observation and interview. Furthermore, qualitative data were analysed using content analysis whereas quantitative data were presented descriptively using a balanced average value. The result of this study showed that a balanced average value before developing the system was 37.73 and after developing the system was 78.90 with the difference equal to 41.17. There needs commitment and support from the head of BKIM in Central Java Province. Implementation of the developed system needs to be continually monitored. Socialisation and training needs to be conducted for all employees who have main tasks and functions relating to health equipment. In addition, budget for operational costs and system maintenance needs to be allocated.

How do rural consumers contribute to quality assurance of health services?

To investigate the reasons for complaint or non-complaint by rural consumers of health services. Qualitative study using focus group discussion of hypothetical scenarios. Selected rural communities in the Loddon-Mallee region of north-western Victoria. Sixty volunteer participants in eight focus groups recruited through advertising. Issues and themes concerning circumstances leading to, and factors inhibiting, complaints about a health service and awareness of complaints mechanisms. Compared with residents of larger towns, those of small communities were more likely to report they would complain to the local provider, whereas those in larger towns were more likely to mention Hospital Boards or the Commissioner. Deterrents to making complaints included the lack of services, scepticism about the role of complaints in bringing about change and an attitude that it was more appropriate to try to fix the problem than complain about it. Lack of awareness of appropriate complaint mechanisms which feed into quality assurance processes was also identified. Previously documented lower complaint rates from rural consumers can not be taken to mean greater satisfaction with health services.

Testing clinical audit of emergency obstetric care in Ghana and Jamaica

One of the key contributors to the high rate of maternal mortality in developing countries is poor quality emergency obstetric care at referral level. In developed countries criterion-based clinical audit (CBCA) is now routinely used as part of quality assurance in health services. The audit team members who are not medically qualified screen medical records in order to determine whether the care received meets these criteria. The audit team and hospital staff then identify and implement actions to improve practice as required. In order to assess the feasibility and effectiveness of CBCA at district hospital level a study was conducted in two hospitals in Ghana and two in Jamaica. The types of obstetric complications chosen for audit were based on their life-threatening nature unambiguous definition and ability to be identified from hospital registers and patient records. They included obstetric hemorrhage eclampsia uterine rupture obstructed labor and sepsis. After devising working definitions for these conditions using best practice from relevant literature an assessment was made of baseline practice. Meetings were then held with hospital staff to encourage them to identify any poor quality management of the five life-threatening complications and how to improve including the setting of realistic targets for improvement. After 12 months of the action plan a second round of assessments using CBCA was conducted at the hospitals. Overall significant improvements were detected in the management of obstetric hemorrhage eclampsia and genital tract sepsis. Although there was some improvement in care for the other two complications the change was not statistically significant. Evidence of a continuing commitment to improving the quality of care at the four participating hospitals was reflected in the intention of staff to repeat the audit cycle until their targets were met and expand the process to other specialisms. (full text)

Best practice in emergency care

An entire edition of the Australian Health Review was recently devoted to Best Practice in the health care sector. The Editor Roy Green observes: “the ‘new competition’ is based on high-quality products and services which are designed and delivered to meet diverse and constantly changing customer requirements.” The managers of health services are being confronted with a whole range of new terms: Best Practice, Bench-marking, Workplace Reform and Enterprise Bargaining to add to the now almost historical Total Quality Management, Continuous Quality Improvement and Quality Assurance. Making sense of all this is the real challenge for health service management in the 1990s. The proponents of each new phrase or concept will sell it with a missionary zeal. They seem to have the innate ability to ensure that we mere mortals, charged with the responsibility of providing health services feel a real sense of inadequacy. We must be absolutely stupid not to be fully aware of the latest fashion. I am conscious of this feeling of ignorance when confronted with the other great mysteries of life - the Hare Clark electoral system, and how to operate a Fax machine. However, I have a feeling that the buzz words are only disguising a concept which is familiar and well trusted by health care professionals. Bench-marking describes the process of modelling your activities, both processes and outcomes, on other successful organisations. Best practice simply describes a comparison with the best available. In many respects, bench-marking is an admission that the evaluation of an organisation's performance is not necessarily straightforward. Were we in the business of making toothpicks, then ensuring quality would be relatively easy. Are they sharp? Do they break when inserted into the cheese? etc etc. Defining the quality of our product is much more difficult. Mortality, morbidity, satisfaction have all been used to try to determine if the quality of our services are consistent with best practice. How can we compare the treatment of heart attacks in Sydney with stonefish stings in Cairns? The complexity of our product and the lack of meaningful performance indicators makes such comparisons difficult. Historically, quality assurance in health services has been limited to ensuring the quality of inputs. Are practitioners trained appropriately? Are we using the best quality equipment available? More recently, supervision, audit and review, have broadened the quality assurance approach. At the individual patient level these combined approaches help to improve the quality of care. However, the organisational and management structures which enable individual practitioners to perform their tasks also need to be clearly defined and evaluated and the performance compared. Such measures focus on the providers view of what is required. What about the patient or customer? Are they satisfied with the service provided? Does our service meet their needs? Are our services properly addressing the needs of the community we serve? How many seriously ill patients are deterred from attending emergency departments by our failure to provide for their quality of service needs as well as quality of care? There is extensive literature on inappropriate attendance at emergency departments. Who defined ‘inappropriate attendance’? How are our services viewed by the patients and customers we serve? Do our services provide comfort and compassion as well as clinical accuracy? Are the patients' relatives looked after? Do we extend our services to meet the patients other needs such as medical retrieval and interhospital transfer? Perhaps we should ask our patients and clients what they think of our service? What bench-marking involves is the comparison of our performance with that of other organisations. Bench-marking should not be restricted to comparisons with other emergency departments. What can we learn by comparison with other providers of services or products? Do hairdressers talk about ‘inappropriate attendance’? “You don't need your haircut now. Go away!” What can we learn about emergency health services from pizza delivery or banks? Are we meeting the needs of clients who are not patients? Police request information and assistance. Communities seek help in disaster preparedness. Hospital administrators need to marshal their resources to meet their client needs. Bench-marking and best practice are concepts well suited to health care in general and emergency health care in particular. They are concepts which counter the simplistic cost cutting of the economic rationalists, with professional standards which recognise ‘best clinical practice’. The challenge for us is to ensure that all services we provide are appropriate to the needs of our patients and other clients of our services, and are consistent with the best practice available.

WHO'S PROGRAMME IN QUALITY ASSURANCE

While WHO headquarters have a long tradition in quality assurance in specific areas such as clinical laboratories and radiology, quality assurance of personal health services was not introduced until the beginning of the 1980s by the WHO Regional Office for Europe. This paper describes the rationale, components, objectives and activities of the WHO programme entitled "Model health care programmes and quality assurance of health services" from 1983 to 1988. The last section of the paper looks at the signs of success, i.e. changes on the quality assurance scene in Europe that may have resulted from WHO's work. As no other major international organization was interested in the quality of care, WHO focused on two qualitative aspects: the appropriate combination of services in the care of patients with a given health problem (model health care programmes) and the quality of service (quality assurance). The programme sets objectives for both Member States and WHO: Member States are expected to establish policies and mechanisms for systematic quality assurance, WHO to clarify and promote the concept and develop methods and models as well as train health professionals. Publications, working groups, training courses and international cooperation have aimed at reaching these objectives. The possible signs of success include changing attitudes, emergence of a critical mass of health professionals interested in quality assurance and laws on, and national plans including, quality assurance.

WHO's European member states look at quality assurance. Report on the technical discussions at the thirty-eighth session of the Regional Committee for Europe.

This paper is the report on the technical discussions on "Quality assurance of health services" at the 38th session of the WHO Regional Committee for Europe, one of the activities aiming at achieving WHO's regional health for all target 31, which requests WHO's Member States to establish a quality assurance mechanism. Attended by national health authorities and experts in quality assurance, the technical discussions identified the European context for developing quality assurance and looked at national initiatives. Having agreed that the question is no more, "Is there a need for quality assurance of health services?" but, "How can it best be carried out?", the participants identified a range of quality assurance activities at national and international levels, including national strategies and financial incentives, criteria for clinical practice, information systems and coordination and management mechanisms. The report concludes with recommendations for Member States on, for example, inclusion of quality assurance in national health policies, dissemination of information, research on quality assurance, information systems and role of professional organizations.

ISSUES IN QUALITY ASSURANCE--THE EUROPEAN SCENE

Originally written as a background document for the technical discussion on quality assurance of health services in connection with the 38th session of the WHO Regional Committee for Europe, the paper discusses issues and current trends in quality assurance primarily from the point of view of a health authority. The paper begins with an analysis of factors such as the discovery of an unexpectedly large variation in the quality of care, the increasing complexity of care, augmenting costs and changes in the medical labour market that have increased the interest of health authorities in quality assurance. The next section describes the concepts of quality and quality assurance, and highlights such current trends as broadening of the scope of quality assurance to include outcomes, patient satisfaction and services provided for by other personnel than physicians, and increasing emphasis on the outcome of care. After a discussion of methods used in quality assurance, the paper turns to measures that can be introduced, on the one hand, at the provider and patient levels and, on the other hand, at the institutional level to improve the quality of care. By posing questions to the health authorities on the concept of quality, methods of quality assurance and division of labour in introducing quality assurance, the last section asks, "What does quality assurance mean in Europe?".