Quality Assurance Initiatives Research Articles

Systematically evaluating the effectiveness of quality assurance programmes in leading to improvements in institutional performance

Higher education institutions worldwide invest significant resources in their quality assurance systems. Little empirical evidence exists that demonstrates the effectiveness (or otherwise) of these systems. Methodological approaches for determining effectiveness are also underdeveloped. Self-study-with-peer-review is a widely used model for ensuring the quality of the core teaching, research and engagement activities of higher education institutions. This article illustrates how an established social-programme evaluation methodology can be used to determine its effectiveness in leading to improvements in institutional performance. The concept of effectiveness and the particular challenges posed by the higher education organisational culture are considered. An example of the systematic evaluation of three self-study programmes is provided to illustrate the concept. It is concluded that social-programme evaluation has significant potential in evaluating the effectiveness of quality assurance initiatives in higher education.

The PACE Program: Home-Based Long-Term Care

Programs of All-Inclusive Care for the Elderly (PACE) provide comprehensive care within the framework of a medical home model for the frail elderly living in the community. Participants must be at least 55 years of age, qualify for nursing facility level of care, and reside safely in the community at the time of enrollment. Often referred to as "nursing homes without walls," PACE programs provide all services covered by Medicare and Medicaid including primary care, medical specialties, adult day health centers, home care, prescription and over-the-counter medications, social work, dietitians, and any other service deemed necessary by the interdisciplinary team. PACE programs offer a multitude of opportunities for pharmacists who specialize in geriatrics, including medication reviews, medication therapy management, therapeutic drug monitoring, fall prevention, quality assurance initiatives, chronic disease management, anticoagulation services, drug information resources, education and inservice programs, medication dispensing and distribution, drug utilization reviews, infection control, and many other services. Senior care pharmacists are uniquely qualified to promote their services to PACE programs and provide quality care to both the interdisciplinary team and participants of the program.

Microchip implants' logistical efficiencies and ethical issues

With businesses striving for better methods and government agencies looking to improve public security, RFID-related technologies have the ability to supply more information than the standard barcode, eliminating the potential for inventory stockouts and reducing theft occurrences. These relationships were empirically investigated through a survey of working professionals and it was found that there was at least some support for companies' initiatives based on RFID-related technologies that allow for improved corporate-level quality assurance initiatives, reduced logistical costs and improved accountability through package and product tracking, as also the use of governmental applications to improve the quality of public services for the general population, based on such stakeholders' personal perceptions of the usefulness and ethical issues associated with microchip implants. However, though on the cutting edge of business technologies, such applications and initiatives still prove to be difficult processes to implement and achieve, despite recent managerial efforts and technological innovations.

601: Cost benefit analysis of additional doses of antibiotic prophylaxis at the time of ceserean delivery

Recent studies have demonstrated that one dose of broad spectrum antibiotics given within 60 minutes of skin incision at the time of a cesarean delivery (CD) decreases maternal infectious morbidity. As part of ongoing quality assurance initiatives at our institution, antibiotic usage at the time of CD was reviewed. We found that patients from one provider were receiving an additional 24 hours of postoperative antibiotics. Hence, our objective is to determine if the additional 24 hours of postoperative antibiotics would further decrease the rate of surgical site infections.

From systematic review to quality standards and clinical reality: Inpatient treatment of anorexia nervosa

This paper considers how audits and service evaluations could incorporate recent developments such as quality assurance initiatives to assist multi-disciplinary teams to reflect on and improve practice in the treatment of anorexia nervosa.

Safety in Radiation Oncology: The Role of International Initiatives by the International Atomic Energy Agency

The International Atomic Energy Agency (IAEA) has a wide range of initiatives that address the issue of safety. Quality assurance initiatives and comprehensive audits of radiotherapy services, such as the Quality Assurance Team for Radiation Oncology, are available through the IAEA. Furthermore, the experience of the IAEA in thermoluminescence dosimetric audits has been transferred to the national level in various countries and has contributed to improvements in the quality and safety of radiotherapy. The IAEA is also involved in the development of a safety reporting and analysis system (Safety in Radiation Oncology). In addition, IAEA publications describe and analyze factors contributing to safety-related incidents around the world. The lack of sufficient trained, qualified staff members is addressed through IAEA programs. Initiatives include national, regional, and interregional technical cooperation projects, educational workshops, and fellowship training for radiation oncology professionals, as well as technical assistance in developing and initiating local radiation therapy, safety education, and training programs. The agency is also active in developing staffing guidelines and encourages advanced planning at a national level, aided by information collection systems such as the Directory of Radiotherapy Centers and technical cooperation project personnel planning, to prevent shortages of staff. The IAEA also promotes the safe procurement of equipment for radiation therapy centers within a comprehensive technical cooperation program that includes clinical, medical physics, and radiation safety aspects and review of local infrastructure (room layout, shielding, utilities, and radiation safety), the availability of qualified staff members (radiation oncologists, medical physicists, and radiation technologists and therapists), as well as relevant imaging, treatment planning, dosimetry, and quality control items. The IAEA has taken the lead in developing a comprehensive program that addresses all of these areas of concern and is actively contributing to the national and international efforts to make radiation therapy safer in all settings, including resource-limited settings.

Overview of the quality assurance movement in health care

This chapter aims to describe the origin and current status of quality assurance (QA) in health care and to provide a background of similar developments in other industries, which have provided a major impetus for QA initiatives in health care. The interest in quality and safety in the health care sector has rapidly risen over the past decade. Without important lessons learnt from other industries, the interest and obtained improvements would have been far less fast. Knowledge on basic principles and challenges faced by other industries like the airline, car, and nuclear energy industry, that drove quality improvement projects, is of major relevance to understand the evolutions taking place in health care. To fully appreciate the QA movement, and design or implement quality improvement projects, its basic principles need to be understood. This chapter aims to give insights in basic principles underlying QA, and to discuss historical lessons that have been learnt from other industries. Furthermore, it discusses how to implement and assure a sustainable QA program.

Effects of Benefits and Harms on Older Persons' Willingness to Take Medication for Primary Cardiovascular Prevention

Quality-assurance initiatives encourage adherence to evidenced-based guidelines based on a consideration of treatment benefit. We examined older persons' willingness to take medication for primary cardiovascular disease prevention according to benefits and harms. In-person interviews were performed with 356 community-living older persons. Participants were asked about their willingness to take medication for primary prevention of myocardial infarction (MI) with varying benefits in terms of absolute 5-year risk reduction and varying harms in terms of type and severity of adverse effects. Most (88%) would take medication, providing an absolute benefit of 6 fewer persons with MI out of 100, approximating the average risk reduction of currently available medications. Of participants who would not take it, 17% changed their preference if the absolute benefit was increased to 10 fewer persons with MI, and, of participants who would take it, 82% remained willing if the absolute benefit was decreased to 3 fewer persons with MI. In contrast, large proportions (48%-69%) were unwilling or uncertain about taking medication with average benefit causing mild fatigue, nausea, or fuzzy thinking, and only 3% would take medication with adverse effects severe enough to affect functioning. Older persons' willingness to take medication for primary cardiovascular disease prevention is relatively insensitive to its benefit but highly sensitive to its adverse effects. These results suggest that clinical guidelines and decisions about prescribing these medications to older persons need to place emphasis on both benefits and harms.

The catheterization laboratory and interventional vascular suite of the future: Anticipating innovations in design and function

The catheterization laboratory and interventional vascular suite of the future: Anticipating innovations in design and function

Fidelity to clinical guidelines using a care pathway in the treatment of first episode psychosis

To evaluate the implementation of clinical practice guidelines in the initial stages of treatment of first episode psychosis, through use of a care pathway within one area mental health service. A fidelity audit was undertaken using data from local Early Psychosis Care Pathway documents, completed for the cohort of clients with early psychosis seen in the first 2 years of an integrated early psychosis programme model, at St Vincent's Mental Health Service, Melbourne, Australia. The utilisation of a care pathway greatly supported both the documentation of clinical process and fidelity to clinical guidelines in early psychosis treatment. Excellent adherence (over 80%) was achieved for therapeutic alliance with the client, conducting a comprehensive bio-psychosocial assessment, medical investigations, reduction of client trauma and increased orientation to the service and the mental health systems of care, and for contact with family. Good adherence (over 70%) was achieved for client re-integration to the community and promotion of carer well-being; the service plans to focus on these areas in future service improvement initiatives, along with a focus on physical health assessment and enhancing primary care liaison. The process of formally operationalizing and implementing clinical guidelines utilizing a care pathway within an area mental health service has proved to be an effective way to ensure fidelity with standard agency practices and protocols. The integrated approach, supported by quality assurance initiatives, provides an excellent goodness-of-fit within an established area mental health service.

Neurology residency training in Europe - the current situation

Little is known about neurological training curricula in Europe. A joint approach by the European Federation of Neurological Societies (EFNS), the Union of European Medical Specialists/European Board of Neurology and the European Association of Young Neurologist and Trainees was established to explore the spectrum of neurology training in Europe. In 2006, a questionnaire-based survey on neurology curricula as well as demographic data was designed by WS and WG and distributed by the EFNS to the national delegates of the EFNS, which comprises all European countries and Israel. By 2009, delegates from 31 of 41 countries (representing 76% of 505 million) had returned the questionnaire. A total of 24,165 specialists (46% women) were registered in the 31 countries. This corresponds to an average of 6.6 neurologists per 100,000 inhabitants (range 0.9-17.4/100,000 inhabitants). Duration of training in Europe was on average 4.9,years, ranging from 3 to 6,years. The number of residents interested in neurological training exceeded the amount of available training positions. Performance of neurological trainees was regularly assessed in 26 countries (84%), usually by recurrent clinical evaluation. Board examinations were held in 23 countries (74%). Interim examinations were performed in three countries, exit examinations in 14 and both interim and exit examination in 6. Considerable differences were also found in manpower (0.9-17.4 neurologists/100,000 inhabitants) and working conditions (e.g. average weekly working hours ranging from 30-80 h/month). We found a significant positive correlation between manpower and theoretical training hours. Considerable differences exist in training curricula of European countries. These data might provide the basis for European training and quality assurance initiatives.

Quality and Quality Assurance in Vocational Education and Training in the Mediterranean Countries: lessons from the European approach

This article reflects on the development of the European approach towards quality and quality assurance in vocational education and training (VET) and its relevance for VET reforms in the European Training Foundation (ETF) partner countries. The analysis is based on an ETF project conducted in 2007‐2008 in the Mediterranean partner countries to promote exchanges of information and experience between the decision makers and experts of the countries concerned and within the EU. More precisely, it aims to analyse how quality assurance (QA) initiatives could promote the quality of systems and support best practices already established in the EU and in the Mediterranean region in order to lay the foundations for specific actions at national and regional level.The authors of the article found out that: the tools developed by the EU to quality assure VET systems are relevant for the Mediterranean region. They can serve as a guideline for identifying strategic priorities. However, they do not provide a well‐delimited concept to be implemented in the short term. Moreover, these EU tools reflect a new model of governance based on decentralization of responsibilities, autonomy of providers and accountability that may be difficult to implement in Mediterranean countries where VET systems remain very centralised and compartimentalised.

S1403: Assessment of Colonoscopy Reporting in a Multicenter Study Using the ASGE Quality Assurance Task Force Guidelines

To adopt continuous quality assurance (QA) initiatives for colonoscopy, it is important to identify quality indicators concerning technical performance which can be monitored in clinical practice. Quality of colonoscopy cannot be measured or improved if data are not properly captured and recorded. The ASGE therefore defined quality indicators for colonoscopy reporting. The aim of this study was to assess to what extent these indicators were reported in daily practice.

The strategic concerns of quality assurance: case studies of large reputable firms in the service sector

Following the Resource-Based View (RBV) of the firm, certain tactical and strategic resources are harder to imitate than others, such as those containing the characteristics of physical uniqueness, path dependence, causal ambiguity and economic deterrence. Creating a strong and recognisable reputation occurs when a client seeks out services primarily based on the success of its quality assurance initiatives. Four service industry organisations were studied by their quality goals, ability to do customised workflow design and implementation and strategically leverage quality assurance techniques and how these organisations can improve its reputation, image and incentives towards achieving superior quality. The four studied organisations are IKON Office Solutions, Inc., Ayco Company, L.P., Highmark, Inc. and Reed Smith, LLP. A brief introduction to their general operating environment is followed by sections describing their general situation and quality-service initiatives and a fairly detailed discussion of the practical applications of the lessons learned from the case studies.

Confronting and resolving an ethical dilemma associated with a practice based evaluation using observational methodology of health information technology.

As the adoption of health information technology (HIT) has escalated, efforts to evaluate its uptake have increased. The evaluation of HIT often requires direct observation of health care practitioners interacting with the system. When in the field, the evaluator who is not a trained health care provider may observe suboptimal use of the technology. If evaluators have plans to share the results of the evaluation at the conclusion of the study, they face a decision point about whether to disclose interim results and the implications of doing so. To provide HIT evaluators with guidance about what issues to weigh when observing the implementation of HIT, this paper presents a study of an actual case and discusses the following considerations: (1) whether the evaluation of HIT is considered to be human subject research; (2) if the evaluation is human subject research, whether the Institutional Review Board will consider it exempt from review or subjected to expedited or full review; and (3) how interim disclosure to the clinic management impacts the research study. The recommendations to evaluators include use of a protocol for interim disclosures to patients, clinicians, and/or clinical management for both quality assurance initiatives and human subjects research.

Quality Assurance in Chinese Higher Education

Quality assurance has been integrated into the fabric of higher education in China, with the issue of quality in higher education – how to evaluate it and how to enhance it – now taking centre stage in Chinese higher education. In the past decade, the development of quality assurance in Chinese higher education has covered a broad spectrum of initiatives, from national policy, quality evaluation methodology, and institutional adoption of quality assurance schemes, to the matrix of quality evaluations. This article attempts to present a comprehensive overview of quality assurance in Chinese higher education by reviewing and analysing the context and development of quality assurance initiatives, alongside the current structure and management of quality assurance in Chinese higher education. By commenting on the current realities and remaining challenges in Chinese higher education, this article also points to some implications for Chinese higher education institutions in their further progress along the quality assurance path.

Organisational value of healthcare quality awards in Andalusia

PurposeThe purpose of this paper is to develop and describe the symbolic value of quality awards as a key indicator of recognition that public organizations have reached in the scope of quality management and continuous improvement.Design/methodology/approachThe paper provides a description of the evolution of the three series of healthcare quality awards that have been held to‐date in one of the biggest regions of Europe: Andalusia.FindingsTheoretical analysis of an instrument conceived as an institutionalised way of recognizing quality assurance initiatives in the Andalusian Public Health System. At the same time, the article focuses on the importance of using a reference model to ensure that the process of assessing the projects is systematic and rigorous and therefore stands as a guarantee of transparency within a public administration.Research limitations/implicationsThe ultimate outcome is dependent of the geographical context and the behaviours and perceptions of people that have participated as assessment panels.Practical implicationsThe conceptual framework provides guidance on what methodology is used to assess the quality projects (process to allocate projects to assessment panels and assessment criteria required) in a complex healthcare system. It serves as a managerial framework to enhance the continuous improvement in all health‐related services.Originality/valueThe paper contributes to create a structured debate between researchers and healthcare leaders regarding the assessment criteria to evaluate healthcare quality projects.

From Quality Assurance to Quality Enhancement in the European Higher Education Area

This article focuses on recent trends in quality assurance initiatives, analyses how the European Higher Education Area promotes quality enhancement mechanisms and their implications for quality cultures in universities. It presents and discusses two approaches towards quality enhancement both at the institutional and programme level: 1. Quality Enhancement at programme level: the Tuning approach and 2. Scottish Enhancement‐led Institutional Review. It also argues that current approaches towards quality culture are reorienting the focus from quality assurance towards contextual quality enhancement and that quality enhancement becomes the primary responsibility of universities and university stakeholders.

Cesarean delivery surveillance system at a maternity hospital in Kabul, Afghanistan

Objective To use an active facility-based maternal and newborn surveillance system to describe cesarean delivery practices and outcomes in a resource-poor setting. Methods Using data from operating room logbooks, 392 cesarean deliveries were evaluated between April 1 and June 30 2006 at a large public maternity hospital in Kabul, Afghanistan. Results The perinatal mortality rate was 89 per 1000 births: 57% antepartum and 37% intrapartum stillbirths. Fetuses with normal birth weight comprised 85% of intrapartum stillbirths. Obstructed labor, uterine rupture, and malpresentation accounted for more than 50% of perinatal deaths. The cesarean delivery rate was 10.2% and there were 2 maternal deaths. Conclusion The high percentage of intrapartum stillbirths among normal birth weight fetuses suggests a need for improved labor monitoring and surgical obstetric practices. The use of a facility-based perinatal surveillance system is critical in guiding such quality assurance initiatives.

Improving Safety for Patients Receiving Radiotherapy: The Successful Application of Quality Assurance Initiatives

Administration of external beam radiation therapy (RT) is a human endeavor, and occasionally RT is not delivered as directed. We have been prospectively monitoring deviations in treatment delivery, and herein assess the impact of clinical, operational, and logistical factors influencing the frequency of treatment deviations. Specifically we hypothesize that (1) Factors such as time of treatment, departmental patient load, and therapist experience will be associated with different deviation rates, and that (2) New quality assurance (QA) measures/tools (e.g.