Quality Improvement Approach Research Articles

Balancing Patients' Eating Habits with Planetary Health-Pilot Study to Decrease Food Waste with Vegetarian Lunches using a Quality Improvement Approach.

Patient health is greatly impacted by increased likelihood of malnutrition if food is not consumed. Food waste also contributes to greenhouse gas emissions and may be possibly reduced by offering vegetarian food options. Therefore, a Plan-Do-Study-Act intervention of "Vegetarian Week" was conducted in an urban geriatric rehabilitation unit. Food waste was measured using the Visual Estimation Method, and the proportion of waste before and after the intervention was compared using a two-tailed z-test. Surveys assessed patients' attitudes towards vegetarian meals. Study population was of 54 (2022) and 65 (2023) patients with the majority being male (62.5%), average age 74.5 years, average length of stay 33 days. Comparing pre- and post-intervention periods, overall food wastage increased at: breakfast (22% to 32%), lunch (22% to 32%), and dinner (20% to 25%) with p values <.001. Considering lunch entrées only, wastage increased from 17% to 38%, with vegetarian entrees wasted (46%) more than non-vegetarian ones (34%). Vegetarian patients wasted (37%) as much as non-vegetarians (39%). Survey response rate pre-PDSA was 45%, with most patients (76%) reporting eating an omnivorous diet, a prior awareness of personal and planetary health benefits of vegetarian diets (59%), and previously trying vegetarian dishes (62%). Post-PDSA survey response rate was lower (22%) with 57% not willing to try vegetarian dishes again. Through evaluation of the patient food experience with Visual Estimation Method and surveys, the very complex issue of food satisfaction was explored in older adults. Although food waste was not decreased during this "Vegetarian Week" pilot, improving patient and planetary health requires ongoing efforts.

Minimizing Radiation Exposure in Neonatal Intensive Care Unit: A Quality Improvement Approach on X-Ray Practices

Purpose: Radiographic examinations are frequently performed for diagnostic and therapeutic purposes in neonatal intensive care units (NICUs). However, concerns are emerging regarding the safety of radiation exposure, especially in vulnerable preterm infants in periods of rapid cellular division. This quality improvement (QI) project aimed to reduce radiation hazards in level-IV NICU.Methods: We established an "X-ray prescription protocol" and educated the physicians to ensure that only essential radiographs were obtained. Additionally, we discouraged full-body infantograms and emphasized the prescription of targeted radiographs, such as chest or abdominal radiographs. Furthermore, to reduce the dose-area product (DAP, Gy·cm&lt;sup&gt;2&lt;/sup&gt;) values, which act as a surrogate for radiation exposure, we provided training to radiologic technologists on meticulous collimation for each radiography session. We aimed to achieve a 30% reduction in the average monthly cumulative DAP per patient, which was calculated by dividing the total monthly DAP from radiographs in the NICU by the monthly average of patient admissions. Retrospective baseline data were collected 8 months pre-intervention and prospectively for 4 months post-interventions.Results: The average monthly X-ray count per patient was 28.3 in the pre-intervention period (October 2022 to May 2023), which decreased to 25.4 in the post-intervention period (June 2023 to September 2023), reflecting a 10.2% reduction (&lt;i&gt;p&lt;/i&gt;=0.109). The average monthly infantogram count per patient showed an 18.0% reduction (25.9% to 21.2%, &lt;i&gt;p&lt;/i&gt;=0.016), and the proportion of infantograms in the total X-ray counts decreased from 91.5% to 83.3% (&lt;i&gt;p&lt;/i&gt;=0.017). The DAP value per X-ray decreased by 42.6%, from an average of 0.25 to 0.14 (&lt;i&gt;p&lt;/i&gt;=0.011). The primary outcome, the average monthly cumulative DAP value per patient, showed a substantial reduction of 48.6%, dropping from 7.00 to 3.60 (&lt;i&gt;p&lt;/i&gt;=0.004). The baseline characteristics and short-term morbidities of the patients did not differ significantly between the pre- and post-intervention period.Conclusion: Our QI approach, which included discouraging excessive prescriptions of infantograms and promoting optimal collimation, significantly reduced the average monthly radiation exposure in the NICU, benefiting both patients and healthcare workers.

The feasibility of a novel national quality improvement programme for tobacco dependency treatment pathways in acute UK hospitals

IntroductionThe prevalence of smoking remains stubbornly high in the UK despite comprehensive tobacco control measures. A national quality improvement (QI) approach to enhance the treatment of an estimated 1,000,000 annual hospital admissions of tobacco smokers could provide a new opportunity to improve population health and reduce healthcare demand. Barriers to QI include knowledge, costs and competing demands.This study aimed to evaluate the feasibility and effectiveness of a national QI programme hosted by the British Thoracic Society, focused on improving NHS tobacco dependency treatment in acute hospitals. MethodsThe programme utilised the Model for Improvement as its QI framework and was delivered over a 6-month period. 25 teams from across the UK were upskilled through a series of webinars and coaching sessions and undertook QI projects focused on specific areas of their local tobacco dependency treatment pathways. ResultsResults of the programme demonstrated improvements across the treatment pathway including screening for smoking status, rapid provision of nicotine replacement therapy to prevent nicotine withdrawal, referrals to inpatient tobacco dependency treatment teams and transfers of care to community services. Other programme outcomes included increases in QI knowledge, confidence and attitudes along with enhanced project management skills. ConclusionThis novel, national, online QI programme supported participating multidisciplinary teams in acute trusts across the UK to deliver tobacco dependency treatment pathway improvements using QI tools and methodology. This programme demonstrated the feasibility and effectiveness of delivering a national QI programme, at low cost using a microsystems approach applied to an important area of clinical medicine.

Enhancing Outcomes and Efficiency in Large Epidermal Cyst Management: Quality Improvement Approach in Primary Care.

Epidermal cysts are common benign lesions encountered in primary care, especially in minor surgery clinics. The management of large epidermal cysts (>5 cm in diameter) poses significant challenges, including surgical intervention requirements, potential for complications, and impacts on patient care and clinic workflow. The prevalence of these cysts underlines the need for optimised management strategies that are essential for enhancing patient outcomes and clinic efficiency. This quality improvement initiative sought to better manage large epidermal cysts in primary care settings. The initiative utilised the Plan-Do-Study-Act (PDSA) cycle over three distinct phases, with an emphasis on improving surgical techniques and postoperative care, optimising clinic workflow, and enhancing patient education and involvement. Over the course of this eighteen-month study, 100 patients who required surgical excision of large epidermal cysts were included. The interventions focused on standardising surgical protocols, implementing a new scheduling system, and developing comprehensive educational materials for patients. The programme contributed to major efficiency gains for surgeries: the average operative time was reduced from 45 min to 30. The postoperative complication rate decreased dramatically while patient and clinician satisfaction went up, as did clinic throughput. With patient education enhancements, follow-up adherence rose to 92% while the postoperative complication rate declined from 18% to 9% with the overall approach to patient engagement. The successful application of the PDSA cycles in this work demonstrates that quality improvement methodologies have a potential role in optimising management for large epidermal cysts in primary care settings. Developed interventions can therefore be put into routine care that will indeed improve patient outcome, clinician experience, and operational efficiency in minor surgery clinics.

Striving for excellence in ventilator bundle compliance through continuous quality improvement initiative in the intensive care unit of a tertiary care hospital in India.

Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in intensive care units (ICUs). Ventilator bundle (VB) implementation has been shown to decrease the incidence of VAP. This study presents a 1-year quality improvement (QI) project conducted in the ICU of a tertiary care hospital with the goal of increasing VB compliance to greater than 90% and evaluating its impact on VAP incidence and ICU length of stay. A series of Plan-Do-Study-Act (PDSA) cycles, including educational boot camps, checklist implementation, and simulation-based training, was implemented. Emphasis on standardization and documentation for each VB component further improved compliance. Data were compared using a chi-square test, unpaired t-test, or Mann-Whitney U-Test, as appropriate. A P-value <0.05 was considered statistically significant. The initial observed compliance was 40.7%, with a significant difference between knowledge and implementation. The compliance increased to 90% after the second PDSA cycle. In the third PDSA cycle, uniformity and standardization of all components of VAP were ensured. After increasing the VB compliance at greater than 90%, there was a significant decline in the incidence of VAP, from 62.4/1,000 ventilatory days to 25.7/1,000 ventilatory days, with a 2.34 times risk reduction in the VAP rate (P= 0.004). The study highlights the effectiveness of a structured QI approach in enhancing VB compliance and reducing VAP incidence. There is a need for continued education, protocol standardization, and continuous monitoring to ensure the sustainability of this implementation.

Diabetes On Track: Redesigning Diabetes Management in Rural Primary Care

OBJECTIVE Diabetes remains an intractable public health problem, particularly in rural communities. The Diabetes On Track initiative returns control of designing and implementing strategies to improve diabetes care delivery systems to the local clinics and community partners. This article reports on protocol development and the first 18 months of the Diabetes On Track project within the health care setting. RESEARCH DESIGN AND METHODS Using a rapid-cycling quality improvement approach, the research team partnered with two rural clinics. Clinics completed a strengths and needs assessment before being offered a menu of possible strategies to implement. Clinics worked with the research team to implement, refine, and adapt these initial interventions and develop further strategies based on local data that were continually collected and shared. Six core indicators were established as primary outcome measures. Process measures were established based on the strategies chosen. RESULTS Both clinics decided to create a registered nurse health coach position to provide diabetes education to individuals with or at risk for developing diabetes. Both clinics also chose to implement a physician dashboard highlighting diabetes-related indicators so clinicians could track panel improvement over time. Other interventions included using a prediabetes outreach list and taking advantage of professional development opportunities, including a diabetes-focused Project ECHO series. CONCLUSION Improving diabetes care in rural communities is a challenge, and novel solutions are needed, with a focus on sustainability. The Diabetes On Track initiative is showing promising results, allowing primary care clinics to use community knowledge and data to redesign effective diabetes care delivery systems.

Nurse-Led Clinical Pathway Development for Cardiac Surgery: A Systematic Quality Improvement Approach

Nurse-Led Clinical Pathway Development for Cardiac Surgery: A Systematic Quality Improvement Approach

National dispensing of evidence-based treatment for New Zealand patients before and after peripheral arterial or percutaneous coronary procedures; undertreatment in plain sight

Abstract Background/Introduction Cardiovascular management guidelines recommend that those undergoing arterial procedures for atherosclerotic disease should be on a long-term antithrombotic agent, statin and blood pressure (BP) lowering (triple therapy) to prevent or delay future ischaemic events or death. Internationally, treatment gaps have been reported for people having peripheral arterial disease (PAD) procedures. Purpose We aimed to investigate national rates of triple therapy dispensing before and after admission for a percutaneous coronary intervention (PCI) compared to a PAD procedure. Methods All people aged 18-84 years admitted for a publicly-funded PCI or PAD procedure in New Zealand between 1 January 2015 and 30 June 2020 were identified. Data were linked to national community dispensing records for antithrombotic agents, statins and BP lowering and the adjusted relative risk (adjRR) of dispensing individual medication classes and triple therapy investigated 6 months prior-procedure and 0-6 months and 7-12 months post-procedure. Analyses were controlled for age, sex, prioritised ethnicity, socioeconomic deprivation index, diabetes and prior cardiovascular disease. Results During the study period, 26,383 people were admitted for a PCI procedure and 10,938 people for PAD. Compared to PCI, those with PAD were more likely to be women, older (median age 69 vs 66 years), of Māori or Pacific ethnicity, living in more deprived communities, more likely to have diabetes (33% vs 24%) and a prior admission for cardiovascular disease (63% vs 52%). Triple therapy in the 6 months prior to procedure was 48% for PAD compared to 37% for PCI (adjRR 1.04; 1.03-1.05); however, in the 6 months post-discharge, improved for PCI more than PAD (PAD 58% vs PCI 91%, [adjRR 0.82; 0.81-0,83]) with decreased dispensing in both cohorts by 7-12 months post procedure (PAD 55% vs PCI 83%, [adjRR 0.84; 0.83-0,84]). Conclusions Patients undergoing atherosclerotic arterial procedures are at high risk of future fatal and nonfatal cardiovascular events. Less than half the patients who were admitted for a PCI or PAD procedure had been dispensed triple therapy in the 6 months prior to admission. Post procedure, 91% of PCI patients were on triple therapy but this substantial increase did not occur for PAD patients. The risk management gap for those who have peripheral arterial compared to coronary procedures indicates clear clinical and system-related deficiencies and a national quality improvement approach is required to address these issues. Figure 1. Adjusted relative risk of being dispensed preventive medications for patients who had a PAD procedure, compared to patients who had a PCI procedure [after adjusting for age, sex, ethnicity, NZDep, history of CHD (including prior PCI and CABG), stroke/TIA, haemorrhagic stroke, heart failure, PVD, and diabetes]

Let’s Get Walking: Establishing Workplace Walking Groups in a regional Public Health Department

Abstract Maintaining staff health and wellbeing (HWB) is an ongoing priority for the Department of Public Health HSE Dublin and Midlands (PHD). This is particularly important in the context of an ongoing programme of reform for Public Health in Ireland. To support this priority, in November 2023 a pilot Workplace Walking Groups initiative was established to increase workplace physical activity and build team relationships. The initiative was designed following staff feedback on team HWB initiatives in September 2023. The Model for Improvement (which includes the Plan-Do-Study-Act cycle) was used to take a structured quality improvement approach to the development and evaluation of the 4-week pilot, led by the PHD HWB Committee. Staff joined across 3 sites. Lunchtime walks were arranged for 1-2 days per week. WhatsApp groups and email supported group communication. Quantitative data on registration and attendance were collected via Microsoft Excel. A virtual focus group was arranged to gather participant feedback, which was analysed into themes. Group registration (n = 10, n = 9, n = 5) and weekly attendance varied by site (n = 10, n = 9, n = 5). Key benefits noted by participants included physical activity, building relationships with colleagues, and getting fresh air. The main barrier was the impact of work schedules on attendance. There was broad support for re-establishment of Workplace Walking Groups for 2024. This pilot Workplace Walking Groups initiative achieved its dual aim of increasing physical activity and social connection among staff. Learning from this pilot informed the launch of a 3-month Walking Groups term for Spring 2024. The initiative is now established practice and is a component of the Department’s blended working policy, being a feature of on-site working days. Key messages • Our successful pilot Workplace Walking Groups project has translated into a sustainable health and well-being initiative for staff, during a time of ongoing reform across Public Health in Ireland. • A structured approach to designing and implementing staff health promotion initiatives is crucial to support the cycle of learning and improvement, and to sustain change over time.

FeTiO3: A low-cost and efficient photocatalytic mineral for sustainable NOx abatement

This study investigates the potential of FeTiO3 as a photocatalyst for the removal of nitrogen oxides (NOx) from gas streams, a critical environmental and health concern. The photocatalytic activity of FeTiO3 was evaluated across a range of operational parameters, with initial NO concentrations set from 5 to 50 ppmv and gas hourly space velocity (GHSV) values of 18, 36, and 54 h−1. The findings demonstrate that FeTiO3 effectively converts NOx, even at room temperature and under saturated atmosphere, with a clear correlation between the photocatalytic removal efficiency and both the initial NO concentration and GHSV. A rigorous mechanism for the photooxidation of NO to nitrate via NO2 was proposed based on these experimental results and the surface characterization of raw and used ilmenite, corroborated by DFT calculations. These outcomes would allow widening the application of air pollution control strategies to flue gas with relatively low NOx concentration and low temperature, where other NOx control techniques show severe drawbacks. Therefore, this research contributes to the development of efficient and sustainable approaches for air quality improvement using photocatalytic systems.

Enhancing infection prevention and control through hand hygiene compliance in six Ugandan hospitals using quality improvement approaches.

Hand hygiene (HH) plays a crucial role in mitigating healthcare-associated infections. Improving HH compliance in healthcare facilities in resource-limited settings is urgently needed. We implemented the World Health Organization (WHO) HH improvement strategy using a continuous quality improvement (CQI) approach targeting improvement in HH compliance by healthcare workers (HCWs). An intervention was implemented in six hospitals using a longitudinal study design between May 2019 and April 2023. We set up and monitored infection prevention and control (IPC) and HH programs using WHO's infection prevention and control assessment framework at the facility level (IPCAF) and hand hygiene self-assessment framework (HHSAF) tools. We implemented HH interventions using CQI techniques while targeting HCW HH knowledge and compliance with the WHO's Five Moments of HH. By the end of the intervention, IPC and HH capacity improved in all six hospitals, from a median score of 547.0 and 252.5 on IPCAF and HHSAF tools at baseline to an advanced score of 635.0 and 350.0 at endline assessment, respectively. Similarly, HCWs' HH knowledge improved in all hospitals, from a mean score of 45.0% at baseline to 76.0% at endline assessment, most notably among nurses. HH compliance, as assessed using WHO's HH observation tool, at least doubled in all hospitals, rising from 19.9% to 53.8%, with before touching a patient registering the highest (22-fold) improvement. On linear regression analysis, no significant association was observed between HH compliance and IPCAF b = -0.0004 (95% CI -0.093, 0.93) p = 0.990, HHSAF b = 0.009 (95% CI -.0127, 0.145) p = 0.842 and HCW knowledge on HH/IPC b = -0.165 (95% CI 0.815, 0.485) p = 0.519. This is the first documented comprehensive utilization of CQI approaches to implement HH as an entry point for the development of hospital IPC programs, and evaluation of WHO tools and approaches for IPC and HH improvement in Uganda. Implementation of the WHO HH improvement strategy using a CQI approach can lead to remarkable improvement in HH capacity, and HCW compliance and knowledge in hospitals within resource-limited settings.

Impact of Applying PDCA Circulation Method on Surgical Care Interventions in the Operating Room on Patients Undergoing Cardiothoracic Surgery: A Retrospective Study

Background: The Plan-Do-Check-Act (PDCA) cycle is a widely recognized methodology for continuous quality improvement. This study evaluated the impact of applying the PDCA cycle on surgical care interventions in the operating room for patients undergoing cardiothoracic surgery. Methods: A retrospective study was conducted on the treatment of patients who underwent continuous cardiothoracic surgery in our Hospital from July 2020 to June 2023. Participants were divided into control and PDCA groups on the basis of the application of the PDCA cycle in their surgical care. Various outcomes were assessed, including psychological well-being (Hospital Anxiety and Depression Scale [HAMA] and Hamilton Depression Rating Scale [HAMD] scales), quality of life (using the QLQ-C30 tool), patient satisfaction, incidence of adverse accidents, clinical parameters, and laboratory measures. Results: The study comprised 133 patients, with 62 in the control group and 71 in the PDCA group. The psychological well-being, as measured by the HAMA and HAMD scales, of the PDCA group showed significant improvements compared with that of the control group (p &lt; 0.05). The Quality-of-Life scores were higher in the PDCA group than in the control group (p &lt; 0.05). In the PDCA group, the patient satisfaction scores related to hospital satisfaction were significantly higher than that in the control group, and the incidence of adverse accidents was lower (all p &lt; 0.05). No significant differences were noted in clinical parameters (ejection fraction and B-type natriuretic peptide levels) nor laboratory measures (serum protein and C-reactive protein (CRP) levels) between the groups (p &gt; 0.05 for all). Conclusion: The implementation of the PDCA cycle in the operating room for patients undergoing cardiothoracic surgery significantly improved psychological well-being and patient satisfaction and reduced the incidence of adverse accidents in the operating room, indicating that this quality improvement approach can enhance patient care experience. Although no significant differences were observed in clinical and laboratory parameters, the findings suggest that the PDCA cycle's strengths lie in its systematic approach to care process optimization and patient-centered outcomes.

A Novel Approach for Power Quality Improvement Using D-STATCOM in Wind Integrated Distribution System

Objectives: The major goal of the proposed article is to enhance the power quality of a wind-integrated radial distribution network utilizing D-STATCOM. It is done by the appropriate allocation of wind turbine-based DGs and D-STATCOM. Methods: The multi-objective optimization problem is implemented using a novel and effective Prairie Dog Optimization (PDO) to attain the best-compromised solutions. This optimization tool is well suited for solving complex, non-linear voltage stability problems. The proposed approach is validated for the modified IEEE-13 bus highly unbalanced system using MATLAB. Findings: The findings indicate enhancements in the voltage profile, system losses, and total harmonic distortion (THD). The THD for the load current is 18%, while the THD for the source current is 2.54% for nonlinear loads using the proposed methodology. The voltage profile of 3.25% is enhanced as compared with the existing method, which is 2.15% better than the other obtainable method. Novelty: Prairie Dog Optimization (PDO) was chosen over traditional algorithms for its nature-inspired approach, simplicity, and efficacy in exploring complicated search fields. Its robust exploration and exploitation skills make it excellent for multi-modal optimization challenges. Keywords: Radial distribution system (RDS), D-STATCOM, Power quality, Prairie Dog Optimization, THD

A Quality Improvement Approach to Increasing Access to long-Acting Reversible Contraceptives in a Federally Qualified Health Center.

Long-acting reversible contraceptives (LARCs) are the most effective forms of contraception available and therefore play a critical role in supporting patients to exercise bodily autonomy and achieve reproductive goals. A comprehensive set of quality improvement (QI) interventions were implemented between March and June 2019 to improve LARC access at a federally qualified health center (FQHC) in (US State). An evaluation study was conducted to assess the impact of the QI initiative considering the number of LARCS delivered as a proxy for access. The Wilcoxon-rank test was applied to test for significance, given a non-parametric sample of LARCs delivered by 13 providers (matched to themselves) pre- and post-intervention. Reimbursement for LARC procedures pre- and post-intervention was also examined to determine economic impact and sustainability of incorporating a new device, the Liletta™, in the floor stock. There was a statistically significant increase in LARC delivery between July 2019-March 2020 compared to July 2018-March 2019. Approximately $1,000 per month increased reimbursement for LARC services occurred post-intervention. The evaluation study concluded success of the QI intervention, with need for further study needed to determine equitable delivery of contraceptive services between different subpopulations and by insurance status. The study provides a blueprint for QI initiatives to improve access to LARCs while also increasing revenue for LARC services in an FQHC setting.

Patients’ understanding of treatment decisions: Impact on major quality metrics and patient informed decision-making at end of life.

170 Background: Blue Ridge Cancer Care (BRCC) is a community oncology practice in rural Virginia and West Virginia. BRCC is an ASCO-certified practice and participates in multiple value-based care programs to ensure a quality improvement and patient-centered approach. BRCC serves regions with low health literacy (LHL) which impacts a patient’s ability to self-manage their disease, make informed health-related decisions, and navigate the health system. The top indicators of LHL are being over 65 years old, having less than any college education, and being insured by Medicare or Medicaid which is 63% of BRCC’s patient population. Methods: BRCC conducted a retrospective analysis of our 2023 end-of-life (EOL) quality measures and 1,682 unique National Comprehensive Cancer Network (NCCN) Distress Tool &amp; Problem List assessments. We then matched the results with each patient’s demographics and disease course. Additional research revealed that LHL levels have the greatest impact on patients engaging in their care and ability to make informed decisions at end of life. Results: 21% of patients reported concerns with understanding treatment decisions (n=353) and they had vastly different outcomes compared to patients that did not have concerns (n=1329). A chi-square test was performed to examine the relation between these events, all outcomes were found to be statistically significant. Detailed outcomes are shown (Table). Conclusions: In our review, patients reporting concerns with or understanding treatment decisions had more aggressive EOL care and used more resources from health care systems. BRCC plans to deepen our understanding of this population by using an evidence-based tool that assess a patient’s understanding of their disease severity, perceived curability, and treatment options to identify gaps in a patient’s prognostic understanding and enhance communication between the care team and better support patients informed decision-making at EOL. Population Reported Concerns with/understanding Treatment Decisions = 21% No Concerns with Treatment Decisions = 79% &gt; 3 Emergency department visits in 1 year 19% 8% Chemotherapy in the last 14 days of life 38% 19% Enrolled in Hospice 14% 54%

The relationship between Healthcare Quality and Inbound Health Tourism: Saudi German Hospital Case Study Cairo -Egypt.

The development and execution of a quality measurement and improvement approach based on a particular combination of two TQM tools SERVQUAL and QFD was investigated in the thesis. The approach focused on whether it was appropriate to apply these quality improvement strategies to the Saudi German hospital medical tourism industry. It was progressively tested and enhanced in three medical tourists’ attractions located in Cairo – Egypt. The introduction chapter delineates the research’s significance, while the literature review develops relevant theoretical viewpoints. The following research question was the focus of the study: How can medical operators enhance their service quality by finding a tool for measuring it? Case study from each of the health medical tourism industry’s cultural, heritage, and environmental segments were chosen to serve as the research’s setting and data source. These are all well-established companies with respectable market and industry profiles. The research instrument has been refined and the execution of the research technique in the extended major case study has been backed by the investigations conducted through two complementary case studies. To assess the accuracy of the data from the various surveys and to account for variations in the outcomes, statistical analyses were used. According to research findings, the combination of the two tools would give small business owners a way to connect customer service satisfaction measurement to the fundamental operational elements of their enterprise with additional refinement and adjustment through ongoing usage. Any major variations in customer expectations about standards of quality service can be partially explained by looking at the visitor profiles of the medical tourists’ attractions that were gathered from the surveys. The results indicate that small medical tourists’ attractions should routinely implement the combined SERVQUAL and QFD quality management technique as a tool for quality improvement to meet customer satisfaction and help achieve external quality service accreditation. Keywords: Healthcare Quality, Inbound Health Tourism, Egypt.

Quality improvement approach to reduce patient cycle time at a student-run free healthcare clinical network

BackgroundThe University of Florida (UF) Equal Access Clinic Network (EACN) is the largest student-run free healthcare clinic network in Florida. The UF EACN serves those who are underinsured or uninsured...

Standards-based audit to improve quality of maternal and newborn care-A stepped-wedge cluster randomised trial in Malawi.

Audit is a quality improvement approach used in maternal and newborn health. Our objective was to introduce the practice of standards-based audit at healthcare facility level, and to examine if this would improve quality of care assessed by compliance with standards developed and agreed with healthcare providers. Our focus was on emergency obstetric and newborn care (EmONC). A multidimensional incomplete stepped-wedge cluster randomised trial with 8 steps was conducted in 44 healthcare facilities in Malawi. A total of 25 standards of care were developed. At each healthcare facility one (health centres) or two (hospitals) standards were audited per cycle with two consecutive audit cycles conducted. Each cycle consisted of five steps: (i) select standard to be audited, (ii) measure compliance with standard (measurement 1), (iii) review findings and identify what changes are required to increase compliance (iv) implement changes, (v) re-measure compliance (measurement 2). Each compliance measurement assessed 25 women. Multilevel mixed effects logistic regression models were used to analyse data for all standards. The crude overall compliance rate rose from 45% in the control phase (measurement 1) to 63% in the intervention phase (measurement 2) (from 51.6% to70.6% at Basic and from 34.5% to 50.8% at Comprehensive EmONC healthcare facilities. When adjusted for standard, facility type, month, and healthcare facility by month, the adjusted OR (95% CI) was 2.80 (1.65, 4.76). Actions taken to improve compliance with standards included improving staff performance of clinical duties and general conduct through re-orientation and staff meetings as well as improved supervision, and, ensuring basic equipment and consumables were available on site (thermometers, rapid diagnostic tests, partograph). The introduction of standards-based audit helped healthcare providers identify problems with service provision, which when addressed, resulted in a measurable and significant improvement in quality of care. ISRCTN registration number: 59931298.

Taking the Piss? Using Lean to Review the Process for Provision &amp; Delivery of Continence Disposable Products

Abstract Background Urinary incontinence (UI) is the unintentional passing of urine. Its impact on older people varies from a diminished quality of life, to social isolation and frailty. Pads or diapers are commonly employed tools in the care of older people with incontinence. Incontinence is largely underreported and poorly managed among older people in community care settings (Yan et al., 2022). This work reviews the process map of the provision and delivery of continence disposable products in the community by the Health Service Executive in Ireland. Methods Lean is a quality improvement approach that consists of the elimination of waste to improve the flow of people, information or goods. We reviewed the process map baseline assessment; captured steps that added value to the patient and the impact on staff in the community. Results The initial assessment tool consists of five pages. There are 28 possible steps presented in the process map. There is a gap in the presentation on connectors to associated processes. Eight people are involved in the ordering, approval and delivery process to the older person. The initial assessment and education add value to the patient. If adverse skin or complaints arise an older person can be referred to a continence advisor or the ADPHN. The patient feedback loop is missing following delivery no check-in for education is provided following initial use. Unclear who is the point of contact for the patient to raise issues. The only noted key performance indicator is the processing of a request to order is inputted in one working day. Objectives are not SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound.) Conclusion Further in-depth research is required to review if the right staff are making the approvals. Need to review KPIs throughout to improve process and SMART objectives. Perspectives of older people and GP supports require further investigation.

Lean Six Sigma quality improvement approach to implement clinical practice guidelines for prescribing opiates for chronic pain in a primary care setting

BackgroundImplementing guidelines for chronic opioid management during a clinic merger posed significant challenges. Our aim was to increase the percentage of chronic pain evaluations and urine toxicology tests in patients...