Quality In Healthcare Organizations Research Articles

Improving Patient Safety and Care Quality Through a "Speaking-Up" Climate: The Mediating Role of Situation Monitoring.

In healthcare settings, a climate that encourages speaking up among staff is believed to enhance patient safety and quality of care. However, the specific mechanisms of this relationship remain underexplored. Particularly, there is a need to understand how components of teamwork, such as situation monitoring, can be linked to the impact of a speaking-up climate on relevant outcomes. This study aimed to investigate the direct and indirect effects of a speaking-up climate on patient safety and quality of care using situation monitoring as a potential mediator. This cross-sectional study used survey data from 380 staff nurses who provided direct patient care at three Korean hospitals. Structural equation modeling was utilized to test a hypothesized mediation model using Mplus 7.0. Our data analysis confirmed the partial mediation model. As hypothesized, a speaking-up climate directly improved patient safety (β = 0.384, p < 0.001) and quality of care (β = 0.393, p < 0.001). Also, we found that indirect effects of a speaking-up climate on patient safety (β = 0.224, p < 0.001) and quality of care (β = 0.186, p = 0.005) through situation monitoring were significant. These results indicate that situation monitoring was found to significantly mediate the relationship between a speaking-up climate, patient safety, and quality of care. Our study demonstrates that the positive impact of a speaking-up climate extends beyond improving nurses' speaking up. Further, fostering a speaking-up climate can significantly improve patient safety and quality of care, and situation monitoring has a critical role in this relationship. These findings contribute to understanding how encouraging a speaking-up climate could benefit patient safety and care quality in healthcare organizations.

Quality accreditation’s impact on effective leadership in healthcare organizations

ABSTRACT Quality improvement is a central objective in healthcare system reform worldwide, requiring healthcare managers' attention and resources to ensure high-quality patient care. Improving quality can be challenging due to various issues healthcare managers must address. Effective methods have been implemented nationally and locally, including external quality assessments. These assessments often rely on ISO standards to certify organizations. However, ISO standards set minimum requirements and assess through document evaluation. In response to these limitations, bodies like The Joint Commission International (JCI) introduced new standards and evaluation methods. This research aims to explore how JCI's method can enhance managerial performance in improving organizational quality. A qualitative approach is used, conducting semi-structured interviews with selected CEOs of JCI-accredited healthcare organizations in Italy. Interviews investigated three key areas: (1) the role of quality accreditation in defining managerial responsibilities, (2) how it can enhance organizational leadership, and (3) its impact on achieving performance goals. Main findings show that leadership plays a crucial role in improving quality in healthcare organizations, creating the conditions and commitment necessary to ensure effective actions. Respondents acknowledge the importance of quality improvement in effectively and efficiently managing the organization, with quality perceived as an integral part of the managerial process.

KUALITAS PELAYANAN DAPAT MENINGKATKAN KEPUASAN PASIEN DI KLINIK GIGI GENTAN SURAKARTA

Oral disease is considered a major health problem because of its high incidence and prevalence worldwide. Dental complaints felt by patients can cause anxiety and stress, so dentists need to provide good dental care services. Paying attention to the quality of service at the dental clinic is the first and most important factor in improving service. Patient satisfaction is one of the key indicators of quality in healthcare organizations. Gentan Dental Clinic Surakarta was founded in 2012. This clinic has not conducted a survey on patient satisfaction levels. This study aims to determine the relationship between service quality and patient satisfaction at the research is quantitative research with a cross sectional approach. The number of samples is 85 people. The sampling technique used purposive sampling with the criteria of patients aged more than 17 years and visiting or receiving services more than once. The research instrument used a questionnaire. Data analysis used the chi square test. The results of the study explained that the quality of service in the good category was 78,8 % and patient satisfaction in the satisfied category was 67,1 %. The statistical test between service quality and patient satisfaction at the Gentan Dental Clinic with a p-value of 0,000.

Sustainable Healthcare System: Providers Initiatives for Quality Improvement of Healthcare Organisation

The study is designed for sustainable healthcare system with providers’ initiatives to provide quality services in healthcare organisations. Healthcare providers’ initiatives promote quality and ensure better healthcare services. Among the healthcare providers who were studied and reviewed, it was observed that the initiatives of the healthcare providers improved the overall quality. There is a distinct scope of further enhancement with the participation of healthcare providers in healthcare organisations. The purpose of this research is to learn and determine the answers to questions through scientific application. This study shows that an augmented frequency of sustainable healthcare systems is only possible through the initiatives of healthcare providers. In healthcare services, patients remain satisfied without expressing their dissatisfaction to the management. To know the needs of patients, there has to be a certain level of relationship between healthcare providers and patients. For this purpose, the system has to be very proficient in the service conditions and their applicability for quality in the hospital. Healthcare organisations management has the conviction that the participative role of healthcare professionals in hospitals will increase patient satisfaction. In this perspective, the pressing priority of healthcare providers for hospitals will always be patients. Thus, apart from the availability of healthcare facilities and quality of care, the location of the hospital has predominant importance. Based on the findings, it is to be stated that sustainable healthcare is subject to provider’s initiatives and actions for quality in healthcare organisations.

Big Data Quality in Healthcare Organizations in Saudi Arabia

The adoption of Big Data analytics by organizations has been expanding across numerous industries, bringing both advantages and challenges. The primary challenge stems from the insufficient quality of data used in the analysis process, as well as its impact on the value of the acquired insights. Therefore, the objective of this research is to investigate the factors that influence the quality of Big Data in Saudi Arabian healthcare organizations. These factors include clear business objectives, data source, data analysis, data quality dimensions, customer engagement, and assessment tools. To investigate these aspects, a descriptive and analytical design is used. Additionally, a questionnaire is distributed in both Arabic and English to 350 respondents working within Saudi Arabia's healthcare industry from a variety of occupations and management positions. To analyse the data acquired via the questionnaire, the statistical package for the social sciences (SPSS) is employed. The study's results indicate that the factors analysed have a significant effect on the quality of Big Data in healthcare organizations. The findings of this study will fill the gap in the existing literature by addressing factors that have not been explored in combination previously.

The Investigation of Physical Design, Executives' Attitude and Policy Towards Service Efficiency Based on Universal Design Principles; A Case Study of Naresuan University Hospital.

Public hospitals should be designed to clover as wider inclusivity levels as possible forproviding access for all. Unfortunately, and for a variety of reasons, a quality service is not always provided. When evaluation of the service quality in healthcare organizations is carried out, it is mostly conducted in terms of medical service quality, whilst the physical layout, functionality and facilitating devices are not given as much scrutiny. Post Occupation Evaluation (POE) is notably an efficient process for checking the satisfaction of users after the building has been in-used for a certain period of times. However, hospital is generally a type of building and service that need to support users with a variety of physical capabilities thus, a conventional POE may not cover all requirements of users, so this research has employed the UD concepts as a basis to combined with POE for evaluating service performance of a hospital of the case study, Naresuan University hospital, THAILAND. Even though the POE delivered a good design suggestion that is beneficial to users with a wide range of physical ability but that may not guarantee the new design will be agreed by all stakeholders and implemented through success. As a matter of fact, to success an implementing of a good design does not depend solely on a designer, specifically for this case study, a universal design to a hospital. This research found that to make UD perfectly effects in a hospital (in Thailand context) may require more supportive factors beyond just pointing out problems related to physical conditions of the design and suggest a design solution. As in the context of Thailand, this research identified 4 factors contributing to the success of UD which the designer should be accountable for (1) public understanding of the basic concepts of UD (2) all the related background such as culture, tradition and economic etc. that contributed the attitudes of all stakeholders (of the hospital) towards people with physical impairments (3) the rights, laws, regulations and policies for people with disabilities in the context of the country and (4) the participation of all types of users. And in doing so, this research added an extensive evaluation to the general POE to cover as more factors as possible to those involved with the design implementation. Therefore, an extensive evaluation process so called "Comprehensive Post-Occupancy Evaluation C-POE" has been created and employed in this study for offering more comprehensive solution that cover all possibilities cause of problems, the evaluation processes are as follows; (1) evaluating physical features and users' behavior (the experimental access audit), (2) examining administrative policy, HA and UD principles and (3) interviewing attitude of executives about UD.

Developing a Data-Driven Approach in Order to Improve the Safety and Quality of Patient Care.

Objective: To improve the safety and quality of patient care in hospitals by shaping clinical pathways throughout the patient journey.Study Setting: A risk model designed for healthcare organizations in the context of the challenges arising from comorbidity and other treatment-related complexities.Study Design: The core of the model is the patient and his intra-hospital journey, which is analyzed using a data-driven approach. The structure of a predictive model to support organizational and clinical decision-making activities is explained. Data relating to each step of the intra-hospital journey (from hospital admission to discharge) are extracted from clinical records.Principal Findings: The proposed approach is feasible and can be used effectively to improve safety and quality. It enables the evaluation of clinical risks at each step of the patient journey.Conclusion: Based on data from real cases, the model can record and calculate, over time, variables and behaviors that affect the safety and quality of healthcare organizations. This provides a greater understanding of healthcare processes and their complexity which can, in turn, advance research relating to clinical pathways and improve strategies adopted by organizations.

COVID-19 and Nurse-Sensitive Indicators: Using Performance Improvement Teams to Address Quality Indicators During a Pandemic.

Nurse-sensitive quality indicators have historically been used as a metric of nursing care quality in health care organizations. At our academic medical center, critically ill COVID-19 patients led to a dramatic change in the organizational standard of care resulting in an increase in nurse-sensitive health care-associated infections. Nursing performance improvement teams provided the structure for development of innovative strategies implemented in real time by our frontline clinicians to address the quality and safety issues found with these elevated health care-associated infections. A new COVID-19 CLABSI (central line-associated bloodstream infection) Tip Sheet and a Prone Positioning Kit for HAPI Prevention are strategies developed to address quality of care issues experienced with the COVID-19 patients. Deployment of these innovative practice strategies has led to a decline in health care-associated infections and instituted a new care standard for the COVID-19 patients.

Development and validation of the Health Care System Distrust scale for cancer screening among Koreans.

The current research addresses the need for developing a Health Care System Distrust scale for cancer screening among Koreans living in the Republic of Korea. This study developed and validated a scale to measure health care system distrust and to examine the psychometric properties of the scale. Interviews, expert reviews, a pilot test, and a cross-sectional survey with 884 Koreans were conducted for instrument development and validation. Content validity, construct validity using exploratory and confirmatory factor analyses, convergent and discriminant validity, and reliability of the scale were examined. Factor analyses demonstrated a three-factor structure (competency of tests and health care providers, quality of health care organizations, and honesty of health care organizations) of the Health Care System Distrust scale with 12 items accounting for a total of 71.47% of the variance (competency=33.35%, quality=21.14%, and honesty=16.97%). Cronbach's α coefficients of the subscales were 0.72-0.92. The newly developed Health Care System Distrust scale will aid in understanding Koreans' distrust of the health care system and their cancer screening behaviors, and will improve cancer screening utilization by transforming distrust into trust.

Evaluation of Service Quality From the Patients’ Viewpoint in the Oncology Setting of a University Hospital in Iran

Background: Hospitals are one of the most important units in providing healthcare services. The assessment of the quality of provided services is essential in these settings. Patient satisfaction is one of the key indicators of service quality in healthcare organizations. Objectives: This study aimed at investigating the gap between the perceptions and expectations of service recipients in Shohada-e-Tajrish Hospital (Tehran, Iran), using the SERVQUAL model in 2020. Methods: This cross-sectional study was conducted on patients with cancer, who were upon discharge from Shohada-e-Tajrish Hospital. Patients (&gt; 18 years) with a cancer diagnosis, who were being discharged from the oncology ward of the hospital, were included in this study. The sample size was estimated at 118. The required information was collected, using the modified SERVQUAL questionnaire. Statistical analyses were performed in SPSS version 20, using a paired t test and one-sample t-test. Results: The results showed that the quality of the provided services from the patients’ perspective was significantly lower than their expectations. The mean gap between the expectations and perceptions of patients was significantly above zero (P &lt; 0.001). The most influential factor in improving patient satisfaction with the quality of services was assurance, followed by reliability, while the least effective factor was empathy. The correlation coefficient between the general status of provided services from the patients’ point of view and loyalty was 0.740 (P &lt; 0.001). Conclusions: The findings of the present study indicated that patient expectations were higher than their satisfaction. Therefore, hospital authorities should take major steps to improve the quality of services, especially reliability and responsiveness, through proper planning, prioritization of services, and review of processes contributing to patient expectations. The existing gaps can also be addressed by considering the perspectives of patients as the clients of healthcare organizations.

Informing quality in emergency care: understanding patient experiences

PurposeAssessing performance and quality in healthcare organisations is moving from focussing solely on clinical care measurement to considering the patient experience as critical. Much patient experience research is quantitative and survey based. The purpose of this paper is to report a qualitative study gathering in-depth data in an emergency department (ED).Design/methodology/approachThe authors used empirical data from seven focus groups to understand patient experience as participants progressed through a major teaching hospital in an Ireland ED. A convenience sampling technique was used, and 42 participants were invited to share their perceptions and outline key factors affecting their journey. A role-playing exercise was used to develop improvement themes. Data were analysed using thematic analysis and data analysis software (NVivo 10).FindingsCapturing ED patient experience increases our understanding and process impact on the patient journey. Factors identified include information, access, assurance, responsiveness and empathy, reliability and tangibles such as surroundings, food and seating.Research limitations/implicationsOwing to the ED patient’s emergency nature, participants were recruited if triaged at levels 3–5 (Manchester Triage System). The study explored patients’ immediate rather than post hoc experiences where recollections may change over time.Originality/valueTo the authors’ knowledge, no study has examined in-depth, ED patient experience in Ireland using qualitative interviewing, obtaining critical process insights as it occurs. The potential to inform patient process improvements in Irish EDs is significant.

Assessing the quality of dental services using SERVQUAL model

The measurement of service quality had an important role in managing service provided, diagnosing the problem, and assessing service performance. Patient satisfaction is one of the key indicators of quality in health-care organizations. This study aimed to measure the service quality gap of patients' perceptions and expectations in five dimensions at a military Specialized Dental Clinic in Iran using SERVQUAL tool. This was a cross-sectional and descriptive-analytical study conducted at a Specialized Dental Clinic affiliated to the Armed Forces of Islamic Republic of Iran in Tehran in 2013. All 385 patients referring to the studied clinic during two working shifts of morning and evening in one month, August, were selected. The required data were collected using the modified SERVQUAL questionnaire. The collected data were analyzed using SPSS 20.0 through statistical tests including Mann-Whitney and Kruskal-Wallis tests. P < 0.05 was considered statistically significant. The results showed that the quality of services provided to patients was significantly lower than their expectations and the quality gaps were statistically significant in all studied dimensions (P < 0.001). Furthermore, the highest and lowest quality gap was related to empathy (-1.16) and reliability (-0.61), respectively. According to the results, the managers of this clinic should take steps toward improving the quality of services in all dimensions, especially responsiveness and empathy, through planning properly, prioritizing services, and reviewing processes with regard to the patients' expectations.

Improving service quality in healthcare organisations through geomarketing statistical tools

PurposeThe purpose of this paper is to demonstrate how geomarketing statical tools (notably, gravitational models) can support healthcare organisations to improve the quality of their services.Design/methodology/approachGeomarketing tools were applied to the analysis of data (91,478 observations) concerning the performance of nuclear magnetic resonance.FindingsGeomarketing models can support and enhance the planning of service provisions of healthcare organisations. Drawing the planning actions on the patient needs and actual behaviours allow the healthcare organisations to obtain better market performance.Practical implicationsThe results support the health service planning activities related to covering the so-called “offer gaps”.Originality/valueThis is the first study to apply geomarketing to improve the quality of healthcare services.

Factors affecting Job Satisfaction and Healthcare Services Quality in Healthcare Organizations

Factors affecting Job Satisfaction and Healthcare Services Quality in Healthcare Organizations

Keys to successful implementation of a French national quality indicator in health care organizations: a qualitative study.

BackgroundSeveral countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice.MethodSeven ethnographic case studies in French HCOs combining in situ observations and 37 semi-structured interviews.ResultsA significant proportion of potential QAF users, such as anesthetists or other health professionals were often unaware of quality data. They were, however, involved in improvement actions to meet the QAF criteria. In fact, three intertwined factors influenced QAF appropriation by anesthesia teams and impacted practice. The first factor was the action of clinical managers (chief anesthetists and head of department) who helped translate public policy into local practice largely by providing legitimacy by highlighting the scientific evidence underlying QAF, achieving consensus among team members, and pointing out the value of QAF as a means of work recognition. The two other factors related to the socio-material context, namely the coherence of information systems and the quality of interpersonal ties within the department.ConclusionsPublic policy tends to focus on the metrological validity of QIs and on ranking methods and overlooks QI implementation. However, effective QI implementation depends on local managerial activity that is often invisible, in interaction with socio-material factors. When developing national quality improvement programs, health authorities might do well to specifically target these clinical managers who act as invaluable mediators. Their key role should be acknowledged and they ought to be provided with adequate resources.

Application of 5S approach to healthcare quality

Much attention has been drawn to the demand for improvement of Quality in Healthcare organisations and to achieve improved outcomes for patients as well as to bring increased patient satisfaction and staff satisfaction. Some important areas to be addressed in this regard are improvement of work environment, reduction of waste and correction of delays in the various care processes and procedures. 5S is a simple, easy to understand management approach that was originally applied in the manufacturing sector for workplace organisation. It is now being practiced in the service sector. It is a stand alone approach that originated in Japan and increasingly used as the first step towards quality improvement in the service sector. If practiced in a hospital it helps to maintain a high degree of cleanliness and orderliness in the work place, and reduces waste in the processes of care, and improves patient flow. It is known for its ability to establish the essential prerequisites of working environment, practices and mind-set, which are the necessary foundations for an effective quality improvement program. This paper presents a brief overview of 5S approach and describes its methodology for implementation in Healthcare organisations.

Defining Patient Experience

In recent years, perceptions of performance and quality of healthcare organizations have begun to move beyond examining the provision of excellent clinical care, alone, and to consider and embrace the patient experience as an important indicator. There is a need to determine the extent to which clear and formal definitions exist, have common overarching themes, and/or have unique, but important constructs that should be considered more widely. In this article, we provide a 14-year synthesis of existing li patient experience. A total of 18 sources (articles or organizational websites) were identified that provided a tangible, explicit definition of patient experience. A narrative synthesis according to constructs of the definitions provided. The objectives of the synthesis were to: (1) identify the key elements, constructs, and themes that were commonly and frequently cited in exis (2) summarize these findings into what might be considered a common shared definition, and (3) identify important constructs that may be missing from and may enhance existing definition(s). The overarching premise and promote a working definition of patient experience that is applicable and practical for research, quality improvement efforts, and general clinical practice. Our findings identified several concepts and recommendations to consider wit regard to the definition of patient experience. First, the patient experience reflects occurrences and events that happen independently and collectively across the continuum of care. Also, it is important to move beyond results from surveys, for example those that specifically capture concepts such as ‘patient satisfaction,’ because patient experience is more than satisfaction alone. Embedded within patient experience is a focus on individualized care and tailoring of services to meet patient needs and engage them as partners in their care. Next, the patient experience is strongly tied to patients’ expectations and whether they were positively realized (beyond clinical outcomes or health status). Finally, the patient experience is integrally tied to the principles and practice of patient continues to emerge as an important focus area across healthcare globally, the need for a standard consistent definition becomes even more evident, making it critical embraced part of the healthcare conversation.

Governing healthcare through performance measurement in Massachusetts and the Netherlands

Massachusetts and the Netherlands have implemented comprehensive health reforms, which have heightened the importance of performance measurement. The performance measures addressing access to health care and patient experience are similar in the two jurisdictions, but measures of processes and outcomes of care differ considerably. In both jurisdictions, the use of health outcomes to compare the quality of health care organizations is limited, and specific information about costs is lacking. New legislation in both jurisdictions led to the establishment of public agencies to monitor the quality of care, similar mandates to make the performance of health care providers transparent, and to establish a shared responsibility of providers, consumers and insurers to improve the quality of health care.In Massachusetts a statewide mandatory quality measure set was established to monitor the quality of care. The Netherlands is stimulating development of performance measures by providers based on a mandatory framework for developing such measures. Both jurisdictions are expanding the use of patient-reported outcomes to support patient care, quality improvement, and performance comparisons with the aim of explicitly linking performance to new payment incentives.

Evaluating Ethics Quality in Health Care Organizations: Looking Back and Looking Forward

To spark a conversation about how best to evaluate ethics quality, this article draws on the collective experience of the IntegratedEthicsTM evaluation team to reflect on what we have learned and to envision an agenda for future work. The article emphasizes the importance of beginning with a well-defined conceptual model, building an expert team, committing the resources necessary to do evaluation well, and tailoring the evaluation methods to the target audience. The article then describes a five-point agenda for future work on ethics quality in health care: further evaluate and improve ethics programs; further evaluate and improve specific ethical practices; examine the relationships among various aspects of ethics quality; examine the relationships between ethics quality and other important organizational outcomes; and foster cross-institutional collaborations to evaluate and improve ethics quality. The hope is that some day ethics will be fully integrated into the mainstream of health care quality management.

Human Capital Questionnaire: Assessment of European nurses' perceptions as indicators of human capital quality

Healthcare accreditation models generally include indicators related to healthcare employees' perceptions (e.g. satisfaction, career development, and health safety). During the accreditation process, organizations are asked to demonstrate the methods with which assessments are made. However, none of the models provide standardized systems for the assessment of employees. In this study, we analyzed the psychometric properties of an instrument for the assessment of nurses' perceptions as indicators of human capital quality in healthcare organizations. The Human Capital Questionnaire was applied to a sample of 902 nurses in four European countries (Spain, Portugal, Poland, and the UK). Exploratory factor analysis identified six factors: satisfaction with leadership, identification and commitment, satisfaction with participation, staff well-being, career development opportunities, and motivation. The results showed the validity and reliability of the questionnaire, which when applied to healthcare organizations, provide a better understanding of nurses' perceptions, and is a parsimonious instrument for assessment and organizational accreditation. From a practical point of view, improving the quality of human capital, by analyzing nurses and other healthcare employees' perceptions, is related to workforce empowerment.