Hospital Quality Management Research Articles

Teaching Hospital Governance Model for Service Quality Performance: Case Study of Indonesian Central General Hospital

This study aims to investigate the effect of teaching hospital management practices on the quality performance of health services by involving elements such as hospital accreditation standards, quality management, and JCI Academic Hospital-specific standards that are indirectly connected. This study chose a survey-based quantitative approach to clinical professional students in vertical teaching hospitals under the direct management of the Ministry of Health of the Republic of Indonesia. Six proposed hypotheses were tested by Partial Least Square-Structural Equation Modeling (PLS-SEM) analysis. The test results showed a positive influence between hospital teaching governance and hospital accreditation compliance, quality assurance and JCI Academic Hospital standards. Third, compliance with teaching hospital standards was also found to have a significant positive effect on the performance of teaching hospital service quality. Understanding the role of governance in encouraging the performance of teaching hospital service quality can help develop effective managerial strategies in achieving complete service quality for patients and clinical profession participants. This research resulted in contributions to existing practices and literature as governance modeling in dual quality standards charged to teaching hospitals.

Escalation process of critical values when these cannot be communicated on first attempt: A hospital-wide process improvement project.

Since laboratory critical values reflect such an abnormal pathologic state that there is imminent danger to the patient, it is crucial to deliver the result upon initial call with an escalation process when the initial call cannot occur. In our 8-hospital system, one of the hospitals used the escalation procedure twice as frequently compared with the other hospitals. This work presents hospital-wide quality improvement processes that decreased escalation of critical value calls so as to reach the same proportion of escalated calls compared to other hospitals in the system. The laboratory met weekly with leaders of different hospital areas and quality management; they presented the interventions they implemented, and the laboratory monitored their progress. Monitoring and reviewing with providers the importance of critical values decreased temporarily escalated calls from 25% to 18%. Having a dedicated phone to call critical values in each hospital area decreased the calls in a sustained fashion, which now fluctuate between 9% and 14%. Other interventions, including having a dedicated person receiving critical value results, did not decrease escalated critical value calls. Having a dedicated phone in each hospital area that receives the initial critical value call simplifies and standardizes the process.

Mediating Impact of Perceived Functional Value of Audit Service on the Relationship between Audit Characteristics and its Effect on Customer Satisfaction with Total Quality Management in Egyptian Hospitals

Mediating Impact of Perceived Functional Value of Audit Service on the Relationship between Audit Characteristics and its Effect on Customer Satisfaction with Total Quality Management in Egyptian Hospitals

The mediating role of job satisfaction and competitive advantage between quality management practices and sustainable performance: Case of hospitals in Guangxi, China

BACKGROUND: Ensuring medical quality and safety is the perpetual focus of healthcare management. Hospitals must prioritize quality management for sustainable growth. However, the complexity of quality management in hospitals, coupled with evolving practices, presents challenges. Achieving the integration of economic, environmental, and social benefits for high-quality development remains difficult. While quality management practices are acknowledged as strategic tools, their impact on job satisfaction, competitive advantage, and sustainable performance is not yet fully understood. OBJECTIVE: The objective of this research was to empirically demonstrate the relationship between quality management practices, job satisfaction, competitive advantage, and sustainable performance. METHODS: The study uses a quantitative research method. A questionnaire survey was conducted in Guangxi, China, among 171 quality management executives in secondary and tertiary hospitals, and the proposed research model was validated using PLS-SEM. RESULTS: The results showed that quality management practices have positive direct and indirect effects on sustainable performance, confirming the partial mediating role of job satisfaction, and competitive advantage in the relationship between quality management practices and sustainable performance. CONCLUSIONS: This study addresses a gap in quality management literature by exploring the relationship between quality management practices, job satisfaction, competitive advantage, and sustainable performance. Findings reveal that higher implementation of quality management practices correlates with increased job satisfaction, stronger competitive advantage, and enhanced sustainable performance in hospitals. These results suggest that implementing quality management practices can boost job satisfaction, enhance competitive advantage, and promote sustainable performance, offering valuable insights for hospital leaders.

Factors driving differences in the adoption of quality management practices among hospitals: A two-phase, sequential mixed-methods analysis.

Although all hospitals aim to deliver high-quality care, there is considerable variation in their adoption of quality management (QM) practices. Organizational and environmental factors are known to drive strategic decision-making in hospitals, but their impact on the adoption of QM practices remains unclear. Our study aims to identify multiple organizational and environmental factors that explain variation in the adoption of QM practices among hospitals and to explore mechanisms underlying these relationships. We conducted a two-phase, sequential mixed-methods study of German acute care hospitals. The quantitative phase used between-effects regressions to identify factors explaining variation in the number of QM practices adopted by hospitals from 2015 to 2019. The qualitative phase used semistructured interviews with quality managers to gain in-depth insights. The number of QM practices adopted by a hospital was significantly associated with factors like hospital size and the presence of an emergency department or QM steering committee. Our qualitative findings highlighted potential mechanisms such as the presence of an emergency department serving as a proxy for organizational complexity or urgency of case-mix. We provide an overview of factors driving QM adoption in hospitals, extending beyond the focus on single factors in previous research. Future studies could explore additional factors highlighted by our interviewees. Our results can inform interventions to strengthen QM in hospitals and guide future research on this topic.

Five Major Missions of the Medical Center Accreditation Drives the Transformation of Hospital Quality Management

<p>新竹臺大分院新竹醫院由區域醫院跨級挑戰醫學中心評鑑，準備過程中首要進行醫療品質與病人安全管理架構重整。透過「平衡計分卡」校準全院的品質管理目標，「品管負責人制度」強化與臨床互動、系統性規劃來培育品管人才，計畫性的推動參與外部競賽及國際的發表，以培養同仁對品質活動的成就感與熱忱。此外，透過諮詢、交流、和共享教育訓練等方式協助區域內醫院解決評鑑或衛生機關訪查的需求，並主動配合地方衛生主管機關進行政策推廣活動，提升區域整體醫療照護品質和病人安全。</p> <p> </p><p>The Hsinchu Branch of National Taiwan University Hospital embarked on the challenge of advancing from a regional hospital to a medical center through comprehensive medical accreditation. A pivotal aspect of the process involved restructuring the hospital’s quality management framework. Employing the "Balanced Scorecard" methodology to align the entire hospital’s quality management objectives, the hospital established the "Quality Control Officer" system to intensify collaboration between the Center for Quality Management and clinical units in quality management. Through strategic participation in external competitions and contributions to international conferences, the hospital seeks to inspire its employees with a sense of accomplishment and a passion for quality improvement. Moreover, through consultation, communication, and the dissemination of educational training, the hospital actively assists other hospitals in the region in meeting the requirements of accreditation or health authority inspections. Concurrently, the hospital proactively collaborates with local health authorities to enhance the overall quality of medical care and patient safety.</p> <p> </p>

Establishment of the quality management system for occupational diseases diagnosis

The quality management system of occupational diseases diagnosis is belonged to one part of the hospital quality management system. It must be adhered to the quality management concept of comprehensive, full staff and whole process. To establish and improve the quality management system should be included: (1) Formulated a quality management manual for occupational disease diagnosis, including organization construction, rules and regulations, responsibilities, work flow, operating procedures and clinical pathways, standard instrument, etc. (2) Managed the document of occupational diseases diagnosis. (3) The continuous improvement of quality management. The quality management of occupational diseases diagnosis focuses on the mastery and implementation of the manual by employees, which is reflected in the continuous improvement of daily work, internal assessment and external assessment.

Occupational Category and Professional Title Influencing the Knowledge, Attitudes and Practice (KAP) of Quality Training: A Cross-Sectional Survey From a Tertiary General Hospital.

Quality improvement is an international priority, and quality education and training are important parts of hospital quality management. The aim of this study was to understand the knowledge, attitudes and practices (KAP) and its influencing factors related to quality training in medical staff. A questionnaire survey was conducted by convenience sampling to assess the KAP of quality training in Taizhou Enze Medical Center. Principal component analysis was used to extract factors from the questionnaire. Descriptive statistics (frequency, median, mean), Kendall grade correlation analysis, and Mann-Whitney U tests were used to analyze the data. A total of 205 staff members participated in the questionnaire survey. For the 5 factors of the KAP scale, the highest score was factor F4, recognition and support for quality training (mean = 90.55, median = 100), followed by factor F3, perceived benefits (mean = 84.46, median = 85.65). Relatively lower scores were found for factor F2, quality knowledge learning and mastery (mean = 63.09, median = 63.89), and F5, quality management practices and sharing (mean = 82.07, median = 75.00). There was a correlation between the 5 factors. The scores of F2 (quality knowledge learning and mastery) for staff with senior professional titles were higher than those for staff with intermediate professional titles or below. The score of F3 (perceived benefits of quality training) in medical technicians and nurses was higher than in doctors and administrative personnel. Our findings showed that the respondents' attitude toward quality training was positive, but their knowledge mastery and practice behaviors should be further improved. Occupational category and professional title were the influencing factors of the quality training KAP. Therefore, hospital should conduct quality management training at a wider scope according to the competency requirements of different groups, and further optimize the improvement and innovation system.

Sustainable quality management in hospitals: The experiences of healthcare quality managers.

Quality management systems are essential in hospitals, but evidence shows a real literature gap on the sustainable implementation of quality. This study aimed to explore and identify enablers towards sustainable quality management in hospitals. Research design and Study Sample: Interviews were conducted with 23 healthcare quality managers from 20 hospitals. Data collection and/or Analysis: Data collection and analysis were conducted simultaneously by using the Qualitative Analysis Guide of Leuven and following the COREQ Guidelines. Thematic analysis from interview transcripts was performed in NVivo 12. The results reveal two categories: (1) quality in the organisation's DNA and (2) quality in the professional's DNA. The first category consists of: bottom-up and top-down management, the organisation-wide integration of quality and an organisational culture shift. The second one consists of: quality awareness, understanding the added value, the encouragement and engagement, the accountability and ownership for quality. Moving towards sustainable quality management systems in hospitals requires a good interaction between a bottom-up approach and leadership to ensure continuous support from healthcare stakeholders. This study contributes to existing conceptual and theoretical foundations with practical insights into sustainable quality management. The findings can guide quality departments and hospital management to regain professionals' commitment to quality and to establish a sustainable quality management system.

Mediating Effect of Work Engagement on the Relationship Between Workplace Spirituality and Total Quality Management of Private Hospitals

The study aims to determine the mediating effect of work engagement on the relationship between workplace spirituality and total quality management in private hospitals. A total of 543 regular employees selected through the stratified sampling approach were surveyed using adapted and validated standardized instruments. Data were analyzed using descriptive statistics, the Pearson r, and the Medgraph Sobel z-test to achieve the study objectives. Results revealed that respondents exhibited very high levels of work spirituality, work engagement, and total quality management. Overall, it was found that work spirituality, work engagement, and total quality management are statistically correlated. Further, it was found that work engagement partially mediates the relationship between work spirituality and total quality management in private hospitals in Panabo City. Implications are discussed in the study.

Challenges encountered by healthcare professionals in monitoring adverse events due to medical devices-A review

Medical devices can be hazardous despite their positive benefits. Reporting medical device adverse events are voluntary for all the health care professionals but the number of reporting adverse medical events are less when compared with all the available studies in India. Hence it is important to address the reasons and challenges that are faced by health care professionals in reporting the events so that safety and quality action can be taken in order to prevent them. Understanding the obstacles to and reasons for patient reporting is necessary and may help to increase the safety of medications. This review provides an insight into factors contributing to underreporting of MDAE such as Health care system capacity related, organizational related barriers, and Industry responsiveness. This review might offer helpful data for overcoming barriers in monitoring and support quality and safety management in hospitals.

Challenges encountered by health care professionals in monitoring adverse events due to medical devices: A review

Materiovigilance is the term used to characterize any negative outcomes brought on by a medical device. The "Materiovigilance Programme of India" is a plan that has been launched in India to track the unfavorable outcomes of the use of medical devices and to take the necessary action to resolve those unfavorable outcomes. On July 6, 2015, DCGI adopted MvPI at the Indian Pharmacopoeia Commission in Ghaziabad. Factors contributing to underreporting of MDAE are Health care system capacity related, Organizational related barriers, and Industry responsiveness. Challenges faced by healthcare professionals in reporting MDAE are administration, healthcare professionals, self-implementation of devices, counter-fit devices, and poor awareness. This approach might offer helpful data for purchasing decisions, and support quality and safety management in hospitals. The present evidence base is of low quality, and there isn't a framework to report error-causing elements, which limits the possibility of learning from mistakes.

Automated Monitoring of Adherence to Evidenced-Based Clinical Guideline Recommendations: Design and Implementation Study.

Clinical practice guidelines are systematically developed statements intended to optimize patient care. However, a gapless implementation of guideline recommendations requires health care personnel not only to be aware of the recommendations and to support their content but also to recognize every situation in which they are applicable. To not miss situations in which recommendations should be applied, computerized clinical decision support can be provided through a system that allows an automated monitoring of adherence to clinical guideline recommendations in individual patients. This study aims to collect and analyze the requirements for a system that allows the monitoring of adherence to evidence-based clinical guideline recommendations in individual patients and, based on these requirements, to design and implement a software prototype that integrates guideline recommendations with individual patient data, and to demonstrate the prototype's utility in treatment recommendations. We performed a work process analysis with experienced intensive care clinicians to develop a conceptual model of how to support guideline adherence monitoring in clinical routine and identified which steps in the model could be supported electronically. We then identified the core requirements of a software system to support recommendation adherence monitoring in a consensus-based requirements analysis within the loosely structured focus group work of key stakeholders (clinicians, guideline developers, health data engineers, and software developers). On the basis of these requirements, we designed and implemented a modular system architecture. To demonstrate its utility, we applied the prototype to monitor adherence to a COVID-19 treatment recommendation using clinical data from a large European university hospital. We designed a system that integrates guideline recommendations with real-time clinical data to evaluate individual guideline recommendation adherence and developed a functional prototype. The needs analysis with clinical staff resulted in a flowchart describing the work process of how adherence to recommendations should be monitored. Four core requirements were identified: the ability to decide whether a recommendation is applicable and implemented for a specific patient, the ability to integrate clinical data from different data formats and data structures, the ability to display raw patient data, and the use of a Fast Healthcare Interoperability Resources-based format for the representation of clinical practice guidelines to provide an interoperable, standards-based guideline recommendation exchange format. Our system has advantages in terms of individual patient treatment and quality management in hospitals. However, further studies are needed to measure its impact on patient outcomes and evaluate its resource effectiveness in different clinical settings. We specified a modular software architecture that allows experts from different fields to work independently and focus on their area of expertise. We have released the source code of our system under an open-source license and invite for collaborative further development of the system.

Authentic leadership, organizational culture and the effects of hospital quality management practices on quality of care and patient satisfaction.

To examine the influence of hospital culture and authentic leadership on the effects of quality improvement practices on patient satisfaction. Nurses in formal leadership roles shape and are shaped by organizational culture to achieve high performance standards to influence quality of care. Using structural equation modelling, we tested a model on quality improvement practices across three participant groups that differed based on authentic leadership and hospital culture. We used survey data from a cross-sectional study conducted in 2015 measuring nurse. Managers' perceptions of authentic leadership, implementation of quality improvement, and organizational culture in Canadian hospitals. 226 nurse managers participated. Our model estimations fit for the high-relational group and mixed group. Our model explained 50.7% and 39.5% variance in our outcome variable of patient satisfaction for the high-relational group and mixed group, respectively. Our model failed to fit the low-relational group. Authentic leadership and developmental/group hospital cultures improve quality management practices, quality of care and patient satisfaction. In organizations with low authentic leadership and hierarchical/rational cultures, strategies should target increasing authentic leadership and shifting to developmental cultures. Organizations with high authentic leadership and/or developmental/group cultures should target employee engagement, autonomy and teamwork. We examined how different combinations of authentic leadership and hospital culture influence the effects of quality management practices on quality improvement and patient satisfaction. Findings demonstrate that having both high authentic leadership and developmental or group hospital cultures are essential for quality improvement practices to enhance the quality of care and patient satisfaction. These organizations would benefit the most from systemic programs aimed at standardizing quality management practices as they have the culture and leadership to support these practices. For hospitals with hierarchical/rational cultures and/or low authentic leadership, enhancing hospital culture and leadership through leadership training and accreditation programs is critically needed. The College and Association of Registered Nurses of Alberta contributed to this study by facilitating data collection and supporting the conduct of the study through messaging to its members.

Peritoneal Dialysis Care in Mainland China: Nationwide Survey.

Peritoneal dialysis (PD) care in mainland China has been progressing in the past 10 years. To complement information from the dialysis registry, a large-scale nationwide survey was conducted to investigate the current infrastructure and management of PD care at hospitals of different tiers. A web-based multiple-choice questionnaire was distributed through the National Center for Nephrology Medical Quality Management and Control to PD centers of secondary and tertiary hospitals in October 2020. The 2-part survey collected the information of PD centers and the clinical management of patients on PD. A total of 788 effective surveys from 746 hospitals were voluntarily returned, and data were extracted and analyzed. The effective survey data covered 101,537 patients on PD, with 95% (96,460/101,537) in the tertiary hospitals. The median number of patients per PD center was 60 (IQR 21-152); this number was 32 (IQR 8-65) and 70 (IQR 27-192) for secondary and tertiary hospitals, respectively. There was a discrepancy in the availability of designated physical areas for different functions of PD care between the secondary and tertiary hospitals. The proportion of tertiary hospitals with PD training (P=.01), storage (P=.09), and procedure area (P<.001) was higher compared to secondary hospitals. PD catheter placement was performed in 96% (608/631) of the PD centers in tertiary hospitals, which was significantly higher compared to 86% (99/115) in secondary hospitals (P<.001). Automated PD was available in 55% (347/631) of the tertiary hospitals, which was significantly higher than that in secondary hospitals (37/115, 32%) according to the survey (P<.001). The most commonly performed PD module was continuous ambulatory peritoneal dialysis (772/788, 98%), followed by intermittent peritoneal dialysis (543/788, 69%). The overall reported nocturnal intermittent peritoneal dialysis was 31% (244/788); it was 28% (220/788) for continuous cycling peritoneal dialysis and 15% (118/788) for tidal peritoneal dialysis. Comparisons between the secondary and tertiary hospitals revealed no significant differences in prophylactic antibiotic use for PD catheter placement and therapeutic use for peritonitis. The first peritoneal equilibrium test was conducted in 58% (454/788) of patients at 4-6 weeks after initiation of PD, and 91% (718/788) reported at least one peritoneal equilibrium test per year. Overall, 79% (570/722) and 65% (469/722) of PD centers performed assessment for dialysis adequacy and residual kidney function, respectively; and 87% (685/788) of patients on PD were followed every 1 to 3 months for laboratory and auxiliary examinations. This national survey reflects the current status and disparities of PD center management in mainland China. The study results suggest that the PD care needs to be more conveniently accessible in secondary hospitals, and quality management and staff training in secondary hospitals are still in high demand.

Management Optimisation of F City People's Hospital from the Perspective of PDCA Cycle

This case describes how F City People's Hospital, the largest hospital in F City, uses PDCA management tools to improve the quality of hospital management continuously. F City People's Hospital integrates PDCA management tools into its daily management by living and learning under the new form of medical reform, providing new ideas for public hospitals' healthy and sustainable development. We will summarise the effectiveness of continuous improvement of hospital quality management, gain experience and insights into PDCA application in hospital quality management, and provide a reference basis for the overall improvement of hospital quality management. The study will provide a reference basis to continuously improve the general quality management level of the hospital.

Drug closed-loop management system using mobile technology

BackgroundDrug closed-loop management reflects the level of hospital management and pharmacist service. It is a challenge for hospital pharmacists to realize the whole-process closed-loop management of drugs in hospital pharmacies. Therefore, this study aimed to evaluate the operational effect of using mobile technology to build a closed-loop drug management system.MethodsUsing mobile technology, replacing the traditional paper dispensing model and constructing a multinode information collection system according to the Healthcare Information and Management Systems Society Standard, we reformed the hospital information system and inpatient pharmacy workflow and then evaluated the new approach using statistical methods.ResultsAfter the transformation, the entire process of drug data can be traced. Closed-loop management, as well as real-time data verification and control, thereby improves the work efficiency and reduces the drug dispensing time. By reducing the work error rate, the number of dispensing errors decreased from 5 to 1 case/month. The comprehensive dispensing process can achieve the whole workflow of paperless operation and reduce the use of paper A4 by 180,000 pieces per year.ConclusionsMobile technology can improve the service level of pharmacies, enhance the level of drug management and hospital quality management, ensure the safety of medication for inpatients, and significantly reduce the amount of paper used.

Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach.

SSIs (surgical site infections) are associated with increased rates of morbidity and mortality. The traditional quality improvement strategies focusing on individual performance did not achieve sustainable improvement. This study aimed to implement the Six Sigma DMAIC method to reduce SSIs and to sustain improvements in surgical quality. The surgical procedures, clinical data, and surgical site infections were collected among 42,233 hospitalized surgical patients from 1 January 2019 to 31 December 2020. Following strengthening leadership and empowering a multidisciplinary SSI prevention team, DMAIC (Define, Measure, Analyze, Improve, and Control) was used as the performance improvement model. An evidence-based prevention bundle for reduction of SSI was adopted as performance measures. Environmental monitoring and antimicrobial stewardship programs were strengthened to prevent the transmission of multi-drug resistant microorganisms. Process change was integrated into a clinical pathway information system. Improvement cycles by corrective actions for the risk events of SSIs were implemented to ensure sustaining improvements. We have reached the targets of the prevention bundle elements in the post-intervention period in 2020. The carbapenem resistance rates of Enterobacteriaceae and P. aeruginosa were lower than 10%. A significant 22.2% decline in SSI rates has been achieved, from 0.9% for the pre-intervention period in 2019 to 0.7% for the post-intervention period in 2020 (p = 0.004). Application of the Six Sigma DMAIC approach could significantly reduce the SSI rates. It also could help hospital administrators and quality management personnel to create a culture of patient safety.

Kết quả cải tiến chất lượng bệnh viện theo bộ tiêu chí chất lượng bệnh viện tại một bệnh viện công lập tỉnh Phú Thọ giai đoạn 2016-2019

Quality management is becoming more crucial issue for healthcare facilities in the current time. Objective: To describe the results of implementation of hospital quality management according to the 83 Criteria at Phu Tho general hospital in the period 2016-2019. Methods: A descriptive study was conducted with a combination of quantitative and qualitative approaches. The quantitative study used secondary data from the reports on the implementation of 83 hospital quality criteria at Phu Tho general hospital in the period 2016 - 2019, the qualitative study employed in-depth interviews with hospital director, head of quality department and focus-group discussion with head of clinical department and head nurses. Results: The main findings showed that the score of hospital quality according to 83 Criteria of hospital quality increased gradually by year from 4.06 points (in 2016) to 4.50 points (in 2017), 4.67 points (in 2018) and 4.70 points (in 2019). These factors influenced to the implementation of hospital quality improvement at Phu Tho general hospital such as the lack of specialized pharmacy staffs, especially clinical pharmacists. Based on the findings, it suggested that the hospital should improve the quality of human resources, particularlly focus on doctors and clinical pharmacists. Moreover, the hospital keep continuing to promote the application of information technology in medical examination and treatment activities, also to improve efficiency and effectively use of medical information at the hospital. Keywords: hospital quality management, quality indicator, healthcare quality, Phu Tho general hospital,…

Application Value of Management Model Based on "Zero Tolerance" Concept in Pressure Ulcer Management.

Background Pressure injuries are the most prevalent health problem worldwide. Improving the quality of hospital pressure injury management is an important indicator to improve the quality of hospital management. Objective To explore the application value of the management model centered on the concept of “zero tolerance” in the management of pressure ulcers (PU). Methods The effects of conventional management mode and management mode centered on the concept of “zero tolerance” on PU patients and nursing staff were retrospectively analyzed. The patients were evaluated by the general comfort questionnaire (GCQ), Generic Quality of Life Inventory 74 (GQOL-74), and pressure ulcer healing scale (PUSH). At the same time, the satisfaction of PU patients and nursing staff with different management modes was investigated. Results When comparing the conditions of patients under different management modes, it was found that the “zero tolerance” management mode can improve the comfort and quality of life of patients during hospitalization. Compared with the conventional management mode, the “zero tolerance” management mode can significantly improve the degree of pressure ulcer healing in patients. In addition, the “zero tolerance” management model can not only improve the satisfaction of patients with management but also improve the satisfaction of nursing staff with management. Conclusion Standardized management of PU patients with the concept of “zero tolerance” as the core can improve the health status and quality of life of patients, promote wound healing, and improve the satisfaction of patients and nurses with the management plan.