Healthcare Quality Standards Research Articles

Accounting for failure: risk-based regulation and the problems of ensuring healthcare quality in the NHS

In this paper, we examine why risk-based policy instruments have failed to improve the proportionality, effectiveness, and legitimacy of healthcare quality regulation in the National Health Service (NHS) in England. Rather than trying to prevent all possible harms, risk-based approaches promise to rationalise and manage the inevitable limits of what regulation can hope to achieve by focusing regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. As such, risk-based approaches have been enthusiastically adopted by healthcare quality regulators over the last decade. However, by drawing on historical policy analysis and in-depth interviews with 15 high-level UK informants in 2013–2015, we identify a series of practical problems in using risk-based policy instruments for defining, assessing, and ensuring compliance with healthcare quality standards. Based on our analysis, we go on to consider why, despite a succession of failures, healthcare regulators remain committed to developing and using risk-based approaches. We conclude by identifying several preconditions for successful risk-based regulation: goals must be clear and trade-offs between them amenable to agreement; regulators must be able to reliably assess the probability and consequences of adverse outcomes; regulators must have a range of enforcement tools that can be deployed in proportion to risk; and there must be political tolerance for adverse outcomes.

The Effect of Quality Accreditation Programs on Patient Safety Experiences in Nursing Services

Introduction: Ministry of Health has initiated Quality Accreditation studies with Transformation Project in Health in 2003. These studies have gained extensive momentum especially in the last decade, and have composed Quality Accreditation Programs (Quality Standards in Healthcare, associated guidelines), which are applied in all healthcare institutions and institutes. The status of achievement in applying the criteria, laid down by Quality Standards in Healthcare, is significantly affected by physical locations of institutions and institutes, technical facilities, and knowledge levels and experiences of personnel. Purpose: This study has been conducted to assess the contributions of Quality Accreditation Programs to patient safety knowledge and practices in nursing services and to measure the effects of different variables on these practices. Methods: The study has been conducted with 175 nurses in different age groups, at different educational levels, and working in hospital clinics, and having different durations of work experience. Data has been obtained by a questionnaire of 12 questions (two questions have sub-questions). Descriptive statistical methods have been used in data analysis, and Chi square test has been used in required sub-group analysis. Findings: The half of the participants was in the age group of 25-34 years. 98.9% of nurses stated that they received patient safety training. 90.9% of participants thought that these trainings were sufficient. The ratio of the ones, indicating that they needed training on this subject, was 22.3%. The ratio of the participants, reporting on patient safety, was detected as 78.3%. The ratio of nurses, reporting on this subject, was found significantly high in the age group of 25-34 years (p=0.012). The rate of receiving training was low in nurses with work experience of less than one year (p=0.038). The rate of reporting on patient safety was significantly low in participants with work experience of less than one year and with work experience of more than 10 years (p=0.049). Conclusion: Although the rate of receiving training on patient safety is high, the rate of participants, practically reporting on this subject, is low. This has led to the thought that training is not always fully effective in attitude change. We think that the implementation of short-term reminder trainings may be useful.

Trailblazers in South Carolina: Clinical pharmacists practiced with family physicians in 1970s

“People think medication management is new, but to us this is old,” said Rick Schnatz, PharmD, a graduate of the second class of the PharmD program at MUSC and now senior manager for compounding and healthcare quality standards at USP. “We were trailblazers back then.” South Carolina has a long history as a training ground for family practice, and student pharmacists in the MUSC program had the choice to train in family medicine during their residency. Upon graduation, Schnatz and a group of other recent PharmD graduates took the interdisciplinary concept and opened up their own practices with some of the physicians they trained with. “We proved it could be done,” said Schnatz.

Clinical Nurse Leader Integration Into Practice: Developing Theory To Guide Best Practice.

Numerous policy bodies have identified the clinical nurse leader (CNL) as an innovative new role for meeting higher health care quality standards. Although there is growing evidence of improved care environment and patient safety and quality outcomes after redesigning care delivery microsystems to integrate CNL practice, significant variation in CNL implementation has been noted across reports, making it difficult to causally link CNL practice to reported outcomes. This variability reflects the overall absence in the literature of a well-defined CNL theoretical framework to help guide standardized application in practice. To address this knowledge gap, an interpretive synthesis with a grounded theory analysis of CNL narratives was conducted to develop a theoretical model for CNL practice. The model clarifies CNL practice domains and proposes mechanisms by which CNL-integrated care delivery microsystems improve health care quality. The model highlights the need for a systematic approach to CNL implementation including a well-thought out strategy for care delivery redesign; a consistent, competency-based CNL workflow; and sustained macro-to-micro system leadership support. CNL practice can be considered an effective approach to organizing nursing care that maximizes the scope of nursing to influence the ways care is delivered by all professions within a clinical microsystem.

Conceptualizing clinical nurse leader practice: an interpretive synthesis.

The Institute of Medicine's Future of Nursing report identifies the clinical nurse leader as an innovative new role for meeting higher health-care quality standards. However, specific clinical nurse leader practices influencing documented quality outcomes remain unclear. Lack of practice clarity limits the ability to articulate, implement and measure clinical nurse leader-specific practice and quality outcomes. Interpretive synthesis design and grounded theory analysis were used to develop a theoretical understanding of clinical nurse leader practice that can facilitate systematic and replicable implementation across health-care settings. The core phenomenon of clinical nurse leader practice is continuous clinical leadership, which involves four fundamental activities: facilitating effective ongoing communication; strengthening intra and interprofessional relationships; building and sustaining teams; and supporting staff engagement. Clinical nurse leaders continuously communicate and develop relationships within and across professions to promote and sustain information exchange, engagement, teamwork and effective care processes at the microsystem level. Clinical nurse leader-integrated care delivery systems highlight the benefits of nurse-led models of care for transforming health-care quality. Managers can use this study's findings to frame an implementation strategy that addresses theoretical domains of clinical nurse leader practice to help ensure practice success.

Results from an audit feedback strategy for chronic obstructive pulmonary disease in-hospital care: a joint analysis from the AUDIPOC and European COPD audit studies.

BackgroundClinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. However, the effectiveness of audit and feedback has shown inconsistent results and the impact of audit and feedback on clinical performance has not been evaluated for COPD exacerbations. In the present study, we analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy.MethodsThe present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation. The first audit was performed from November–December 2008. The feedback strategy consisted of personalized reports for each participant center, the presentation and discussion of the results at regional, national and international meetings and the creation of health-care quality standards for COPD. The second audit was part of a European study during January and February 2011. The impact of the feedback strategy was evaluated in term of clinical care provided and in-hospital survival.ResultsA total of 94 centers participated in the two audits, recruiting 8,143 admissions (audit 1∶3,493 and audit 2∶4,650). The initially provided clinical care was reasonably acceptable even though there was considerable variability. Several diagnostic and therapeutic procedures improved in the second audit. Although the differences were significant, the degree of improvement was small to moderate. We found no impact on in-hospital mortality.ConclusionsThe present study describes COPD hospital care in Spanish hospitals and evaluates the impact of peer-benchmarked, individually written and group-oral feedback strategy on the clinical outcomes for treating COPD exacerbations. It describes small to moderate improvements in the clinical care provided to COPD patients with no impact on in-hospital mortality.

HEALTH INSURANCE SYSTEM IN SERBIA – QUALITY, REFORM, FINANCIAL SUSTAINABILITY

Constrained by difficult economic situation, the health system in Serbia is facing a great challenge, and in order to overcome it and handle the gap between possibilities and expectations, it is necessary to implement economic reform of health care sector in Serbia, i.e. its decentralization, which implies improvements in providing health services while trying to find a model of financial sustainability of health care system in Serbia. One of the most essential impulses of society to its economic and general social development is the health of its population. In fact, in addition to being a social potential, health is to be considered as an economic potential of a country as well. The need to examine health from economic point of view, as well as in the sense of sustainable economic development, is gaining in presence in the newly made circumstances of an advancing economic crisis. There is an evident gap in the social community between the expectations of health care beneficiaries who are used to high-quality services with considerably subsidized health care and the new situation where health care institutions dispose of no funds to ensure the necessary prerequisites for providing health care, with an obvious weakening of social interlinkage and a fading trust in health care institutions. Any change in terms of scope, quality and prices of health care may and does runs into the wall of disapproval, even judgment; therefore, it is necessary to regulate and legally define health care quality standards in the health system of Serbia and thus precisely determine the quality of service provided and, at the same time, manner of payment, i.e. responsibility for the costs incurred. In order to reach a financially sustainable health care system in Serbia, it is necessary to analyze different models of funding, implement rationalization and reorganization of methods of funding and reexamine the health insurance models in Serbia. The priority concerning the health system financing is the selection of the most adequate method of raising sufficient funds. There are numerous factors which will determine our choice of a particular The address of the author: Ana Gavrilovic  anagavrilovic22@gmail.com Gavrilovic A. Health insurance system in Serbia MEST Journal Vol. 1 No. 2 pp. 114 – 126 Published: July 2013 MESTE | 115 model of health care system funding in Serbia, among which the following are most important: degree of socio-economic development of the country, fiscal capacity of the country, methods and efficiency of fund raising, support from the political system in its feasibility.

CARE PLANNING IN ADVANCE: THE PROCESS OF BRINGING AN IMPOSSIBLE MISSION TO AN INSTITUTIONAL REALITY AT ST VINCENT'S HOSPITAL MELBOURNE

BackgroundThe development of a systematised advanced care planning process in Catholic faith based institutions has presented challenges that have seen unsustainable unsupported programme. Increasing clinician need, a changing understanding of...

Indicadores de calidad asistencial para la atención de personas que viven con el virus de la inmunodeficiencia humana, adaptados a la edad pediátrica

IntroductionSince infection with human immunodeficiency virus (HIV) was first described, there have been many advances in its diagnosis, monitoring and treatment. However, few contributions are related to the area of health care quality.In this sense, the Spanish Study Group on AIDS (GESIDA) has developed a set of quality care indicators for adult patients living with HIV infection that includes a total of 66indicators, 22 of which are considered to be relevant. Standards were calculated for each of them in order to reflect the level of the quality of care offered to these patients. Similar documents for pediatric patients are currently lacking. MethodsPreparation of a set of quality care indicators applicable to pediatric patients based on the GESIDA document and the Spanish Guidelines for monitoring of pediatric patients infected with HIV. Each indicator was analysed with respect to the required standards in all patients under 18years of age followed-up in our Unit, with the aim of evaluating the quality of care provided. ResultsA total of 61indicators were collected (51 from the GESIDA document and 10 from currently available pediatric guidelines), 30 of which were considered to be relevant. An overall compliance of 81%-83% was obtained when assessing the relevant indicators. ConclusionThe availability of health care quality standards is essential for the care of pediatric HIV-infected patients. The assessment of these indicators in our Unit yielded satisfactory results.

Healthcare quality standards provide opportunity and expectation for dietitians

Healthcare quality standards provide opportunity and expectation for dietitians

Let’s be effective, let the patients talk! Does ‘patient intelligence’ have an effect on improvements in quality within the healthcare environment?

Let’s be effective, let the patients talk! Does ‘patient intelligence’ have an effect on improvements in quality within the healthcare environment? Nadine van DongenVan Dongen Research Ltd, London, UKAbstract: This paper examines the interaction of patients within the context of efficiency in the pharmaceutical environment. Measurements of quality standards in healthcare are reviewed with an emphasis on the question of whether ‘patient intelligence’ can improve quality standards in healthcare. Something given particular consideration is the ethical point of view versus the business point of view, in relation to the integration of patients into the decision-making process of a healthcare organization. The paper focuses on the formal and informal reasons for involvement of patients in corporate and/or market access strategies for healthcare organizations.Keywords: healthcare, decision-making process, efficiency, patient intelligence, patients

Health-Care Quality Standards in Chronic Obstructive Pulmonary Disease

Although clinical practice guidelines have contributed to improving the quality of health care offered to patients with chronic obstructive pulmonary disease (COPD), the level of adherence to recommendations continues to be inadequate and variable. Standards of care in COPD are written after applying an evidencebased approach, with the aim of unifying health-care criteria, establishing levels of acceptable adherence, and providing a way to assess quality; the ultimate goal is to improve patient care. In this statement we propose a series of health-care quality criteria and related indicators that will facilitate the quantitative evaluation of adherence to recommendations. The level of adherence that should be required is stipulated. This statement is not intended to provide a detailed description of how COPD should be managed. The aim is rather to set out quality assurance criteria that will contribute to the improvement of health-care access and equity, guaranteeing application of the highest levels of scientific and technical quality possible within the constraints of available resources, with the final purpose of satisfying the patient with COPD. The quality criteria have been grouped in 3 categories: a) so-called key criteria, to which adherence is essential; b) a set of conventional quality standards; and c) health-care administrative standards. Finally, we propose a framework on which to base the eventual accreditation of health-care quality for COPD patients.

THE VALUE COMPONENT OF EVIDENCE-BASED MEDICINE

THE VALUE COMPONENT OF EVIDENCE-BASED MEDICINE

Inpatient care of mentally ill people in prison: results of a year's programme of semistructured inspections

Objective: To investigate the facilities for inpatient care of mentally disordered people in prison.Design: Semistructured inspections conducted by doctor and nurse. Expected standards were based on healthcare quality standards published...

Quality-of-care challenges for rural health.

The purpose of this article is to examine the issue of quality of care in rural America and to help others examine this issue in a way that is consistent with the very real challenges faced by rural communities in ensuring the availability of adequate health services. Rural citizens have a right to expect that their local health care meets certain basic standards. Unless rural providers can document that the quality of local health care meets objective external standards, third-party payers might refuse to contract with rural providers, and increasingly sophisticated consumers might leave their communities for basic medical care services. To improve the measurement of health care quality in a rural setting, a number of issues specific to the rural environment must be addressed, including small sample sizes (volume and outcome issues), limited data availability, the ability to define rural health service areas, rural population preferences and the lower priority of formal quality-of-care assessment in shortage areas. Several current health policy initiatives have substantial implications for monitoring and measuring the quality of rural health services. For example, to receive community acceptance and achieve fiscal stability, critical access hospitals (CAHs) must be able to document that the care they provide is at least comparable to that of their predecessor institutions. The expectations for quality assurance activities in CAHs should consider their limited institutional resources and community preferences. As managed care extends from urban areas, there will be an inevitable collision between the ability to provide care and the ability to measure quality. As desirable as it might be to have a national standard for health care quality, this is not an attainable goal. The spectrum and content of rural health care are different from the spectrum and content of care provided in large cities. Accrediting agencies, third-party carriers and health insurance purchasers need to develop rural health care quality standards that are practical, useful and affordable.

The quality of health care in prison: results of a year's programme of semistructured inspections

Objectives: To assess, as part of wider inspections by HM Inspectorate of Prisons, the extent and quality of health care in prisons in England and Wales.Design: Inspections based on a...

Metodologia para a estimativa de padrões de qualidade: o caso do infarto agudo do miocárdio

This study outlines the steps for estimating quality standards in health care to be used in quality improvement programs and funding mechanisms, focusing on the case of acute myocardial infarction (AMI). The methodology is based on existing scientific evidence related to technologies currently used for treatment of AMI in Brazil. Hospital lethality was estimated for selected sets of technologies corresponding to more or less complex units. Basic parameters used for estimating standards were efficacy (percentage reduction in death rates ratio) and the percentage corresponding to the referent (indications) associated with each technology. Standards were adjusted for age and time interval from onset to hospital admission. Estimated standard hospital lethality varied from 28% (traditional care wards) to 8.5% (relatively complex coronary care units). Limitations of the proposed methodology are discussed.