August 29, 2011
Canada has invested significant financial resources and energy (including numerous federal and provincial commissions) in efforts to make the healthcare system more responsive to evolving needs. Nonetheless, there is general consensus that Canada’s healthcare systems have been too slow to adapt. A 2008 report by the Health Council of Canada concludes that since the 2003 Health Accord there have been improvements in access to care in some clinical priority areas, such as hip and knee replacement and cataract surgery. However, it also identifies a number of areas where “progress on the accord commitments is not a cause for celebration” (HCC, 2008:34). These areas include drug coverage and safe and appropriate prescribing; home care; aboriginal health; primary healthcare; the healthcare workforce; electronic health records and information technology; and accountability.
This paper suggests avenues that governments can take to support the transformation of the healthcare system to provide better care and services.
Posted in READ Portal, Reports & Papers | Tagged with Canada, Health care reform, Quality improvement | No Comments
August 24, 2011
Background: Urgent, unplanned hospital readmissions are increasingly being used to gauge the quality of care. We reviewed urgent readmissions to determine which were potentially avoidable and compared rates of all-cause and avoidable readmissions.
Methods: In a multicentre, prospective cohort study, we reviewed all urgent readmissions that occurred within six months among patients discharged to the community from 11 teaching and community hospitals between October 2002 and July 2006. Summaries of the readmissions were reviewed by at least four practising physicians using standardized methods to judge whether the readmission was an adverse event (poor clinical outcome due to medical care) and whether the adverse event could have been avoided. We used a latent class model to determine whether the probability that each readmission was truly avoidable exceeded 50%.
Results: Of the 4812 patients included in the study, 649 (13.5%, 95% confidence interval [CI] 12.5%–14.5%) had an urgent readmission within six months after discharge. We considered 104 of them (16.0% of those readmitted, 95% CI 13.3%–19.1%; 2.2% of those discharged, 95% CI 1.8%–2.6%) to have had a potentially avoidable readmission. The proportion of patients who had an urgent readmission varied significantly by hospital (range 7.5%–22.5%; χ2 = 92.9, p < 0.001); the proportion ofreadmissions deemed avoidable did not showsignificant variation by hospital (range 1.2%–3.7%; χ2 = 12.5, p < 0.25). We found no association between the proportion of patients who had an urgent readmission and the proportion of patients who had an avoidable readmission (Pearson correlation 0.294; p = 0.38). In addition, we found no association between hospital rankings by proportion of patients readmitted and rankings by proportion of patients with an avoidable readmission (Spearman correlation coefficient 0.28, p = 0.41).
Interpretation: Urgent readmissions deemed potentially avoidable were relatively uncommon, comprising less than 20% of all urgent readmissions following hospital discharge. Hospital-specific proportions of patients who were readmitted were not related to proportions with a potentially avoidable readmission.
Posted in Journal Articles, READ Portal | Tagged with Indicators, Quality improvement | No Comments
August 19, 2011
“Rising healthcare costs and the new Excellent Care for All Act quality legislation suggest a paradigm shift toward a new performance-based healthcare system in Ontario that will aim to improve the quality of care and health outcomes, and lead to more sustainable healthcare expenditures through evidence-based funding. As the province shapes new performance-based policies, hospitals with appropriate information management infrastructures and business intelligence (BI) capabilities will be well equipped with the decision-making tools that will help them adapt their business and operational models to align with these policies, deliver higher-quality care and emerge as high performers. Currently, however, Ontario hospitals find themselves at different stages of information management and BI “maturity” and therefore at different levels of readiness to meet these reforms. In addition to outlining key challenges to developing fully mature information management and BI capabilities, this paper identifies eight key BI dimensions that can help hospitals advance their information management and BI agendas. To stay abreast of healthcare changes, hospitals must assess their current information management and BI maturity and identify the steps they will need to take to overcome gaps and meet demands for higher-quality care in the future.”
Posted in Journal Articles, READ Portal | Tagged with Process improvement, Quality improvement, Quality of care | No Comments
August 17, 2011
“Despite widespread acknowledgment of waste and inefficiency in the U.S. health care system, there have not been dramatic breakthroughs that point the way to more cost-effective alternatives. The problems that contribute to high costs and mediocre quality are complex and intertwined with the organization and financing of health services. There are, however, changes under way within leading organizations that suggest significant improvements in quality and value can be achieved. In 2008, the Leapfrog Group’s Hospital Recognition Program began identifying hospitals that have made “big leaps in health care safety, quality, and customer value.” Thirteen hospitals out of nearly 1,300 who voluntarily submitted data in 2008 achieved top scores in quality of care while keeping resource use low.
To learn what opportunities exist for all hospitals to achieve greater efficiency, we conducted case studies of four of the 13 Leapfrog Group–designated “Highest Value Hospitals.” These included Fairview Southdale Hospital in Edina, Minn., North Mississippi Medical Center in Tupelo, Miss., Park Nicollet Methodist Hospital in St. Louis Park, Minn., and Providence St. Vincent Medical Center in Portland, Ore. This paper offers a synthesis of lessons from their experiences.”
Posted in READ Portal, Reports & Papers | Tagged with Benchmarking, Cost effectiveness, Efficiency, Quality assessment, Quality improvement | No Comments
August 12, 2011
“Despite markedly different systems, some healthcare providers in the US have successfully combined quality improvements with savings to the bottom line…
We (the authors) share our impressions of what we have observed in some of the US healthcare providers that have successfully focused their attention on quality improvements, while keeping a close eye on their bottom line. We describe the common themes we have noted and that appear to be helpful in building the necessary will to execute change:
1. A consistent approach to improvement, and capability building for improvement;
2. Population health thinking and solution building;
3. Leading with intelligence;
4. Leadership for quality from the very top, and for the long haul;
5. The patient and their family are the focus of attention at all times;
6. Alignment of financial measures and quality measures.”
Posted in Journal Articles, READ Portal | Tagged with Benchmarking, Quality assessment, Quality improvement | No Comments
August 11, 2011
“This How-to Guide is designed to support hospital-based teams and their community partners in codesigning and reliably implementing improved care processes to ensure that patients who have been discharged from the hospital have an ideal transition to the next setting of care (such as a primary care practice, home care, or a skilled nursing facility).
The Guide includes:
- Getting Started: This section lists steps to get started on creating an ideal transition for patients being discharged from the hospital, a post-acute care setting, or a rehabilitation facility.
- Key Changes: Four key recommendations for improving the transition out of the hospital are described, including typical failures encountered, recommended measures to guide improvement, and tools and resources to help teams implement the changes.
- Testing, Implementing, and Spreading Changes: A review of fundamental improvement methods and resources for testing changes before they are implemented and spread more widely throughout the organization.
- Case Studies: The cases provide examples of how organizations implemented the key changes to improve transitions from the hospital.
- Resources and References: Worksheets and other tools to help hospital teams implement the changes, along with a bibliography of selected resources.”
Posted in Multimedia, READ Portal | Tagged with Outpatient care, Patient-centered care, Process improvement, Quality improvement | No Comments
August 5, 2011
“The North Wales Cancer Treatment Centre (NWCTC) has to deal with an increasing demand in the number of patients who require chemotherapy, with the escalating use of second line, third line, and additional treatment for many cancers. As a result, there is growing pressure on the chemotherapy unit to deliver treatment quickly, efficiently, and safely. Following guidelines from the Department of Health’s Manual for Cancer Services, we are constantly looking for ways to improve and develop the level of care provided at our center, and the process of receiving chemotherapy has been identified as an area of high risk. Therefore, a team was established to review and explore current practices at the NWCTC with the goal of implementing an improved process to minimize the risks of chemotherapy treatment.”
Posted in Journal Articles, READ Portal | Tagged with Cancer, Patient-centered care, Quality improvement, Risk assessment, Risk management | No Comments
June 21, 2011
“A RAND study of teamwork-improvement initiatives in hospital labor and delivery (L&D) units was designed to document and learn from the experiences and outcomes of five L&D units as they implemented improvements in their teamwork practices over a one-year period. The study had two objectives:
- better understand the conditions and actions required for hospital L&D units to achieve effective and sustainable teamwork practices, and
- assess the extent to which successful adoption of teamwork practices may influence the experiences of L&D staff and patient outcomes.
Substantial progress is possible in one year of implementing teamwork practices, which can improve proximal outcomes, such as staff knowledge and perceptions. More than a year of implementation effort is required to achieve a high level of performance on teamwork practices. Two dynamics might be involved in later years of implementation:
- momentum from the first year might continue into later years, such that subsequent implementation might reinforce continued improvement, and
- it might not be possible to sustain high intensity in implementation beyond the first year.
The study results reinforce the importance of developing and implementing a well-crafted strategy by training staff in the L&D units, working consistently with staff to introduce practices, and providing coaching on effective use of practices. The study identified some key factors required by any given strategy for teamwork improvement, but it did not point to a standard template for implementation. This result implies that there may not be one fixed “intervention” that could be tested in comparative-control studies to develop further evidence for teamwork practices.”
Posted in READ Portal, Reports & Papers | Tagged with Health human resources, Quality improvement, Teamwork | No Comments
May 31, 2011
This article from Healthcare Quarterly reviews the Saskatchewan’s Health Quality Council (HQC) Accelerating Excellence initiative. The initiative, launched in 2008, was designed to help the HQC refresh and renew its approach to healthcare delivery. While the process is still underway, the Accelerating Excellence program has shifted the focus of the HQC from the mechanics of care delivery to the needs and comfort of the patient. The initiative is trying to erase long waiting times, reduce doctor form-completion error, implement strong leadership, set measurable goals, and more. The HQC example serves as a learning template for other provinces wishing to revamp their approach to quality healthcare delivery.
Posted in Journal Articles, READ Portal | Tagged with Canada, Patient satisfaction, Patient-centered care, Quality improvement, Quality of care | No Comments
May 30, 2011
“The lack of systematic oversight of physician performance has led to some serious cases related to physician competence and behaviour. We are currently implementing a hospital-wide approach to improve physician oversight by incorporating it into the hospital credentialing process. Our proposed credentialing method involves four systems: (1) a system for monitoring and reporting clinical performance; (2) a system for evaluating physician behaviour; (3) a complaints management system; and (4) an administrative system for maintaining documentation. In our method, physicians are responsible for implementing an annual performance assessment program. The hospital will be responsible for the complaints management system and the system for collecting and reporting relevant health outcomes. Physicians and the hospital will share responsibility for monitoring professional behaviour. Medical leadership, effective governance, appropriate supporting information systems and adequate human resources are required for the program to be successful. Our program is proactive and will allow our hospital to enhance safety through a quality assurance framework and by complementing existing safety activities. Our program could be extended to non-hospital physicians through regional health or provider networks. Central licensing authorities could help to coordinate these programs on a province- or state-wide basis to ensure uniformity of standards and to avoid duplication of efforts.”
Posted in Journal Articles, READ Portal | Tagged with Leadership, Process improvement, Quality control, Quality improvement, Safety | No Comments
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