November 18, 2011
“Background: Despite major policy initiatives in the United Kingdom to enhance women’s experiences of maternity care, improving in-patient postnatal care remains a low priority, although it is an aspect of care consistently rated as poor by women. As part of a systems and process approach to improving care at one maternity unit in the South of England, the views and perspectives of midwives responsible for implementing change were sought.
Methods: A Continuous Quality Improvement (CQI) approach was adopted to support a systems and process change to in-patient care and care on transfer home in a large district general hospital with around 6000 births a year. The CQI approach included an initial assessment to identify where revisions to routine systems and processes were required, developing, implementing and evaluating revisions to the content and documentation of care in hospital and on transfer home, and training workshops for midwives and other maternity staff responsible for implementing changes. To assess midwifery views of the quality improvement process and their engagement with this, questionnaires were sent to those who had participated at the outset.
Results: Questionnaires were received from 68 (46%) of the estimated 149 midwives eligible to complete the questionnaire. All midwives were aware of the revisions introduced, and two-thirds felt these were more appropriate to meet the women’s physical and emotional health, information and support needs. Some midwives considered that the introduction of new maternal postnatal records increased their workload, mainly as a consequence of colleagues not completing documentation as required.
Conclusions: This was the first UK study to undertake a review of in-patient postnatal services. Involvement of midwives at the outset was essential to the success of the initiative. Midwives play a lead role in the planning and organisation of in-patient postnatal care and it was important to obtain their feedback on whether revisions were pragmatic and achieved anticipated improvements in care quality. Their initial involvement ensured priority areas for change were identified and implemented. Their subsequent feedback highlighted further important areas to address as part of CQI to ensure best quality care continues to be implemented. Our findings could support other maternity service organisations to optimise in-patient postnatal services.”
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Posted in Journal Articles, READ Portal | Tagged with Hospital administration, Quality assessment, Quality improvement | No Comments
November 17, 2011
“Background: U.S. healthcare organizations are confronted with numerous and varied transformational strategies promising improvements along all dimensions of quality and performance. This article examines the peer-reviewed literature from the U.S. for evidence of effectiveness among three current popular transformational strategies: Six Sigma, Lean/Toyota Production System, and Studer’s Hardwiring Excellence.
Methods: The English language health, healthcare management, and organizational science literature (up to December 2007) indexed in Medline, Web of Science, ABI/Inform, Cochrane Library, CINAHL, and ERIC was reviewed for studies on the aforementioned transformation strategies in healthcare settings. Articles were included if they: appeared in a peer-reviewed journal; described a specific intervention; were not classified as a pilot study; provided quantitative data; and were not review articles. Nine references on Six Sigma, nine on Lean/Toyota Production System, and one on StuderGroup meet the study’s eligibility criteria.
Results: The reviewed studies universally concluded the implementations of these transformation strategies were successful in improving a variety of healthcare related processes and outcomes. Additionally, the existing literature reflects a wide application of these transformation strategies in terms of both settings and problems. However, despite these positive features, the vast majority had methodological limitations that might undermine the validity of the results. Common features included: weak study designs, inappropriate analyses, and failures to rule out alternative hypotheses. Furthermore, frequently absent was any attention to changes in organizational culture or substantial evidence of lasting effects from these efforts.
Conclusion: Despite the current popularity of these strategies, few studies meet the inclusion criteria for this review. Furthermore, each could have been improved substantially in order to ensure the validity of the conclusions, demonstrate sustainability, investigate changes in organizational culture, or even how one strategy interfaced with other concurrent and subsequent transformation efforts. While informative results can be gleaned from less rigorous studies, improved design and analysis can more effectively guide healthcare leaders who are motivated to transform their organizations and convince others of the need to employ such strategies. Demanding more exacting evaluation of projects consultants, or partnerships with health management researchers in academic settings, can support such efforts.”
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Posted in Journal Articles, READ Portal | Tagged with Process improvement, Quality assessment | No Comments
November 10, 2011
“In high-income countries, patients with complex care needs account for a disproportionate share of national health spending… These patients typically see multiple clinicians at different locations, making care coordination imperative. To learn more about the experiences of these “sicker adults,” a new Commonwealth Fund survey focused on patients with high care needs in 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the U.S.
Despite variation in patients’ experiences across the globe, all countries are facing similar challenges in providing effective care to sicker adults, contending with coordination gaps, lapses in communication between providers, and missed opportunities for engaging patients in management of their own care. Moreover, all countries can learn from one another, the authors conclude.
(The bottom line is) across 11 countries, adults with complex care needs who had a medical home reported fewer coordination failures with their care, including medical errors and test duplication, as well as better relationships with their doctors and greater satisfaction with care.”
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Posted in READ Portal, Reports & Papers | Tagged with Benchmarking, Chronic disease, Integrated care, Quality assessment | No Comments
November 3, 2011
“Several regional healthcare systems around the world have achieved high levels of performance through system-wide efforts to improve quality that include long-term strategies and investments to improve the delivery of care and outcomes, while limiting cost increases.
An analysis of three such systems in Alaska, Utah and Sweden suggests 10 themes underlying the creation and sustaining of high performance. These themes are:
- Quality and system improvement as a core strategy
- Developing organizational capabilities and skills to support improvement
- Robust primary care teams at the centre of the delivery system
- Engaging patients in their care and in the design of care
- Promoting professional cultures that support teamwork, continuous improvement and patient engagement
- More effective integration of care that promotes seamless care transitions
- Information as a platform for guiding improvement
- Effective learning strategies and methods to test and scale up improvements
- Leadership activities that embrace common goals and align activities throughout the organization
- Providing an enabling environment buffering short-term factors that undermine success.
Healthcare systems in Canada have experienced difficulties in creating and sustaining large-scale improvements; local initiatives are difficult to replicate and spread, and improvement efforts are often limited in scale.
Canada could support a broader strategy to implement many of the elements responsible for success in the three exemplary systems studied. These elements include:
- Expand and enhance the roles of quality councils and similar bodies to support the development of improvement skills and to facilitate system-wide efforts to improve the quality and efficiency of care
- Create greater local capacity for improvement through training and leadership development
- Place greater emphasis on physician leadership training to enhance organizational capability, not just individual capability
- Identify priority areas for improvement with specific targets and timelines to help align system-wide efforts
- Continue to focus on the development of electronic clinical information systems; but enhance supports for collecting and using data on current performance even if such data require manual collection
- Expand current projects to improve patient engagement in the design and improvement of care delivery in order to promote patient-centred care and to engage and align clinicians”
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Posted in READ Portal, Reports & Papers | Tagged with Benchmarking, Canada, Quality assessment, Quality improvement | No Comments
October 17, 2011
“Engaging physicians’ performance measurement can help improve service line margin. Effective data-driven analyses of service-line performance require:
- Buy-in and agreement at the outset from all parties (hospital and physicians) on the validity of the data used to evaluate service-line performance
- Actionable data and metrics relevant to physicians, with financial goals tangibly linked to clinical improvement
- Transparent sharing of data with physicians to build their trust and support the case for change
- A physician champion who can help validate findings and guide how data are presented
- Willingness of physicians to acknowledge that the opportunity for improved margin depends largely on the variable costs that they control as individuals”
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Posted in Mass Media Articles, READ Portal | Tagged with Quality assessment, Quality improvement | 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
May 2, 2011
Klein, S., & McCarthy, D. (2011). Sentara Healthcare: Making Patient Safety an Enduring Organizational Value. The Commonweatlh Fund. http://www.commonwealthfund.org/Content/Publications/Case-Studies/2011/Mar/Sentara-Healthcare.aspx. Sentara Healthcare, an integrated health care delivery system serving parts of Virginia and North Carolina, has developed a systematic program to foster a culture of safety throughout its member hospitals, with the aim of reducing the […]
Posted in Journal Articles, READ Portal | Tagged with Benchmarking, Efficiency, Policy, Quality assessment, Quality control, Quality improvement, Safety | No Comments
April 26, 2011
“Variations in health care in the NHS are a persistent and ubiquitous problem. But which variations are acceptable or warranted – for example, variations driven by clinical need and informed patient choice – and which are not? The important question is how to promote ‘good’ variation and minimise ‘bad’ variation.
Variations in health care: The good, the bad and the inexplicable explores the possible causes of variation, shows the different ways in which variations can be measured, and analyses variations by PCT in rates of elective hospital admissions for selected procedures.
The causes of variation are complex and inter-related – they may be affected by, for example, differences in geographical patterns of illness, differences in clinicians’ behaviour, the effects of incentives in the financing of health care. These causes are mapped and discussed.”
Posted in Journal Articles, READ Portal | Tagged with Decision making, Policy, Program evaluation, Quality assessment, Quality control, Quality improvement, Safety | No Comments
April 7, 2011
“Canada spends more than $190 billion annually on healthcare, and healthcare expenditures are rising faster than overall economic growth. At the same time, there is an expectation for increasing demand for healthcare services among the aging baby-boom generation, a shift in focus to person-centred care, a renewed emphasis on patient safety, and ongoing public concerns about wait times and access. These trends, among others, are contributing to greater scrutiny of health system performance and growing concerns about the sustainability of Canada’s universal healthcare system. As a result, there is heightened pressure to identify ways to deliver high quality healthcare in a more cost-effective manner.
PricewaterhouseCoopers (PwC) was retained by the Canadian Health Services Research Foundation (CHSRF) to conduct a National Health Leadership Survey on Performance and Quality Improvement to:
Posted in READ Portal, Reports & Papers | Tagged with Benchmarking, Canada, Hospital administration, Indicators, Quality assessment, Quality improvement | No Comments
