scholarly journals The applicability of COBIT processes representation structure for quality improvement in healthcare: a Delphi study

2020 ◽  
Vol 32 (9) ◽  
pp. 577-584
Author(s):  
Boştjan Žvanut ◽  
Milena Burnik ◽  
Tamara Štemberger Kolnik ◽  
Patrik Pucer
Keyword(s):  
Quality Improvement ◽  
Delphi Study ◽  
Management Practices ◽  
Expert Panel ◽  
Quality Improvements ◽  
Process Improvements ◽  
Process Representation ◽  
Hand Control ◽  
Representation Structure ◽  
Healthcare Processes

Abstract Objectives In healthcare, a variety of quality management practices are used. Although they are important sources for quality improvement initiatives, they do not focus on each particular process. On the other hand, ‘Control Objectives for Information and Related Technologies’ (COBIT) offers a well-defined process representation structure for representing potential process improvements. The objective of this study was to adopt the COBIT structure for healthcare processes and assess the applicability of such process representations. Design A two-round Delphi technique was applied: in round 1, open-ended interviews were performed with the participants; in round 2, the participants responded to the web questionnaire. Settings The participants provided their opinion between 11 September 2018 and 26 June 2019. Participants It included 37 members of an expert panel from 8 European countries. Intervention N/A Main Outcome Measures In round 1, strengths, weaknesses, opportunities and threats indicators of using the proposed structure in healthcare were identified. These were evaluated on a 9-point Likert scale in round 2. Results All participants noted that elements of the COBIT process representation structure were suitable for representing healthcare processes. The consensus was reached only for strengths and opportunities indicators. Conclusions A set of processes represented with the suggested structure has the potential to become a valid reference in healthcare quality improvements initiatives, as COBIT in IT domain. Despite the fact that the expert panel members confirmed the applicability of the COBIT process representation structure for healthcare processes, the identified weaknesses and threats cannot be ignored.

scholarly journals Development of a simple, practice-based tool to assess quality of paediatric emergency care delivery in resource-limited settings: identifying critical actions via a Delphi study

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e021123
Author(s):  
Rajesh Kirit Daftary ◽  
Brittany Lee Murray ◽  
Teri Ann Reynolds
Keyword(s):  
Quality Improvement ◽  
Critically Ill ◽  
Delphi Study ◽  
Emergency Departments ◽  
Expert Panel ◽  
Care Delivery ◽  
Delphi Process ◽  
Critically Ill Children ◽  
Initial Management

ObjectiveProvision of timely, high-quality care for the initial management of critically ill children in African hospitals remains a challenge. Monitoring the completion of critical actions during resuscitations can inform efforts to reduce variability and improve outcomes. We sought to develop a practice-based tool based on contextually relevant actions identified via a Delphi process. Our goal was to develop a tool that could identify gaps in care, facilitate identification of training and standardised assessment to support quality improvement efforts.DesignSix sentinel conditions were selected based on disease epidemiology and mortality at rural and urban African emergency departments. Potential critical actions were identified through focused literature review. These actions were evaluated within a three-round modified Delphi process. A set of logistical filters was applied to the candidate list to derive a practice-based tool.Setting and participantsAttendees at an international emergency medicine conference comprised an expert panel of 25 participants, with 84% working primarily in African settings. Consensus rounds allowing novel responses were conducted via online and in-person surveys.ResultsThe expert panel generated 199 actions that apply to six conditions in emergently ill children. Application of appropriateness criteria refined this to 92 candidate actions across the following seven categories: core skills, active seizure, altered mental status, diarrhoeal illness, febrile illness, respiratory distress and polytrauma. From these, we identified 28 actions for inclusion in a practice-based tool contextually relevant to the initial management of critically ill children in Africa.ConclusionsA group consensus process identified critical actions for severely ill children with select sentinel conditions in emergency paediatric care in an African setting. Absence of these actions during resuscitation might reflect modifiable gaps in quality of care. The resulting practice-based tool is context relevant and can serve as a foundation for training and quality improvement efforts in African hospitals and emergency departments.

scholarly journals How well did Norwegian general practice prepare to address the COVID-19 pandemic?

2020 ◽  
Vol 8 (4) ◽  
pp. e000512
Author(s):  
Ingvild Vatten Alsnes ◽  
Morten Munkvik ◽  
W Dana Flanders ◽  
Nicolas Øyane
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
General Practitioners ◽  
Home Page ◽  
Quality Improvements ◽  
Geographical Differences ◽  
Home Office ◽  
Isolation Room ◽  
Improvement Measures ◽  
The Mean

ObjectivesWe aimed to describe the quality improvement measures made by Norwegian general practice (GP) during the COVID-19 pandemic, evaluate the differences in quality improvements based on region and assess the combinations of actions taken.DesignDescriptive study.SettingParticipants were included after taking part in an online quality improvement COVID-19 course for Norwegian GPs in April 2020. The participants reported whether internal and external measures were in place: COVID-19 sign on entrance, updated home page, access to video consultations and/or electronic written consultations, home office solutions, separate working teams, preparedness for home visits, isolation rooms, knowledge on decontamination, access to sufficient supplies of personal protective equipment (PPE) and COVID-19 clinics.ParticipantsOne hundred GP offices were included. The mean number of general practitioners per office was 5.63.ResultsMore than 80% of practices had the following preparedness measures: COVID-19 sign on entrance, updated home page, COVID-19 clinic in the municipality, video and written electronic consultations, knowledge on how to use PPE, and home office solutions for general practitioners. Less than 50% had both PPE and knowledge of decontamination. Lack of PPE was reported by 37%, and 34% reported neither sufficient PPE nor a dedicated COVID-19 clinic. 15% reported that they had an isolation room, but not enough PPE. There were no geographical differences.ConclusionsNorwegian GPs in this study implemented many quality improvements to adapt to the COVID-19 pandemic. Overall, the largest potentials for improvement seem to be securing sufficient supply of PPE and establishing an isolation room at their practices.

scholarly journals Quality function deployment: more than a design tool

2019 ◽  
Vol 11 (2) ◽  
pp. 142-166 ◽  
Author(s):  
Nadiye Ozlem Erdil ◽  
Omid M. Arani
Keyword(s):  
Quality Improvement ◽  
Quality Function Deployment ◽  
Design Tool ◽  
Quality Improvements ◽  
Literature Study ◽  
Quality Function ◽  
Content Type ◽  
Study Approach ◽  
Design Activities

Purpose This paper aims to investigate to what extent quality function deployment (QFD) can be used in quality improvement rather than design activities. Design/methodology/approach A framework was developed for implementation of QFD as a quality improvement tool. A case study approach is used to test this framework, and quality issues were analyzed using the framework in a ceramic tile manufacturing company. Findings The results showed considerable improvements in the critical quality characteristics identified and sales rates, demonstrating the potential of QFD to be used in assessing and prioritizing areas of improvement, and converting them into measurable process or product requirements. Research limitations/implications One case study was completed. More studies would be beneficial to support current findings. Practical implications This framework provides structured approach and guidelines for practitioners in adapting QFD for quality improvements in existing products or processes. Originality/value This study proposes a new framework to use QFD in quality improvement activities, expanding its application areas. Moreover, the results of the literature study performed provide a valuable collection of practical QFD implementation examples.

A Quality Improvement Project on Pain Management at a Tertiary Pediatric Hospital

2021 ◽  
pp. 084456212110477
Author(s):  
Jodi Wilding ◽  
Hailey Scott ◽  
Victoria Suwalska ◽  
Zarina Geddes ◽  
Carolina Lavin Venegas ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pain Management ◽  
Chart Review ◽  
Management Practices ◽  
Pain Treatment ◽  
Management Strategies ◽  
Improvement Project ◽  
Pain Scores ◽  
Health Quality ◽  
T1 And T2

To assess and improve pain management practices for hospitalized children in an urban tertiary pediatric teaching hospital. Methods Health Quality Ontario Quality Improvement (QI) framework informed this study. A pre (T1) – post (T2) intervention assessment included chart reviews and children/caregiver surveys to ascertain pain management practices. Information on self-reported pain intensity, painful procedures, pain treatment and satisfaction were obtained from children/caregivers. Documented pain assessment, pain scores, and pharmacological/non-pharmacological pain treatments were collected by chart review. T1 data was fed back to pediatric units to inform their decisions and pain management targets. Results At T1, 51 (58% of eligible participants) children/caregivers participated. At T2, 86 (97%) chart reviews and 51 (54%) children/caregivers surveys were completed. Most children/caregivers at T1 (78%) and T2 (80%) reported moderate to severe pain during their hospitalization. A mean of 2.6 painful procedures were documented in the previous 24 h, with the most common being needle-related procedures at both T1 and T2. Pain management strategies were infrequently used during needle-related procedures at both time points. Conclusion No improvements in pain management as measured by the T1 and T2 data occurred. Findings informed further pain management initiatives in the participating hospital.

A multi-method quality improvement approach to systematically improve and promote the quality of national health and social care information

2020 ◽  
pp. 183335832092642
Author(s):  
Niamh McGrath ◽  
Barbara Foley ◽  
Caroline Hurley ◽  
Maria Ryan ◽  
Rachel Flynn
Keyword(s):  
Quality Improvement ◽  
Health Information ◽  
Information Management ◽  
Management Practices ◽  
Clinical Decision Making ◽  
Social Care ◽  
Good Practice ◽  
Improvement Program ◽  
Health And Social Care

Safe and reliable healthcare depends on access to health information that is accurate, valid, reliable, timely, relevant, legible and complete. National data collections are repositories of health and social care data and play a crucial role in healthcare planning and clinical decision-making. We describe the development of an evidence-informed multi-method quality improvement program aimed to improve the quality of health and social care data in Ireland. Specific components involved: development of guidance to support implementation of health information standards; review program to assess compliance with standards; and educating health information stakeholders about health data and information quality. Observations from implementation of the program indicate enhanced health information stakeholder awareness of, and increased adoption of information management standards. The methodology used in the review program has proved to be a robust approach to identify areas of good practice and opportunities for improvement in information management practices. There has been positive adoption of the program among organisations reviewed and acceptance of the proposed recommendations. Early indications are that this multi-method approach will drive improvements in information management practices, leading to an improvement in health and social care data quality in Ireland. Aspects of this approach may be adapted to meet the needs of other countries.

Delphi study to determine the key qualities consultant histopathologists look for in their trainees

2020 ◽  
Vol 73 (10) ◽  
pp. 642-647
Author(s):  
Daniel J Brierley ◽  
Paula M Farthing ◽  
Sandra Zijlstra-Shaw
Keyword(s):  
Patient Care ◽  
Delphi Study ◽  
Expert Panel ◽  
Qualitative Interviews ◽  
Relative Importance ◽  
Diagnostic Competence ◽  
Diagnostic Competences ◽  
Pathological Report

AimsA Delphi study to triangulate and determine the relative importance of the key qualities of trainees identified from qualitative interviews that sought to understand how consultant histopathologists determine diagnostic competences in trainees.MethodsTwelve participants were purposively chosen for the Delphi to form an expert panel of relevant stakeholders. Participants were asked to score and rank the items presented to them.ResultsA total of 22 out of 27 of the key qualities of trainees (items) reached ‘consensus in’ after round 2 suggesting participants were able to agree that the majority of the items identified in the qualitative interviews were important to diagnostic competence. Five items reached ‘no consensus’. Participants did not suggest any additional items. Participants particularly valued qualities of reflection and professionalism and trainees who understood the process of reaching a diagnosis and how their pathological report could impact on patient care.ConclusionsThis study has triangulated findings from our qualitative interviews and show that consultants value a wide variety of qualities when determining diagnostic competence in their trainees. The judgement is complex and is therefore best assessed longitudinally and on a number of cases, so consultants can look for consistency of both approach to diagnosis and of trainee behaviour.

scholarly journals Delphi study among international expert panel to develop waterpipe-specific health warning labels

2019 ◽  
pp. tobaccocontrol-2018-054718 ◽  
Author(s):  
Taghrid Asfar ◽  
Michael Schmidt ◽  
Mohammad Ebrahimi Kalan ◽  
Wensong Wu ◽  
Kenneth D Ward ◽  
...  
Keyword(s):  
Delphi Study ◽  
Expert Panel ◽  
Scientific Evidence ◽  
Warning Labels ◽  
International Expert ◽  
Health Warning ◽  
Harm To Others ◽  
Harmful Effects ◽  
Target Country ◽  
Specific Health

BackgroundWaterpipe (WP) smoking is increasing globally. The rise of WP has been fuelled by widespread misperception of reduced-harm compared to cigarettes. Health warning labels (HWLs) are one strategy to communicate smoking-related risks and address reduced-harm misperceptions. Therefore, the development of WP-specific HWLs represents a priority for WP control.MethodsA panel of experts in WP science developed 28 WP-specific HWLs corresponding to five themes (health risks, addiction, harm to others, WP-specific harm, WP harm compared to cigarettes). Subsequently, a three-round Delphi study was conducted among international expert panel to reach consensus on a set of the most effective HWLs for each theme. Levels of agreement between participants were assessed using interquartile deviations, and the rank between the tied HWLs was based on the median.ResultsStarting with 28 candidate HWLs stratified according to five WP-related themes, our international expert panel reached consensus on the 13 most important WP-specific HWLs. Labels with the highest agreement were related to oral and heart disease, WP’s harmful effects on newborn children and the amount of smoke inhaled from WP compared to cigarettes.ConclusionThis study is the first to systematically develop and evaluate potential WP-specific HWLs based on the scientific evidence about WP’s harmful effects, scientific understanding of HWL for cigarettes and the opinions of experts in WP science, tobacco control and health communication. The final selected HWLs can be adapted based on the context and policy landscape of the target country and can be further fine-tuned based on feedback from WP smokers and non-smokers.

Stand Development and Economic Analysis of Alternative Cutting Methods in Northern Hardwoods: 32-Year Results

1990 ◽  
Vol 7 (4) ◽  
pp. 153-158 ◽  
Author(s):  
Michael D. Erickson ◽  
David D. Reed ◽  
Gleen D. Morz
Keyword(s):  
Quality Improvement ◽  
Economic Analysis ◽  
Northern Hardwoods ◽  
Stand Development ◽  
Quality Improvements ◽  
Managed Forest ◽  
Cutting Method ◽  
Northern Hardwood ◽  
Stand Conditions ◽  
Economic Criteria

Abstract Changes in stand quality and financial returns are evaluated for Upper Michigan northern hardwood stands managed for 32 years under eight alternative cutting techniques. Improvements in tree grade and stand soundness were greatest under a light improvement cutting method which support recommendations that bole quality improvement can be attained through selection type cuttings. Harvest revenues were maximized by a 12-in. diameter limit cut, followed by a 16-in. diameter limit and a light improvement cutting. In contrast, the managed forest value, assuming sustainable stand conditions have been achieved for all treatments, was maximized by the 16-in. diameter limit cut, followed closely by the light improvement treatment. Although the 16-in. diameter limit cut provided returns slightly greater than the light improvement cut and had a more even flow of revenues, it did not lead to quality improvements. These results support those of other studies which indicate the importance of considering economic criteria in developing silvicultural recommendations. North. J. Appl. For. 7:153-158, December 1990.

Developing an Appreciative Management Scale (AMS 1.0)

2017 ◽  
Vol 22 (3) ◽  
pp. 183-194 ◽  
Author(s):  
Merja Harmoinen ◽  
Vuokko Niiranen ◽  
Mika Helminen ◽  
Tarja Suominen
Keyword(s):  
Delphi Study ◽  
Management Practices ◽  
Psychometric Evaluation ◽  
Working Life ◽  
Management Skills ◽  
Two Phase ◽  
Study Approach ◽  
Multi Phase ◽  
Management Expectations ◽  
Panel Evaluation

In working life, ageing and retiring staff and managers are being replaced by younger generations which come from different working life cultures. This may give rise to different management expectations. As a result, this creates a need to assess how the concept of appreciative management is implemented in health care. The aim was to develop a valid and reliable instrument to assess appreciative management. A multi-phase, mixed-method and psychometric evaluation of the Appreciative Management Scale (AMS) was conducted. A concept analysis and systematic literature review were carried out. The instrument’s development employed a two-phase Delphi study approach including essays, survey iteration rounds and expert panel evaluation. The instrument was pre-tested and tested empirically in a survey completed by staff respondents and managers. AMS 1.0 has 83 items that are categorised into Systematic Management, Equality, Appreciation of Know-How, and the Promotion of Wellbeing at Work. The instrument was found to be valid and reliable. The AMS 1.0 scale needs to be tested internationally in order to conduct evaluative surveys of appreciative management in other countries. By using the AMS 1.0 instrument to assess managers’ management practices, managers receive valuable feedback on their own management skills and also the skills of workers.

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