Interprofessional, multitiered daily rounding management in a high-acuity hospital

2020 ◽  
Vol 33 (6) ◽  
pp. 447-461
Author(s):  
Pracha Peter Eamranond ◽  
Arti Bhukhen ◽  
Donna DiPalma ◽  
Schawan Kunuakaphun ◽  
Thomas Burke ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
High Reliability ◽  
Care Quality ◽  
Total Quality ◽  
Content Type ◽  
Hospital Safety ◽  
High Acuity ◽  
Hospital Systems

PurposeThe purpose of this explanatory case study is to explain the implementation of interprofessional, multitiered lean daily management (LDM) and to quantitatively report its impact on hospital safety.Design/methodology/approachThis case study explained the framework for LDM implementation and changes in quality metrics associated with the interprofessional, multitiered LDM, implemented at Saint Francis Hospital and Medical Center (SFHMC) at the end of 2018. Concepts from lean, Total Quality Management (TQM) and high reliability science were applied to develop the four tiers and gemba rounding components of LDM. A two-tailed t-test analysis was utilized to determine statistical significance for serious safety events (SSEs) comparing the intervention period (January 2019–December 2019) to the baseline period (calendar years 2017 and 2018). Other quality and efficiency metrics were also tracked.FindingsLDM was associated with decreased SSEs in 2019 compared to 2017 and 2018 (p ≤ 0.01). There were no reportable central line-associated blood stream infection (CLABSI) or catheter-associated urinary tract infection (CAUTI) for first full calendar quarter in the hospital's history. Hospital-acquired pressure injuries were at 0.2 per 1,000 patient days, meeting the annual target of <0.5 per 1,000 patient days. Outcomes for falls with injury, hand hygiene and patient experience also trended toward target. These improvements occurred while also observing a lower observed to expected length of stay (O/E LOS), which is the organizational marker for hospital’s efficiency.Research limitations/implicationsLDM may contribute greatly to improve safety outcomes. This observational study was performed in an urban, high-acuity, low cost hospital which may not be representative of other hospitals. Further study is warranted to determine whether this model can be applied more broadly to other settings.Practical implicationsLDM can be implemented quickly to achieve an improvement in hospital safety and other health-care quality outcomes. This required a redistribution of time for hospital staff but did not require any significant capital or other investment.Social implicationsAs hospital systems move from a volume-based to value-based health-care delivery model, dynamic interventions using LDM can play a pivotal role in helping all patients, particularly in underserved settings where lower cost care is required for sustainability, given limited available resources.Originality/valueWhile many hospital systems promote organizational rounding as a routine quality improvement process, this study shows that a dynamic, intense LDM model can dramatically improve safety within months. This was done in a challenging urban environment for a high-acuity population with limited resources.

Patient satisfaction and brand loyalty in health-care organizations in India

2017 ◽  
Vol 11 (1) ◽  
pp. 73-87 ◽  
Author(s):  
Vinay Sharma
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Quality Management ◽  
Conceptual Model ◽  
Health Care Quality ◽  
Care Quality ◽  
Care Organization ◽  
Total Quality ◽  
Content Type ◽  
New Instrument

Purpose This paper aims to examine the major factors affecting patients’ satisfaction and loyalty at a health-care organization in India. Design/methodology/approach A conceptual model has been developed that includes the behavioural dimensions of total quality management (TQM), patient satisfaction and loyalty. This study is exploratory in nature and has used the existing literature to build the conceptual model. Findings A solution for improving the quality of health-care services can be found in the application of total relationship management and TQM, together with a customer orientation strategy. Practical implications The results can be used creatively by hospitals to re-engineer and redesign their quality management processes and reorient the future directions of their more effective health-care quality strategies. Originality/value In this research, a study is described involving a new instrument and a new method which assure a reasonable level of relevance, validity and reliability, while being explicitly change-oriented.

The essence, content and characteristics of medical services’ quality

2021 ◽  
pp. 40-43
Author(s):  
Constantin Etco ◽  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care System ◽  
Health Care Quality ◽  
Services Quality ◽  
Care Quality ◽  
Medical Services ◽  
Total Quality ◽  
Care System

One of the priorities of the health care system in Moldova is the medical services’ quality improvement. Th is article presents various defi nitions for health care quality and the principles connected with quality improvement. An important part in this article is allocated to the structure and main principles of total quality management in the health care system. Th is part reveals the problems of the commissions that are studying the quality of medical services in healthcare establishments.

(Re)descriptions of medical professional work: exploring accounting as a performative device within an emergency unit health-care context

2020 ◽  
Vol 32 (2) ◽  
pp. 159-176 ◽  
Author(s):  
Cemil Eren Fırtın ◽  
Tom S. Karlsson
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Treatment Time ◽  
Medical Professional ◽  
Care Quality ◽  
Medical Terminology ◽  
Professional Work ◽  
Content Type ◽  
Emergency Health Care ◽  
Number Of Patients

PurposeThis article addresses issues of calculation and economization in contemporary public organizations. In particular, it investigates how choices of organizing emergency health-care have been affected by accounting as a performative device. Special attention has been paid to how accounting brings about performative consequences in shaping the medical profession and its context.Design/methodology/approachThe article employs qualitative research methods and draws its analysis on empirical data from in-depth interviews at an emergency health-care unit in Sweden.FindingsIt is demonstrated how accounting, in the form of calculations of treatment time and number of patients, enables performative consequences for medical professional work. It is also demonstrated how the use of accounting engages (re)descriptions of practices and roles, creates accounts of patients, and helps to sustain such (re)descriptions. Accounting terms (such as efficiency and control) have been reframed into medical terminology (such as health-care quality and security), ensuring and retaining (re)described medical professional work in terms of practices and emerging roles.Originality/valueThis article contributes to (1) the literature on accounting practices within health-care contexts by demonstrating a case where the accounting ideas and practices of medical professionals are coexistent and interwoven and (2) the increasing body of literature focusing on accountingization by showing how emerging calculative technologies carry performative power over medical professional work through formative (re)descriptions.

Cultural dynamics and tensions when applying design thinking for improving health-care quality

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jonas Boström ◽  
Helene Hillborg ◽  
Johan Lilja
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Health Care Quality ◽  
Design Thinking ◽  
User Involvement ◽  
Clinical Work ◽  
Care Quality ◽  
Content Type ◽  
Improving Health Care ◽  
Practical Implications

Purpose The purpose of this paper is to contribute knowledge concerning the dynamics and potential cultural tensions that occur when applying user involvement and design thinking (DT) for improving quality in a health-care setting. Design/methodology/approach This paper is based on a case study following a quality improvement (QI) project in a medium-sized Swedish county council in the field of somatic care. The project involved eight health-care professionals, one designer, four patients and two relatives. A multiple data collection method over a period of ten months was used. It included individual interviews, e-mail correspondence and observations of workshops that covered the QI project. Findings The result shows tensions between QI work and the daily clinical work of the participants. These tensions primarily concern the conflict between fast and slow processes, the problem of moving between different fields of knowledge, being a resource for the individual clinic and the system and the participants’ expectations and assumptions about roles and responsibilities in a QI project. Furthermore, these findings could be interpreted as signs of a development culture in the health-care context. Practical implications There are several practical implications. Among others, the insights can inspire how to approach and contextualize the current concepts, roles and methods of DT and user involvement so that they can be more easily understood and integrated into the existing culture and way of working in the health-care sector. Originality/value This study provides a unique insight into a case, trying to uncover what actually is going on and perhaps, why certain things are not happening at all, when user involvement and design practices are applied for improving health-care quality.

Quality improvement in large healthcare organizations

2016 ◽  
Vol 30 (1) ◽  
pp. 133-153 ◽  
Author(s):  
Elisabet Höög ◽  
Jack Lysholm ◽  
Rickard Garvare ◽  
Lars Weinehall ◽  
Monica Elisabeth Nyström
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care Quality ◽  
Health Care Systems ◽  
Care Quality ◽  
Care Organization ◽  
Longitudinal Case Study ◽  
Systematic Analysis ◽  
Content Type

Purpose – The purpose of this paper is to investigate the obstacles and challenges associated with organizational monitoring and follow-up (M & F) processes related to health care quality improvement (QI) and development. Design/methodology/approach – A longitudinal case study of a large health care organization during a system-wide QI intervention. Content analysis was conducted of repeated interviews with key actors and archival data collected over a period of four years. Findings – The demand for improved M & F strategies, and what and how to monitor were described by the respondents. Obstacles and challenges for achieving M & F strategies that enables system-wide and coherent development were found in three areas: monitoring, processing, and feedback and communication. Also overarching challenges were found. Practical implications – A model of important aspects of M & F systems is presented that can be used for analysis and planning and contribute to shared cognition of such systems. Approaches for systematic analysis and follow-up of identified problems have to be developed and fully incorporated in the organization’s measurement systems. A systematic M & F needs analytic and process-oriented competence, and this study highlights the potential in an organizational function with capacity and mandate for such tasks. Originality/value – Most health care systems are flooded with a vast amount of registers, records, and measurements. A key issue is how such data can be processed and refined to reflect the needs and the development process of the health care system and how rich data can be used for improvement purposes. This study presents key organizational actor’s view on important factors to consider when building a coherent organizational M & F strategy.

Advancing health care quality and safety through action learning

2017 ◽  
Vol 30 (2) ◽  
pp. 148-158 ◽  
Author(s):  
Simon Mathews ◽  
Sherita Golden ◽  
Renee Demski ◽  
Peter Pronovost ◽  
Lisa Ishii
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Quality ◽  
Design Methodology ◽  
Action Learning ◽  
Care Quality ◽  
Quality And Safety ◽  
Content Type ◽  
Learning Health System ◽  
Academic Medical

Purpose The purpose of this study is to demonstrate how action learning can be practically applied to quality and safety challenges at a large academic medical health system and become fundamentally integrated with an institution’s broader approach to quality and safety. Design/methodology/approach The authors describe how the fundamental principles of action learning have been applied to advancing quality and safety in health care at a large academic medical institution. The authors provide an academic contextualization of action learning in health care and then transition to how this concept can be practically applied to quality and safety by providing detailing examples at the unit, cross-functional and executive levels. Findings The authors describe three unique approaches to applying action learning in the comprehensive unit-based safety program, clinical communities and the quality management infrastructure. These examples, individually, provide discrete ways to integrate action learning in the advancement of quality and safety. However, more importantly when combined, they represent how action learning can form the basis of a learning health system around quality and safety. Originality/value This study represents the broadest description of action learning applied to the quality and safety literature in health care and provides detailed examples of its use in a real-world context.

Next level of board accountability in health care quality

2018 ◽  
Vol 32 (1) ◽  
pp. 2-8 ◽  
Author(s):  
Peter J. Pronovost ◽  
C. Michael Armstrong ◽  
Renee Demski ◽  
Ronald R. Peterson ◽  
Paul B. Rothman
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Health System ◽  
Management System ◽  
Health Care Quality ◽  
High Reliability ◽  
Care Quality ◽  
Quality And Safety ◽  
Content Type

Purpose The purpose of this paper is to offer six principles that health system leaders can apply to establish a governance and management system for the quality of care and patient safety. Design/methodology/approach Leaders of a large academic health system set a goal of high reliability and formed a quality board committee in 2011 to oversee quality and patient safety everywhere care was delivered. Leaders of the health system and every entity, including inpatient hospitals, home care companies, and ambulatory services staff the committee. The committee works with the management for each entity to set and achieve quality goals. Through this work, the six principles emerged to address management structures and processes. Findings The principles are: ensure there is oversight for quality everywhere care is delivered under the health system; create a framework to organize and report the work; identify care areas where quality is ambiguous or underdeveloped (i.e. islands of quality) and work to ensure there is reporting and accountability for quality measures; create a consolidated quality statement similar to a financial statement; ensure the integrity of the data used to measure and report quality and safety performance; and transparently report performance and create an explicit accountability model. Originality/value This governance and management system for quality and safety functions similar to a finance system, with quality performance documented and reported, data integrity monitored, and accountability for performance from board to bedside. To the authors’ knowledge, this is the first description of how a board has taken this type of systematic approach to oversee the quality of care.

scholarly journals Embedding the Pillars of Quality in Health Information Technology Solutions Using “Integrated Patient Journey Mapping” (IPJM): Case Study (Preprint)

2019 ◽  
Author(s):  
Stephen McCarthy ◽  
Paidi O'Raghallaigh ◽  
Simon Woodworth ◽  
Yoke Yin Lim ◽  
Louise C Kenny ◽  
...  
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Health Service ◽  
Health Information ◽  
Health Care Quality ◽  
Care Quality ◽  
Multidisciplinary Teams ◽  
Patient Journey ◽  
Connected Health

BACKGROUND Health information technology (HIT) and associated data analytics offer significant opportunities for tackling some of the more complex challenges currently facing the health care sector. However, to deliver robust health care service improvements, it is essential that HIT solutions be designed by parallelly considering the 3 core pillars of health care quality: clinical effectiveness, patient safety, and patient experience. This requires multidisciplinary teams to design interventions that both adhere to medical protocols and achieve the tripartite goals of effectiveness, safety, and experience. OBJECTIVE In this paper, we present a design tool called <i>Integrated Patient Journey Mapping</i> (IPJM) that was developed to assist multidisciplinary teams in designing effective HIT solutions to address the 3 core pillars of health care quality. IPJM is intended to support the analysis of requirements as well as to promote empathy and the emergence of shared commitment and understanding among multidisciplinary teams. METHODS A 6-month, in-depth case study was conducted to derive findings on the use of IPJM during <i>Learning to Evaluate Blood Pressure at Home</i> (LEANBH), a connected health project that developed an HIT solution for the perinatal health context. Data were collected from over 700 hours of participant observations and 10 semistructured interviews. RESULTS The findings indicate that IPJM offered a constructive tool for multidisciplinary teams to work together in designing an HIT solution, through mapping the physical and emotional journey of patients for both the current service and the proposed connected health service. This allowed team members to consider the goals, tasks, constraints, and actors involved in the delivery of this journey and to capture requirements for the digital touchpoints of the connected health service. CONCLUSIONS Overall, IPJM facilitates the design and implementation of complex HITs that require multidisciplinary participation. CLINICALTRIAL

The United States Army Medical Command, becoming a learning organization

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Bonnie Hartstein ◽  
Edward Yackel
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
High Reliability ◽  
Safety Data ◽  
The United States ◽  
Care Quality ◽  
The Body ◽  
Content Type ◽  
Army Medical ◽  
System Changes

Purpose This study aims to describe how the Army and the Army Medical Department matured as a learning organizations (LOS) during the period after the 2014 Military Health System Review through the incorporation of changes aimed at improving patient safety, data transparency and becoming a high reliability organization. This study explores the relationship between HRO and LO concepts by adding to the body of knowledge in both disciplines. Design/methodology/approach Four large scale system changes are presented and evaluated against the principles of the LO. Metric data were collected longitudinally and presented as submitted to several nationally recognized organizations in health-care quality and safety. Post initiative observations are paired with a corresponding LO principle to assess MEDCOM’s maturation as a LO. System changes/improvements and the advancement of LO principles are discussed. Findings System improvements, analyzed critically alongside paired LO principles, show strong correlation between high reliability and LO principles. Despite inherent institutional barriers, this study demonstrates that when leveraged effectively, the leadership hierarchy and command culture can accelerate transformation into an LO. Originality/value This study explores changes implemented in the U.S. Army Medical Command (MEDCOM), as it evolved as a stronger LO. It demonstrates how health-care organizations and other high-risk industries that embrace high reliability concepts will become better LO, and expands current knowledge on how LO concepts in health care can affect better system accountability and improved patient safety. Organizations can learn from MEDCOM’s journey changes that can hasten progress toward adoption of LO principles, especially in hierarchical organizations.

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