Determinants of good and poor quality as perceived by US health care managers

2018 ◽  
Vol 32 (5) ◽  
pp. 708-725 ◽  
Author(s):  
Rebecca Amati ◽  
Amer A. Kaissi ◽  
Annegret F. Hannawa
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Quality Care ◽  
Poor Quality ◽  
Health Care Managers ◽  
Content Type ◽  
Written Narratives ◽  
Care Managers ◽  
Care Assessment

Purpose The scientific literature evidences that the quality of care must be improved. However, little research has focused on investigating how health care managers – who are responsible for the implementation of quality interventions – define good and poor quality. The purpose of this paper is to develop an empirically informed taxonomy of quality care as perceived by US managers – named the Integrative Quality Care Assessment Tool (INQUAT) – that is grounded in Donabedian’s structure, process and outcome model. Design/methodology/approach A revised version of the critical incident technique was used to collect 135 written narratives of good and poor quality care from 74 health care managers in the USA. The episodes were thematically analyzed. Findings In total, 804 units were coded under the 135 written narratives of care. They were grouped under structure (9 percent, n=69), including organizational, staff and facility resources; process (52 percent, n=419), entailing communication, professional diligence, timeliness, errors, and continuity of care; outcomes (32 percent, n=257), embedding process- and short-term outcomes; and context (7 percent, n=59), involving clinical and patient factors. Process-related categories tended to be described in relation to good quality (65 percent), while structure-related categories tended to be associated with poor quality (67 percent). Furthermore, the data suggested that managers did not consider their actions as important factors influencing quality, but rather tended to attribute the responsibility for quality care to front-line practitioners. Originality/value The INQUAT provides a theoretically grounded, evidence-based framework to guide health care managers in the assessment of all the components involved with the quality of care within their institutions.

Patient satisfaction with the quality of care in Ghana’s health-care institutions

2019 ◽  
Vol 13 (2) ◽  
pp. 160-170 ◽  
Author(s):  
Aaron Asibi Abuosi ◽  
Mahama Braimah
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Service Delivery ◽  
National Survey ◽  
Health Care Facilities ◽  
Health Facilities ◽  
Content Type ◽  
Care Facilities

Purpose The purpose of this study was to examine patient satisfaction with the quality of care in Ghana’s health-care facilities using a disaggregated approach. Design/methodology/approach The study was a cross-sectional national survey. A sample of 4,079 males and females in the age group of 15-49 years were interviewed. Descriptive statistics, principal component analysis and t-tests were used in statistical analysis. Findings About 70 per cent of patients were satisfied with the quality of care provided in health-care facilities in Ghana, whereas about 30 per cent of patients were fairly satisfied. Females and insured patients were more likely to be satisfied with the quality of care, compared with males and uninsured patients. Research limitations/implications Because data were obtained from a national survey, the questionnaire did not include the type of facility patients attended to find out whether satisfaction with the quality of care varied by the type of health facility. Future studies may, therefore, include this. Practical implications The study contributes to the literature on patient satisfaction with the quality of care. It highlights that long waiting time remains an intractable problem at various service delivery units of health facilities and constitutes a major source of patient dissatisfaction with the quality of care. Innovative measures must, therefore, be adopted to address the problem. Originality/value There is a paucity of research that uses a disaggregated approach to examine patient satisfaction with the quality of care at various service delivery units of health facilities. This study is a modest contribution to this research gap.

Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study

2021 ◽  
Vol 33 (2) ◽  
Author(s):  
Yubraj Acharya ◽  
Nigel James ◽  
Rita Thapa ◽  
Saman Naz ◽  
Rishav Shrestha ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Antenatal Care ◽  
Quality Care ◽  
National Level ◽  
Poor Quality ◽  
Public Hospitals ◽  
World Health ◽  
Outcome Variable

Abstract Background Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients’ socio-economic gradient. Methods We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users’ characteristics. In the qualitative component, we synthesized users’ and providers’ narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews. Results Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced. Conclusion The quality of ANC in Nepal’s primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.

Workplace-based clinical leadership training increases willingness to lead

2015 ◽  
Vol 28 (2) ◽  
pp. 100-118 ◽  
Author(s):  
Aleece MacPhail ◽  
Carmel Young ◽  
Joseph Elias Ibrahim
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Leadership Training ◽  
Low Cost ◽  
Leadership Role ◽  
Leadership Roles ◽  
Senior Executive ◽  
Clinical Leadership ◽  
Content Type

Purpose – The purpose of this paper is to reflect upon a workplace-based, interdisciplinary clinical leadership training programme (CLP) to increase willingness to take on leadership roles in a large regional health-care centre in Victoria, Australia. Strengthening the leadership capacity of clinical staff is an advocated strategy for improving patient safety and quality of care. An interdisciplinary approach to leadership is increasingly emphasised in the literature; however, externally sourced training programmes are expensive and tend to target a single discipline. Design/methodology/approach – Appraisal of the first two years of CLP using multiple sourced feedback. A structured survey questionnaire with closed-ended questions graded using a five-point Likert scale was completed by participants of the 2012 programme. Participants from the 2011 programme were followed up for 18 months after completion of the programme to identify the uptake of new leadership roles. A reflective session was also completed by a senior executive staff that supported the implementation of the programme. Findings – Workplace-based CLP is a low-cost and multidisciplinary alternative to externally sourced leadership courses. The CLP significantly increased willingness to take on leadership roles. Most participants (93 per cent) reported that they were more willing to take on a leadership role within their team. Fewer were willing to lead at the level of department (79 per cent) or organisation (64 per cent). Five of the 11 participants from the 2011 programme had taken on a new leadership role 18 months later. Senior executive feedback was positive especially around the engagement and building of staff confidence. They considered that the CLP had sufficient merit to support continuation for at least another two years. Originality/value – Integrating health-care professionals into formal and informal leadership roles is essential to implement organisational change as part of the drive to improve the safety and quality of care for patients and service users. This is the first interdisciplinary, workplace-based leadership programme to be described in the literature, and demonstrates that it is possible to deliver low-cost, sustainable and productive training that increases the willingness to take on leadership roles.

Health care managers learning by listening to subordinates’ dialogue training

2014 ◽  
Vol 28 (3) ◽  
pp. 437-454 ◽  
Author(s):  
C. Grill ◽  
G. Ahlborg Jr ◽  
E. Wikström
Keyword(s):  
Health Care ◽  
Work Environment ◽  
Middle Managers ◽  
Qualitative Content Analysis ◽  
Strategic Communication ◽  
Care Quality ◽  
Structured Interviews ◽  
Health Care Managers ◽  
Content Type ◽  
Care Managers

Purpose – Middle managers in health care today are expected to continuously and efficiently decide and act in administration, finance, care quality, and work environment, and strategic communication has become paramount. Since dialogical communication is considered to promote a healthy work environment, the purpose of this paper is to investigate the ways in which health care managers experienced observing subordinates’ dialogue training. Design/methodology/approach – A qualitative study using semi-structured interviews and documents from eight middle managers in a dialogue programme intervention conducted by dialogue trainers. Focus was on fostering and assisting workplace dialogue. Conventional qualitative content analysis was used. Findings – Managers’ experiences were both enriching and demanding, and consisted of becoming aware of communication, meaning perceiving interaction between subordinates as well as own silent interaction with subordinates and trainer; Discovering communicative actions for leadership, by gaining self-knowledge and recognizing relational leadership models from trainers – such as acting democratically and pedagogically – and converting theory into practice, signifying practising dialogue-promoting conversation behaviour with subordinates, peers, and superiors. Research limitations/implications – Only eight managers participated in the intervention, but data afforded a basis for further research. Practical implications – Findings stressed the importance of listening, and of support from superiors, for well-functioning leadership communication at work. Originality/value – Studies focusing on health care managers’ communication and dialogue are few. This study contributes to knowledge about these activities in managerial leadership.

Factors influencing the quality of care learning disabled patients receive in hospital

2020 ◽  
Vol 25 (2) ◽  
pp. 83-92
Author(s):  
Alice Durrant
Keyword(s):  
Health Care ◽  
Learning Disabilities ◽  
Quality Of Care ◽  
General Hospital ◽  
Learning Disabled ◽  
Care Staff ◽  
Content Type ◽  
Increased Risk ◽  
Disabled Patients

Purpose In total, 40% of the deaths of patients with learning disabilities have been classed as avoidable, and there is a known increased risk of harm while inpatients in hospital. This paper aims to look at the current experiences and treatment of people with learning disabilities within a general hospital setting to examine factors that affect their care. Design/methodology/approach A comprehensive literature search was conducted of primary research between 2013 and 2019 to evaluate what is known about the quality of care and treatment that learning disabled patients experience within a general hospital. Findings The research suggests that people with learning disabilities receive haphazard care in hospital settings, with inconsistent implementation of reasonable adjustments, insufficient arrangements to support family and other carer input, and poor knowledge of learning disability amongst hospital staff. Originality/value Previously, reviews focussing on hospital care have mainly focussed on access to health care rather than its delivery. This review has found evidence of significant failings in delivering care to this patient group, identifying a gap of knowledge in this field regardless of policies and laws already in place. There should be stricter monitoring of the Equality Act’s enforcement, along with improved and mandatory training for all general health-care staff. It is crucial that health-care professionals learn from mistakes to improve the care and experiences of learning disabled inpatients.

scholarly journals Analyzing U.S. nurse turnover: Are nurses leaving their jobs or the profession itself?

2015 ◽  
Vol 4 (4) ◽  
pp. 48 ◽  
Author(s):  
Olena Mazurenko ◽  
Gouri Gupte ◽  
Guogen Shan
Keyword(s):  
Health Care ◽  
Registered Nurses ◽  
Quality Care ◽  
The United States ◽  
National Sample ◽  
Sample Survey ◽  
P Value ◽  
Health Care Managers ◽  
Policy Makers ◽  
Care Managers

Objective: To examine and compare factors associated with making the decision to vacate a job (organizational turnover) versus leaving the profession (professional turnover) among registered nurses (RN) in the United States (U.S.).Methods: Nationally representative data from the 2008 National Sample Survey of Registered Nurses was used. The sample consisted of 8,796 RNs who held an active RN license as of March 10, 2008, but changed a place of work or left the profession entirely. The analysis has been performed using SAS, version 9.3.Results: The results of binary logistic regression revealed that RNs who reported work-related disability (OR = 14.51; p-value: < .001), illness (OR = 3.32; p-value: < .001), experienced high physical demands (OR = 1.57; p-value: < .001) or burnout (OR = 1.39; p-value: < .001), were unsatisfied with their schedule (OR = 2.16; p-value: < .001), or staffing arrangements (OR = 1.41; p-value: < .001) were more likely to leave the profession. Whereas RNs who reported high levels of stress (OR = 0.59; p-value: < .001) were unsatisfied with the organization’s leadership (OR = 0.22; p-value: < .001), unsatisfied with their opportunity to advance their career (OR = 0.56; p-value: < .001), or were not adequately compensated (OR = 0.63; p-value: < .001), were more likely to leave the organization.Conclusions: Policy makers and health care managers should be aware of the different factors that are associated with RNs’ decision to leave the profession or an organization. Health care managers involved in the development of nurse retention strategies should address organizational leadership and consider development of comprehensive career development programs. Policy makers should consider allocating additional resources to ensure that RN workforce is of adequate size, is qualified, and is able to provide high quality care in the U.S..

Barriers to healthcare delivery in Iranian prisons: a qualitative study

2020 ◽  
Vol 16 (4) ◽  
pp. 373-388
Author(s):  
Ahmad Hajebrahimi ◽  
Khalil Alimohammadzadeh ◽  
Seyed Mojtaba Hosseini ◽  
Ali Maher ◽  
Mohammadkarim Bahadori
Keyword(s):  
Health Care ◽  
Human Resources ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Process Data ◽  
Health Care Managers ◽  
Barriers To Health Care ◽  
Content Type ◽  
Care Managers ◽  
Barriers To Health

Purpose High quality health-care delivery is not only the governments’ responsibility but also every prisoner’s right. Health care in prison and, particularly, of Iranian prisoners is increasingly important topic because of the rising number of the prison population. This paper aims to explore health-care managers’ perspectives and experiences of prisons and the barriers to health-care delivery in Iranian prisons. Design/methodology/approach A qualitative research design was conducted in Iran from October 2018 to August 2019. The participants consisted of 51 health-care managers (50 men and one woman) from Iranian prisons. A combination of face-to-face (N = 42) and telephonic (N = 9) semi-structured interviews were used because of the geographical distribution of the respondents. The first part of the interview guide consisted of demographic characteristics, and the second part consisted of three main open ended-questions. Interviews were recorded and transcribed, and thematic descriptive analysis was used to interpret the data. Findings The barriers to health-care delivery in Iranian prisons were categorized into four main topics: human resources, financing, facilities and barriers related to the health-care delivery process. Data synthesis identified the following themes for barriers to human resources: barriers to human resources planning (with eight sub-themes); barriers to education (with three sub-themes); and motivational barriers (with seven sub-themes). Moreover, barriers to financing consisted of five sub-themes. The barriers to facilities consisted of barriers related to physical infrastructures (with two sub-themes) and barriers related to equipment (with six sub-themes). Finally, barriers to the health-care delivery process included the following themes: communication barriers (with six sub-themes); legal barriers (with five sub-themes); and environmental-demographic factors (with seven sub-themes). Originality/value Identifying the barriers to health-care delivery in Iranian prisons plays a critical role in the improvement of planning, decision-making and the health-care delivery process.

Fad and fashion? The relevance of subjective performance measures

2018 ◽  
Vol 56 (11) ◽  
pp. 2391-2407 ◽  
Author(s):  
Maria Chiara Demartini ◽  
Sara Trucco
Keyword(s):  
Health Care ◽  
Performance Measures ◽  
Sem Analysis ◽  
Performance Measurement System ◽  
Objective Measures ◽  
Health Care Managers ◽  
Data Set ◽  
Content Type ◽  
Care Managers ◽  
Antecedents And Consequences

Purpose The purpose of this paper is to investigate the effect of the use of subjective (objective) performance measures on relevant organisational outcomes, namely perceived managerial discretion (PMD) and manager’s satisfaction with the performance measurement system (PMS). Furthermore, the paper analyses the indirect link between subjective vs objective measures and managers’ satisfaction through PMD. Design/methodology/approach To test the research hypotheses, a paper-based questionnaire was sent to Italian health care managers in Lombardy. Thus, a PLS-SEM analysis was performed on a data set of 97 Italian health care managers. Findings Empirical findings showed that objective measures are more capable of supporting the managerial perception of discretion when compared to more subjective ones such as “fads” and “fashions”, and that managers are more satisfied with the PMS when it is grounded on objective measures rather than subjective ones. Originality/value The paper operationalizes and empirically tests the measure of PMD, linking this to antecedents and consequences. It also extends the literature on subjectivity in the PMS, since it develops new knowledge on the choice between subjective and objective measures by applying this choice to a variety of PMS, whereas prior literature on objective vs subjective measures has mainly focussed on performance evaluation.

Do performance measurement models have any impact on primary health care? A systematic review

2020 ◽  
Vol 25 (4) ◽  
pp. 319-334
Author(s):  
Brahim Zaadoud ◽  
Youness Chbab ◽  
Aziz Chaouch
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Quality Of Care ◽  
Primary Health Care ◽  
Performance Measurement ◽  
Conceptual Framework ◽  
Conceptual Frameworks ◽  
Content Type ◽  
Primary Health

PurposeThe purpose of this article is to analyze and compare between the frameworks of performance measurement in primary health care in the world. The subject of search is to compare if the frameworks of performance measurement in primary health care have an influence on performances of health centers.Design/methodology/approachWe conducted a systematic review of the literature to (1) identify the conceptual framework for measuring quality management systems, (2) assess the effects of conceptual framework on quality improvement and quality of care outcomes. We opted for the frameworks that are more cited in the literature and we analyzed and compared between these frameworks.FindingsEight dimensions were identified for assessing performance in Primary Health Care Facilities “PHCF” in more than 50% frameworks: Effectiveness, Safety, Accessibility, Equity, Efficiency, Acceptability, Patient Centeredness and Timeliness.Research limitations/implicationsThe limits of this study can be represented by the following elements: (1) lack of exhaustiveness with regard to the current Frameworks. (2) The evaluation of reliability and validity of the qualitative studies remains difficult to appreciate. (3) Most of the evaluation tools of the primary health care are not validated yet. (4) The difference in performance levels between countries, especially for the developed countries and the multitude of the frames of measure of performance, limits the comparability of the results.Practical implicationsThis study provides a conceptual and descriptive literature on the different conceptual frameworks for performance measurement in primary health care, and a practical and useful tool for comparison between the different conceptual frameworks. Several organisations of accreditation or certification introduced, developed, incorporated and checked the indicators of clinical quality in the organizations of health care. Some studies revealed links with the governance, the access, the continuity, the coordination, the efficiency and the strength primary care (Dionne Kringos, 2018). Improvements in the quality of care have been observed in the results of accreditation and certification bodies regarding hospital infection control infrastructure, organization and performance.Originality/valueEven if the links are not established within the framework of a scientific research, quality approaches are generally recognized as an essential tool to help establishments to improve the quality and the safety of the patients. Until now, it is not still common to make evaluation of the quality of care in the “PHCF” to obtain the relevant information. The necessity of having performance measurement tools, which puts in coherence the piloting of the operational level with the strategy, to integrate the organizational objectives into the measures of operational performances and make estimate its structures towards a real management by the quality.

Sense of community and job satisfaction among social and health care managers

2015 ◽  
Vol 28 (3) ◽  
pp. 228-244 ◽  
Author(s):  
Mai-Stiina Lampinen ◽  
Elina Annikki Viitanen ◽  
Anne Irmeli Konu
Keyword(s):  
Job Satisfaction ◽  
Health Care ◽  
Sense Of Community ◽  
Middle Managers ◽  
Linear Regression Analysis ◽  
Front Line ◽  
Health Care Managers ◽  
Open Communication ◽  
Content Type ◽  
Care Managers

Purpose – The purpose of this paper is to identify how the factors associated with sense of community at work are connected with job satisfaction among the front-line managers and middle managers in social and health-care services in Finland. Design/methodology/approach – A questionnaire prepared for this study was sent to 241 social and health-care managers (front line and middle managers) in Finland. A total of 136 of managers responded to the survey (response rate was 56 per cent). Data were analyzed by using descriptive statistics, exploratory factor analysis and multiple linear regression analysis. Findings – Alongside job meaningfulness, open communication and good flow of information within the organization, sense of security provided by close relationships at work and managers’ own superiors’ appreciation of their leadership skills all are related to managers’ job satisfaction. Originality/value – The study adds to our understanding of factors which are connected to the job satisfaction among social and health-care managers’. The findings of this study can be used in the development of leadership to support managers in coping at work.

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