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.

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.

Creating a fractal-based quality management infrastructure

2014 ◽  
Vol 28 (4) ◽  
pp. 576-586 ◽  
Author(s):  
Peter J Pronovost ◽  
Jill A Marsteller
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Of Care ◽  
Quality Management ◽  
Health System ◽  
Fractal Structure ◽  
Coordination Theory ◽  
Content Type ◽  
Fractal System

Purpose – The purpose of this paper is to describe how a fractal-based quality management infrastructure could benefit quality improvement (QI) and patient safety efforts in health care. Design/methodology/approach – The premise for this infrastructure comes from the QI work with health care professionals and organizations. The authors used the fractal structure system in a health system initiative, a statewide collaborative, and several countrywide efforts to improve quality of care. It is responsive to coordination theory and this infrastructure is responsive to coordination theory and repeats specific characteristics at every level of an organization, with vertical and horizontal connections among these levels to establish system-wide interdependence. Findings – The fractal system infrastructure helped a health system achieve 96 percent compliance on national core measures, and helped intensive care units across the USA, Spain, and England to reduce central line-associated bloodstream infections. Practical implications – The fractal system approach organizes workers around common goals, links all hospital levels and, supports peer learning and accountability, grounds solutions in local wisdom, and effectively uses available resources. Social implications – The fractal structure helps health care organizations meet their social and ethical obligations as learning organizations to provide the highest possible quality of care and safety for patients using their services. Originality/value – The concept of deliberately creating an infrastructure to manage QI and patient safety work and support organizational learning is new to health care. This paper clearly describes how to create a fractal infrastructure that can scale up or down to a department, hospital, health system, state, or country.

Assessing health care quality in adolescent clinics, implications for quality improvement

2018 ◽  
Vol 23 (4) ◽  
pp. 269-280 ◽  
Author(s):  
Emmanuel Anongeba Anaba ◽  
Aaron Asibi Abuosi
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Adolescent Health ◽  
Health Care Quality ◽  
Care Quality ◽  
Urban Setting ◽  
Content Type ◽  
Seek Health Care

Purpose Adolescents are more exposed to risky health behaviors. However, many adolescents do not seek health care due to the poor quality of care. The purpose of this paper is to assess health care quality in adolescent clinics in Tema, a suburb of Ghana. Design/methodology/approach Cross-sectional survey design was adopted to collect data from 365 adolescent respondents. Data were analyzed with the aid of Statistical Package for Social Science (version 20) using descriptive statistics and multiple linear regression. Findings The results demonstrate that adolescents perceived quality of care in adolescent clinics to be good. The significant predictors of adolescents’ overall perceptions of quality of care were provider competencies (β=0.311, p<0.01), adolescent’s health literacy (β=0.359, p<0.01), appropriate package of services (β=0.093, p<0.05), and equity and non-discrimination (β=0.162, p<0.01). Research limitations/implications The study was conducted in an urban setting. Therefore, the generalization of findings must be done with caution. Originality/value Adolescent health care quality in Ghana is below expectation. However, it has received little attention from researchers. This study provides empirical evidence for adolescent health care quality improvement in developing countries like Ghana.

scholarly journals Quality indicators of dental health care in Serbia

2019 ◽  
Vol 66 (1) ◽  
pp. 36-42
Author(s):  
Svetlana Jovanović ◽  
Maja Milošević ◽  
Irena Aleksić-Hajduković ◽  
Jelena Mandić
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health System ◽  
Quality Indicators ◽  
Health Care Quality ◽  
Care Quality ◽  
System Quality ◽  
Quality Health Care ◽  
Quality Health

Summary Health care has witnessed considerable progresses toward quality improvement over the past two decades. More precisely, there have been global efforts aimed to improve this aspect of health care along with experts and decision-makers reaching the consensus that quality is one of the most significant dimensions and features of health system. Quality health care implies highly efficient resource use in order to meet patient’s needs in terms of prevention and treatment. Quality health care is provided in a safe way while meeting patients’ expectations and avoiding unnecessary losses. The mission of continuous improvement in quality of care is to achieve safe and reliable health care through mutual efforts of all the key supporters of health system to protect patients’ interests. A systematic approach to measuring the process of care through quality indicators (QIs) poses the greatest challenge to continuous quality improvement in health care. Quality indicators are quantitative indicators used for monitoring and evaluating quality of patient care and treatment, continuous professional development (CPD), maintaining waiting lists, patients and staff satisfaction, and patient safety.

scholarly journals Optimalisasi peran & fungsi manajemen kepala ruangan dalam supervisi dokumentasi asuhan keperawatan di rumah sakit x Jakarta

2021 ◽  
Vol 14 (4) ◽  
pp. 536-544
Author(s):  
Teresa Teresa ◽  
Tuti Afrianti ◽  
Tini Suminarti
Keyword(s):  
Quality Of Care ◽  
Nursing Care ◽  
Health Care Quality ◽  
Descriptive Analysis ◽  
Pilot Project ◽  
Poor Quality ◽  
Care Quality ◽  
Nursing Documentation ◽  
Head Nurse

The role of a head nurse in optimizing of management function in supervision of nursing care documentation at X hospital in JakartaBackground: Nursing documentation is important thing that  is indicator quality of care. Since the nursing documentation is still a poor quality, it requires a supervision by the head nurse.Purpose: The head of nursing is responsible for the direction, organization and strategic planning collaborate with nursing staffs in ensuring the quality of nursing care to achieve accurate, effective and efficient documentation and to complete supervision.Method: A pilot project using questionnaire and observation methods was conducted at difference times on two hospital units in Jakarta.Results: The descriptive analysis results showed that among 18 nurses, 4 nurses believed that nursing documentation is an important, effective and clear way to  ease their job. Hence, supervision is continuity needed to support the improvement of health care quality. The innovative projects will be applied in health care.Conclusion:  Nursing documentation must show continuity and quality of  care nursing under the control and supervision of the head nurse and EMR is used as the instrument for documentation.Keywords :  The role; Head nurse; Management; Supervision; Nursing care; DocumentationPendahuluan: Dokumentasi asuhan keperawatan adalah hal yang penting karena menjadi indikator kualitas perawatan. Penerapan dokumentasi asuhan keperawatan saat ini belum optimal sehingga membutuhkan arahan dan supervisi dari Kepala Ruang/Kepala Unit.Tujuan: Tercapainya supervisi dan keberhasilan pelaksanaan dokumentasi asuhan keperawatan yang komprehensif, berkesinambungan, efektif dan  efisien.Metode: Metode pilot project di salah satu Rumah Sakit di Jakarta dengan pengambilan data melalui  observasi dan kuestioner. Instrumen diujikan pada dua ruangan dalam  waktu yang berbeda.Hasil: Analisis deskripsi pada  sejumlah 18 perawat, 4 orang menyatakan bermanfaat, penting dan mudah dalam penerapannya. Supervisi dilakukan untuk memberikan support terhadap kelangsungan pendokumentasian asuhan keperawatan yang berkesinambungan. Proyek inovasi akan ditindaklanjuti dan diaplikasikan dalam program kerja bidang pelayanan keperawatan.Simpulan: Asuhan keperawatan yang berkualitas memerlukan adanya supervisi. Sarannya penggunaan Instrumen Supervise Dokumentasi Asuhan Keperawatan akan disesuaikan dengan penggunaan pencatatan asuhan keperawatan Elektronic Medical Record/EMR

Supporting and activating clinical governance development in Ireland: sharing our learning

2015 ◽  
Vol 29 (4) ◽  
pp. 455-481 ◽  
Author(s):  
Maureen A. Flynn ◽  
Thora Burgess ◽  
Philip Crowley
Keyword(s):  
Patient Safety ◽  
Clinical Care ◽  
Clinical Governance ◽  
Quality And Safety ◽  
Content Type ◽  
Governance Framework ◽  
Integrative Research ◽  
Action Project ◽  
Action Projects

Purpose – The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care. Design/methodology/approach – A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning. Findings – Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations Research limitations/implications – The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals. Practical implications – The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety. Originality/value – Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

Quality of care and patient satisfaction amongst Caucasian and non-Caucasian patients

2016 ◽  
Vol 33 (3) ◽  
pp. 298-320 ◽  
Author(s):  
Somayeh Alizadeh ◽  
Meena Chavan ◽  
Hamin Hamin
Keyword(s):  
Treatment Outcome ◽  
Health Service ◽  
Service Quality ◽  
Health Care Quality ◽  
Care Quality ◽  
Equation Modeling ◽  
Content Type ◽  
Health Service Quality ◽  
Caucasian Patients

Purpose – The purpose of this paper is to explore the key aspects of service quality within the outpatient context. The secondary aim is to compare views on quality of health service by Caucasian and non-Caucasian patients in Australia. Design/methodology/approach – A mixed-method approach was adopted for this study. Qualitative data were collected from 40 patients to develop a scale for measuring health service quality. Quantitative data were collected using self-administered questionnaires available in English, Arabic, Persian, Chinese and Vietnamese. A total of 447 patients in six outpatient clinics completed the survey and data were analyzed using the structural equation modeling technique. Findings – The qualitative findings determined eight dimensions of quality for outpatient care as follows: doctor professionalism; doctor empathy; doctor expertise; treatment outcome; staff concern; timeliness; tangibles; and operation. The quantitative findings indicated that factors related to technical aspect of care, including doctor expertise and treatment outcome were assumed the strongest predictors of overall health care quality in both Caucasian and non-Caucasian groups. Furthermore, no significant discrepancy was found between these two groups’ ratings of overall service quality and satisfaction with care. Originality/value – The study captured ethnically diverse patients’ perspectives on health service quality and highlighted the significance of technical quality, which is generally neglected in service quality measures.

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