scholarly journals A hospital-based mixed-methods observational study to evaluate a hip and knee replacement quality improvement project

2021 ◽  
Vol 33 (7) ◽  
pp. 272-294
Author(s):  
Thomas W. Wainwright ◽  
David McDonald
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Observational Study ◽  
Knee Replacement ◽  
Clinical Pathways ◽  
Contextual Factors ◽  
Care Process ◽  
Improvement Project ◽  
Content Type ◽  
Care Processes

PurposeHealth services continue to face economic and capacity challenges. Quality improvement (QI) methods that can improve clinical care processes are therefore needed. However, the successful use of current QI methods within hospital settings remains a challenge. There is considerable scope for improvement of elective clinical pathways, such as hip and knee replacement, and so the use and study of QI methods in such settings is warranted.Design/methodology/approachA model to manage variability was adapted for use as a QI method and deployed to improve a hip and knee replacement surgical pathway. A prospective observational study, with a mixed-methods sequential explanatory design (quantitative emphasised) that consisted of two distinct phases, was used to assess its effectiveness.FindingsFollowing the use of the novel QI method and the subsequent changes to care processes, the length of hospital stay was reduced by 18%. However, the interventions to improve care process highlighted by the QI method were not fully implemented. The qualitative data revealed that staff thought the new QI method (the model to manage variability) was simple, effective, offered advantages over other QI methods and had highlighted the correct changes to make. However, they felt that contextual factors around leadership, staffing and organisational issues had prevented changes being implemented and a greater improvement being made.Originality/valueThe quality of QI reporting in surgery has previously been highlighted as poor and lacking in prospective and comprehensively reported mixed-methods evaluations. This study therefore not only describes and presents the results of using a novel QI method but also provides new insights in regard to important contextual factors that may influence the success of QI methods and efforts.

Use of prone position restraint within a mental health trust

2017 ◽  
Vol 22 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Elizabeth Shaw ◽  
Anushtayini Sivananthan ◽  
David Phillip Wood ◽  
James Partington ◽  
Alison Pearl Reavy ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Prone Position ◽  
Clinical Audit ◽  
Physical Restraint ◽  
Challenging Behaviour ◽  
Improvement Project ◽  
Content Type ◽  
Care Processes ◽  
Improvement Interventions ◽  
Quality Improvement Interventions

Purpose The purpose of this paper is to improve the quality of care of patients presenting with challenging behaviour. Design/methodology/approach Current guidelines are described, and adherence to the standards is audited, with a particular emphasis on physical restraint. Findings The results of the clinical audit revealed that in the substantial majority of episodes of challenging behaviour, non-physical techniques were used prior to the need to intervene with physical restraint; however, when physical restraint was used, there was limited use of staff debriefs to facilitate reflection- and work-based learning. A potential diagnostic link to the likelihood of use of prone position restraint was also a finding. The results of a quality improvement project undertaken in response to the findings of the clinical audit demonstrated significant and sustained improvements in adherence to most standards. Practical implications Continuous improvements to the safety of both patients and staff when managing acute challenging behaviour requires ongoing quality improvement interventions underpinned by the application of human factors principles. Originality/value The completion of this audit cycle suggests that it is useful to measure specific points of care processes, however, continuous improvement interventions are indicated to lead to sustained improvement – in this paper this is demonstrated by the safer management of challenging behaviour.

Lessons learned in establishing a quality improvement project to reduce hospital acquired infections in the neonatology ward at a referral hospital in Rwanda

2016 ◽  
Vol 24 (4) ◽  
pp. 341-348 ◽  
Author(s):  
Naasson Gafirimbi ◽  
Rex Wong ◽  
Eva Adomako ◽  
Jeanne Kagwiza
Keyword(s):  
Quality Improvement ◽  
Lessons Learned ◽  
Referral Hospital ◽  
Quality Improvement Project ◽  
Injection Technique ◽  
Improve Quality ◽  
Improvement Project ◽  
Content Type ◽  
Hospital Acquired

Purpose Improving healthcare quality has become a worldwide effort. Strategic problem solving (SPS) is one approach to improve quality in healthcare settings. This case study aims to illustrate the process of applying the SPS approach in implementing a quality improvement project in a referral hospital. Design/methodology/approach A project team was formed to reduce the hospital-acquired infection (HAI) rate in the neonatology unit. A new injection policy was implemented according to the root cause identified. Findings The HAI rate decreased from 6.4 per cent pre-intervention to 4.2 per cent post-intervention. The compliance of performing the aseptic injection technique significantly improved by 60 per cent. Practical implications This case study illustrated the detailed application of the SPS approach in establishing a quality improvement project to address HAI and injection technique compliance, cost-effectively. Other departments or hospitals can apply the same approach to improve quality of care. Originality/value This study helps inform other hospitals in similar settings, the steps to create a quality improvement project using the SPS approach.

Healthcare leaders’ views on successful quality improvement initiatives and context

2017 ◽  
Vol 31 (1) ◽  
pp. 54-63 ◽  
Author(s):  
Stuart Barson ◽  
Fiona Doolan-Noble ◽  
Jonathon Gray ◽  
Robin Gauld
Keyword(s):  
Quality Improvement ◽  
Critical Success Factors ◽  
Success Factors ◽  
Contextual Factors ◽  
Structured Interviews ◽  
Content Type ◽  
Critical Success ◽  
Source Of Information ◽  
Practical Implications ◽  
Healthcare Leaders

Purpose The purpose of this paper is to investigate the contextual factors contributing to the sustainability of healthcare quality improvement (QI) initiatives. Design/methodology/approach Themes from semi-structured interviews with international healthcare leaders are compared with Kaplan and Provost et al.’s (2012) model for understanding success in quality (MUSIQ). Critical success factors within these themes are shown in detail. Findings The interviews provide a rich source of information on critical success factors. The themes largely correspond with MUSIQ, reinforcing its robustness. An important factor emerging from the interviews was the importance of engagement with patients and families in QI, and this needs consideration in seeking to understand context in QI. Research limitations/implications Interview participants represent a limited set of western countries and health systems. Their experiences may not hold true in other settings. Practical implications The detail on critical success factors provides QI practitioners with guidance on designing and implementing sustainable initiatives. Originality/value Including consideration of contextual factors for engagement with patients and families in frameworks for context in QI appears to be an original idea that will add value to such frameworks. Researchers in patient engagement are starting to address contextual factors and connections should be made with this work.

Improvement of hand hygiene compliance among health professional staff of Neonatology Department in Nyamata Hospital

2016 ◽  
Vol 24 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Solange Umulisa ◽  
Angele Musabyimana ◽  
Rex Wong ◽  
Eva Adomako ◽  
April Budd ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Compliance Rate ◽  
Professional Staff ◽  
Routine Practice ◽  
Improve Hand Hygiene ◽  
Improvement Project ◽  
Content Type ◽  
Hygiene Compliance

Purpose The purpose of this study is to improve the hand hygiene compliance in a hospital in Rwanda. Hand hygiene is a fundamental routine practice that can greatly reduce risk of hospital-acquired infections; however, hand hygiene compliance in the hospital was low. Design/methodology/approach A multiple-strategy intervention was implemented with a focus on ensuring stable water supply was available through installing mobile hand hygiene facilities. Findings The intervention significantly increased the overall hand hygiene compliance rate by 35 per cent. The compliance for all of the five hand hygiene moments and all professions also significantly increased. Practical implications By implementing an intervention that involved multiple strategies to address the root causes of the problem, this quality improvement project successfully created an enabling environment to increase hand hygiene compliance. The hospital should encourage using the strategic problem-solving method to conduct more quality improvement projects in other departments. Originality/value Findings from this study may be useful for hospitals in similar settings seeking to improve hand hygiene compliance.

scholarly journals Exploring the usefulness of Lexis diagrams for quality improvement

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sara Dahlin
Keyword(s):  
Quality Improvement ◽  
Survival Data ◽  
Gynecological Cancer ◽  
Care Quality ◽  
Care Process ◽  
Related Factors ◽  
Domain Experts ◽  
Quality Registry ◽  
Care Processes ◽  
Timely Feedback

Abstract Background Visualization is important to aid practitioners in understanding local care processes and drive quality improvement (QI). Important aspects include timely feedback and ability to plot data over time. Moreover, the complexity of care also needs to be understood, as it affects the variation of care processes. However, there is a lack of QI methods visualizing multiple, related factors such as diagnosis date, death date, and cause of death to unravel their complexity, which is necessary to understand processes related to survival data. Lexis diagrams visualize individual patient processes as lines and mark additional factors such as key events. This study explores the potential of Lexis diagrams to support QI through survival data analysis, focusing on feedback, timeliness, and complexity, in a gynecological cancer setting in Sweden. Methods Lexis diagrams were produced based on data from a gynecological cancer quality registry (4481 patients). The usefulness of Lexis diagrams was explored through iterative data identification and analysis through semi-structured dialogues between the researcher and domain experts (clinically active care process owners) during five meetings. Visualizations were produced and adapted by the researcher between meetings, based on the dialogues, to ensure clinical relevance, resulting in three relevant types of visualizations. Results Domain experts identified different uses depending on diagnosis group and data visualization. Key results include timely feedback through close-to-real-time visualizations, supporting discussion and understanding of trends and hypothesis-building. Visualization of care process complexity facilitated evaluation of given care. Combined visualization of individual and population levels increased patient focus and may possibly also function to motivate practitioners and management. Conclusion Lexis diagrams can aid understanding of survival data, triggering important dialogues between care givers and supporting care quality improvement and new perspectives, and can therefore complement survival curves in quality improvement.

scholarly journals Improving feedback on junior doctors’ prescribing errors: mixed-methods evaluation of a quality improvement project

2016 ◽  
Vol 26 (3) ◽  
pp. 240-247 ◽  
Author(s):  
Matthew Reynolds ◽  
Seetal Jheeta ◽  
Jonathan Benn ◽  
Inderjit Sanghera ◽  
Ann Jacklin ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Prescribing Errors ◽  
Improvement Project ◽  
Mixed Methods Evaluation

Development and validation of a care process self-evaluation tool

2007 ◽  
Vol 20 (3) ◽  
pp. 189-202 ◽  
Author(s):  
Kris Vanhaecht ◽  
Karel De Witte ◽  
Roeland Depreitere ◽  
Ruben Van Zelm ◽  
Leentje De Bleser ◽  
...  
Keyword(s):  
Clinical Pathway ◽  
Quantitative Methods ◽  
Clinical Pathways ◽  
Care Process ◽  
Process Of Care ◽  
Evaluation Tool ◽  
Self Evaluation ◽  
Care Processes ◽  
Development And Validation ◽  
The Impact

Clinical pathways are used as a method of organizing care processes. Although they are used worldwide, the concept remains unclear, with little understanding of what exactly is being implemented. A recent systematic review revealed that, although a tool exists to score the instrumental qualities of clinical pathways, no tools are available to assess how the clinical pathway influences the process of care. These tools are needed for a better understanding of the impact of clinical pathways on the length of hospital stay and patient outcomes. In this study, a Care Process Self-Evaluation Tool (CPSET), based on the clinical pathway concept, for assessing the organization of the process of care has been developed and tested. Qualitative and quantitative methods, involving 885 professionals and patients, were used in the development and validation. The CPSET is a valid and reliable 29-item instrument for assessing how the process of care is organized. The CPSET has five subscales: patient-focused organization, coordination of care, communication with patients and family, cooperation with primary care and monitoring/follow-up of the care process. The CPSET can be used in the audit and accreditation of care processes and will help managers and clinicians to understand better how care processes are organized.

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