Journey to facility birth in Zanzibar: a questionnaire-based cohort study of patients’ perspectives on preparedness, access and quality of care

IntroductionTackling substandard maternity care in health facilities requires engaging women’s perspectives in strategies to improve outcomes. This study aims to provide insights in the perspectives of women with severe maternal morbidity on preparedness, access and quality of care in Zanzibar’s referral hospital.MethodsIn a prospective cohort from April 2017 to December 2018, we performed semistructured interviews with women who experienced maternal near-miss complications and matched controls. These focused on sociodemographic and obstetric characteristics, perceived accessibility to and quality of facility care with 15 domains, scored on a one-to-five scale. Participants’ comments and answers to open questions were employed to illustrate quantitative outcomes. Zanzibar’s Medical Research and Ethics Committee approved the study (ZAMREC/0002/JUN/17).ResultsWe included 174 cases and 151 controls. Compared with controls, patients with a near-miss had less formal education (p=0.049), perceived their wealth as poor (p=0.002) and had a stillbirth more often (p<0.001). Many experienced a delay in deciding to seek care. More than controls, near-miss patients experienced barriers in reaching care (p=0.049), often of financial nature (13.8% vs 4.0%). Quality of care was perceived as high, with means above 3 out of 5, in 14 out of 15 domains. One-fifth had an overall suboptimal experience, mostly regarding informed choice and supplies availability. Additional comments were expressed by a minority of participants.ConclusionMost patients promptly sought, accessed and received maternity care in Zanzibar’s referral hospital. A minority experienced barriers, mostly financial, in reaching care and more so among patients with near-miss complications. Quality of facility care was generally highly rated. However, some reported insightful critical perceptions. This study highlights the impact of sociodemographic differences on health, the value of involving patients in decisions regarding maternity care and the need to ensure availability of medical supplies, all which will contribute to improved maternal well-being.

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Understanding the Link between Family Caregiver Quality of Life and the Care Provided to Older People With Dementia

Innovation in Aging ◽

10.1093/geroni/igaa057.500 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 153-154

Author(s):

Afeez Hazzan

Keyword(s):

Quality Of Life ◽

Quality Of Care ◽

Older People ◽

Family Caregivers ◽

Family Caregiver ◽

Well Being ◽

The United States ◽

People With Dementia ◽

The Impact

Abstract Dementia is one of the most rapidly growing diseases in the United States. In 2018, the direct costs to American society of caring for older people with dementia was approximately $277 billion. Primary informal caregivers are mainly responsible for the care of older people with dementia including Alzheimer’s disease. Caregivers perform a myriad of duties ranging from shopping for their loved ones’ groceries, helping with medications, and managing finances. The caregiving role becomes more demanding as the disease progresses over time, and studies have shown that the quality-of-life (QoL) experienced by caregivers of older adults who have dementia is lower than the QoL of caregivers for older people who do not have dementia. To the best of our knowledge, there has been no research conducted to investigate whether lower caregiver QoL affects the level or quality of care that caregivers provide to persons with dementia. In the current study, we interviewed family caregivers living in Rochester, New York to inquire about their quality of life and the care provided to older people living with dementia. Further, caregivers completed the 36-item Short Form Health Survey (SF-36) as well as a draft questionnaire for measuring the quality of care provided to older people living with dementia. Both quantitative and qualitative findings from this study reveals important relationships between family caregiver QoL and the care provided, including the impact of social support and financial well-being. The study findings could have significant impact, particularly for the provision of much needed support for family caregivers.

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Investigations of agent-based modelling for inpatient healthcare systems

10.32920/ryerson.14649378.v1 ◽

2021 ◽

Author(s):

Amirkiarash Kiani

Keyword(s):

Quality Of Care ◽

Recovery Time ◽

Well Being ◽

Patient Acuity ◽

Agent Based ◽

Agent Based Modelling ◽

Novel Approach ◽

Research Plan ◽

The Impact

The goal of this research was to investigate the possibility of using Agent-based Modelling, a novel approach in computerized simulation, to assess the effects of staff ratio on recovery time and to develop an empirical research plan based on an inpatient unit. By creating a virtual unit, the researcher was able to develop an adjustable model to test several scenarios based on empirical evidence; to comprehend the impact of changes to staff ratio and patient acuity on nurses’ workload and quality of care to patients. This investigation found that acuity indices of patients have no significant effect on available recovery time or the number of unperformed activities. On the contrary, nurse/patient ratio has substantial effects on both available recovery time and the number of unperformed activities; which asserts the significant effect of insufficient nurse staffing on the well-being of nurses as well as quality of care to patients.

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An evaluation of foundation doctor training: a mixed-methods study of the impact on workforce well-being and patient care [the Evaluating the Impact of Doctors in Training (EDiT) study]

Health Services and Delivery Research ◽

10.3310/hsdr01150 ◽

2013 ◽

Vol 1 (15) ◽

pp. 1-208 ◽

Cited By ~ 3

Author(s):

S Mason ◽

C O’Keeffe ◽

A Carter ◽

R O’Hara ◽

C Stride

Keyword(s):

Health Care ◽

Quality Of Care ◽

Longitudinal Study ◽

Phase 1 ◽

Well Being ◽

Junior Doctors ◽

Phase 2 ◽

Adequate Quality ◽

The Impact

BackgroundA major reform of junior doctor training was undertaken in 2004–5, with the introduction of foundation training (FT) to address perceived problems with work structure, conditions and training opportunities for postgraduate doctors. The well-being and motivation of junior doctors within the context of this change to training (and other changes such as restrictions in working hours of junior doctors and increasing demand for health care) and the consequent impact upon the quality of care provided is not well understood.ObjectivesThis study aimed to evaluate the well-being of foundation year 2 (F2) doctors in training. Phase 1 describes the aims of delivering foundation training with a focus on the role of training in supporting the well-being of F2 doctors and assesses how FT is implemented on a regional basis, particularly in emergency medicine (EM). Phase 2 identifies how F2 doctor well-being and motivation are influenced over F2 and specifically in relation to EM placements and quality of care provided to patients.MethodsPhase 1 used semistructured interviews and focus groups with postgraduate deanery leads, training leads (TLs) and F2 doctors to explore the strategic aims and implementation of FT, focusing on the specialty of EM. Phase 2 was a 12-month online longitudinal study of F2 doctors measuring levels of and changes in well-being and motivation. In a range of specialties, one of which was EM, data from measures of well-being, motivation, intention to quit, confidence and competence and job-related characteristics (e.g. work demands, task feedback, role clarity) were collected at four time points. In addition, we examined F2 doctor well-being in relation to quality of care by reviewing clinical records (criterion-based and holistic reviews) during the emergency department (ED) placement relating to head injury and chronic obstructive pulmonary disease (COPD).ResultsPhase 1 of the study found that variation exists in how successfully FT is implemented locally; F2 lacks a clearly defined end point; there is a minimal focus on the well-being of F2 doctors (only on the few already shown to be ‘in difficulty’); the ED presented a challenging but worthwhile learning environment requiring a significant amount of support from senior ED staff; and disagreement existed about the performance and confidence levels of F2 doctors. A total of 30 EDs in nine postgraduate medical deaneries participated in phase 2 with 217 foundation doctors completing the longitudinal study. F2 doctors reported significantly increased confidence in managing common acute conditions and undertaking practical procedures over their second foundation year, with the biggest increase in confidence and competence associated with their ED placement. F2 doctors had levels of job satisfaction and anxiety/depression that were comparable to or better than those of other NHS workers, and adequate quality and safety of care are being provided for head injury and COPD.ConclusionsThere are ongoing challenges in delivering high-quality FT at the local level, especially in time-pressured specialties such as EM. There are also challenges in how FT detects and manages doctors who are struggling with their work. The survey was the first to document the well-being of foundation doctors over the course of their second year, and average scores compared well with those of other doctors and health-care workers. F2 doctors are benefiting from the training provided as we found improvements in perceived confidence and competence over the year, with the ED placement being of most value to F2 doctors in this respect. Although adequate quality of care was demonstrated, we found no significant relationships between well-being of foundation doctors and the quality of care they provided to patients, suggesting the need for further work in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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The impact of COVID-19 on the provision of respectful maternity care: findings from a global survey of health workers

10.1101/2021.05.05.21256667 ◽

2021 ◽

Author(s):

Anteneh Asefa ◽

Aline Semaan ◽

Therese Delvaux ◽

Elise Huysmans ◽

Anna Galle ◽

...

Keyword(s):

Quality Of Care ◽

Maternity Care ◽

Qualitative Data ◽

Health Workers ◽

Qualitative Content Analysis ◽

Standards Of Care ◽

Respectful Maternity Care ◽

The Impact ◽

Maternal And Newborn

Background Significant adjustments to the provision of maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care. Aim To explore how the COVID-19 pandemic affected frontline health workers' ability to provide respectful maternity care globally. Methods We conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected quantitative and qualitative data between July and December 2020 and conducted a qualitative content analysis to explore open-ended responses. Findings Health workers (n=1,127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers' fear of getting infected and measures taken to minimise COVID-19 transmission. Discussion Multidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term. Conclusions The measures taken during the COVID-19 pandemic disrupted the quality of care provided to women during labour and childbirth generally, and respectful maternity care specifically. Keywords Maternal health; Quality of care; Labour; Childbirth; Newborn health; Intrapartum care, Antenatal care, Postnatal care

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Quality of Care and Quality of Life: Convergence or Divergence?

Health Services Insights ◽

10.4137/hsi.s13283 ◽

2014 ◽

Vol 7 ◽

pp. HSI.S13283 ◽

Cited By ~ 2

Author(s):

Wadi B. Alonazi ◽

Shane A. Thomas

Keyword(s):

Quality Of Life ◽

Health Care ◽

Health Policy ◽

Quality Of Care ◽

Effective Treatment ◽

Well Being ◽

World Health ◽

The World ◽

The Impact

The aim of this study was to explore the impact of quality of care (QoC) on patients’ quality of life (QoL). In a cross-sectional study, two domains of QoC and the World Health Organization Quality of Life-Bref questionnaire were combined to collect data from 1,059 pre-discharge patients in four accredited hospitals (ACCHs) and four non-accredited hospitals (NACCHs) in Saudi Arabia. Health and well-being are often restricted to the characterization of sensory qualities in certain settings such as unrestricted access to healthcare, effective treatment, and social welfare. The patients admitted to tertiary health care facilities are generally able to present themselves with a holistic approach as to how they experience the impact of health policy. The statistical results indicated that patients reported a very limited correlation between QoC and QoL in both settings. The model established a positive, but ultimately weak and insignificant, association between QoC (access and effective treatment) and QoL ( r = 0.349, P = 0.000; r = 0.161, P = 0.000, respectively). Even though the two settings are theoretically different in terms of being able to conceptualize, adopt, and implement QoC, the outcomes from both settings demonstrated insignificant relationships with QoL as the results were quite similar. Though modern medicine has substantially improved QoL around the world, this paper proposes that health accreditation has a very limited impact on improving QoL. This paper raises awareness of this topic with multiple healthcare professionals who are interested in correlating QoC and QoL. Hopefully, it will stimulate further research from other professional groups that have new and different perspectives. Addressing a transitional health care system that is in the process of endorsing accreditation, investigating the experience of tertiary cases, and analyzing deviated data may limit the generalization of this study. Global interest in applying public health policy underlines the impact of such process on patients’ outcomes. As QoC accreditation does not automatically produce improved QoL outcomes, the proposed study encourages further investigation of the value of health accreditation on personal and social well-being.

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A randomised controlled trial to evaluate the impact of a human rights based approach to dementia care in inpatient ward and care home settings

Health Services and Delivery Research ◽

10.3310/hsdr06130 ◽

2018 ◽

Vol 6 (13) ◽

pp. 1-134 ◽

Cited By ~ 2

Author(s):

Peter Kinderman ◽

Sarah Butchard ◽

Ashley J Bruen ◽

Abbie Wall ◽

Nia Goulden ◽

...

Keyword(s):

Human Rights ◽

Quality Of Care ◽

Assessment Tool ◽

Well Being ◽

Care Homes ◽

Booster Sessions ◽

Human Rights Based Approach ◽

Future Work ◽

The Impact

BackgroundAlthough it is widely recognised that adopting a person-centred approach is beneficial in the care of people living with dementia, a gap remains between the rhetoric and the reality of quality care. Some widely adopted care practices can result in the personhood of this group being threatened and their human rights being undermined.ObjectivesTo evaluate the impact of applying a human rights based approach in dementia inpatient wards and care homes on the quality of care delivered and the well-being of the person living with dementia.DesignA cluster randomised design was employed to compare the impact of implementing a human rights based approach intervention (i.e. training, applying the ‘Getting It Right’ assessment tool and receiving booster sessions) at 10 intervention sites with 10 control sites.SettingEight NHS dementia inpatient wards and 12 care homes in the north-west of England.ParticipantsPeople living with dementia who were residing on dementia inpatient wards or in care homes, and staff working at these sites. The aim was to recruit 280 people living with dementia.InterventionsA sample of staff (an average of 8.9 per site) at each of the sites was trained in a human rights based approach to care, including the application of the ‘Getting It Right’ assessment tool. The tool was then introduced at the site and monthly booster sessions were delivered.Main outcome measuresThe primary outcome measure used in the research was the Quality of Life in Alzheimer’s Disease scale to assess the subjective well-being of the person with dementia. Secondary outcome measures included measures of the quality of care provided (dementia care mapping) and direct measures of the effectiveness of the training in increasing knowledge of and attitudes towards human rights. The study also included an economic evaluation utilising the EuroQol-5 Dimensions, three-level version, and the Adult Social Care Outcomes Toolkit measure.ResultsThe study recruited 439 people living with dementia: 213 to the intervention arm and 226 to the control arm. Primary outcome data were analysed using a linear mixed model. There were no significant differences found in the reported quality of life of residents between the control and intervention groups after the intervention [F(1,16.51) = 3.63;p = 0.074]. The mean difference between the groups was 1.48 (95% confidence interval –7.86 to 10.82).ConclusionsDespite the fact that the training increased staff knowledge of and positive attitudes towards human rights, and although there were some changes in staff decision-making strategies in clinical situations, there was no change in the quality of care provided or in the reported well-being of people living with dementia in these settings. This led to questions about the efficacy of training in bringing about cultural change and improving care practices.LimitationsThere was limited uptake of the training and booster sessions that were integral to the intervention.Future workFuture work could usefully focus on understanding the difficulty in translating change in attitude and knowledge into behaviour.Trial registrationCurrent Controlled Trials ISRCTN94553028.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 13. See the NIHR Journals Library website for further project information.

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Cost control, Access and Quality of Care: The Impact of IUD Revisit Norms in Ecuador

World Health & Population ◽

10.12927/whp..17490 ◽

2013 ◽

Vol 1 (1) ◽

Author(s):

James Foreit ◽

John Bratt ◽

Karen Foreit ◽

Teresa Vargas

Keyword(s):

Quality Of Care ◽

Cost Control ◽

Access And Quality ◽

The Impact

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Magnitude Matters: Art Image Size and Waiting Time Impact Perceived Quality of Care

HERD Health Environments Research & Design Journal ◽

10.1177/1937586719892602 ◽

2019 ◽

Vol 13 (3) ◽

pp. 140-153

Author(s):

Ann Sloan Devlin ◽

Alaina Anderson ◽

Sarah Hession-Kunz ◽

Margaret Kelly ◽

Lilly Noble ◽

...

Keyword(s):

Quality Of Care ◽

Waiting Time ◽

Positive Impact ◽

Well Being ◽

Healthcare Outcomes ◽

Image Size ◽

Perceived Quality Of Care ◽

Dependent Variables ◽

The Impact

Objective: The study fills a gap in the literature by examining the size of the art displayed and waiting time in an exam office on patients’ judgments of the quality of care they are likely to receive. Background: A body of research shows that the content of art in healthcare settings has an impact on patients’ well-being, yet no work has empirically systematically examined the size of the art displayed on perceived healthcare outcomes. Method: A fully crossed 4 ×2 between-subjects experimental design examined the impact of exposure to images in an outpatient exam room that varied in the size of what was displayed (a landscape scene: small, medium, large, and control—blank wall) crossed by the time waiting for the physician (10 vs. 45 min). The Dependent Variables were the reported anxiety and various measures of satisfaction with the healthcare visit. Results: The size of the art had a significant effect on the majority of the dependent variables; specifically, the large image had a more positive impact than the other sizes; longer waits were also negatively evaluated by patients and affected anxiety and judgments of room spaciousness. Conclusions: Identifying the recommended content of art displayed is necessary but not sufficient; the size of the art in its context has the potential to impact a range of important perceptions related to healthcare. When the size does not match the available wall space (i.e., the canonical size was not utilized), a variety of ratings of the healthcare environment (including the practitioner) were negatively affected.

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Investigations of agent-based modelling for inpatient healthcare systems

10.32920/ryerson.14649378 ◽

2021 ◽

Author(s):

Amirkiarash Kiani

Keyword(s):

Quality Of Care ◽

Recovery Time ◽

Well Being ◽

Patient Acuity ◽

Agent Based ◽

Agent Based Modelling ◽

Novel Approach ◽

Research Plan ◽

The Impact

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Nurse Leadership Style and Quality of Care in Clinical Setting: a Systematic Review

NurseLine Journal ◽

10.19184/nlj.v6i1.19831 ◽

2021 ◽

Vol 6 (1) ◽

pp. 45

Author(s):

Sakti Oktaria Batubara ◽

Hsiu Hung Wang ◽

Kuei Min Chen

Keyword(s):

Job Satisfaction ◽

Quality Of Care ◽

Organizational Commitment ◽

Leadership Style ◽

Critical Role ◽

Well Being ◽

Empirical Literature ◽

Improve Quality ◽

The Impact

Background: Nowadays there are mounting concerns about leadership style because of its critical role in job satisfaction and the quality of care of patients. Objectives: To explore different of leadership style to improve quality of care in healthcare setting upon empirical literature published in the last ten years. Design: Literature review. Data sources: A comprehensive electronic database search was conducted in PubMed (2010–2020), Web of Science (2010–2020), CINAHL (2010–2020), Cochrane (2010–2020), to retrieve relevant articles published in English April 2015 and Mei 2020. Review methods: Key terms and phrases associated with leadership style, quality of care and nurses. The abstracts or full texts of research papers were reviewed prior to their inclusion in the review. Results: A total of 9 papers were included in this review. The impact of leadership style to improve quality of care in decreasing cost, increasing patient satisfaction, and patient safety has been identified in a number of research studies. Leadership style is closely related to quality of care, extra effort, effectiveness, job satisfaction, organizational commitment, staff intention to stay, inspirational motivation, general health well being, sex, age, educationl background and nurses’ assigned unit. Various mediating or moderating pathways have been identified with leadership style and quality of care such as work environment, structural empowerment, organizational commitment and job satisfaction. Conclusions: It is vital to choose effective leadership style because this has the potential both to improve quality of care and ensure an adequate nursing workforce. The indirect relationships and predictors of leadership style and quality of care contribute to a more comprehensive understanding of the complex phenomenon of leadership style which in turn may aid the development of effective strategies to address the nursing shortage and increase the quality of patient care.

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