What became of the ‘eyes and the ears’?: exploring the challenges to reporting poor quality of care among trainee medical staff

2021 ◽  
pp. postgradmedj-2021-140463
Author(s):  
Philip Berry

The importance of trainee medical staff in alerting Trusts to patient safety risks and low-quality care was established by the Francis Report, yet many remain hesitant about speaking up. Known barriers include lack of feedback, sceptical attitudes to the likelihood of change and fear of consequences. The author explores other factors including moral orientation in the workplace, role modelling by senior clinicians, discontinuity, ‘normalisation of deviance’, human reactions to burnout/moral injury, loyalty and the spectrum of motivation. The issues of absent feedback and fear are discussed in detail. Challenges met by those receiving reports are also described, such as how to collate soft intelligence, putting concerns into context (the ‘bigger picture’) and stewardship of resources. Initiatives to encourage reporting of trainees’ concerns such as speak up guardians, ‘Speak Up for Safety’ campaign and simulation training are described. A proposal to embed proactive intelligence-gathering arrangements is presented.

2021 ◽  
Vol 33 (2) ◽  
Author(s):  
Yubraj Acharya ◽  
Nigel James ◽  
Rita Thapa ◽  
Saman Naz ◽  
Rishav Shrestha ◽  
...  

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.


Author(s):  
Ronald Ma

Healthcare system performance needs information on cost and revenue of care because of the rising healthcare costs. Empowering clinicians with clinical costing information is central to the success of containing costs. This information holds clinical data linkage unifying clinical, financial and administrative datasets, and seems to facilitate the spending of scarce health care resources in a way that produces the biggest difference in clinical outcomes. This chapter looks at the methodology and processes of clinical costing and its potential applications to facilitate the delivery of value-based healthcare, which confers quality care at lowest unit cost. Policy implications would be purchasing value-based healthcare, based mostly on quality of care after removing avoidable costs for inefficiency and poor quality. Clinician participation in the clinical costing is the key to success, because clinicians will be informed of the options available to choose the most value-based healthcare, which will, in turn, take care of the tight healthcare budget. Yet, this method of clinical costing is still at the margins.


2007 ◽  
Vol 12 (3) ◽  
pp. 173-180 ◽  
Author(s):  
Richard Lilford ◽  
Alex Edwards ◽  
Alan Girling ◽  
Timothy Hofer ◽  
Gian Luca Di Tanna ◽  
...  

Objective: The quality of clinical care is often assessed by retrospective examination of case-notes (charts, medical records). Our objective was to determine the inter-rater reliability of case-note audit. Methods: We conducted a systematic review of the inter-rater reliability of case-note audit. Analysis was restricted to 26 papers reporting comparisons of two or three raters making independent judgements about the quality of care. Results: Sixty-six separate comparisons were possible, since some papers reported more than one measurement of reliability. Mean kappa values ranged from 0.32 to 0.70. These may be inflated due to publication bias. Measured reliabilities were found to be higher for case-note reviews based on explicit, as opposed to implicit, criteria and for reviews that focused on outcome (including adverse effects) rather than process errors. We found an association between kappa and the prevalence of errors (poor quality care), suggesting alternatives such as tetrachoric and polychoric correlation coefficients be considered to assess inter-rater reliability. Conclusions: Comparative studies should take into account the relationship between kappa and the prevalence of the events being measured.


2018 ◽  
Vol 32 (5) ◽  
pp. 708-725 ◽  
Author(s):  
Rebecca Amati ◽  
Amer A. Kaissi ◽  
Annegret F. Hannawa

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.


Author(s):  
Ronald Ma

Healthcare system performance needs information on cost and revenue of care because of the rising healthcare costs. Empowering clinicians with clinical costing information is central to the success of containing costs. This information holds clinical data linkage unifying clinical, financial and administrative datasets, and seems to facilitate the spending of scarce health care resources in a way that produces the biggest difference in clinical outcomes. This chapter looks at the methodology and processes of clinical costing and its potential applications to facilitate the delivery of value-based healthcare, which confers quality care at lowest unit cost. Policy implications would be purchasing value-based healthcare, based mostly on quality of care after removing avoidable costs for inefficiency and poor quality. Clinician participation in the clinical costing is the key to success, because clinicians will be informed of the options available to choose the most value-based healthcare, which will, in turn, take care of the tight healthcare budget. Yet, this method of clinical costing is still at the margins.


2017 ◽  
Vol 23 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Gwendolyn Cherese Godlock ◽  
Rebecca Suzie Miltner ◽  
Dori Taylor Sullivan

Since the seminal report by the Institute of Medicine, To Err Is Human, was issued in 1999, significant efforts across the health care industry have been launched to improve the safety and quality of patient care. Recent advances in the safety of health care delivery have included commitment to creating high-reliability organizations (HROs) to enhance existing quality improvement activities. This article will explore key elements of the HRO concept of deference to expertise, describe the structural elements that support nurses and other personnel in speaking up, and provide examples of practical, evidence-based tools to help organizations support and encourage all members of the health care team to speak up.


2020 ◽  
Vol 29 (21) ◽  
pp. 1252-1259
Author(s):  
Jane Congdon ◽  
Judy Craft ◽  
Martin Christensen

When it comes to determining what constitutes nursing workload, there are a number of approaches that represent and characterise the work of nursing across the three traditional shift patterns (morning/day, afternoon/evening and night). These are observational, self-reporting and work-sampling techniques. A review of the quantitative and qualitative literature to examine workload distributions between the three nursing shifts was undertaken. Using data sourced from the CINAHL, Scopus and Medline databases, the findings suggest that there is an inadequacy in establishing nursing productivity that is perhaps representative of the methods used to decipher nursing workload. This may contribute to poor quality care, and the high cost of excess nursing time contributes to the increasingly high costs of care. Linked to this is the nurse's job satisfaction. Quality of care and job satisfaction are important factors for the sustainability of the nursing workforce. There are few high-quality nursing articles that detail the workload distributions across the three nursing shifts and this is a potential area for further research.


2020 ◽  
pp. 34-36
Author(s):  
M. A. Pokhaznikova ◽  
E. A. Andreeva ◽  
O. Yu. Kuznetsova

The article discusses the experience of teaching and conducting spirometry of general practitioners as part of the RESPECT study (RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related aetiology). A total of 33 trained in spirometry general practitioners performed a study of 3119 patients. Quality criteria met 84.1% of spirometric studies. The analysis of the most common mistakes made by doctors during the forced expiratory maneuver is included. The most frequent errors were expiration exhalation of less than 6s (54%), non-maximal effort throughout the test and lack of reproducibility (11.3%). Independent predictors of poor spirogram quality were male gender, obstruction (FEV1 /FVC<0.7), and the center where the study was performed. The number of good-quality spirograms ranged from 96.1% (95% CI 83.2–110.4) to 59.8% (95% CI 49.6–71.4) depending on the center. Subsequently, an analysis of the reasons behind the poor quality of research in individual centers was conducted and the identified shortcomings were eliminated. The poor quality of the spirograms was associated either with the errors of the doctors who undertook the study or with the technical malfunctions of the spirometer.


2019 ◽  
Vol 7 (3) ◽  
pp. 232-237
Author(s):  
Hana Larasati ◽  
Theresia Titin Marlina

Background: stroke is a disorder of nervous system function that occurs suddenly and is caused by brain bleeding disorders that can affect the quality of life physical dimensions, social dimensions, psychological dimensions, environmental dimensions. Based on the result of Lumbu study (2015) the number of samples were 71 people collected data using the (WHOQOL-BREF). There were 56 people (78,9%) had the poor quality of life of post stroke. The mean of post-stroke quality of life domain was physical domain (45,27%), psychological domain (49,87%), social relations domain (48,15%) and environmental domain (50.01%). Objective: the purpose of the study was know the quality of life of the stroke patients in Outpatient Polyclinic of Private Hospital in Yogyakarta. Methods: used descriptive quantitative by using questionnaire test of purposive sampling system based on patients who have been affected of ischemic or hemorrhagic stroke before, number 30 respondents. Result: quality of life of stroke patient of medium physical dimension (67%), psychological dimension (71%), social dimension (67%), dimension good environment (63%). Conclusion: the quality of life of stroke patients of physical dimension, psychological dimension, and moderate social dimension, while the quality of life of stroke patients were good environmental dimension.   Keywords: Hemorrhagic stroke, ischemic stroke, quality of life


2020 ◽  
pp. 3-53
Author(s):  
Yu.B. Vinslav

The article analyzes the main indicators of the evolution of the domestic economy and its industrial complex in the past year (in January — November 2019). It Identifies trends in this evolution, including negative trends that determine the preservation of reproductive threats in 2020: sluggishness, instability and low quality of economic growth. The main reasons for the fact that the objective resource capabilities of the macro level were clearly not used enough to effectively solve the urgent problems of technological modernization of the economy and increase people’s welfare are established. The main reason is the poor quality of public administration, including imperfect strategic planning and industrial policy; there is still no modern national innovation system in the country. Accordingly, recommendations for improving the quality of state regulation in its specified components are justified. The recommended measures, according to the author, will help the economy to move to a trajectory of rapid, sustainable and high-quality growth.


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