scholarly journals It’s a small bit of advice, but actually on the day, made such a difference…: perceptions of quality in abortion care in England and Wales

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Katherine C. Whitehouse ◽  
Rebecca Blaylock ◽  
Shelly Makleff ◽  
Patricia A. Lohr
Keyword(s):  
Service User ◽  
Care Pathway ◽  
Quality Care ◽  
Waiting Times ◽  
Positive Interactions ◽  
Interpersonal Interactions ◽  
Healthcare Outcomes ◽  
England And Wales ◽  
Important Contributor ◽  
Abortion Care

Abstract Background Quality of care (QOC) is increasingly identified as an important contributor to healthcare outcomes, however little agreement exists on what constitutes quality in abortion care or the recommended indicators from the service-user perspective. Our study aimed to explore perceptions and experiences of abortion QOC in England and Wales. Methods We performed in-depth interviews (via phone or in-person) with participants who had an abortion at a nationwide independent sector provider in the previous 6 months. We explored their experiences of the abortion service at each point in the care pathway, their perspectives on what contributed to and detracted from the experience meeting their definitions of quality, and their reflections on different aspects of QOC. We used content analysis to generate themes. Results From December 2018 to July 2019, we conducted 24 interviews. Ten participants had a surgical and 14 had a medical abortion. Seventeen (71%) were treated in the first 12 weeks of pregnancy and 7 (29%) beyond that, with an average gestational age of 10 weeks + 5 days (range 5–23 + 6). We identified 4 major themes that contributed to participant’s perception of high quality care: (1) interpersonal interactions with staff or other patients, (2) being informed and prepared, (3) participation and choices in care and (4) accessibility. Nearly all participants identified interpersonal interactions with staff as an important contributor to quality with positive interactions often cited as the best part of their abortion experience and negative interactions as the worst. For information and preparation, participant described not only the importance of being well prepared, but how incongruencies between information and the actual experience detracted from quality. Participants said that making choices about their care, for example, method of abortion, was a positive contributor. Finally, participants identified access to care, specifically in relation to waiting times and travel, as an important aspect of QOC. Conclusions Participants situated quality in abortion care in 4 domains: interpersonal aspects of care, information and preparation, choices, and accessibility. Indicators identified can be used to develop standard metrics to ensure care meets service-user needs.

scholarly journals "It's a small bit of advice, but actually on the day, made such a difference...": perceptions of quality in abortion care in England and Wales

2021 ◽  
Author(s):  
Katherine Whitehouse ◽  
Rebecca Blaylock ◽  
Shelly Makleff ◽  
Patricia Lohr
Keyword(s):  
Service User ◽  
Care Pathway ◽  
Quality Care ◽  
Waiting Times ◽  
Medical Abortion ◽  
Positive Interactions ◽  
Interpersonal Interactions ◽  
Healthcare Outcomes ◽  
Important Contributor ◽  
Abortion Care

Background: Quality of care (QOC) is increasingly identified as an important contributor to healthcare outcomes, however little agreement exists on what constitutes quality in abortion care or the recommended indicators from the service-user perspective. Our study aimed to explore perceptions and experiences of abortion QOC in England and Wales.Methods: We performed in-depth interviews (via phone or in-person) with participants who had an abortion at a nationwide independent sector provider in the previous 6 months. We explored their experiences of the abortion service at each point in the care pathway, their perspectives on what contributed to and detracted from the experience meeting their definitions of quality, and their reflections on different aspects of QOC. We used content analysis to generate themes. Results: From December 2018 to July 2019, we conducted 24 interviews. Ten participants had a surgical and 14 had a medical abortion. Seventeen (71%) were treated in the first 12 weeks of pregnancy and 7 (29%) beyond that, with an average gestational age of 10 weeks + 5 days (range 5-23 + 6). We identified 4 major themes that contributed to participant’s perception of high quality care: 1) interpersonal interactions with staff or other patients, 2) being informed and prepared, 3) participation and choices in care and 4) accessibility. Nearly all participants identified interpersonal interactions with staff as an important contributor to quality with positive interactions often cited as the best part of their abortion experience and negative interactions as the worst. For information and preparation, participant described not only the importance of being well prepared, but how incongruencies between information and the actual experience detracted from quality. Participants said that making choices about their care, for example, method of abortion, was a positive contributor. Finally, participants identified access to care, specifically in relation to waiting times and travel, as an important aspect of QOC. Conclusions: Participants situated quality in abortion care in 4 domains: interpersonal aspects of care, information and preparation, choices, and accessibility. Indicators identified can be used to develop standard metrics to ensure care meets service-user needs.

Understanding the Abortion Experiences of Young People to Inform Quality Care in Argentina, Bangladesh, Ethiopia, and Nigeria

2021 ◽  
pp. 0044118X2110110
Author(s):  
Laura E. Jacobson ◽  
Ana Maria Ramirez ◽  
Chiara Bercu ◽  
Anna Katz ◽  
Caitlin Gerdts ◽  
...  
Keyword(s):  
Young People ◽  
Quality Care ◽  
First Trimester ◽  
Structural Barriers ◽  
Structured Interviews ◽  
Safe Abortion ◽  
Medication Abortion ◽  
Abortion Care ◽  
The Mean ◽  
Reproductive Healthcare

Young people face social and structural barriers when accessing abortions. High-quality, sexual and reproductive healthcare is needed; however, literature on youth-informed abortion services is limited. This study assesses accounts of youth who obtained an abortion in Argentina, Bangladesh, Ethiopia, and Nigeria and provides recommendations to improve person-centered aspects of abortion quality. We analyzed 48 semi-structured interviews with clients recruited from clinics, safe abortion hotlines, and patent and proprietary medicine vendors. We coded transcripts and conducted a thematic analysis. The mean age was 21 years (range 16–24), and the majority had a first trimester, medication abortion. Prominent themes included access to information; privacy; stigma associated with age or marital status; the decision-making process; and comfort and rapport with providers. Youth-centered abortion care should anticipate the distinct needs of younger clients. Supportive providers have an important role in offering a non-judgmental service that makes young clients feel comfortable and prepared.

scholarly journals The National Pain Audit for specialist pain services in England and Wales 2010–2014

2018 ◽  
Vol 13 (3) ◽  
pp. 185-193 ◽  
Author(s):  
Cathy Price ◽  
Amanda C de C Williams ◽  
Blair H Smith ◽  
Alex Bottle
Keyword(s):  
Quality Improvement ◽  
Waiting Times ◽  
Pain Clinic ◽  
Standards Of Care ◽  
National Audit ◽  
England And Wales ◽  
Safety Standards ◽  
Diagnostic Coding ◽  
Pain Clinics ◽  
Pain Services

Introduction: Numerous reports highlight variations in pain clinic provision between services, particularly in the provision of multidisciplinary services and length of waiting times. A National Audit aims to identify and quantify these variations, to facilitate raising standards of care in identified areas of need. This article describes a Quality Improvement Programme cycle covering England and Wales that used such an approach to remedy the paucity of data on the current state of UK pain clinics. Methods: Clinics were audited over a 4-year period using standards developed by the Faculty of Pain Medicine of The Royal College of Anaesthetists. Reporting was according to guidance from a recent systematic review of national surveys of pain clinics. A range of quality improvement measures was introduced via a series of roadshows led by the British Pain Society. Results: 94% of clinics responded to the first audit and 83% responded to the second. Per annum, 0.4% of the total national population was estimated to attend a specialist pain service. A significant improvement in multidisciplinary staffing was found (35–56%, p < 0.001) over the 4-year audit programme, although this still requires improvement. Very few clinics achieved recommended evidence-based waiting times, although only 2.5% fell outside government targets; this did not improve. Safety standards were generally met. Clinicians often failed to code diagnoses. Conclusion: A National Audit found that while generally safe many specialist pain services in England and Wales fell below recommended standards of care. Waiting times and staffing require improvement if patients are to get effective and timely care. Diagnostic coding also requires improvement.

Breast cancer: Global quality care

2019 ◽  
Keyword(s):  
Breast Cancer ◽  
Best Practices ◽  
Cancer Care ◽  
Care Pathway ◽  
Health Care Systems ◽  
Quality Care ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Global Quality ◽  
Care Systems

Caregivers delivering care to breast cancer patients wish to provide the highest quality breast care possible. Due to the complexity of the care pathway, this care should be delivered by a multidisciplinary team working in a breast cancer unit/centre. This book was written by experts from different disciplines and presents ideas for developing a breast unit wherever you live. The authors provide thorough descriptions of high-quality breast cancer care, define targets, methods to assess one’s care, and ideas on how to improve care within one’s resources. A global view of the quality of breast cancer care shows specific best practices applicable to many centres operating in various health care systems with different financial and political situations. Foundation hallmarks of innovation, communication, patient-centred care, multidisciplinary, and budget considerations guide specific recommendations for each component of care. This book discusses global and local considerations so that optimally ‘integrated’ breast cancer care can be organized. Each component of care (e.g. imaging, surgery, etc.) is discussed from both theoretical and practical aspects. The recommendation for each component of care is facilitated by experienced experts laying out rational and practical approaches to each step. This book provides guidance how to integrate the different disciplines into breast cancer care. Beyond treatment, it provides practical considerations regarding accreditation and certification, and it comments on the influence of budget and of treatment. Finally, it demonstrates how best practices may be altered by the emerging involvement of patients, technologies, and transitions of future societal values.

scholarly journals Improving Person-Centered Access to Dental Care: The Walk-In Dental Encounters in Non-Emergency Situations (WIDENESS)

2019 ◽  
Vol 7 (4) ◽  
pp. 116
Author(s):  
Noémie Gulion ◽  
Jean-Noel Vergnes
Keyword(s):  
Dental Care ◽  
Care Pathway ◽  
Waiting Times ◽  
Oral Care ◽  
Structured Interview ◽  
University Hospital ◽  
Research Approach ◽  
Emergency Situations ◽  
Access To Dental Care ◽  
Data Saturation

Background: We hypothesized that access to dental care could be improved by the conceptualization of a new type of consultation: The walk-in dental encounter for non-emergency situations (WIDENESS). The aim of this study was to assess patient perspectives regarding walk-in dental consultations, with a particular focus on non-emergency situations. Methods: We followed a qualitative research approach using a semi-structured interview guide in a sample of random participants recruited from the dental department of the Toulouse University Hospital, France. We performed a thematic analysis of the interview transcripts. Data saturation was obtained after interviewing 11 participants. Results: When asked about walk-in dental consultations, three main topics emerged: (1) Walk-in dental consultation in general is important for emergency situations, but WIDENESS did not correspond to any specific long-standing need from participants; (2) WIDENESS could be a way to improve access to oral care (facilitating access to care relative to time constraints, reduction of dentist-related anxiety, better overall follow-up for the care pathway, and the complementary nature of consultations with and without appointments); and (3) WIDENESS has some potential drawbacks—apprehension about long waiting times was mentioned by several participants. Conclusions: Participants found the idea of WIDENESS promising, despite spontaneously mentioned reservations, which constitute major challenges to its implementation.

scholarly journals P140: Investigating volunteer perspectives on leading patient-centred practices in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S114-S115
Author(s):  
L. Witt ◽  
T. Oyedokun ◽  
D. Goodridge ◽  
J. Stempien ◽  
T. Graham
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Quality Care ◽  
Waiting Times ◽  
Physical Space ◽  
Cultural Safety ◽  
Wait Times ◽  
Two Phase ◽  
Survey Responses ◽  
Current Practices

Introduction: Patient satisfaction is an essential component of effective delivery of quality care in the emergency department (ED). Frequent reflection on current practices is required to detect areas in need of improvement. The Ontario Hospital Association (OHA) outlined five ‘Leading Practices’ (LPs) targeted to increase patient satisfaction in this setting. The ED volunteers are a group of individuals who have unique perspectives on ED practices that are unbiased by confounders affecting patients and staff. The goal of this study was to explore the unique perspectives of ED volunteers involving what they believe will improve the delivery of patient-centered care, as well as to examine to what extent Saskatoon EDs are embracing the principles outlined in the OHA LPs. Methods: A two-phase mixed methods approach, with a survey followed by interviews that allowed participants to expand on survey findings was used. The pool of 45 ED volunteers was extended the opportunity to participate resulting in 36 survey responses and 6 interviews. The 13 Likert-grade survey questions were generated to align to each of the LPs and allowed room for qualitative feedback. Interview questions were generated following 15 survey responses to expand on the LPs that were rated below average. Results: Analysis of responses identified inefficient ED processes leading to increased waiting times, inefficient patient location, inadequate signage, a lack of physical space, unclean environments, and a lack of staff and volunteer awareness regarding spiritual care and interpreter services, perceptions of received care by patients due to long wait times and level of cultural safety training of ED staff. Themes reduced from interviews yielded common themes such as patient frustration, disorganization, uncomfortable environment, overcrowding, prolonged wait times, and patient misconception of ED processes at Site 1. Themes common to Site 2 included organization, patient-friendly environment, patient misconception of ED processes, and prolonged wait times. Additionally, the volunteers suggested a plethora of interventions that could improve the current processes in Saskatoon's EDs to make them more patient friendly. Conclusion: Saskatoon EDs comply reasonably well to the OHA Leading practices. Surveying ED volunteers provides important insight into current practices and areas for improvement, and should be considered at other sites to improve adherence to the OHA LPs.

Implementation of a quality care management system for patients with arthritis of the hip and knee

2013 ◽  
Vol 37 (1) ◽  
pp. 88 ◽  
Author(s):  
Christine R. Doerr ◽  
Stephen E. Graves ◽  
Graham E. Mercer ◽  
Richard H. Osborne
Keyword(s):  
Management System ◽  
Care Management ◽  
Quality Care ◽  
Waiting Times ◽  
South Australia ◽  
Waiting List ◽  
Service Access ◽  
Management Service ◽  
Joint Replacement Surgery ◽  
Wide Range

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery. What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting. What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative. What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.

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