scholarly journals Strengthening the health system to improve the quality of care and patient safety

2017 ◽  
Vol 23 (2) ◽  
pp. 55
Author(s):  
Chrishantha Abeysena
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Health System

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.

scholarly journals Can the craze for patient safety hinder a more holistic care of the person in the health care system?

2018 ◽  
Vol 8 (12) ◽  
pp. 9
Author(s):  
Mamane Abdoulaye Samri ◽  
Daphney St-Germain
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Of Care ◽  
Health System ◽  
Continuous Improvement ◽  
Clinical Governance ◽  
Decision Makers ◽  
Holistic Care

Background and objective: Since the publication of a report by the Institute of Medicine on the mortality associated with adverse events in the hospital, patient safety has become one of the essential objectives of the health care system. However, this movement tends to obscure the fundamental link between safety and quality of care in the health system. The study was aimed to demonstrate that the only focus on patient safety concept overshadow the more holistic care of the person and the population in the health care system.Methods: Documentary research in the Pubmed database and the Google Scholar search engine, from 1999 to 2017.Results and conclusion: Highly targeted safety research without addressing quality at first can only be a long-term panacea for current health policies. For cause, a one-way look at patient safety could lead to significant impacts at the population level. In order to get out of this craze, health system decision-makers would benefit from supporting clinical governance advocating humanistic and holistic strategies for interventions, engaging in a process of continuous improvement of the Quality of care more profitable in the long term. In order to overcome this craze, health system decision-makers would benefit from supporting clinical governance that advocates humanistic and holistic strategies for interventions, by engaging in a process of continuous improvement in the quality of care that is most beneficial in the long term. This posture is similar to Caring's well-known nursing model.

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.

scholarly journals A Narrative Review of Clinical Decision Support for Inpatient Clinical Pharmacists

2021 ◽  
Vol 12 (02) ◽  
pp. 199-207
Author(s):  
Liang Yan ◽  
Thomas Reese ◽  
Scott D. Nelson
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Controlled Trials ◽  
Clinical Pharmacists ◽  
Randomized Controlled ◽  
The Impact

Abstract Objective Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. Methods We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle–Ottawa Scale. Results Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. Conclusion These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy.

Relationship Between Performance Measurement and Accreditation: Implications for Quality of Care and Patient Safety

2005 ◽  
Vol 20 (5) ◽  
pp. 239-252 ◽  
Author(s):  
Marlene R. Miller ◽  
Peter Pronovost ◽  
Michele Donithan ◽  
Scott Zeger ◽  
Chunliu Zhan ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Performance Measurement

scholarly journals Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

2015 ◽  
Vol 8 (6) ◽  
pp. 75 ◽  
Author(s):  
Mu'taman Jarrar ◽  
Hamzah Abdul Rahman ◽  
Mohammad Sobri Don
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Health Plan ◽  
Care Service ◽  
Health Care Service ◽  
Working Environment ◽  
Annual Reports ◽  
Related Factors ◽  
Global Initiatives

<p><strong>BACKGROUND &amp; OBJECTIVE:</strong> Demand for health care service has significantly increased, while the quality of healthcare has become both a national and an international priority. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia.</p><p><strong>DESIGN:</strong> A narrative review of the literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) and the MOH Annual Reports in Malaysia were reviewed.</p><p><strong>RESULTS: </strong>The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10<sup>th</sup> Malaysia Health Plan promotes the theme “1 Care for 1 Malaysia” in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors.</p><p><strong>CONCLUSION: </strong>There is no single intervention of optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.</p>

scholarly journals Adjustment of oxygen use by means of pulse oximetry: an important tool for patient safety

2010 ◽  
Vol 8 (4) ◽  
pp. 449-455 ◽  
Author(s):  
Telma de Almeida Busch Mendes ◽  
Paola Bruno de Araújo Andreoli ◽  
Leny Vieira Cavalheiro ◽  
Claudia Talerman ◽  
Claudia Laselva
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Physical Therapy ◽  
Confidence Interval ◽  
Pulse Oximetry ◽  
Patient Care ◽  
Physical Therapists ◽  
Severe Damage ◽  
Margin Of Error

ABSTRACT Objective: To assess patient's level of oxygenation by means of pulse oximetry, avoiding hypoxia (that causes rapid and severe damage), hyperoxia, and waste. Methods: Calculations were made with a 7% margin of error and a 95% confidence interval. Physical therapists were instructed to check pulse oximetry of all patients with prescriptions for physical therapy, observing the scheduled number of procedures. Results: A total of 129 patients were evaluated. Hyperoxia predominated in the sectors in which the patient was constantly monitored and hypoxia in the sectors in which monitoring was not continuous. Conclusions: Professionals involved in patient care must be made aware of the importance of adjusting oxygen use and the risk that non-adjustment represents in terms of quality of care and patient safety.

Use of medical emergency call data as a marker of quality of emergency department care in the post-National Emergency Access Target era

2018 ◽  
Vol 42 (5) ◽  
pp. 607
Author(s):  
Lorraine Westacott ◽  
Judy Graves ◽  
Mohsina Khatun ◽  
John Burke
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Quality Of Care ◽  
Emergency Admission ◽  
Emergency Call ◽  
Medical Emergency ◽  
Negative Consequences ◽  
Model Of Care ◽  
Emergency Calls

Objectives Any new model of care should always be accompanied by rigorous monitoring to ensure that there are no negative consequences, especially any that impact upon patient safety. In 2013, ‘THERMoSTAT’ (Two- Hour Evaluation and Referral Model for Shorter Turnaround Times), an emergency department model of care developed by Royal Brisbane and Women’s Hospital staff was launched to gain efficiencies and improve hospital National Emergency Access Target (NEAT) compliance. The aim of this study was to trial the use of medical emergency call data as a novel marker of the quality of care delivered by our emergency department. Methods Incidence of medical emergency calls for hospital emergency admission patients for the 2 years pre- and 1 year post-THERMoSTAT were compared after standardising for overall hospital activity. Results During the study period, hospital activity increased 10%, and the emergency department experienced a total of 222 645 presentations, 68 000 (30.5%) of which converted into an admission. THERMoSTAT improved NEAT compliance by 17% (from 57.7% to 74.9%) with no change in any patient-safety indicators. A total of 8432 medical emergency calls were made on 5930 patients, 2831 of whom were emergency admissions. After adjusting for hospital activity, there was no change in the average number of patients per week who triggered a medical emergency call after the introduction of THERMoSTAT. These results were reproduced when data was analysed for: total number of inpatients triggering calls; emergency admission patients; and emergency admission patients within the first 24 h or first 4 h of admission. Conclusions This is the first report to investigate the correlation between inpatient medical emergency call incidence and emergency department model of care. Medical emergency call data showed significant promise as a measure of morbidity and as a more direct, objective, simple, quantitative and meaningful measure of patient safety. What is known about the topic? It is well established that extended emergency department lengths of stay are associated with poorer patient outcomes. The corollary of this is not always true however; shorter emergency department length of stay does not automatically translate into better care. Although the underlying philosophy of NEAT is to enhance patient care, there is a risk of negative consequences if NEAT is seen as an end in itself. Many of the commonly used emergency department key performance indicators focus on the timeliness of care and there is a scarcity of easily quantifiable markers that reliably reflect the quality of that care. What does this paper add? This study builds on the concept of medical emergency call incidence as a marker of safety and quality. It explores the utility of using the number of medical emergency calls made in the first few hours of an emergency admission as an indicator of the quality of care delivered by the emergency department. This is significant because it introduces a measure that has a focus that embraces more than the timeliness of care only. What are the implications for practitioners? If medical emergency call incidence in early emergency admissions can be proven to accurately reflect emergency department quality of care then it would provide an easily monitored, objective, quantitative and prompt measure that evaluates dimensions other than timeliness.

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