What makes an effective Quality Improvement Manager? A qualitative study in the New Zealand Health System

Purpose Quality improvement is an international priority, and health organisations invest heavily in this endeavour. Little, however, is known of the role and perspectives of Quality Improvement Managers who are responsible for quality improvement implementation. We explored the quality improvement managers’ accounts of what competencies and qualities they require to achieve day-to-day and long-term quality improvement objectives. Design Qualitative exploratory design using an interpretivist approach with semi-structured interviews analysed thematically. Setting and participants. Interviews were conducted with 56 quality improvement managers from 15 (out of 20) New Zealand District Health Boards. Participants were divided into two groups: traditional and clinical quality improvement managers. The former group consisted of those with formal quality improvement education—typically operations managers or process engineers. The latter group was represented by clinical staff—physicians and nurses—who received on-the-job training. Results Three themes were identified: quality improvement expertise, leadership competencies and interpersonal competencies. Effective quality improvement managers require quality improvement experience and expertise in healthcare environments. They require leadership competencies including sense-giving, taking a long-term view and systems thinking. They also require interpersonal competencies including approachability, trustworthiness and supportiveness. Traditional and clinical quality improvement managers attributed different value to these characteristics with traditional quality improvement managers emphasising leadership competencies and interpersonal skills more than clinical quality improvement managers. Conclusions We differentiate between traditional and clinical quality improvement managers, and suggest how both groups can be better prepared to be effective in their roles. Both groups require a comprehensive socialisation and training process designed to meet specific learning needs.

Stakeholder views of the development of a clinical quality registry for interventional radiology: a qualitative study

Background Clinical quality registries (CQRs) can likely improve quality in healthcare and research. However, studies indicate that effective use of CQRs is hindered by lack of engagement and interest among stakeholders, as well as factors related to organisational context, registry design and data quality. To fulfil the potential of CQRs, more knowledge on stakeholders’ perceptions of the factors that will facilitate or hamper the development of CQRs is essential to the more appropriate targeting of registry implementation and the subsequent use of the data. The primary aim of this study was to examine factors that can potentially affect the development of a national CQR for interventional radiology in Norway from the perspective of stakeholders. Furthermore, we wanted to identify the intervention functions likely to enable CQR development. Only one such registry, located in Sweden, has been established. To provide a broader context for the Norwegian study, we also sought to investigate experiences with the development of this registry. Methods A qualitative study of ten Norwegian radiologists and radiographers using focus groups was conducted, and an in-depth interview with the initiator of the Swedish registry was carried out. Questions were based on the Capability, Opportunity and Motivation for Behaviour Model and the Theoretical Domains Framework. The participants’ responses were categorised into predefined themes using a deductive process of thematic analysis. Results Knowledge of the rationale used in establishing a CQR, beliefs about the beneficial consequences of a registry for quality improvement and research and an opportunity to learn from a well-developed registry were perceived by the participants as factors facilitating CQR development. The study further identified a range of development barriers related to environmental and resource factors (e.g., a lack of organisational support, time) and individuallevel factors (e.g., role boundaries, resistance to change), as well as several intervention functions likely to be appropriate in targeting these barriers. Conclusion This study provides a deeper understanding of factors that may be involved in the behaviour of stakeholders regarding the development of a CQR. The findings may assist in designing, implementing and evaluating a methodologically rigorous CQR intervention.

Remote clinical quality management of endovascular care

Aim. To assess the effectiveness of remote clinical quality management of endovascular care.Methods. The system of clinical quality management of medical care in myocardial infarction (MI) including the quality of remote control of endovascular care was developed and introduced into the health care system of the Moscow Region as a part of the comprehensive study in 2008–2020. The number of people under the study was 8375. The ground for assessing the effectiveness of remote clinical management in 2019–2020 was the health care system of megapolis. Based on the analysis of 2966 endovascular procedures protocols, the treatment tactics effectiveness of intraoperative decisions was studied after an emergency coronary angiography (ECA) had been performed by interventional cardiologists. The system of remote clinical quality management of endovascular care included a complex of audiovisual communications, computer system processes, mentoring and the algorithm for making an intraoperative decision. The effectiveness of remote clinical quality management of endovascular care was investigated on the number of percutaneous coronary interventions (PCI) in MI, mortality of patients with MI in the Regional vascular center in 2019–2020. The T-criteria was used to assess the reliability. The material statistical processing was carried out in the Statistica 6.0 package calculating adequate statistical indicators and their reliability at p≤0.005.Results. Ratio PCI/ECA in 2019, January-March 2020 counted up to 48.95%. In AprilDecember 2020 it increased up to 71.6% (p<0.001). The frequency of performing PCI increased by 1.46 times (p<0.001). Hospital mortality from MI decreased during the following period 2019, April-December 2020 from 9.7% to 8.2% (p = 0.005).Conclusion. Remote clinical management based on telemedicine and mentoring process technologies contributes to improving the quality of endovascular care in MI.

Sosialisasi Manajemen Klinis untuk peningkatan mutu pelayanan kesehatan bagi Profesional Perekam Medis

Health facilities are very important services for the community. The most important health service is to produce beneficial outcomes for patients, users and society. Achieving this outcome is highly dependent on the quality of health services. Improving the quality of clinical services is one of the efforts to manage the quality of health services. Information about health services from all users of medical services and all individuals is needed as a source of data to answer questions about the quality of health services. So that accurate information is obtained. The purpose of this activity is to provide information and knowledge to medical recorders about the quality of health services related to clinical quality management in improving performance and implementing clinical management concepts. There are several perspectives regarding the quality of health services, including according to consumers of health services as a service that can meet the needs of the community, according to quality health service providers, namely the availability of equipment, work procedures, professional freedom in performing health services, according to funders of health services as a health service. In an effective and efficient manner, according to the owner of health care facilities, quality health services can generate income that is able to cover operational costs, while according to health service administrators, it can provide for the needs of patients and health care providers. The method used is by providing information directly through virtual media to medical recorders. Keywords: Management, Clinical, Quality, Service, Medical Record Abstrak Fasilitas kesehatan merupakan pelayanan yang sangat penting bagi masyaraka. Pelayanan kesehatan yang paling utama adalah menghasilkan outcome yang menguntungkan bagi pasien, pengguna dan masyarakat. Pencapaian outcome ini sangat tergantung pada mutu pelayanan kesehatan. Peningkatan mutu pelayanan klinis merupakan salah satu upaya manajemen mutu pelayanan kesehatan. Informasi mengenai pelayanan kesehatan dari seluruh pengguna jasa pelayanan medis maupun seluruh individu diperlukan sebagai sumber data untuk menjawab pertanyaan mengenai mutu pelayanan kesehatan. Sehingga diperoleh informasi yang akurat. Tujuan kegiatan adalah untuk memberikan informasi dan pengetahuan kepada para perekam medis tentang mutu pelayanan kesehatan terkait manajemen mutu klinis dalam peningkatan kinerja serta mengimplementasikan konsep manajemen klinis. Terdapat beberapa perspektif mengenai mutu pelayanan kesehatan diantaranya menurut konsumen layanan kesehatan sebagai suatu layanan yang dapat memenuhi kebutuhan masyarakat, menurut provider layanan kesehatan yang bermutu yaitu tersedianya peralatan, prosedur kerja, kebebasan profesi dalam melakukan layanan kesehatan, menurut penyandang dana layanan kesehatan sebagai suatu layanan kesehatan yang efektif dan efisien, menurut pemilik sarana layanan kesehatan bahwa layanan kesehatan yang bermutu dapat menghasilkan pendapatan yang mampu menutupi biaya operasional sedangkan menurut administrator layanan kesehatan dapat menyediakan kebutuhan pasien serta pemberi layanan kesehatan. Adapun metode yang dilakukan adalah dengan cara memberikan informasi langsung melalui media virtual kepada perekam medis. Kata kunci: Manajemen, Klinis, Mutu, Pelayanan, Perekam Medis

Effects of the Dietary Approaches to Stop Hypertension (DASH) diet on clinical, quality of life, and mental health outcomes in women with migraine: A randomised controlled trial

The relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and clinical, quality of life, and mental health outcomes in migraine is unknown. To address this knowledge gap, we conducted a parallel-group, randomised controlled trial to evaluate the effect of the DASH diet on these health outcomes in women with migraine. Of 102 eligible women (20-50 years), 51 randomised to the DASH and 51 to the usual dietary advice (control) groups completed a 12-week intervention. The DASH diet was designed using a 7-day menu cycle to provide 15-20% of total daily energy requirements from proteins, 25-30% from fats, and 55-60% from carbohydrates. Dietary records and serum vitamin C levels were used to assess women’s compliance with the DASH diet. The clinical symptoms of migraine (i.e., frequency, duration, severity) and quality of life and mental health (i.e., depression, anxiety, stress) outcomes were assessed in groups pre-and post-intervention. We observed greater decreases in the frequency (-3.00 vs. -1.40, P=0.025) and severity (-1.76 vs. -0.59, P<0.001) of migraine in the DASH vs. control group post-intervention. Similarly, the DASH group exhibited a tendency toward greater decreases in migraine duration (-0.58 vs -0.33 days, P=0.053) and had lower scores of depression (-4.50 vs. -2.73, P=0.019) and stress (-5.84 vs -2.98, P=0.011) vs. controls. However, the quality of life and anxiety outcomes remained comparable in groups post-intervention. Together, evidence supports the benefits of the DASH diet on improving migraine health outcomes in reproductive-aged women. Further research is needed to confirm our findings.

Anteseden Dari Process Orientation Serta Dampaknya Terhadap Financial Performance dan Patient Satisfaction

Industri pelayanan kesehatan semakin meningkat tiap tahunnya, demi memenangkan persaingan pada Industri tersebut rumah sakit swasta harus terus berinovasi untuk meningkatkan performa finansial perusahaan dan kepuasan pasien. Penelitian kali ini menguji pengaruh dari process orientation pada rumah sakit swasta XYZ di Indonesia dengan menggunakan model penelitian yang diadopsi dari penelitian sebelumnya. Penelitian kali ini berhasil mengumpulkan data dari 167 responden dengan menggunakan kuesioner dengan skala likert yang disebarkan pada bulan maret 2021 yang kemudian dilakukan analisa dengan PLS-SEM. Hasil penelitian ini menunjukan adanya pengaruh positif yang kuat antara process orientation terhadap kepuasan pasien dan performa finansial dengan ketiga variable mediasi operational efficiency, workforce condition and clinical quality terbukti memiliki pengaruh positif dan signifikan terhadap financial performance dan kepuasaan pasien, dimana pengaruh terbesar ditemukan pada jalur mediasi dengan workforce condition. Namun pada penelitian ini juga ditemukan bahwa workforce condition tidak memiliki pengaruh yang signifikan terhadap operational efficiency. Model hasil penelitian ini menunjukan predictive accuracy sedang sehingga perlu dikembangkan lebih lanjut pada penelitian berikutnya.