Validating a generic cancer consumer quality index in eight European countries, patient reported experiences and the influence of cultural differences

Background Taking patient centeredness into account is important in healthcare. The European Cancer Consumer Quality Index (ECCQI) is a validated tool for international benchmarking of patient experiences and satisfaction. This study aimed to further validate the ECCQI in larger and more uniform groups of high volume tumours such as breast and prostate cancer. A second objective was the verification of the influence of cultural factors of the country to determine its possible use in international benchmarking. Methods Data from two survey studies in eight European countries were combined. Socio-demographic correlations were analysed with Kruskall-Wallis and Mann-Whitney tests. Cronbach’s alpha was calculated to validate internal consistency. Influences of masculinity (MAS), power distance (PD) and uncertainty avoidance (UA) were determined by linear regression analysis in a general model and subgroup models. Results A total of 1322 surveys were included in the analysis (1093 breast- and 348 prostate cancer patients). Cronbach’s alpha was good (α ≥ 0.7) or acceptable (0.5 ≤ α ≤ 0.7) in 8 out of 9 questionnaire categories, except in the category ‘Safety’ (α = 0.305). Overall ECCQI scores ranged from 22.1 to 25.1 between countries on a 1–35 scale (categories had a 1–4 scale). In certain subcategories such as ‘Organisation’ (range 2.2 vs 3.0) and ‘Supervision & Support’ (range 3.0 vs 3.8) a large difference was observed between countries. Differences in ‘Overall opinion’ were however small: mean scores of 3.7 vs 3.9, whereas median scores were all the maximum of 4.0. Power distance was positively associated with higher patient satisfaction scores whereas Uncertainty avoidance was negatively associated with these scores. Masculinity was only associated with patient satisfaction scores in lower educated patients. We found the highest impact of culture on overall scores in Hungary and Portugal and the lowest in Romania. Conclusions The ECCQI shows high internal consistency in all categories except ‘Safety’. Especially in separate categories and overall ECCQI scores the questionnaire showed discriminative value. This study showed a positive correlation of power distance and a negative correlation for uncertainty avoidance in some countries. When using the ECCQI for international benchmarking these two dimensions of culture should be taken into account.

Benchmarking outcomes on multiple contextual levels in lean healthcare: a systematic review, development of a conceptual framework, and a research agenda

Background Reliable benchmarking in Lean healthcare requires widely relevant and applicable domains for outcome metrics and careful attention to contextual levels. These levels have been poorly defined and no framework to facilitate performance benchmarking exists. Methods We systematically searched the Pubmed, Scopus, and Web of Science databases to identify original articles reporting benchmarking on different contextual levels in Lean healthcare and critically appraised the articles. Scarcity and heterogeneity of articles prevented quantitative meta-analyses. We developed a new, widely applicable conceptual framework for benchmarking drawing on the principles of ten commonly used healthcare quality frameworks and four value statements, and suggest an agenda for future research on benchmarking in Lean healthcare. Results We identified 22 articles on benchmarking in Lean healthcare on 4 contextual levels: intra-organizational (6 articles), regional (4), national (10), and international (2). We further categorized the articles by the domains in the proposed conceptual framework: patients (6), employed and affiliated staff (2), costs (2), and service provision (16). After critical appraisal, only one fifth of the articles were categorized as high quality. Conclusions When making evidence-informed decisions based on current scarce literature on benchmarking in healthcare, leaders and managers should carefully consider the influence of context. The proposed conceptual framework may facilitate performance benchmarking and spreading best practices in Lean healthcare. Future research on benchmarking in Lean healthcare should include international benchmarking, defining essential factors influencing Lean initiatives on different levels of context; patient-centered benchmarking; and system-level benchmarking with a balanced set of outcomes and quality measures.

Testing ZELPH ['sɛlf] – a self-assessment instrument to surface intended and unintended outcomes of work-integrating pedagogies

PurposeThis paper's twofold purpose is, first, to present ZELPH ['sɛlf], a self-assessment instrument that enables those developing the pedagogy of work-integrating study programmes in higher education (HE) systematically to surface the intended and unintended outcomes of their programme's approach to integrating professional practice into an academic course. Secondly, the paper reports on a small pilot study with programme staff from five different HE institutions in various countries who tested ZELPH.Design/methodology/approachZELPH operationalises aspects of key theories on work-integrating learning pedagogy, and thereby enables a simplified depiction of the reality of combining classroom-based and worksite-based learning. Programme staff from Germany, the United Kingdom, France, South Africa and Taiwan applied the instrument to their respective work-integrating study programmes and evaluated its perceived value and feasibility.FindingsThe findings suggest that ZELPH offers value as a practical instrument, in particular to those less familiar with developing work-integrating learning pedagogy as well as to those keen to compare programmes across national, cultural and institutional contexts.Originality/valueZELPH contributes to addressing the lack of practically applicable instruments to support the design and international benchmarking of work-integrating learning pedagogy in HE.