Monitoring and improving QA project from an efficiency and effectiveness standpoint

Citation

Hurst, K. (2012), "Monitoring and improving QA project from an efficiency and effectiveness standpoint", International Journal of Health Care Quality Assurance, Vol. 25 No. 7. https://doi.org/10.1108/ijhcqa.2012.06225gaa.001

Monitoring and improving QA project from an efficiency and effectiveness standpoint

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 25, Issue 7

Laboratory services user satisfaction, especially Asian hospital laboratory service patients, is not a topic that features regularly in IJHCQA, so it is good to move away from mainstream patient satisfaction research. Aradhana Bhargava, Archana Thakur, Bibhabati Mishra, Juhi Taneja, Vinita Dogra and Poonam Loomba believe their study is India’s first. They take a robust approach – reviewing the literature for related publications to help them compile a valid and reliable laboratory service user-satisfaction questionnaire (specimen questions are included). Their findings raise obvious and not-so-obvious user-concerns. Consequently, their policy and practice recommendations are useful to laboratory service managers and clinicians and to developing country QA researchers wanting to replicate the study.

Saving money and time in QA policy and practice projects is a distinct theme in this issue. Many IJHCQA authors are conscious that imposing QI initiatives on over-stretched health service staff can be a problem. Moreover, busy staff’s knowledge and skills may not be up-to-the-mark and even when individuals are keen, given time and space to implement service quality reviews, their peers and superiors’ long-term interests may not be apparent. While there were positive findings in Ann Esain and Sharon Williams’ study reported in this issue, the authors highlight significant barriers to individual and group CQI efforts in NHS England. Interestingly and importantly, they chose to use formative (how things are done) rather than summative (focussing on outputs and outcomes) evaluation. They took an opportunity to invite participants from several English acute and primary care trusts involved in a learning network organised by Cardiff and Warwick Universities. New insights emerge from their evaluation, but perhaps the most important is that NHS staff are a relatively stable workforce and improving their CQI knowledge and skills is a worthwhile investment as long as leaders/visionaries are supported to implement their projects. In short, the authors do well to synthesise complex issues in the literature with findings emerging from their study.

Effective and efficient QA projects improve health and social care services. They’re especially important in services for vulnerable patients, but they’re not mandatory in all European countries. So, robust and user friendly CQI methods are needed. In this issue, we publish Ursula Hoyningen-Süess, David Oberholzer and René Stalder’s community patient quality of life (QoL) study. They describe an extensive project that aimed to measure and improves care home residents’ QoL. Their literature review and fieldwork show how complex QoL is – notably its intertwining variables. Consequently, they developed intra-net based software to help care home staff assess residents’ QoL and filter the prominent factors that seem to influence QoL like socialising. As we might expect, reporting occurs at individual and organisational levels, so it’s likely that the software will be applicable to any country.

It is hard to imagine what QoL is like after a major disaster such as the Japanese tsunami and nuclear power station incidents. Gholamreza Sepehri, Naser Haj-Akbari, Ehsan Sepehri and Motahareh Mohsen-Beigi explain in this issue that psychological studies among major disaster victims have broad-ranging clinical implications. For example, can anything be learned from more independent datasets such as post-disaster prescribing patterns and drug use? Logically, anxiolytic medications might help survivors cope; but what else? The authors’ findings from a prescribing study five years after the Iranian Bam earthquake reveal a surprising medication-range, which changed remarkably compared to pre-disaster prescribing. There seems to be inappropriate prescribing post disaster – particularly antibiotics (leading to bacterial resistance) and steroids (which mask symptoms). Notably not only medicine type but also administrative route, with obvious clinical, cost and quality implications issues emerge from the study.

Looking at pharmacology from another perspective, substance abuse (SA), a societal bane, owing to related crime such as theft to feed the users’ drugs habits, is not a topic that we publish regularly. Yet, SA health and social care programmes can make significant differences to individual QoL specifically and society generally. Moreover, if SA programmes work then they recoup their costs and then some owing to their positive effect on recidivism. It is important, therefore, that SA services are quality assured to improve their efficiency and effectiveness. In this issue, Matthew Chinman, Sarah Hunter and Patricia Ebener in this issue look closely at validating and accrediting North American SA treatment and prevention programmes. They review continuous quality improvement (CQI) methods generally and their place in SA programmes specifically. They focus on the plan, do, study, act (PDSA) and bottom-up approaches. They note, however, that SA processes and outcomes are hard to define and measure. However, working closely with SA programme coal-face staff they create robust measures within existing resources to emulate real-world research. Review programmes were selected by local staff and understandably the more challenging and grandiose projects were less successful. The authors noted that participants’ enthusiasm waned over the CQI programme’s life. The authors’ warts-and-all report has many valuable lessons for CQI workers broadly and SA programme workers specifically.

Iatrogenic disease such as venous thrombo-embolism (VTE) affects significant inpatients and has attracted political and media interest not least because 25,000 VTE-related deaths could be prevented in the UK each year. Consequently, VTE in the English NHS got its own “league table”, which ranks hospitals according to their risk assessment performance. Moreover, the National Institute for Health and Clinical Excellence (NICE) released evidence-based VTE prevention clinical guidelines. But clinicians have questioned and challenged these guidelines because they reduce orthopaedic surgeons’ clinical autonomy. Consequently, the guidelines were revised. Dushan Thavarajah and Martin Wetherill in this issue, therefore, explored how well VTE risk assessment was done in one hospital orthopaedic service before implementing a VTE alert to remind clinicians that assessment and re-assessment are due. Performance before the alert system was poor, which improved significantly after they changed VTE practices. Nevertheless, they question whether VTE risk assessment and re-assessment should be compulsory and recommend that the NICE VTE prevention and treatment guidelines should be changed.

Taxpayers and individuals pay significant sums into healthcare services, but how accountable are service managers and practitioners for the services they provide? Accountability is mostly associated with legal redress, i.e. who compensates patients and relatives when healthcare practitioners make mistakes. But is it possible that strengthening accountability and making structure and processes transparent might encourage service providers to get it right first time especially if poor-service managers stand up when services go wrong? Should we assume that providers are fully aware of their accountability to patients and that patients fully understand their rights? Understanding these issues is at least enlightening and potentially valuable to help us improve health service quality. Consequently, Mohammad Nurunnabi and Syed Kamrul Islam in this issue explore how accountability is perceived in Bangladesh. They use high-level statistics to extract dimensions from survey data that best explain how accountability is perceived. The authors paint a grim picture because Bangladeshi patients seem have lost faith in the government’s ability to provide safe and equitable healthcare. Worryingly, respondents were not keen to give their views to the researchers, fearing recriminations. Consequently, health tourism is increasing (one dimension emerging from the authors’ statistical analysis), which means, economically, the country is bleeding. Government policy does not seem to have kept pace with healthcare developments so the authors recommend drastic changes to Bangladeshi healthcare policy and practice.

Keith HurstEditor