Changing services means understanding them

Citation

Hurst, K. (2014), "Changing services means understanding them", International Journal of Health Care Quality Assurance, Vol. 27 No. 2. https://doi.org/10.1108/IJHCQA.06227baa.001

Changing services means understanding them

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 27, Issue 2

Ensuring that hospitals and related organisations have enough staff with the right skills in the right place at the right time and at the right price is a logistical nightmare in these austere times. Even if these workforce planning and development requirements are met, deploying staff, so that full-time services are staffed appropriately is a second headache that managers and clinicians face. But why do some staff do this task well? In this issue, Marco Santos and colleagues explore rostering/scheduling by: interviewing stakeholders; analysing related documents and software; and reviewing the literature. Based on their findings, they describe a six-step rostering/scheduling process before making recommendations to help schedulers understand and manage the process more efficiently and effectively.

Most people have slipped, tripped and fallen in strange environments. The experience is at least embarrassing and at worst causes (sometimes life-threatening) injuries. Lost confidence in the recovery phase after a fall is more problematic among the elderly, potentially leading to sufferers becoming immobile and isolated – injuries that compound the original harm caused by a fall. Understanding the reasons why older people fall in care homes and how staff respond to these untoward incidents may offer insights that reduce risks and help to improve services. Merav Ben Natan and colleagues in this issue, therefore, explore untoward incidents (more broadly) in care homes. Falls were the commonest untoward incident and the authors noted that recording and reporting incidents varied according to staff grade, experience and seniority – a problem if falls and other untoward incidents are to be understood, prevented and reduced.

The old adage in healthcare; if treatment and care is not recorded then it is not done, is a painful lesson for those who have unfortunately been on the wrong end of a public inquiry into patient outcomes; i.e. patients and relatives say that care was not received, while front-line staff protest that it was. Even if we have the structures and processes in place to properly document investigations, treatment and care; how accurate is the information when third parties, for example someone who transcribes dictated notes, works with the raw materials. In this issue, Gary David and colleagues explain how they analysed medical transcription document accuracy. As a bonus, they compare voice-recognition outputs with manually dictated transcripts prepared by medical transcriptionists. The error rates are surprising, although errors range from trivial to potentially lethal. The authors suggest, therefore, that dictation quality assurance (QA) procedures are needed to trap these errors and that follow-up studies should locate more precise causation.

After several well-publicised incidents, where patients died unnecessarily, safety research is rapidly climbing the QA priority list. Portuguese QA researchers are especially active in this field. Margarida Eiras and her Portuguese colleagues, for example, rather than re-inventing the wheel, adopted and translated an established patient-safety questionnaire in their study. High-level statistical techniques were used to assess instrument validity, reliability and usability to confirm that each question worked in Portuguese contexts. Findings clearly show that simply adopting research instruments developed in one context and expecting them to work in another is unsafe and that thorough psychometric testing is required before generic questionnaires are adopted. Clearly, the authors are well placed to measure and improve Portuguese healthcare services.

Moving from a critical care unit (CrCU) to a general ward affects patients and relatives during a vulnerable period for both. But how does the transition affect those involved and can negative processes and outcomes be minimised? Asking patients about these issues may not be the right way to answers transition R&D questions because some or all the time patients spent in the CrCU may be a blur, particularly if they were sedated. Asking patients’ relatives about the preparation for transfer and how it was implemented, on the other hand, seems to be fruitful. Marie Häggström and colleagues in this issue summarise how they investigated 65 relatives’ views about the transition. Findings are surprising; e.g. about 40 per cent were unhappy with structures, processes and outcomes. Similar to Margarida Eiras and colleagues, Häggström et al., resisted the temptation to design new instruments to measure the CrCU-general ward transfer processes – preferring instead to adopt and pre-test an established patient satisfaction questionnaire.

Information technology has transformed audit and research; Mats Lundström and colleagues, in this issue, for example, explore how an international cataract-surgery database was compiled and developed for benchmarking purposes. The authors were particularly sensitive to data-entry demands on clinicians (i.e. not removing surgeons from clinical work) while stressing that learning and clinical improvement, and not policing medical practice is the registry’s purpose. The authors are confident that because surgeons can benchmark their practice against their counterparts in other countries, new guidelines emerging from the database are more likely to be adopted by practitioners.

Choose and book in the UK (and its equivalents in other countries with largely state-funded healthcare) was a major policy initiative, which proved a more complex exercise than many expected. For example, even the apparently simple question – what drives patients to select hospitals and clinician are reasonably well understood although, as we have seen in previous IJHCQA articles, choice can be context-specific; e.g. patients’ deference to healthcare professionals varies among cultures. As we might expect, experience, word of mouth and general practitioner recommendations are major drivers. As Ali Mosadeghrad explains in this issue, policy makers and service managers can capitalise on knowing what their patients prefer and expect in specific contexts as patients consider where and to whom to go for diagnosis, treatment and care.

Keith Hurst