Top-down and bottom-up quality management

Citation

Hurst, K. (2010), "Top-down and bottom-up quality management", International Journal of Health Care Quality Assurance, Vol. 23 No. 7. https://doi.org/10.1108/ijhcqa.2010.06223gaa.001

Top-down and bottom-up quality management

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 23, Issue 7

Previous IJHCQA issues have featured supply chain theory and practice analytical articles that offer useful insights and guidance for health service managers dealing with networks, queues, waiting lists and backlogs. It is hardly surprising, therefore, that growing service sectors, such as health and social care, attract supply chain theoreticians and practitioners. In this issue, Cherian Samuel and colleagues take a closer look at broader supply chain theory and practice before applying both to a busy Indian tertiary hospital. Specifically, they look at queuing and the effects increasing and reducing capacity have on waiting times. Even from their brief literature review and more detailed case study, we can see (as we saw in previous articles) that supply chains are relevant and helpful to health service staff not least because they are connected to and draw from lean thinking theory and practice.

I doubt if any reader has not taken a medicines prescription to a pharmacist for dispensing. But, thinking back, how much do we reflect on what happened in that short encounter (measured in minutes rather than hours), how technical the transaction was and how important accuracy is to patient safety, particularly when poly-pharmacy (increasingly) is involved. Incorrect drugs administration wastes time (following up errors), costs money (prescriber, dispenser and customer time), reduces the treatment’s therapeutic value (non-compliance) and may even harm patients (uncorrected dosage errors). Moreover, pharmacist roles as healthcare providers are being strengthened not least because community pharmacists are uniquely placed in the “high street” to advise patients and also because dispensing is the last step in the healthcare service pathway. Drug prescribing and dispensing errors are well studied, but what takes place during the pharmacist-customer transaction (advice and guidance, etc), on the other hand, is less well understood. However, Luciana Souza d’Ávila and colleagues in their article in this issue look at dispensing transactions and information giving by the pharmacist – clearly an important function. The circumstances, in which more or less information is communicated, from pharmacist to customer, range from the expected (less information peak-workload times), to the unusual (depending on which physician is the vicinity), which readers will find useful.

As we have seen from manuscripts submitted to IJHCQA and from article download statistics, patient satisfaction remains a popular writer and reader topic. Authors have no difficulty finding new angles, which shows how much we still need to learn about patient expectations and satisfaction. In this issue, Mohsin Butt writes about modifying the SERVQUAL questionnaire for use in Malaysia’s growing and developing health service, which combines highly competitive private and public services. The article is useful from several perspectives. First, the authors’ literature review, especially their industry and health-service quality definition section; second, their study’s methodological detail; and third the policy and practice perspectives that generate useful insights. Malaysian private healthcare is costly and service user expectations are rising, hence why evaluating Malaysian health services is important; not least because satisfied customers are more likely to return and recommend the service to family and friends – crucial if the service is to survive. Consequently, the author’s decision to concentrate on SERVQUAL’s psychometric properties in the first instance is the right one.

Clinical records, despite their: medico-legal importance (as an information resource following untoward incidents); research (clinical audit source); educational value (teaching students); service quality (learning from complaints); and not least their contribution to patient welfare (informing family doctors), perhaps do not get the attention they deserve. Selena Pillay and colleague’s relatively small but elegant study double-underlines our concerns. High-quality medical records require a multidisciplinary effort – from clinician’s timely dictation to the filing clerk accurately lodging copy letters in the case notes, which was the authors’ starting-point. Their case notes, selected randomly, included several without letters between hospital staff and family practitioner; some with hand-written amendments; letters with no electronic counterpart; delays between consultation date and letter despatch; and no verification that family doctors received the letter. Clearly, regularly auditing universal communication standards is needed. Indeed, owing to the topic’s importance, perhaps an independent, clinical record quality standard, such as ISO 9001, should be in place.

Whistle blowing is gaining importance universally owing to patient complainants’ increasing frustration about healthcare professionals seemingly closing ranks and patients feeling they are kept in the dark about compliant procedure structures, processes and outcomes. The English Care Quality Commission’s (formerly the Healthcare Commission) annual National Health Service employee perceptions survey, which specifically addresses untoward incidents and whistle blowing, provides results that indicate healthcare professionals’ concerns. Greece health service quality managers clearly are taking this issue seriously since this is the second article on adverse event reporting written by the same author that we have published (see IJHCQA, Vol. 23 No. 1). Naturally, healthcare professionals are wary and cautious about whistle blowing because it may leave them open to litigation and recrimination. They are also wary about being disloyal to their workmates. Nevertheless, that should not stop us learning more about untoward incident dynamics for staff development and service improvement purposes. Consequently, Anastasius Moumtzoglou’s follow-up article takes a closer look at clinician’s reporting perceptions and preferences. The questionnaire survey’s relatively poor response is disappointing although the author confirms that the sample represents Greek practitioners. There are remarkable similarities between the Greek health service survey findings and those from studies in other countries where the same questionnaire was used. In contrast, there are remarkable differences between doctors and nurses’ views; to the extent that universal policy and practices are not possible, which complicates decision making and actions we might take. Nevertheless, the author concludes with many sound recommendations.

Keith HurstMedicine and Health Faculty, Leeds Health Sciences Institute, Health and Social Care Centre, Leeds University, Leeds, UK, February 2010