Editorial

Citation

Hurst, K. (2012), "Editorial", International Journal of Health Care Quality Assurance, Vol. 25 No. 1. https://doi.org/10.1108/ijhcqa.2012.06225aaa.001

Editorial

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 25, Issue 1

Experienced peer reviewers, academics and university examiners are often disconcerted by researchers’ failure to build-in D(evelopment) into health service R(esearch) – usually shortened to R&D. Our argument is, in short, what’s the R’s purpose if services aren’t developed as a consequence. Indeed, IJHCQA reviewers are instructed to be fairly brutal when it comes to commenting and accepting manuscripts missing the D. In this issue, we see our strict policy’s effects. For example, waste disposal generally is a major cost and quality of life issue. Clinical waste, specifically, adds unique problems such as bacterial contamination. It is surprising, therefore, that we do not publish more articles on this topic. In this issue, Peter Mochungong and colleagues present three case studies – each exploring incineration-based clinical waste disposal in a developing country that highlight different public health and environmental hazards. Their results are troubling. All three sites fell well short of acceptable operating standards, which place staff, patients and public at risk. The hazard list arising from three sites is surprisingly long and wider ranging than readers might expect. The authors recommend important clinical waste management policy and practice guidance. Notably, they review alternatives to incineration (again, remarkably enlightening), choice, no doubt, depends are finances.

Staffing is the most expensive health service cost. Moreover, service running costs do not usually include pre-registration education and training (which are usually funded separately to mainstream healthcare), so healthcare plus staff education and training costs are even higher when all is considered. Also, post registration training costs may mean that hospital managers invest significant money into their workforce; but if, after this significant health service staff investment, clinicians move on, then the next employer benefits. It makes sense, therefore, for employers to retain their staff for efficiency and effectiveness reasons not least because poor retention adds to remaining staff workload, which causes more job dissatisfaction – a classic vicious cycle. So, do we know why staff move on apart from the fairly obvious promotion? In this issue, Ken Kato and colleagues answer this question by taking a close look at clinicians’ intention to leave – in short, why they vote with their feet. The authors’ sample size and analytical techniques are impressive, although the doctor response rate is typically disappointing. They looked at desire to stay – more than one-third doctor-respondents said they intend to move on – in the light of several other variables, such as employer appraisal systems, night duty and shift length. As one might expect when several variables are analysed using high-level statistics, data relationships are complex. However, the reader may be surprised how certain variables such as working hours and shift length over-ride others. So, it helps when the authors employ Herzberg’s theory to help us appreciate their findings – which works well. Overall, the authors’ findings indicate that hospital personnel managers have a major role if medical staff are encouraged to stay.

Clinical audit, which is usually cheaper than full-scale R&D, has a significant impact on service quality. Done well, retrospective or live audits generate remarkable insights into policy and practice. In this issue, Kamini Vasudev and colleagues use a retrospective audit to explore how well valproate best-practice prescribing guidelines are followed. However, they hit an early snag – their systematic review revealed ambiguous findings. Nevertheless, their case note audit revealed inconsistent and inappropriate prescribing that seemed to influence patients’ length of stay and recovery. Surprisingly, UK valproate prescribing guidelines are thin – clearly an area ripe for research.

As health services shift from secondary to primary care services and acute bed numbers fall, it becomes even more important for clinicians and managers to use secondary care resources efficiently and effectively. Clearly, there are financial, service quality and patient welfare issues at stake. So, any empirical work highlighting surgical delays and their reasons are important. In this issue, Mehmet Savsar and colleagues use high-level statistical techniques to connect pre-surgery structures and processes, and treatment delays. The authors remind us that the literature is relatively weak, notably the authors’ research designs. The delays Savsar et al., unearth in one hospital, graphically well-represented in the article, although sometimes surprising, are fairly basic things that are relatively easy to resolve. Consequently, the authors recommend important policy and practice changes.

Mouth cancer is the world’s eleventh commonest malignancy and Saudi Arabia’s fourth. Dental screening is probably the most common examination/screening we do so opportunities to detect malignant and pre-malignant oral conditions are available. So why should patients continue to be at risk? Louay Jaber and colleagues explore Saudi Arabian practitioner knowledge and skills. They tested a representative sample – asking respondents to detect mouth cancer’s predisposing factors (such as tobacco, diet and alcohol). Surprisingly, medical practitioners scored “better” than dental, but both scored less-well than their North American and UK counterparts. Consequently, the authors were able to recommend important changes to Saudi education and training policy and practice.

What possible harm could result from setting treatment deadlines for cancer patients? The sooner patients with cancer symptoms are referred, diagnosed and treated the better. Consequently, the UK’s outgoing Labour government initiated several referral-to-treatment deadlines. However, in this issue, Anil Agarwal and colleagues remind us that only 10 percent of patients with cancer-indicating symptoms actually have a malignancy – which has generated controversy – not least because fast-tracking suspected cancer patients was politically driven and that the NHS’ limited resources meant that patients with non life-threatening conditions might wait longer. It is possible that fast-tracking patients towards diagnostic procedures could intensify their anxieties even though they wait less time. Suspected colorectal cancer cases were part of the two-week rule from attending a general practitioner to diagnostic procedure – for life saving reasons. We know how well hospital clinicians perform on this target. We know less about how patients feel about fast tracking. The authors carried out detailed interviews with patients completing the two-week rule referral procedure. Interesting themes and sub themes emerge from their qualitative research study. Quantitative studies often come over as dry, so the authors’ quotations from patients are illuminating and lively especially when they tie-in their findings to long-standing psychological theories such as Bowlby. Clearly, qualitative- and quantitative-based R&D can add significantly to NHS R&D.

Keith Hurst