SciCombinator

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Journal: International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua

197

Lean is a widely used quality improvement methodology initially developed and used in the automotive and manufacturing industries but recently expanded to the healthcare sector. This systematic literature review seeks to independently assess the effect of Lean or Lean interventions on worker and patient satisfaction, health and process outcomes, and financial costs.

Concepts: Health care provider, Evaluation, Illness, Manufacturing, Industry, Lean manufacturing, Six Sigma, ISO 9000

165

OBJECTIVE: /st>To study the psychometric properties of a translated version of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture (HSOPSC) in the Slovenian setting. DESIGN: /st>A cross-sectional psychometric study including principal component and confirmatory factor analysis. The percentage of positive responses for the 12 dimensions (42 items) of patient safety culture and differences at unit and hospital-level were calculated. SETTING: /st>Three acute general hospitals. PARTICIPANTS: /st>Census of clinical and non-clinical staff (n = 976). MAIN OUTCOME MEASURES: /st>Model fit, internal consistency and scale score correlations. RESULTS: /st>Principal component analysis showed a 9-factor model with 39 items would be appropriate for a Slovene sample, but a Satorra-Bentler scaled χ(2) difference test demonstrated that the 12-factor model fitted Slovene data significantly better. Internal consistency was found to be at an acceptable level. Most of the relationships between patient safety culture dimensions were strong to moderate. The relationship between all 12 dimensions and the patient safety grade was negative. The unit-level dimensions of patient safety were perceived better than the dimensions at the hospital-level. CONCLUSION: /st>The original 12-factor model for the HSOPSC was a good fit for a translated version of the instrument for use in the Slovene setting.

Concepts: Hospital, Psychometrics, Factor analysis, Principal component analysis, Confirmatory factor analysis, Safety, Patient safety, Slovenia

165

OBJECTIVE: /st>The aim of the study was to determine accreditation surveyors' and hospitals' use and perceived usefulness of clinical indicator reports and the potential to establish the control relationship between the accreditation and reporting systems. The control relationship refers to instructional directives, arising from appropriately designed methods and efforts towards using clinical indicators, which provide a directed moderating, balancing and best outcome for the connected systems. DESIGN: /st>Web-based questionnaire survey. SETTING: /st>Australian Council on Healthcare Standards' (ACHS) accreditation and clinical indicator programmes. RESULTS: /st>Seventy-three of 306 surveyors responded. Half used the reports always/most of the time. Five key messages were revealed: (i) report use was related to availability before on-site investigation; (ii) report use was associated with the use of non-ACHS reports; (iii) a clinical indicator set’s perceived usefulness was associated with its reporting volume across hospitals; (iv) simpler measures and visual summaries in reports were rated the most useful; (v) reports were deemed to be suitable for the quality and safety objectives of the key groups of interested parties (hospitals' senior executive and management officers, clinicians, quality managers and surveyors). CONCLUSIONS: /st>Implementing the control relationship between the reporting and accreditation systems is a promising expectation. Redesigning processes to ensure reports are available in pre-survey packages and refined education of surveyors and hospitals on how to better utilize the reports will support the relationship. Additional studies on the systems' theory-based model of the accreditation and reporting system are warranted to establish the control relationship, building integrated system-wide relationships with sustainable and improved outcomes.

Concepts: Game theory, Better, Report, Management, Utility, Trent Accreditation Scheme

27

To examine the effect of nurse staffing and the work environment on 10- and 30-day unplanned readmissions for US Medicare patients following elective total hip and knee replacement.

18

Although incident reporting systems are widespread in health care as a strategy to reduce harm to patients, the focus has been on reporting incidents rather than responding to them. Systems containing large numbers of incidents are uniquely placed to raise awareness of, and then characterize and respond to infrequent, but significant risks. The aim of this paper is to outline a framework for the surveillance of such risks, their systematic analysis, and for the development and dissemination of population-based preventive and corrective strategies using clinical and human factors expertise.

Concepts: Health care, Health care provider, Medicine, Health, Clinical trial, Medical ethics, Illness, Systems psychology

16

To investigate the extent of objective ‘non-beneficial treatments (NBTs)’ (too much) anytime in the last 6 months of life in routine hospital care.

10

Health systems are continually being reformed. Why, and how? To answer these questions, we draw on a book we recently contributed, Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries We analyse the impact that these health-reform initiatives have had on the quality and safety of care in an international context-that is, in low-, middle- and high-income countries-Argentina, Australia, Brazil, Chile, China, Denmark, England, Ghana, Germany, the Gulf states, Hong Kong, India, Indonesia, Israel, Italy, Japan, Mexico, Myanmar, New Zealand, Norway, Oman, Papua New Guinea (PNG), South Africa, the USA, Scotland and Sweden. Popular reforms in less well-off countries include boosting equity, providing infrastructure, and reducing mortality and morbidity in maternal and child health. In countries with higher GDP per capita, the focus is on new IT systems or trialling innovative funding models. Wealthy or less wealthy, countries are embracing ways to enhance quality of care and keep patients safe, via mechanisms such as accreditation, clinical guidelines and hand hygiene campaigns. Two timely reminders are that, first, a population’s health is not determined solely by the acute system, but is a product of inter-sectoral effort-that is, measures to alleviate poverty and provide good housing, education, nutrition, running water and sanitation across the population. Second, all reformers and advocates of better-quality of care should include well-designed evaluation in their initiatives. Too often, improvement is assumed, not measured. That is perhaps the key message.

Concepts: Health care, Health insurance, Southeast Asia, Indonesia, Papua New Guinea, Hygiene, New Guinea, Reform

6

Early detection of patient deterioration and prevention of adverse events are key challenges to patient safety. This study investigated clinical staff perceptions of current monitoring practices and the planned introduction of continuous monitoring devices on general wards.

Concepts: Clinical trial, Vital signs, Safety, Key signature

6

PURPOSE: /st>Being able to compare hospitals in terms of quality and safety between countries is important for a number of reasons. For example, the 2011 European Union directive on patients' rights to cross-border health care places a requirement on all member states to provide patients with comparable information on health-care quality, so that they can make an informed choice. Here, we report on the feasibility of using common process and outcome indicators to compare hospitals for quality and safety in five countries (England, Portugal, The Netherlands, Sweden and Norway).Main Challenges IdentifiedThe cross-country comparison identified the following seven challenges with respect to comparing the quality of hospitals across Europe: different indicators are collected in each country; different definitions of the same indicators are used; different mandatory versus voluntary data collection requirements are in place; different types of organizations oversee data collection; different levels of aggregation of data exist (country, region and hospital); different levels of public access to data exist; and finally, hospital accreditation and licensing systems differ in each country. CONCLUSION: /st>Our findings indicate that if patients and policymakers are to compare the quality and safety of hospitals across Europe, then further work is urgently needed to agree the way forward. Until then, patients will not be able to make informed choices about where they receive their health care in different countries, and some governments will remain in the dark about the quality and safety of care available to their citizens as compared to that available in neighbouring countries.

Concepts: Health care, Health insurance, Comparison, Health, European Union, Hospital, Europe, Regulation

5

OBJECTIVE: /st>To examine the associations of four distinct nursing care organizational models with patient safety outcomes. DESIGN: /st>Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. SETTING: /st>Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. PARTICIPANTS: /st>Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. MAIN OUTCOME MEASURE: /st>Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events ‘without major’ consequences for patients and events ‘with’ consequences. RESULTS: /st>After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. CONCLUSIONS: /st>Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.

Concepts: Regression analysis, Logistic regression, Kidney, Patient, Urinary tract infection, Hospital, Physician, Nursing