An Ambulance Service evaluation of Quality Control Measures based on patients‘ perception in Qatar

Background: The lack of healthcare quality management poses significant legal and financial implications 1,2 . A proactive approach to systems improvement seems warranted and reasonable. It is not clear if current quality control measures are perceived by patients. The study aims to understand if any correlation exists in this respect in the context of patients using the Hamad Medical Corporation Ambulance Service in Qatar. Methods: A survey was distributed to adult patients transported by the Ambulance Service's emergency division to the Hamad General Hospital's See and Treat unit in Doha (n = 255). The patients had to be free from serious injury/illness, fully conscious, and with re-collection of the service received. The original SERVQUAL model 3 consisting of 5 dimensions (Reliability/Assurance/Tangibility/Empathy/Responsiveness) was modified and a 6th dimension (Quality Control) was added. The Spearman's rank correlation was used to test the strength between quality control (QC) and service quality responses. Results: The mean age was 33.46 years ( ± 9.62). Patients’ continent of origin distribution is presented in Table 1. The QC dimension was correlated with that of the SERVQUAL dimensions presented in Table 2. Most of the SERQUAL dimensions had strong correlations with QC. Interestingly, there was a weak correlation between Assurance/QC and a moderate correlation between Tangibility/QC. The results seem to be driven by providing service within promised timeframes, access to care, and patients’ perception of ambulance staff's willingness to help. Conclusion: An awareness of the variables with strong correlations is indicative of the significant impact QC measures have and the associated perception of importance held by patients. This study sheds light on the importance of evaluating quality processes and limiting internal costs. The number of patients by continent of origin did not enable valid statistical tests based on that variable. The Ambulance Service's QC measures appear to maintain favorable patients’ perceptions of services received

Qatar Ambulance Service staff's perception on the Quality-of-Service delivery to patients

Background: Quality improvement has been well documented in various industries to improve safety and processes. 1 However, limited research has taken place within the pre-hospital sector in this regard. Various factors can be attributed to the delivery of effective services. Studies often investigate customer/patient perception and often sideline the importance of employee perception. 2 This study evaluates Qatar's Hamad Medical Corporation Ambulance Service (HMCAS) staffs’ perception on service delivery to patients they treat and transport. Methods: An online survey was designed and distributed to HMCAS staff working within the emergency section (N = 750). A 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) was used. The SERVQUAL model consisting of 5 dimensions (RATER): Reliability, Assurance, Tangibility, Empathy, and Responsiveness was used. 3 Two variables with the highest perception score were regarded as the drivers of service quality. A negative gap score (perception minus expectation) was used as the basis for the study recommendations. Results: As per the required calculated sample size to achieve a 95% confidence interval, 255 questionnaires were completed. Respondents were 79% Ambulance Paramedics, 18% supervisors, and 3% managers. The weights of each dimension's variables were calculated to obtain perception and expectation scores. Descriptive statistics and gap scores of the survey responses are presented in Table 1 for the two variables of each dimension. None of the gap scores were found to be statistically significant. The proposed recommendations generated from this study are presented in Table 2. Conclusion: A standardized staff quality perception tool can assist in identifying potentially missed quality-related service issue(s). In this study, the SERVQUAL model was easily adapted and applied to the pre-hospital Emergency Medical Service setting in Qatar and proved useful in identifying service delivery proponents needing attention. Overall and reassuringly, the staff believes that they provide quality service to their patients

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)