TQM : fad or fixture? Implementing total quality management in health care setting through the development and use of customer-supplier models

This research study reviews the global advances made in health care quality assurance, tracing its origins from the manufacturing and service industries through to the context of the health care industry. The Total Quality Management (TQM) model, originally adopted by the industrial sector is investigated as a possible paradigm for the health sector. Customer-supplier modelling, a novel methodology founded on the TQM philosophy is developed and applied to a hospital setting to test whether it can provide the framework for inter-disciplinary quality improvement. In essence this thesis examines whether it is possible to implement a quality assurance system in a large London teaching hospital based on the TQM philosophy, and whether the development of customer-supplier models can provide the framework for coherent, interdisciplinary, continuous quality improvement. Application of the models is found to be particularly relevant and beneficial to the clinical directorate - the front end of health care delivery - and examples are given at both macro and micro level. In particular, practical application issues are highlighted which include the importance of leadership from the clinical director, support from medical doctors and the role of the quality facilitator. But tantamount to all these requirements is team working, without which Total Quality Management can never be achieved. The benefits of customer-supplier modelling are shown to promote inter-disciplinarity, genuine dialogue, co-operation and an holistic approach to health service provision. This research has shown that an inter-disciplinary, systems approach to quality improvement, based on the use of customer-supplier modelling and the quality assurance cycle, provides a frame-work for the identification, analysis and solution of quality problems which involves both internal and external customers and suppliers. The results from this research have contributed towards the goal of inter-professionalism and genuine dialogue with the customer. This thesis concludes by recommending that there is a real requirement to look towards developing more participative ways of involving clients in the definition, evaluation, monitoring, supervision, production and reformation of health care quality and health care delivery systems

Examining the psychometric properties of the headspace Youth (mental health) Service Satisfaction Scale in a mental health service in Ireland

Introduction: Evaluating service quality and satisfaction is central to the provision of accessible and developmentally appropriate youth mental health services. However, there are limited suitable measures and a lack of published evidence on the psychometric properties of measures to assess young people's satisfaction with youth mental health services. The headspace Youth (Mental Health) Service Satisfaction Scale (YSSS) was designed and implemented to assess young people's satisfaction with headspace mental health services in Australia. This study examined the reliability and factor structure of the YSSS in a youth mental health service in Ireland. Methods: The sample comprised 1449 young people (66.2% female) aged 12–25 years (M = 16.48, SD = 2.97). Participants completed the YSSS after their final brief intervention session through Jigsaw—The National Centre for Youth Mental Health. Confirmatory factor analysis (CFA) was performed on one- and four-factor models to test findings from previous studies. Reliability was also examined. Results: CFA supported a single-factor structure of the YSSS, and all items were suitable for inclusion. The internal consistency of the measure was deemed acceptable (α = 0.89). Conclusions: Findings suggest that the YSSS is a reliable measure for monitoring satisfaction with youth mental health services in an Irish context. The measure demonstrated a unidimensional construct of satisfaction. These findings support the broader application of the YSSS and add to existing knowledge on measuring satisfaction within youth mental health services.</p

Giving something back? Sentiments of privilege and social responsibility among elite graduates from Britain and France

This article explores the complex relationship between transnational elites and civil society through examining the contrasting orientations of two cohorts of ‘elite graduates’ from Paris and Oxford. Both cohorts believe their privileged status has been earned through hard work and ability. But they are also aware that they have benefited from advantages not available to all. Perhaps because of this, they express the need to ‘give something back’. However, the means through which they seek to discharge their social responsibilities are very different. While the Oxford graduates seek to ‘give something back’ through volunteering and third sector engagement, the Paris graduates will ‘give something back’ through public service. The article discusses how the contrasting relationship between the state, civil society and the education system in these two countries may shape dispositions, and speculates on the extent to which these elite recruits’ commitment to ‘give something back’ will make a difference

A latent trait approach to measuring HIV/AIDS related stigma in healthcare professionals: application of mokken scaling technique

The attitudes of healthcare professionals towards HIV positive patients and high risk groups are central to the quality of care and therefore to the management of HIV/AIDS related stigma in health settings. Extant HIV/AIDS stigma scales that measure stigmatising attitudes towards people living with HIV/AIDS have been developed using scaling techniques such as principal component analysis. This approach has resulted in instruments that are often long. Mokken scale analysis is a nonparametric hierarchical scaling technique that can be used to develop unidimensional cumulative scales. This technique is advantageous over the other approaches; as the scales are usually shorter, while retaining acceptable psychometric properties. Moreover, Mokken scales also make no distributional assumptions about the underlying data, other than that the data are capable of being ordered by item and by person. In this study we aimed at developing a precise and concise measure of HIV/AIDS related stigma among health care professionals, using Mokken scale analysis

HIV issues and people with disabilities: A review and agenda for research

The recent AIDS and Disability Partners Forum at the UN General Assembly High Level Meetings on AIDS in New York in June 2011 and the International AIDS Conference in Washington, DC in July 2012 underscores the growing attention to the impact of HIV and AIDS on persons with disabilities. However, research on AIDS and disability, particularly a solid evidence base upon which to build policy and programming remains thin, scattered and difficult to access. In this review paper, we summarise what is currently known about the intersection between HIV and AIDS and disability, paying particular attention to the small but emerging body of epidemiology data on the prevalence of HIV for people with disabilities, as well as the increasing understanding of HIV risk factors for people with disabilities. We find that the number of papers in the peer-reviewed literature remains distressingly small. Over the past 20 years an average of 5 articles on some aspect of disability and HIV and AIDS were published annually in the peer-reviewed literature from 1990 to 2000, increasing slightly to an average of 6 per year from 2000 to 2010. Given the vast amount of research around HIV and AIDS and the thousands of articles on the subject published in the peer-reviewed literature annually, the continuing lack of attention to HIV and AIDS among this at risk population, now estimated to make up 15% of the world’s population, is striking. However, the statistics, while too limited at this point to make definitive conclusions, increasingly suggest at least an equal HIV prevalence rate for people with disabilities as for their nondisabled peers

The Coexistence of Natural and Supernatural Explanations Across Cultures and Development

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91141/1/j.1467-8624.2012.01743.x.pd

Ice-confined construction of a large basaltic volcano—Austurfjöll massif, Askja, Iceland

Austurfjöll is the largest basaltic glaciovolcanic massif at Askja volcano (Central Iceland), and through detailed studies of its volcanological and geochemical characteristics, we provide a detailed account of the sequence and structure of the ice-confined construction of a large Icelandic basaltic volcano. In particular, Austurfjöll represents a geometry of vents, and resulting glaciovolcanic morphology, not previously documented in ice-confined basaltic volcanoes. Austurfjöll was constructed during two major phases of basaltic volcanism, via seven eruptive episodes through disperse fissure-dominated eruptions. The earliest episode involved a rare and poorly exposed example of subaerial activity, and this was succeeded by six episodes involving the eruption of ice-confined pillow lavas and numerous overlapping fissure eruptions of phreatomagmatic tephra. Evidence of local subaerial lavas and tephras indicates the local growth of eruptive centers above englacial lake levels, and subsequent flooding, but no prolonged subaerial activity. Localized ice-contact facies, paleowater levels, and diamictons indicate the position and thickness of the ice was variable during the construction of Austurfjöll, and eruptive activity likely occurred in multiple and variable level meltwater lakes during the last glacial period. Lithofacies evidence including gradational transitions from effusive to explosive deposits, superposition of fragmental facies above coherent facies, and drainage channels suggest that changes in eruptive style were driven largely by external factors such as drainage and the increasing elevation of the massif. This study emphasizes the unique character of Austurfjöll, being composed of large pillow lava sheets, numerous (> 40) overlapping glaciovolcanic tindars, and only localized emergent deposits, as a product of its prolonged ice-confined eruptive history, contrasts with previous descriptions of tuyas and tindars