Quality in Health Care: Whose Responsibility Is It?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66941/2/10.1177_0885713x9300800202.pd

Hospital management staffing and training issues

Hospitals dominate health care in most parts of the world and for a variety of reasons are likely to continue being a key factor in the overall performance of the health care system. Any efforts to improve this performance must therefore give greater hospital efficiency the highest priority. After discussing key issues of managerial, clinical, and production efficiency, this paper suggests an agenda for the most useful areas of research.Health Monitoring&Evaluation,Pharmaceuticals&Pharmacoeconomics,Housing&Human Habitats,Environmental Economics&Policies,Health Systems Development&Reform

Follow-up study of chronically ill patients discharged from hospital

A study was made of 82 patients with selected illnesses of specified severity before and after discharge from the ward services of three general hospitals in a metropolitan community. An initial appraisal was made by a resident physician who evaluated the health status of each patient and made recommendations for care and supervision following discharge from hospital. After an average period of 3 months, each patient was visited by a student of social work who reconstructed the course of events following discharge and determined the extent to which the physicians' recommendations were complied with and the reasons for non-compliance. The usual consequences of chronic illness--persistent disability, unemployment and recurrent and lengthy institutionalization--were amply evident in this group. So was the fact that the burden of continued care falls heavily upon the members of the family. Other sources of help were trivial by comparison. The recommendations made by the discharging physician constitute an interesting, and sobering, inventory of continued need for care. More than a half of all patients did not comply with one or more recommendations made by the physician. In addition, about 40 per cent of patients reported unmet need for one or more services touching upon many aspects of medical care. A variety of lessons relevant to the organized provision of care may be drawn from a consideration of the services needed and desired by patients and of the reasons for, and factors related to, non-compliance with medical recommendations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32173/1/0000228.pd

Predictors of patient safety culture in hospitals in Venezuela

An organization's culture with regard to patient safety is important because it defines the beliefs and practices of the organization, and consequently its efficiency and productivity. Knowing the level of this and the factors that influence or not their dynamic represents a challenge, due to the degree of complexity and specificity of the elements involved. The aim of this study was to analyze predictors of patient safety culture in public and private hospitals and examining the factors that contribute to it, constructing a new and specific theoretical and methodological model. This study was carried out by reviewing medical records, detecting healthcare professionals directly involved in caring (N = 588), for patients in 2 public hospitals and 2 private hospitals in Venezuela (N = 566), conducting an "Analysis of Patient Safety Culture" questionnaire. The results were subsequently analyzed, derived 3 predictors factors and using a Patient Safety Culture Index (PSCI) for specific determination to evaluate patient safety culture level. The analysis showed that all hospitals had a "moderately unfavorable" PSCI (public = 52.96, private = 52.67, sig = 0.90). The PSCI was calculated by assessing the weight of the following factors in the index: occupational factors (factor loading = 32.03), communication factors (factor loading = 11.83), and organizational factors (factor loading = 9.10). Traumatology presented the lowest PSCI of all the care units, falling into the "unfavorable" category (36.48), and Laboratory the highest (70.02) (sig = 0.174), falling into the "moderately favorable" category. When analyzing professional groups, nurses had the highest PSCI, with a "moderately unfavorable" rating (PSCI = 61.1) and medical residents the lowest, falling into the "unfavorable" category (35.2). Adverse event reporting is determined by "management expectations and actions" (sig = 0.048) and "direct interaction with the patient" (sig = 0.049). The use of this theoretical and methodological approach in other contexts may provide a more objective system for identifying more specific needs and factors that influence in patient safety culture, and consequently, opportunities for improvement when constructing a patient safety culture in healthcare institutions. Efforts need to be made to improve safety culture in the hospitals studied, irrespective of whether they are public or private

Perceptions and attitudes of clinicians in Spain toward clinical practice guidelines and grading systems : A protocol for a qualitative study and a national survey

FADQThis project has been funded by the Instituto de Salud Carlos III, co-financed by the European Regional Development Fund (PI08 90647). The publication of this document has been funded within the framework of collaboration designed for the Quality Plan of the Spanish National Health System, under the agreement signed by the Carlos III Health Institute and the Aragon Health Science Institute as GuiaSalud secretariat. Pablo Alonso-Coello is funded by a Miguel Servet contract by the Instituto de Salud Carlos III (CP09/00137).Background: Clinical practice guidelines (CPGs) have become a very popular tool for decision making in healthcare. While there is some evidence that CPGs improve outcomes, there are numerous factors that influence their acceptability and use by healthcare providers. While evidence of clinicians' knowledge, perceptions and attitudes toward CPGs is extensive, results are still disperse and not conclusive. Our study will evaluate these issues in a large and representative sample of clinicians in Spain. Methods/Design. A mixed-method design combining qualitative and quantitative research techniques will evaluate general practitioners (GPs) and hospital-based specialists in Spain with the objective of exploring attitudes and perceptions about CPGs and evidence grading systems. The project will consist of two phases: during the first phase, group discussions will be carried out to gain insight into perceptions and attitudes of the participants, and during the second phase, this information will be completed by means of a survey, reaching a greater number of clinicians. We will explore these issues in GPs and hospital-based practitioners, with or without previous experience in guideline development. Discussion. Our study will identify and gain insight into the perceived problems and barriers of Spanish practitioners in relation to guideline knowledge and use. The study will also explore beliefs and attitudes of clinicians towards CPGs and evidence grading systems used to rate the quality of the evidence and the strength of recommendations. Our results will provide guidance to healthcare researchers and healthcare decision makers to improve the use of guidelines in Spain and elsewhere. © 2010 Kotzeva et al; licensee BioMed Central Lt

Perceptions and attitudes of clinicians in Spain toward clinical practice guidelines and grading systems: a protocol for a qualitative study and a national survey

BACKGROUND: Clinical practice guidelines (CPGs) have become a very popular tool for decision making in healthcare. While there is some evidence that CPGs improve outcomes, there are numerous factors that influence their acceptability and use by healthcare providers. While evidence of clinicians' knowledge, perceptions and attitudes toward CPGs is extensive, results are still disperse and not conclusive. Our study will evaluate these issues in a large and representative sample of clinicians in Spain. METHODS/DESIGN: A mixed-method design combining qualitative and quantitative research techniques will evaluate general practitioners (GPs) and hospital-based specialists in Spain with the objective of exploring attitudes and perceptions about CPGs and evidence grading systems. The project will consist of two phases: during the first phase, group discussions will be carried out to gain insight into perceptions and attitudes of the participants, and during the second phase, this information will be completed by means of a survey, reaching a greater number of clinicians. We will explore these issues in GPs and hospital-based practitioners, with or without previous experience in guideline development. DISCUSSION: Our study will identify and gain insight into the perceived problems and barriers of Spanish practitioners in relation to guideline knowledge and use. The study will also explore beliefs and attitudes of clinicians towards CPGs and evidence grading systems used to rate the quality of the evidence and the strength of recommendations. Our results will provide guidance to healthcare researchers and healthcare decision makers to improve the use of guidelines in Spain and elsewhere

Specialization in Clinical Performance Monitoring

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67720/2/10.1177_0885713x9000500404.pd

Quality Assessment and Monitoring

A commentary on the papers in the two special issues on Quality Assurance which shows how they contribute to some important conceptual, methodological, andpolicy issues. These issues pertain to the definition of quality; the distinction between quality assessment and program evaluation; the role of the market in regulating the quality of care; the role of more direct consumer participation in defining and assessing quality; professional responsibility for quality; the applicability of the structure-processoutcome paradigm to quality assessment; the format, methods of formulation, and validity of the criteria;probability sampling and purposive selection of the topics to be assessed; problems of scaling and measurement; the applicability of industrial control methods to quality monitoring; bringing about behavior change in response to the findings of quality monitoring; measuring the costs and benefits of quality assessment methods, including a consideration of their screening efficiency; and the relationship between quality monitoring and cost containment through competition or by other means.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68001/2/10.1177_016327878300600309.pd