The Impact of Hospital Demographic Factors on Total Quality Management Implementation: A Case Study of UAE Hospitals

Aim:  Maintaining service quality and value using quality and management tools is crucial in any organization. In essence, improving service quality boosts both efficiency of organizations and consumer pleasure. The deployment of quality development programs such as Total Quality Management (TQM) is one technique that businesses may employ to deliver exceptional customer service. The health sector, in particular, is one of the industries that require TQM adoption due to its complexity and the need for constant service improvement. TQM helps to improve service quality in health facilities through advanced clinical and administrative procedures. This research comprehensively assesses TQM levels and the impact of hospital demographics on its implementation process in hospitals in the United Arab Emirates (UAE).   Methods:  The study used a quantitative research strategy based on a survey study design. Questionnaires were used to gather primary data from respondents deployed a self-administered technique. 1850 questionnaires were delivered to the hospital's senior staff based on their number in each hospital. Of the 1850 questionnaires distributed, 1238 usable questionnaires were analyzed, yielding a response rate of 66.9%. The study used a binary logistic regression model to determine if hospital demographics affected TQM implementation. The study data were examined and analysed using version 25.0 of the SPSS software.   Results: The results show that most of the health facilities with an overall TQM between 4.12 and 4.82 were utilized, governmental, accredited and utilized and large hospitals, while the hospitals with a mean between 2.91 and 3.45 were small, unaccredited private, and non-specialised. Thus, large hospitals have a higher TQM utilization rate than small hospitals. In addition, the findings of the t-test revealed that a high TQM is represented by means of 4.68, 4.67, 4.43, and 4.12 for accredited, utilized, governmental and large hospitals. The binary regression analysis also reveals similar results: large, governmental, utilized and accredited hospitals have greater chances of TQM adoption than other categories of hospitals (Exp (B): 1.2; 95%CI: 1.001 – 1.421, P< .05); (Exp (B): 1.3; 95%CI: 1.012 – 1.721, P< .05); (Exp (B): 1.5; 95%CI: 1.127 – 2.051, P< .01); and (Exp   (B): 1.5; 95%CI: 1.102 – 2.012, P< .05); correspondingly. Another observation from the results is that hospitals that implemented technological tools had a greater chance of successfully executing the TQM program than hospitals that did not utilize advanced technologies due to the limited availability of resources (Exp (B): 1.7; 95%CI: 1.332 – 2.187, P< .01). Conclusion: Even though health facilities need to adopt TQM, its implementation depends on the hospital size and demographics that significantly influence the adoption of TQM programs. However, this study will help bridge the current gap on the usage of TQM in the health context by examine the influence of demographic factors on adopting TQM in hospitals. Hence, provide adequate information to help the UAE hospital administrators appropriately execute the TQM program in the hospitals and enhance the efficacy of their operations. &nbsp

The Impact of Hospital Demographic Factors on Total Quality Management Implementation: A Case Study of UAE Hospitals

Aim:  Maintaining service quality and value using quality and management tools is crucial in any organization. In essence, improving service quality boosts both efficiency of organizations and consumer pleasure. The deployment of quality development programs such as Total Quality Management (TQM) is one technique that businesses may employ to deliver exceptional customer service. The health sector, in particular, is one of the industries that require TQM adoption due to its complexity and the need for constant service improvement. TQM helps to improve service quality in health facilities through advanced clinical and administrative procedures. This research comprehensively assesses TQM levels and the impact of hospital demographics on its implementation process in hospitals in the United Arab Emirates (UAE).   Methods:  The study used a quantitative research strategy based on a survey study design. Questionnaires were used to gather primary data from respondents deployed a self-administered technique. 1850 questionnaires were delivered to the hospital's senior staff based on their number in each hospital. Of the 1850 questionnaires distributed, 1238 usable questionnaires were analyzed, yielding a response rate of 66.9%. The study used a binary logistic regression model to determine if hospital demographics affected TQM implementation. The study data were examined and analysed using version 25.0 of the SPSS software.   Results: The results show that most of the health facilities with an overall TQM between 4.12 and 4.82 were utilized, governmental, accredited and utilized and large hospitals, while the hospitals with a mean between 2.91 and 3.45 were small, unaccredited private, and non-specialised. Thus, large hospitals have a higher TQM utilization rate than small hospitals. In addition, the findings of the t-test revealed that a high TQM is represented by means of 4.68, 4.67, 4.43, and 4.12 for accredited, utilized, governmental and large hospitals. The binary regression analysis also reveals similar results: large, governmental, utilized and accredited hospitals have greater chances of TQM adoption than other categories of hospitals (Exp (B): 1.2; 95%CI: 1.001 – 1.421, P< .05); (Exp (B): 1.3; 95%CI: 1.012 – 1.721, P< .05); (Exp (B): 1.5; 95%CI: 1.127 – 2.051, P< .01); and (Exp   (B): 1.5; 95%CI: 1.102 – 2.012, P< .05); correspondingly. Another observation from the results is that hospitals that implemented technological tools had a greater chance of successfully executing the TQM program than hospitals that did not utilize advanced technologies due to the limited availability of resources (Exp (B): 1.7; 95%CI: 1.332 – 2.187, P< .01). Conclusion: Even though health facilities need to adopt TQM, its implementation depends on the hospital size and demographics that significantly influence the adoption of TQM programs. However, this study will help bridge the current gap on the usage of TQM in the health context by examine the influence of demographic factors on adopting TQM in hospitals. Hence, provide adequate information to help the UAE hospital administrators appropriately execute the TQM program in the hospitals and enhance the efficacy of their operations.     Conflict of interest: None declare

Development of Liver Cancers as an Unexpected Consequence of Anabolic Androgenic Steroid Use

Although the relationship between androgens and hepatocellular tumor development has been noted since 1975, cases involving hepatocellular carcinoma (HCC) or cholangiocarcinoma development in patients on chronic androgen therapy or anabolic androgenic steroid (AAS) use are few, and far between. We present three cases of patients who developed hepatic and bile duct malignancies in the setting of AAS use and testosterone supplementation, arising from a single tertiary referral center. Additionally, we review the literature for the mechanisms behind the possible androgen-mediated malignant transformation of these liver and bile duct tumors

The Pandemic Within the Pandemic

Background and aimThe third leading preventable cause of death in the United States is excessive alcohol consumption. Our study sought to assess the impact of the coronavirus disease 2019 (COVID-19) on hospitalizations for alcohol-related hepatitis at a community hospital system. We hypothesized an increase in cases of alcohol-related hepatitis requiring inpatient management, mirroring the strain on economic and societal norms imposed by the COVID-19 pandemic.Approach/resultsWe performed a retrospective chart review to study the incidence of alcohol-related hepatitis in patients presenting to 3 community hospitals in Fresno, California, before and during the COVID-19. Data including patient demographics, markers of disease severity, and clinical course were extracted from electronic medical records for 329 patients included in the study. There was a 51% increase in the overall incidence of alcohol-related hepatitis requiring hospitalization between 2019 and 2020 (P=0.003) and 69% increase (P<0.001) after implementation of the stay-at-home orders. In addition, 94% (P=0.028) increase in rehospitalizations was noted in 2020 (P=0.028), a 100% increase in patients under the age of 40 (P=0.0028), as well as a trend towards a 125% increase (P=0.06) of female patients admitted with this diagnosis during the COVID-19 pandemic.ConclusionsOur study revealed drastic increases in severe alcohol-related hepatitis requiring inpatient management, specifically in patients under the age of 40 and in women during the COVID-19 pandemic. Given the high morbidity and mortality associated with severe alcohol-related hepatitis, these findings have far-reaching and lasting implications for our already strained health care system extending beyond the COVID-19 pandemic timeframe. Urgent public health interventions are needed to combat the rising misuse of alcohol and its consequences

A Devastating Case of Hepatitis C-Induced Mixed Cryoglobulinemia

Hepatitis C-induced mixed cryoglobulinemia leading to rapidly progressive gangrene, necessitating amputations, is a rare presentation. We describe a case of a 55-year-old man with untreated chronic hepatitis C virus (HCV) presenting with arthralgia and palpable purpura, which rapidly progressed to life-threatening gangrene of all extremities requiring amputations in the setting of mixed cryoglobulinemia. Treatment for HCV was initiated which led to the arrest of gangrene progression and the patient's survival. Patients with HCV-induced cryoglobulinemia should be closely monitored and started on early therapy with direct-acting antiviral therapy to prevent progression of vasculitis to gangrene. Universal screening for HCV can aid in early diagnosis and treatment to prevent devastating consequences

Soaring rates of alcohol‐related hepatitis in the latter phase of the COVID‐19 pandemic: A new normal?

BackgroundStudies have reported that the COVID-19 pandemic has led to an increase in alcohol consumption and alcohol-associated health problems in the general population. Our previous study documented a rise in severe alcohol-related hepatitis cases requiring inpatient admission in our hospital system in the early pandemic (2019 vs. 2020). This study assesses the rates of severe alcohol-related hepatitis in the latter part of the pandemic (2021).MethodsWe performed a retrospective chart review via an electronic medical record to evaluate the number of cases of alcohol-related hepatitis in patients presenting to three community hospitals in Fresno, California, between 2019 (pre-pandemic) and 2021. A total of 547 patients were included in the study. We compared the demographics, clinical course, and outcomes of patients with alcohol-related hepatitis pre-pandemic (2019), early pandemic (2020), and during the later phase of the pandemic (2021).ResultsThe number of cases increased from 131 in 2019 to 201 in 2020 and 215 in 2021 (53% and 64% increase, respectively). The number of young patients (age <40 years) increased from 30 in 2019 to 61 in 2020 and 71 in 2021 (103% and 136% increase, respectively) (p = 0.13). The number of admissions of women increased from 24 in 2019 to 55 in 2020 and 67 in 2021 (129% and 179% increase, respectively) (p = 0.026). Deaths during hospitalization increased from 20 in 2019 to 26 in 2021 (p = 0.674). The number of rehospitalizations within 3 months increased 4.5 times from 18 in 2019 to 80 in 2021 (p < 0.001).ConclusionOur study revealed that the admissions for alcohol-related hepatitis remained significantly above the pre-pandemic levels through the end of 2021. We believe this sustained increase in cases of alcohol-related hepatitis in our hospital system reflects a much larger national problem. Alcohol-related hepatitis is associated with significant morbidity, mortality, and societal cost. Urgent public health interventions are needed at a national level to prevent this rise in cases from becoming a new normal

Long-term clinical outcomes of patients with COVID-19 and chronic liver disease: US multicenter COLD study.

BackgroundCOVID-19 is associated with higher morbidity and mortality in patients with chronic liver diseases (CLDs). However, our understanding of the long-term outcomes of COVID-19 in patients with CLD is limited.MethodsWe conducted a multicenter, observational cohort study of adult patients with CLD who were diagnosed with COVID-19 before May 30, 2020, to determine long-term clinical outcomes. We used a control group of patients with CLD confirmed negative for COVID-19.ResultsWe followed 666 patients with CLD (median age 58 years, 52.8% male) for a median of 384 (interquartile range: 31-462) days. The long-term mortality was 8.1%; with 3.6% experiencing delayed COVID-19-related mortality. Compared to a propensity-matched control group of patients with CLD without COVID-19 (n=1332), patients with CLD with COVID-19 had worse long-term survival [p<0.001; hazards ratio (HR): 1.69; 95% CI: 1.19-2.41] and higher rate of hospitalization (p<0.001, HR: 2.00, 1.62-2.48) over a 1-year follow-up period. Overall, 29.9% of patients reported symptoms of long-COVID-19. On multivariable analysis, female sex (p=0.05, HR: 2.45, 1.01-2.11), Hispanic ethnicity (p=0.003, HR: 1.94, 1.26-2.99), and severe COVID-19 requiring mechanical ventilation (p=0.028, HR: 1.74, 1.06-2.86) predicted long-COVID-19. In survivors, liver-related laboratory parameters showed significant improvement after COVID-19 resolution. COVID-19 vaccine status was available for 72% (n=470) of patients with CLD and history of COVID-19, of whom, 70% (n=326) had received the COVID-19 vaccine.ConclusionsOur large, longitudinal, multicenter study demonstrates a high burden of long-term mortality and morbidity in patients with CLD and COVID-19. Symptoms consistent with long-COVID-19 were present in 30% of patients with CLD. These results illustrate the prolonged implications of COVID-19 both for recovering patients and for health care systems