Improving quality and safety of hospital care: a reappraisal and an agenda for clinically relevant reform

Scott, Ian A; Poole, Phillippa; Jayathissa, Sisira

doi:10.1111/j.1445-5994.2007.01456.x

Cited by 29 publications

(42 citation statements)

References 92 publications

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“…In the area of information systems, the main challenge was design of a system based on the requirements of the hospital with capability to monitor and evaluate indices. Scott and Gringer stress that performance indicators can be measured through information and audit systems (15, 44). The information about patients must be available to service providers, in a timely and confidential manner (45).…”

Section: Discussionmentioning

confidence: 99%

Challenges in Evaluating Clinical Governance Systems in Iran: A Qualitative Study

Hooshmand¹,

Tourani²,

Ravaghi³

et al. 2014

Iran Red Crescent Med J

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Background:In spite of the pivotal role of clinical governance in enhancing quality of services provided by hospitals across the country, a scientific framework with specific criteria for evaluating hospitals has not been developed so far.Objectives:This study was conducted with the aim to identify the challenges involved in evaluating systems of clinical governance in Iran.Materials and Methods:For the purposes of this qualitative study, 15 semi-structured interviews with experts in the field were conducted in 2011 and the data were analyzed using framework analysis method.Results:Five major challenges in evaluating clinical governance include managing human resources, improving clinical quality, managing development, organizing clinical governance, and providing patient-oriented healthcare system.Conclusions:Healthcare system in Iran requires a clinical governance program which has a patient-oriented approach in philosophy, operation, and effectiveness in order to meet the challenges ahead.

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Section: Discussionmentioning

confidence: 99%

Challenges in Evaluating Clinical Governance Systems in Iran: A Qualitative Study

Hooshmand¹,

Tourani²,

Ravaghi³

et al. 2014

Iran Red Crescent Med J

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“…Documentation, standardisation and validation processes allow assessment of hospital services and ensure that the service provided is targeted towards the quality of patient care 5. The importance of introducing quality and standardisation in healthcare has been recognised, however it is occurring at a relatively slow pace in European countries,6 particularly with respect to clinical pharmacy services. Examples of initiatives in Northern Ireland and Sweden have been reported from the Intregrated Medicines Management project,7 the Lund Integrated Medicines Management project8 and Uppsala projects, respectively 9…”

Section: Introductionmentioning

confidence: 99%

Standardising pharmacist patient-profiling activities in a rehabilitation hospital in Malta

et al. 2013

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Objectives To develop, validate, test for applicability and practicality, implement and undertake a preliminary evaluation of a standard operating procedure (SOP) for pharmacist patient-profiling activities at Rehabilitation Hospital Karin Grech (RHKG). Methods Following direct observation of pharmacist patient-profiling activities in the hospital, a draft SOP was developed. The SOP was validated twice using a self-administered validation questionnaire and was amended according to suggestions proposed during validation. The validated SOP was tested for applicability and practicality through an observation study. Pharmacists were trained to follow the SOP correctly and the SOP was subsequently implemented. Preliminary evaluation of the SOP was undertaken using a self-administered evaluation questionnaire 1 and 4 months post implementation. Results A ‘patient-profiling’ SOP for pharmacists was developed. Validation was beneficial since constructive suggestions were proposed and improvements with respect to SOP content, length, presentation, layout and comprehensiveness were implemented to develop the final version of the SOP. The SOP was found to be practical and applicable for use at RHKG. Preliminary evaluation showed that all pharmacists (nine) found the SOP fit for purpose, easy to follow for training new pharmacists, user friendly, easy to understand and promotes consistency in patient-profiling activities. Conclusions The ‘patient-profiling’ SOP provides a comprehensive approach to standardisation of pharmacist patient-profiling activities at RHKG to improve the quality of patient care. The SOP will need to be regularly reviewed and updated and can be transferred to other hospital settings with minor amendments.

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“…This approach does not appear to have been as successful as hoped as the lack of measurement while "getting on with it" means we are not at all sure about the state of the safety in the health care system. It is easy to state that in 18 years since the Harvard Medical Practice Study little has changed 57 and the inadequacy of measurement cannot be disputed. Yet today multidisciplinary team work is normal, multidisciplinary stroke units are in widespread use and medical emergency teams are present in more than 75% of Australian hospitals.…”

Section: Resultsmentioning

confidence: 99%

“…55 In a recent call for clinically relevant reform, Scott et al challenge health care providers and institutions to reconsider their safety and quality focus, to "tackle the core of first-order clinically relevant issues central to making hospital care visibly safer". 57 To actually decide on the clinically relevant issues and to measure "visibly" safer care, research is needed on ways to routinely and effectively include the patient view in decisions and measures. In an Australian institution with a routine comprehensive patient survey process, implementation of a new approach to clinical handover communications resulted in a measurable improvement in patient satisfaction about how staff work together.…”

Section: Measurement Of Safetymentioning

confidence: 99%

Using research to make health care safer

Jorm¹,

White²

2009

Aust. Health Review

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There is a fine balance that needs to be maintained between research and improvement in safety and quality in health care -when do we need more research and when can we just get on with it? The moral imperative to improve care may have been a distractor, preventing adequate attention to research. Three research areas are proposed as current priorities for patient safety: getting evidence into practice, measurement of safety, and the evaluation of complex interventions. A focus on these areas should ensure that research becomes more central to the process of WHAT PLACE DOES RESEARCH play in safety and quality and when should we just "get on with it"? The discourse of modern government is crisp, if not blunt: the National Health and Hospitals Reform Commission had among its terms of reference the requirement to "reduce inefficiencies generated by cost-shifting, blame-shifting and buck passing". 1 (p. 357) The development of performance indicators continues apace, and the research community is not always seen as essential to the process of making health care safer.The research-policy divide is well documented and has led to the modern development of new specialties such as knowledge transfer or translation, 2 and brokering and exchange. 3 However, policy imperatives mean policy makers are impatient with research timeframes and wary of recommendations that may make compromise difficult. 4 Human interaction has been described as "the engine that drives research into practice", 5 yet the inclusion of clinicians, managers and policy makers (or research users) into research funding programs is rare in Australia and only partial in Canada. 5 In the case of quality and safety, however, there are further problems. Traditional quantitative research methods may be inadequate tools (particularly for areas such as clinical handover and other health care communication), and in addition, the need to improve safety and quality has been associated with a moral imperative which has been held to obviate the need for research and has been associated with denigration of its value. Berwick, in a recent piece advocating safety and quality research, used rhetoric displaying the customary antagonism of safety and quality exponents towards research: "Health care researchers What is known about the topic? It is unsure how much safety and quality has improved over the last two decades. There is a deficiency of high quality research to support the design of safety improvement. What does this paper add?The lack of formal study means that neither clinicians nor policy makers understand the system in which they work sufficiently to reliably get evidence into practice. Inadequate measurement in safety prevents appropriate priority setting. Meaningful evaluations must include the study of failure. The use of a theoretical basis for both intervention and evaluation increases the likelihood of transferable learning. What are the implications for practitioners? Safety and quality advocates are requested to accompany their exhortations for cha...

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Improving quality and safety of hospital care: a reappraisal and an agenda for clinically relevant reform

Cited by 29 publications

References 92 publications

Challenges in Evaluating Clinical Governance Systems in Iran: A Qualitative Study

Challenges in Evaluating Clinical Governance Systems in Iran: A Qualitative Study

Standardising pharmacist patient-profiling activities in a rehabilitation hospital in Malta

Using research to make health care safer

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