Vision to improve: quality improvement in ophthalmology

Ma, Jingyi; Wong, Brian M.; Micieli, Jonathan A.; Calafati, Jennifer; Low, Stephanie A.W.; El‐Defrawy, Sherif; Hatch, Wendy

doi:10.1016/j.jcjo.2019.07.020

Cited by 6 publications

(5 citation statements)

References 46 publications

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“…The use of pre-post quasi-experimental designs [ 28 , 29 ] and the PDSA model in health care [ 30 ] in general and in ophthalmology [ 31 ] in particular, has been widely reported. A similar study was conducted in Ethiopia using an appointment system [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention

Mbwogge¹,

Astbury²,

Nkumbe³

et al. 2022

JMIRx Med

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Background Waiting time can considerably increase the cost to both the clinic and the patient and be a major predictor of the satisfaction of eye care users. Efficient management of waiting time remains as a challenge in hospitals. Waiting time management will become even more crucial in the postpandemic era. A key consideration when improving waiting time is the involvement of eye care users. This study aimed at improving patient waiting time and satisfaction through the use of Plan-Do-Study-Act (PDSA) quality improvement cycles. Objective The objectives of this study were to determine the waiting time and patient satisfaction, measure the association between waiting time and patient satisfaction, and determine the effectiveness of the PDSA model in improving waiting time and satisfaction. Methods This was a pre-post quality improvement study among patients aged 19 to 80 years, who are consulting with the Magrabi International Council of Ophthalmology Cameroon Eye Institute. We used PDSA cycles to conduct improvement audits of waiting time and satisfaction over 6 weeks. A data collection app known as Open Data Kit (Get ODK Inc) was used for real-time tracking of waiting, service, and idling times at each service point. Participants were also asked whether they were satisfied with the waiting time at the point of exit. Data from 51% (25/49) preintervention participants and 49% (24/49) postintervention participants were analyzed using Stata 14 at .05 significance level. An unpaired 2-tailed t test was used to assess the statistical significance of the observed differences in times before and after the intervention. Logistic regression was used to examine the association between satisfaction and waiting time. Results In total, 49 participants were recruited with mean age of 49 (SD 15.7) years. The preintervention mean waiting, service, and idling times were 450 (SD 96.6), 112 (SD 47), and 338 (SD 98.1) minutes, respectively. There was no significant association between patient waiting time and satisfaction (odds ratio 1, 95% CI 0.99-1; P=.37; χ23=0.4). The use of PDSA led to 15% (66 minutes/450 minutes) improvement in waiting time (t47=2; P=.05) and nonsignificant increase in patient satisfaction from 32% (8/25) to 33% (8/24; z=0.1; P=.92). Conclusions Use of PDSA led to a borderline statistically significant reduction of 66 minutes in waiting time over 6 weeks and an insignificant improvement in satisfaction, suggesting that quality improvement efforts at the clinic have to be made over a considerable period to be able to produce significant changes. The study provides a good basis for standardizing the cycle (consultation) time at the clinic. We recommend shortening the patient pathway and implementing other measures including a phasic appointment system, automated patient time monitoring, robust ticketing, patient pathway supervision, standard triaging, task shifting, physician consultation planning, patient education, and additional registration staff.

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Section: Introductionmentioning

confidence: 99%

Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention

Mbwogge¹,

Astbury²,

Nkumbe³

et al. 2022

JMIRx Med

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“…For a vision to be clear, a thorough understanding of the principles and practices underpinning that vision is essential. A clear vision is critical for the explication of a framework for quality improvement, the identification of key stakeholders and the selection of measures for evaluation (Ma et al, 2020). These effects were weaker or not seen in the mixed and low-low groups.…”

Section: Discussionmentioning

confidence: 99%

Authentic leadership, organizational culture and the effects of hospital quality management practices on quality of care and patient satisfaction

Tate

Penconek

Dias

et al. 2023

Journal of Advanced Nursing

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Aim To examine the influence of hospital culture and authentic leadership on the effects of quality improvement practices on patient satisfaction. Background Nurses in formal leadership roles shape and are shaped by organizational culture to achieve high performance standards to influence quality of care. Design Using structural equation modelling, we tested a model on quality improvement practices across three participant groups that differed based on authentic leadership and hospital culture. Methods We used survey data from a cross‐sectional study conducted in 2015 measuring nurse. Managers' perceptions of authentic leadership, implementation of quality improvement, and organizational culture in Canadian hospitals. Results 226 nurse managers participated. Our model estimations fit for the high‐relational group and mixed group. Our model explained 50.7% and 39.5% variance in our outcome variable of patient satisfaction for the high‐relational group and mixed group, respectively. Our model failed to fit the low‐relational group. Conclusion Authentic leadership and developmental/group hospital cultures improve quality management practices, quality of care and patient satisfaction. In organizations with low authentic leadership and hierarchical/rational cultures, strategies should target increasing authentic leadership and shifting to developmental cultures. Organizations with high authentic leadership and/or developmental/group cultures should target employee engagement, autonomy and teamwork. Impact We examined how different combinations of authentic leadership and hospital culture influence the effects of quality management practices on quality improvement and patient satisfaction. Findings demonstrate that having both high authentic leadership and developmental or group hospital cultures are essential for quality improvement practices to enhance the quality of care and patient satisfaction. These organizations would benefit the most from systemic programs aimed at standardizing quality management practices as they have the culture and leadership to support these practices. For hospitals with hierarchical/rational cultures and/or low authentic leadership, enhancing hospital culture and leadership through leadership training and accreditation programs is critically needed. Patient or Public Contribution The College and Association of Registered Nurses of Alberta contributed to this study by facilitating data collection and supporting the conduct of the study through messaging to its members.

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“…4 Numerous quality improvement projects focused on enhancing ophthalmology clinic efficiency have been reported in the literature. 7 Some effective techniques have included developing a data-driven scheduling template based on appointment length, using portable radios in clinic to improve team communications, and having a wider distribution of appointment slots. [8][9][10] Increasingly, a number of studies have sought to improve efficiency using Lean Six Sigma, a combination of two overlapping manufacturing industry principles: Lean (a streamlining process i.e., designed to reduce waste) and Six Sigma (a systematic and rigorous methodology that focuses on reducing process variation and enhancing process control).…”

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confidence: 99%

Successful Interventions to Improve Efficiency and Reduce Patient Visit Duration in a Retina Practice

Lin

et al. 2021

Retina

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Purpose: To reduce the total clinic visit duration among retina providers in an academic ophthalmology department.Methods: All patient encounters across all providers in the department were analyzed to determine baseline clinic visit duration time, defined as the elapsed time between appointment time and checkout. To increase photography capacity, a major bottleneck identified through root cause analysis, four interventions were implemented: training ophthalmic technicians to perform fundus photography in addition to optical coherence tomographies, relocating photography equipment to be adjacent to examination rooms, procuring three additional Optos widefield retinal photography units, and shifting staff schedules to better align with that of the providers. These interventions were implemented in the clinics of two retina providers.Results: The average baseline visit duration for all patients across all providers was 87 minutes (19,550 patient visits). The previous average visit duration was 80 minutes for Provider 1 (557 patient visits) and 81 minutes for Provider 2 (1,246 patient visits). In the 4 weeks after interventions were implemented, the average visit duration decreased to 60 minutes for Provider 1 and 57 minutes for Provider 2.Conclusion: A systematic approach and a multidisciplinary team resulted in targeted, cost-effective interventions that reduced total visit durations.

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Vision to improve: quality improvement in ophthalmology

Cited by 6 publications

References 46 publications

Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention

Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention

Authentic leadership, organizational culture and the effects of hospital quality management practices on quality of care and patient satisfaction

Successful Interventions to Improve Efficiency and Reduce Patient Visit Duration in a Retina Practice

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