Non-compliance with Occupational Therapy Outpatient Attendance: A Quality Assurance Study

Therapists working in the outpatients service of a general hospital observed a problem regarding patient attendance at agreed appointment times. Valuable staff time was “lost” waiting for patients who failed to keep appointments. To develop policies and procedures about management of patient non-attendance a quality assurance study was conducted. This identified the extent of non-attendance, the reasons for this and the impact on the department. Of 192 appointments, 25 were non-attendances. Non-attendance was found to be a problem which occurred regularly, had an effect on staff job satisfaction and was a considerable financial cost to the department in terms of direct patient service delivery time lost. A number of methodological problems in the study are identified which limit the conclusions which can be drawn. These relate to data collection regarding the total outpatient service population which meant comparisons between attenders and non-attenders could not be made. On the basis of the information gained from the literature and the study a number of recommendations were made to decrease non-attendance. These include environmental changes to department waiting areas, the introduction of appointment reminder systems, waiting time policies, appointment negotiation procedures and a new protocol for dealing with non-attendance in the department.     

"以顾客为中心",不断提高医院整体质量

文章将工业理论中的持续性质量提高理论运用于卫生领域，结合医院现代管理理念．提出医院在一定的质量标准下．通过对医院质量和病人满意度的调查，找出医院存在的问题．提出改进措施。文章认为提高医院的质量应该“以顾客为中心”．以提高管理质量和内部顾客(医务人员)的质量(临床质量和服务质量)为根本，不断改善医院总体质量，提高医院的经济效益和社会效益。     

护理质量考核在提升护理质量管理中的效果分析

目的创新的护理质量管理方法可以提升护理工作质量,为患者提供高质量的优质护理服务。方法制订包括护理核心制度执行、护理服务与安全质量管理、护理病历书写质量、病人护理质量四大项内容的18项子项护理质量考核细则,每月汇总形成各护理单元护理质量考核成绩,产生各护理单元的月度护理质量绩效奖。结果实施3年,医院护理质量考核平均成绩有较大幅度的提升,护士质量管理意识增强,护理不良事件明显减少。结论从考核体系的形成、考核指标的达成和修改、质控的实施和评价反馈、问题追踪和整改整个过程中,发挥了护士长及每一位护士的作用和潜能,保证了护理工作的及时性、正确性和完整性。     

建立感控能力评价体系在持续改进医院感控质量中的运用

目的 探索建立医院工作人员感控能力评价体系,促进医院感控质量持续改进.方法 于2019年6月和7月分别进行1次工作人员感控能力评价,两次评价的内容、方法、人员完全相同;两次评价均按照标准的程序,采用现场查看和询问的方法 对感控三基三严知识知晓率、执行率进行评价;对两次评价的结果 进行比较,分析感控工作是否达到促进持续质...     

PDCA内训师在促进医院质量持续改进中的探索与实践

为了更好地促进医院医疗质量持续改进,提高员工发现、分析和解决问题的能力,南方医科大学珠江医院采取组建内训师团队、制定内训师培养方案、开发培训课程体系、内训师牵头开展及辅导质量持续改进项目等系列措施,逐步搭建了PDCA内训师体系,员工持续改进能力有效提升,推动了医院质量持续改进。     

全面质量管理（TQM）在放射治疗质量管理中的应用

将全面质量管理（TQM）的理念和方法应用于放射治疗质量管理,通过建立放射治疗质量管理体系、规范放疗流程、加强放疗设备和物理技术质控、注重安全防护和人员培训,提高放射治疗质量控制和质量保证水平。     

The Central Role of Performance Measurement in Improving the Quality of Transitional Care

SUMMARY

The objectives of this study were: (1) to demonstrate the ability of the Care Transitions Measure (CTM) to identify care deficiencies; (2) to devise and implement a quality improvement approach designed to remedy these deficiencies; (3) to assess the impact of the quality improvement approach on CTM scores; and (4) to test whether the CTM-3 predicts return to the emergency department. The CTM was found to be a sensitive tool able to capture changes in performance. The 3-item CTM was found to significantly predict post-hospital return to the emergency department within the first 30 days (p = 0.004).     

医院质量与安全内部评价体系建设的难点及对策

2013年,中南大学湘雅医院以医院等级评审等外部评审为契机,创立了"医院质量与安全内部评价体系",通过定期开展内审培训、数据监测、现场评价等活动,发现、反馈、分析、整改问题,借助FOCUS-PDCA、QCC、RCA等质量管理工具推动医院质量持续改进,实现了从被动评审向主动内审、常态化内审、信息化内审转变,形成了"自我改进、自我突破"的湘雅模式。针对内审工作开展过程中难点问题、重要环节及对策效果作具体介绍,为正在借鉴内审理念进行医院质量与安全改进的管理者提供参考。     

品管圈活动在提高住院患者对护理工作满意度的作用

目的探讨品管圈活动前后住院患者对护理工作满意度的作用。方法发放问卷调查开展品管圈活动前后妇科住院患者对护理工作的满意程度。由本病区10位护士组成品管圈,采用头脑风暴法分析存在的问题,采取相应解决措施。结果品管圈活动可发现并解决护理工作中存在的重要问题,品管圈活动后住院患者对护理工作的满意度大幅提高。结论品管圈活动是改善住院患者对护理工作满意度的有效方法。     

Hospital Board Oversight of Quality and Patient Safety: A Narrative Review and Synthesis of Recent Empirical Research

Context

Recurring problems with patient safety have led to a growing interest in helping hospitals’ governing bodies provide more effective oversight of the quality and safety of their services. National directives and initiatives emphasize the importance of action by boards, but the empirical basis for informing effective hospital board oversight has yet to receive full and careful review.

Methods

This article presents a narrative review of empirical research to inform the debate about hospital boards’ oversight of quality and patient safety. A systematic and comprehensive search identified 122 papers for detailed review. Much of the empirical work appeared in the last ten years, is from the United States, and employs cross-sectional survey methods.

Findings

Recent empirical studies linking board composition and processes with patient outcomes have found clear differences between high- and low-performing hospitals, highlighting the importance of strong and committed leadership that prioritizes quality and safety and sets clear and measurable goals for improvement. Effective oversight is also associated with well-informed and skilled board members. External factors (such as regulatory regimes and the publication of performance data) might also have a role in influencing boards, but detailed empirical work on these is scant.

Conclusions

Health policy debates recognize the important role of hospital boards in overseeing patient quality and safety, and a growing body of empirical research has sought to elucidate that role. This review finds a number of areas of guidance that have some empirical support, but it also exposes the relatively inchoate nature of the field. Greater theoretical and methodological development is required if we are to secure more evidence-informed governance systems and practices that can contribute to safer care.     

优质护理服务模式对提升住院患者满意度的影响分析

目的研究住院服务中心推行优质护理服务模式对患者满意度的影响。方法住院服务中心实行优质护理服务,通过增进护患沟通,制定温馨提示展板,改进工作模式及健康教育模式,定时随访特床患者,提高护士工作的积极性等,比较分析优质护理服务模式推行前、后的患者满意度。结果患者满意度由模式推行前的91.54%上升至推行后的97.05%,两者差异显著(P<0.05)。结论优质护理服务模式能有效提高住院服务中心患者满意度。     

Improving the quality of preventive cardiovascular care provided by primary care physicians: insights from a US Quality Improvement Organization.

BACKGROUND: During 2000-03, Qualidigm, a US Quality Improvement Organization, conducted a project to improve the care received by elderly Medicare patients with coronary artery disease or cardiovascular risk factors. METHODS: We recruited primary care physicians in private practice in the state of Connecticut. Then, we identified approximately 30-50 patients per physician from the periods 1 January 2000 to 31 December 2000 and 1 November 2001 to 31 October 2002. We abstracted medical records to assess processes and outcomes of care, and we provided the physicians with performance data and a variety of practice-enhancing materials. The physicians utilized those materials that they perceived to be most helpful. RESULTS: We identified and recruited 974 primary care physicians to participate. Of these, 103 (10.6%) committed to participate, and 85 of the 103 completed the project. Among the intervention tools, physicians and their office personnel utilized personal digital assistants (PDAs) (36.5%) and patient education materials (34.1%) most commonly. Overall, quality of care improved for most physicians (mean quality score 62.0 to 67.8%, P < 0.001). However, not all improved, and most improvements were modest [mean absolute improvement in quality score 5.8%, standard deviation (SD) 6.8%]. CONCLUSIONS: Quality Improvement Organizations and others interested in improving outpatient quality of care face significant challenges in recruiting self-employed primary care physicians to quality improvement projects and in bringing about transformational change. Future primary care quality improvement projects should include careful assessments of practice-specific barriers, interventions that are linked to these barriers, and support of the practices on implementation.     

消毒供应中心实施持续质量改进模式的实效性探究

目的针对消毒供应中心管理问题,研究分析对其实施持续质量改进的模式管理的效果分析。方法在我院的消毒供应中心中,于2012年实施常规的管理,并选择30名的中心工作人员作为一个中心成员小组,记为A组;在2013年,管理改为持续质量改进管理模式,同样随机选择30名成员小组,记为B组,最后,关于不同的质量管理模式,调查分析其管理质量。结果经由研究调查分析结果,A组的工作效率只有83.3%,明显低于B组的100%。分析其他各项指标,B组均优于A组,均达到了较为显著的差异（P〈0.05）。结论对于消毒管理中心的管理模式选取,应选择满意度较高的持续质量改进模式管理,可以有效的促进中心管理工作的顺利进行。     

军队医院心血管疾病介入诊疗质量控制体系构建

为提高心血管疾病介入诊治技术的精细化管理水平,在全军范围内建立了心血管疾病介入诊疗技术资质准入及质量控制制度,该体系的建立,有效的保证医疗安全,杜绝过度医疗行为,并为在全军范围内实行心血管疾病数据挖掘及科研协作奠定基础,促进学科健康、快速、有序地发展。     

Improving quality: bridging the health sector divide.

ISSUE: All too often, quality assurance looks at just one small part of the complex system that is health care. However, evidently each individual patient has one set of experiences and outcomes, often involving a range of health professionals in a number of settings across multiple sectors. ADDRESSING THE ISSUE: In order to solve the problems of this complexity, we need to establish high-quality electronic recording in each of the settings. In the UK, primary care has been leading the way in adopting information technology and can now use databases for individual clinical care, for quality assurance using significant event and conventional auditing, and for research. BUILDING TOWARDS A SOLUTION: Before we can understand and quality-assure the whole health care system, we need electronic patient records in all settings and good communication to build a summary electronic health record for each patient. Such an electronic health record will be under the control of the patient concerned, will be shared with the explicit consent of the patient, and will form the vehicle for quality assurance across all sectors of the health service.     

严格设备质量控制管理 着力提高使用效能

目的：探讨分析部队卫生装备质量控制的基本方法。方法：结合工作实际,建立健全并严格落实各项制度,切实做好必要的检定/检测。结果：质量控制常规化、制度化可以有效提高医疗设备的应用质量,降低医疗器械相关的医患风险。结论：质量控制对提高医疗诊断的准确性和治疗结果的有效性起着非常重要的作用。同时,强化设备效能考核可以充分发挥设备资源效率,确保医疗设备使用效能的最大化。     

Improving the quality of the admission process in a French psychiatric hospital: impact on the expertise of the professional team.

INTRODUCTION: A 20-month quality improvement project was undertaken in order to improve the patient admission process at a 350-bed French public psychiatric hospital. In addition to improving the quality of patient admissions, the project was expected to increase the expertise of quality improvement team members. METHODS: The project team consisted of two physicians, three heads of nursing, one senior manager, one member of the admissions staff and one secretary. A pharmacist acted as internal facilitator. The team used problem-solving methodology to identify and correct any shortcomings in the existing admission process. Validated data were collected before and after implementation of corrective actions. The team was trained to become more effective on the basis of a published how-to manual for building an effective work team. Team effectiveness was compared before and after the project. RESULTS: Changes in relevant variables were as follows: (i) patients going through the admissions department (40% after corrective action, versus 20% before); (ii) no delay in admission formalities for patients entering hospital by long-standing arrangement (100% versus 20%); and (iii) no delay in admission formalities for patients whose hospitalisation was not predetermined but foreseen (45% versus 0%). The expertise of team members improved in terms of the four tested items: meeting customers' needs and expectations (P< 2 x 10(-6)); contribution of the team to the internal quality improvement strategy (P< 0.01); understanding of the methodology (P< 0.04) and accountability (P< 2 x 10(-5)). Improvements in adherence to the mission statement were also observed. A total of 728 hours were spent on project management. DISCUSSION: Objective improvements were achieved; in particular, the team was shown to have become more effective. The extent to which the lessons learned here can be extrapolated may depend on the openness to change of members of other project teams. CONCLUSION: This project demonstrated that it is possible to put theory into action and thereby make progress. In order to advance further, a second quality improvement project is planned.     

持续质量改进在护理质量控制中的应用

目的探讨护理质量控制中运用持续质量改进的效果.方法 通过修订护理工作各项考核标准,督促检查和评价环节质量,对护理问题不断总结改进,促使终末质量提高.结果护理质量稳步上升,患者满意度不断提高.结论 持续质量改进能将护理质量管理建立一个良性循环的模式,有效地控制了不良因素的发生,确保了护理质量.