Evaluating implementation of quality management systems in a teaching hospital's clinical departments.

OBJECTIVES: This study evaluated a strategy for implementing continuous quality improvement based on a decentralized quality management system in the clinical departments of a hospital. SETTING: The institution is a 2000-bed teaching hospital of tertiary health care employing 8000 people. METHODS: The quality management intervention was tested in six volunteer departments. This intervention comprised an instructional seminar, methodological assistance, and the dissemination of guidelines. The program was evaluated 1 year after the intervention and included a quality audit, interviews with department staff, and analysis of the written documents produced by the departments. RESULTS: The quality management systems are functioning in all the departments. Quality teams meet regularly and multidisciplinary work groups are in place. The topics most often addressed are patient reception and communication between department staff members. The level of compliance with the guidelines has increased, from 39% before the seminar to 54% 1 year later (P < 0.05). All of the staff members interviewed judged the process useful for them and for the department, while waiting for the concrete results. Among the difficulties the staff members encountered were changing their work habits, lack of time, and the tedious aspect of writing procedures. CONCLUSION: Implementing continuous quality improvement in hospital departments seems to be an interesting alternative to organization-wide implementation strategies. However, these results need to be confirmed by long-term evaluations and by deploying the program i n other departments.     

医疗质量持续改进的探讨

针对全球面临"患者安全"问题的挑战,明确"患者安全"是医疗质量的首要问题和最基本的要求。结合当前医疗质量存在的问题,提出医院实现质量持续改进的意见与建议。     

Issues in the assessment of continuous quality improvement implementation in health care organizations.

OBJECTIVE: This paper has two primary aims. First, it examines the need for improved assessment of continuous quality improvement implementation. Second, it analyzes current worldwide measures and studies of continuous quality improvement implementation. METHOD: A comprehensive literature review was conducted which included all published (English language) studies of organization-wide continuous quality improvement implementation. RESULTS: Analysis of the content and research methods incorporated into current measures of continuous quality improvement implementation used worldwide supports a strong consensus regarding the major criteria that need to be addressed. However, there are still promising areas for future research, namely increased use of criteria other than the Baldrige categories, increased focus upon financial variables, improved measures of implementation stage/phase and the use of different types of respondents from multiple organizational levels. CONCLUSION: Increased understanding of the empirical benefits and costs of continuous quality improvement in health care organizations is heavily contingent upon the continued development and improvement of measures of continuous quality improvement implementation.     

Promoting quality: the health-care organization from a management perspective.

BACKGROUND: Although agreement about the need for quality improvement in health care is almost universal, the means of achieving effective improvement in overall care is not well understood. Avedis Donabedian developed the structure-process-outcome framework in which to think about quality-improvement efforts. ISSUE: There is now a robust evidence-base in the quality-improvement literature on process and outcomes, but structure has received considerably less attention. The health-care field would benefit from expanding the current interpretation of structure to include broader perspectives on organizational attributes as primary determinants of process change and quality improvement. SOLUTIONS: We highlight and discuss the following key elements of organizational attributes from a management perspective: (i) executive management, including senior leadership and board responsibilities (ii) culture, (iii) organizational design, (iv) incentive structures and (v) information management and technology. We discuss the relevant contributions from the business and medical literature for each element, and provide this framework as a roadmap for future research in an effort to develop the optimal definition of 'structure' for transforming quality-improvement initiatives.     

持续质量改进在泌尿造口病人健康教育中的应用

目的探讨持续质量改进(Continue quality improvement,CQI)在泌尿造口病人健康教育中的应用效果。方法对40例泌尿造口病人进行健康教育质量改进,分析产生问题的原因,制定预期的目标,并根据目标采取相应整改措施,及评价措施效果。结果实施CQI后,护士对泌尿造口理论知识及操作的合格率由78%上升至97%,健康教育覆盖率由90%上升至100%,泌尿造口患者对护理人员的满意度由95%上升至100%。持续质量改进后,患者自我护理能力有显著性提高(P<0.05)。结论持续质量改进用于泌尿造口患者的健康教育,有利于提高泌尿造口患者的自我护理能力。     

Assessing the factors influencing continuous quality improvement implementation: experience in Korean hospitals.

OBJECTIVE: To assess the extent of continuous quality improvement (CQI) implementation in Korean hospitals and to identify its influencing factors. DESIGN: Cross-sectional study by mailed questionnaire survey. STUDY PARTICIPANTS: One hundred and seventeen staff members with responsibility for CQI at 67 hospitals with > or = 400 beds. MAIN OUTCOME MEASURES: The degree of CQI implementation was measured using the Malcolm Baldrige National Quality Award Criteria (MBNQAC). Factors related to the degree of CQI implementation were the four components of the CQI pyramid, namely the cultural, technical, strategic, and structural attributes of individual hospitals. RESULTS: The average CQI implementation score across the seven dimensions by MBNQAC was 3.34 on a 5-point scale. The highest score was achieved in the dimension of 'customer satisfaction' (3.88), followed by 'information/analysis' (3.59), and 'quality management' (3.35). Regression analysis showed that hospitals which better fulfilled technical requirements, such as improving information systems (P< 0.05), using more scientific CQI tools, and adopting systematic problem-solving approaches (P<0.01), tended to achieve higher degrees of CQI implementation. Although statistically insignificant, positive trends were observed for group/developmental culture and the degree of employee empowerment, and the use of prospective strategy. CONCLUSION: It appears that the most important contributing factors to active CQI implementation in Korean hospitals were the use of scientific skills in decision-making and the adoption of a quality information system capable of producing precise and valid information.     

Bridging the quality chasm: integrating professional and organizational approaches to quality.

Current Western health care practices face the challenge to improve their quality on multiple dimensions simultaneously. This requires new ways to think about how to deliver health care services. A careful and 'flexible' standardization of care into 'care programs', we argue, is central. Yet such standardization is powerless without the application of four additional design principles: a thorough restructuring and delegation of tasks, the application of integrated planning, the use of indicators about the functioning of the care programs, and implementing process-supporting information technology. Vice versa, these additional principles can only function properly when integrated with care programs. We will only be able to improve the safety, effectiveness, patient-centeredness, and timeliness of health care, while reducing costs and improving equity, by integrating professional and organizational approaches to quality. This paper describes a series of interrelated design principles that together depict how future health care delivery could be organized.     

品管圈在产房护理质量持续改进中的应用价值探析

目的 探讨品管圈(QCC)在产房护理质量持续改进中的应用价值。方法 将2019年6月—2020年4月本院实施常规产科护理期间接收的42例待产妇设为对照组,2020年5月—2021年3月开展QCC活动期间接收的42例待产妇设为观察组。对比两组产妇心理状态、妊娠结局及护理满意度。结果 观察组干预后焦虑(SAS)、抑郁(SDS)评分低于对照组,差异有统计学意义[(34.28±6.43) vs (42.15±7.48),t=5.171;(37.66±6.49) vs (44.51±7.80),t=4.375,P均<0.001];观察组不良妊娠结局发生率7.17%,低于对照组的23.81%,差异有统计学意义(χ2=4.459,P=0.035);观察组护患沟通能力、解决问题能力、专业水平、纽卡斯尔护理服务满意度量表(NSNS)评分均高于对照组,差异均有统计学意义[(95.62±1.17) vs (93.05±1.66),(94.19±1.40) vs (92.33±1.52),(96.22±1.03) vs (94.25±1.28),(90.30±1.12) vs (86.49±1.78),P均<0.001]。结论 QCC活动在产房护理质量持续改进中的应用价值较高,能够改善产妇心理状态,预防不良妊娠结局,从而提高护理满意度。     

Perception and use of the results of patient satisfaction surveys by care providers in a French teaching hospital.

OBJECTIVE: . The aim of this study was to assess clinical staff's opinions on the results of in-patient satisfaction surveys and their use within the quality improvement process. SETTING: The institution is a 2200-bed teaching hospital of tertiary health care employing 8000 professionals. Patient satisfaction surveys are carried out each year using a validated questionnaire mailed to a random sample of patients. The specific results of each department are sent to the medical and paramedical managers. METHODS: We conducted a questionnaire survey on 500 care providers randomly selected in every medical and surgical department. RESULTS: A total of 261 questionnaires were returned and analysed. Overall, 94% of responders had a favourable opinion of the patient satisfaction surveys. They considered that the patient was able to judge hospital service quality, especially in its relational, organizational, and environmental dimensions. The specific results for the department were less well known than the overall hospital results (60 versus 76%). These results were formally discussed in the department according to 40% of responders; 40% declared that these data resulted in improvement actions and considered that they led to modifications in their behaviour with patients. CONCLUSIONS: Despite a declared interest in satisfaction surveys, the results remain underused by hospital staff and insufficiently discussed within teams.     

Hospital staffing, organization, and quality of care: cross-national findings.

OBJECTIVE: To examine the effects of nurse staffing and organizational support for nursing care on nurses' dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals. DESIGN: Multisite cross-sectional survey. SETTING: Adult acute-care hospitals in the United States (Pennsylvania), Canada (Ontario and British Columbia), England, and Scotland. STUDY PARTICIPANTS: 10 319 nurses working on medical and surgical units in 303 hospitals across the five jurisdictions. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Nurse job dissatisfaction, burnout, and nurse-rated quality of care. RESULTS: Dissatisfaction, burnout, and concerns about quality of care were common among hospital nurses in all five sites. Organizational/managerial support for nursing had a pronounced effect on nurse dissatisfaction and burnout, and both organizational support for nursing and nurse staffing were directly, and independently, related to nurse-assessed quality of care. Multivariate results imply that nurse reports of low quality care were three times as likely in hospitals with low staffing and support for nurses as in hospitals with high staffing and support. CONCLUSION: Adequate nurse staffing and organizational/managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout and, ultimately, to improving the nurse retention problem in hospital settings.     

持续质量改进对ICU导管相关性感染的控制效果

目的 了解持续质量改进对重症监护病房(ICU)导管相关性感染的控制效果.方法 2007年1月-2012年2月在外科重症监护病房(SICU)开展导管相关性感染目标性临测,监测内容包括气管切开使用呼吸机、中心静脉插管和泌尿道插管的使用率及呼吸机相关性肺炎(VAP)、中心静脉插管相关性血流感染(CLABSI)及泌尿道插管相关性尿路感染(CAUTl)的感染率进行监测;监测工作中采取综合控制措施并持续质量改进,评价持续改进的效果.结果 通过持续质量改进,2007- 2010年导管相关性感染率明显下降,尤其是VAP感染率下降显著,2010年较2007年明显下降(P=0.00);改进控制措施实施后,呼吸机使用率从46.49％降至40.72％,泌尿道插管从93.44％降至88.77％.均明显下降(P=0.00);CAUTI感染率从4.25例/1000导管日降至0.39例/1000导管日,差异有统计学意义(P＜0.01).结论 持续质量改进对控制导管相关性感染有重要意义,并可取得较好的效果.     

Assessing the implementation of the chronic care model in quality improvement collaboratives

OBJECTIVE: To measure organizations' implementation of Chronic Care Model (CCM) interventions for chronic care quality improvement (QI). DATA SOURCES/STUDY SETTING: Monthly reports submitted by 42 organizations participating in three QI collaboratives to improve care for congestive heart failure, diabetes, depression, and asthma, and telephone interviews with key informants in the organizations. STUDY DESIGN: We qualitatively analyzed the implementation activities of intervention organizations as part of a larger effectiveness evaluation of yearlong collaboratives. Key study variables included measures of implementation intensity (quantity and depth of implementation activities) as well as fidelity to the CCM. DATA COLLECTION/EXTRACTION METHODS: We developed a CCM-based scheme to code sites' intervention activities and criteria to rate their depth or likelihood of impact. PRINCIPAL FINDINGS: The sites averaged more than 30 different change efforts each to implement the CCM. The depth ratings for these changes, however, were more modest, ranging from 17 percent to 76 percent of the highest rating possible. The participating organizations significantly differed in the intensity of their implementation efforts (p<.001 in both quantity and depth ratings). Fidelity to the CCM was high. CONCLUSIONS: Collaborative participants were able, with some important variation, to implement large numbers of diverse QI change strategies, with high CCM fidelity and modest depth of implementation. QI collaboratives are a useful method to foster change in real world settings.     

品管圈持续质量改进方案在提高过氧化氢等离子灭菌器灭菌质量中的应用

目的 研究基于品管圈(QCC)的持续质量改进方案对提高过氧化氢等离子灭菌器灭菌质量的效果。 方法 分析某院2019年8月—2022年7月过氧化氢等离子灭菌器灭菌情况, 其中2019年8—12月为QCC实施前, 2020年1月开始实施基于QCC的持续质量改进方案, 2020年1月—2022年7月为QCC实施后。比较不同时间段过氧化氢等离子灭菌器灭菌故障发生率及灭菌质量。 结果 2019年8—12月、2020年、2021年、2022年1—7月过氧化氢等离子灭菌器分别使用514、1 245、2 174、1 289次。过氧化氢等离子灭菌器灭菌故障发生率2019年8—12月为7.78%, 实施QCC活动后2020年为2.57%, 2021年为1.47%, 2022年1—7月为0.85%。不同年份过氧化氢等离子灭菌器灭菌故障发生率比较, 差异有统计学意义(χ²=121.656, P＜0.001)。不同时间段过氧化氢等离子灭菌器清洁、消毒灭菌、包装合格率比较, 差异均有统计学意义(χ²值分别为33.740、66.558、84.675, 均P＜0.001)。实施QCC活动后的合格率均高于实施前, 均有逐年增高趋势。 结论 基于QCC的持续质量改进方案能明显降低过氧化氢等离子灭菌器灭菌故障发生率, 提高灭菌质量。     

The moderate success of quality of care improvement efforts: three observations on the situation.

Why is the health care system still unable to achieve a breakthrough in its quality performance? This commentary offers three observations on the problem of the moderate success of quality of care improvement efforts. We based our discussion on theoretical models from management theory and research. We conclude that health care organizations invest efforts in quality improvement initiatives; however, there is a potential in improving the fit between these efforts and the specific problems these organizations face.     

医疗质量实时控制与持续质量改进的方法研究

本文重在研究建立医疗质量实时控制的要素管理、过程管理、监测控制管理模式，确定医院病种质量与费用实时控制方法、病案实时控制方法，达到医疗质量的持续改进和提高。