A conceptual framework for hospital quality management

Overview of quality management models for inpatient healthcare settings. A scoping review

PURPOSE

This scoping review aimed to generate an overview of existing quality management (QM) models for inpatient healthcare published in peer-reviewed literature.

DATA SOURCES

Peer-reviewed publications published until June 2016 were retrieved from the databases Medline, PubMed, CINAHL and Cochrane Library using search terms related to QM and models.

STUDY SELECTION

Publications mentioning a QM model for general application in healthcare or inpatient care in their title or abstract were included. Languages considered were: English, French, German, Italian and Spanish.

DATA EXTRACTION

Data extraction was 3-fold. First, publication characteristics were summarized. Second, the frequency of each identified model was documented and the publications were divided into conceptual and implementation publications. Third, relevant QM models were identified and information regarding the model, including content and relationship with other models, was extracted.

RESULTS OF DATA SYNTHESIS

Of 925 retrieved publications, 213 were included. The included publications reported on 64 different QM models that were suitable for or used in inpatient care. Seventeen models were identified as being relevant. The 17 models were then categorized into three different levels: conceptual quality improvement models, concrete application models and country specific adaptations.

CONCLUSION

This scoping review provides an overview of 17 existing QM models for inpatient care and their relationships with each other. Various types of models with differing aspects and components exist. In searching for QM models, many different concepts like QM system, accreditation or methodologies appeared. For future investigation, concepts of interest should be clarified.

Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals

OBJECTIVE

The objective of the study was to describe the resources and activities associated with childbirth services.

STUDY DESIGN

We adapted models for assessing the quality of healthcare to generate a conceptual framework hypothesizing that childbirth hospital resources and activities contributed to maternal and neonatal outcomes. We used this framework to guide development of a survey, which we administered by telephone to hospital labor and delivery nurse managers in California. We describe the findings by hospital type (ie, integrated delivery system [IDS], teaching, and other [community] hospitals).

RESULTS

Of 248 nonmilitary childbirth hospitals in California, 239 (96%)responded; 187 community, 27 teaching, and 25 IDS hospitals reported. The context of services varied across hospital types, with community hospitals more likely to have for-profit ownership, be in a rural or isolated location, and have fewer annual deliveries per hospital. Results included the findings of the following: (1) 24 hour anesthesia availability in 50% of community vs 100% of IDS and teaching hospitals (P < .001); (2) 24 hour in-house labor and delivery physician coverage in 5% of community vs 100% of IDS and 48% of teaching hospitals (P < .001); (3) 24 hour blood bank availability in 88% of community vs 96% of IDS and 100% of teaching hospitals (P = .092); (4) adult subspecialty intensive care unit availability in 33% of community vs 36% of IDS and 82% of teaching hospitals (P < .001); (5) ability to perform emergency cesarean delivery in 30 minutes 100% of the time in 56% of community vs 100% of IDS and 85% of teaching hospitals (P < .001); (6) pediatric care available both day and night in 54% of community vs 63% of IDS vs 76% of teaching hospitals (P = .087); and (7) no neonatal intensive care unit in 44% of community vs 12% of IDS and 4% of teaching hospitals (P < .001).

CONCLUSION

Childbirth services varied widely across California hospitals. Cognizance of this variation and linkage of these data to childbirth outcomes should assist in the identification of key resources and activities that optimize the hospital environment for pregnant women and set the groundwork for identifying criteria for the provision of maternal risk-appropriate care.

ISO 9001 in health service sector: a review and future research proposal

Purpose

– This paper aims to describe the state-of-the-art in ISO 9001 research in healthcare service sector and propose the future research agenda.

Design/methodology/approach

– A comprehensive literature review of the ISO 9001 studies in healthcare service sector was carried out.

Findings

– The effectiveness of ISO 9001 implementation in healthcare service sector is still not clear. Previous researches show common stages for implementing ISO 9001 in a healthcare service organization. However, there is no previous research that reveals the content of the system implemented. In addition, there is no previous research that reveals the interpretation of ISO 9001 based on the practice of ISO 9001 implementation in an organization. Based on the review, eight future research agendas were proposed.

Originality/value

– The paper is believed to be the first to discuss the state-of-the-art of ISO 9001 researches in healthcare service sector.

An Empirical Exploration of Hospital Service Quality Assessment Criteria in China

This paper reports on a research project within the context of the Chinese healthcare sector. From a functional quality aspect, the research identifies, selects and confirms the service quality assessment criteria suitable for Chinese hospitals via literature search, focus group and survey investigation; the numbers of the criteria have also been reduced based on principal component analysis; then through importance-performance analysis, provides further understanding/prioritisation on the criteria and also groups them accordingly to reflect their influence on service quality. The research produces a set of appropriate service quality criteria suitable for evaluating hospitals' performance in a Chinese context. Meanwhile, the learning obtained from the research and the grouped criteria (quality performance indicators) can support consequential empirical research projects for obtaining more insights into running hospital businesses, and provide guidance to a wider range of Chinese hospitals on their business operations. They can also be used to guide foreign healthcare providers on developing/implementing their business management strategies while planning to enter the Chinese healthcare marketplace.

Ambulatory healthcare information system: a conceptual framework

Despite the tremendous amount of data collected in the field of ambulatory care, political authorities still lack synthetic indicators to provide them with a global view of health services utilization and costs related to various types of diseases. Moreover, public health indicators fail to provide useful information for physicians' accountability purposes. The approach is based on the Swiss context, which is characterized by the greatest frequency of medical visits in Europe, the highest rate of growth for care expenditure, poor public information but a lot of structured data (new fee system introduced in 2004). The proposed conceptual framework is universal and based on descriptors of six entities: general population, people with poor health, patients, services, resources and effects. We show that most conceptual shortcomings can be overcome and that the proposed indicators can be achieved without threatening privacy protection, using modern cryptographic techniques. Twelve indicators are suggested for the surveillance of the ambulatory care system, almost all based on routinely available data: morbidity, accessibility, relevancy, adequacy, productivity, efficacy (from the points of view of the population, people with poor health, and patients), effectiveness, efficiency, health services coverage and financing. The additional costs of this surveillance system should not exceed Euro 2 million per year (Euro 0.3 per capita).