Quality management in health care: a 20-year journey

A systematic review: the dimensions to evaluate health care performance and an implication during the pandemic

BACKGROUND

The balanced scorecard (BSC) has been implemented to evaluate the performance of health care organizations (HCOs). BSC proved to be effective in improving financial performance and patient satisfaction.

AIM

This systematic review aims to identify all the perspectives, dimensions, and KPIs that are vital and most frequently used by health care managers in BSC implementations.

METHODS

This systematic review adheres to PRISMA guidelines. The PubMed, Embase, Cochrane, and Google Scholar databases and Google search engine were inspected to find all implementations of BSC at HCO. The risk of bias was assessed using the nonrandomized intervention studies (ROBINS-I) tool to evaluate the quality of observational and quasi-experimental studies and the Cochrane (RoB 2) tool for randomized controlled trials (RCTs).

RESULTS

There were 33 eligible studies, of which we identified 36 BSC implementations. The categorization and regrouping of the 797 KPIs resulted in 45 subdimensions. The reassembly of these subdimensions resulted in 13 major dimensions: financial, efficiency and effectiveness, availability and quality of supplies and services, managerial tasks, health care workers' (HCWs) scientific development error-free and safety, time, HCW-centeredness, patient-centeredness, technology, and information systems, community care and reputation, HCO building, and communication. On the other hand, this review detected that BSC design modification to include external and managerial perspectives was necessary for many BSC implementations.

CONCLUSION

This review solves the KPI categorization dilemma. It also guides researchers and health care managers in choosing dimensions for future BSC implementations and performance evaluations in general. Consequently, dimension uniformity will improve the data sharing and comparability among studies. Additionally, despite the pandemic negatively influencing many dimensions, the researchers observed a lack of comprehensive HCO performance evaluations. In the same vein, although some resulting dimensions were assessed separately during the pandemic, other dimensions still lack investigation. Last, BSC dimensions may play an essential role in tackling the COVID-19 pandemic. However, further research is required to investigate the BSC implementation effect in mitigating the pandemic consequences on HCO.

Implementing a material planning and control method for special nutrition in a Brazilian public hospital

This study aims to (i) propose a demand forecast model for special nutrition materials in the context of health services, and (ii) comparatively evaluate three inventory management and control systems (periodic review, continuous review and mixed) for special nutrition materials. For that, we carried out a case study in a Brazilian public teaching hospital where data and information collection were conducted over a span of 22 months (from January 2018 and were consolidated until October 2019). A six-step approach was followed to propose the demand forecasting models and, later, evaluate the inventory control systems for special nutrition materials. Results indicate that if the organization implements the proposed inventory management method, there could be savings of up to 33% in the stock values managed by the healthcare organization. This research shows the planning and control of special nutrition materials in an integrated manner. Demand forecasting methods have been combined with inventory management to promote systemic improvements to healthcare organization.

Making high quality care an organisational strategy: Results of a longitudinal mixed methods study in Australian hospitals

Significant resources are spent on monitoring and improving the quality and safety of hospital care; however, evidence suggests that this investment is achieving disproportionately limited results. Accreditation and expectations of funders have focused hospital service quality management on compliance, with an over emphasis on the 'control' aspect of Juran's Quality Trilogy. This study compared the impact of the implementation of a strategic quality management system with existing compliance-focused quality management systems in a sample of Australian hospitals. Through action research, mixed methods data were tracked and compared implementation progress and outcomes between four experimental and four control hospitals from 2015 to 2017. While three years was not enough time to observe quality changes resulting from the implementation, three experimental hospitals made high quality care a strategic priority for their organisation and developed organisation-wide processes to achieve it. These hospitals demonstrated that including a strategic quality planning component in quality system design and implementation, as advocated by Juran but absent in many hospital quality systems, was a positive lever for staff commitment to delivering consistently high quality care.

Bridging existing governance gaps: five evidence-based actions that boards can take to pursue high quality care

Objective To explore the impact of the organisational quality systems on quality of care in Victorian health services. Methods During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. Results This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Conclusion Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. What is known about this topic? Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation's pursuit of high quality care. What does this paper add? Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. What are the implications for practitioners? Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for successful implementation, which is actively guided and monitored by the board.

Effective quality systems: implementation in Australian public hospitals

PURPOSE

The purpose of this paper is to review the implementation of seven components of quality systems (QSs) linked with quality improvement in a sample of Australian hospitals.

DESIGN/METHODOLOGY/APPROACH

The authors completed a systematic review to identify QS components associated with measureable quality improvement. Using mixed methods, the authors then reviewed the current state of these QS components in a sample of eight Australian hospitals.

FINDINGS

The literature review identified seven essential QS components. Both the self-evaluation and focus group data suggested that none of the hospitals had all of these seven components in place, and that there were some implementation issues with those components that were in use. Although board and senior executives could point to a large number of quality and safety documents that they felt were supporting a vision and framework for safe, high-quality care, middle managers and clinical staff described the QSs as compliance driven and largely irrelevant to their daily pursuit of safe, high-quality care. The authors also found little specific training in quality improvement for staff, lack of useful data for clinicians on the quality of care they provide and confusion about how organisational QSs work.

PRACTICAL IMPLICATIONS

This study provides a clearer picture of why QSs are not yet achieving the results that boards and executives want to achieve, and that patients require.

ORIGINALITY/VALUE

This is the first study to explore the implementation of QSs in hospitals in-depth from the perspective of hospital staff, linking the findings to the implementation of QS component identified in the literature.

Estimating Willingness to Pay for an Improved Service Delivery to Patients Referring Namazi Hospital Chemical Therapy Ward in Iran Using Contingent Valuation

Objective

The aim of this study was to estimate patients’ willingness to pay (WTP) for improving the quality of non-medical aspect in Namazi hospital patients chemotherapy an assessment using the contingent valuation method (CVM).

Patients and Methods

This was an applied, cross-sectional and analytical-descriptive study carried out in Iran, Shiraz in 2013. A sample of 185 patients was determined using random sampling. Multiple choice questions and follow-up open-ended questions were employed to elicit patients’ WTP. The question asked patients would have to pay for this improving their own pocket. linear regression were used to Econometrically estimate the maximum WTP using STATA 11 software.

Results

The results of this study indicated that 31% were male and 69% were female and the adjusted mean WTP was PPPUS$15 for pat maximum amount of willing to pay was for to get the same quality service in own city respondents (PPPUS$16) and minimum amount of willing to pay was to get advice of experienced nurse(PPPUS$10) Patients were willing to pay more if their satisfaction with two attributes of care were increased. The cancer type and income taking care of you are significant factors influencing a patient’s WTP.

Conclusions

In the worst socio-economic conditions of the people were willing to pay to improve the reducing wait times in receiving a drug and get the same quality service in own city respondents. In Future efforts Health policymakers should consider the ability to pay when making their decision.

Developing and validating a total quality management model for healthcare organisations

Purpose

– The purpose of this paper is to develop a total quality management (TQM) model for healthcare organisations and validate it using a sample of Iranian healthcare organisations.

Design/methodology/approach

– A validated questionnaire was used to collect data from all healthcare organisations that implemented TQM in Isfahan province, Iran.

Findings

– Using the proposed model, TQM implementation was measured in healthcare organisations. The level of TQM success in Isfahan healthcare organisations was medium. The highest score was achieved in the dimension of “customer management”, followed by “leadership” and “employee management”. Employee management, information management, customer management, process management and leadership had the most positive effect on TQM success. Using a series of quality management techniques had “synergistic” effect on TQM success.

Practical implications

– Top management support, effective management of human resources, full involvement of the entire workforce including physicians, education and training, team working, continuous improvement, a corporate quality culture, customer focus and using a combination of management techniques under a quality management system are necessary for TQM successful implementation.

Originality/value

– A healthcare context-specific model of TQM was developed and tested and suggestions were provided for its successful implementation.

Attitudes toward quality improvement among healthcare professionals

Purpose

– The purpose of this article is to describe how the training of healthcare professionals in improvement work can be performed, and evaluate potential changes in attitude as a result of the initiative.

Design/methodology/approach

– The study was carried out at a University Hospital in Sweden. There were 443 participants in the study. The response rate before the intervention was 55 per cent (242 respondents) and six months later, it was 43 per cent (190 respondents). A two-day training program about quality improvement was performed on seven different occasions and after the training had been concluded, participants were encouraged to translate their newly acquired knowledge into improvement projects. Surveys on attitudes toward improvement work were completed by the participants right before the training and six months afterwards. The results were analyzed using a Mann-Whitney test.

Findings

– The analysis showed some statistically significant changes in attitude among the participants. There were also differences between groups of participants based on their profession and the number of years in their current position.

Research limitations/implications

– A limitation of the study is that it was solely based on attitudes expressed during the survey and did not include any observed changes in behavior. Another limitation is that attitudes after the intervention were only measured once.

Originality/value

– It is possible to use training to change attitudes toward improvement work. The result differs among groups of participants, which raises the question as to whether training should be tailored to better suit the needs of different groups to create positive change. Further research is needed regarding how to reach and fully implement a quality improvement mindset.

Verification of a quality management theory: using a delphi study

BACKGROUND

A model of quality management called Strategic Collaborative Quality Management (SCQM) model was developed based on the quality management literature review, the findings of a survey on quality management assessment in healthcare organisations, semi-structured interviews with healthcare stakeholders, and a Delphi study on healthcare quality management experts. The purpose of this study was to verify the SCQM model.

METHODS

The proposed model was further developed using feedback from thirty quality management experts using a Delphi method. Further, a guidebook for its implementation was prepared including a road map and performance measurement.

RESULTS

The research led to the development of a context-specific model of quality management for healthcare organisations and a series of guidelines for its implementation.

CONCLUSION

A proper model of quality management should be developed and implemented properly in healthcare organisations to achieve business excellence.

Obstacles to TQM success in health care systems

PURPOSE

Many healthcare organisations have found it difficult to implement total quality management (TQM) successfully. The aim of this paper is to explore the barriers to TQM successful implementation in the healthcare sector.

DESIGN/METHODOLOGY/APPROACH

This paper reports a literature review exploring the major reasons for the failure of TQM programmes in healthcare organisations.

FINDINGS

TQM implementation and its impact depend heavily on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in healthcare organisations can be attributed to the strongly departmentalised, bureaucratic and hierarchical structure, professional autonomy, tensions between managers and professionals and the difficulties involved in evaluating healthcare processes and outcomes. Other obstacles to TQM success include lack of consistent managers' and employees' commitment to and involvement in TQM implementation, poor leadership and management, lack of a quality-oriented culture, insufficient training, and inadequate resources. The review was limited to empirical articles written in the English language during the past 30 years (1980-2010).

PRACTICAL IMPLICATIONS

The findings of this article provide policy makers and managers with a practical understanding of the factors that are likely to obstruct TQM implementation in the healthcare sector.

ORIGINALITY/VALUE

Understanding the factors that obstruct TQM implementation would enable managers to develop more effective strategies for implementing TQM successfully in healthcare organisations.