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Endalamaw A, Khatri RB, Mengistu TS, Erku D, Wolka E, Zewdie A, Assefa Y. A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact. BMC Health Serv Res 2024; 24:487. [PMID: 38641786 PMCID: PMC11031995 DOI: 10.1186/s12913-024-10828-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/05/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND The growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts. METHODS This qualitative scoping review was conducted using Arksey and O'Malley's methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works. RESULTS A total of 87 articles, which covered 14 CQI models, were included in the review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI. CONCLUSIONS Implementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it's crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Resham B Khatri
- School of Public Health, The University of Queensland, Brisbane, Australia
- Health Social Science and Development Research Institute, Kathmandu, Nepal
| | - Tesfaye Setegn Mengistu
- School of Public Health, The University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Erku
- School of Public Health, The University of Queensland, Brisbane, Australia
- Centre for Applied Health Economics, School of Medicine, Grifth University, Brisbane, Australia
- Menzies Health Institute Queensland, Grifth University, Brisbane, Australia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Wu C, O'Keeffe C, Sanford J, Hagel J, Childs S, Evers G, Melbourne J, West C, Koch M, Cornia PB. Simple signature/countersignature shared-accountability quality improvement initiative to improve reliability of blood sample collection: an essential clinical task. BMJ Open Qual 2022; 11:bmjoq-2021-001765. [PMID: 36130832 PMCID: PMC9494581 DOI: 10.1136/bmjoq-2021-001765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/19/2022] [Indexed: 11/04/2022] Open
Abstract
Background Timely lab results are important to clinical decision-making and hospital flow. However, at our institution, unreliable blood sample collection for patients with central venous access jeopardised this outcome and created staff dissatisfaction. Methods A multidisciplinary team of nurses including a specialist clinical nurse leader (CNL), the hospital intravenous team and quality improvement (QI) consultants aimed to achieve >80% blood sample collection reliability among patients with central venous access by employing a simple signature/countersignature form coupled with audit-feedback and behavioural economics strategies. The form was piloted on one 25-bed unit. Data were collected for 60 weeks and interpreted per standard run chart rules. Results Blood sample collection reliability exceeded the 80% goal by week 22. The practice was sustained on the pilot unit and spread successfully to other wards despite significant operational threats including the COVID-19 pandemic. Conclusions At our institution, a simple signature/countersignature form supplemented by audit-feedback and behavioural economics strategies led to sustained practice change among staff. The pairing of CNL to QI consultant enhanced change potency and durability.
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Affiliation(s)
- Chenwei Wu
- Hospital and Specialty Medicine, VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Chatty O'Keeffe
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Jesse Sanford
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Jean Hagel
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Shelia Childs
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Gary Evers
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Julie Melbourne
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Collyn West
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Michael Koch
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Paul B Cornia
- Hospital and Specialty Medicine, VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Tsai ER, Tintu AN, Demirtas D, Boucherie RJ, de Jonge R, de Rijke YB. A critical review of laboratory performance indicators. Crit Rev Clin Lab Sci 2019; 56:458-471. [PMID: 31393193 DOI: 10.1080/10408363.2019.1641789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Healthcare budgets worldwide are under constant pressure to reduce costs while improving efficiency and quality. This phenomenon is also visible in clinical laboratories. Efficiency gains can be achieved by reducing the error rate and by improving the laboratory's layout and logistics. Performance indicators (PIs) play a crucial role in this process as they allow for performance assessment. This review aids in the process for selecting laboratory PIs-which is not trivial-by providing an overview of frequently used PIs in the literature that can also be used in clinical laboratories. We conducted a systematic review of the laboratory medicine literature on PIs. As the testing process in clinical laboratories can be viewed as a production process, we also reviewed the production processes literature on PIs. The reviewed literature relates to the design, optimization or performance assessment of such processes. The most frequently cited PIs relate to pre-analytical errors, timeliness, resource utilization, cost, and the amount of congestion. Their citation frequency in the literature is used as a proxy for their importance. PIs are discussed in terms of their definition, measurability and impact. The use of suitable PIs is crucial in production processes, including clinical laboratories. By also reviewing the production processes literature, additional relevant PIs for clinical laboratories were found. The PIs in the laboratory medicine literature mostly relate to laboratory errors, while the PIs in the production processes literature relate to the amount of congestion in the process.
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Affiliation(s)
- Eline R Tsai
- Department of Clinical Chemistry, Erasmus MC, University Medical Center , Rotterdam , the Netherlands.,Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente , Enschede , the Netherlands.,Department of Clinical Chemistry, Amsterdam UMC , Amsterdam , the Netherlands
| | - Andrei N Tintu
- Department of Clinical Chemistry, Erasmus MC, University Medical Center , Rotterdam , the Netherlands
| | - Derya Demirtas
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente , Enschede , the Netherlands
| | - Richard J Boucherie
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente , Enschede , the Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam UMC , Amsterdam , the Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center , Rotterdam , the Netherlands
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Kantartjis M, Melanson SEF, Petrides AK, Landman AB, Bates DW, Rosner BA, Goonan E, Bixho I, Tanasijevic MJ. Increased Patient Satisfaction and a Reduction in Pre-Analytical Errors Following Implementation of an Electronic Specimen Collection Module in Outpatient Phlebotomy. Lab Med 2017; 48:282-289. [DOI: 10.1093/labmed/lmx024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Indexed: 11/12/2022] Open
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Inal TC, Goruroglu Ozturk O, Kibar F, Cetiner S, Matyar S, Daglioglu G, Yaman A. Lean six sigma methodologies improve clinical laboratory efficiency and reduce turnaround times. J Clin Lab Anal 2017; 32. [PMID: 28205271 DOI: 10.1002/jcla.22180] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/21/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Organizing work flow is a major task of laboratory management. Recently, clinical laboratories have started to adopt methodologies such as Lean Six Sigma and some successful implementations have been reported. This study used Lean Six Sigma to simplify the laboratory work process and decrease the turnaround time by eliminating non-value-adding steps. METHODS The five-stage Six Sigma system known as define, measure, analyze, improve, and control (DMAIC) is used to identify and solve problems. The laboratory turnaround time for individual tests, total delay time in the sample reception area, and percentage of steps involving risks of medical errors and biological hazards in the overall process are measured. RESULTS The pre-analytical process in the reception area was improved by eliminating 3 h and 22.5 min of non-value-adding work. Turnaround time also improved for stat samples from 68 to 59 min after applying Lean. Steps prone to medical errors and posing potential biological hazards to receptionists were reduced from 30% to 3%. CONCLUSION Successful implementation of Lean Six Sigma significantly improved all of the selected performance metrics. This quality-improvement methodology has the potential to significantly improve clinical laboratories.
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Affiliation(s)
- Tamer C Inal
- Department of Medical Biochemistry, Medical Faculty, Çukurova University, Adana, Turkey
| | | | - Filiz Kibar
- Department of Medical Microbiology, Medical Faculty, Çukurova University, Adana, Turkey
| | - Salih Cetiner
- Hospital Central Laboratory, Medical Faculty, Çukurova University, Adana, Turkey
| | - Selcuk Matyar
- Medical Biochemistry Laboratory, Adana Numune Teaching Hospital, Adana, Turkey
| | - Gulcin Daglioglu
- Hospital Central Laboratory, Medical Faculty, Çukurova University, Adana, Turkey
| | - Akgun Yaman
- Department of Medical Microbiology, Medical Faculty, Çukurova University, Adana, Turkey
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Abstract
Procedural distress is a common occurrence in the NICU and is tied to attempts to support the life and development of vulnerable premature infants. We discuss the epidemiology of procedural distress and the potential negative consequences on infant neurodevelopment. We define procedural distress in the NICU and outline three approaches to limit or to reduce its detrimental effects including minimizing the number of procedures, instituting measures for developmentally supportive care, and using preemptively pharmacologic and nonpharmacologic analgesia. Despite the pervasiveness of procedural distress in the NICU, clinical and administrative measures are available to ameliorate possible harmful outcomes.
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Baskin L, Abdullah A, Guo M, Naugler C. Use of geospatial mapping to determine suitable locations for patient service centers for phlebotomy services. Am J Clin Pathol 2015; 144:727-30. [PMID: 26486736 DOI: 10.1309/ajcp4j1xkdvjiugs] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Approaches to determining optimal locations for patient service centers (phlebotomy clinics) have not been addressed in the published literature. Using the city of Calgary, Alberta, Canada, as a test case, our objective is to present a novel method for determining underserviced geographic areas within a city to guide the choice of potential new patient service center locations. METHODS Data on travel distances for 198,883 phlebotomy visits as well as population data from the 2011 Canada Census were used for this study. Using geospatial mapping techniques, we produced maps of the city showing actual relative travel distances for patients as well as the geographic distribution of population density of patients undergoing phlebotomies. RESULTS There was a striking pattern of increased travel distances in certain parts of the city. These also corresponded to geographic areas with greater density of patients seeking phlebotomies. CONCLUSIONS This analysis provided clear, objective evidence of communities that are currently relatively underserved by patient service centers. This approach could be used by other laboratories to plan the location of new patient service centers.
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