Supporting healthcare staff in their QA duties

Supporting healthcare staff in their QA duties

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 28, Issue 3.

One IJHCQA maxim is that patient complaints are gems to be treasured; fortunately, health and social care service users are not afraid to say when they are unhappy with a service encounter. However, we still can not be sure that all patients no longer fear reprisals and recriminations if they complain about their investigations, treatment and care. Neither can we be sure that health and social care staff are not singled out and punished if patients complain – when the preferred approach is to learn from errors and develop services to stop the mistake happening again. Dental complaints analysis is a relatively new and uncommon IJHCQA topic, but one that is welcome. Nora Hiivala and colleagues in this issues report a remarkably detailed dental patient safety incident and complaints study. Readers, may be staggered at the topics about which dental patients complain; e.g., professionals apparently drunk during consultations and that practitioners do not learn from complaints investigations because they repeat the mistake again. Constructively, the authors are confident that dental complaints are a useful patient safety thermometer, which is a healthy approach to complaints analysis.

The context in which private and public healthcare service staff compete for patient loyalty is complex; e.g., private healthcare service waiting times are shorter than state services (which attracts patients) but private healthcare staff can not provide the comprehensive service that national health services provide, which appears that are cherry picking patients. It would be helpful, therefore to understand what drives patients towards a service provider and what keeps them loyal. Antonio Moreira and Pedro Silva examine these issue using sophisticated statistical techniques to: test their data collection instrument’s psychometric properties before; highlighting the main factors driving customer loyalty. There techniques allowed them to distinguish between loyalty and commitment, service quality and patient satisfaction. Distinguishing the finer points between them will interest IJHCQA readers.

Post-basic quality assurance certificate and diploma courses, even though short duration, can be expensive per capita, especially if they are taught off site. So, it makes sense to intensively educate and educate and train selected hospital staff who cascade the programme to their colleagues. Most quality improvement course curricula are evidenced-based and have been polished over time, so it is not sensible to deviate from the programme’s structure and content. If trainers are deviating from the curriculum back at base then to what extent and why? Marcia Ward and colleagues answer these and related questions by investigating a popular American patient safety education and training programme. Curricular deviations during hospital-based education programmes were widespread in their study, especially in smaller organisations with fewer resources. The authors generate useful insights and underline their recommendations, which hospital managers should not ignore when localising a national curriculum.

The way IJHCQA authors synthesis individual QA components into models that describe linear and branching relationships between healthcare quality elements is impressive. In this issue, Bahari Mohamed and Noor Azlinna Azizan, using powerful statistical techniques, explore how patient perceptions and satisfaction address patient compliance with treatment and care. The authors generate new insights and find other ways for healthcare managers and practitioners to measure and correct service shortcomings with patient-centred services.

The jury’s still out about whether we should call patients customers; not least because it forces us to say if we are dealing with internal (workmates) or external (patients) customers. Nevertheless, patient-customer is in our lexicon. Colin Clarke and Lesley-Jane Eales-Reynolds move the debate along significantly in this issue by marrying customer care to patient safety in a human factor theoretical framework (sometimes linked to patient safety in the literature). The authors are convinced that customer care and patient safety are tethered; suggesting to managers that NHS workforce planning and development has to address a new conceptual framework if patient safety is not compromised.

Jane Solomon and colleagues contribute an interesting and valuable article in this issue. First, they show that self-assessment with peer review follow-up in CAMHS services is a robust data collection method. Second, the authors underline service elements that improve, remain unchanged or deteriorate over time. Third, they examine if the extent to which staff control the audit cycle adds impetus to service improvement processes. All three elements sit in a CAMHS accreditation project sustained over five years during which participating unit staff formed a network – an ideal way to share intelligence and add value to service improvement projects.

Patient recovery evaluation instruments (commonly called early warning scores or EWS) should be efficient and effective mechanisms for spotting deteriorating patients. But what if the EWS does not perform as expected and worse, they add to clinician workloads. Peter Neary and colleagues evaluate Ireland’s national early warning score system/programme (NEWS) in one hospital, six months after its introduction, using a straight-forward but effective questionnaire sent to surgeons and surgical nurses. Results are gloomy; i.e., clinicians aren’t convinced that the NEWS benefits outweigh its downsides and suggest that clinical judgement and additional resources such as rapid response teams (part of an escalation protocol) may be more effective. The authors make a strong case to evaluate NEWS before rolling out the system in Ireland.

Readers who have been involved in internal or external accreditation processes know what time and effort are required if their service is to obtain a “kite mark”. Wise senior managers will appoint a quality systems managers to oversee and coordinate the accreditation process. Many will also buy a consultant’s expertise to check that service structures, processes and outcomes are in order before the external assessors arrive. To help managers and practitioners prepare for internal and external assessment, Dimitris Theodorou and Padelis Giannelos create a simple but effective checklist for medical laboratory staff undertaking the management review element to ensure that all quality management system aspects are addressed. Now the authors have a checklist framework in place, readers may be able to capitalise by adopting the principles for their laboratory and other services.

Professor Robin Gourlay

It is my sad duty to inform our authors, reviewers and readers that Robin died in January 2015. Robin was the International Journal of Health Care Quality Assurance’s founding editor. The Journal is approaching its 30th year in print and we owe a debt to Robin’s vision and fortitude when establishing a new journal in the 1980s in a field that was novel to healthcare. I was fortunate enough to work with Robin in academia before supporting him as IJHCQA co-editor in the 1990s. Authors and reviewers will remember him as a charming person – a gentleman to the core. He was a mentor and friend and we will miss his wise council and steadying hand. Our deepest condolences go to Robin’s wife, Janet, and his family.

Keith Hurst