Measuring and reporting service efficiency and effectiveness

Citation

Hurst, K. (2014), "Measuring and reporting service efficiency and effectiveness", International Journal of Health Care Quality Assurance, Vol. 27 No. 6. https://doi.org/10.1108/IJHCQA-02-2014-0015

Measuring and reporting service efficiency and effectiveness

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 27, Issue 6.

The British population (paid through general and specific taxes) has enjoyed free healthcare at the point of access since 1948. Other countries adopted similar policies much later. For example, in this issue, Farung Mee-Udon evaluates Thailand's universal health coverage scheme implemented in the 1990s. Using an unusual research method, the author compared urban and rural scheme-users’ insurance scheme perceptions. The results are surprising; although positive outweigh negative perceptions, user views are markedly candid. Clearly, the Thai population has high healthcare expectations and there is dissatisfaction with the nation's health insurance scheme; including people who refuse to participate, which, no doubt, gives politicians food for thought.

Sickle cell disease (SCD) is an unpleasant and debilitating condition, so anything that can be done to improve sufferers’ quality of life (QoL) should be a priority. Emmanuel Nwenyi and colleagues explore a relatively new treatment's (hydroxyurea) benefits. They took the opportunity to robustly test hydroxyurea's effect on New York child SCD sufferers’ QoL. They had two natural groups: one willing to take hydroxyurea and another, unpersuaded group, who weren’t convinced about the drug's value. Detailed and important (mainly QoL) data were collected in both groups and differences were compared. Outcomes were remarkable, hydroxyurea users’ QoL improved but findings show that other variables influence QoL, which specialist healthcare professionals might also explore for their patients.

Lean management is felt to be a panacea to inefficient and ineffective public and private services. Implementing the Lean service improvement method has resource implications, however, so decisions to apply Lean rather than another method shouldn’t be taken lightly. Bryan McIntosh and colleagues question Lean's value in healthcare because they found that hard evidence showing its contribution is thin. They tested their suspicions by systematically reviewing the Lean literature for clues about its healthcare nature and value. The authors’ doubts about Lean were partly confirmed although they found that some Lean components have merit, which healthcare managers and practitioners should consider.

Quality assurance researchers sometimes face overwhelming datasets, which can be hard to condense; e.g. one quality assurance dataset I maintain and interrogate most days is currently 1479 columns wide, 1480 rows deep and cells are occupied with strings and numbers. Fortunately, over the years, researchers and analysts, aided by powerful software like Excel and SPSS, kept on top by developing sophisticated data modelling techniques. Gangaraju Vanteddu and colleagues in this issue apply their generic analytical approach to healthcare services. Readers preferring to visually represent their data should take a look at this article for tips.

Taking a jewels-to-be-treasured-approach to complaints handling, never really caught hold in UK healthcare. If it did then we wouldn’t need a whistle-blowers charter for patients and staff, so that complainants are protected. There have been instances when staff and patients who complained have experienced repercussions. The NHS England staff perceptions surveys (involving several thousand employees) double underline these fears, notably how staff perceive how clinical incidents are reported and remedied. Moreover, senior clinicians being sent on gardening leave while the complaints they made are investigated don’t inspire potential complainants. Claudette Satchell and colleagues reflect on healthcare complaints handling, focusing on both healthcare policy and practice. Their literature review is troubling and underlines how far we’ve come, but how far we’ve to travel before robust healthcare complaint structures, processes and outcomes exist.

The service quality that public healthcare service staff provide is constantly scrutinised, which means service providers are accountable to their patients and commissioners. Private and lesser-known healthcare staff, on the other hand, rely on self-assessment or independent R&D projects to evaluate and improve their services. Pankaj Deshwal and colleagues in this issue explore such services – college campus health clinics. Using SERVQUAL as a starting point, the authors develop service quality dimensions that were unique to campus clinics before asking staff and students to judge service they received. SERVQUAL's usual tangibles feature; however, new insights emerge, which campus service staff can use to improve the service users’ lot.

Clinical records are an information goldmine, but systematically trawling data from patient notes to generate new insights into healthcare quality is fraught with ethical and practical problems. Therefore, we take off our hats to José Labarère and colleagues who relate clinical records to patient satisfaction; e.g. the connection between discharge process evidence in the records and patient satisfaction. Their findings are illuminating and remarkably useful for managers responsible for clinical record policy and practice. We’re all surprised that only modest associations exist between clinical records’ main elements and patient satisfaction. Is that because none exist or is it because clinicians don’t record the right information – a study in the making?

Ali Mohammad Mosadeghrad contributes regularly to IJHCQA on TQM topics. The authors’ cumulative experience and ongoing empirical work reveals that we’re in a strong position to say what ingredients are needed to successfully implement TQM in healthcare. The author's list, drawn mainly form healthcare workers’ experiences and perceptions, is daunting, but no one said TQM is easy.

Keith Hurst