Improving service efficiency and effectiveness: the resource implications

Citation

Hurst, K. (2014), "Improving service efficiency and effectiveness: the resource implications", International Journal of Health Care Quality Assurance, Vol. 27 No. 1. https://doi.org/10.1108/IJHCQA.06227aaa.001

Improving service efficiency and effectiveness: the resource implications

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 27, Issue 1

Patient satisfaction is among the most common healthcare outcomes we measure and a powerful policy and practice change mechanism. Consequently, patient satisfaction questionnaires are being refined. For example, major efforts are made to convert existing patient satisfaction instruments for use in countries other than the one where the questionnaire was developed and used. In this issue, Roghayaeh Khabiri and colleagues go an extra mile to ensure that an established patient satisfaction questionnaire is valid, reliable and usable among Tehran’s Persian speaking inpatients. The literature review, patient and expert staff interviews, and statistical testing, using powerful techniques, ensure the final instrument was appropriate. The psychometric issues that emerged may surprise our readers, which underline that off-the-shelf questionnaires need testing and possibly developing in alien environments. The down side, on the other hand, is that patient satisfaction data met-analyses become more challenging if the questionnaire varies in different contexts.

A second, condition-specific (rheumatoid arthritis) patient-satisfaction article, by Andrew Borg and colleagues in this issue, also employs a bespoke patient satisfaction measures. The authors focus their study on rheumatoid condition patients (a remarkably thinly researched topic) – especially how patients cope in general outpatient departments (OPD). The patient interviews reveal some not-so-obvious OPD service strengths and weaknesses, and findings provide significant ammunition for clinicians and managers wanting to improve their services, which the authors point out, don’t always need extra resources. In short, patients with certain conditions, requiring long-term follow-up care, require OPD staff to tailor healthcare services so that the outpatient’s experiences are improved.

One recent UK quality improvement (QI) project cost approximately £2,000 per hospital ward. The project team were fortunate to have strong financial backing. In developing countries, on the other hand, weighty financing may not be available. So, how do QI project teams, with minimum resources, plan and implement QI initiatives? And if project money is tight then do R&D outcomes suffer? Joshua Berman and colleagues in this issue show how successful projects can emerge from developing countries. The QI initiative’s effect on service efficiency and effectiveness is impressive not least because staff carefully designed projects that were sustainable maintained momentum. Clearly, careful QI project planning pays dividends.

Six Sigma (SS), borrowed by healthcare analysts from industry, is a powerful statistical QI technique. Mehmet Tolga Taner illustrates SS’s statistical role admirably in this issue by applying SS to cataract surgery. Using the full SS toolbox, Dr Taner takes the cataract service apart and rebuilds it minus the defects (identified using root-cause analysis), which caused the cataract service to fall down. It’s impressive how SS techniques can diagnose and correct healthcare structures, processes and improve service outputs and outcomes. The article also underlines how skilful change management techniques were needed to ensure that service staff joined-in and maintained the cataract service QI project’s momentum.

The UK NHS quality innovation productivity and prevention (QUIPP) programme encourages (using financial rewards) clinicians and managers to review and improve health services. William Nash and Ed Britton provide a first-class example (the hip fracture (FNoF) best practice tariff) in this issue. The FNoF QI initiative was designed to speed-up the orthopaedic surgical pathway using multi-disciplinary teams. The authors’ audit clearly shows that FNoF patient treatment and care improved (impressively so) not least because orthopaedic staff went the extra mile); but the knock-on effects on other orthopaedic services were worrying. What other unexpected service implications arise when new government initiatives are implemented?

Given the total people taking prescribed and off-the-shelf medications, poly-pharmacy combined with reduced patient-healthcare professional contact causes us to worry what drug-drug and drug-food /drink interactions might be taking place. Brenda Bertrand and colleagues in this issue examine a risky situation; one with potentially lethal consequences. They focus on nurses’ drug-food interaction knowledge and their findings show that patients looked after by nurses with low or inaccurate knowledge about drug-food interactions may be at risk. To be fair, drug and food policy and practice issues are overwhelming, and adding pharmacology/nutrition teaching and learning into the nursing curriculum has to be balanced with the fundamental nursing care elements in the syllabus – an area that nurses are increasingly criticised for failing the patients.

Accurate diagnosis and appropriate treatment usually depends on precise laboratory testing. The burden on laboratory staff for ensuring the right test is done on the right sample for the right patient, therefore (i.e. laboratory quality control) is significant. Laboratory staff relies heavily on laboratory equipment, which has to maintained and calibrated. Readers will be surprised when they read Alexander Katayev and James Fleming’s article about the problems and pitfalls laboratory staff face on calibration aspects alone. Consequently, the authors propose a technical quality assurance procedure that uses mostly existing resources, which can be rolled out for laboratory tests worldwide.

Keith Hurst
Editor