Health service staffing and service quality

Citation

Hurst, K. (2009), "Health service staffing and service quality", International Journal of Health Care Quality Assurance, Vol. 22 No. 6. https://doi.org/10.1108/ijhcqa.2009.06222faa.001

Health service staffing and service quality

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 22, Issue 6

Articles in this issue have a staffing structure, process and outcome connection. For example, audit data quality checks are important not least because audit is a commonplace activity and complacency can set in. Clinically, sound patient outcomes rely on audit-based healthcare policy and practice decisions. Jacqueline Martin and her colleagues, therefore, describe a study that explored ICU audit data accuracy and completeness. Several surprising methodological and clinical findings emerged from their large-scale study. Sample size and sampling technique, for example, became crucial issues when they realised sampling was too ambitious. On one hand, random sampling was important for claiming their data represented Australia’s and New Zealand’s ANZIC database. On the other, over-stretching data collectors by ambitious data size targets needed careful thought. A 31 per cent audit data error rate, either missing or inaccurate, emerged from the study. Implications are clear; how valuable are benchmarks arising from these data? Consequently, their recommendations that regular data quality auditing is essential must be tempered by streamlining data collection.

We published a managed care special issue in IJHCQA, Vol. 21 No. 3. Understandably, therefore, authors were prompted to submit new managed care material. Consequently, Ranjita Misra and colleagues wrote an important and unusual article on managed care organisation (MCO) ethnic minority issues from a provider and user perspective. We learned in the special issue that MCOs are generally challenging. But if we dig deeper then are there service user and provider subsets that are finding an even greater struggle? The US population is ethnically diverse and healthcare provision needs to reflect that if service quality and job satisfaction aren’t to suffer. Ranjita et al., therefore, take a closer look at American Asian physicians and their MCO roles. If Asians are the US’s largest physician group and they are under-represented in MCOs then why? If Asian physicians rely on MCO patients for financial survival then is it discrimination? From the literature we see that surprisingly little is known about these issues, but following their analysis, the authors show the picture is more complicated than we imagine. For example, Asian physicians are more likely to look after lower socio-economic groups residing in deprived areas; people less likely to have health insurance. The article also teaches us about MCO research methods. For example, the authors 24 per cent response rate is addressed.

Patient satisfaction studies also remain a popular IJHCQA author and download topic, and also featured as a special issue in IJHCQA, Vol. 21 No. 1. Patient choice and loyalty, a patient satisfaction subset, is rapidly climbing the agenda and we are receiving articles that are generating useful insights. Bodil and Gerry Larson present an intriguing analysis on factors that persuade and dissuade patients from returning to the same Swedish provider. A surprisingly large patient number (10 per cent) aren’t inclined to return. Ten per cent, on the other hand, may not seem much; but large retail stores or car manufacturers would be horrified losing one in 10 customers. The authors make an excellent case for analysing patient loyalty in a patient satisfaction context. We also benefit from their clearly explained statistical techniques especially the way they attempt to control confounding variables. A range of factors emerge that seem to influence patient loyalty – some are surprising. Unsurprisingly, important research questions emerge; for example, what happens to patient choice for those living in isolated areas with limited provision? Clearly, patient satisfaction and loyalty are fruitful quality assurance research areas and we look forward to learning more.

I am always surprised about the relatively minor role the internet plays in QA policy and practice. The web, in its 20th year, transformed publishing, banking and online shopping, for example, but using the web to inform users, providers and monitoring service quality don’t seem to feature enough in day-today QA activity. The Larsson study shows how software can improve QA efficiency and effectiveness, while Gauthier Desuter and colleagues look at the web’s unsatisfactory side. They remind us they that around 5 per cent internet searches are health related, so they systematically analysed Belgian hospital web sites for QA policy and practice evidence as if patients were looking at the sites. They conclude that hospital web sites do not do justice to hospital service quality strengths; their overall conclusion that sites are “naive” is carefully chosen. They suggest that manager-driven hospital web site design may not be the best approach to informing prospective and actual employees and patients. Clearly, their findings can be used to improve hospital web sites.

Staff wages are the largest health service costs item. Nurses, as the largest staff group, are the most costly. It is unsurprising; therefore, that nursing workforce planning and development studies are commonplace. The link between staffing and quality is well established after a range of high-profile studies were published in several countries. Inpatient nursing workload is determined mainly be occupancy, throughout and patient dependency. In this issue Uri Gabbay and Michael Bukchin take a close look at steady and stable nurse staffing in a shifting workload context. Nurse staffing methods range from simple to complex and implementation costs follow suit. Consequently, the authors were determined to use existing hospital information before applying statistical process control to their large hospital datasets. Workload determined tolerable and acceptable staffing was worryingly low at times. A surprising finding was how much nursing workload was driven by staff availability. The implications for a workforce that is short of skilled staff and recruitment and retention implications are clear. The authors examine feasible solutions. In short, getting managers, employees and trades unions to tackle pressing problems collectively is imperative.

An article on nursing stress and sickness, written by Hiromasa Ida and his colleagues, links nicely with Gabbay and Buchkin’s article. Nurse stress levels are generally greater than the population’s, but nursing workplace stressors are complex and uncertain. The authors found a yearly average 75 days, sickness absence in some nursing groups, which is an expensive and important issue for nurse managers given nursing numbers and registered nurse shortage. If sickness-absence is work-stress related then anything we can do to understand and improve the situation is important, especially when nursing outcomes may suffer. The authors undertake a mixed methods approach to analysing important relationships between workplace stress, coping ability and nursing performance in one large Japanese hospital. They used several questionnaires:

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  health risk behaviour;

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  environment; and

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  sense of achievement

along with staff interviews and medical error rate analyses.

Many expected and some unexpected findings emerge from the study notably work perception differences at various career levels. The authors conclude that “sense of achievement” is a reliable sickness predictor and suggest several ways to assists nurses to cope with the main sickness drivers.

Keith HurstEditor