The components of a quality assurance program for smaller hospitals in British Columbia have been defined. These components have been defined by a comparison of the normative standards as determined in the literature and by a survey of administrators. Sixteen administrators of predominantly acute-care, accredited, 20-50-bed hospitals in B.C. were surveyed. Twelve of these administrators were surveyed twice. A new requirement for accreditation was introduced by the Canadian Council on Hospital Accreditation (C.C.H.A.) called the Quality Assurance Standard (1985). This Standard required that quality assurance (QA) programs be established in every department or service in the hospital. The Standard does not give a clear description of the QA functions for each individual department in a smaller hospital. An important and relevant list of specific functions for a QA program were identified at various C.C.H.A. seminars held across Canada in late 1983 and early 1984. The literature review indicated that there were a number of controversial issues affecting the implementation of the QA Standard. In spite of many methodological problems associated with quality measurement and assurance, most hospitals will adopt a quality assurance model. The first survey asked the administrators to define the purpose, goals and objectives of a QA program. They were also asked to determine the QA functions for four areas: hospital board, dietary, nursing and pharmacy. Administrators were asked to identify who in the hospital is primarily responsible for the overall QA program and for the QA program in four areas; the problems and benefits encountered when trying to implement a QA program; and their opinion of the new QA requirements for accreditation. The second survey asked the administrators to assign a priority to those functions identified in Round I. The empirical findings were then compared with the normative standards. With some exceptions, the empirical data were consistent with the normative standards. The empirical findings shows that there are problems related to implementing a QA program but at the same time there are a number of benefits related to the program. The priority ratings of the functions indicated areas of high or low importance to the administrator. It is likely that these priority ratings are useful for planning when alternatives must be considered during this time of fiscal restraint. Government policies along with the strong voluntary support of accreditation programs make it vitally important that suitable models for implementing QA are developed. The Doll model is suggested as a basis for implementing QA. Further areas for research are presented. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Typescript. / Thesis (D.P.H.)--University of Hawaii at Manoa, 1984. / Bibliography: leaves [171]-177. / Photocopy. / xi, 177 leaves bound ill. 29 cm

The evolution of e-health has the potential to assist in the management of scarce resources and the shortage of skills, enhance efficiencies, improve quality and increase work productivity within the healthcare sector. As a result, an increase is seen in e-health solutions developments with the aim to improve healthcare services, hospital information systems, health decision support, telemedicine and other technical systems that have the potential to reduce cost, improve quality, and enhance the accessibility and delivery of healthcare. However, unfortunately their implementation contiues to fail. Although there are several reasons for this, in this study a lack of project quality management is viewed as a key contributor to the failure of e-health solutions implementation projects in rural hospitals. This results in neglected aspects of quality assurance (QA), which forms an integral part of project quality management. The purpose of this study is to develop a Genertic Quality Assurance Model (GQAM) for the successful acquisition (i.e. development and implementation) of e-health solutions in rural hospitals in the Eastern Cape Province to enable improved quality of care and service delivery. In order to develop and test this model it was necessary to identify the QA methodologies that are currently used in rural hospitals and to evaluate their strengths and weaknesses, as well as their impact on project success. The study is divided into four phases; in each phase different study designs were followed. The study used triangulation of qualitative and some elements of quantitative research approaches, in terms of which a case study approach was adpoted to answer the research questions. This study did indeed develop a GQAM that can be used to ensure e-health solution success in rural hospitals. Furthermore, to aid in the implementation of this model, a set of QA value chain implementation guidelines were developed, as a framework, to inject the nodel into typical (SDLC) phases.

The quality of service from a hospital is the number one factor that will either turn a customer/patient away or make one for life. More and more hospitals are competing for greater shares in the market and customer-driven quality management is becoming the preferred method for improving their performance. Awali hospital is a private hospital in the Kingdom of Bahrain. It is a small 35-bed hospital that offers private medical services to the public. The hospital was originally built to serve the Bahrain Petroleum Company (Bapco) refinery workers but later opened its doors to the public. With the introduction of private patients came higher expectations of quality and higher demands on the overall services. A number of service quality shortfalls were identified over the years but never identified quantitatively by a patient evaluation survey. An English and Arabic version of the questionnaire based on SERVQUAL (Zeithaml, Parasuraman and Berry, 1988) was developed and placed in Awali hospital to test these service quality shortfalls. This study intends to evaluate these areas by answering questions about the relevant areas of service provided by the hospital. It measured patient satisfaction by looking at human aspects of service (responsiveness, reliability, empathy and assurance) with only one factor of the instrument being devoted to the non-human aspect of care rendered (tangibles). The SERVQUAL instrument has five dimensions that were measured by 21 pairs of item statements. One statement from each pair reflects perceptions, the other expectations. Measurement was accomplished by subtracting expectation from perceptions resulting in a service quality score. Positive or zero scores would reflect ideal or adequate service quality offered by the hospital. A negative score would be indicative of a service experience that did not meet customer expectations. Using the SERVQUAL questionnaire provided, quantifiable reasoning to the research questions in each dimension could be obtained so that precision, objectivity and rigour replaced hunches, experience and intuition as a means of investigating problem areas. Customers were first asked to supply some additional demographic information, for example gender, number of hospital visits, nationality, patient type (Bapco worker, general practitioner referred or private) and type of visit (inpatient, outpatient or both). They werethen asked to rate the hospital service on a 7-point Likert scale ranging from Strongly Agree (7) to Strongly Disagree (1). At the end of the questionnaire was space to write open comments. In total 600 paper questionnaires were distributed in the hospital, 300 English and 300 Arabic. Another 150 electronic questionnaires via emails were sent to refinery workers. Of the total 750 questionnaires distributed 162 were returned of which 156 (or 21.6%) could be statistically analysed. The empirical data results showed that the perception scores were significantly different at the p < 0.05 level from expectation scores. All the service quality differences (SQ=P-E) were negatively scored. This indicated that patients were not satisfied in all five dimensions of services offered by the hospital. Of the five dimensions responsiveness had the largest difference with assurance and reliability following with no significant differences between them. The demographic information revealed some interesting differences between the groups. Of all the demographic groups the most significant differences were between groups, “patient types” and “types of visit”, which showed differences between private patients and refinery workers and patients who used the hospital only as an outpatient and patients who used both services, outpatient and inpatient. In terms of the managerial implications, it was recommended that Awali hospital look to closing Gaps 1-4 of the SERVQUAL gap model which would result in closing the consumer gap, Gap 5. A process model for continuous measurement and improvement of service quality was recommended that looks at asking questions about how the hospital is performing. By adopting some of the recommendations identified in the research questions, Awali hospital could improve their quality of service, and as a consequence, their customer satisfaction and loyalty.

This case study was undertaken from mid 2003 to December 2005. It investigates the influence of the Corporate Services Centre (CSC) on customer (patient) service quality in the East London Hospital Complex (ELHC). This approach was justified on the basis that even though most patients do not have enough knowledge of clinical practices in order to make an accurate assessment on their quality, the same patients would readily appreciate factors such as faster turnaround times, drug availability and cleanliness. The study focuses on both service providers and end users for a quality health service delivery by looking at the potential of the shared corporate services centre. This was done by identifying important areas for improvements, such as response times, waiting periods and other aspects of the various services. The ELHC was formed from the merger of Frere and Cecilia Makiwane Hospitals, with a distance of 26km between the two institutions. The complex itself was in its infancy stages, having had to go through a process of re-engineering, rationalisation and standardisation of the two hospitals. The study seeks to answer the following key question: What has been the contribution of the corporate service centres in relation to health care service quality? The study examines the impediments to the realization of full potential of the Corporate Services Centre (CSC) through expedited decision-making and improved turnaround times. The main functions of the CSC were Procurement and Asset Management; General Administration (including but not limited to Transport, Office equipment, Patient Administration, Office Support, and Professional Secretariat Support); Financial Management and Administration; and Human Resource Management and Human Resources Administration. The study recommends that the CSC, to justify its existence, needs to consult with the clinicians and the patients to better understand what their needs and aspirations are. The study also emphasizes that the CSC is there purely to remove the administrative load and ease the processes and the biggest mistake is to make it an authority over the hospital, instead of being a support. Finally, it was realized that a lot of structural changes, business processes and organisational cultural changes are essential if one wants to create an impact through shared corporate services.

Introduction<p>Dans le monde, presque 10,6 millions d’enfants meurent chaque année avant d’avoir atteint leur cinquième anniversaire. En dépit de l’existence théorique d’interventions curatives efficaces, on constate que la mortalité intrahospitalière peut demeurer très élevée dans les services de pédiatrie de nombreux pays à faible revenu notamment en Afrique. Pour améliorer la prise en charge des enfants dans ces hôpitaux et par conséquent la survie des enfants, il est nécessaire avant tout de faire le constat de la situation et de la reconnaître, d’en analyser les causes, de s’attaquer aux déterminants vulnérables et de se doter d’outils d’évaluation de la qualité de soins dans les hôpitaux. En tant que pédiatre oeuvrant à l’HPG, j’ai constaté que la mortalité intrahospitalière était élevée. Fruit d’une démarche personnelle, ce travail avait pour objectif global la réduction de cette mortalité.<p>Pour y arriver, les objectifs spécifiques étaient les suivants :<p>1) Décrire et évaluer la qualité des soins intrahospitaliers chez les enfants à l’HPG.<p>2)Préciser la mortalité intrahospitalière globale ainsi que les mortalités spécifiques.<p>3)Etudier l’importance des facteurs associés à la surmortalité des enfants à l’Hôpital Provincial de Goma.<p>4)Construire un modèle de prédiction de la mortalité globale intrahospitalière ainsi qu’un score pronostique adapté au contexte.<p>5)Mettre en place un programme de formation et de supervision du personnel médical et paramédical.<p>6)Etudier l’impact de ce programme sur la mortalité intrahospitalière. <p><p>Méthodologie<p>Les analyses ont porté sur les données des études qui se sont déroulés dans le service de pédiatrie de l’hôpital provincial de Goma (HPG), il s’agit des études suivantes: une étude descriptive d’observation d’évaluation de la qualité des soins intrahospitaliers des enfants en décembre 2004 (étude qualitative utilisant la méthode de Nolan), une étude de cohorte prospective intrahospitalière portant sur les indicateurs prédictifs de la mortalité (du 1er avril 2003 au 31 mars 2004) (« avant ») ,suivi d’une intervention dont l’impact avait été évalué de nouveau par une étude de cohorte prospective intrahospitalière (du 1er janvier 2005 au 31 décembre 2005) (« après ») (étude d’intervention quasi-expérimentale). <p><p>Résultats<p>Les résultats du travail étaient les suivants :<p>A) -Les facteurs qui augmentent le risque de décès étaient la référence tardive et la sévérité de la maladie à l’admission. <p>-Les facteurs limitant la qualité de la prise en charge et qui contribuaient probablement au mauvais pronostic étaient :<p>1)A l’admission, le triage n’était pas toujours correctement fait, les soins d’urgences étaient retardés l’après-midi et la nuit et 12% des admissions étaient différés. Il n’y avait pas de grille d’évaluation initiale, ni des guides pratiques de l’OMS, ni les guides standardisés de prise en charge, ni de kit d’urgence.<p>2)En hospitalisation, il y avait une insuffisance en nombre du staff (surtout l’après-midi et la nuit), le monitoring de base et les soins infirmiers étaient insuffisants surtout la nuit, les cliniciens notaient les signes cliniques, mais ne les documentaient pas toujours, le délai pour avoir le diagnostic était trop long et l’indisponibilité des médicaments prescrits.<p>-Le staff du service avait des connaissances théoriques et pratiques insuffisantes et une motivation insuffisante<p>B)-Durant la première étude de cohorte, une mortalité globale de 15,9% et des mortalités spécifiques anormalement élevées ont été observés. Les enfants les plus à risque de décès avaient, à l’admission, les caractéristiques suivantes :un âge < 1 an, un périmètre brachial < 115 mm ou un retard de croissance pondérale (-3< Z-PPA ≤ -2 et Z-PPA ≤ -3), une altération de la conscience, une raideur de la nuque, un tirage intercostal et une infection.<p>C)-Ces premières données avaient permis de construire le modèle Goma1 basé essentiellement sur les indicateurs suivants :l’âge,le périmètre brachial, l’état de conscience et le type d’infection. Grâce au score pronostique, il était destiné à la sélection à l’admission des enfants à risque élevé de décès pour une admission en soins intensifs et à la standardisation de la mortalité en vue de l’évaluation de la qualité de prise en charge. <p>D)-Une intervention a été menée, en décembre 2004 portant essentiellement sur la formation et la supervision du personnel de santé œuvrant à l’HPG. Grâce à une évaluation avant-après, on a pu déterminer l’impact probable de cette intervention :la mortalité globale a diminué de 15,9% (avant l’intervention) à 4,6% (après l’intervention) et restait toujours plus basse après l’intervention et après ajustement à l’aide du modèle. <p><p>Conclusions<p>La mortalité pédiatrique intrahospitalière est généralement beaucoup trop élevée et c’était le cas à l’HPG.<p>Notre démarche après ce constat et l’évaluation de la qualité des soins donnés aux enfants sur base d’un questionnaire qualitatif a été d’intervenir sur un des points mis en exergue par cette évaluation (formation et supervision du personnel insuffisante) et d’évaluer l’impact de ce programme sur la mortalité globale.<p>Les résultats ont suggéré un impact positif de ce programme (mortalité globale de 15,9% avant l’intervention et de 4,6% après l’intervention).<p>Si de nombreuses critiques liées à la méthodologie (évaluation uniquement qualitative, étude quasi-expérimentale avant-après, intervention limitée, etc) doivent être épinglées et limitent la portée de ce travail, la démarche entreprise a cependant permis de mobiliser le personnel de santé œuvrant dans des conditions difficiles, autour d’un projet commun et améliorer ainsi la prise en charge des enfants hospitalisés à l’HPG. / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished