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1	The Influence of Staffing Change on Quality of Care in Emergency Room¢wAn Example of Three Hospitals Chou, Chien-Ho 09 January 2004 (has links) In light of the competitions of different medical services and the National Health Insurance¡¦s patient-oriented goal, the quality of medical care in the emergency room has been a top priory for improvement in many major medical centers. The purpose of this research is to evaluate the differences of medical quality after adjustment of physician manpower in three emergency departments of three separate hospitals. We will attempt to suggest ways to improve medical quality and make good use of medical resources. This is a retrospective survey using data from three emergency departments of three separate hospitals. The date ranged from March to April of 2002 and March to April of 2003. A total of 66,025 cases were gathered, minus 311 cases with incomplete data, the total valid data were 65,714 cases. The three hospitals A, B, C have 24,010 cases, 17,690 cases, and 24,014 cases, respectively. The result of this study showed that hospital A had increased the number of medical staff when comparing 2003 to 2002 data, however, the quality of care did not improve. Hospital B had increased the number of physicians on duty, decreased the waiting time for the patients, and the number of patients taken care per doctor had been increased too. However, within the 72-hour clinic follow-up patient numbers have increased. Hospital C have decreased the number of physicians on duty, but the waiting time have also decreased. The number of patients being taken care of by physicians, and 72-hour clinic follow-up are all increased. When compare the month between March and April of 2002, the highest ratio of 72-hour clinic follow-up is hospital A, followed by hospital B and C, in descending order. When compare the two study period of March and April of 2002 and 2003, waiting time and the ratio of waiting time in emergency department more than 6 hours is hospital A more than hospital C more than hospital B; the ratio of waiting time less than 2 hours is hospital C more than hospital B more than hospital A. The ratio of waiting time more than 2 hour but less than or equal to 4 hours and waiting time more than 4 hours but less than or equal to 6 hours is hospital A more than hospital B more than hospital C. This study suggests that the hospitals must establish a complete quality indicators, and must conduct periodic evaluation. At the same time, we must incorporate these indicators into our hospital information system and monitoring the effectiveness, in order to promote the quality of care. Physician manpower Quality of medical care Emergency Department
2	A Study on Medical Service Quality and Operating Performance for Kaohsiung Municipal Hospitals Shih, Wei-min 19 July 2010 (has links) The establishment of medical institutions in Kaohsiung municipal is mainly to cooperate with the Kaohsiung City government in promoting health policy, equally allocating medical resources, enhancing the health of the citizens, looking after mid- or low-income citizens, and taking charge of the medical care services of special patients. However, many institutions encounter various internal constraints and environmental challenges, such as bureaucratic personnel management, inflexible accounting system, faulty implementation of national healthy insurance and competition between hospitals, the Taiwanese medical system has become ¡§high competition, low profitability¡¨. More institutions follow the trend to modify their medical care operation. Outsourcing is one of the methods to strength their medical services. The medical industry currently is highly competitive. By increasing awareness of health concern, patients are more cautious in searching for appropriate and reliable medical care. Therefore, the hospital management regards patient satisfaction, confidence, and loyalty as the core values to improve its medical care services. In this research paper, we discuss the relationship between the quality of medical care services in Kaoshiung municipal hospitals and their operating performance. We also compare the operating differences between public hospitals and outsourcing hospitals to provide authoritative reference. In our research, we selected samples of patients from the Kaoshiung Municipal Minsheng Hospital, United Hospital (Kaohsiung Museum of Fine Art Branch), Hsiaokang Hospital, and Cijin Hospital. We sent out 310 surveys and collected 287 responses by Apr 15 2010. Data analysis and hypothesis testing was based on SPSS for Windows12.0. Based on this research, we concluded that: 1.There is a significant correlation between quality of medical care services and hospital operating performance. Also, process of medical care services was highly correlated with operating performance. In addition, hospital operating performance could be effectively evaluated by quality of medical care services. 2.With regards to the evaluation of medical care services and operating performance for the four municipal hospitals, United Hospital received the highest scores, followed by Minsheng Hospital, Hsiaokang Hospital, and Cijin Hospital. However, the performance of these hospitals is average, indicating that their medical care services need improvement. 3.Finally, outsourcing hospitals have a competitive advantage, which could help the improvement of medical care services. Due to the different operating systems for each hospital, the regulatory authority should be cautious in supervising the performance of the hospital. confidence quality of medical care services loyalty operating performance patient satisfaction
3	Factors Related to the Timing of Intestinal Stoma Closure and Outcomes after the Surgery Wu, Chin-Yu 05 February 2011 (has links) Patients of stoma caused by the colorectal disease or trauma are increasing and most of the patients are keen to have their stoma closed as early as possible to lower the burdens in their life. However, stoma often associated with complications such as wound. The interval between constructing and closing of stoma is still controversial. This study will figure out a way to predict an appropriate timing of stoma closure to get better outcome by using NHI database, from January 1, 2007 to December 31, 2008, in Taiwan. In 463 stoma closure patients, mean age: 65.94 years, ratio of male to female: 1.66, 70.19% Colostomy, 29.81% Ileostomy, mean timing: 156.73 days, mean length of stay: 10.81 days, mean fees: 57,698.06 TWD, only one death in hospital, 35 readmission within 30 days after discharged; with £\ = 0.05 level, the timing is significant in comorbidity, primary diagnosis; the outcomes are associated with the timing of stoma closure, comorbidity, patients¡¦ age and gender, hospital ownership and physician annual volume. Through this study, a perfect timing of stoma closure should be determined by the characteristics of patient and physician. Physicians could predict the timing through the stratified analysis and well organize the resource of hospital to improve the quality of medical care. Stratified Analysis Quality of Medical Care NHI database Stoma Closure Timing of Stoma Closure
4	Kokybės vadybos sistemos diegimas privačios sveikatos priežiūros įstaigos darbuotojų požiūriu / Implementation of the system of quality management with the attitude towards the workers of private medical institution Kalantienė, Aušra 03 January 2007 (has links) Kokybė apima kiekvieną ir visas veikas, atliekamas sveikatos priežiūros įstaigoje. Šio darbo tikslas yra iš įvertinti sveikatos priežiūros kokybės sistemų diegimo aspektus privačioje gydymo įstaigoje medicinos darbuotojų požiūriu. Sveikatos priežiūros kokybę užtikrinančių sistemų diegimas – pagrindinė įstaigos sritis, siekiant pelningos veiklos. Baigiamajame darbe, analizuojami Lietuvos Respublikos teisės aktai, įvairi mokslinė literatūra bei anketinės apklausos metodu vertinama UAB „Kardiolita“ medicinos darbuotojų požiūrį apie šios įstaigos kokybės vadybos sistemų diegimą. Išnagrinėta, jog privačios sveikatos priežiūros įstaigos akcininkai bei vadovai suinteresuoti diegti sėkmingas kokybės vadybos sistemas, tačiau dėl nepakankamo dėmesio atskiriems etapams – informacijos darbuotojams stokos, kontrolės organizavimo, nepakankamo darbuotojų mokymo bei supažinimo su kokybės vadybos sistemos nauda bei neanalizuojant kokybės kaštų – aptinkami trūkumai, kurie trukdo gerinti kokybę minimaliomis išteklių sąnaudomis. Efektyvus sveikatos priežiūros kokybės vadybos sistemos valdymas pasiekiamas, kai dalyvauja visų lygių darbuotojai ir analizuojami kokybės kaštai, o visam procesui vadovauja atatinkamą išsilavinimą turinti sveikatos vadybininkas. / The title of the final work – is implementation of the system of quality management with the attitude towards the workers of private medical institution. Key words: quality, quality of medical care, systems of quality management, quality management, the rate of medical workers, education of workers, quality cost outlay. Summary. Quality covers all and each action performed at a medical institution. The aim of this work is to evaluate the aspects of the quality of implementation of the system in medical care with the attitude towards the workers of medical institution. The implementation of the systems which quarantee the quality of medical care – is the main sphere of the institution in order to reach profitable activy. The acts of Lithuanian Republic law are being analysed in the final work as well as a varied scientific literature. The system of the implementation of quality management at the stock company „Cardiolita“ was evaluated by a survey with the attitude of its workers. It was analysed that the shareholders and managers are interested in the successful implementation of the quality management system. Marketing and Administration Kokybė Sveikatos priežiūros kokybė Kokybės vadybos sistemos Quality Quality of medical care Systems of quality management
5	Kvalita služeb lůžkové rehabilitace z pohledu uživatelů, srovnání dvou pracovišť / Client oriented assessment of servis quality of two inpatient physiotherapy units, a comparative study Tomková, Alice January 2012 (has links) The main object of this diploma thesis is to compare two inpatient physiotherapy units from the patients point of view. The first part of this thesis is focused on theory connected with current economic position of individual medical facilities in the system of Czech healthcare, their image and credit. The next part defines quality of service in medicine and methods of assessment of quality, both objective and subjective. Objective methods cover the system of Medical Standards, Accreditation and Specialized Medical Assessment Systems. Subjective methods comprise both qualitative and quantitative assessment. In the practical part of this thesis the quantitative assessment questionnaires from two physiotherapy units are analyzed to identify fields for future improvement at each medical facility. Both physiotherapy units are described and structure of questionnaire is defined. The results indicate reserves in the field of communication between patient and medical professionals, quality of patients wards and degree of privacy. Sociological probe as a part of thesis reveals some key factors for patients from different social groups to be satisfied with their stay at the physiotherapy unit. KEY WORDS Quantitative Assessment, Assessment Questionnaire, Quality of Medical Care, Quality Assessment, Patient...
6	Clients' Service Expectations and Practitioners' Treatment Recommendations in Veterinary Oncology Stoewen, Debbie Lynn 18 May 2012 (has links) Service provision in veterinary oncology in Ontario was examined using a mixed methods approach. First, an interview-based qualitative study explored the service expectations of oncology clients at a tertiary referral centre. Next, a survey-based quantitative study established an understanding of oncology service in primary care practice and investigated the treatment recommendations of practitioners for dogs diagnosed with cancer. The first study, which involved 30 individual and dyadic interviews, identified “uncertainty” (attributable to the unpredictable nature of cancer and its treatment) as an overarching psychological feature of clients’ experience. Consequently, “the communication of information” (both content and process) was the foremost service expectation. For clients, it enabled confidence in the service, the ability to make informed patient care decisions, and preparedness for the potential outcomes of those decisions; it also contributed to creating a humanistic environment, which enhanced client resiliency. Findings suggest that services can support client efforts to manage uncertainty through strategic design and delivery of service, and incorporate intentional communication strategies to support clients’ psychological fortitude in managing the cancer journey. The second study, a vignette-based survey of primary care practitioners across Ontario (N=1071) which investigated veterinarian decision-making in relation to oncology care, determined that 56% of practitioners recommended referral as their first choice of intervention, while 28% recommended palliative care, 13% in-clinic treatment, and 3% euthanasia. Recommendations were associated with patient, client and veterinarian factors. Specifically, referral and treatment were recommended for younger dogs, healthier dogs, and dogs with lymphoma versus osteosarcoma; for strongly bonded clients, and financially secure clients; and by veterinarians who graduated from a North American college, had experience with treating cancer, felt confident in the referral centre, and believed treatment was worthwhile, with variation in relation to practitioner gender and the type of medicine practiced. The human-animal bond appeared to be the primary factor associated with practitioners’ advocacy for quality of medical care for patients. Through a blend of qualitative and quantitative methodologies, this thesis contributes to the evidence upon which best practices may be built so as to enhance the quality of patient and client care in veterinary oncology. / Ontario Veterinary College Pet Trust Fund 049406 and 049854 client expectations treatment recommendations veterinary oncology practitioner service expectations qualitative research quantitative research thematic analysis vignette-based vignette-based inquiry full factorial experiment vignette-based research specialty oncology service primary care practice veterinary client logistic regression analysis uncertainty client uncertainty interview cancer cancer care canine cancer lymphoma osteosarcoma veterinary communication communication communication skills information content and process veterinary cancer care Ontario survey questionnaire referral euthanasia in-clinic treatment palliative care quality of care quality of medical care illness uncertainty service provision oncology epidemiology tertiary referral centre social epidemilogy veterinary epidemiology client well-being human-animal bond practitioner attitude best practice information preferences preparatory information cancer journey communication process continuity of care clinical decision making decision making practice variation adaptation

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