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

Thesis (Ph. D.)--Virginia Commonwealth University, 2005. / Prepared for: Dept. of Health Administration. Bibliography: leaves 202-251. Also available online.

By 2014 the NHS is expected to make �21 billion in efficiency savings and increase productivity by 6% per annum, while maintaining or improving the quality of care. Given that the cost of the 1.7 million strong workforce represents 60% of the NHS budget, changes are likely. This context of innovation and cost-effectiveness has resulted in an ever greater emphasis to fully engage and support community nursing.

published_or_final_version / Community Medicine / Master / Master of Public Health

Background: The Adult Social Care Outcomes Toolkit was developed to measure outcomes of social care in England. In this study, we translated the four level self-completion version (SCT-4) of the ASCOT for use in the Netherlands and performed a cross-cultural validation. Methods: The ASCOT SCT-4 was translated into Dutch following international guidelines, including two forward and back translations. The resulting version was pilot tested among frail older adults using think-aloud interviews. Furthermore, using a subsample of the Dutch ACT-study, we investigated test-retest reliability and construct validity and compared response distributions with data from a comparable English study. Results: The pilot tests showed that translated items were in general understood as intended, that most items were reliable, and that the response distributions of the Dutch translation and associations with other measures were comparable to the original English version. Based on the results of the pilot tests, some small modifications and a revision of the Dignity items were proposed for the final translation, which were approved by the ASCOT development team. The complete original English version and the final Dutch translation can be obtained after registration on the ASCOT website (http://www.pssru.ac.uk/ascot). Conclusions: This study provides preliminary evidence that the Dutch translation of the ASCOT is valid, reliable and comparable to the original English version. We recommend further research to confirm the validity of the modified Dutch ASCOT translation. (authors' abstract)

Pesquisa do tipo metodológico quando se procurou realizar a adaptação semântica e cultural do instrumento SERVQUAL, com o objetivo de avaliar a qualidade do serviço de enfermagem, a partir da percepção do paciente, com a aplicação do referido instrumento. Quanto aos aspectos éticos, a pesquisa atendeu a Lei Geral da Saúde do México com a aplicação dos termos de consentimento livre e esclarecido. Participaram 222 pacientes que ingressaram nos serviços de urgências do Hospital Geral de Celaya, Guanajuato, México, para serem internados nos setores de medicina interna, cirurgia e ginecologia. Para a coleta de dados, foram utilizados como instrumentos um formulário de registro de identificação e aplicação dos questionários de expectativas e percepções, na forma de entrevista, que compõem a escala SERVQUAL adaptada para enfermagem e validada para a população mexicana. Para a análise dos dados utilizou-se do programa estatístico SPSS, versão 15.0, com realização de estatística descritiva e inferencial. Na adaptação semântica e cultural da escala SERVQUAL para população mexicana, foi realizada a avaliação por quatro juízes peritos na área, que avaliaram a equivalência semântica e cultural do instrumento, tendo sido acatadas todas as sugestões. Após essa fase foi feito um teste piloto e aplicado o teste alpha de Cronbach com o resultado de =0,74, considerado satisfatório. Na amostra houve predomínio do sexo feminino (72,1 %), na faixa etária de 20 a 39 anos (68,5%) e média de 34,02±9,25 anos, com internação principalmente nos serviços de Ginecologia (51,8%) e Cirurgia (33,3%). Na análise das diferenças entre percepções e expectativas (P - E) para cada um dos itens, os resultados foram predominantemente negativos, o que significa que a qualidade percebida (Qp) do serviço de enfermagem pelo paciente foi negativa, ou seja, as percepções foram menores em relação às expectativas, em cada um dos itens, com exceção do item 9, com uma Qp=0,02. Não se encontrou diferença significativa quando se relacionou a qualidade percebida do serviço de enfermagem com idade, sexo e serviço de internação. Conclui-se, com base nos resultados obtidos, que a escala SERVQUAL é um instrumento útil para a avaliação da qualidade do serviço de enfermagem em população mexicana e que a qualidade do serviço de enfermagem percebida pelos pacientes é satisfatória. Entretanto, os resultados negativos indicam que os profissionais de enfermagem necessitam formular estratégias com vistas à melhoria do serviço de enfermagem e com isto assegurar a oferta de um serviço de qualidade. / Methodological study aimed to perform semantic and cultural adaptation of the SERVQUAL instrument in order to evaluate the quality of nursing services from the patient\'s perception. Regarding ethical aspects, the research complied with the Mexican General Health Law with the application of free and clarified consents. A total of 222 patients, who were included in the urgency services of the General Hospital of Celaya, Guanajuato, Mexico to be hospitalized in the internal medicine, surgery and gynecology. The data collection was carried out through a registration form of identification and application of the questionnaires of expectations and perceptions through interview. These questionnaires comprise the SERVQUAL scale adapted for nursing and validated for the Mexican population. The statistical program SPSS, version 15.0, was used for the data analysis with descriptive and inferential statistics. Evaluation of the semantic and cultural adaptation of the SERVQUAL scale for the Mexican population was performed by four judges, experts in the area. They evaluated the semantic and cultural equivalence of the instrument and all their suggestions were implemented. After this stage, a pilot test was performed and Cronbach\'s alpha test applied whose result was =0.74, which was considered satisfactory. The sample presented predominance of the female gender (72.1 %), age range from 20 to 39 years (68.5%) with mean of 34.02 ± 9.25 years, with hospitalization mainly in the gynecology services (51.8%) and surgery (33.3%). In the analysis of differences between perceptions and expectations (P-E) for each of the items, the results were predominantly negative, which means that the patient\'s perception of the nursing services quality (Qp) was negative, that is, the perceptions were lower than expectations in all items with exception of the item 9, with a Qp=0.02. There were no significant differences when the perceived nursing service quality was related with age, gender and hospitalization service. The conclusion, based on the results obtained, was that the SERVQUAL scale is a useful instrument to evaluate the nursing services quality in the Mexican population and that the patients\' perception of the nursing services quality is satisfactory. However, the negative results indicate that nursing professionals need to formulate strategies in order to improve the nursing services to assure the supply of quality services.

Pesquisa do tipo metodológico quando se procurou realizar a adaptação semântica e cultural do instrumento SERVQUAL, com o objetivo de avaliar a qualidade do serviço de enfermagem, a partir da percepção do paciente, com a aplicação do referido instrumento. Quanto aos aspectos éticos, a pesquisa atendeu a Lei Geral da Saúde do México com a aplicação dos termos de consentimento livre e esclarecido. Participaram 222 pacientes que ingressaram nos serviços de urgências do Hospital Geral de Celaya, Guanajuato, México, para serem internados nos setores de medicina interna, cirurgia e ginecologia. Para a coleta de dados, foram utilizados como instrumentos um formulário de registro de identificação e aplicação dos questionários de expectativas e percepções, na forma de entrevista, que compõem a escala SERVQUAL adaptada para enfermagem e validada para a população mexicana. Para a análise dos dados utilizou-se do programa estatístico SPSS, versão 15.0, com realização de estatística descritiva e inferencial. Na adaptação semântica e cultural da escala SERVQUAL para população mexicana, foi realizada a avaliação por quatro juízes peritos na área, que avaliaram a equivalência semântica e cultural do instrumento, tendo sido acatadas todas as sugestões. Após essa fase foi feito um teste piloto e aplicado o teste alpha de Cronbach com o resultado de =0,74, considerado satisfatório. Na amostra houve predomínio do sexo feminino (72,1 %), na faixa etária de 20 a 39 anos (68,5%) e média de 34,02±9,25 anos, com internação principalmente nos serviços de Ginecologia (51,8%) e Cirurgia (33,3%). Na análise das diferenças entre percepções e expectativas (P - E) para cada um dos itens, os resultados foram predominantemente negativos, o que significa que a qualidade percebida (Qp) do serviço de enfermagem pelo paciente foi negativa, ou seja, as percepções foram menores em relação às expectativas, em cada um dos itens, com exceção do item 9, com uma Qp=0,02. Não se encontrou diferença significativa quando se relacionou a qualidade percebida do serviço de enfermagem com idade, sexo e serviço de internação. Conclui-se, com base nos resultados obtidos, que a escala SERVQUAL é um instrumento útil para a avaliação da qualidade do serviço de enfermagem em população mexicana e que a qualidade do serviço de enfermagem percebida pelos pacientes é satisfatória. Entretanto, os resultados negativos indicam que os profissionais de enfermagem necessitam formular estratégias com vistas à melhoria do serviço de enfermagem e com isto assegurar a oferta de um serviço de qualidade. / Methodological study aimed to perform semantic and cultural adaptation of the SERVQUAL instrument in order to evaluate the quality of nursing services from the patient\'s perception. Regarding ethical aspects, the research complied with the Mexican General Health Law with the application of free and clarified consents. A total of 222 patients, who were included in the urgency services of the General Hospital of Celaya, Guanajuato, Mexico to be hospitalized in the internal medicine, surgery and gynecology. The data collection was carried out through a registration form of identification and application of the questionnaires of expectations and perceptions through interview. These questionnaires comprise the SERVQUAL scale adapted for nursing and validated for the Mexican population. The statistical program SPSS, version 15.0, was used for the data analysis with descriptive and inferential statistics. Evaluation of the semantic and cultural adaptation of the SERVQUAL scale for the Mexican population was performed by four judges, experts in the area. They evaluated the semantic and cultural equivalence of the instrument and all their suggestions were implemented. After this stage, a pilot test was performed and Cronbach\'s alpha test applied whose result was =0.74, which was considered satisfactory. The sample presented predominance of the female gender (72.1 %), age range from 20 to 39 years (68.5%) with mean of 34.02 ± 9.25 years, with hospitalization mainly in the gynecology services (51.8%) and surgery (33.3%). In the analysis of differences between perceptions and expectations (P-E) for each of the items, the results were predominantly negative, which means that the patient\'s perception of the nursing services quality (Qp) was negative, that is, the perceptions were lower than expectations in all items with exception of the item 9, with a Qp=0.02. There were no significant differences when the perceived nursing service quality was related with age, gender and hospitalization service. The conclusion, based on the results obtained, was that the SERVQUAL scale is a useful instrument to evaluate the nursing services quality in the Mexican population and that the patients\' perception of the nursing services quality is satisfactory. However, the negative results indicate that nursing professionals need to formulate strategies in order to improve the nursing services to assure the supply of quality services.

Purpose Traditionally, researchers have relied on eliciting preferences through face-to-face interviews. Recently, there has been a shift towards using internet-based methods. Different methods of data collection may be a source of variation in the results. In this study, we compare the preferences for the Adult Social Care Outcomes Toolkit (ASCOT) service user measure elicited using best-worst scaling (BWS) via a face-to-face interview and an online survey. Methods Data were collected from a representative sample of the general population in England. The respondents (face-toface: n = 500; online: n = 1001) completed a survey, which included the BWS experiment involving the ASCOT measure. Each respondent received eight best-worst scenarios and made four choices (best, second best, worst, second worst) in each scenario. Multinomial logit regressions were undertaken to analyse the data taking into account differences in the characteristics of the two samples and the repeated nature of the data. Results We initially found a number of small significant differences in preferences between the two methods across all ASCOT domains. These differences were substantially reduced-from 15 to 5 out of 30 coefficients being different at the 5% Level-and remained small in value after controlling for differences in observable and unobservable characteristics of the two samples. Conclusions This comparison demonstrates that face-to-face and internet surveys may lead to fairly similar preferences for social care-related quality of life when differences in sample characteristics are controlled for. With or without a constant sampling frame, studies should carefully design the BWS exercise and provide similar levels of clarification to participants in each survey to minimise the amount of error variance in the choice process.

<p>The social service care system for the elderly has undergone a number of changes during the last decades. These reforms, especially the purchaser-provider split, have changed the role of the state in this sector somewhat, from being a monolithic provider of tax-financed elderly care to primarily being a purchaser who might choose to purchase elderly care services from private providers. However, the state has still retained a public elderly care service. Needless to say, the reform paved the way for a number of private enterprises in the area, causing competition between public and private providers. Adherents of the reform have argued that private providers can improve efficiency, while opponents have claimed that the chase for profit might affect the quality of the care in a negative way.</p><p>This study focused on the basis for this controversy by examining the relationship between factors such as profit, efficiency, care quality, incentives, motivation and productivity. The study was performed by interviewing thirteen employees and managers in four different care organizations (of which half were public and the other half private). Their answers were analyzed from three theoretical aspects; incentives and motivation, efficiency and productivity, and care quality.</p><p>The findings were that, since the revenue size is beyond their control, private providers can only create profits by reducing costs in a number of ways. Some of these ways, such as cutting down on education, team building activities and salaries, might be detrimental for the company in the long term (and thereby increase costs over time) and have adverse effects on quality. Others, however, such as increasing the efficiency of non-care activities (less administration and optimized scheduling, for example), avoid hiring overqualified staff and instead providing them with enough education for the task at hand, and optimizing work hours, might be more enduring over time and have none or small adverse effects on quality. More dispiritingly, it was also shown that the purchasers do not have any real knowledge about the quality of the work performed, regardless of the provider being private or public, and that in some municipalities users are denied to choose provider for themselves.</p>

The social service care system for the elderly has undergone a number of changes during the last decades. These reforms, especially the purchaser-provider split, have changed the role of the state in this sector somewhat, from being a monolithic provider of tax-financed elderly care to primarily being a purchaser who might choose to purchase elderly care services from private providers. However, the state has still retained a public elderly care service. Needless to say, the reform paved the way for a number of private enterprises in the area, causing competition between public and private providers. Adherents of the reform have argued that private providers can improve efficiency, while opponents have claimed that the chase for profit might affect the quality of the care in a negative way. This study focused on the basis for this controversy by examining the relationship between factors such as profit, efficiency, care quality, incentives, motivation and productivity. The study was performed by interviewing thirteen employees and managers in four different care organizations (of which half were public and the other half private). Their answers were analyzed from three theoretical aspects; incentives and motivation, efficiency and productivity, and care quality. The findings were that, since the revenue size is beyond their control, private providers can only create profits by reducing costs in a number of ways. Some of these ways, such as cutting down on education, team building activities and salaries, might be detrimental for the company in the long term (and thereby increase costs over time) and have adverse effects on quality. Others, however, such as increasing the efficiency of non-care activities (less administration and optimized scheduling, for example), avoid hiring overqualified staff and instead providing them with enough education for the task at hand, and optimizing work hours, might be more enduring over time and have none or small adverse effects on quality. More dispiritingly, it was also shown that the purchasers do not have any real knowledge about the quality of the work performed, regardless of the provider being private or public, and that in some municipalities users are denied to choose provider for themselves.