The NHS must increase productivity by 6% every year if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. We know staff costs make up 60% of the NHS budget, so it is likely that both the number and composition of the 1.7 million-strong workforces will need to change in order to meet these targets. We argue that while substituting registered nurses with healthcare assistants (HCAs) is desirable in terms of financial benefits, there is not enough research evidence to identify the impact of changes or maximisation in skill mix upon efficiency (represented by the number of NHS cases treated) and the quality of care experienced by service users.

ABSTRACT Aim: To assess the overall quality of child health services provided at primary health care facilities in the Johannesburg metropolitan area. Objectives: Primary Objective To evaluate the quality of clinical care provided by health care workers caring for children; including an assessment of the treatment of common childhood illnesses, counselling and health promotion. Secondary Objectives 1. To assess the quality of well baby services such as immunisation, growth promotion and developmental monitoring. 2. To assess the availability of drug supplies and equipment. 3. To assess the quality of record keeping. 4. To describe the infrastructure available at health facilities and the availability of services provided to children, including appropriate referral services. Design: This was a cross-sectional, observational study over a two-month period conducted at 16 primary health care facilities in the Johannesburg Metropolitan area; four community health centres (CHC) and 12 primary health care (PHC) clinics. A researcher-developed structured checklist, based on national guidelines and protocols was utilised. Results: A total of 141 sick child and 149 well child visits were observed. Caregivers experienced long waiting hours (mean [SD] of 135±72 minutes). Many routine examination procedures were poorly performed, with an appropriate diagnosis established in only 77% of consultations. Almost half of the children (46%) received antibiotics; their use was unwarranted in one-third of instances. Health promotion activities (such as growth monitoring) were consistently ignored during sick child visits. The mother or sick child’s HIV status was seldom considered or investigated. At least a third of children requiring cotrimoxazole prophylaxis were not prescribed the antibiotic. Growth promotion and nutritional counselling at well child visits was generally inadequate with not one of 11 children requiring food supplementation receiving it. The majority of facilities were adequately equipped and well-stocked with drugs. A lack of capacity to manage children with chronic conditions (such as asthma), mental health problems and disabilities exists. Conclusion: The poor quality of care offered to children in the richest city in Africa is a sad indictment of the inability of health service providers in the city to meaningfully address children’s health needs. Nothing short of a deliberate and radical overhaul in the way that health care is organised for children, with clearly defined and monitored standard clinical practice routines, is likely to significantly change the status quo.

The final thesis follows up the quality of health care. This topic has been nowadays much discussed and is very current. The aim of this work was to bring the issue of health care quality and analyze the quality of health care in the facility Dr. Pírko Clinic by using a questionnaire to research the satisfaction of it's patients.

Recent federal legislation has incentivized hospitals to focus on quality of patient care. A primary metric of care quality is patient readmissions. Many methods exist to statistically identify patients most likely to require hospital readmission. Correct identification of high-risk patients allows hospitals to intelligently utilize limited resources in mitigating hospital readmissions. However, these methods have seen little practical adoption in the clinical setting. This research attempts to identify the many open research questions that have impeded widespread adoption of predictive hospital readmission systems. Current systems often rely on structured data extracted from health records systems. This data can be expensive and time consuming to extract. Unstructured clinical notes are agnostic to the underlying records system and would decouple the predictive analytics system from the underlying records system. However, additional concerns in clinical natural language processing must be addressed before such a system can be implemented. Current systems often perform poorly using standard statistical measures. Misclassification cost of patient readmissions has yet to be addressed and there currently exists a gap between current readmission system evaluation metrics and those most appropriate in the clinical setting. Additionally, data availability for localized model creation has yet to be addressed by the research community. Large research hospitals may have sufficient data to build models, but many others do not. Simply combining data from many hospitals often results in a model which performs worse than using data from a single hospital. Current systems often produce a binary readmission classification. However, patients are often readmitted for differing reasons than index admission. There exists little research into predicting primary cause of readmission. Furthermore, co-occurring evidence discovery of clinical terms with primary diagnosis has seen only simplistic methods applied. This research addresses these concerns to increase adoption of predictive hospital readmission systems. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Aim of the study. To evaluate possibilities to implement the program of health care quality assurance in health care institutions from the physicians’ point of view. 58.4 percent of respondents are aware with the program of health care quality assurance. 71.2 percent of those who are aware with the program believe in health care quality improvement when the program will be implemented. 41.5 percent of respondents maintain that program will be implemented under condition of proper financing while 20.8 percent assert that program will not be implemented. 65.4 percent of physicians evaluate quality of care in their institution as good and 33.7 percent as satisfactory. According the opinion of the respondents’ quality of care could be improved with teamwork and good qualification of the physicians, a half of respondents maintain that the main obstacle for better examination of the patients is insufficient financing. Almost one third of physicians state that information about safety of health care is insufficient. 44.6 percent of respondents are not satisfied with their work, and 85.1 percent affirm that quality of care is influenced with satisfaction with work, 93.1 percent maintain that quality of care is influenced with workload, 43.6 percent relate their quality of work with payment. The major part of physicians assesses their knowledge about quality management as satisfactory and would like to improve in that area. 83.6 percent of physicians state that proper financing is... [to full text]

With one in two women delivering surgically, Iran has one of the highest rates of cesarean section (CS) worldwide. CS overuse in low-risk pregnancies potentially exposes women to Maternal Near-Miss (MNM) morbidity with minimal health benefits. This thesis studied obstetric care quality and MNM at hospitals with high rates of CS in Tehran, Iran. In Study I, we investigated whether audits of CS indications and feedback influenced CS rates at a general hospital. Subsequent to the audit, a 27% reduction in the risk of primary CS was found. In Study II, characteristics of MNM were investigated at university hospitals between 2012 and 2014. During a 26-month period, 82 MNM cases were identified using the WHO MNM approach. Severe postpartum hemorrhage (35%), severe preeclampsia (32%), and placenta previa including abnormally invasive placenta (10%) were the main three causes of MNM. Iran has a huge influx of migrants from Afghanistan. Women with antepartum CS and those who lacked health insurance, almost all Afghans, had increased risk of MNM. In Study III, audits examined whether MNM care quality differed between 54 Iranians and 22 Afghans and whether near-miss events were preventable. A majority of MNM cases (62%) arrived at hospital in a moribund state and obstetric care was more suboptimal for Afghans than Iranians (adjusted odds ratio 5.1, 95% confidence interval 1.2–22.6). Moreover, MNM was commonly (71%) potentially preventable and professionals with suboptimal practice were involved in 85% of preventable cases. In Study IV, a qualitative interview study was conducted to explore care experiences of Afghan MNM survivors. Discrimination, insufficient medical attention, and ineffective counseling were the main experiences. To a lesser extent, poverty and low education were perceived as contributing factors to delays in accessing care. This thesis emphasizes the importance of high-quality care for preventing undesirable maternal outcomes. The audit method along with interviews was useful to determine quality and equity gaps in care provision. Policymakers and professionals should consider these gaps when structuring programs to reduce adverse maternal outcomes.

Master of Science / Department of Family Studies and Human Services / Bronwyn Fees / An increased focus on school readiness in recent years has placed more attention on the importance of quality early care and education settings for children ages 3 to 5 years. The first five years of a child’s life represent a crucial period for development, and care settings impact children’s outcomes in a variety of domains. Preparation of teachers in order to provide a high-quality level of care that supports positive outcomes for children is critical. This report assesses the current state of the literature on effective professional development for early childhood professionals (primarily those working center-based settings with children ages 3 to 5 years), specifically as it relates to improved outcomes for children in the areas of social-emotional competence and language and literacy development. Methods for adult learning are also reviewed and recommendations for appropriate models of professional development based upon this review are provided. It is recommended that specific aspects within models of professional development be reviewed further to determine more concrete predictors in terms of what is effective for adult learning and application of concepts. It also is recommended that early care and education providers take part in professional development activities that have an added level of support and feedback, such as coaching, to assist in improving instructional practices to impact developmental outcomes in targeted areas, such as literacy.

Hospital readmission rates are considered to be an important indicator of quality of care because they may be a consequence of actions of commission or omission made during the initial hospitalization of the patient, or as a consequence of poorly managed transition of the patient back into the community. The negative impact on patient quality of life and huge burden on healthcare system have made reducing hospital readmissions a central goal of healthcare delivery and payment reform efforts. In this project, we will focus on COPD (Chronic Obstructive Pulmonary Disease) which is one of the leading causes of disability and mortality worldwide. This project will design and develop a prognostic COPD healthcare management system which is a sustainable clinical decision-support system to reduce the number of readmissions by identifying those patients who need preventive interventions to reduce the probability of being readmitted. Based on patient’s clinical records and discharge summary, our system would be able to determine the readmission risk profile of patients treated for COPD. Suitable interventions could then be initiated with the objective of providing quality and timely care that helps prevent avoidable readmission. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Child care researchers divide child care quality into two separate categories: structural child care quality (adult-child ratios, class size, amount of physical space, etc.) and dynamic child care quality (number and quality of teacher-child relationships). A consensus has emerged in the child care literature that structural child care quality has no direct effect on children's developmental outcomes (e.g., language development, social development, school readiness) . Rather, structural child care quality facilitates dynamic child care quality, which then has a direct effect on child outcomes. While child care researchers frequently assert that structural variables merely facilitate dynamic variables, and have no direct impact on child outcomes, this assertion has never been empirically tested. The presented study tested the relative impact of structural and dynamic child care quality on child outcomes using multiple regression analysis. A data set from the European Child Care and Education Study involving 1,246 subjects was used, and 20 structural quality variables, 10 dynamic quality variables, and four measures of child outcomes were used in the multiple regression equations. In each case it was found that structural quality variables continued to be correlated with child outcomes after the variance associated with dynamic quality variables was removed, indicating that structural child care quality has an influence on child outcomes beyond merely facilitating dynamic quality . The prevailing view that structural child care quality merely facilitates dynamic child care quality, and has no direct influence on child outcomes, was not supported by the present study.

The purpose of this study was to understand what the care recipients considering as care quality in their long-term eldercare. Our intention has been to contribute a bit to the development of the care work. Previous studies show that user surveys are carried out regularly but there is very few studies that are based on care recipients own opinions and experiences. The main questions in the study have been to examine what is considered as good elder care from a user perspective. Even to understand the characteristics of a good meeting with the care staff and also examine how the elder care in Nybro municipality can improve. This study was based on a qualitative method in the form of seven interviews with recipient of elder care. The interviews were based on five themes which were; background, care, interaction, "special housing and social interaction" and also changes. The collected material is analyzed from a symbolic interactionism perspective. We view the symbolic interactionism as a useful perspective to gain an understanding of the interaction between care recipients and staff, and how it can develop care work The result revealed that the elder care in Nybro Municipality is generally of good quality and that it works well with home care. The care recipients appreciate when the care staffs are cheerful and friendly during visits, and they use the term "helpfulness" to describe what characterize a good treatment. What emerges as a negative aspect of the elder care is that the care staffs are extremely busy and always in a rush at each visit, which may partly affect the care a bit negative. The study shows a desire for change to improve care staff working environment. All respondents have different perceptions of the elderly and what is considered quality of care. Although there are common views on certain things, it is because of their differing views at who they interact with and in what context, the overall situation.