Bakgrunn: I arbeid som sykepleier erfarte jeg at utøvere i helsetjenesten hadde ulik holdning til læring og fagutvikling. Min nysgjerrighet ble vekket om det er en sammenheng mellom utøvernes interesse for læring og en tilstand av empowerment.  Hensikt: Søken etter kunnskap om hvilke faktorer utøvere i pleie- og omsorgstjenesten opplever stimulerer til å lære, for å øke forståelsen av hva som kan styrke dem til å ”empower” seg selv.  Metode og Materiale: Fenomenografi ble brukt som tilnærmingsmetode og fokusgruppeintervju som datainnsamlingsmetode. 17 personer ansatt i pleie- og omsorgstjenesten i to kommuner deltok i studien. Informantene var fordelt på fem kvalitetsgrupper som hadde lært å forbedre arbeidsoppgaver i regi av Fylkesmannens kvalitetsrådgiver. Resultater: Dataene er presentert i en kjernekategori og tre hovedkategorier. Kjernekategorien viser til en struktur av bestemte tiltak som organisasjonen hadde iverksatt for at utøverne skulle lære forbedringsarbeid. Tiltakene kan oppsummeres ved følgende faktorer: Organisasjonen har fokus på forbedringsarbeid, økonomiske midler er bevilget til å lære forbedringsarbeid, tid og rom er avsatt til læring, en ekstern kvalitetsrådgiver gir opplæring i forbedringsarbeid, og ledelsen håndterer endring. Hovedkategoriene antyder at utøvere opplever seg selv som medansvarlige, at gruppa fungerer som et forum for læring og at flytskjema som forbedringshjelpemiddel er praktisk og konkret.   Konklusjon Hovedfunnet indikerer at en struktur iverksatt av organisasjonen legitimerer læringsarbeidet for utøvere i pleie- og omsorgstjenesten. Denne opplevelsen av legitimitet stimulerer utøvere til å lære forbedringsarbeid, og gjennom dette oppleve økt empowerment. / Background: Experiences in my work as a nurse made me interested in the correlation between the inclination of health care professionals to learn and their status as empowered people. Purpose: The aims of this study is to gain more knowledge about how health care professionals perceive the experience of being involved in conscious learning processes and to get a better understanding of factors that are critical in this empowerment process.   Method and material: Phenomenography was used as the research method. 17 health care professionals, who are working in the primary health care system in two different Norwegian municipalities, participated in focus group interviews. They were divided into five quality management groups. All informants had previously learned from an external supervisor how to improve the quality of their work by using flow charts. Results: The data were categorized into one core category and three main categories. Critical factors are: the organisation’s focus on quality improvement, sufficient human and economical resources for learning, time for reflection and learning, an external supervisor teaching and supporting the groups, and leadership supporting change. Other important factors are how the professionals accept the extra work involved in being learners, group dynamics, and efficient use of flow charts. Conclusion: The findings suggest that a structure which gives the health care professional a feeling of legitimacy for giving priority to learning, is more likely to enter the process of empowerment / <p>ISBN 978-91-85721-27-6</p>

Purpose ¿ This paper aims to examine the role of e-commerce in hospital pharmacy in the procurement of pharmaceuticals and determine how this has improved the internal pharmaceutical supply chain. Whilst e-commerce is in its infancy in this area it is still considered to be an important facet of supply chain management. E-trading within NHS pharmacies is conducted via electronic data interchange (EDI) offering proven benefits and ensuring the efficient and effective transmission of data between remote parties. Design/methodology/approach ¿ The data were collected via a case-study in an NHS trust pharmacy supported and by questionnaires distributed to NHS and community pharmacies in the north-west of England. Findings ¿ The findings support the view that there are benefits to be gained from introducing EDI into a purchasing department as the next logical step towards a total e-commerce solution (internet-based) and instigating quality improvements. It also proposes that the implementation and use of e-commerce in hospital pharmacies can be aligned with progress made in small- to medium-sized enterprises (SMEs), and questions why, if such benefits can be realised, the use of e-commerce systems are not more widespread. Research limitations/implications ¿ The implications of this research is that it offers a ¿snap-shot¿ of progress made-to-date of e-commerce in NHS Pharmacy, which can provide guidance for mangers and healthcare professionals managing their e-commerce/quality improvement agenda. The research conducted was restricted to a specific regional area of the NHS and could be applied to a larger national sample group. Future research within this field should also consider the cost of not introducing e-commerce in pursuing quality improvement. Originality/value ¿ This discussion offers an insight into how a pharmacy approached EDI, and this is further supported by recent research conducted into examining the pharmacy systems in operation in the north-west of England and accompanying EDI systems and an analysis of EDI uptake and use in a sample of pharmacies in the same region, the latter being supported by anecdotal evidence of pros and cons to using EDI and potential barriers to its introduction.

Baggrund: Antibiotikaresistente mikroorganismer er et globalt folkesundhedsproblem. Trods forebyggende indsatser ses en fortsat en markant stigningi resistensudviklingen,som er en alvorlig trussel for både nuværende og fremtidens patienter. Formål: Studiet skulle belyse hvordan læger og sygeplejersker fra de danske infektions-hygiejniske enheder oplevede og håndterede risikoen for udvikling af antibiotikaresistente mikroorganismer, og om der var behov for initiativer til at sikre bedre overensstemmelse mellem den officielle og de enkelte beslutningstageres forståelse og håndteringaf problemet. Metode: Kvalitativt design,hvor det empiriske materiale blevindsamlet ved semi-strukturerede interviewsaflæger og sygeplejersker fra infektionshygiejniske enheder. Data blev analyseret med kvalitativ indholdsanalyse. Den teoretiske ramme for studiet var ledelse, intersektorielt og tværsektorielt samarbejde, samt kvalitetsforbedring og evaluering. Resultat: Studietviser at den hidtidige indsats i Danmark ikke har været tilstrækkelig for at hindre smittespredning og udvikling af nye resistente mikroorganismer. Som årsag anføres, at man ikke i tilstrækkeligt omfang efterlever anbefalingerne til, hvad der bør indgå i et infektionskontrolprogram, såsom videreuddannelse, retningslinjer, information og undervisning, overvågning og en national antibiotikapolitik. Udmeldingen var, at der var tilstrækkeligt mange og overensstemmende nationale og internationale guidelines; der var ikke behov for flere, men derimod behov for en langt bedre implementering og information til alle involverede personalegrupper Konklusion: Der bør etableres et intersektorielt og tværsektorielt nationalt samarbejde, bl.a. med fokus på at minimere antibiotikaforbruget. Til dette kræves deltagelse af praktiserende læger, fagprofessionelle fra sundhedsvæsenet, landbruget, Fødevarestyrelsen og -ikke mindst -involvering af ledere samt relevante organisationer og ministerier / Background: Antimicrobial resistance is a serious threat to present and future patients. Despite several interventions, the increase in multidrug-resistant microorganisms is a global challenge in public health. Aim: This study describes and analyzesthe viewpoint of infection control specialists (physicians and infection control nurses) regarding the threat of antimicrobial resistance. It was also evaluated whether specialists perceive a need to improve the match between individual specialist and decision makers. Methods: Qualitative content theory was used to analyze empirical data based upon semi-structured interviews with infection control specialists. Management, inter-and cross-sector cooperation, and quality improvement and evaluationformed the theoretical framework for this thesis. Results: Interviewees reported thatDenmark’s efforts to prevent the spread of infection and the development of new resistant micro-organisms have been insufficient. The interviewees viewed current national and international guidelines as sufficient but the interviewees expressed that there is in adequate compliance withvarious elements of the infection control program, including vocational training, guidelines, information and education, monitoring, and a national antibiotic strategy. However, there is a need for more focus and emphasis on implementation and information to all involved personnel. Conclusion: Antimicrobial resistance requires greaterinter-and cross-sector cooperationin Denmark, regarding the overuse of antibiotics. This effort will require the participation of general practitioners, healthcare professionals, veterinarian specialists, as well as the involvement of leaders and relevant organizations and ministries / <p>ISBN 978-91-86739-91-1</p>

Effective implementation of quality improvement (QI) initiatives is associated with enhanced clinical outcomes, increased patient and provider satisfaction, and reduced length of hospital stay. However resources and effort invested in the QI initiatives do not always meet clinical or patient expectations. As a prerequisite for changing this situation the aims of this qualitative study were to examine: (a) the process underlying implementation of QI initiatives in the emergency department (ED); and, (b) the use of an implementation audit checklist to improve performance. This qualitative exploratory study was conducted over a four-week period. Purposive intensity sampling was employed to recruit six ED healthcare providers who were: (a) a male or female ED registered nurse or ED physician; and, (b) involved with designing, planning and implementing QI initiatives in the ED. Numerical and free text data were collected from six implementation audit checklists. Data were also collected from six face-to-face interviews. Findings are consistent with previous studies. Critical features of effective implementation are: prioritization of initiatives; diligence in planning; staff and leadership engagement; on-going evaluation; collaborative teamwork; and, resources. The implementation audit checklist consisting of step-by-step guidelines, definition of capacity and resource allocation is perceived as a promising intervention tool for use by multidisciplinary healthcare professionals. This checklist, a facilitator for transferring implementation theory into operational and clinical practice, has potential to improve emergency department performance.

Syfte: Studiens syfte var att undersöka vad patienterna har för upplevelser av sjukvården, samt vilka förbättringar de föreslår. Metod: Undersökningsgruppen bestod av 50 patienter som svarat på de öppna frågorna i en nationell patientenkät. Svaren analyserades med kvalitativ innehållsanalys. Resultat: Analysen av materialet resulterade i fem kategorier och elva underkategorier. De fem kategorierna bestod av: bemötande, sjukhusmaten, vårdmiljön under sjukhusvistelsen, in- och utskrivning samt väntetider under vårdtiden och samarbete mellan professioner. Patienter som vårdades inom slutenvården ansåg att det bemötande de erhöll i huvudsak varit gott, men att det förekom vissa negativa attityder som bör förändras till det bättre. Förbättringar av måltider och sjukhusmiljön önskades, dessa områden upplevdes otillfredsställande. Vidare föreslogs förbättringar rörande information och kommunikation. Dessa två faktorer spelade, enligt patienter, roll för hur trygga de kände sig inom vården. Väntetiderna upplevdes vara alltför långa och patienterna önskade att dessa ska bli kortare. Slutsats: Patienterna i denna studie hade både positiva och negativa upplevelser av slutenvården, samt föreslog förbättringar på ett antal områden. Detta resultat, samt framtida patientundersökningar, kan vara ett underlag för sjuksköterskors kvalitetsförbättringsarbete i den kliniska verksamheten då det identifierar områden i behov av förbättring. / Aim: The aim of this study was to examine patients’ experiences of health care, and which improvements they propose. Method: The study group consisted of 50 patients who answered the open-ended questions in a national patient satisfaction questionnaire. The patients’ answers were analyzed with qualitative content analysis. Results: The analysis resulted in five categories and eleven subcategories. The five categories were:  social interaction with staff, hospital food, hospital environment during the stay, admission, discharge and delays and collaboration with other professions. Patients who received hospital care generally considered themselves treated well by staff, but some experienced negative attitudes from staff which leaves room for improvement. Other areas considered dissatisfying were the hospital food and the hospital environment. Furthermore, suggestions were made concerning the improvement of information and communication. These factors, according to patients, affect whether they feels safe or not when receiving health care. Patients also expressed that waiting times and delays were too long, and ought to be shortened. Conclusion: Patients in this study had both positive and negative experiences of their hospital stay. They suggest improvements in several areas. These results, together with future patient satisfaction surveys, can develop a basis for nurses to improve the quality of care in clinical practice since they identify areas in need of improvement.

The role of the evaluation for Official Development Assistance (ODA) enterprises including educational development has become critical after increasing “aid fatigue” experienced by the international community in the 1990s. To date, however, monitoring and evaluating outcomes of the projects has been limited to the project life. Consequently these have been mainly through the international aid agencies. Furthermore, the monitoring and evaluation led by international aid agencies have paid little attention to aspects of the sustainability of technical cooperation in educational development. To sustain the impact of technical cooperation, the reinforcement of evaluation has drawn increasing attention in light of the emerging modalities in international development. Therefore this research was inspired to investigate alternative evaluation frameworks for an educational reform project for teacher quality improvement that may increase possibilities for long term sustainability. Importantly, the new modalities in international development and educational issues provide new options. In addition, the research reviewed theoretical and practical issues surrounding evaluation in general, and highlighted the evaluation of education reform projects. The research reported explored via case studies, the evaluation processes employed by the Egyptian education reform projects implemented by the Japan International Cooperation Agency (JICA) and the United Nations Children’s Fund (UNICEF). The case studies used three data sources (archival and relevant documents, a survey questionnaire and interviews) to illuminate the contextually-embedded evaluation processes. The research found that process evaluation is a potential alternative method since it is likely to be locally institutionalised, which may yield long-term sustainability of the projects.

The study explores the management of patient complaints at a private hospital in Taiwan (i.e. the Case Hospital). The case study aims to identify factors which influence the response of the hospital to patient complaints and whether it incorporates information derived from patient complaints in its quality improvement efforts. The study was conducted in two stages. The first stage was a cross-institutional comparison of quality management systems between a hospital in Britain and a hospital in Taiwan. The study explored how these hospitals managed patient complaints and whether they took such feedback into account in reviewing priority of services. The second stage included a detailed case study of the hospital in Taiwan (the Case Hospital), exploring the hospital???s responses to patient complaints, along with the factors which may have influenced these responses. The study was designed to triangulate data through the use of a multi-method approach to derive converging or diverging empirical evidence from a variety of data sources. Data were obtained through interviews with hospital senior managers, a senior social worker, government officials, and managers of non-government organisations. A questionnaire survey was administered to managers, and the Critical Incident Technique (CIT), along with observation, was applied, as well as analysis of documents. Principally, this study adopts the techniques of thematic analysis (Lincoln and Guba, 1985a) with an interpretivist approach to analyse the empirical data. The results of the study indicate that although the Case Hospital appeared to be concerned about patients??? complaints, it did not respond in a systematic way to the messages received. Hospital managers appeared to merely attempt to pacify complainants while ignoring the underlying causes of their complaints. It was evident that there were no protocols in place as to how staff should handle complaints, and as a result, the hospital was failing to use the information about systemic problems provided by patient complaints to make any sustainable quality improvement. In other words, whilst the Case Hospital was attempting to resolve patient complaints on a case-by-case basis (doing things right for the patient, or in the terms of Argyris (1990), using ???single-loop??? learning), it was not reviewing or acting on these complaints as a collective group to identify systemic problems and deficiencies (doing right things, i.e. ???double-loop??? learning). The study found that the organisational response to complaints was influenced by features of the complaints and institutional attributes. Features of complaints affected the response pathways to complaints, such as patients??? status, the severity of complaints, and the nature of complaints. In terms of systemic features, the organisational response to complaints was influenced by the interaction between managerial factors (e.g. organisational structure and organisational culture), operational factors (e.g. documentation and communication), and technical factors (e.g. complaints handling techniques and information systems). The values of the top hospital management have been recognised as a powerful influence on these factors. Generally, results show that although the Case Hospital tends to take action to address individual complainants, there was no evidence of sustainable quality improvement within the organisation as a result of complaints data. The study recommends that if the hospital intends to use patient complaints to improve quality of clinical care, a ???double-loop??? learning strategy should be adopted within the organisation. This study also argues that governments need to take more responsibility and demand more accountability from hospitals, in terms of complaints handling. The individual hospital would thus be able to respond to patient complaints in a systemic way. Hospitals need to be more accountable when using patient complaints to drive quality improvement in the future.

Type 2 diabetes mellitus (T2DM) is a chronic and debilitating disease contributing to the rise in healthcare associated costs in the United States (ADA, 2013a; USDHHS, 2013). T2DM management is complex and requires an ongoing multi-system approach (Goderis et al., 2010). In this quality improvement project, the DNP student led a team in a family care practice setting through a systematic quality improvement process, the PDSA cycle, for the improvement of performance rates of quality indicators including A1C testing, LDL testing, and performance of comprehensive foot examinations. The QI team developed a multi-component intervention to include utilization of an electronic type 2 diabetes mellitus (T2DM) decision support tool. The expected outcome was to increase current performance rates of A1C testing, LDL testing, and comprehensive foot examinations at a family care practice by at least 10% within four weeks of implementing the intervention. A1C testing improved from a pre-intervention median of 70.97% to a post-intervention median of 91.38%, an increase of 20.41%. LDL testing improved from a pre-intervention median of 74.19% to a post-intervention median of 91.38%, an increase of 17.19%. Comprehensive foot examinations improved from a pre-intervention median of 58.06% to a post-intervention median of 84.48%, an increase of 26.42%. While results demonstrate a trend of improvement, the duration of the intervention was insufficient for statistical significance. The QI project served as a first systematic change process for the family care practice and a model for future change processes at the clinic. This project highlights the DNP's role in utilizing evidence-based research and applying a systematic change model for quality improvement in the primacy care practice setting.

INTRODUCTION: Language barriers between providers and low English proficiency (LEP) families in pediatric hospital care can reduce the quality of care provided to LEP patients/families. Boston Medical Center serves a population with a large LEP patient base. Currently, there is no existing model of care that efficiently and effectively incorporates interpreters on all morning rounds to optimize communication for all patients, especially LEP patients/families. OBJECTIVE: To improve communication between providers and LEP families on morning rounds in the Pediatric Inpatient Unit of Boston Medical Center. The aim for the QI initiative was to increase the percentage of rounding episodes with LEP patients/families in which the care plan was discussed between providers and families through the use of an in-person interpreter during morning rounds by 50% by February 28, 2015. METHODS: A quality improvement initiative utilizing residents, medical students, the unit coordinator and the ward assistant to introduce, streamline and standardize a process to incorporate interpreters on all morning rounds as needed for LEP families. The Model for Improvement was used for testing this initiative. Four Plan-Do-Study-Act (PDSA) cycles of testing were conducted between October 21, 2014 and February 20, 2015. The primary outcome was the proportion of rounding episodes for LEP patients/families in which the care plan was discussed between the provider and patients/families through an in-person interpreter. This data was collected through a newly created "Interpreter Rounding Form" (IRF) that served as a checklist for the process. The secondary outcome looked at patient satisfaction for both LEP and English proficient (EP) patients. This data was collected through survey questions from the CAHPS and AHRQ patient surveys. Process measures included if interpreter was requested, if interpreter was used and if any change in care management due to having in-person interpreter present. Balancing measures included duration of rounds, interpreter arrival time, and resident satisfaction. Language being included in resident verbal signouts and written signouts between teams was also tracked. Run charts were analyzed for all outcomes and measures to determine the effectiveness of changes tested. RESULTS AND CONCLUSIONS: For the first three PDSAs, there was a significant amount of variation in data measurement, which required focused efforts on better operationalizing our measurement framework. Changes were made after each PDSA to streamline the process and enforce completion of IRF, with which data was collected. For the fourth PDSA, starting in January 2015, completion rates for the IRF slowly increased to a median of 40%. Primary outcome data for PDSA 1-4 showed a median of 52% based on the rounding episodes that were recorded on the IRF forms, which suggests that the aim for a 50% increase in using an in-person interpreter on all morning rounds was achieved by February 28, 2015. However, this data may not reflect all the requests and encounters in which an in-person interpreter was used due to the missing data from a low completion rate of forms before PDSA 4. Further analysis of PDSA 4 data showed that though an in-person interpreter was used at a median of 38% of all encounters with LEP patients/families, providers were communicating with patients/families in their preferred language at 100% of the time; if did not request interpreter, providers used a resident or medical student who spoke the family's language 43% of the time. Patient survey data suggested that out of all patients in the unit, 80% of patients/families reported having "Always" understood the doctors, with LEP patients/families at a slightly higher percent than EP patients (100% vs 88%). Patients reported "Good" or higher for the quality of the information that was provided by the doctors on morning rounds at a median of 84%, with LEP patients at 100% compared to 84% for English-speaking patients. Qualitative analysis of patient responses showed that LEP patients liked the explanations and information provided in the morning rounds while EP patients mostly liked the attitude and approach of the doctors. One major limitation to our process was the constantly rotating residents/medical students and the need to train new teams. The project is ongoing with a focus on further standardization until a goal of 90% completion rate for IRF and 80% for primary outcome can be reached. Future PDSAs will encourage using medical interpreters for all LEP patient encounters and family-centered rounding.

Made available in DSpace on 2018-06-18T13:27:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2017 / O ensino a distância tem-se proliferado mundialmente em grandes proporções, inclusive na área da saúde, e para melhor atender a todos os públicos, os órgãos responsáveis pela educação do país, vem trabalhando fortemente com a questão da qualidade do ensino. Preocupados com a formação e com as ofertas dos cursos a distância, muitos foram os alcances ao longo dos anos. Recentemente, foi publicada a Resolução nº 1, de 11 de março de 2016, que estabelece as Diretrizes e Normas Nacionais para a Oferta de Programas e Cursos de Educação Superior na Modalidade a Distância. A partir de então, as Instituições de Ensino que se propuserem a fornecer educação nesta modalidade poderão seguir estes indutores, bem como sendo base para as políticas e processos de avaliação e de regulação dos cursos e das Instituições de Educação Superior (IES). Contudo, levando em consideração a grande oferta dos cursos de pós-graduação na área da saúde, por meio da modalidade a distância, torna-se premente, a avaliação destes cursos. Objetivo: identificar e analisar os critérios de qualidade para Educação Permanente em Saúde, na modalidade a distância, no curso de Especialização em Saúde da Família, ofertado pela UNA-SUS/UNIFESP, por meio da percepção dos sujeitos de pesquisa, sendo eles os alunos, tutores e coordenadores deste curso, analisar o projeto pedagógico do curso e comparar os critérios ressaltados nas falas dos participantes, com os indutores de qualidade sugeridos pelo Ministério da Educação. Método: Pesquisa descritiva, exploratória e qualitativa, que seguiu os seguintes passos metodológicos: pesquisa bibliográfica e pesquisa empírica, a fim de que ambas pudessem fornecer dados importantes acerca dos critérios de qualidade adotados pelo curso de Especialização Saúde da Família da UNA-SUS, emergiram então dos participantes à percepção da qualidade ao ensino a distância na educação permanente em saúde. Resultados: Após análise dos dados, verificou-se algumas particularidades relacionadas à educação permanente em saúde, destacadas pelos participantes da pesquisa, que devem ser tratadas e trabalhadas de forma exclusiva e gradativamente, também foi possível observar uma proximidade entre os critérios de qualidade indutores já divulgados pelo Ministério da Educação, nas expressões dos participantes desta pesquisa. Considerações Finais: Com os resultados, foi possível definir possíveis critérios de qualidade para educação permanente em saúde, na modalidade a distância, ficando estes disponíveis como produto de entrega desta pesquisa, para nortear e auxiliar instituições de ensino que ofertam cursos na área da saúde nesta modalidade. / The distance education has been proliferated globally in large proportions, including in the health area, and to serve better all the public, the responsible agencies of education in the country has been working hard on the issue of quality education. Concerned about the formation and the offers of distance courses, many have been the advances over the years. Recently, Resolution nº 1 of March 11th, 2016, which establishes National Guidelines and Norms for the Offering of Programs and Higher Education Courses in Distance Mode, was published. Since then, the Education Institutions that proposed to provide education in this modality can follow these inductors, as well as being the base for the evaluation policies and processes and regulation of courses and Higher Education Institutions. However, taking into account the big offer of postgraduate courses in the health area, by the distance modality, it becomes urgent the evaluation of these courses. Objective: to identify and to analyze the quality criteria for Permanent Health Education, in the distance modality in the specialization course in Family's Health, offered by the UNA-SUS/UNIFESP, by the perception of the participants of the research, which were students, tutors and coordinators of this course; to analyze the pedagogical project of the course and to compare the emphasized topics in the speeches of the participantes with the inductors suggested by the Education Ministry. Method: Descriptive, exploratory and qualitative research, which followed these methodological steps: bibliographic research and empirical research, with the proposal that both could provide important data about the quality criteria adopted by the UNA-SUS' Family Health Specialization course. That is, the perception of the quality of the distance education in the permanent education in health emerged by the participants. Results: After analyzing the data, there were some particularities related to the permanent education in health, emphasized by the participants of the research, which must be treated and worked exclusively and gradually, it was also possible to observe a proximity between the quality criteria already divulged by the Education Ministry, in the speeches of the participants of this research. Considerações Finais: With the results, it was possible to define possible quality criteria for permanent health education in the distance modality, being available as a product of this research, to guide and help education institutions that offer courses in the health area in this modality.