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Publisher: Emerald   (Total: 308 journals)

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A Life in the Day     Hybrid Journal   (Followers: 8)
Accounting Auditing & Accountability J.     Hybrid Journal   (Followers: 17)
Accounting Research J.     Hybrid Journal   (Followers: 22, SJR: 0.155, h-index: 2)
Accounting, Auditing and Accountability J.     Hybrid Journal   (Followers: 3)
Advances in Accounting Education     Hybrid Journal   (Followers: 10)
Advances in Appreciative Inquiry     Hybrid Journal   (Followers: 2)
Advances in Dual Diagnosis     Hybrid Journal   (Followers: 23)
Advances in Mental Health and Intellectual Disabilities     Hybrid Journal   (Followers: 38, SJR: 0.133, h-index: 2)
Advances in Mental Health and Learning Disabilities     Hybrid Journal   (Followers: 20)
African J. of Economic and Management Studies     Hybrid Journal   (Followers: 7)
Agricultural Finance Review     Hybrid Journal   (Followers: 1)
Aircraft Engineering and Aerospace Technology     Hybrid Journal   (Followers: 183, SJR: 0.285, h-index: 13)
American J. of Business     Hybrid Journal   (Followers: 6)
Anti-Corrosion Methods and Materials     Hybrid Journal   (Followers: 4, SJR: 0.219, h-index: 22)
Arts Marketing : An Intl. J.     Hybrid Journal   (Followers: 10)
Asia Pacific J. of Marketing and Logistics     Hybrid Journal   (Followers: 6)
Asia-Pacific J. of Business Administration     Hybrid Journal   (Followers: 2, SJR: 0.167, h-index: 4)
Asian Education and Development Studies     Hybrid Journal   (Followers: 5)
Asian J. on Quality     Hybrid Journal   (Followers: 2)
Asian Review of Accounting     Hybrid Journal   (Followers: 1, SJR: 0.119, h-index: 2)
Aslib Proceedings     Hybrid Journal   (Followers: 334, SJR: 0.64, h-index: 22)
Assembly Automation     Hybrid Journal   (Followers: 1, SJR: 0.301, h-index: 18)
Baltic J. of Management     Hybrid Journal   (Followers: 2, SJR: 0.279, h-index: 8)
Benchmarking : An Intl. J.     Hybrid Journal   (Followers: 5, SJR: 0.671, h-index: 25)
British Food J.     Hybrid Journal   (Followers: 6, SJR: 0.441, h-index: 20)
Built Environment Project and Asset Management     Hybrid Journal   (Followers: 13)
Business Process Management J.     Hybrid Journal   (Followers: 6, SJR: 0.7, h-index: 24)
Business Strategy Series     Hybrid Journal   (Followers: 5, SJR: 0.139, h-index: 2)
Campus-Wide Information Systems     Hybrid Journal   (Followers: 5, SJR: 0.292, h-index: 11)
Career Development Intl.     Hybrid Journal   (Followers: 10, SJR: 0.75, h-index: 19)
China Agricultural Economic Review     Hybrid Journal   (Followers: 1, SJR: 0.315, h-index: 4)
China Finance Review Intl.     Hybrid Journal   (Followers: 3)
Chinese Management Studies     Hybrid Journal   (Followers: 4, SJR: 0.254, h-index: 6)
Circuit World     Hybrid Journal   (Followers: 9, SJR: 0.241, h-index: 14)
Clinical Governance: An Intl. J.     Hybrid Journal   (Followers: 15, SJR: 0.232, h-index: 12)
Collection Building     Hybrid Journal   (Followers: 9, SJR: 0.433, h-index: 8)
COMPEL: The Intl. J. for Computation and Mathematics in Electrical and Electronic Engineering     Hybrid Journal   (Followers: 3, SJR: 0.244, h-index: 16)
Competitiveness Review : An Intl. Business J. incorporating J. of Global Competitiveness     Hybrid Journal   (Followers: 3)
Construction Innovation: Information, Process, Management     Hybrid Journal   (Followers: 14)
Corporate Communications An Intl. J.     Hybrid Journal   (Followers: 4, SJR: 0.535, h-index: 15)
Corporate Governance Intl. J. of Business in Society     Hybrid Journal   (Followers: 6, SJR: 0.285, h-index: 17)
Critical Perspectives on Intl. Business     Hybrid Journal   (SJR: 0.312, h-index: 9)
Cross Cultural Management An Intl. J.     Hybrid Journal   (Followers: 5, SJR: 0.434, h-index: 4)
Development and Learning in Organizations     Hybrid Journal   (Followers: 5, SJR: 0.128, h-index: 5)
Direct Marketing An Intl. J.     Hybrid Journal   (Followers: 6)
Disaster Prevention and Management     Hybrid Journal   (Followers: 13, SJR: 0.283, h-index: 21)
Drugs and Alcohol Today     Hybrid Journal   (Followers: 23, SJR: 0, h-index: 1)
Education + Training     Hybrid Journal   (Followers: 15, SJR: 0.338, h-index: 18)
Education, Business and Society : Contemporary Middle Eastern Issues     Hybrid Journal  
Employee Relations     Hybrid Journal   (Followers: 5, SJR: 0.331, h-index: 13)
Engineering Computations     Hybrid Journal   (Followers: 3, SJR: 0.435, h-index: 30)
Engineering, Construction and Architectural Management     Hybrid Journal   (Followers: 16, SJR: 0.329, h-index: 18)
Equal Opportunities Intl.     Hybrid Journal   (Followers: 2)
Equality, Diversity and Inclusion : An Intl. J.     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 2)
Ethnicity and Inequalities in Health and Social Care     Hybrid Journal   (Followers: 8, SJR: 0.128, h-index: 1)
EuroMed J. of Business     Hybrid Journal  
European Business Review     Hybrid Journal   (Followers: 3, SJR: 0.425, h-index: 13)
European J. of Innovation Management     Hybrid Journal   (Followers: 15, SJR: 0.556, h-index: 19)
European J. of Marketing     Hybrid Journal   (Followers: 16, SJR: 0.811, h-index: 31)
European J. of Training and Development     Hybrid Journal   (Followers: 7, SJR: 0.387, h-index: 14)
Evidence-based HRM     Hybrid Journal   (Followers: 7)
Facilities     Hybrid Journal   (Followers: 1, SJR: 0.323, h-index: 11)
foresight     Hybrid Journal   (Followers: 7, SJR: 0.47, h-index: 14)
Gender in Management : An Intl. J.     Hybrid Journal   (Followers: 10, SJR: 0.294, h-index: 14)
Grey Systems : Theory and Application     Hybrid Journal  
Health Education     Hybrid Journal   (Followers: 3, SJR: 0.278, h-index: 11)
Higher Education, Skills and Work-based Learning     Hybrid Journal   (Followers: 28, SJR: 0.112, h-index: 2)
History of Education Review     Hybrid Journal   (Followers: 4, SJR: 0, h-index: 1)
Housing, Care and Support     Hybrid Journal   (Followers: 7, SJR: 0.187, h-index: 1)
Human Resource Management Intl. Digest     Hybrid Journal   (Followers: 12, SJR: 0.105, h-index: 4)
Humanomics     Hybrid Journal   (Followers: 2)
Indian Growth and Development Review     Hybrid Journal   (SJR: 0.121, h-index: 1)
Industrial and Commercial Training     Hybrid Journal   (Followers: 5, SJR: 0.184, h-index: 8)
Industrial Lubrication and Tribology     Hybrid Journal   (Followers: 4, SJR: 0.433, h-index: 14)
Industrial Management & Data Systems     Hybrid Journal   (Followers: 3, SJR: 0.979, h-index: 49)
Industrial Robot An Intl. J.     Hybrid Journal   (Followers: 2, SJR: 0.483, h-index: 21)
Info     Hybrid Journal   (SJR: 0.374, h-index: 14)
Information Management & Computer Security     Hybrid Journal   (Followers: 12, SJR: 0.397, h-index: 25)
Information Technology & People     Hybrid Journal   (Followers: 185, SJR: 0.565, h-index: 18)
Interactive Technology and Smart Education     Hybrid Journal   (Followers: 10)
Interlending & Document Supply     Hybrid Journal   (Followers: 252, SJR: 0.411, h-index: 9)
Internet Research     Hybrid Journal   (Followers: 226, SJR: 0.899, h-index: 40)
Intl. J. for Lesson and Learning Studies     Hybrid Journal   (Followers: 2)
Intl. J. for Researcher Development     Hybrid Journal   (Followers: 8)
Intl. J. of Accounting and Information Management     Hybrid Journal   (Followers: 5, SJR: 0.125, h-index: 1)
Intl. J. of Bank Marketing     Hybrid Journal   (Followers: 4, SJR: 0.716, h-index: 21)
Intl. J. of Climate Change Strategies and Management     Hybrid Journal   (Followers: 9)
Intl. J. of Clothing Science and Technology     Hybrid Journal   (Followers: 4, SJR: 0.154, h-index: 18)
Intl. J. of Commerce and Management     Hybrid Journal  
Intl. J. of Conflict Management     Hybrid Journal   (Followers: 10, SJR: 0.459, h-index: 28)
Intl. J. of Contemporary Hospitality Management     Hybrid Journal   (Followers: 8, SJR: 0.795, h-index: 19)
Intl. J. of Culture Tourism and Hospitality Research     Hybrid Journal   (Followers: 13)
Intl. J. of Development Issues     Hybrid Journal   (Followers: 5)
Intl. J. of Disaster Resilience in the Built Environment     Hybrid Journal   (Followers: 5, SJR: 0.337, h-index: 4)
Intl. J. of Educational Management     Hybrid Journal   (Followers: 3)
Intl. J. of Emergency Services     Hybrid Journal   (Followers: 1)
Intl. J. of Emerging Markets     Hybrid Journal   (Followers: 2)
Intl. J. of Energy Sector Management     Hybrid Journal   (Followers: 4, SJR: 0.249, h-index: 6)
Intl. J. of Entrepreneurial Behaviour & Research     Hybrid Journal   (Followers: 6, SJR: 0.441, h-index: 16)
Intl. J. of Event and Festival Management     Hybrid Journal   (Followers: 9)

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Journal Cover International Journal of Health Care Quality Assurance     [SJR: 0.327]   [H-I: 22]
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0952-6862
   Published by Emerald Homepage  [308 journals]
  • An empirical study on hospital selection in India
    • Authors: Manimay Ghosh et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 28, Issue 1, February 2015. Purpose The purpose of this study was to understand the different factors patients consider in choosing a hospital in a major city in India, prior to admission. Design/methodology/approach A twenty-item scale to identify various factors a patient considers in choosing a hospital was developed. A field survey was conducted on patients who were discharged in the recent past from a public or a private hospital. The data collected were analysed using multivariate techniques. Findings The data analysis highlighted several factors in the hospital choice selection process, namely quality of treatment, referral, transport convenience, cost, and safety and services. Research limitations/implications This research study was carried out in one of the four major metropolitan cities of India. Nonetheless, the study provides valuable insights into the hospital selection process in a developing country like India. Practical implications Hospital managers, in general, can use the study findings to improve the operating performance of their hospitals so that they are able to attract more patients in the future. Additionally, the information can be useful to the marketing managers for developing appropriate marketing strategies for their hospitals. Originality/value Majority of the empirical research on hospital choice process has been conducted in Europe and North America. Limited knowledge exists on the same in a developing nation like India. This research illustrates a comprehensive study to address that concern.
      PubDate: Sat, 10 Jan 2015 04:07:45 GMT
  • Managerial process improvement: a lean approach to eliminating medication
           delivery errors in healthcare
    • Authors: George Munchus et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 28, Issue 1, February 2015. Purpose Statistical evidence shows that medication errors are a major cause of injuries that concerns all health care oganizations. Depsite all the efforts to improve the quality of care,the lack of understanding and inability of managment to design a robust sytem that will strategically target those factors is a major cause of distress. Design/methodology/approach Achieving optimum organizational performance requires two key variables;work process factors and human performance factors. Our approach is that healthcare admininstrators must take in acount both variables in designing a strategy to reduce medication errors. However strategies that will combat such phenomena require that managers and administrators understnd the key factors that are causing medication delievery errors. Findings We recommend that healthcare organizations implement the Toyota Production System combined with Human Performance Improvement methodologies to eminate medication delivery errors in hospitals. Originality/value Despite all the efforts to improve the quality of care,there continues to be a lack of understanding and the ability of management to to design a robust system that will strategically target those factors associated with medication errors. This paper proposes a solution to an ambiguous workflow process using the Toyota Production System combined with the Human Performance Improvement system.
      PubDate: Sat, 10 Jan 2015 04:07:40 GMT
  • Workshops as a useful tool to better understand care professionals’
           Views of a Lean change program
    • Authors: Pascale Simons et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 28, Issue 1, February 2015. Purpose For change programs to succeed, it is vital to have a detailed understanding of employees’ views regarding the program, especially when the proposed changes are potentially contested. Gaining insight into employee perceptions helps managers to decide how to proceed. We conducted two workshops in a radiotherapy institute to assess the benefits and drawbacks, as well as their underlying causes, of a proposed lean change program. Managers’ views on the workshops’ usefulness were charted. Design/methodology/approach Two workshops were organized in which employees predicted positive and negative effects of a lean program. The workshops combined a structured brainstorm (KJ-technique) and an evaluation of the expected effects. Eight top managers judged the workshops’ value on supporting decision making. Findings Fifteen employees participated in the workshops. Participants from workshop 2 reported more expected effects (27 effects; 18 positive) than from workshop 1 (14 effects; 6 positive). However, when effects were categorized, similar results were shown. Three from eight managers scored the results relevant for decision making and four neutral. Seven managers recommended future use of the instrument. Increased employee involvement and bottom-up thinking combined with relatively low costs were appreciated most. Practical implications The workshop could serve as a simple instrument to improve decision making and enhance successful implementation of change programs, as it was expected to enhance employees’ involvement and was relatively easy to conduct and cheap. Originality/value The workshop increased insight into employee views, facilitating adaptive actions by healthcare organization managers.
      PubDate: Sat, 10 Jan 2015 04:07:38 GMT
  • Facilitating a Just and Trusting Culture
    • Authors: Jill Pattison et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 28, Issue 1, February 2015. Purpose The purpose of the studies was to identify managerial and organizational characteristics and behaviors that facilitate the fostering of a just and trusting culture within the healthcare system. Design/methodology/approach Two studies were conducted. The initial qualitative one was used to identify themes based on interviews with health care workers that facilitate a just and trusting culture. The quantitative one used a policy-capturing design to determine which factors were most likely to predict outcomes of manager and organizational trust. Findings The factors of violation type (ability vs. integrity), providing an explanation or not, blame vs. no blame by manager, and blame vs. no blame by organization were all significant predictors of perceptions of trust. Research limitations/implications Limitations to the generalizability of findings included both a small and non-representative sample from one health care region. Practical implications The present findings can be useful in developing training systems for managers and organizational executive teams for managing medical error events in a manner that will help develop a just and trusting culture. Originality/value This is the first field study experimentally manipulating aspects of organizational trust within the health care sector. The use of policy-capturing is a unique feature that sheds light into the decision-making of health care workers as to the efficaciousness of particular managerial and organizational characteristics that impact a just and trusting culture.
      PubDate: Sat, 10 Jan 2015 04:07:37 GMT
  • Food Production and Service in UK Hospitals
    • Authors: Mohamed Omar Ahmed Sayed Ahmed et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 28, Issue 1, February 2015. Purpose This paper applies value stream mapping holistically to hospital food production/service systems focused on high-quality food. Design/methodology/approach Multiple embedded case study of three (two private-sector and one public-sector) hospitals in the UK. Findings The results indicated various issues affecting hospital food production including: the menu and nutritional considerations; food procurement; food production; foodservice; patient perceptions/ expectations. Research limitations/implications Value stream mapping is a new approach for food production systems in UK hospitals whether private or public hospitals. Practical implications The paper identifies opportunities for enhancing hospital food production systems. Originality/value The paper provides a theoretical basis for process enhancement of hospital food production and the provision of high-quality hospital food.
      PubDate: Sat, 10 Jan 2015 04:07:36 GMT
  • Doctors’ trustworthiness, practice orientation, performance and
           patient satisfaction
    • Authors: Barend Van Den Assem et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 28, Issue 1, February 2015. Purpose This paper provides a greater understanding of the General Practitioner (GP)-patient relationship for academics and practitioners. A new model for dyadic professional relationships specifically designed for research into the doctor-patient relationship was developed and tested. Various conceptual models of trust and related constructs in the literature were considered and assessed for their relevance as were various related scales. Design/methodology/approach The model was designed and tested using purposefully designed scales measuring doctors’ trustworthiness, practice orientation performance and patient satisfaction. A quantitative survey used closed-ended questions and 372 patients responded from seven GP practices. The sample closely reflected the profile of the patients who responded to the DoH/NHS GP Patient Survey for England, 2010. Findings Hierarchical Regression and Partial Least Squares both accounted for 74% of the variance in ‘overall patient satisfaction’, the dependent variable. Trust accounted for 39% of the variance explained, with the other independent variables accounting for the other 35%. ANOVA showed good model fit. Practical implications The findings on the factors which affect patient satisfaction and the doctor-patient relationship have direct implications for GPs and other health professionals. They are of particular relevance at a time of health reform and change. Originality/value The paper provides: a new model of the doctor-patient relationship and specifically designed scales to test it; a greater understanding of the effects of doctors’ trustworthiness, practice orientation and performance on patient satisfaction; and a new framework for examining the breadth and meaning of the doctor-patient relationship and the management of care from the patient’s viewpoint.
      PubDate: Sat, 10 Jan 2015 04:07:35 GMT
  • Intensive care patient and family satisfaction
    • Authors: Vineet Sarode et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 28, Issue 1, February 2015. Purpose The aim of this study was to measure family member satisfaction with the care provided in an Australian private intensive care unit (ICU) at two time points separated by two years. The study was part of a quality improvement process for ICU, and was designed with reference to the revised Australian Commission on Safety and Quality in Health care Design/methodology/approach This prospective study involved family members of patients admitted in ICU in February 2011 and February 2013.All patients admitted to during the study month were eligible. Questionnaire addressed staff competence, treatment of family, communication, environment and overall satisfaction, using a Likert scale. There was one free text question. The first survey was done by handing the survey package to the next of kin at the time of discharge while the second involved mailing a survey package within a week of discharge from ICU. Quantitative analysis was based on 10 Likert items and qualitative analysis based on the free text question. Findings The response rate was 53% (54/102) in 2013 (mailed) compared to 44% (44/100) in 2011 (hand delivered). The results from second (2013) survey showed statistically significant improvement in satisfaction associated with nursing and medical competency. Other areas with improvement were the relative’s waiting room and visiting hours. The area lacking improvement was ease of finding ICU the hospital. It confirmed that families were satisfied with the care provided and highlighted areas for improvement. The results indicated high satisfaction overall, especially with the hospital staff competency and the overall care quality their relative received. Though most responses also indicated satisfaction with communication and support services, these areas did not perform as well. Originality/value This study provided a simple and effective mechanism to monitor consumer satisfaction with ICU.
      PubDate: Sat, 10 Jan 2015 04:07:20 GMT
  • Lean practices for quality results: case illustration
    • Authors: Pauline Hwang et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 8, September 2014. Purpose Increasingly, healthcare providers are implementing lean practices to achieve quality results. The challenges of implementing lean practices in healthcare organizations are unique compared to manufacturing and other service industries. This study presents a research model that identifies and defines key success factors of lean implementation in healthcare organizations. Design/methodology/approach The research model is based on an extant literature review, and a case illustration explores actual lean implementation in a major USA hospital located in a Midwestern city (approximately 300,000 people). An exploratory/descriptive study using observation and follow-up interviews was conducted to identify lean practices in the hospital. Findings Key drivers for lean practices include growing elderly populations, rising medical expenses, decreasing insurance coverage, and decreasing management support. Effectively implementing lean practices to increase bottom-line results and improve organizational integrity requires shared understanding about the goals and processes among healthcare managers and professionals. Practical implications The case illustration explains the research model. This study provides a sound foundation for future empirical studies. Practical implications are included. Lean practices minimize waste and unnecessary hospital stays while simultaneously enhancing customer values and deploying resources in supply systems. Leadership requires clear project targets based on sound front-end planning because initial implementation steps involve much uncertainty and ambiguity (i.e., fuzzy front-end planning). Since top management support is crucial in order to implement lean practices successfully, a heavyweight manager who communicates well both with top managers and project teams is an important success factor when implementing lean practices. Originality/value More healthcare managers are adopting business practices that improve efficiency and productivity while ensuring the healthcare mission and guaranteeing that customer values are achieved. Shared understanding about complex goals (e.g., reducing waste and enhancing customer value) on the front-end is crucial when implementing successful lean practices. In particular, this study shows that nursing practices, which are both labour intensive and technology enabled, are good candidates for lean practice implementation.
      PubDate: Tue, 30 Sep 2014 13:17:31 GMT
  • Library and information services: impact on patient care quality
    • Authors: Joanne Gard Marshall et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 8, September 2014. Purpose To explore library and information service impact on patient care quality. Design/methodology/approach A large-scale critical incident survey of physicians and residents at 56 library sites serving 118 hospitals in the US and Canada. Respondents were asked to base their answers on a recent incident in which they had used library resources to search for information related to a specific clinical case. Findings Of 4,520 respondents, 75% said that they definitely or probably handled patient care differently using information obtained through the library. In a multivariate analysis, three summary clinical outcome measures were used as value and impact indicators: (i) time saved; (ii) patient care changes; and (iii) adverse events avoided. The outcomes were examined in relation to four information access methods: (i) asking librarian for assistance; (ii) performing search in a physical library; (iii) searching library’s website; or (iv) searching library resources on an institutional intranet. All library access methods had consistently positive relationships with the clinical outcomes, providing evidence that library services have a positive impact on patient care quality. Originality/value Electronic collections and services provided by the library and the librarian contribute to patient care quality.
      PubDate: Tue, 30 Sep 2014 13:17:31 GMT
  • Quantifying Complexity in Translational Research: an Integrated Approach
    • Authors: David Andres Munoz et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 8, September 2014. Purpose This article quantifies complexity in translational research. The impact of the major operational steps and technical requirements (TR) is calculated with respect to their ability to accelerate the process of moving new discoveries into clinical practice. Design/methodology/approach A three-phase integrated Quality Function Deployment (QFD) and Analytic Hierarchy Process (AHP) methodology was used to quantify complexity in translational research. A case study in obesity was used to illustrate the usability of the methodology. Findings In general, the evidence generated from the methodology was found to be valuable to understand the impact of the various components in translational research. In particular, for the case study presented, it was found that collaboration networks, multidisciplinary team capacity, and community engagement are crucial to accelerate the translation of new discoveries into practice. Research limitations/implications As the methodology is mainly based on subjective opinion, some could argue that the results suffer from risk of bias. However, a consistency ratio is calculated and can be used as a guide on subjectivity. Alternatively, a larger experts sample may be incorporated to reduce bias. Practical implications The integrated QFD-AHP framework provides evidence that could be helpful to generate agreement, develop guidelines, allocate resources wisely, identify benchmarks and enhance collaboration among similar projects. Originality/value Current conceptual models in translational research provide little or no clue to assess complexity. The proposed methodology aimed to fill this existing gap. Additionally, according to our review of the literature, it includes various features that have not been explored in translational research.
      PubDate: Tue, 30 Sep 2014 13:17:30 GMT
  • Patient-Clinician Concordance, Face-time and Access
    • Authors: James Stahl et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 8, September 2014. Purpose People in socially disadvantageous positions may receive less time with their clinicians and consequently reduced access to healthcare resources, potentially magnifying health disparities. Socio-cultural characteristics of clinicians and patients may influence the time spent together. The purpose of this paper is to explore the relationship between clinician/patient time and clinician and patient characteristics using real-time location systems (RTLS). Design/methodology/approach In the MGH/MGPO Outpatient RFID (radio-frequency identification) project clinicians and patients wore RTLS tags during the workday to measure face-time (FT), the duration patients and clinicians are co-located, wait time (WT); i.e., from registration to clinical encounter and flow time (FLT) from registration to discharge. Demographic data were derived from the health system’s EMR. The RTLS and EMR data were synthesized and analyzed using standard SQL and statistical analytic methods. Findings From 1/01/2009-1/01/2011, 1593 clinical encounters were associated with RTLS measured face-times, which differed with socioeconomic status and gender: women and lower income people received greater face-time. Wait time was significantly longer for lower socioeconomic patients and for patients seeing trainee clinicians, women or majority ethnic group clinicians (Caucasian). Flow Time was shortest for men, higher socioeconomic status and for attending physician patients. Demographic concordance between patient and clinician did not significantly affect process times. Research limitations/implications Our study demonstrates RTLS’ ability to capture clinically relevant process measures and suggests that the clinical delivery system surrounding a clinical encounter may more significantly influence access to clinician time than individual patient and clinician characteristics. Originality/value Applying Real-time location systems to healthcare is coming. We can now successfully install and run these systems in healthcare settings and extract useful information from them. Interactions with the clinical delivery system are at least as important as interactions with clinicians for providing access to care. • We can measure face-time, wait time and flow time with RTLS • We can link clinical behavior, e.g., face-time, with patient characteristics • We can explore how individual characteristics interact with system behavior
      PubDate: Tue, 30 Sep 2014 13:17:30 GMT
  • CRIB conditional on gender: nonparametric ROC curve
    • Authors: Maria Filipa Mourão et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 8, September 2014. Purpose In this work we use the kernel method to produce a smoothed ROC curve and show how the sex of babies can influence the discrimination of the CRIB scale according to the survival (normal) and dead (abnormal) risk. Design/methodology/approach To obtain the ROC curve conditioned by covariates, two methods may be followed: (1) indirect adjustment, in which the effect of the covariate distribution indicator is first modeled within the two groups and then by generating the curve of the modified distributions; (2) direct smoothing in which the effect of the covariate is modeled within the ROC curve itself. To verify if the sex of the newborns weighing less than 1500g, affects the classification according to the CRIB scale, the study uses the direct method. Results include a sample of 160 babies (54.4% female; 45.6% male) from a Portuguese hospital. Findings The smoothing applied to the ROC curves, indicates that the ROC curve original shape does not change when a bandwidth h = 0.1 is used. Furthermore, sex seems to be a significant covariate in predicting babies’ death. A higher value was obtained for the AUC (Area Under Curve) generated when conditional on the female babies. Practical implications The challenge is to determine whether the baby´s sex influences the discrimination between death and survival babies. Originality/value We constructed empirical ROC curves for the CRIB data and empirical ROC curves conditioned on babies’ sex. We calculate the corresponding AUC and tested the difference between them. We also constructed smooth ROC curves for the two approaches.
      PubDate: Tue, 30 Sep 2014 13:17:29 GMT
  • IMRT Utilization in Ontario: Qualitative Deployment Evaluation
    • Authors: Kate Bak et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 8, September 2014. Purpose To describe a jurisdiction-wide implementation and evaluation of Intensity-Modulated Radiation Therapy (IMRT) in Ontario, Canada, highlighting innovative strategies and lessons learned. Design/methodology/approach To obtain an accurate provincial representation, six cancer centres were chosen (based on their IMRT utilization, geography, population, academic affiliation and size) for an in-depth evaluation. At each cancer centre semi-structured, key informant interviews were conducted with senior administrators. An electronic survey, consisting of 40 questions, was also developed and distributed to all cancer centres in Ontario. Findings Twenty-one respondents participated in the interviews and a total of 266 electronic surveys were returned. Funding allocation, guidelines and utilization targets, expert coaching and educational activities were identified as effective implementation strategies. The implementation allowed for hands-on training, an exchange of knowledge and expertise and the sharing of responsibility. Future implementation initiatives could be improved by creating stronger avenues for clear, continuing and comprehensive communication at all stages to increase awareness, garner support and encourage participation and encouraging expert-based coaching. IMRT utilization for has increased without affecting wait times or safety (from fiscal year 2008/09 to 2012/13 absolute increased change: Prostate 46%, Thyroid 36%, Head and Neck 29%, Sarcoma 30%, and CNS 32%). Research limitations/implications Originality/value This multifaceted, jurisdiction-wide approach has been successful in implementing guideline recommended IMRT into standard practice. The expert based coaching initiative, in particular presents a novel training approach for those who are implementing complex techniques. This paper will be of interest to those exploring ways to fund, implement and sustain complex and evolving technologies.
      PubDate: Tue, 30 Sep 2014 13:17:28 GMT
  • Clinical decision support system (CDSS) – effects on care quality
    • Authors: Marco Santos et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 8, September 2014. Purpose Despite their efficacy, some recommended therapies are underused. This study describes clinical decision support system (CDSS) development and its impact on clinical guideline adherence. Design/methodology/approach A new CDSS was developed and introduced in a cardiac intensive care unit (CICU) in 2003, which provided physicians with patient-tailored reminders and permitted data export from electronic patient records (EPRs) into a national quality registry. To evaluate CDSS effects in the CICU, process indicators were compared to a control group using registry data. All CICUs were in the same region and only patients with acute coronary syndrome were included. Findings CDSS introduction was associated with increases in guideline adherence, which ranged from 16% to 35%, depending on the therapy. Statistically significant associations between guideline adherence and CDSS use remained over the five-year period after its introduction. During the same period, no relapses occurred in the intervention CICU. Practical implications Guideline adherence and healthcare quality can be enhanced using CDSS. This study suggests that practitioners should turn to CDSS to improve healthcare quality. Originality/value This article describes and evaluates an intervention that successfully increased guideline adherence, which improved healthcare quality when the intervention CICU was compared to the control group.
      PubDate: Tue, 30 Sep 2014 13:17:28 GMT
  • Are adequate fluid challenges prescribed for severe sepsis'
    • Authors: Michael Courtney et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 8, September 2014. Purpose The early management of severe sepsis has several recognised benefits. Correct early management includes delivery of an appropriate fluid challenge. This study aimed to assess whether junior doctors prescribe adequate fluid challenges to severely septic patients. Design/methodology/approach A questionnaire outlining three scenarios, each involving a patient with severe sepsis but with varying weights (50/75/100kg), was distributed to junior doctors involved in the management of surgical patients working in two UK hospitals . Participants were asked the volume of fluid challenge that they would prescribe for each. Responses were compared with the Surviving Sepsis Campaign’s recommended volume at the time of study (20ml/kg). Findings Seventy-seven questionnaires were completed. There were 12/231 (5%) correct responses. The median volume chosen in each scenario was 500ml, equating to 5-10ml/kg. There was no significant difference between grades of doctors (FY1 and SHO) in any scenario . With the most junior doctors (FY1) there was no difference in responses according to weight; for SHOs the only significant difference was between 75kg and 100kg scenarios. Practical implications Junior doctors are not following guidelines when prescribing fluid challenges to severely septic patients, giving too little and not adjusting volume according to weight. This implies that a high prevalence, high mortality condition is not being treated appropriately by those most likely to treat it. More teaching, training and reassessment is required to improve care. Originality/value This, the first case-based survey of its kind that we could find, highlights an issue requiring significant improvement. The implications are likely to be relevant to clinicians in all UK hospitals.
      PubDate: Tue, 30 Sep 2014 13:17:27 GMT
  • Getting (QA) Research into Practice (GRIP).
    • Authors: Keith Hurst et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 8, September 2014.
      PubDate: Tue, 30 Sep 2014 13:17:27 GMT
  • Quality and price – impact on patient satisfaction
    • Authors: Angelos Pantouvakis et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 8, September 2014. Purpose This study synthesises existing quality-measurement models and applies them to healthcare by combining a Nordic service-quality with an American service performance model. Design/methodology/approach Results are based on a questionnaire survey of 1,298 respondents. Service quality dimensions were derived and related to satisfaction by employing a multinomial logistic model, which allows prediction and service improvement. Findings Qualitative and empirical evidence indicates that customer satisfaction and service quality are multi-dimensional constructs, whose quality components, together with convenience and cost, influence the customer’s overall satisfaction. Originality/value The proposed model identifies important quality and satisfaction issues. It also enables transitions between different responses in different studies to be compared.
      PubDate: Tue, 30 Sep 2014 13:17:26 GMT
  • Improving operating room productivity via parallel anesthesia processing
    • Authors: Michael J Brown et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 8, September 2014. Purpose Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoing upper extremity surgical procedures. This study’s aim is to evaluate whether performing regional anesthesia outside the OR in parallel will increase the number of cases per day and improve efficiency and productivity. Design/methodology/approach Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model was used to evaluate pure operating modes of regional anesthesia performed in the OR and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes), and assuming a standard case load of three per day, what was the predicted end-of-day time and minutes of overtime exposure. Findings Modeling results show that parallel processing of regional anesthesia would increase the average number of cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the average proportion of days going to overtime was reduced by 43% with parallel block. The amount of overtime with parallel anesthesia was also projected to be an average of 40 minutes less per day per surgeon. Research limitations/implications Key limitations include the assumption that all cases used regional anesthesia in our comparisons. Many days may have a mix of both regional and general anesthesia. Also, as a case study, the single center nature of this research may limit generalizability. Practical implications Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved. Originality/value Simulation modeling can be an effective tool to show the potential of practice changes at a system-wide level.
      PubDate: Tue, 30 Sep 2014 13:17:25 GMT
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