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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: 21, 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: 172, 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: 320, 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: 16, SJR: 0.232, h-index: 12)
Collection Building     Hybrid Journal   (Followers: 7, 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: 15)
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: 24, 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: 9, SJR: 0.256, h-index: 2)
Ethnicity and Inequalities in Health and Social Care     Hybrid Journal   (Followers: 7, 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: 15, 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: 3, SJR: 0, h-index: 1)
Housing, Care and Support     Hybrid Journal   (Followers: 6, SJR: 0.187, h-index: 1)
Human Resource Management Intl. Digest     Hybrid Journal   (Followers: 11, 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: 173, SJR: 0.565, h-index: 18)
Interactive Technology and Smart Education     Hybrid Journal   (Followers: 10)
Interlending & Document Supply     Hybrid Journal   (Followers: 233, SJR: 0.411, h-index: 9)
Internet Research     Hybrid Journal   (Followers: 212, 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: 6, 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
   [8 followers]  Follow    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 0952-6862
     Published by Emerald Homepage  [308 journals]   [SJR: 0.327]   [H-I: 22]
  • 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
  • Saudi Arabian ICU safety culture and nurses’ attitudes
    • Authors: Abdulrahman S. Alayed et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 7, Page 581-593, August 2014. Purpose – The purpose of this paper is to examine nurses’ attitudes towards safety culture in six Saudi Arabian intensive care units (ICUs). Design/methodology/approach – The study is descriptive with a cross-sectional design. The Safety Attitude Questionnaire (SAQ)-ICU version was distributed and 216 completed questionnaires were returned. Findings – The findings provide a basis for further research on Saudi Arabian ICU safety culture. This study showed that the SAQ-ICU can be used to measure safety climate to identify areas for improvement according to nurse attitudes and perceptions. Findings indicate that ICU safety culture is an important issue that hospital managers should prioritise. Practical implications – The SAQ-ICU questionnaire, used to measure safety climate in Saudi Arabian ICUs, identifies service strengths and improvement areas according to attitudes and perceptions. Originality/value – To the knowledge, this is the first study to use SAQ to examine nurses’ safety culture attitudes in Saudi Arabian ICUs. The present findings provide a baseline and further details about Saudi Arabian ICU safety. Study participants represented nine nationalities, indicating the nursing workforce's diversity, which is expected to continue in the future. Such a nursing cultural heterogeneity calls for further studies to examine and evaluate attitudes and values to improve ICU safety culture.
      PubDate: Wed, 13 Aug 2014 09:21:56 GMT
  • Implementation of patient-focused care: before-after effects
    • Authors: Bodil Wilde-Larsson et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 7, Page 594-604, August 2014. Purpose – The purpose of this paper is to evaluate an organizationally oriented, patient-focused care (PFC) model's effects on care quality and work climate. Design/methodology/approach – The study has a before-after (PFC implementation) design. The sample included 1,474 patients and 458 healthcare providers in six participating wards before and after PFC implementation, plus five additional randomly chosen wards, which only featured in the post-assessment. Findings – No pre-post differences were found regarding care perceptions or provider work climate evaluations. Statistically significant improvements were noted among provider care evaluations. Using aggregate-level ward data, multiple regression analyses showed that high adherence to PFC principles and a positive work climate contributed significantly to variance among care quality ratings. Research limitations/implications – Among healthcare providers, questions related to specific PFC aspects during evenings, nights and weekends had to be dropped owing to a low response rate. Practical implications – An important requirement for both practice and research is to tailor PFC to various health and social care contexts. Originality/value – The study is large-scale before-after PFC model review, where patient and provider data were collected using well-established measurements.
      PubDate: Wed, 13 Aug 2014 09:21:54 GMT
  • Discharge planning in a cardiology out-patient clinic: a clinical audit
    • Authors: Shirley Ingram et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 7, Page 573-580, August 2014. Purpose – The purpose of this paper is to audit the active discharge (DC) planning process in a general cardiology clinic, by pre-assessing patients’ medical notes and highlighting those suitable for potential DC to the clinic physician. Design/methodology/approach – The cardiology clinical nurse specialist (CNS) identified patients’ for nine- to 12-month return visits one week prior to attendance. The previous consultation letter was accessed and information was documented by the CNS in the medical record. The key performance indicator (KPI) used was patient DCs for each clinic visit. The process was audited at three separate times to reflect recommended action carried out. Findings – The CNS pre-assessment and presence at the clinics significantly increased total DCs during the first period compared to usual care, 11 vs 34 per cent (p
      PubDate: Wed, 13 Aug 2014 09:21:52 GMT
  • Hospital rounding – EHR's impact
    • Authors: Chih-Yang Tsai et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 7, Page 605-615, August 2014. Purpose – The purpose of this paper is to understand the time spent on various tasks during physician inpatient rounds and to examine the new electronic health records (EHRs) impact on time distribution. Design/methodology/approach – Trained observers shadowed hospital physicians to record times for various tasks before and after EHR implementation. Findings – Electronic records did not improve efficiency. However, task times were redistributed. Physicians spent more time reviewing patient charts using time saved from miscellaneous work. Research limitations/implications – The study focusses solely on work distribution and the changes it underwent. It does not include quality measures either on patient results or physician satisfaction. Practical implications – As EHR provides rich information and easier access to patient records, it motivates physicians to spend more time reviewing patient charts. Hospital administrators seeking immediate returns on EHR investment, therefore, may be disappointed. Originality/value – Unlike previous work, this study was conducted in a non-teaching hospital, providing a task-time comparison without any educational and team factor influence. The result serves as a benchmark for many community hospital managers seeking to address the same issue.
      PubDate: Wed, 13 Aug 2014 09:21:51 GMT
  • Quality indicators for a consultation-liaison psychiatry service
    • Authors: Rebecca Wood et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 7, Page 633-641, August 2014. Purpose – Consultation-liaison psychiatry (CLP) researchers have not yet developed accepted quality indicators to measure efficiency or effectiveness. The purpose of this paper is to combine objective and subjective quality indicators to assess hospital-based CLP service utilisation, efficiency and effectiveness. Design/methodology/approach – Service utilisation rate was calculated over the service's first four years. Patient characteristics and objective quality indicators relating to response timeliness in 2012 were examined. Totally, 41 staff and 52 consecutive patients completed evaluation surveys to subjectively evaluate effectiveness. Findings – The utilisation rate increased initially and then slightly declined to 1.03 per cent of all hospital admissions. In 2012, 91.5 per cent were seen on the same referral day and 99.4 per cent by the next day. The benchmark for urgent referrals was not met (77.4 per cent). Patients rated involvement with the CLP service a positive experience (90 per cent), but were less clear about follow-up plans (68 per cent). Staff believed that the service improved the patients’ hospital course (98 per cent) and was communicated well (93-95 per cent). Only 63 per cent agreed that relevant CLP education was provided and 76 per cent rated follow-up plans as clear. Originality/value – This CLP service was evaluated by measuring utilisation rates, referral response timeliness and consumer feedback. Referral to contact time is a useful objective quality indicator but should be combined with subjective yet standardised measures surveying service recipients (patients and referring staff) to be comprehensive and meaningful.
      PubDate: Wed, 13 Aug 2014 09:21:49 GMT
  • Health and social care workforce planning and development – an
    • Authors: Keith Hurst et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 7, Page 562-572, August 2014. Purpose – The purpose of this paper is to discuss the issues relating to getting the right health and social care staff with the right skills in the right place at the right time and at the right price. Design/methodology/approach – Key points arising from several master-classes with health and social care managers, supported by a literature review, generated remarkable insights into health and social care workforce planning and development (WP&D). Findings – Flawed methods and overwhelming data are major barriers to health and social care WP&D. Inefficient and ineffective WP&D policy and practice, therefore, may lead to inappropriate care teams, which in turn lead to sub-optimal and costly health and social care. Increasing health and social care demand and service re-design, as the population grows and ages, and services move from hospital to community, means that workforce planners face several challenges. Issues that drive and restrain their health and social care WP&D efforts are lucid and compelling, which leave planners in no doubt what is expected if they are to succeed and health and social care is to develop. One main barrier they face is that although WP&D definitions and models in the literature are logical, clear and effective, they are imperfect, so planners do not always have comprehensive tools or data to help them determine the ideal workforce. They face other barriers. First, WP&D can be fragmented and uni-disciplinary when modern health and social care is integrating. Second, recruitment and retention problems can easily stymie planners’ best endeavours because the people that services need (i.e. staff with the right skills), even if they exist, are not evenly distributed throughout the country. Practical implications – This paper underlines triangulated workforce demand and supply methods (described in the paper), which help planners to equalise workloads among disparate groups and isolated practitioners – an important job satisfaction and staff retention issue. Regular and systematic workforce reviews help planners to justify their staffing establishments; it seems vital, therefore, that they have robust methods and supporting data at their fingertips. Originality/value – This paper stock-takes the latest health and social care workforce planning and development issues.
      PubDate: Wed, 13 Aug 2014 09:21:48 GMT
  • Does process flow make a difference to mortality and cost' An
           observational study
    • Authors: Kate Silvester et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 7, Page 616-632, August 2014. Purpose – The purpose of the paper is to investigate the potential relationships between emergency-care flow, patient mortality and healthcare costs using a patient-flow model. Design/methodology/approach – The researchers used performance data from one UK NHS trust collected over three years to identify periods where patient flow was compromised. The delays’ root causes in the entire emergency care system were investigated. Event time-lines that disrupted patient flow and patient mortality statistics were compared. Findings – Data showed that patient mortality increases at times when accident and emergency (A&E) department staff were struggling to admit patients. Four delays influenced mortality: first, volume increase and mixed admissions; second, process delays; third, unplanned hospital capacity adjustments and finally, long-term capacity restructuring downstream. Research limitations/implications – This is an observational study that uses process control data to find times when mortality increases coincide with other events. It captures contextual background to whole system issues that affect patient mortality. Practical implications – Managers must consider cost-decisions and flow in the whole system. Localised, cost-focused decisions can have a detrimental effect on patient care. Attention must also be paid to mortality reports as existing data-presentation methods do not allow correlation analysis. Originality/value – Previous studies correlate A&E overcrowding and mortality. This method allows the whole system to be studied and increased mortality root causes to be understood.
      PubDate: Wed, 13 Aug 2014 09:21:44 GMT
  • Physician recruitment and retention in rural and underserved areas
    • Authors: Dane M. Lee et al
      Abstract: International Journal of Health Care Quality Assurance, Volume 27, Issue 7, Page 642-652, August 2014. Purpose – The purpose of this paper is to identify the challenges when recruiting and retaining rural physicians and to ascertain methods that make rural physician recruitment and retention successful. There are studies that suggest rural roots is an important factor in recruiting rural physicians, while others look at rural health exposure in medical school curricula, self-actualization, community sense and spousal perspectives in the decision to practice rural medicine. Design/methodology/approach – An extensive literature review was performed using Academic Search Complete, PubMed and The Cochrane Collaboration. Key words were rural, rural health, community hospital(s), healthcare, physicians, recruitment, recruiting, retention, retaining, physician(s) and primary care physician(s). Inclusion criteria were peer-reviewed full-text articles written in English, published from 1997 and those limited to USA and Canada. Articles from foreign countries were excluded owing to their unique healthcare systems. Findings – While there are numerous articles that call for special measures to recruit and retain physicians in rural areas, there is an overall dearth. This review identifies several articles that suggest recruitment and retention techniques. There is a need for a research agenda that includes valid, reliable and rigorous analysis regarding formulating and implementing these strategies. Originality/value – Rural Americans are under-represented when it comes to healthcare and what research there is to assist recruitment and retention is difficult to find. This paper identify the relevant research and highlights key strategies.
      PubDate: Wed, 13 Aug 2014 09:21:42 GMT
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