Dissertations / Theses: 'Health service improvement'

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Hardacre, Jeanne E. "Exploring the links between leadership and improvement in the UK National Health Service." Thesis, University of Warwick, 2011. http://wrap.warwick.ac.uk/53648/.

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Whilst the need for leadership in healthcare is well-recognised, there is still a lack of understanding about how leadership contributes to improving healthcare services. The body of knowledge concerning improvement has grown significantly in recent years, but evidence about links between leadership and health services improvement remains poor, especially within the UK National Health Service. It remains unclear how and why leadership is important to service improvement. This thesis describes aspects of a broader study commissioned by The Health Foundation. Firstly, the work aimed to explore the extent to which different types of service improvement require different types of leadership behaviour. Secondly, it aimed to investigate the nature of any links between leadership behaviour and improving services. The work draws on theoretical models and concepts of leadership and improvement in the literature, as well as empirical research in these areas. A typology of healthcare improvement was developed in order to classify different types of improvement work. Data about leadership behaviours were derived from semistructured interviews and using Q-Sort methodology. The study provides insights into which aspects of leadership are used for different types of improvement work. It makes an original and NHS-specific contribution to the literature, providing empirical evidence of how NHS leadership is associated with service improvement. Results highlight the importance of the relational aspects of leadership behaviour in improving NHS services, reinforcing trends in the literature which promote shared and distributed leadership approaches. A model of improvement leadership is proposed, based on the concept of ‘interdependence’. This model could provide the basis for an alternative emphasis in developing leadership in healthcare organisations, away from teaching skills to individuals, towards a collective, team-based approach to leading services with a shared purpose.

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O’Donnell, Barbara Ann. "Quality improvement, or quality care : an ethnographic study of frontline National Health Service staff engagement with a quality improvement initiative." Thesis, University of the West of Scotland, 2018. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.768251.

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Nordin, Annika. "Expressions of shared interpretations - Intangible outcomes of continuous quality improvement efforts in health- and elderly care." Doctoral thesis, Hälsohögskolan, Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-37302.

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This thesis is anchored in improvement science, the research field of improvement. Improvement science describes and explores improvement in real-life contexts and “system of profound knowledge” (Deming, 2000) is a cornerstone. Performance measures, including their variation over time, are fundamental in the research and evaluation of outcomes of continuous quality improvement efforts (CQI efforts). However, the strong emphasis on operationalisations and measurements risks overshadowing other kinds of outcomes to which CQI efforts can lead. Research has shown that it is advantageous that those performing change have some kind of “sharedness”, e.g. shared cognitions, understanding, knowledge, interpretations or frame of reference. Despite the diversity of concepts and scientific studies, “sharedness” is mainly described as a prerequisite for change. This thesis addresses the call to broaden the scientific approach in improvement science and to take advantage of knowledge developed since Deming's time. It has a point of departure in the presumption that CQI efforts also lead to intangible outcomes; qualitative effects that are not easily captured with traditional performance measures. The concept “Expressions of shared interpretations” is used to study “sharedness” as intangible outcomes. The overall aim with this thesis is to explore Expressions of shared interpretations as intangible outcomes of CQI efforts from the perspective of clinical microsystems and healthcare professionals. The specific aims are to examine and establish how Expressions of shared interpretations develop, influence CQI efforts and change over time. Using a qualitative approach, this thesis comprises four papers, based on three studies. The empirical context is healthcare and welfare organizations providing care: hospital clinics in county councils/regions and nursing homes in municipalities. The studies include time periods from one to three and a half years, totalling six years. Expressions of shared interpretations inherently mean that the methods for data analysis need to be based on commonalities or patterns in the data. In this thesis three methods are used: qualitative content analysis, thematic analysis and directed content analysis. To examine time-related changes, year-to-year comparative analyses of themes and categories are done. To explore Expressions of shared interpretations, different theoretical frameworks are used: team cognitions (Paper 1), sensemaking theory (Paper 2), cognitive shifts (Paper 3) and programme theories (Paper 4). A directed content analysis is applied in a meta-analysis of the results presented in the four papers. The results indicate that Expressions of shared interpretations develop as intangible outcomes of CQI efforts and a general programme theory of CQI efforts in health- and elderly care is developed, illuminating how Expressions of shared interpretations change and influence CQI efforts. The general programme theory incorporates the PDSA cycle and describes the complex, interconnected and continuous development of Expressions of shared interpretations. It also illuminates how Expressions of shared interpretations provide change performers with momentum to engage in forthcoming PDSA cycles and how sensemaking is a central activity. CQI efforts in health- and elderly care are characterised by a “just get on with it” attitude, while in this thesis, thoughtfulness is emphasized. Existing improvement tools support collaboration, creativity and analysis of critical aspects of the operations, yet none of the improvement tools help change performers gain understanding of the CQI effort as such. To address this, this thesis suggests that change performers complement the use of improvement tools with an inquiring mind, that they collaborate in thoughtful dialogues and that leaders function as inquirers. To support this posture, the widely used Model for improvement is complemented with a fourth question: What are our assumptions? The question pinpoints the need to be thoughtful in every step of the CQI effort, not just in the analysis of the problem at hand.

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Gilbert, Nathalie. "Understanding the Process of Patient Engagement in Planning and Evaluation of Health Services: A Case Study of the Psychosocial Oncology Program at the Ottawa Hospital." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37893.

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The underlying philosophy of patient-centred care (PCC) advocates for patients to have an active role in all areas of their care, including broader areas of the health care system such as planning and evaluation. Despite efforts made in the past decade that would see greater patient engagement, conventional evaluation approaches continue to dominate the landscape in health services evaluation. To date, limited empirical research has examined the effects of patient engagement or the best approach to engage patients (Abelson et al., 2015; Baker, 2014; Baker, Judd, Fancott, & Maika, 2016). Furthermore, a relative lack of collaboration and shared knowledge exists between the evaluation community and health sector in the rapidly developing area of patient engagement and the development of best practices. Consequently, health organizations continue to struggle with how best to involve patients (i.e., process) in health service improvement initiatives, as well as learn from patient experience (Baker, 2014; Baker, Judd, et al., 2016; Luxford et al., 2011). This dissertation responded to some of these challenges and through this intervention study, the specific purpose of the thesis study was to gain a better understanding of the process of patient engagement in planning and evaluation by addressing the following research questions: 1. What are the facilitators and barriers of engaging patients in planning and evaluation of health services and why? 2. What did the process of engagement look like with respect to Cousins and Whitmore’s (1998) three dimensions of collaborative inquiry? 3. What are the observed effects of the engagement process? This longitudinal qualitative case study began with the creation of the Patient and Family Engagement Committee (PFEC) at the Ottawa Hospital Psychosocial Oncology Program (PSOP) and completed an evaluation project over a period of six months. The research study occurred in parallel with the evaluation project and was designed to gain a better understanding of the process of patient engagement and the role that evaluation plays in this context. The study consisted of three phases and data collection relied on multiple sources. Facilitators that influenced the patient engagement process include: accommodating participant needs, commitment, orientation meeting, designated lead with evaluation skills, homework between meetings, and mutual respect. Having a designated lead, mutual respect, and commitment to the project were the three most highly endorsed facilitators at the end of the project. Conversely, barriers identified include time and resources, imbalanced participation, change in health status, and living at a distance. Time and resources was endorsed as the most significant barrier to the patient engagement process across all three phases of the study. Motivations for participant involvement revolved around giving back, improving health services, learning, commitment to research/evaluation, and providing or hearing a unique perspective. The study examined participatory aspects of the focal evaluation using Cousins and Whitmore’s (1998) three fundamental dimensions of process in collaborative approaches to evaluation: stakeholder diversity, control of evaluation process, and depth of participation. Findings revealed that intended benefits of participant involvement included reach to decision-makers, improved health services, increased diffusion of patient/family engagement, improved access/awareness of services, and a follow-up to assess influence of engagement. Participants’ experiences of being involved invoked enthusiasm for the project, were personally rewarding, instilled a sense of optimism that the project would have an influence, closed the loop on healing, contributed to a shift from a personal to broader health care focus, and contributed to learning. Further research is needed to gain a better understanding of the processes involved or evaluation approaches that could contribute to translating patient engagement into improved outcomes. The findings of this study have enhanced understanding of key contributions that patients, family members, health professionals, and evaluators bring to the patient engagement process, and enriched understanding of key facilitators and barriers to ensure successful patient engagement.

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Verma, Swati. "Defining service quality in an outpatient clinic with complex constituency." [Tampa, Fla.] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0002240.

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Lupaszkoi, Hizden Thomas. "Creating a community of practice to prevent readmissions : An improvement work on shared learning between an intensive care unit and a surgical ward." Thesis, Hälsohögskolan, Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-30244.

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Background ICU readmissions within 72 hours after discharge from the intensive care unit (ICU) is a problem because this leads to higher mortality and longer hospital stays. This is a particular problem for the hospital studied for this thesis because there are only three fully equipped ICU beds available. Aim To prevent readmissions by introducing nursing rounds as a concept of “communities of practice” (CoP) and to identify supportive and prohibitive mechanisms in the improvement work and knowledge needed for further improvement work in similar settings. Methods Questionnaires, focus groups, Nelson’s improvement ramp, and qualitative content analysis. Results There were no readmissions from the participating ward after the nursing rounds started, but the reason for this is not clear. The staff experienced the nursing rounds as valuable and they reported greater feelings of confidence, increased exchange, and use of their own knowledge. Discussion The findings presented here support that hypothesis that CoP builds knowledge that can improve patient care. The information provided to the participants during the improvement project was identified as the most supportive mechanism for improvement work, and a lack of resources was seen as the most prohibitive mechanism.

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Etheridge, Lucinda. "The trouble with culture : an interpretive case study of organisational culture, learning and quality improvement in the National Health Service." Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/10018723/.

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This interpretive case study investigates the relationship between organisational culture, organisational learning and cultural change in the National Health Service (NHS). Starting from a social constructivist standpoint, it conceives of organisational culture as a dynamic entity, socially and discursively constructed through engagement with surroundings, in contrast to the managerial discourse evident in NHS policy and research literature. The conceptual framework informing the research is based on cultural historical activity theory and a three perspectives theory of organisational culture. This allows exploration of individual and collective learning within the context of organisational social and cultural practice, exploring the organisation at the macro level but also through the lived experiences of individuals. An interprofessional department in an NHS provider organisation was studied for four months as it went through a programme of service improvement. Data was collected and analysed iteratively through a combination of observation, interview, documentary reading and field notes. Analysis using an activity theoretical approach generated a „thick description‟ of the organisation. Organisational stories were analysed to explore meaning making. Findings suggest that organisational culture can be considered a shared epistemic object within fluid networks of activity. Individual and collective learning is linked through practice, mediated by external political motivations and internally generated contradictions. Understandings of professional power play a major part and can lead to unexpected directions of travel. Conceptually, the study shows activity theory to be a useful framework for analysing learning and cultural change in NHS organisations. It adds to the debate on the self and the role of power and contradiction in activity theory through the application of a three perspectives approach to culture. It can help guide practitioners and policy makers in the NHS by encouraging them to rethink their understandings of culture and how cultural change is achieved through mediated practice.

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Eriksson, Per Gustav. "Analysis of Physiotherapists Perceptions for Improvement of Digital Innovation." Thesis, KTH, Medicinteknik och hälsosystem, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-279129.

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With the current challenges for the healthcare such as increased demand for care, financial and resource constraints along with rapid changes and complexity there is high believe in digital innovation and digitalisation to efficacy resources and aid in delivering a safer, more accessible and patient centred valuable care. There is a digitalisation that is ongoing, being used and implemented over several different areas of healthcare. Since healthcare can be seen as a complex adaptive system, there is a need to understand several agents. The aim is to gather more knowledge about perceptions within the physiotherapy staff and give recommendations and directions for improvements regarding digital innovation. Opinions about digital innovation have been gathered with open interviews and a semisystematic literature review with focus on physiotherapy. Too find subjective data the mixed method Q methodology was applied. The open interviews resulted in eight categories: digital innovation, digital innovation being used, digital innovation not used, management, obstacles, education, wishful thinking, applications and systems and associated opinions. The semi-systematic literature review showed on a rapid scientifically development, 25 articles was found and thematically analysed. 140 cited viewpoints and facts was merged with the results from the open interviews. Ten physiotherapists performed the q-sort consisting of 25 statements. Three factors were found. Interpreted as digital innovation optimism & patient oriented, digital innovation scepticism & management oriented and digital innovation sceptical optimism. Video-call technique is strongly encouraged by factor one contrary to factor two. Integrity is the major conflicting viewpoint between the factors. The result shows that gender can affect if a physiotherapist is either optimistic or sceptical to digital innovation. Using existing models such as UTAUT could improve acceptance about digital innovation. Education is perceived as important among all factors. Nine participants responded on baseline questions showing low knowledge of the term mHealth and little communication with IT departments.

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Karolina, Nord. "Att leva inte bara existera : Att arbeta personcentrerat med sociala aktiviteter på ett äldreboende." Thesis, Hälsohögskolan, Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-34180.

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Personcentrerad omsorg är en del av värdegrunden inom svensk äldreomsorg och har visat sig ha positiva effekter på de boendes välbefinnande och bibehållandet av förmågor. Syftet med förbättringsarbetet: Med stöd av förbättringsmetoder erbjuda de boende en mer personcentrerad omvårdnad genom ett systematiskt och kontinuerligt arbete med individuellt anpassade sociala aktiviteter och reminiscens. Syftet med studien av förbättringsarbetet var att beskriva omsorgspersonalens upplevelser av lärande och förbättringar både i sin arbetssituation och för de boende. Förbättringsarbetets metod mätningar och förbättringsverktyg. Förbättringsidén utgörs av tydliga rutiner för arbetsdagen och för morgonmötet, där individuellt anpassade aktiviteter skall vara inplanerade och genomföras minst en (1) ggr/vecka för varje boende. Studiens metod: Kvalitativ innehållsanalys av skriftliga svar på öppna frågor. Resultat: Vid mätperiodens slut syns en tydlig uppåtgående trend. Dock hade inte ett stabilt resultat med 1 aktivitet/vecka och boende uppnåtts. Alla avdelningar hade nya rutiner för dagen på plats samt en struktur för dagsplaneringen. Det mätinstrument som utvecklats under arbetet används systematiskt som både mät- och planeringsverktyg. Som en del i arbetet har bland annant Reminiscenslådor och Aktivitetsskåp utvecklats på boendet. Studien visade tydliga förbättringar i de boendes välbefinnande. De uppfattas som lugnare, mindre stressade och de uttrycker mindre ensamhet och oro. Omvårdnadspersonalen beskriver också tydliga förbättringar i sin arbetsmiljö, de känner sig mer tillfredsställda då de kan arbeta mer personcentrerat och de upplever bättre teamarbete och mer ordning och reda och struktur med de nya rutinerna på plats. Slutsats: Systematiskt arbete med rutiner kan frigöra tid till att arbeta mer personcentrerat och med att individanpassa de sociala aktiviteter som erbjuds de boende. Tydliga mandat, stöd från ledning samt tydlig coaching av medarbetarna är avgörande faktorer för att lyckas med förändringsarbetet.
Introduction: A quality improvement project was started to provide person-centered care through personalized social activities. The specific aim was to systematically offer residients person-centered care through personalized social activities minimum once a week. The aim of the study was to describe staff's views on learning and improvements both for the residents an in their work situation. Method: The improvement model was used throughout the improvement project. A tool to measure the number of activities in a simple and illustrative way was developed. The case study was conducted through open questions that the staff answered in writing. The material was then analyzed using qualitative content analysis. Results: The results have been going up consistently throughout the whole measuring period. All three sections at the nursing home have implemented new routines and structure for planning the day. The instrument to measure the number of social activities called "Blomman" is now also functioning as a planning tool. Boxes for Reminiscence and lockers with items and various tools for social activities have been installed. The quality improvement gave improvements in the wellbeing of the residents. The staff describes residents as calmer, less stressed and that they express less loneliness. The staff also desbride that they have gotten to know the residents better. The results also show that staff is more satisfied by providingt person-centered care. They work better as a team and have more order and structure and results show a general improvement in the work environment. Conclusion: Implementing routines and structure for planning can be a way of getting more time for the staff to provide more person-centered care. This can be done by individualizing social activities so that they correspond to the residents' needs and interests. To be successful it is essential to have support from the management for a project like this and to be able to support the staff throughout the change process.

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Gertsson, Sara-Marie. "Förbättrad vård efter bristning vid förlossning : En fallstudie om patientdelaktighet." Thesis, Hälsohögskolan, Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-46852.

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Bakgrund. Att få en allvarlig bristning i samband med förlossning kan ge kvinnor smärta, lidande, och låg livskvalitet under lång tid. Syfte. Syftet med förbättringsarbetet har varit att förbättra eftervården genom att införa strukturerad uppföljning, öka kvalitén i bedömning och diagnostik, förbättra informationen till patienten och utveckla former för patientdelaktighet i förbättringsarbetet. Syftet med studien har varit att ur ett verksamhetsperspektiv beskriva erfarenheterna av patientdelaktigheten i förbättringsarbetet. Metod. Förbättringsarbetet har designats med hjälp av Förbättringstrappan och utgått från ett patientprocessorienterat perspektiv. Metod för studien var kvalitativ i form av en fallstudie. Resultat. Genom förbättringsarbetet följs kvinnorna upp via bristningsregistret, uppföljningsbesök med 3D- ultraljud görs på en specialinrättad mottagning. Vidare får kvinnorna individuell fysioterapeutinformation innan hemgång, en vårdkedja har införts och former för patientdelaktighet har utformats och använts. Dessa är frågeformulär, intervjuer, workshops och patientföreträdare i förbättringsnätverket. Resultatet från studien visar att formerna för patientdelaktighet ger skilda förutsättningar för delaktigheten. Resultatet visar på betydelsen av organisatoriska förutsättningar, värdet av patientdelaktighet, utmaningar vid införande och vilket reellt inflytande som patientdelaktigheten haft under processen och för resultaten av förbättringsarbetet. Slutsatser. Patientdelaktighet skapar värde i flera dimensioner. Patientdelaktighet behöver designas, anpassas till kontexten och förbättringsarbetets mål och dess syfte behöver vara tydligt uttryckt.
Background. Perineal tears during childbirth can lead to after-delivery complications that leads to great suffering and low quality of life for a long time. Purpose. The purpose has been to improve after-delivery care by systematic follow-up, increasing the quality of diagnostics and management of these women, improving the information for the patient and developing new ways of improving including patients in the improvement work. The purpose of the study has been to study the effect of patient participation in the improvement work. Method. "The improvement ramp" and patient process-oriented perspective has been used to design the improvement work. The method of the study was qualitative in the form of a case study. Results. Follow-up using 3D-ultrasound is introduced. A care chain has been introduced and ways of patient participation have been designed and used. These are questionnaires, interviews, workshops and patient representatives in the improvement network. The results of the study show that the ways of patient participation provide different conditions for participation. The result shows the importance of organizational conditions, the value of patient participation, challenges in the introduction and the real influence that patient participation has had during the process and on the results of the improvement work. Conclusions. Patient-participation in QI creates values in several dimensions. Patient-participation needs to be carefully designed in compliance with context, goals and purpose.

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Mikkelä, Stange Karolina. "Raka vägen till raka tänder : Förbättring av ortodontisk diagnostik och behandling i allmäntandvården." Thesis, Hälsohögskolan, Jönköping University, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-50032.

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Tillgänglighet till ortodontisk vård behövde förbättras. Förbättringsarbetet fokuserade på processen för ortodontisk diagnostik och behandling i allmäntandvården. Syftet med förbättringsarbetet var att på ett mer resurseffektivt sätt identifiera och behandla patienter med ett ortodontiskt behandlingsbehov för att öka tillgänglighet och erbjuda patienterna optimal behandling. Studiens syfte var att utifrån berörda tandläkares erfarenheter utvärdera vad som har betydelse för att insatser för bättre ortodontisk vård fungerar som de gör. Förbättringsarbetet utgick från strukturen i förbättringsrampen. I fallstudien användes data från enkäter, intervjuer och förbättringsarbetet. Gemensam tolkning genomfördes med triangulering. Riktlinjer och förändrade ortodontikonsultationer infördes. Tiden för konsultationer för ortodontisten minskade trots bibehållen mängd patienter. I fallstudien identifierades stödjande och hindrande faktorer av betydelse för utfallet av förbättringsinsatserna. Förändringar i processen för ortodontisk diagnostik och behandling i allmäntandvården bidrog till att frigöra tid för ortodontisten och därmed förbättrad tillgänglighet till specialisttandvård för patienterna. Stödjande och hindrande faktorer av betydelse för insatser för bättre ortodontisk vård kan komma till nytta vid spridning av arbetssättet.
Access to orthodontic care needed to be improved. The improvement project focused on the process for orthodontic diagnosis and treatment in general practice. The aim of the improvement project was to make the process for orthodontic diagnosis and treatment planning more efficient, to improve accessibility and offer patients optimal treatment. The study aimed to explore the experience of dentists in general practice related to the impact of changes on orthodontic care. The improvement project followed the steps of the improvement ramp. In the case study data from questionnaires, interviews and the improvement project were used. Triangulation was used for interpretation. Guidelines and alterations in orthodontic consultations were introduced. Scheduled time for consultations was reduced, despite no change in the number of patients. The case study identified constraining and enabling factors to be considered in relation to the improvement project. Changes in the process contributed to making consultations less time consuming and thereby useful to improve accessibility to care. The impact of constraining and enabling factors in relation to the improvement efforts can promote transfer of learning to other caregivers in adopting improvement activities.

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Danko, Charlott. "Traceability of Medical Devices Used During Surgeries : A Study of the Current Traceability System at the Karolinska University Hospital in Solna and Research of Improvement." Thesis, KTH, Medicinteknik och hälsosystem, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-279135.

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The last few decades' development of technology has greatly affected healthcare. The implementation of technology in healthcare has advanced and improved it immensely, but it has also brought a new level of complexity. One of the modern issues introduced to healthcare is the traceability of medical devices. The main reason why traceability is becoming a more important matter in regards to healthcare is because of patient safety. Patient safety is one of the greatest priorities in healthcare but is constantly challenged by new innovations. Enabling traceability of medical devices is a part of the process of ensuring patient safety. The aim of this master thesis project was to research how medical devices used in surgeries are traced and how the routine can be improved. The idea of this thesis was based on the application of two new regulations, Regulation (EU) 745/2017 and Regulation (EU) 746/2017, both with the purpose of improving traceability. Qualitative methods such as observations, surveys, and interviews were used for this project. To gain multiple perspectives on the issue, different target groups were defined for the collection of data. The qualitative data was then analysed and conclusions based on the data could be drawn. The results of this project showed that the current traceability routine is lacking and that there is a lot of potential for improvements. The computer systems that manages information regarding medical devices can enable proper traceability if combined with other systems. Improvements of features in the systems are suggested, as well as an idea of an integrated system that combines functionalities of other software. Some of the project's challenges are discussed and suggestions for how to further develop the research are presented.

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Sjöstrand, Håkan. "Erfarenheter från införande av personcentrerad vård på en hjärtavdelning : En studie om effekter och upplevelser av ett förbättringsarbete med syftet att öka patientdelaktighet på hjärtavdelningen vid medicinkliniken i Växjö." Thesis, Hälsohögskolan, Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-37339.

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Inledning: En nyligen publicerad rapport visar att patientdelaktigheten i Sverige på flera sätt är låg i jämförelse med andra jämförbara länder. Personcentrering är ett förhållningssätt syftande till att öka patientdelaktighet och som i studier visat sig ha positiva hälsoeffekter. Vårdbehovet kan minskas framför allt för patienter med kroniska åkommor såsom hjärtsvikt vilket är den enskilt vanligaste orsaken till inneliggande vård i Sverige. Syfte: Syftet med förbättringsarbetet var att införa ett personcentrerat arbetssätt och därigenom öka patienternas delaktighet på en kardiologisk vårdavdelning. Syftet med studien av förbättringsarbetet var att undersöka personalens upplevelse av detta. Fynden skulle kunna underlätta vidare införande av denna arbetsmetod. Metod: Förbättringsarbetet bedrevs i projektform och genomfördes enligt Nolans förbättringsmodell. Ronden ersattes med ett fördjupat inskrivningssamtal varvid en skriftlig vårdplan upprättades. Patienterna fick skatta upplevd delaktighet i samband med hemgång. Personalens upplevelse studerades med induktiv kvalitativ ansats genom fokusgruppsintervjuer. Resultat: Enligt enkäterna var upplevelsen av delaktighet hög såväl före som efter införandet av personcentrerat arbetssätt, men variationen var stor. Samtliga yrkeskategorier tyckte arbetssättet gav mervärde, både för patienter och personal. Främst betonades ökad patientdelaktighet, bättre förståelse för sammanhanget, ökad teamkänsla och bättre framförhållning. Slutsats: Upplevelsen av införande av personcentrerad vård var allmänt positiv och skiljde sig inte mellan de olika yrkesgrupperna. Personal såg värde av ökad patientdelaktighet, bättre framförhållning samt ökad samstämmighet och samhörighetskänsla med ett personcentrerat arbetssätt.
Introduction: A recent published report shows that patient involvement in Sweden is in several ways low compared with other comparable countries. Person-centering is an attitude aimed at increasing patient involvement and which in studies has shown positive health effects. The need for care can be reduced especially for patients with chronic diseases such as heart failure, which is the single most common cause of inpatient care in Sweden. Purpose: The purpose of the improvement work aimed at introducing a person-centered approach and thereby increase the patient's involvement in a cardiac care department. The purpose of the study of the improvement work was to investigate the staff's experience of this. The findings could facilitate further implementation of this method of work. Method: Improvement work was conducted in a project form and implemented according to Nolan's improvement model. The round was replaced with an in-depth enrollment interview, and a written care plan was established. Patients were asked to rate their perceived involvement at time for discharge. The staff's experience was studied with inductive qualitative approach through focus group interviews. Result: According to the surveys, the experience of involvement was high both before and after the introduction of person-centered work methods, but the variation was high. All occupational categories thought the person-centered approach had added value, both for patients and staff. The main emphasis was on increased patient participation, better understanding of the context, increased team spirit and better advancement. Conclusion: The experience of introducing person-centered care was generally positive and did not differ between the different occupational groups. The staff saw value of increased patient involvement, better long term planning and increased coherence and sense of togetherness with a person-centered approach.

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McAllister, Steve Randolph. "Implementation of Food Safety Regulations in Food Service Establishments." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5902.

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Food service businesses in the United States have experienced millions of dollars in losses caused by foodborne illness outbreaks, which can lead to bankruptcy and business closures. More than 68% of all foodborne illness outbreaks occur in food service establishments. The purpose of this descriptive case study was to explore the strategies leaders of food service establishments use to implement food safety regulations. Force field analysis was the conceptual framework for this study. The population for the study consisted of 3 leaders of food service establishments located in the southeastern region of the United States. Data were collected using semistructured interviews and a review of the business policies and procedures that support compliance with critical food safety regulations. The methodological triangulation approach was used to assist in correlating the interview responses with company policies and procedures during the data analysis process. Yin's 5-step data analysis approach resulted in 3 themes: (a) organizational performance analysis for improvements in food safety, (b) strategies applied to improve food safety, and (c) stability of new strategies for food safety. The key strategies identified included adhering to the guidelines of food code and regulation, conducting employee training and awareness building, and working closely with food safety inspectors. The implications for positive social change include the potential to add knowledge to businesses, employees, and communities on the use of effective food safety strategies to minimize foodborne illnesses. Such results may lead to the improvement of service performance and long-term growth and sustainability of food service establishments.

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Edberg, Lina. "Förbättrad informationsöverföring i äldreomsorg : - en fallstudie om implementering av ett modifierat SBAR-verktyg." Thesis, Hälsohögskolan, Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-40744.

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Brister i kommunikation är den enskilt största orsaken till att avvikelser inträffar i hälso-och sjukvård. Genom att standardisera kommunikation och informationsöverföring minskar variationen, och logik och ömsesidig överenskommelse skapas. Syftet med förbättringsarbetet var att öka patientsäkerheten genom att förenkla kommunikationen inom teamet på ett vård-och omsorgboende, genom att införa kommunikationsverktyget SBAR. Den efterföljande studien syftade till att undersöka hur SBAR upplevs inom äldreomsorgen, och vad som kan vara framgångsfaktorer och fallgropar vid införande. Action research har tillämpats och en innehållsanalys har utförts efter fokusgruppsintervjuer. Verksamheten såg en positiv utveckling av förbättrad informationsöverföring men nådde inte upp till de uppsatta målen. SBAR upplevdes användbart när de professionella hade fått praktisk träning. De professionella kände en ökad trygghet då den muntliga rapporteringen kombinerades med skriftlig rapportering. Projektet skapade gemensamt lärande genom deltagande observationer. Projektet gjorde att de omgivande strukturerna blev tydligare för personalgruppen och informationsöverföringens fokus lyftes från individnivå till systemnivå. SBAR-strukturen förenklades något för att passa bättre i den flerspråkiga kontexten. Nya områden för förbättring identifierades och en aktivitetstavla skapades. Att hålla jämn utbildningstakt och utbilda vikarier var en utmaning i projektet.
Lack of communication is the single biggest reason for errors in healthcare. By standardizing the communication, the variation is reduced and logic and mutual agreement are created. The purpose of the improvement work was to increase patient safety by simplifying communication by introducing the SBAR communication tool. The subsequent study aimed to investigate how SBAR was experienced in the elderly care team, and to describe success factors and difficulties at the time of implementation. The author was inspired by action research. A content analysis has been applied on the data collected. There was an improvement in the information transfer, but the unit did not reach the set targets. SBAR was found useful by the professionals after practical training. The professionals felt greater security with a combination of oral and written report. The project created common learning through participatory observations and by clarifying the surrounding structures for the professionals. The project contributed to changed focus from an individual to a system level concerning the information process. The SBAR structure was slightly simplified to fit the multilingual context. New areas for improvement were identified and an activity board for the elderly was created. Keeping consistent education and training temporary staff was a challenge.

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Hördegård, Linda, and Anna Ninov. "Förbättringsarbete för patientsäkerhet och patientdelaktighet - en studie om medarbetarnas uppfattning av att använda digitaliseringsverktyg." Thesis, Hälsohögskolan, Jönköping University, The Jönköping Academy for Improvement of Health and Welfare, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-49963.

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Kilström, David. "Mot en rättssäker bedömning : Kvalitetsförbättringar av klinisk träning inom sjuksköterskeutbildningen utifrån en programteoretisk ansats med studie av samsyn mellan lärare." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-45291.

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Sjuksköterskors praktiska kunskaper är avgörande för säker vård. Inom sjuksköterskeutbildningen kontrolleras färdigheter genom färdighetsexaminationer. Utifrån kartlagda brister i rättssäkerhet och arbetsmiljö vid färdighetsexaminationer initierades ett förbättringsarbete. Syftet med förbättringsarbetet var att förbättra processen för klinisk träning inom sjuksköterskeprogrammet genom att utveckla färdighetsexaminationer. En studie av förbättringsarbetet genomfördes i syfte att: Undersöka samsyn mellan lärare kring färdighetsexamination som pedagogisk aktivitet. Analysera och utveckla initial programteori utifrån intervjudata. Förbättringsarbete har utformats efter förbättringsmodellen, förbättringsrampen och programteoretisk ansats. Studie genomfördes med kvalitativa intervjuer och innehållsanalys utifrån en interaktiv och abduktiv ansats. Förbättringsarbetet resulterade i minskad variation mellan lärare i bedömningen av färdighetsexaminationer. Nya arbetssätt har lett till ökad samsyn mellan lärare och bättre arbetsmiljö. Programteorin reviderades utifrån intervjudata. Minskad variation visar på en ökad rättssäkerhet. Reviderad programteori har ökat möjligheten att dra lärdom av förbättringsarbetet såväl lokalt som generellt. Arbetet har bidragit till en utveckling av sjuksköterskeutbildningen och dess bidrag till en god och säker hälso- och sjukvård.
Nurses' practical knowledge is crucial for safe care. Within the nursing program skills are checked through clinical examinations. Based on identified deficiencies in terms of legal validity and working environment related to clinical examinations improvement work was initiated. The purpose of the improvement work was to improve the process of clinical training within the nursing program by developing the clinical examination. A study of the improvement work was conducted with the purpose of: Exploring teachers shared interpretations with clinical examinations as an educational activity. Analysing and developing initial program theory based on interview data. Improvement work was designed according to the model for improvement, improvement ramp, and a program theory approach. The study includes qualitative interviews with content analysis based on an interactive and abductive approach. The improvement work led to improved consensus between teachers and a better work environment. A reduction in variation between teachers’ assessments of clinical examinations was reached. The program theory was revised based on interview data. Reduced variation shows increased legal validity. Revised program theory has increased the possibility of learning from the improvement work both locally and in general. The work has developed the nursing education and its contribution to good and safe healthcare.

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Maslan, Alma. "Personalens sjukfrånvaro som en kvalitetsaspekt i vård och omsorg: en kvalitativ studie av sjukfrånvaro och dess betydelse för hållbar kompetensförsörjning i hemtjänsten." Thesis, Högskolan i Jönköping, Hälsohögskolan, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-35666.

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Att värna och behålla en verksamhets mest värdefulla tillgång – dess mänskliga resurser – är av stor vikt för verksamhetens hållbarhet och framgång. Hälsa och ohälsa kopplat till arbetsmiljö- och kompetensförsörjningsfrågor har därför under en lång tid intresserat forskare. Den Svenska nationella statistiken över sjukskrivningar inom arbetslivet talar sitt tydliga språk: flest sjukfall har funnits och finns fortfarande bland vård- och omsorgsyrken. Med hänvisning till detta och med tanke på de utmaningar inom vård- och omsorg som avser svårigheter med kompetensförsörjning och rekrytering blir arbetsmiljöfrågor av ytterst vikt att fokusera på och undersöka vidare. Denna kvalitativa studie består av en intervjuundersökning med ett målstyrt urval. Syftet med studien är att belysa och fördjupa förståelsen för viktiga faktorer som medverkar till sjukskrivning av personal inom social omsorg. Resultaten bygger på svar från en semistrukturerad intervjuundersökning som genomfördes med 8 undersköterskor som arbetar i den kommunala hemtjänsten. Det empiriska materialet analyserades med hjälp av en tematisk innehållsanalys, vilket innebär att intervjumaterialet kategoriserades och analyserades utifrån ett index av centrala teman – de av intervjupersonerna beskrivna och identifierade huvudfaktorerna. Resultatet visar att fysiskt påfrestande arbetsuppgifter, väderaspekter, samt personalbrist är ergonomiska faktorer som leder till sjukfrånvaro i hemtjänsten. Psykosociala faktorer som beskrivs som medverkande till sjukfrånvaro anses utgöras av sammanhållningen i arbetslaget, ojämn arbetsbelastning som påverkas av brukaromsättning, mellanmänskliga relationer, strukturell organisering av arbetet, så som delade turer, när arbetsuppgifter utförs med minskad kvalitet, samt när personalen inte räcker. I uppsatsen redogörs först för den teoretiska bakgrunden och metod. Därefter belyses faktorer som bidrar till sjukfrånvaro och deras påverkan på personalens fysiska- och psykosociala arbetsmiljön. Uppsatsen avslutas med en diskussion om resultatet kopplat till kvalitetsförbättring.

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Lysfoss, Gunnerfeldt Malin. "Tre vägar mot en säkrare vård : Ett förbättringsarbete för att minska antalet fall och andel trycksår samt en kvalitativ studie om medarbetares erfarenheter av patientsäkerhetsarbete." Thesis, Jönköping University, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-54719.

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Vårdskador skapar lidande och ger ökade kostnader för vården. Fallskador och trycksår är två vårdskador som kan drabba en patient vid vistelse i slutenvården. Syftet med förbättringsarbetet var att minska antalet fall och andelen trycksår på lungmedicinavdelningen Skaraborgs sjukhus Skövde (SkaS). Genom att införa och implementera de förbättringsidéer som var: utbildning i hjälpmedel, Gröna korset och mentorskap var målen att antal fall i förhållande till antal vistelser skulle minska från 6 till under 4 fall per 100 vistelser och andelen trycksår, kategori 1–4 skulle ligga inom målvärdet <3 %. Syftet för studien var att undersöka medarbetares erfarenheter av patientsäkerhetsarbete på avdelningen i relation till förbättringsarbetet. Förbättringsarbetet skedde i microsystemet på en slutenvårdsavdelning och metoden utgår från Nolans förbättringsmodell. Mätningar för att följa resultatet bygger på värdekompassen. Kvalitativ metod med induktiv ansats valdes som metod för studien. Kvalitativa intervjuer med medarbetare utifrån en intervjuguide med semistrukturerade frågor har genomförts. Analysen av data har analyserats med kvalitativ innehållsanalys. De planerade förbättringsåtgärderna infördes under olika tidpunkter och resultatet av förbättringsarbetet visar att antalet fall har legat inom målvärdet en månad. Efter förbättringsarbetets start sågs en tydlig minskning av andelen trycksår och det låg inom målvärdet sex av tio månader. De förändringar som införts har ännu inte kunnat påvisa tydliga förbättringar Resultatet visar även att det finns förbättringsmöjligheter inom informationsöverföringen mellan medarbetare och patient när det gäller fallförebyggande och trycksårsförebyggande åtgärder. Då införandet av vissa förbättringsidéer dröjt på grund av arbete med covid-19-pandemin behövs ytterligare tid för att genomföra förbättringsidéerna. Resultatet av studien påvisar bland annat att en ökad kunskap om patientsäkerhet hos medarbetarna på avdelningen har skett och att patientdelaktighet är viktigt för ökandet av patientsäkerheten.
Health injuries create suffering and increase costs for care. Fall injuries and pressure ulcers are two health injuries that can affect a patient during a stay in inpatient care. The aim of the improvement project was to reduce the quantity of falls and the proportion of pressure ulcers at the pulmonary medicine department at Skaraborg Hospital in Skövde (SkaS). By implementing the improvement ideas that were: training in aids, the Green Cross and mentorship. The goals were that the number of falls in relation to the number of stays would reduce from 6 to under 4 falls per 100 stays and the proportion of pressure ulcers, categories 1-4 would be within the target value <3%. The purpose of the study was to study coworkers’ experiences of patient safety in the department in relation to the improvement work. The method is based on Nolan's improvement model. Qualitative method with inductive approach was the method for the study. Qualitative interviews with co-workers have been conducted. The analysis of data has been analyzed with qualitative content analysis. The planned improvement ideas were introduced at different times and the results of the improvement has not yet shown any clear improvement. Further time is needed to implement the improvement ideas. There are opportunities for improvement concerning information between co-workers’ and patients regarding fall and pressure ulcer prevention. The results of the study show, among other things, that an increased knowledge of patient safety among the co-workers’ in the department has taken place and that patient participation is important for increasing patient safety.

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Aronsson, Mattias. "Health Economic Evaluations of Screening Programs - Applications and Method Improvements." Doctoral thesis, Linköpings universitet, Avdelningen för hälso- och sjukvårdsanalys, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-141556.

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Screening to detect diseases early is attractive as it can improve the prognosis and decrease costs, but it is often a problematic concept and there are several pitfalls. Many healthy individuals have to be investigated to avoid a disease in a few, which results in a dilemma because to save a few, many are exposed to a procedure that could potentially harm them. Other examples of problems associated with screening are latent diseases and over-treating. The question of optimal design of a screening program is another source of uncertainty for decision-makers, as a screening program may potentially be implemented in very different ways. This highlights the need for structured analyses that weigh benefits against the harms and costs that occur as consequences of the screening. The aim of this thesis is, therefore, to explore, develop and implement methods for health economic evaluations of screening programs. This is done to identify problems and suggest solutions to improve future evaluations and in extension policy making. This aim was analysed using decision analytic cost-effectiveness analyses constructed as Markov models. These are well-suited for this task given the sequential management approach where all relevant data are unlikely to come from a single source of evidence. The input data were in this thesis obtained from the published literature and were complemented with data from Swedish registries and the included case studies. The case studies were two different types of screening programs; a program of screening for unknown atrial fibrillation and a program to detect colorectal cancer early. Further, the implementation of treatment with thrombectomy and novel oral anticoagulants were used to illustrate how factors outside the screening program itself have an impact on the evaluations. As shown by the result of the performed analyses, the major contribution of this thesis was that it provided a simple and systematic approach for the economic evaluation of multiple screening designs to identify an optimal design. In both the included case studies, the screening was considered costeffective in detecting the disease; unknown atrial fibrillation and colorectal cancer, respectively. Further, the optimal way to implement these screening programs is dependent on the threshold value for cost-effectiveness in the health care sector and the characteristics of the investigated cohort. This is because it is possible to gain increasingly more health benefits by changing the design of the screening program, but that the change in design also results in higher marginal costs. Additionally, changes in the screening setting were shown to be important as they affect the cost-effectiveness of the screening. This implies that flexible modelling with continuously updated models are necessary for an optimal resource allocation.

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Ström, Anna. "Samverkan för trygg hemgång : Ett förbättringsarbete om övergången mellan geriatrik, ASIH och primärvård för den multisjuka patienten." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-42022.

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Introduktion: Multisjuka patienter är individer med många sjukdomar och komplexa vårdbehov. För denna grupp är vikten av kontinuitet för att öka känslan av trygghet stor. Syfte med förbättringsarbetet: : Att skapa en trygg och möjlig ASIH-vård för multisjuka äldre genom att utveckla arbetssätt som möjliggör anslutning och en trygg utskrivning för multisjuka äldre. Syftet med studie av förbättringsarbetet: Att undersöka och analysera medarbetares gemensamma erfarenheter. Metod: Förbättringsarbetet genomfördes med stöd av Nolans förbättringsmodell. Studien av förbättringsarbetet genomfördes med en fallstudie med kvalitativ innehållsanalys. Resultat: Förbättringsarbetet resulterade i ett jämnt inflöde av remisser och kortare anslutningstid till ASIH. Patientens upplevelse av trygghet skattades i en enkät till 76%. Möjlighet till återanslutning till ASIH fick 7 patienter mellan 1-7 gånger under förbättringsprojektet. Studien av förbättringsarbetet sammanfattades i temat: ”Villkor för samverkan mot det gemensamma målet” då ett tydligt mönster framkom i fokusgruppsintervjuerna. Följande villkor sågs som betydelsefulla: kontinuitet, lärande, samarbete och kommunikation.. Diskussion: ASIH är en alternativ vårdform som kan bidra till att skapa trygghet och underlätta övergången till hemmet för gruppen multisjuka äldre. I bästa fall också minska behov av vård på akutsjukhus vid försämring. För att möjliggöra denna vård krävs återkoppling som skapar lärande genom tydliga mål och mätbara resultat.
Introduction: Patients with multiple illnesses are individuals with complex needs of care. For this group of patients, continuity of care and their sense of security is is of great importance. Improvement work objective: To create secure and accessible ASIH for elders with multiple illnesses by¨develop ways of working to enable re-admittance and secure discharges for this group of patients. Case study objective: To Investigate and analyze team members’ common experiences. Method: Implementation using Nolan’s improvement model. A case study using qualitative contents analysis. Result: The improvement work resulted in an even flow of referrals and shortened admission times to ASIH. Patients’ sense of security were rated to 76%. Seven Seven patients had the possibility towere be re-admitted 1-7 times 1-7 times during the project. Casestudy summary: ”Conditions for cooperationfor a common goal”. A clear pattern with the following significant conditions emerged from the focusgroups interviews: continuity, learning, cooperation, and communication. Discussion: ASIH can be an option to facilitate the transition home for elderly patients with multiple illnesses. ASIH provides a sense of security and may prevent re-hospitalization. This model of cooperation requires clear, common goals and opportunities for feedback to enable learning contributes to measurable results.

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Karlsson, Linda, and Ann-Helene Trofast. "Att förändra ett mikrosystem med hjälp av patientkontrollerad sedering : Studie angående medarbetares erfarenheter av systematiskt förbättringsarbete." Thesis, Jönköping University, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-53554.

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I dagens samhälle vill människor bli delaktiga och få medbestämmande. Personcentrerad vård medför att sjukvårdens strävar efter att patienten involveras och vården anpassas efter dennes behov och förutsättningar. På så sätt blir vården mer jämlik och kan utföras på ett kostnadseffektivt sätt. Vid utgångsläget på studerat sjukhus utfördes mindre gynekologiska interventioner på operationsavdelningen. Processen var resurskrävande och hade låg patientdelaktighet. Patientkontrollerad sedering (PCS) betyder att patienten styr sederingen själv. På så sätt kan både patientens delaktighet och värdet i mikrosystemet öka. Förbättringsarbetet innebar att utbilda sjuksköterskor från kvinnoklinikens mottagning att erbjuda PCS självständigt utan att anestesisjuksköterskan deltar. Då skapas möjlighet att utföra vissa interventioner på mottagningen istället för på operation. Syftet med förbättringsarbetet var att öka patientens delaktighet genom att införa patientkontrollerad sedering vid gynekologiska interventioner på kvinnoklinikens mottagning, Värnamo sjukhus. Eftersom detta arbetssätt inte är vedertaget var studiens syfte var att undersöka medarbetarnas erfarenheter av att erbjuda patientkontrollerad sedering. Förbättringsarbetet utgick från Nolans förbättringsmodell och strukturen i förbättringsrampen. Värdekompassens perspektiv och mätetal användes för att belysa effekten av förändringen, både för patienten, medarbetarna och verksamheten. Studien genomfördes med kvalitativ metod med hjälp av semistrukturerad fokusgruppintervju av medarbetare på kvinnoklinikens mottagning, Värnamo Sjukhus. Förbättringsarbetet resulterade i en funktionell sederingsmetod och ett förändrat mikrosystem för kvinnor som ska genomgå gynekologiska interventioner. Förbättringsarbetet stärkte patientens delaktighet och ökade möjligheten att bli en aktiv medspelare i sin egen vård. Samtliga värdekompassens balanserade mått påvisade att arbetssättet var välfungerande, patientsäkert och uppskattat både av patienter och medarbetare. Ytterligare effekt var att medarbetarnas kompetens ökade och att samverkan mellan klinikerna förbättrades. Studien påvisade att medarbetarna upplevde att det nya arbetssättet stärkte den personcentrerade vården. Införandet av PCS upplevdes både relationsskapande, engagerande och resurskrävande.
In modern society people prefer participation and co-determination. Person-centred care leads health care to involve the patient and the care adapts to the patient´s needs and conditions. This way the care will be more equal and can be performed in a more cost-effective way. Originally gynaecological interventions were costly performed in the operating room (OR) with lack of participation. Patient- controlled sedation (PCS) means that the patient controls the sedation itself. With this the patient's participation grows and increases value in the microsystem. The Quality improvement (QI) involved to teach nurses at the out-patient clinic (OPC) to handle PCS by themselves, without an anaesthetic nurse attending. In this way some interventions could be performed in the OPC instead of in the OR. The purpose of QI was to increase patient-participation by introducing PCS during interventions at the gynaecological OPC at Värnamo hospital. The study aimed at determining the co-worker's experiences when introducing PCS. The QI started from Nolans improvement model and the structure in the improvement ramp. The value-compass and measurements were used to evaluate the effects of the changes. The study was performed in a qualitative method with inductive approach using focus-group interview with co-workers at the gynaecological OPC. By introducing PCS in the QI women became participants in the gynaecological OPC. The QI resulted in that more interventions could safely be performed in the OPC. The new procedure makes the patient an active co-player, the competence of the co-workers rises, the collaboration between the clinics grows and the care is performed at the right level of care. The study showed that the co-workers experienced increased patient-centered care. The QI built relationships, was engaging and demanding resources.

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Aronsson, Frida, and Sofia Johansson. "Organisatoriskt lärande för att öka vårdkvalitet : Lärdomar av att utveckla processledning vid en operations- och intensivvårdsklinik." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-40722.

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Bakgrund: Komplexa verksamheter måste fokusera på processerna, ett organisatoriskt helhetsperspektiv och lärande samt ha patienten i centrum för att säkra vårdkvaliteten. På Operations- och intensivvårdskliniken, Ryhov, har processarbete påbörjats men utvecklingspotential finns samt utrymme för tydligare rutiner gällande patientdelaktighet. Syfte: Förbättringsarbetets syfte var att identifiera och minska kvalitetsgap i verksamheten som påverkar patienten, genom att utveckla klinikens processledning och det organisatoriska lärandet. Studiens syfte var att beskriva medarbetarens uppfattning om processledningens koppling till vårdkvalitet, samt beskriva deras erfarenheter från processledningsutvecklingsarbetet. Metod: Förbättringsarbetet har i projektgruppsformat och med Nolans förbättringsmodell utvecklat det organisatoriska lärandet kring två pilotprocesser. Studien av förbättringsarbetet är kvalitativ och baseras på sex fokusgruppsintervjuer. Intervjumaterialet analyserades med hjälp av kvalitativ innehållsanalys med induktiv ansats. Resultat: Processledning kräver tillgång till förbättrings- och yrkeskompetens. Organisationen måste ge förutsättningar för en varaktighet där nyttan är tydlig och resurser är tillräckliga. Vårdkvaliteten ökar när organisationen arbetar strukturerat, personcentrerat och med patientsäkerhet som fokus. Slutsatser: Processledning kan ge organisationen förutsättningar att skapa kontinuerlig förbättring med fokus på organisatoriskt lärande och ökad vårdkvalitet för patienten. Organisationen måste arbeta aktivt för att göra detta till en integrerad och levande del av verksamheten.
Background: Complex organizations need to be patient centred, focus on processes, have holistic view and promote organizational learning to secure quality. Operation and intensive care unit, Ryhov, has potential to develop its Process Management (PM) and there is room for improved patient participation. Purpose: The purpose of the quality improvement project (QIP) was to identify and reduce quality gaps affecting patients, by develop PM and organizational learning. The purpose of the study was to describe co-workers’ understanding of the connection between PM and quality of care and describe their experiences from QIP. Methods: The QIP has developed organizational learning concerning two pilot processes by using Nolan’s model for improvement. The study of the QIP is qualitative, based on six focus group interviews. Qualitative content analysis was used to analyse the interviews. Results: PM demands access to improvement and professional knowledge. The organization need to create conditions for sustainability, make benefits obvious and ensure enough resources. Quality of care increases when the organization works structured and patient centred. Conclusions: PM creates conditions for continual improvements with focus on organizational learning and increased quality of care. The organization need to actively make PM an integral and living part.

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Adeniran, Olayemi, and Kate E. Beatty. "The Role of Public Health Funding and Improvement of Health Status of Rural Communities." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6863.

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Local Health Departments (LHDs) are administrative unit of a local or state government, concerned with the health of a community or county. There are approximately 2,800 agencies or units that meet the profile definition of LHD. These LHDs vary in size and composition depending on the population they serve. However, all these communitybased agencies share a common mission of “protecting and improving community wellbeing by preventing disease, illness, and injury while impacting social, economic, and environmental factors fundamental to excellent health”. One of the ongoing challenge of a focus on community-level, population-based prevention is the manner in which local public health agencies have been funded. Most LHDs funding comes from federal funds, supplemented by state and local funds. Many of these funds come to LHDs through competitive grants programs. This study was therefore undertaken to investigate the sources of funding for the Local Public Health Agencies, according to geography specifically rurality. We utilized the data already compiled by the National Association of County & City Health Officials (NACCHO) in 2013. The population served by these health agencies were compared to the funding sources, and one –way ANOVA to estimate the significance between these variables. Our dependent variables were assigned to be the funding sources, while the independent variables were the two population categories –rural and urban. A categorical variable reflecting three levels of rurality was constructed using RUCA codes. “Urban” included census tracts with towns with populations >50,000. “Large rural” included census tracts with towns of between 10,000 and 49,999 population and census tracts tied to these towns through commuting. “Small rural” included census tracts with small towns of fewer than 10,000 population, tracts tied to small towns, and isolated census tracts. Furthermore, we also determined the proportion of revenue from these funding sources received by these three population groups. All analyses were completed using SPSS. There were no differences in the amount of revenues received by both the large and small rural and urban agencies from the State & Federal sources (p value = 0.182). However, urban agencies receive more funding from Medicare and Medicaid services (19.9%) compared to small rural with 6.9% (p<0.001). Comparatively, the amount of revenue generated by rural agencies is just a fraction of what the urban agencies generate. Residents of rural areas in the United States tend to be older and poorer, report more risky health behaviors, have more barriers to accessing health care, and have worse health status and health outcomes than do their urban counterparts. These rural LHDs have fewer resources and face strenuous challenges in carrying out their activities of keeping the community safe due to limited revenues. Until public health agencies are firmly connected to payment and funding mechanisms across the health system, communities, the overall health system and accountable care organizations will not see the true benefits of population-focused, community-based, prevention services.

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Engvall, Charlotte. "Förbättrade förutsättningar för resiliens inom specialiserad barnsjukvård : tillämplighet av ”Resilience Assessment Grid”." Thesis, Hälsohögskolan, Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-36618.

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Inom specialiserad barnsjukvård finns behov av säkerhetsstrategier utvecklade för komplexa adaptiva system. Tillvägagångssätt från ”Resilience Engineering” kan användas när säkerhetsstrategier utvecklas, men erfarenheten av detta är begränsad inom sjukvården. Masterarbetet genomfördes för att utforska hur ett förbättringsarbete kring att utveckla och använda instrumentet ”Resilient Assessment Grid”, RAG, kunde stödja medarbetarnas förutsättningar att arbeta på ett resilient sätt. Förbättringsarbetet genomfördes enligt Nolans förbättringsmodell. Studien var en fallstudie med kvalitativ ansats på en vårdavdelning inom specialiserad barnsjukvård. Studieresultatet visade att arbetet med att utveckla och använda RAG kunde stödja medarbetarnas förutsättningar att arbeta på ett resilient sätt genom att de fick tillgång till ett sätt att mäta förutsättningar för resiliens och genomföra strategiska förbättringsinterventioner. Medvetenheten och kunskapen om patientsäkerhet och resiliens ökade, vilket har lett till en ökad förståelse för verksamheten, och för vad som är viktigt för god patientsäkerhet. Vi har hittills inte kunnat påvisa förbättrade förutsättningar för resiliens genom att använda instrumentet RAG. Innan längre tid förflutit och ytterligare RAG-mätningar gjorts kan vi varken påvisa eller utesluta att förutsättningarna kommer förbättras. Erfarenheterna från masterarbetet kan nyttjas i kommande initiativ, inom komplexa adaptiva system i hälso- och sjukvården, som syftar till att förbättra förutsättningarna för resiliens.
This master´s thesis explores how an improvement work of developing and using the “Resilience Assessment Grid”, RAG, can support the potential for resilient performance on a paediatric ward, in light of the need for new safety strategies developed for complex adaptive systems. A qualitative case study of the improvement work was conducted. The improvement work was done according to the Model for Improvement. The work of developing and using RAG for measuring and managing resilient performance, supported the employees' potential for resilient performance by helping them in implementing strategic improvement interventions. The awareness and knowledge of patient safety and resilience increased, which led to increased understanding of the system and the needs of the system in terms of patient safety. We have not been able to show that the potential for resilient performance has improved by using RAG for measurement. We can neither demonstrate nor exclude that the potential will improve before further measurements have been made. Experience from the present study can be used in future interventions of improving the potential for resilient performance and patient safety in a complex adaptive system in the health care setting.

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Mangan, Brian Gerard. "The implementation and evaluation of a quality assessment and quality improvement system in mental health services within a health board." Thesis, Queen's University Belfast, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.301742.

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Johnson, Kendra, Kim K. Nguyen, Shimin Zheng, and Robin P. Pendley. "The Relationship between Quality Improvement and Health Information Technology Use in Local Health Departments." UKnowledge, 2013. https://uknowledge.uky.edu/frontiersinphssr/vol2/iss6/2.

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This research examined if there is a relationship between engagement in quality improvement (QI) and health information technology (HIT) for local health departments (LHDs) controlling for workforce, finance, population, and governance structure. This was a cross-sectional study that analyzed data obtained from the Core questions and Module 1 in the NACCHO 2010 Profile of LHDs. Descriptive statistics, bivariate analyses, and logistic regression analyses were conducted. Findings suggest that LHD engagement in QI has a relationship with utilization of HIT including electronic health records, practice management systems, and electronic syndromic surveillance systems. This study provides baseline information about the HIT use of LHDs. LHDs and their system partners (hospitals, federally qualified health centers, and primary care providers) that utilize HIT as part of their QI decision making may have an easier time of using data to support evidence-based decision making and implementing the provisions of the Patient Protection and Affordable Care Act of 2010 in order to achieve population health for all.

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Murray, Christopher J. L. "The determinants of health improvement in developing countries : case-studies of St. Lucia, Guyana, Paraguay, Kiribati, Swaziland and Bolivia." Thesis, University of Oxford, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.304625.

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Lai, Tai-yee Barbara. "Pay for patient satisfaction what is the evidence for quality of improvement? /." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B4299486X.

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Coronel, Gabriela V. "Long-Term Sustainment of Rapid Improvement Events: A Case Study in “Room Readiness”." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/honors/382.

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Shifting payment models from fee for service (FFS) to pay for performance (P4P) have fundamentally changed the environment of healthcare administration in the United States (Center for Medicaid and Medicare Services (CMS), 2011). Due to this shift, there has been an increase in demand for tracking and improving quality measures to ensure not only patient safety, but optimization of utilization. Constraints on resources and capacity, coupled with increasing safety measures has developed a new study of patient flow (Miró, Sánchez, Espinosa, et al., 2003). Decreasing patient room turnover times has the potential to maximize utilization while ensuring patient safety and quality (Dyrda, 2012). LEAN and A3 Methodology were applied to create a process improvement initiative at a 500-bed regional medical center (RMC). Using a Rapid Improvement Event (RIE), efforts were made to identify gaps and improve processes to address issues which prevented patients from being in the right place, for the appropriate amount of time, and patient rooms cleaned in a timely manner. These gaps prevented adequate patient flow in the RMC. After tracking the implemented improvements for a year, the RMC ceased following the newly designed process. This study examines the original RIE, factors that changed since the event, and additional process improvements made two years post-RIE.

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Mazur, Lukasz Maciej. "The study of errors, expectations and skills for medication delivery systems improvement." Thesis, Montana State University, 2008. http://etd.lib.montana.edu/etd/2008/mazur/MazurL0508.pdf.

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Medication errors occurring in hospitals are a growing national concern. The enormous gaps in knowledge related to medication errors are often seen as major reasons for increased patient safety risks and increased waste in the hospital setting. However, little research effort in industrial and management engineering has been devoted specifically to medication delivery systems to improve or optimize their operations in terms of patient safety and systems efficiency and productivity. As a result, the current literature does not offer integrated solutions to overcome the workflow and management difficulties with medication delivery. Therefore, a better understanding of workflow and management sources of medication errors is needed to help support decisions about investing in strategies to reduce medication errors. Using qualitative and quantitative research methods the work reported in this dissertation makes several contributions to the existing body of knowledge. First, using healthcare professionals' perceptions of medication delivery system, a set of simple and logical workflow design rules are proposed. If properly implemented, the proposed rules are capable of eliminating the unnecessary variations in the process of medication delivery which cause medication errors and waste. Second, a theoretical model of 'expectations' for effective management of medication error reporting, analysis and improvement is provided. The practical implication of this theoretical model extends to effective management strategies that can increase feelings of competence and help create a culture that values improvement efforts. Third, eight propositions for effective use of a systems engineering method (in this research the "Map-to-Improve" (M2I) method) for medication delivery improvement are offered. Finally, a set of skills needed for future healthcare professionals to effectively use systems engineering methods is provided. The proposed insights into these areas can result in improved pedagogy for professional development of healthcare professionals. The practical implication extends to the development of better methods for healthcare systems analysis. In summary, the author of this research work hopes that the findings and discussions will help healthcare organizations to achieve satisfactory improvement in medication delivery.

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Arsov, Svetoslav A. "Primary Care and Behavioral Health Services in a Federally Qualified Health Center." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6966.

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Between 2013 and 2016, 8.1% of U.S. adults 20 years and older suffered from depression, but only 29% of them sought help. This project addressed the low depression screening rate in a Federally Qualified Health Center (FQHC) that supported integrated care. The purpose of the project was to evaluate the integration of behavioral health into primary care in an FQHC through the rate of depression screenings. Two theoretical frameworks, the find-organize-clarify-understand-select/plan-do-study-act model and the Centers for Disease Control and Prevention's framework for program evaluation in public health were combined into a list of questions and data validity tests that were used to conduct the evaluation. This quality improvement (QI) project evaluated an existing QI initiative. Findings revealed that 75% of the patients seen, and not the initially reported 53%, received depression screenings, which indicated an improved outcome. Other findings were inadequate use of theoretical frameworks, poor data quality, and suboptimal effectiveness of QI team processes. The strategies and tools recommended in this project could be used by organizational leaders and QI teams to evaluate and improve QI initiatives. The project's contribution to awareness about depression through integrated care could increase patients' access to care, quality of life, and life expectancy, and positively impact social change.

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Hunt, Jennifer R., Kelli Jo Ouellette, and Michelle Reece. "Using Lean to Enhance Heart Failure Patient Identification Processes and Increase Core Measure Scores." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/8207.

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Background: Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. Health systems target readmission rates for quality improvement and cost reduction. Local Problem: Heart failure core measure (CM) scores at our medical center were lower than the national average, and methods for capturing the appropriate documentation on HF patients to ensure CM compliance were not clear. Methods: An interdisciplinary team determined barriers to increasing CM scores, gathered baseline data, and identified gaps in the existing process. Interventions: The team implemented an accurate reporting system and error-proofing process, redesigned the process for identifying patients admitted with a HF diagnosis, and developed a patient appointment section before discharge in the electronic medical record. Results: There was a decrease in readmissions within 30 days of implementation from 12% to 8%, and HF CM compliance score increased from 88% to 100%. The percentage of HF patients not identified during hospitalization decreased from 17% to 0%. Heart failure patients discharged with a 7-day follow-up appointment increased from 88% to 98%. Conclusion: Through implementation of an interdisciplinary-led process improvement and lean methodologies, metrics and CMs were achieved.

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Kerrins, Ryan, and Jean Hemphill. "Screening, Brief Intervention and Referral to Treatment (SBIRT): Process Improvement in a Nurse-Managed Clinic Serving the Homeless." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/12.

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Purpose The Johnson City Downtown Day Center (JCDDC) provides integrated inter-professional primary care, mental health, and social work case management services to homeless and under-served persons who have difficulty accessing traditional systems. Because of the exponential rise in substance abuse in the Appalachian region, the JCDDC providers and staff initiated SBIRT as recommended standard of care, as endorsed by SAMHSA, United States Public Health Services Task Force, and the National Institute on Alcohol Abuse and Alcoholism. The JCDDC has two mechanisms by which patients can choose to participate in substance abuse treatment: SMART Recovery, and psychiatric nurse practitioner (NP) referrals. The purpose of the project evaluates use of SBIRT at the JCDDC by determining process of (1) referral and (2) follow-up rates of those who received SBIRT; analyzing outcomes by measuring numbers of: (1) screens administered; (2) brief interventions; (3) positive screens; (4) referrals to either SMART Recovery or to the psychiatric NP; (5) participation in one follow-up. Review of Literature: Approximately 6.4 million people, or 2.4% of the U.S. population 12 years and older, currently misuse prescription medications. There is an undeniable and tangible correlation between the chronic disease of substance use disorder and unstable housing or homelessness (de Chesnay & Anderson, 2016). Similarly, substance use disorder was found to be much more common in people facing homelessness than in people who had stable housing (National Coalition for the Homeless, 2009). Substance Abuse and Mental Health Services Administration (SAMHSA) has been the most significant funding source for SBIRT proliferation in the United States. Despite a demonstrated need for substance abuse services among this vulnerable population, people who are homeless have substantially greater barriers to obtaining treatment and often go without. Summary of Innovation or Practice The current SBIRT process includes use of DAST-10 and AUDIT tools. Evaluating clinic processes and outcomes in vulnerable populations who have inconsistent erratic follow-up is challenging. However, new ways of understanding patterns and incremental outcomes is essential to addressing clinic practice that can impact outcomes in vulnerable groups. Implications for NPs The heterogeneity of the homeless population is often precipitated by a host of complicating factors including co-occurring mental illness, multiple chronic conditions, unstable income, and lack of transportation. Therefore, the importance of finding effective, cost-conscious processes that are population specific and patient-centered is essential for future research and policy. The inter-professional model of care also informs future practice by evaluating the feasibility of administering all of the elements of SBIRT in a single facility.

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Grubnic, Suzana. "The social construction of care pathways : a nursing management initiative towards operationalising continuous quality improvement in a children's hospital." Thesis, University of Derby, 2000. http://hdl.handle.net/10545/227118.

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The literature is dominated by prescriptive accounts of the application of Continuous Quality Improvement and care pathways in the acute hospital services sector. The authors assume that the organisation is a designed artefact (Scapens, Otley and Lister, 1984): goals can be achieved. This thesisr eports on the nature, processa nd consequenceso f a Nurse Manager introducing care pathways in a Children's Hospital It believes, in opposition to the conventional view, that the organisation is a culture. The actions and interactions of individuals and groups shape initiatives. This is within context and within time. The research investigation was conducted over a twenty-five month period, from February 1996 to April 1998. It was ethnographic in nature. Interviews were conducted with managers, nurses and doctors, formal meetings and activity in the Children's Emergency Department observed, and documentation collected. The findings are, however, presented from the nurses' perspective using their words. Files for newspaper clippings were created and maintained. The thesis contributes to the literature in three ways. In the main, it represents the first contextual and critical account of the implementation of care pathways than that believed to be contained in the literature. Further, it purposefully utilises for the first time two conceptualf rameworks in order to explicate the changep rocessesin the Children's Hospital. These are Watson's (1994) Strategic Exchange Perspective and Dawson's (1994) Processual Framework. It presents the descriptive part of the findings in the form of a narrative. The Nurse Manager established a project to multiskill experienced nurses in the diagnosis and treatment of minor conditions using care pathways as the vehicle. Her role changed during the process of implementation, but the project had little, if no, impact on power structures between and decision making of doctors and nurses

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Clark, Rebecca Teresa, Christine Michelle Mullins, and Jean Croce Hemphill. "Monitoring Prediabetes Screening in Two Primary Care Clinics in Rural Appalachia: A Quality Improvement Project." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/12.

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Introduction: Prediabetes is major risk factor for the development of Type 2 Diabetes Mellitus (T2DM). One-third of the population in the United States has prediabetes, but 90% remain undiagnosed because healthcare providers are not performing screenings, making this a public health challenge. The purpose of this process improvement project was to implement prediabetes screening, prediabetes identification, and a referral process to a nutritionist to prevent or delay the onset of T2DM in patients in two Federally Qualified Health Centers. Methods: This was a quality improvement project conducted over a six-week period after receiving exemption from the University’s Internal Review Board. The Knowledge to Action framework was used to guide implementation of screening, prediabetes identification, management, and referral process. The outcomes were to measure the number and percent of screenings performed after provider education on prediabetes screening, those at risk for prediabetes, and the evidence-based interventions providers chose for management. The prediabetes risk assessment tool (PRAT) was the “Are you at risk for Type 2 Diabetes?” It was administered in both English and Spanish to adults who were not pregnant and had no previous diagnosis of Type 1 Diabetes Mellitus or T2DM. The preferred interventions included referral to a nutritionist, encourage 5%-7% total body weight loss, and/or 150 minutes of exercise per week. The PRAT and interventions data were coded, extracted into SPSS Version 25, and analyzed. Descriptive statistics were used to report patient characteristics, quantity of screenings performed, evidence-based recommendations offered, and patient risk factors for prediabetes. Results: In both clinics, 41% (n=269) of patients screened were found to be at risk for prediabetes. The most self-reported risk factor for prediabetes was family history of T2DM. Healthcare providers mostly provided education on weight loss and exercise, and recommended/referred less than 20% (n=49) of patients for nutritional education. The screening rates in the clinics were 52% (n=92) at site A and 72% (n=177) in site B, falling below the goal of 100%. Conclusions: There remains a gap in provider knowledge and use of evidence-based recommendations to decrease patients’ risk for prediabetes. The authors project that implementation of the PRAT and evidence-based interventions in the electronic health record would positively impact future screening results. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.

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Nichols, Sarah, Nathan Justice, Anjali Malkani, and David Wood. "The Path(way) to a Clean Colon: Improving the Management of Functional Constipation." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/42.

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Title: The path(way) to a clean colon: Improving the management of functional constipation Authors: Sarah Nichols, D.O. Pediatrics Resident, Nathan Justice, M.D. Pediatrics Hospital Medicine, Anjali Malkani, M.D. Pediatric Gastroenterology, David Wood, M.D., MPH General Pediatrics and Adolescent Medicine Purpose / Objectives: Hospitalization for the treatment of functional constipation is a leading cause among encounters that incur a financial loss at our institution. There are few resources that describe best practices or quality improvement efforts in the management of children who are hospitalized with functional constipation. A clinical pathway was implemented to promote interventions that improve hospital resource utilization for this group of children. Design / Methods: A clinical pathway was developed by a multidisciplinary team of stakeholders. The pathway emphasized interventions known to improve resource utilization and believed to facilitate a more effective and efficient cleanout. The inpatient arm of the pathway was implemented on a 24-bed medical/surgical unit; members of the medical and clinical staff of this unit received education with dissemination of the pathway. An electronic order set was implemented concurrently to facilitate practitioners’ application of pathway recommendations. Plan-Do-Study-Act (PDSA) cycles were used to monitor process measures and outcomes. Inpatient utilization was selected as the primary outcome for this effort’s first iteration; length of stay and frequency of readmissions were monitored as a secondary outcome and balancing measure, respectively. Results: Pathway utilization reached 65% within two periods of implementation. Adherence to selected process measures exceeded 80% within two periods. Inpatient utilization demonstrated initial improvement, increasing from 20% at baseline to 50% post-implementation; however, it subsequently fell below baseline performance after third-party payers revised admission criteria during period 6. Length of stay and frequency of readmissions remained unchanged post-intervention. Conclusion / Discussion: A clinical pathway for the treatment of functional constipation was quickly adopted by clinicians within two periods of implementation (spanning two months). The pathway was effective at promoting interventions that improved inpatient utilization; however, these improvements could not be sustained in the face of an unanticipated, external force. Future improvement cycles will be directed at reducing the length of stay to improve hospital resource utilization.

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AOYAMA, ATSUKO, SANEYA RIZK EL BANNA, MICHIYO HIGUCHI, NAGAH MAHMOUD ABDOU, NAWAL ABDEL MONEIM FOUAD, INASS HELMY HASSAN ELSHAIR, LEO KAWAGUCHI, and CHIFA CHIANG. "IMPROVEMENTS IN THE STATUS OF WOMEN AND INCREASED USE OF MATERNAL HEALTH SERVICES IN RURAL EGYPT." Nagoya University School of Medicine, 2012. http://hdl.handle.net/2237/16734.

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Islam, Farzana. "Quality Improvement System for Maternal and Newborn Health Care Services at District and Sub-district Hospitals in Bangladesh." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-48416.

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In Bangladesh, research focusing on the quality of maternal and newborn health (MNH) services in hospitals remains neglected. There have only been a few studies conducted on quality issues and found the quality of MNH care provided at district and sub-district hospitals to be poor. The overall objective of this thesis was to develop, implement and evaluate a framework for quality improvement (QI) system for MNH care at the district and sub-district level government hospitals in Bangladesh. The thesis is comprised of four papers. Mixed methods were used in paper I and paper IV. In paper II quantitative methods were utilized, and to develop the “Model QI System”, exploratory methodological approaches were used and illustrated in paper III. Group discussions, focus group discussions, in-depth interviews, documents review and photography were utilised as qualitative data collection techniques. Through structured observation and exit interviews quantitative data were obtained. Findings of baseline survey identified several keyfactors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under useof patient-management protocols; lack of training; and insufficient supervision. The clinical performance of health care providers was found unsatisfactory. Utilizing the baseline survey findings and existing information on QI models, theories and QI intervention programmes implemented in defferent settings an adapted “Model QI System” and its implementation framework, guidelines and tools were developed. The key areas of this “Model QI System” included health system support, clinical service delivery, inter-departmental coordination; and utilization of services and client satisfaction. The adopted “Model QI System” was incorporated within the existing hospital management system and it was found that the quality of care improved. The evaluation of the study showed that the “Model QI System” was acceptable to the top health managers, health care providers and hospital support staff and feasible to implement in district and sub-district hospitals in Bangladesh.

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Lai, Tai-yee Barbara, and 黎德怡. "Pay for patient satisfaction: what is the evidence for quality of improvement?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B4299486X.

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Petitfour, Laurène. "Potential for improvement of efficiency in health systems : three empirical studies." Thesis, Université Clermont Auvergne‎ (2017-2020), 2017. http://www.theses.fr/2017CLFAD012/document.

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Dans l'optique du troisième Objectif de Développement Durable ("Santé et Bien-Etre pour tous"), il est nécessaire d'augmenter les ressources consacrées à la santé dans les pays à faible revenus, mais aussi de s'assurer que ces ressources sont allouées de façon optimale. Pour cela, les mesures d'efficience sont un outil d'analyse adapté pour évaluer la performance des systèmes au niveau macroéconomique ou des établissement de santé au niveau microéconomique, afin d'obtenir "plus de santé pour son argent" (Organisation Mondiale de la Santé, 2010). Au travers de ses quatre chapitres, cette thèse s'inscrit dans la littérature empirique de l'évaluation de l'efficience des systèmes de santé.Le premier chapitre est une revue méthodologique des mesures non-paramétriques d'efficience, utilisées dans les trois chapitres empiriques qui suivent. Le second chapitre estime l'efficience d'un échantillon de 120 pays à revenu faible ou intermédiaire de 1997 à 2014. On considère que les systèmes de santé produisent des résultats en termes de santé (de la survie maternelle et infantile) grâce à des dépenses de santé. Les résultats montrent que, pour un état de santé identique, les pays de l'échantillon pourraient dépenser 20\% de ressources en moins en moyenne, et que l'inefficience augmente avec le niveau de développement.Les deux derniers chapitres sont des études de cas. Le troisième porte sur un échantillon d'hôpitaux municipaux à Weifang, dans la province chinoise du Shandong. Il met en lumière, grâce à des données d'enquête, le potentiel d'amélioration en termes de performance, et le rôle de certains facteurs sur l'inefficience des hôpitaux: la demande de soins, et la part de subventions dans leur revenu. Le quatrième chapitre traite de l'efficience des établissements de soins de santé primaires à Oulan-Bator, en Mongolie. Avec les mêmes ressources, ils pourraient produire 30\% de soins supplémentaires en moyenne. Le bassin de desserte est positivement associé au niveau d'efficience, mais la faible rémunération du personnel, ainsi qu'un équilibre sous-optimal entre personnel médical et non-médical semblent freiner l'efficience des établissements de santé
In the perspective of the third Sustainable Development Goal ("Good Health and Well-being"), it is necessary to increase financial resources for health in low income countries, but also to ensure that those resources are optimally allocated. To this purpose, efficiency measures appear as a useful tool to assess the performance of healh systems at the macroeconomic level, or of health facilities as the microeconomic level to get "more health for the money" (WHO,2010). Through its four chapters, this thesis provides some empirical evidence to the assessment of the efficiency of health system.The first chapter is a methodological review of nonparametric efficiency measures, used in the three empirical studies that follow. The second chapter assesses the efficiency of a sample of 120 low and middle income countries over the 1997/2014 period. Production function is defined as health expenditures producing health outcomes (maternal and juvenile survival). It concludes that, for the same health outcomes, countries could spend more than 20\% for the same health outcomes, and that inefficiency increases with the level of development of coutries. The last two chapters are case studies. The third one focuses on Township Health Centers in Weifang, Shandong province, China, relying on survey data. It highlights the potential for performance improvement and the role of demand side determinants and of the share of subsidies in incomes to explain efficiency scores. The fourth chapter deals with the efficiency of primary healthcare facilities in Ulan-Bator, Mongolia. It concludes that efficiency could be spurred by about 30\%. Demand side factors are positively associated to efficiency, but low levels of staff remuneration, as well as a suboptimal balance between medical and non-medical staff seem to hinder activity and efficiency of health facilities

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Wood, III John. "The Influence of Emergency Department Wait Times on Inpatient Satisfaction." Thesis, University of North Texas, 2019. https://digital.library.unt.edu/ark:/67531/metadc1609108/.

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Patient satisfaction dimensions have a wide ranging and significant impact on organizational performance in the healthcare industry. In addition, the Centers for Medicare and Medicaid Services Hospital Value Based Purchasing (HVBP) Program links patient satisfaction to Medicare reimbursement, putting millions of dollars at risk for health systems. A gap in the literature exists in the exploration of how a patient's experience in the emergency department affects their satisfaction with inpatient services. In a multiple regression analysis, the relationship between HVBP Patient Experience of Care and hospital level factors including emergency department wait times are explored. Results indicate a statistically significant relationship between hospital level factors and standardized measure of patient satisfaction with a moderate adjusted effect size (p= <.0001, R2 adjusted= 0.184). Emergency department wait times post physician admit orders were most salient in predicting patient satisfaction scores (rs2= 0.434, β= -0.334, p= <.001). Recommendations to improve emergency department wait times include focusing on key decision points and implementation of electronic systems to support the movement of admitted patients out of the emergency department as quickly as possible.

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Alkahtani, Minahi Mesfer. "An Evaluation of Modified Empathic Design for the Improvement of the Quality of Primary Health Care Services in Saudi Arabia." Thesis, Lancaster University, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.518156.

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Caldana, Graziela. "Adaptação transcultural e validação do questioná¡rio Quality Improvement Implementation Survey e subescalas do Preparation of Health Services for Accreditation." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-31072018-104428/.

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Na perspectiva de contribuir para a melhoria da qualidade, os serviços de saúde precisam desenvolver e aprimorar seus processos internos para melhoria de seus resultados assistenciais. A adoção de programas para a melhoria contínua da qualidade, como a acreditação, é uma maneira de avaliar se esses processos promovem, de fato, a segurança e a qualidade do atendimento. Este estudo, de delineamento metodológico, objetivou adaptar e validar, para uso no Brasil, instrumentos que possibilitem mensurar aspectos destes programas de melhoria da qualidade. Para tanto optou-se pelo questionário Quality Improvement Implementation Survey II (QIIS) e pelas subescalas do Preparation of Health Services for Accreditation (PHSA), analisando as suas propriedades psicométricas para profissionais que atuam nas áreas assistenciais, administrativas e de apoio de hospitais acreditados. O QIIS é divido em duas seções, denominadas A e B. A primeira mensura e classifica o tipo de cultura na qual se enquadra o hospital; as respostas são obtidas em escores entre 0 e 100 pontos e integra cinco subescalas e vinte itens analisados em quatro categorias: Cultura de Grupo; de Desenvolvimento; Hierárquica e Racional. A seção B destaca as ações do hospital para a melhoria da qualidade; apresenta sete subescalas com cinquenta e oito itens: Liderança, Informação e Análise, Planejamento Estratégico da Qualidade, Utilização de Recursos Humanos, Gestão da Qualidade, Resultados da Qualidade e Satisfação do Cliente. As subescalas denominadas Acreditação e Benefício da Acreditação foram adotadas do PHSA. A primeira subescala possui quatro itens e a segunda, oito. Tanto para a seção B do QIIS e subescalas do PHSA, as respostas foram medidas por meio de escalas do tipo Likert. O delineamento metodológico seguiu os seguintes passos: tradução e síntese das traduções, avaliação por comitê de especialistas, retrotradução, pré-teste e análise das propriedades psicométricas. Os dados foram coletados em sete hospitais 8 acreditados, no período de junho de 2016 a agosto de 2017. Participaram do estudo 581 profissionais. A validade de face e conteúdo dos instrumentos foi avaliada pelo comitê de especialistas, tradutores, respondentes do pré-teste e pelas pesquisadoras que conduziram este estudo. Quanto à análise das propriedades psicométricas, realizou-se a Análise Fatorial Exploratória e Análise Fatorial Confirmatória. Em termos de resultados, o delineamento do perfil da amostra apresentou-se de maioria feminino (68,2%), com idade média de 35,4 anos e cerca de 8 anos de atuação nos hospitais, sendo que a maioria das respostas eram de sujeitos que atuavam em hospitais com fins lucrativos (66,4%), 19% de respostas foram de hospitais públicos e 14,2% de filantrópicos. Após ajustes do modelo, a seção A da versão final do QIIS passou a ter quatro subescalas e treze itens; já a seção B, o mesmo número de subescalas, porém com quarenta e um itens. Quanto às subescalas do PHSA, houve mudança apenas na segunda (Benefício da Acreditação), com a exclusão de dois itens. Com relação à confiabilidade, obteve-se valor adequado para a consistência interna das seções A e B da versão adaptada do QIIS e subescalas do PHSA, tendo os Alphas de Cronbach variando de 0,64 a 0,94; exceto na categoria \"Cultura Racional\", que não apresentou medidas de ajustes adequadas (Alpha 0,53). Diante dos resultados, conclui-se que, apenas na categoria \"Cultura Racional\" não houve medidas adequadas para a sua aplicabilidade. A versão adaptada do QIIS e escalas do PHSA atenderam aos critérios de validade e confiabilidade na amostra estudada. Acredita-se que a utilização possibilitará um diagnóstico situacional dos hospitais brasileiros que adotaram a acreditação como estratégia para a melhoria contínua da qualidade
In order to contribute to the improvement of the quality of health services need to develop and improve their internal processes to improve their care results.. The adoption of programs for continuous quality improvement, such as accreditation, is one way to assess whether these processes actually promote safety and quality of care. The purpose of this study was to adapt and validate the Quality Improvement Implementation Survey II (QIIS) and subscales of the Preparation of Health Services for Accreditation (PHSA) for use in Brazil, as well as to analyze its psychometric properties for professionals working in care areas , administrative and support services of accredited hospitals. The QIIS is divided into two sections, named A and B. The first measures and classifies the type of culture in which the hospital fits; the answers are obtained in scores between zero and 100 points and integrates five subscales and twenty items analyzed in four categories: Group Culture; Hierarchical and Rational; of Development. Section B highlights the hospital\'s actions to improve quality; presents seven subscales with fifty-eight items: Leadership, Information and Analysis, Quality Strategic Planning, Use of Human Resources, Quality Management, Quality Results and Customer Satisfaction. The Accreditation and Accreditation Benefit subscales were adopted from the PHSA, used to measure the results of the implementation of an accreditation program under the nurses\' perspective. The first subscale has fourth items and the second, eight. For both section B of QIIS and PHSA, responses were measured using the Likert scale. The methodological design followed the following steps: translation and synthesis of translations, evaluation by expert committee, back-translation, pre-test and analysis of psychometric properties. Data were collected from seven accredited hospitals from June 2016 to August 2017. A total of 581 professionals participated in the study. The face and content validation of the instruments was evaluated by the committee of experts, translators and researchers who conducted this study. Regarding the analysis of the psychometric 10 properties, the Exploratory Factor Analysis and Confirmatory Factor Analysis were performed. In terms of results, the outline of the sample profile was female (68.2%), with an average age of 35.4 years and and about 8 years old in hospitals, with the majority of responses being from subjects who worked in for-profit hospitals (66.4%), 19% from public hospital responses and 14.2% from philanthropists. After adjustments of the model, section A of the final version of QIIS, now has four subscales (thirteen items); already section B, the same number of subscales, but with forty-one items. As for the subscales of the PHSA, there was change only in the second subscale (Benefit of Accreditation), with the exclusion of two items. Regarding reliability, an adequate value for the internal consistency of section A and B were obtained, of the adapted version of the QIIS and subscales of the PHSA with the alphabets of Cronbach varying from 0.64 to 0.94; except in the \"Rational Culture\" category, which did not present adequate adjustment measures (Alpha 0.53). In the light of the results, it is concluded that, only in the category \"Rational Culture\" there were no adequate measures for its applicability. The adapted version of the QIIS and PHSA scales met the criteria of validity and reliability in the sample studied. It is believed that the use will enable a situational diagnosis of Brazilian hospitals that have adopted accreditation as a strategy for the continuous improvement of quality

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Calero, Lucero, Aracelli Maccasi, and Carlos Raymundo. "Lean model of services for the improvement in the times of attention of the emergency areas of the health sector." Springer Verlag, 2020. http://hdl.handle.net/10757/656140.

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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
In Peru, the health service has had certain problems in the attention of users. The emergency service of clinics has been saturated due to changes in the needs of people and demand, exposing the prestige of health entities that have this unit and generating risks for the health of users, this is reflected in the low level of satisfaction with regard to care. Based on the Lean philosophy, a model is developed using SMED, Kanban and pull tools to reduce waiting times. The application of this model of pilot in the Clinic reduces the waiting time for the first attention in 30% thereby reducing the number of fines imposed by the corresponding regulatory entity and the desertion in emergency, achieving an average time of 37 min.

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Bardach, David R. "Evidence-Based Hospitals." UKnowledge, 2015. http://uknowledge.uky.edu/epb_etds/5.

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In 2011 the University of Kentucky opened the first two inpatient floors of its new hospital. With an estimated cost of over $872 million, the new facility represents a major investment in the future of healthcare in Kentucky. This facility is outfitted with many features that were not present in the old hospital, with the expectation that they would improve the quality and efficiency of patient care. After one year of occupancy, hospital administration questioned the effectiveness of some features. Through focus groups of key stakeholders, surveys of frontline staff, and direct observational data, this dissertation evaluates the effectiveness of two such features, namely the ceiling-based patient lifts and the placement of large team meeting spaces on every unit, while also describing methods that can improve the overall state of quality improvement research in healthcare.

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Karpenko, Veronika. "Clinically Significant Symptom Change in Adolescents Receiving Outpatient Community Mental Health Services: Does it Relate to Satisfaction, Perceived Change, Therapeutic Alliance, and Improvement in Presenting Problems?" Ohio University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1273609072.

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Dolgin, Natasha H. "Frailty and Outcomes in Liver Transplantation: A Dissertation." eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/817.

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In recent years, the transplant community has explored and adopted tools for quantifying clinical insight into illness severity and frailty. This dissertation work explores the interplay between objective and subjective assessments of physical health status and the implications for liver transplant candidate and recipient outcomes. The first aim characterizes national epidemiologic trends and the impact of Centers for Medicare and Medicaid quality improvement policies on likelihood of waitlist removal based on the patient being too frail to benefit from liver transplant (“too sick to transplant”). This aim includes more than a decade (2002–2012) of comprehensive national transplant waitlist data (Scientific Registry of Transplant Recipients (SRTR)). The second aim will assess and define objective parameters of liver transplant patient frailty by measuring decline in lean core muscle mass (“sarcopenia”) using abdominal CT scans collected retrospectively at a single U.S. transplant center between 2006 and 2015. The relationship between these objective sarcopenia measures and subjective functional status assessed using the Karnofsky Functional Performance (KPS) scale are described and quantified. The third aim quantifies the extent to which poor functional status (KPS) pre-transplant is associated with worse post-transplant survival and includes national data on liver transplantations conducted between 2005 and 2014 (SRTR). The results of this dissertation will help providers in the assessment of frailty and subsequent risk of adverse outcomes and has implications for strategic clinical management in anticipation of surgery. This research will also to serve to inform national policy on the design of transplant center performance measures.

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Dolgin, Natasha H. "Frailty and Outcomes in Liver Transplantation: A Dissertation." eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsbs_diss/817.

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In recent years, the transplant community has explored and adopted tools for quantifying clinical insight into illness severity and frailty. This dissertation work explores the interplay between objective and subjective assessments of physical health status and the implications for liver transplant candidate and recipient outcomes. The first aim characterizes national epidemiologic trends and the impact of Centers for Medicare and Medicaid quality improvement policies on likelihood of waitlist removal based on the patient being too frail to benefit from liver transplant (“too sick to transplant”). This aim includes more than a decade (2002–2012) of comprehensive national transplant waitlist data (Scientific Registry of Transplant Recipients (SRTR)). The second aim will assess and define objective parameters of liver transplant patient frailty by measuring decline in lean core muscle mass (“sarcopenia”) using abdominal CT scans collected retrospectively at a single U.S. transplant center between 2006 and 2015. The relationship between these objective sarcopenia measures and subjective functional status assessed using the Karnofsky Functional Performance (KPS) scale are described and quantified. The third aim quantifies the extent to which poor functional status (KPS) pre-transplant is associated with worse post-transplant survival and includes national data on liver transplantations conducted between 2005 and 2014 (SRTR). The results of this dissertation will help providers in the assessment of frailty and subsequent risk of adverse outcomes and has implications for strategic clinical management in anticipation of surgery. This research will also to serve to inform national policy on the design of transplant center performance measures.

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Malin, Sköld. "Callcenter för ökad telefontillgänglighet : En fallstudie av en ny verksamhet för att höja telefontillgängligheten i ett specifikt område i Närhälsan i Västra Götaland." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-40912.

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Bakgrund: Låg telefontillgänglighet till vårdcentralerna medför att alla patienter inte kommer fram till sin vårdcentral samma dag. Det kan vara en av orsakerna att patienterna blir missnöjda. Syfte: Förbättringsarbetet var att förbättra telefontillgängligheten i ett avgränsat geografiskt område i Västra Götalandsregionen. Delmål att 90 % av befolkningen skulle komma fram till sin vårdcentral samma dag o slutmål 100 % av patienterna skulle nå sin vårdcentral samma dag. Studiens syfte var att se hur samverkan fungerade mellan personal som inte sitter tillsammans och hur det påverkar telefontillgängligheten Metod: Studien är en explorativ fallstudie av en avgränsad kontext. Data från semisstrukturerade fokusgrupper analyserades med en induktiv ansats som var kopplade till förbättringsarbetet. Resultat: Telefontillgängligheten förbättrades till att börja med och detta visades med statistik från telefonsystemet som är tillgängligt i Västra Götalandsregionen. Personal visade en positiv inställning till den nya verksamheten. Slutsatser: Resultatet av studien och förbättringsarbetet indikerar att det går att förändra telefontillgängligheten med sjuksköterskor som stöttar olika vårdcentraler, trots att de inte är fysiskt på plats i verksamheten. Ett hinder för callcenter var journalsystemet. Trots att det var samma journal så är upplägget med exempelvis färgsättning av likande tidstyper olika på alla vårdcentraler.
Background: Low phone call accessibility to health centers entails that patients will not reach their health center on the day that they wish. This may be one of the reasons patients are dissatisfied. Purpose: The improvement study was to improve phone call accessibility in a limited geographical area in Västra Götaland. Sub-target: 90% of the population should reach their health center the same day. Main-target: 100% of the patients should reach their health center the same day. The purpose was to investigate weather cooperation could function between staff on separate locations and how this affects phone call accessibility. Method: Exploratory case study within a limited context. Data: semi-structured focus groups were analyzed using an inductive approach connected to the improvement study. Results: Phone call accessibility improved to begin with which was presented using statistics from the phone system, available in Västra Götalandsregionen. Staff displayed positive attitudes towards the new call center. Conclusions: It’s possible to change phone call accessibility using nurses supporting different centers, despite not being employed by those centers. An issue for the center was the journal system where color codes had different meanings in the booking system.

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Dissertations / Theses on the topic 'Health service improvement'

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