Quality in Health Care
ISSN : 0963-8172
Current Publisher: BMJ (10.1136)
Total articles ≅ 110
Latest articles in this journal
Quality in Health Care, Volume 10; doi:10.1136/qhc.0100021..
Investigations of accidents in a number of hazardous domains suggest that a cluster of organisational pathologies—the “vulnerable system syndrome” (VSS)—render some systems more liable to adverse events. This syndrome has three interacting and self-perpetuating elements: blaming front line individuals, denying the existence of systemic error provoking weaknesses, and the blinkered pursuit of productive and financial indicators. VSS is present to some degree in all organisations, and the ability to recognise its symptoms is an essential skill in the progress towards improved patient safety. Two kinds of organisational learning are discussed: “single loop” learning that fuels and sustains VSS and “double loop” learning that is necessary to start breaking free from it.
Quality in Health Care, Volume 10; doi:10.1136/qhc.0100038..
If professionals are to be equipped better to meet the needs of modern health care systems and the standards of practice required, significant educational change is still required. Educational change requires leadership, and lack of educational leadership may have impeded change in the past. In practical terms standards refer to outcomes, and thus an outcome based approach to clinical education is advocated as the one most likely to provide an appropriate framework for organisational and system change. The provision of explicit statements of learning intent, an educational process enabling acquisition and demonstration of these, and criteria for ensuring their achievement are the key features of such a framework. The derivation of an appropriate outcome set should emphasise what the learners will be able to do following the learning experience, how they will subsequently approach these tasks, and what, as a professional, they will bring to their practice. Once defined, the learning outcomes should determine, in turn, the nature of the learning experience enabling their achievement and the assessment processes to certify that they have been met. Provision of the necessary educational environment requires an understanding of the close interrelationship between learning style, learning theory, and methods whereby active and deep learning may be fostered. If desired change is to prevail, a conducive educational culture which values learning as well as evaluation, review, and enhancement must be engendered. It is the responsibility of all who teach to foster such an environment and culture, for all practitioners involved in health care have a leadership role in education. Quality in Health Care(Quality in Health Care 2001;10(Suppl II):ii38–ii45)
Quality in Health Care, Volume 10; doi:10.1136/qhc.0100064..
This paper examines the issues that arise in the broad area of competence assessment in surgical practice, with particular reference to the objective assessment of technical skill which has historically been the weakest aspect of assessment in surgical training. To facilitate a thorough appraisal of competence, a simple model of surgical practice is advanced, followed by a review of both current and experimental methods of assessing technical skill. The review comprises not only the published literature, but also work (both from the authors' and other groups) that is in progress or under consideration for publication. Significant issues in the implementation of these new technologies, especially the necessary further validation, and the imperative to demonstrate that the process introduced does indeed improve the outcomes are discussed.
Quality in Health Care, Volume 10, pp 199-200; doi:10.1136/qhc.0100199..
Quality in Health Care, Volume 10, pp 200-1; doi:10.1136/qhc.0100200..
Quality in Health Care, Volume 10, pp 201-202; doi:10.1136/qhc.0100201..
Quality in Health Care, Volume 10, pp 211-217; doi:10.1136/qhc.0100211..
Background—The need for quality improvement and increasing concern about the costs and appropriateness of health care has led to the implementation of quality systems in healthcare organisations. In addition, nursing homes have made significant investments in their development. The effects of the implementation of quality systems on health related outcomes are not yet clear.
Quality in Health Care, Volume 10, pp 224-228; doi:10.1136/qhc.0100224..
Objective—To assess the effects of feedback of patients' evaluations of care to general practitioners. Design—Randomised trial. Setting—General practice in the Netherlands. Subjects—55 GPs and samples of 3691 and 3595 adult patients before and after the intervention, respectively. Interventions—GPs in the intervention group were given an individualised structured feedback report concerning evaluations of care provided by their own patients. Reference figures referring to other GPs were added as well as suggestions for interpretation of this feedback, an evidence-based overview of factors determining patients' evaluations of care, and methods to discuss and plan improvements. Main outcome measures—Patients' evaluations of nine dimensions of general practice measured with the CEP, a previously validated questionnaire consisting of 64 questions, using a six point answering scale (1=poor, 6=very good). Results—Mean scores per CEP dimension varied from 3.88 to 4.77. Multilevel regression analysis showed that, after correction for baseline scores, patients' evaluations of continuity and medical care were less positive after the intervention in the intervention group (4.60 v 4.77, p<0.05 and 4.68 v 4.71, p<0.05, respectively). No differences were found in the remaining seven CEP dimensions. Conclusions—Providing feedback on patients' evaluations of care to GPs did not result in changes in their evaluation of the care received. This conclusion challenges the relevance of feedback on patients' evaluations of care for quality improvement.
Quality in Health Care, Volume 10, pp 218-223; doi:10.1136/qhc.0100218..
Objective—To assess the deleterious effects of waiting for admission to a nursing home on the state of health of patients and their informal caregivers, and on the burden of caring. Design and participants—Prospective longitudinal study consisting of interviews with informal caregivers during the period on the waiting list and after admission of the patient to a nursing home. Analysis of patients' files on diagnosis, date of registration on the waiting list, and date of admission to nursing home. Setting—Ninety three patients registered on waiting lists for admission to a psychogeriatric nursing home in two regions of Amsterdam. Results—Seventy eight of the 93 patients were admitted to a nursing home. The burden on the caregivers declined after admission of the patient but depressive symptoms did not. After 6 months a subgroup of 19 caregivers whose relatives were still waiting to be admitted were interviewed. The health of these patients remained stable during this waiting period and only problems in activities of daily living increased. The burden on these 19 informal caregivers and their state of health remained stable during the waiting period. Conclusions—A decline in the state of health and a rise in the burden on caregivers during the waiting period did not occur. However, a decrease in the burden and an improvement in mental health could have started earlier if patients had been admitted earlier.