Quality management in health care (Qual Manag Health Care)

Publisher: Lippincott, Williams & Wilkins

Journal description

This peer-reviewed quarterly journal provides a forum to explore the theoretical, technical, and strategic elements of total quality management in health care. Each issue of Quality Management in Health Care (QMHC) features a timely symposium that addresses a key issue in health care quality management. Also included in each issue is an in-depth interview with a key individual in health care quality management, an educational tutorial on basic quality management tools and processes, an information clearinghouse to encourage informal communication among those involved in the field of health care quality management, and a reference center that reviews books, journal articles, seminars, and videos of interest.

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Additional details

5-year impact 0.00
Cited half-life 0.00
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Website Quality Management in Health Care website
Other titles Quality management in health care, QMHC
ISSN 1063-8628
OCLC 26178154
Material type Periodical
Document type Journal / Magazine / Newspaper

Publisher details

Lippincott, Williams & Wilkins

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
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    • 12 months embargo
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    • Pre-print must be removed upon acceptance for publication
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    • Publisher's version/PDF cannot be used
    • Must include statement that it is not the final published version
    • Published source must be acknowledged with full citation
    • Set statement to accompany deposit
    • Must link to publisher version
    • NIH authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 12 months embargo (see policy for details)
    • Wellcome Trust and HHMI authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 6 months embargo (see policy for details)
    • Publisher last reviewed on 19/03/2015
  • Classification
    ‚Äč yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Quality management in health care 06/2009; 18(3):149-50. DOI:10.1097/QMH.0b013e3181aea1ce
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    ABSTRACT: Practice-based learning and improvement (PBLI) combines the science of continuous quality improvement with the pragmatics of day-to-day clinical care delivery. PBLI is a core-learning domain in nursing and medical education. We developed a workbook-based, project-focused curriculum to teach PBLI to novice health professional students. Evaluate the efficacy of a standardized curriculum to teach PBLI. Nonrandomized, controlled trial with medical and nursing students from 3 institutions. Faculty used the workbook to facilitate completion of an improvement project with 16 participants. Both participants and controls (N = 15) completed instruments to measure PBLI knowledge and self-efficacy. Participants also completed a satisfaction survey and presented project posters at a national conference. There was no significant difference in PBLI knowledge between groups. Self-efficacy of participants was higher than that of controls in identifying best practice, identifying measures, identifying successful local improvement work, implementing a structured change plan, and using Plan-Do-Study-Act methodology. Participant satisfaction with the curriculum was high. Although PBLI knowledge was similar between groups, participants had higher self-efficacy and confidently disseminated their findings via formal poster presentation. This pilot study suggests that using a workbook-based, project-focused approach may be effective in teaching PBLI to novice health professional students.
    Quality management in health care 01/2009; 18(3):174-81. DOI:10.1097/QMH.0b013e3181aea218
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    ABSTRACT: Following the landmark Leuven study in 2001, health care organizations implemented intensive insulin therapy (IIT) as the standard of care for critically ill patients. However, a recent meta-analysis showed no mortality benefit and an increased safety risk for patients treated with IIT. IIT affects labor and capital decisions related to nurses, physicians, pharmacists, managers, laboratory personnel, and informatics staff. The expenditure of labor and capital to provide IIT without corresponding outcome improvements suggests the adoption of IIT produces inefficiency in hospital. In sociology and organizational studies, the tendency for organizations to become more similar without necessarily becoming more efficient is called normalfont institutional isomorphism. Institutional isomorphism examines the pressure that organizations encounter from peers, regulators, and professions through mimetic, coercive, and normative mechanisms, respectively. To enhance their prospects of survival, organizations establish and maintain legitimacy by adopting socially acceptable approaches to work endorsed by successful peer organizations, regulatory agencies, and professional societies. ORGANIZATIONAL INFLUENCE IN THE ADOPTION OF IIT: This paper describes how organizational influence-through the Leuven study, the Joint Commission, and professional organizations-played a role in the widespread adoption of IIT. Divergence from institutionalized forms may explain variation in IIT studies following Leuven. Health care researchers practitioners, and managers should consider organizational influence when implementing large-scale clinical activities.
    Quality management in health care 01/2009; 18(2):115-9. DOI:10.1097/QMH.0b013e3181a02bac
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    ABSTRACT: This article reports an intervention to improve the quality and safety of hospital patient care by introducing the use of pharmacy robotics into the medication distribution process. Medication safety is vitally important. The integration of pharmacy robotics with computerized practitioner order entry and bedside medication bar coding produces a significant reduction in medication errors. The creation of a safe medication-from initial ordering to bedside administration-provides enormous benefits to patients, to health care providers, and to the organization as well.
    Quality management in health care 01/2009; 18(2):103-14. DOI:10.1097/QMH.0b013e3181a02771
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    ABSTRACT: Quality improvement in health care organizations requires structural reorganization and system reform and the development of an appropriate organizational "culture." In 2007, the Division of Quality and Excellence in Civil Service in Israel developed a concept to improve quality management in governmental institutions throughout the country. To put this strategy into practice, Western Galilee Hospital, a governmental hospital, in northern Israel, developed a plan to advance the quality management system where each department and unit is autonomously responsible for its own quality and excellence. Since the hospital has been certificated by ISO 9001 for more than 10 years (the only hospital in Israel to have this certificate), the main challenge now is to improve the quality and excellence system in every department. The aim of this article is to describe the implementation of a comprehensive program designed to raise the ability of managers and workers in Western Galilee Hospital in addressing all of the government's requirements for quality and excellence in service in Israel.
    Quality management in health care 01/2009; 18(2):141-5. DOI:10.1097/QMH.0b013e3181a02c5e
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    ABSTRACT: Medical students, nursing students, and other health care professionals in training were integrated with health care workers on interprofessional quality improvement (QI) teams at our academic health center. Teams received training in QI, accompanied by expert QI mentoring, with dual goals of increasing expertise in improvement while improving care. Eighty-six learners and health system workers participated in 12 improvement teams in 2 years. Upon completion of the training, participants expressed that the program enhanced QI and teamwork skills and increased understanding of other health care professions. At the end of the program, fourth-year medical students showed greater ability to apply QI skills, as measured by the QI Knowledge Assessment Tool than did control students who did not participate in the program (P < .0001 in 2006-2007 and P < .0005 in 2007-2008). Many teams were successful in improving care processes. The design of "learning QI by doing," accompanied by just-in-time training and ongoing expert mentoring in QI, was identified by faculty as the most important factor contributing to success. This model successfully improved application of QI skills by learners while improving care within our academic health center. Testing of the model at other academic health centers and in other training environments is warranted.
    Quality management in health care 01/2009; 18(3):194-201. DOI:10.1097/QMH.0b013e3181aea249
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    ABSTRACT: To create an index that would serve as a simple tool to measure the quality of hospital care by race and ethnicity. Following extensive review of existing disparities indices, we created a disparities quality index (DQI) designed to easily measure differences in the quality of care hospitals deliver to different populations. The DQI uses performance data already collected by virtually all hospitals. It highlights areas where there are large numbers of patients in a specific population receiving potentially lower-quality care. Data were collected from 2 acute care hospitals that participated in a multihospital collaborative. We applied the DQI to 2 hospitals' quality data, specifically to their performance on the Hospital Quality Alliance measure for patients with heart failure who were receiving angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The DQI was simple to apply and was able to measure differences in the care of different ethnic groups. It also detected changes in disparities over time. The DQI can help hospitals and other providers focus on the domain of equity in their quality-improvement efforts. Further testing is required to determine its applicability for community-wide equity projects.
    Quality management in health care 01/2009; 18(2):84-90. DOI:10.1097/01.QMH.0000349973.61836.41
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    ABSTRACT: This pilot study describes the development of an instrument to measure nursing quality knowledge, skills, and attitudes for practicing pediatric oncology nurses. Because many nurse leaders of academic centers are responsible for outcomes at both local and global level, ensuring nursing quality is critical, given the variability in practice outcomes. Quality Improvement Knowledge, Skills, and Attitudes (QulSKA), a 73-item electronic questionnaire was developed using QSEN competencies; the six domains include: quality improvement (QI), safety, evidence-based practice, teamwork, patient-centered care, and informatics. Content validity was established by pediatric oncology, QI, and test-construction experts. Nurses from St Jude Children's Research Hospital and US and Latin American affiliate sites were surveyed. Thirty-seven of 216 RNs surveyed participated in the study. The QulSKA inter-item correlation coefficient was 0.839 (P = .001). The mean knowledge score (based on 100) was 69.2 +/- 11.3. Scores were highest for safety (82.9%) and lowest for teamwork (48.6%). The mean skills rating was 3.3 +/- 0.74 (used 2-4 times). Lowest rated skills were in analysis and QI tools. The mean attitude rating was 3.8 +/- 0.25 (highly important). Data suggest that QulSKA may be reliable to measure quality knowledge, skills, and attitudes among pediatric oncology nurses-nurses were knowledgeable in QI, yet they lacked skills in practice application.
    Quality management in health care 01/2009; 18(3):202-8. DOI:10.1097/QMH.0b013e3181aea256
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    ABSTRACT: Retail medicine clinics have become widely available. However, few studies have been published reporting on the outcomes of care from these clinics. The purpose of this study was to assess the risk of early return visits for patients using a retail walk-in clinic. Medical records of patients seen in a large group practice in Minnesota in the first 2 months of 2008 were analyzed for this study. Three groups of patients were studied: those using the retail walk-in clinic (n = 300), a comparison group using regular office care in the previous year (n = 373), and a same-day acute care clinic in a medical office (n = 204). The dependent variable was a return office visit within 2 weeks. Multiple logistic regression analysis was used to adjust for case-mix differences between groups. The percentage of office visits within 2 weeks for these groups was 31.7 for retail walk-in patients, 38.9 for office visit patients, and 37.1 for same-day acute care clinic patients, respectively (P = .13). The corresponding percentages of return office visits within 2 weeks for the same reasons were 14.0, 24.4, and 20.6 (P < .01). After adjustment for age, sex, marital status, acuity, and number of office visits in the previous 6 months, no significant differences in risk of early return visits were found among clinic types. Our retail walk-in clinic appeared to increase access without increasing early return visits.
    Quality management in health care 01/2009; 18(1):19-24. DOI:10.1097/01.QMH.0000344590.61971.97
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    ABSTRACT: The Centers for Disease Control and Prevention (CDC) defines influenza-like illness (ILI) for its sentinel providers as fever (temperature > or =100.5 degrees F or 37.8 degrees C) and a cough and/or a sore throat in the absence of a known cause other than influenza. For electronic disease surveillance systems, classifying ILI with clinical data that identify only individual aspects of the case definition may add excessive levels of unwanted noise to the system; however, the capability to analyze a patient's body temperature along with other available clinical data (International Classification of Diseases, Ninth Revision codes) could improve diagnostic precision and more accurately classify cases of ILI in a syndromic surveillance system. Developing Boolean algorithms to properly classify true cases of influenza plays an important role toward understanding accurate levels of disease in a community and can also be a key tool for allocating urgent prophylaxis such as antiviral medications during severe outbreaks and pandemics. Results for this study show that elevated body temperature was 40% efficient in correctly predicting laboratory-positive confirmations of influenza (sensitivity) but at the same time was 76% efficient in ruling out influenza (specificity) in the group of sampled members who were tested for influenza.
    Quality management in health care 01/2009; 18(2):91-102. DOI:10.1097/QMH.0b013e3181a0274d
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    ABSTRACT: The content and spectrum of rural health care services are different from those in urban areas. The extent to which health care consumers' perceptions of the quality of these services vary across settings and the association of these perceptions with features of rural and urban settings are unclear. To determine whether perceptual differences of quality exist and contrast rural/urban associations between contextual characteristics and perceived quality of health care. Multilevel, cross-sectional analysis of a state-representative sample of 33 786 adults, stratified by rural/urban status linked with county-level data describing contextual features (eg, health care, economics, and social capital). The dependent variable was respondents' perceived quality of health care received in the past year. Weighted multilevel random intercept models examined the independent association of contextual characteristics with perceived quality. Overall perceived quality did not differ between rural and urban settings. Similarly, the pattern of associations between perceived quality and contextual characteristics was generally comparable between settings. A notable difference was an association between higher quality with an increasing proportion of hospitals offering more than 25 services in urban areas (beta = .763; P < .05). Despite rural/urban differences in contextual characteristics with potential influence on health care delivery, overall consumer perception of health care quality was similar in both settings. This suggests that health care managers may be adopting setting-specific strategies to enhance consumer satisfaction despite contextual differences.
    Quality management in health care 01/2009; 18(4):257-67. DOI:10.1097/QMH.0b013e3181bee1ce
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    ABSTRACT: The Institute of Medicine called for the integration of interprofessional education (IPE) into health professions curricula, in order to improve health care quality. In response, we developed, implemented, and evaluated a campus wide IPE program, shifting from traditional educational silos to greater collaboration. Students (155) and faculty (30) from 6 academic programs (nursing, medicine, public health, allied health, dentistry, and pharmacy) engaged with a university hospital partner to deliver this program. The content addressed principles of IPE, teamwork development and 2 common quality care problems: hospital-acquired infections and communication errors. Pre-/post-surveys, the Readiness for Interprofessional Learning Scale, and the Interprofessional Education Perception Scale, were used for descriptive assessment of student learning. Students demonstrated increased understanding of health care quality and interprofessional teamwork principles and reported positive attitudes toward shared learning. While responses to the Readiness for Interprofessional Learning Scale grew more positive after the program, scores on the Interprofessional Education Perception Scale were more homogeneous. Both students and faculty highly evaluated the experience. This program was a first step in preparing individuals for collaborative learning, fostering awareness and enthusiasm for IPE among students and faculty, and demonstrating the feasibility of overcoming common barriers to IPE such as schedule coordination and faculty buy-in.
    Quality management in health care 01/2009; 18(3):165-73. DOI:10.1097/QMH.0b013e3181aea20d
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    ABSTRACT: In response to the Institute of Medicine challenge to improve patient safety and quality of care, an office directing patient safety/quality of care at an academic medical center and faculty from health professions schools collaborated on design, delivery, and evaluation of an interprofessional student curriculum on patient safety, quality, and teamwork. Annually for 6 years, second-year medical students, senior baccalaureate nursing students, second-year masters in health administration students, and junior baccalaureate respiratory therapy students participated. A pre-/postsurvey assessing students' attitudes about quality, safety, and teamwork was developed and modified to reflect course revisions. Survey items were grouped into 1 of the 6 subscales: human fallibility, disclosure, teamwork/communication, error reporting, systems of care, and curricular time spent with other professionals. At pretest, there were significant professional group differences in all the 6 subscales. At completion, differences in 4 subscales were resolved with the exception of human fallibility (P < .001) and curricular time spent together (P < .001). Interprofessional exercises within our curriculum mediated most differences among student groups. As more interprofessional curricular experiences are designed, examining baseline group differences is essential to optimize learning outcomes.
    Quality management in health care 01/2009; 18(3):182-93. DOI:10.1097/QMH.0b013e3181aea237
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    ABSTRACT: To demonstrate the level of compliance to metformin-prescribing guidelines and to evaluate the effectiveness of 2 pharmacy-based interventions. Retrospective chart review of all inpatients who had received at least 2 doses of metformin while hospitalized. Two cohorts of patients had chart audits-one group (group A) hospitalized between March and August of 2003 (487 patients) and one group (group B) hospitalized between August of 2005 and January of 2006 (370 patients). In December of 2003, the pharmacy inserted a safety alert in the electronic ordering system and mailed a printed safety alert to all clinical staff outlining the contraindications and precautions concerning metformin use. More than two-thirds (69.3%) of the charts reviewed demonstrated that metformin was used in accordance with the prescribing guidelines. Surgical procedures, intravenous contrast use, and elevated serum creatinine levels accounted for the greatest percentage of guideline violations. The prescribing guidelines were violated 27.4% (47/137 charts) of the times in group A and 34.3% (40/146 charts) of the times in group B. The significance of this study is that metformin is often given in spite of the presence of contraindications to its use. Two pharmacy interventions were ineffective in decreasing the guideline violation frequency in a group of patients who were prescribed the drug.
    Quality management in health care 01/2009; 18(1):71-6. DOI:10.1097/01.QMH.0000344595.48510.cb
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    ABSTRACT: Despite the widespread use of branding in nearly all other major industries, most health care service delivery organizations have not fully embraced the practices and processes of branding. Facilitating the increased and appropriate use of branding among health care delivery organizations may improve service and technical quality for patients. This article introduces the concepts of branding, as well as making the case that the use of branding may improve the quality and financial performance of organizations. The concepts of branding are reviewed, with examples from the literature used to demonstrate their potential application within health care service delivery. The role of branding for individual organizations is framed by broader implications for health care markets. Branding strategies may have a number of positive effects on health care service delivery, including improved technical and service quality. This may be achieved through more transparent and efficient consumer choice, reduced costs related to improved patient retention, and improved communication and appropriateness of care. Patient satisfaction may be directly increased as a result of branding. More research into branding could result in significant quality improvements for individual organizations, while benefiting patients and the health system as a whole.
    Quality management in health care 01/2009; 18(2):126-34. DOI:10.1097/QMH.0b013e3181a02c04
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    ABSTRACT: In response to growing concerns about patient safety, many hospitals are implementing rapid response teams (RRTs). Although the staff nurse plays a critical role in recognizing the need for the RRT and initiating the call, little is known about actions of staff nurses in relation to the RRT. The purpose of this study was to examine relationships between nurse educational preparation, years of experience, degree of engagement, and the RRT call status (independent vs dependent). Nurse engagement was measured by the Manifestations of Early Recognition Scale. A descriptive correlational design was used. The sample comprised 75 staff nurses at an academic medical center who cared for patients for whom the RRT was called. Educational level and nursing experience were independent predictors of call status, after controlling for effects of other independent variables. Independent callers were almost 5 times more likely to have a BSN degree, and almost 4 times more likely to have more than 3 years of experience, than did RNs who called because someone asked them to call. High levels of engagement were also significantly associated with call status, but after controlling for educational level and nursing experience, the relationship was not significant. This study has implications for clinicians and managers in health care facilities that rely on RRTs.
    Quality management in health care 01/2009; 18(1):40-7. DOI:10.1097/01.QMH.0000344592.63757.51
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    ABSTRACT: The ways in which tailored interventions foster sustained improvement in the quality of health care delivery across different practice settings are not well understood. Using the empirically developed Practice Change Model (PCM), we identify and describe assessment and tailoring activities with potential to enhance the fit between proposed interventions and practice settings. We obtained quantitative and qualitative data from 2 quality improvement trials conducted in diverse primary care practices in northeast Ohio. A multidisciplinary team used a PCM-based template to identify features of practice assessment and tailoring associated with practices' willingness and ability to change. Our results suggest that intervention tailoring requires assessment of key stakeholders' motivations, external influences, resources and opportunities for change, and the interactions between these factors. Using this information, intervention tailoring then includes seeking and working with key stakeholders, building assets, providing options, keeping change processes flexible, offering feedback, providing exposure to scientific evidence, facilitating group processes, involving new partners, brainstorming, using stories/play acting/humor, assuming a consultant role, reframing, moving meetings off-site, and stepping back or pausing. A model-driven approach guiding practice assessment enables tailored responses to the unique and emerging conditions that distinguish health care practices and influence implementation of quality management interventions.
    Quality management in health care 01/2009; 18(4):268-77. DOI:10.1097/QMH.0b013e3181bee268