Rosa Sunol

Rosa Sunol
Avedis Donabedian Research Institute (FAD) · Board of Trustees

MD PhD

About

179
Publications
33,282
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Introduction
Professor Doctor Rosa Sunol is President of the Board of Trustees at Fundación Avedis Donabedian. In this position, she oversees this non-for-profit organization that supports quality improvement efforts in health and social care in Spain since 1989. Additionally, Professor Doctor Sunol held the Donabedian Research Chair in Quality at the Faculty of Medicine (2006-2018). She previously served as a board member for the Joint Commission International (JCI) (1999-2007). She is Deputy Editor of the International Journal for Quality in Health Care since 1991. Rosa has published more than 80 articles and books and has over 30 years of experience in health and social care research on quality, particularly on patient empowerment and self-management and implementation science.

Publications

Publications (179)
Article
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Self-management interventions (SMIs) can improve the life of patients living with obesity. However, there is variability in the outcomes used to assess the effectiveness of SMIs and these are often not relevant for patients. In the context of COMPAR-EU, our aim was to develop a core outcome set (COS) for the evaluation of SMIs for patients with obe...
Article
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Background The commitment of hospital managers plays a key role in decisions regarding investments in quality improvement (QI) and the implementation of quality improvement systems (QIS). With regard to the concept of social capital, successful cooperation and coordination among hospital management board members is strongly influenced by commonly s...
Article
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Context The literature on self-management interventions (SMIs) is growing exponentially, but it is characterized by heterogeneous reporting that limits comparability across studies and interventions. Building an SMI taxonomy is the first step towards creating a common language for stakeholders to drive research in this area and promote patient self...
Article
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An organization's culture with regard to patient safety is important because it defines the beliefs and practices of the organization, and consequently its efficiency and productivity.Knowing the level of this and the factors that influence or not their dynamic represents a challenge, due to the degree of complexity and specificity of the elements...
Article
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Background Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (...
Preprint
Background: Fostering the understanding of the relationship between the prevalence of adverse events (AEP), the patient safety culture of healthcare professionals (PSC) and patient safety perception (PSP) could be an important step to operationalizing patient safety through an integration of different perspectives. Objective: To assess the relation...
Article
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Background: A large body of evidence suggests that self-management interventions (SMIs) may improve outcomes in chronic obstructive pulmonary disease (COPD). However, accurate comparisons of the relative effectiveness of SMIs are challenging, partly due to heterogeneity of outcomes across trials and uncertainty about the importance of these outcom...
Article
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Background The consolidated framework for implementation research states that personal leadership matters in quality management implementation. However, it remains to be answered which characteristics of plural leadership in hospital management boards make them impactful. The present study focuses on social determinants of implementation power of h...
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Introduction: Hip fracture is an important cause of morbidity and mortality among elderly patients worldwide. It poses a particular challenge for healthcare systems with limited financial and human resources. Objectives: To assess factors associated with the length of hospital stay and in-hospital mortality, focusing on the admission to surgery...
Article
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Introduction Population ageing and increasing chronic illness burden have sparked interest in innovative care models. While self-management interventions (SMIs) are drawing increasing attention, evidence of their efficacy is mostly based on pairwise meta-analysis, generally derived from randomised controlled trials comparing interventions versus a...
Article
Objective: This article describes the adoption of Individual Placement and Support (IPS) supported employment between 2013 and 2017 in Catalonia (Spain) in the context of high unemployment and a predominance of traditional preemployment training approaches. It reports the experience of implementing IPS to promote competitive job placement of peopl...
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With this paper, we initiate the Supplement on Deepening our Understanding of Quality in Australia (DUQuA). DUQuA is an at-scale, cross-sectional research programme examining the quality activities in 32 large hospitals across Australia. It is based on, with suitable modifications and extensions, the Deepening our Understanding of Quality improveme...
Article
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Hospital governance is broadening its orientation from cost and production controls towards 'improving performance on clinical outcomes'. Given this new focus one might assume that doctors are drawn into hospital management across OECD countries. Hospital performance in terms of patient health, quality of care and efficiency outcomes is supposed to...
Article
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INTRODUCTION: Despite the growing body of research on quality and safety in healthcare, there is little evidence of the association between the way hospitals are organised for quality and patient factors, limiting our understanding of how to effect large-scale change. The 'Deepening our Understanding of Quality in Australia' (DUQuA) study aims to...
Article
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Background: Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness. Objective: To assess variations in clinical practice and explore associations with hospital- and department-level qua...
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This study aimed to investigate the associations of quality management systems with teamwork and safety climate, and to describe and compare differences in perceptions of teamwork climate and safety climate among clinical leaders and frontline clinicians. We used a multi-method, cross-sectional approach to collect survey data of quality managemen...
Article
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Purpose – The purpose of this paper is to review how patient and public involvement (PPI) can contribute to quality improvement functions and describe the levels of PPI in quality improvement functions at hospital and departmental level in a sample of European hospitals. Design/methodology/approach – Literature review and cross-sectional study. F...
Article
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It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual factors in the literature on the effectiveness of...
Article
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Objectives: Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. How...
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Background: There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge. Methods:...
Article
It has been published that hospital adverse events are an important source of morbidity and mortality in different countries and settings. The aim of this study was to evaluate the frequency, magnitude, distribution and degree of preventability of adverse events in the Autonomous Community of Catalonia (Spain). We conducted a retrospective cohort s...
Article
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Topic: Individual Placement and Support (IPS) is a psychosocial intervention with a considerable body of evidence for its effectiveness in helping people with severe psychiatric disorders to obtain and maintain competitive jobs. In the last decades several European studies have replicated earlier American outcomes, generating widespread interest a...
Article
Objective: To explore the added value of community-orientated programmes aimed at enhancing healthy lifestyles associated with the key components of cardiovascular risk management (CVRM) in coronary heart disease (CHD) patients. Methods: Observational study in Spain, including 36 practices, 36 health professionals, and 722 CHD patients (mean (SD...
Article
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Previous empirical studies found that strategic leadership is an important organizational capability, and is essential for quality and safety improvement in hospital settings. Moreover, the quality of leadership depends crucially on a common set of shared values and relationships of mutual trust among hospital management board members. In accordanc...
Article
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Objective: To define a checklist that can be used to assess the performance of a department and evaluate the implementation of quality management (QM) activities across departments or pathways in acute care hospitals. Design: We developed and tested a checklist for the assessment of QM activities at department level in a cross-sectional study us...
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Objective: The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were developed. This study investigates the relationships...
Article
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/st>To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals. /st>A multi-method, multi-level, cross-sectional observational study. /st>As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospita...
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Introduction and OBJECTIVE: /st>This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework an...
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/st>Stakeholders of hospitals often lack standardized tools to assess compliance with quality management strategies and the implementation of clinical quality activities in hospitals. Such assessment tools, if easy to use, could be helpful to hospitals, health-care purchasers and health-care inspectorates. The aim of our study was to determine the...
Article
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/st>The aim of this study was to develop and validate an index to assess the implementation of quality management systems (QMSs) in European countries. /st>Questionnaire development was facilitated through expert opinion, literature review and earlier empirical research. A cross-sectional online survey utilizing the questionnaire was undertaken bet...
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OBJECTIVE /st>To investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals. DESIGN /st>A mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management systems, illustrated by four clinical pathw...
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/st>The objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies. /st>A cross-sectional, multilevel STUDY DESIGN: that surveyed quality managers and department he...
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/st>To explore how European hospitals have implemented patient safety strategies (PSS) and evidence-based organization of care pathway (EBOP) recommendations and examine the extent to which implementation varies between countries and hospitals. /st>Mixed-method multilevel cross-sectional design in seven countries as part of the European Union-funde...
Article
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/st>To describe hospitals' organizational arrangements relevant to the abstraction of administrative data, to report on the completeness of administrative data collected in the eight countries and to assess associations between organizational arrangements and completeness of data submission. /st>A cross-sectional STUDY DESIGN: utilizing administrat...
Article
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OBJECTIVE /st>To assess whether there is a relationship between having quality as an item on the board's agenda, perceived external pressure (PEP) and the implementation of quality management in European hospitals. DESIGN /st>A quantitative, mixed method, cross-sectional study in seven European countries in 2011 surveying CEOs and quality manager...
Technical Report
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This guidebook provides an updated framework to assess quality and safety improvements in hospitals. It is based on state-of-the-art research and synthesises the results of the DUQuE project and other large scale empirical studies, systematic reviews, and expert knowledge. The key findings of this synthesis are are reflected in "Seven ways to impro...
Article
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Background: Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essentia...
Article
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Multimorbidity and polypharmacy pose challenges to improving the quality of care. To determine the association between prescription of recommended treatment in ambulatory patients with chronic heart failure and multiple comorbidities and hospitalisation events. A population-based retrospective cohort study in Catalonia (north-east Spain). We includ...
Article
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/st>Health-care providers invest substantial resources to establish and implement hospital quality management systems. Nevertheless, few tools are available to assess implementation efforts and their effect on quality and safety outcomes. This review aims to (i) identify instruments to assess the implementation of hospital quality management system...
Article
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Background Handover practices at hospital discharge are relatively under-researched, particularly as regards the specific risks and additional requirements for handovers involving vulnerable patients with limited language, cognitive and social resources. Objective To explore handover practices at discharge and to focus on the patients’ role in hand...
Data
Statistical specifications. Statistical specification and links to the R syntax for the bootstrapping procedure, robust regression procedure and Box-Cox transformation procedure.
Data
Definition of hospital adjusted complications. List of complications included in the calculation of the indicator 'hospital adjusted complications'.
Article
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Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. The maturity classification scheme was developed based on survey results from 389 hospitals in...
Article
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ABSTRACT: Service accreditation is a structured process of recognising and promoting performance and adherence to standards. Typically, accreditation agencies either receive standards from an authorized body or develop new and upgrade existing standards through research and expert views. They then apply standards, criteria and performance indicator...
Article
Cross-border patients have specific quality and safety requirements for hospital care. Little is known to what extent hospitals meet these requirements. We aim to assess their current level, and the factors associated with their implementation. A cross-sectional survey of 315 hospitals and cardiology departments in the Czech Republic, France, Polan...
Article
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Hospital accreditation and International Standardisation Organisation (ISO) certification offer alternative mechanisms for improving safety and quality, or as a mark of achievement. There is little published evidence on their relative merits. To identify systematic differences in quality management between hospitals that were accredited, or certifi...
Article
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The Health Department of the Regional Government of Catalonia, Spain, issued a quality plan for substance abuse centers. The objective of this paper is to evaluate the impact of a multidimensional quality improvement initiative in the field of substance abuse care and to discuss potentials and limitations for further quality improvement. The study...
Article
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Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. We propose to study the relationships among organisational quality improvement systems, patient empowerment, organisational cultu...
Article
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Quality problem: There is no simple tool to assess compliance with common national and European directives, guidance and professional advice on the management of healthcare institutions. Despite evidence of unacceptable variations in the protection of patient and staff safety little attention has been given to harmonizing the way services are orga...
Article
This study describes the stage of development of the Spanish acute care hospitals quality improvement systems. It also presents data on their achievement of some specific requirements related to clinical safety and patient oriented care. Additional data from seven other European countries are included, in order to provide a comparative reference fo...
Article
Objectives This study describes the stage of development of the Spanish acute care hospitals quality improvement systems. It also presents data on their achievement of some specific requirements related to clinical safety and patient oriented care. Additional data from seven other European countries are included, in order to provide a comparative r...
Article
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This supplement is focused on the methods, results and recommendations from the research project “Methods of Assessing Response to Quality Improvement Strategies” (MARQuIS). MARQuIS was funded by the Scientific Support to Policies component of the European Union Sixth Framework Research Programme (Contract SP21-CT-2004-513712), and it lasted from J...