Editorial

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 23, Issue 6

This issue of the IJHCQA brings the readers many different topics of how quality can be improved for people who use the service. It spans from the clinical quality and safety perspectives to examining “health” of organisations in terms of process flow and indicators together with bringing to the fore some disparities that women may encounter in a developing country.

Cole and Radnor’s paper looks at the topic of governance and accountability within organisations through the annual health check (AHC), the system used to review performance and awarding of annual ratings. The research focused on four areas to identify the key systems used by trusts in the UK to measure progress against the AHC. Overall, the research found considerable variation and diversity in the rate of progress individual trust’s have made towards implementing the AHC, however in many of the participating organisations the basic structural components appeared to be in place. Although some Trusts reported more established systems and processes, leadership arrangements, organisational structures, strategic direction and performance than others, the AHC did appear to have been embraced at least to some degree by all of the NHS trusts who participated in the study.

In a Swedish context Schröder et al.’s research aimed to test the psychometric properties and dimensionality of a new instrument, quality in psychiatric care (QPC), and to describe and compare quality of care among in-patients as measured by this instrument. The instrument was based on a definition of quality of care from the patients’ perspective which made it possible to identify the aspects of care that are related to higher and lower quality. The overall results of this study show that the QPC is psychometrically adequate for evaluating patients’ experiences of the quality of in-patient care. As a result of this research the instrument will contribute to theory development and health care improvement in the field of psychiatry. The findings in this study imply several clinical recommendations. Firstly, the knowledge about patients’ ratings of low quality of care regarding the dimension participation, and younger patients’ low ratings of the dimension Secure environment, can be used in the improvement of the quality.

Also from Sweden, Ulfvarson et al. studied using a descriptive intervention methodology a computerized system for medication reviews that could support physician decisions and improve the quality of drug treatment in the elderly. Part of the intervention involved the involvement and input of a clinical pharmacologist working with a computerised support at a distance. The findings indicated that there was improved quality of drug use, in relation to the quality indicators for drug use in elderly published by the Swedish National Board of Health and Welfare (2003). Further the study found that there were reductions for all indicators and specifically there was marked reductions of treatment with inappropriate drugs for some diagnoses together with a decline in the use of drugs that should be avoided or prescribed with caution in connection with impaired kidney function. The author suggests that further research is needed in aspect to the patients’ point-of-view, for example, how they perceive this kind of interventions, and adherence to advice given from different professions involved in their drug treatment. The findings from this study will help and assist in the overall patient safety program of any organisation.

The aim of the study reported by Yousefshahi et al. was to compare the effects of Sanosil and glutaraldehyde 2 per cent in disinfecting ventilator connecting tubes in an intensive care environment through a 12-week open-labelled clinical trial. The findings indicate that Sanosil is an effective agent in reducing the contamination risk in the tubes used in ICUs. Through this study the authors suggest that it was the rinsing process is the possible factor contributing to the positive cultures reported in the glutaraldehyde group. The findings of this study will be of use to all practitioners who are involved in the process of ensuring that sterilisation is evidence based.

In the paper presented by Andaleeb and Millet the authors suggest that disparities faced by women, especially in Bangladesh, have a long and contentious history and argues that marginalisation of women has been stark in many areas including healthcare. The main aim of the study was to examine whether women experience poorer services than men in the hospitals in the Bangladesh healthcare environment. However the results indicated that very few differences were found between the service experienced by male and female patients. Despite the results of the study the author surmises that there may be deeper systemic changes underway that are reflected in service providers’attitudes toward women and concludes that the findings may be unique to the sample of patients included in the study. It can be concluded that more research is required to fully validate the study given the arguments postulated by the author.

An interesting topic studied by Reynolds et al. in the USA was the use of a simulation model to simulate the patient flow in a clinic for homeless patients. Through the simulation the quality of care for different staffing levels, the dependence of distributions on service times and the impact of service time variability on quality of care to patients was analysed. The findings indicated that system performance was primarily dependent on the mean and coefficients of variation rather than a complete distribution of serviced times. The author argues that a piece wise linear approximation formula can be utilised so that patient waiting time in homeless clinics can be estimated for any variability with only two simulations. The results presented in the paper provide an easier approach for medical practitioners to evaluate different scenarios, examine needed resources, and carry out what-if analysis to predict the impact of any changes in the system, to determine an optimal system configuration. A benefit of this study is that it can be easily adapted to model other health care facilities.

I hope and trust that the readers of this issue will gain an insight into the different topics included in the papers and that practitioners will find the studies useful for their every day practice. I sincerely thank the authors for the submissions of their research to this journal.

Kay Downey-EnnisCo-Editor