The traditional process flow model has long shaped workups for evaluation and diagnosis in chest pain. In an effort to eliminate costly inefficiencies in the traditional diagnostic process, a study was conducted involving the development of a new approach on the basis of the application of Six Sigma methodology to reduce process variation. Sameer Kumar and Kory M. Thomas report on the formulation and application of a best practices diagnosis and treatment model created to streamline the diagnosis and treatment of patients experiencing chest pain.
The level of patient satisfaction is often considered one of the indicators of health care quality. Since a short waiting time for care in an office or clinic contributes to patient satisfaction, it follows that identifying and correcting the factors contributing to prolonged waiting times may be recognized as a factor in improving the quality of care. Lynn J. Groome and E. J. Mayeaux Jr report on their study, in which Six Sigma methodology and root cause analysis were used to improve this aspect of patient care quality by identifying and eliminating or mitigating root causes of waiting time variation.
In Quality Management in Health Care's January 2010 issue (19:1), Farrokh Alemi et al reported on "The Impact of Online Counseling on Drug Use: A Pilot Study." In the present issue, Farrokh Alemi and Heibatollah Baghi address the difficulties in assessing the impact of treatment on drug use in the absence of any universally used measure. They argue that the use of a unified measure would permit reconciling the findings of disparate research studies. Carrying this notion beyond the authors' analysis and proposal, the use of universally accepted units of measurement in research could be very valuable in the development of drug treatment policy. The authors draw their inferences from data reported by the members of 2 study samples- experimental and control-whose members reported their days of drug use and underwent urine tests.
To paraphrase an observation made by Diane M. Fesler-Birch, the nurse's role in the planning and management of patient care has developed and expanded along with advances in biotechnology and in quality evaluation methodology. This development in their responsibilities makes the ability to think critically an increasingly important attribute of nurses. The author points out that critical thinking ability is not at all the same thing as competency, so often seen as the primary criterion of nursing performance. The objective of the study reported here was to develop a tool with which to measure the critical thinking skills of perioperative nurses. One of the more intriguing findings was that open-mindedness was a significant predictor of the level of critical thinking.
The predictive relationship between nurse staffing and patient outcomes in hospitals is explored in a study reported by Karen H. Frith, E. Faye Anderson, Barbara Caspers, Fan Tseng, Kathleen Sanford, Nancy G. Hoyt, and Kim Moore. The authors studied a sample of nearly 35 000 patients from 11 medical-surgical units in 4 hospitals. On the basis of the findings, they conclude that the number of registered nurse (professional nurse) hours and the percentage of professional nurses in the skill mix of medical-surgical units bear a positive relationship to the quality of patient outcomes.
In Alberta, Canada, the Living Well With a Chronic Condition program provides disease-specific and generic health education programs at facilities in a city and surrounding rural areas to people suffering from various chronic diseases. Potential participants were experiencing potentially harmful month-long delays in gaining access to the programs. Sheila Golnaz Shayesteh, Gordon Kliewer, and Louise Morrin report on the course and results of a program embodying classic quality management strategies to reduce the access delays.
Even today, Oscar E. Firbank suggests that the concepts and practices of continuous quality improvement (CQI) remain in the early stages of development in the Canadian home care community. The author points to doubts that have been raised about CQI's suitability to a field characterized by diversity and decentralization. A 4-year study employing a qualitative multiple case study approach provided data from 4 home care agencies in Quebec, Canada. Firbank presents and analyzes the ways in which differing organizational cultures affected agency receptivity to CQI programs.
It is no news to quality management practitioners that cultural attitudes toward misbehavior and punishment color the way workers perceive performance evaluation. Where sanctions are severe and performance criteria are essentially personal and judgmental, varying from one supervisor to another, fear of reprisal will prevent workers from reporting their own errors ("incidents") and those of their coworkers. In many health care settings, a culture of silence persists in connection with patient safety and incident reporting. Sweeping these issues under the carpet effectively prevents analyzing and correcting behaviors that may endanger patient safety. Ayako Okuyama, Minako Sasaki, and Katsuya Kanda studied the effect of open discussion of incidents and incident reporting at the unit level on staff's willingness to report and analyze incidents in Japanese hospitals. They found a positive relationship between open supervisor-and-staff discussion of incidents and staff willingness to report them.
To some extent, the perception of health care quality is a sociological phenomenon, and the cultural variations revealed through reports of quality studies in different societies may have a predictive value with respect to the focus of future improvement efforts. Yu-Ying Huang and Shiy-Jane Li suggest that 1 factor in improving the quality of care in a hospital outpatient setting is to explore and resolve the differences in how hospital management, clinical staff, and outpatients perceive and measure patient care quality. They report on a study in Taiwan of the differences in the 3 groups' perceptions of quality, using a questionnaire-based system. The authors recommend that administrators conduct more market research to find out what patients want and expect.
-Jean Gayton Carroll, PhD
Editor