Strategic Management in Quality Improvement at State Madrasah

This study aims to analyze strategic planning, policy implementation and evaluation of quality improvement programs at a State Madrasah Aliyah Medan. This study uses a qualitative approach with data collection techniques through interviews, observation and documentation. While strengthening the validity of the data from research findings, the use of data validity standards based on Lincoln Guba consists of credibility, transferability, dependability, and confirmability. The results of this study indicate that; 1) strategic planning in quality improvement is carried out by deliberation and teamwork to formulate the madrasa's vision and mission, analysis of the internal environment of the resources owned by the madrasa and the external environment of the madrasa environment both geographically, socio-culturally and economically, analysis of strategy selection and the key to success appropriate, and strategy selection; 2) Implementation of madrasa policies in quality improvement is carried out by implementing education quality improvement programs and adopting policies to carry out continuous process improvements, establishing quality assurance and quality standards for quality improvement, creating a madrasa culture or culture, making organizational changes and maintaining good relations with stakeholders both central government, regional and community; and 3) Evaluation of the quality improvement program is carried out through monitoring all the results of planning and implementation, measuring the performance of individuals and madrasah institutions, compiling reports on the implementation of activities and taking corrective steps.

Predictive factors of diagnostic and therapeutic divergence in a nationwide cohort of patients seeking second medical opinion

Objectives The aim of this study was to describe the profile of patients who sought a second medical opinion (SMO) on their therapeutic or diagnostic strategy using nationwide data from a French physician network dedicated to SMOs. Methods An observational cohort study was conducted and the study population consisted of patients residing in France or in the French overseas territories who submitted a request for an SMO through a dedicated platform between January 2016 and October 2020. Patient characteristics were compared between convergent and divergent SMOs. The divergent rate for all patients excluding those with mental diseases were described. Logistic regression was used to estimate the probability of a divergent SMO according to patient characteristics. Results and discussion In total, 1,552 adult patients over several French regions were included. The divergence rate was 32.3 % (n = 502 patients). Gynecological [Odds Ratio (OR) and 95 % CI: 5.176 (3.154 to 8.494)], urological [OR 4.246 (2.053 to 8.782)] and respiratory diseases [OR 3.639 (1.357 to 9.758)] had the highest probability of a divergent SMO. Complex cases were also associated with a significantly higher risk of a divergent opinion [OR 2.78 (2.16 to 3.59)]. Age, sex, region and profession were not found to be predictive of a divergent second opinion. Conclusions Policymakers should encourage new research on patient outcomes such as mortality and hospitalization rates after a SMO. When proven effective, SMO networks will have the potential to benefit from specific public funding or even play a key role in national healthcare quality improvement programs.

The role of Primary Health Networks in cardiovascular disease prevention: A qualitative interview study

Background: Since the inception of Primary Health Networks (PHNs) in Australia, it has been unclear what their role is regarding implementing chronic disease prevention activities in general practice. This study aimed to qualitatively explore the views of PHN staff on the role of PHNs in promoting prevention, with a focus on cardiovascular disease (CVD) prevention.Methods: Content analysis of PHN Needs Assessments was conducted to inform interview questions. 29 semi-structured interviews were conducted with 32 PHN staff, between June and December 2020, in varied roles across 18 PHNs in all Australian states and territories. Transcribed audio-recordings were thematically coded, using the Framework Analysis method to ensure rigour.Results: We identified three main themes about the role of PHNs in promoting, supporting, and improving CVD prevention. 1) Informal prevention: All respondents agreed the role of PHNs in prevention was indirect and, for the most part, outside the formal remit of PHN Key Performance Indicators (KPIs.) Nevertheless, prevention activities were conducted in partnership with external stakeholders, professional development and quality improvement programs, and PHN-funded data extraction and analysis software for general practice. 2) Constrained by financial incentives: Most interviewees felt the role of PHNs in prevention was contingent on the financial drivers provided by the Commonwealth government, such as Medicare funding and national quality improvement programs. 3) Shaped through competing priorities: The role of PHNs in prevention is a function of competing priorities. There was strong agreement amongst participants that the myriad competing priorities from government and local needs assessments impeded prevention activities.Conclusions: PHNs are well positioned to foster prevention activities in general practice and local communities. However, we found that PHNs role in prevention activities were informal, constrained by financial incentives, and shaped through competing priorities. Prevention can be improved through a more explicit prevention focus at Commonwealth government level. To optimise the role of PHNs therefore requires prioritising prevention, aligning it with KPIs, and supporting stakeholders like general practice.

Evaluation of the Indicators of Quality and Safety Using the Global Models of Pharmacy Accreditation in Iranian Pharmacies

Background & Objective: Utilizing optimal accreditation methods in pharmacies could improve quality and safety. The present study aimed to evaluate the quality and safety indicators of Iranian pharmacies based on the global models of pharmacy accreditation. Methods: The first phase of the study was exploratory, followed by descriptive, comparative, cross-sectional, analytical stages using the structural equation modeling technique. A regular search was conducted in databases such as PubMed and Google Scholar, websites of other reputable organizations (WHO), and pharmacy accreditation organizations using various keywords, including accreditation program, pharmacy, quality, safety, model, and their Persian equivalents. In total, 1,217 sources and studies were identified, 199 of which were relevant to the research subject. Based on the objectives of the study, the identified sources were refined, and 10 models were finally analyzed using the structural equation modeling technique. In addition, exploratory factor analysis was performed in SPSS, and confirmatory factor analysis was performed in the AMOS software. The validity and reliability of the model were evaluated for the sample size of 300. Results: The quality and safety indicators were determined to be professional ethics, correct principles of medication, quality improvement programs, monitoring of quality improvement programs and improvement of the results, safety programs, error reporting, and monitoring of safety programs. Conclusions: Our study could be considered a tool to improve the performance of pharmacies.

An inter-agency expert panel’s prioritisation of clinical quality improvement topics in a paramedic system

Introduction Quality improvement (QI) programs have become common in paramedic systems, but they are often limited to individual agencies. Modern paramedicine involves many different agencies and inter-agency QI programs would better reflect their co-operative efforts. Similarly, inter-agency use of clinical outcome measurements can offer system level performance data. This study’s intent was to explore the feasibility of planning an inter-agency QI program that uses outcome measures. Methods This study used a modified Delphi methodology. A 49-member panel of inter-agency representatives was convened to identify and prioritise clinical outcome-based topics. Over a 3-month period, two online surveys were conducted followed by a 1-day face-to-face meeting. Results The study demonstrated very high participation rates. Results progressed from an initial wide range of 38 topics to a final consensus of two: infection/sepsis and patient safety/care pathways, complete with outcome measures. Conclusion Inter-agency quality improvement planning is an under investigated area, but this study demonstrates that it is feasible. Additionally, this planning can incorporate clinical outcome measures that inform system level discussions about quality. Other paramedic agencies may draw on the study’s processes when planning their own quality improvement programs.

Addressing Communication Breakdowns during Emergency Care Transitions of Older Adults: Evaluation of a Standardized Inter-Facility Health Care Communication Form

Transitions for older persons from long-term care (LTC) to the emergency department (ED) and back, can result in adverse events. Effective communication among care settings is required to ensure continuity of care. We implemented a standardized form for improving consistency of documentation during LTC to ED transitions of residents 65 years of age or older, via emergency medical services (EMS), and back. Data on form use and form completion were collected through chart review. Practitioners’ perspectives were collected using surveys. The form was used in 90/244 (37%) LTC to ED transitions, with large variation in data element completion. EMS and ED reported improved identification of resident information. LTC personnel preferred usual practice to the new form and twice reported prioritizing form completion before calling 911. To minimize risk of harmful unintended consequences, communication forms should be implemented as part of broader quality improvement programs, rather than as stand-alone interventions.

The Challenges of Physicians' Participation in Hospital Accreditation Programs: A Qualitative Study in Iran

Background. Due to the increasing pressure on hospitals to improve the quality of patient care, the need for physicians to participate in quality improvement Programs, especially hospital accreditation, has become more important. The present study was conducted to describe challenges of physicians' participation in accreditation programs in Iran using a qualitative approach.Methods. We conducted interviews with 11 managers, 9 physicians, 8 officials and experts in the field of quality management selected through purposive snowball sampling. The initial in-depth unstructured interviews were reviewed and transformed into semi-structured ones. The data obtained were analyzed in ATLAS.ti using the conceptual framework method.Results. 3 main concepts (cultural, organizational, behavioral) and 12 sub-concepts (Motivation, patient demand, mutual trust and evaluation system, high workload, understanding the role of quality management unit, unrealistic accreditation, nature of accreditation, empowerment of physicians in the field of quality, effective communication, resource constraint, ambiguity in the role of uncertainty about participation), And 57 items emerged from the analysis of the data.Conclusion. The implementation of this program can be improved through Culture building, proper accreditation training and quality improvement activities in the medical community helped to implements.