The purpose of this paper is to describe and understand the effects of the accreditation process on organizational control and quality management practices in two Quebec primary-care health organizations.
A multiple-case longitudinal study was conducted taking a mixed qualitative/quantitative approach. An analytical model was developed of the effects of the accreditation process on the type of organizational control exercised and the quality management practices implemented. The data were collected through group interviews, semi-directed interviews of key informers, non-participant observations, a review of the literature, and structured questionnaires distributed to all the employees working in both institutions.
The accreditation process has fostered the implementation of consultation mechanisms in self-assessment teams. Improving assessments of client satisfaction was identified as a prime objective but, in terms of the values promoted in organizations, accreditation has little effect on the perceptions of employees not directly involved in the process. As long as not all staff members have integrated the basis for accreditation and its outcomes, the accreditation process appears to remain an external, bureaucratic control instrument.
This study provides a theoretical model for understanding organizational changes brought about by accreditation of primary services. Through self-assessment of professional values and standards, accreditation may foster better quality management practices.
The Native American Cancer Survivors' Support Network is an innovative public health program designed to improve survival from cancer and the quality of life after a cancer diagnosis for American Indians, Alaska Natives, and Canadian Aboriginal patients and their loved ones. The Network, initiated in 1999, now has more than 300 survivors enrolled as members. This article briefly describes the process that led to its formation and preliminary findings, primarily for breast cancer survivors, of ongoing qualitative and quantitative research. Network data show patterns of cancer care that are partially responsible for poor survivorship outcomes.
To assess the quality of anaesthesia care from the patients' viewpoint compared with the hospital record.
Prospective study during 1988-9.
Four teaching hospitals (A-D) in Canada.
15,960 inpatients receiving anaesthetic requiring at least an overnight stay, for whom an interview and review of hospital records within 72 hours of surgery were complete.
Rates of postoperative symptoms of discomfort (nausea or vomiting, headache, back pain, sore throat, eye symptoms, and tingling) according to the hospital record versus interview and the relation between symptoms and patients' satisfaction with the anaesthetic experience.
The preparation of completed interviews ranged from 31.0% to 72.7%, owing mainly to patients discharge (hospitals A and B) and severity of illness (C and D). Interviewed patients were similar to all inpatients in the hospitals but were younger and healthier and more had had effective operations and were general surgical than cardiovascular or neurosurgical patients. In all, 26% to 46% of patients at the four hospitals reported at least one symptom of discomfort. Agreement between interviews and hospital records was low, symptoms being more commonly reported by interview than in the record (for example, headache was reported for 5.8%-17% of patients compared with 0.3%-3.0% in hospital records). After controlling for case mix patients who reported at least one symptom were 2.91 times (95% confidence interval 1.89 to 4.50) more likely to be dissatisfied with their anaesthetic care than patients who did not.
Anaesthesia services are typically neglected in studies of hospital quality, yet patients express considerable anxiety about anaesthetic care. Monitoring and recording patients' discomfort clearly need to be improved if the quality of anaesthesia is to be properly evaluated.
Cites: J Clin Epidemiol. 1988;41(1):83-903335873
Cites: Am J Epidemiol. 1986 May;123(5):894-9003962971
This article describes the application of the Iowa Model of Evidence-Based Practice to Promote Quality Care to creating standards of practice for Basic Cardiac Life Support certification of the nursing staff at a merged health center in Montreal, Quebec, Canada. Selected outcomes and adopted practice guidelines are presented.
This pilot project involved the application, in Canada, of the innovative 80/20 staffing model to a hospital in a small rural setting. The model provides the voluntary participants with 20% of their salaried time off from direct patient care in order to pursue various types of professional development activities. The project, overseen by a steering committee, lasted from June 2009 to February 2010 and involved 14 nurses on the pediatric unit of Royal Inland Hospital in Kamloops, British Columbia. It entailed a collaborative partnership of the British Columbia Nurses' Union, Interior Health Authority, Thompson Rivers University and the British Columbia Ministry of Health, and aimed to demonstrate how professional development opportunities can improve recruitment and retention of nurses, quality of work life and quality of patient care.