RESUMEN

INTRODUCTION: The purpose of this study was to evaluate the perception of the quality of care, considering both patient experience and health care professionals' perceptions as well as patient outcome measures of an integrated lung cancer pathway. METHODS: A cross-sectional study was conducted in 2016 at Ferrara University Hospital, Italy. OPportunity for Treatment In ONcology (OPTION) questionnaires were administered to 77 patients, and the Care Process Self-Evaluation Tool (CPSET) questionnaires were given to 38 health care professionals. The effectiveness of the pathway was evaluated by analysing the tool's positive impact on lung cancer surgery volume and 30-day mortality. RESULTS: Seventy-seven patients were enrolled, and 38 health care professionals assessed the CPSET questionnaire. The highest scores were related to "respect" (100%), "satisfaction" (98.7%), and "trust" (97.4%) on the OPTION and to "patient-focused vision" (97.2%) and "patient engagement" (94.4%) on the CPSET. The lowest scores were related to "information" (26%) and "cooperation with general practitioner" (17.6%) on the OPTION and "cooperation between the hospital and primary care" (23.5%) for the CPSET. The outcomes analysis shows an increase in the volume of activity and a decrease in 30-day mortality after pathway implementation. DISCUSSION: The lung cancer pathway is a patient-centred intervention that enables care to be shaped for patient needs in order to improve the quality and efficiency of service and clinical outcome.

RESUMEN

INTRODUCTION: In order to ensure high-quality treatment for patients with cancer it is vital to implement organisational models (pathways and networks) and that guarantee continuity of care. Appropriate assessment tools that promote the evaluation and analysis of care pathways from the patients' perspective are available. Hence the aim of this study was to verify whether or not the coordination between the various stages and care providers in a cancer treatment pathway is perceived by our patients. METHODS: Patients being treated for cancer of the lung, breast or colorectal tract by the Ferrara University Hospital (FUH) and the wider Romagna regional health service (RRHS), Italy, were administered the OPTION evaluation questionnaire. Univariate descriptive statistics of patients' sociodemographic features and care pathways were generated, and means and standard deviations were calculated for patient responses to OPTION items 1-19 on continuity of care throughout their treatment pathway. RESULTS: Responses from 341 patients (37.2 % treated by the FUH and 62.8% by the RRHS) were obtained. All mean scores provided for items 1-19 were above 4 on a Likert scale of 1-5, showing that the patients' perception of the continuity of their care was very positive on the whole. The highest mean scores were given for items regarding their emotional experience, while the lowest were given for those regarding information and integration with the GPs. DISCUSSION AND CONCLUSIONS: Organisational efforts to promote patient-centred continuity of oncological care improved the experience of patients in our sample. Our data suggest that integration with the GPs still remains a problem, both from an organisational standpoint and in the perception of the patient being treated for cancer at one of the facilities under investigation. Although our findings are non-controlled and not generalisable to other geographical areas, they do show how such tools can be used to monitor and analyse patient's experience with continuity of care with a view to continual improvement in care provision.

Asunto(s)

RESUMEN

Purpose - Operating room (OR) turnaround time is a key process indicator for hospital business management: delays lead to a reduced surgical interventions per day with a consequent increase in costs and decrease in efficiency. The purpose of this paper is to increase understanding by assessing the process' steady-state behaviour and identifying changes that indicate either improvement or deterioration in quality. Design/methodology/approach - With this purpose, the authors retrospectively applied Shewhart control charts and exponentially weighted moving average control charts to data extracted from an hospital information system. Findings - The results showed that statistical process control is able to identify steady-state behaviour process and to detect positive or negative changes in process performance. In particular the authors detected a deterioration in the process performance coinciding with the change in the operating room patient transfer staff. Practical implications - This study showed that statistical quality control is a valuable tool for monitoring performance indicators. Currently, hospital managers are designing an OR dashboard which also includes the control charts. Originality/value - The paper highlights the control chart application to organizational indicators allowing an objective OR system performance assessment.

Asunto(s)

RESUMEN

BACKGROUND: By means of the ICONAS project, the Healthcare Agency of an Italian Region developed, and used a standardised questionnaire to quantify the organisational climate. The aims of the project were (a) to investigate whether the healthcare institutions were interested in measuring climate, (b) to estimate the range of applicability and reliability of the instrument, (c) to analyse the dimensions of climate among healthcare personnel, (d) to assess the differences among employees with different contractual positions. METHODS: The anonymous questionnaire containing 50 items, each with a scale from 1 to 10, was offered to the healthcare organisations, to be compiled during ad hoc meetings. The data were sent to the central project coordinator. The differences between highly specialised staff (mostly physicians) and other employees were assessed after descriptive statistical analysis of the single items. Both Principal Component Analysis and Factor Analysis were used. RESULTS: Ten healthcare organisations agreed to participate. The questionnaire was completed by 8691 employees out of 13202. The mean value of organisational climate was 4.79 (range 1-10). There were significant differences among single items and between the 2 groups of employees. Multivariate methods showed: (a) one principal component explained > 40% of the variance, (b) 7 factors summarised the data. CONCLUSION: Italian healthcare institutions are interested in assessing organisational phenomena, especially after the reforms of the nineties. The instrument was found to be applicable and suitable for measuring organisational climate. Administration of the questionnaire leads to an acceptable response rate. Climate can be described by means of 7 underlying dimensions.

Asunto(s)