Managing healthcare quality using logical framework analysis
Tóm tắt
The purpose of this paper is to develop an integrated quality management model that identifies problems, suggests solutions, develops a framework for implementation and helps to evaluate dynamically healthcare service performance.
This study used the logical framework analysis (LFA) to improve the performance of healthcare service processes. LFA has three major steps – problems identification, solution derivation, and formation of a planning matrix for implementation. LFA has been applied in a case‐study environment to three acute healthcare services (Operating Room utilisation, Accident and Emergency, and Intensive Care) in order to demonstrate its effectiveness.
The paper finds that LFA is an effective method of quality management of hospital‐based healthcare services.
This study shows LFA application in three service processes in one hospital. This very limited population sample needs to be extended.
The proposed model can be implemented in hospital‐based healthcare services in order to improve performance. It may also be applied to other services.
Quality improvement in healthcare services is a complex and multi‐dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in healthcare delivery, they are not without flaws. There is an absence of an integrated approach, which can identify and analyse issues, provide solutions to resolve those issues, develop a project management framework to implement those solutions. This study introduces an integrated and uniform quality management tool for healthcare services.
Từ khóa
Tài liệu tham khảo
Akroyd, D. (1995a), “The Logical Framework Approach and the post‐evaluation of health sector projects by the African Development Bank”, Project Appraisal, Vol. 10 No. 4, pp. 210‐22.
Akroyd, D. (1995b), “Steps toward the adoption of Logical Framework Approach in the African Development Bank: some illustrations for agricultural sector projects”, Project Appraisal, Vol. 10 No. 1, pp. 19‐30.
Akroyd, D. (1999), “Logical framework approach to project planning, socio‐economic analysis and to monitoring and evaluation services: a smallholder rice project”, Impact Assessment and Project Appraisal, Vol. 17 No. 1, pp. 54‐66.
Argeetey, E. (1998), “Consultative processes in community development in Northern Ghana”, Community Development Journal, Vol. 33 No. 4, pp. 301‐33.
Australian Government (2004), “AusGUIDElines: The Logical Framework Approach 3”, available at: www.ausaid.gov.au/ (accessed February 2004).
Banerjea, K. (2004), “Process reengineering of accident and emergency services in the Queen Elizabeth Hospital, Barbados”, unpublished DM thesis, University of the West Indies, Barbados.
Berwick, D.M. (1998), “Developing and testing changes in the delivery of care”, Annals of Internal Medicine, Vol. 128, pp. 651‐6.
Bitencourt, C.C. (2003), “Resource‐based theory and strategic management: the link with organizational learning”, International Journal of Innovation and Learning, Vol. 1 No. 2, pp. 166‐76.
Bornstein, L. (2003), “Management standard and development practices in South African aid chain”, Public Administration and Development, Vol. 23 No. 5, pp. 393‐404.
Brook, R.H. and McGlynn, E.A. (1996), “Measuring quality of care”, New England Journal of Medicine, Vol. 335 No. 13, pp. 966‐9.
Chen, H.K., Chen, H.Y., Wu, H.H. and Lin, W.T. (2004), “TQM implementation in a healthcare and pharmaceutical logistics organization: the case of Zuellig Pharma in Taiwan”, Total Quality Management, Vol. 15 Nos 9‐10, pp. 1171‐8.
Copeland, G.P., Jones, D. and Walters, M. (1991), “POSSUM: a scoring system for surgical audit”, British Journal of Surgery, Vol. 78, pp. 355‐60.
Cordingley, D. (1995), “Incorporating the Logical Framework into the management of technical co‐operation projects”, Project Appraisal, Vol. 10 No. 2, pp. 103‐12.
Department of Health (South Africa) (2004), “Roll back malaria logical framework”, available at: www.doh.gov.za (accessed February 2004).
Dey, P.K., Hariharan, S., Kumar, A.Y. and Moseley, H.S.L. (2004), “Performance measurement of intensive care services in hospital: the case of Barbados”, International Journal of Service Technology Management, Vol. 5 Nos 5/6, pp. 579‐95.
DFID (1997), “Guidelines on humanitarian assistance” May, available at: http://62.189.42.51./DFIDstage/faqs/files/guidelines_on_humanitarian_assistance _v5.0a.doc (includes guidance on preparing log frames).
DFID (2005), “Logical frameworks”, available at: http://62.189.42.51/DFIDstage/FOI/tools/chapter_05_frame.htm.
Donabedian, A. (1988), “The quality of care – how can it be assessed?”, Journal of American Medical Association, Vol. 260, pp. 1743‐8.
Feeney, A. and Zairi, M. (1996), “TQM in healthcare”, Journal of General Management, Vol. 22 No. 1, pp. 35‐47.
Fernandes, C.M.B. and Christenson, J.M. (1995), “Use of continuous quality improvement to facilitate patient flow through the triage and fast‐track areas of an emergency department”, Journal of Emergency Medicine, Vol. 13 No. 6, pp. 847‐55.
Fernandes, C.M.B. and Christenson, J.M. (1996), “Continuous quality improvement reduces length of stay for fast‐track patients in an emergency department”, Academic Emergency Medicine, Vol. 3, pp. 258‐63.
Glance, L.G., Osler, T.M. and Dick, A. (2002), “Rating the quality of intensive care units: is it a function of the intensive care scoring system?”, Critical Care Medicine, Vol. 30 No. 9, pp. 1976‐82.
Green, J., Wintfield, N., Krasner, M. and Wells, C. (1997), “In search of America's best hospitals – the promise and reality of quality assessment”, Journal of American Medical Association, Vol. 277, pp. 1152‐5.
Hariharan, S., Moseley, H.S.L. and Kumar, A.Y. (2002), “Outcome evaluation in a surgical intensive care unit in Barbados”, Anaesthesia, Vol. 57 No. 5, pp. 434‐41.
Harharan, S., Dey, P.K., Moseley, H.S.L. and Kumar, A.Y. (2005), “Analytic hierarchy process as a tool for the performance measurement on intensive care services in hospital”, Critical Care Medicine.
Harharan, S., Dey, P.K., Moseley, H.S.L., Kumar, A.Y. and Gora, J. (2004), “A new tool for measurement of process‐based performance of multispecialty tertiary care hospitals”, International Journal of Health Care Quality Assurance, Vol. 17 No. 6, pp. 302‐12.
Knaus, W.A., Wagner, D.P., Draper, E.A., Zimmerman, J.E., Bergner, M. and Bastos, P.G. (1991), “The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults”, Chest, Vol. 100, pp. 1619‐36.
Lurie, J.D., Merrens, E.J., Lee, J. and Splaine, M.E. (2002), “An approach to hospital quality improvement”, Medical Clinics of North America, Vol. 86 No. 4, pp. 825‐45.
Marik, P.E. and Varon, J. (1999), “Severity scoring and outcome assessment: computerized predictive models and scoring systems”, Critical Care Clinics, Vol. 15 No. 3, pp. 633‐46.
Palmer, R.H. (1997), “Process‐based measures of quality: the need for detailed clinical data in large health care databases”, Annals of Internal Medicine, Vol. 127, pp. 733‐8.
Popovich, M.J. (2002), “If most intensive care units are graduating with honors, is it genuine quality or grade inflation?”, Critical Care Medicine, Vol. 30 No. 9, pp. 2145‐6.
Ramesh, J., Walrond, E.R. and Hariharan, S. (2005), “Evaluation of the reasons for the delays and cancellations of surgeries in a developing country”, International Journal of Clinical Practice, Vol. 59 No. 6, pp. 716‐20.
Re, R.N. and Krousel‐Wood, M.A. (1991), “How to use continuous quality improvement theory and statistical quality control tools in a multidisciplinary clinic”, QRB Quality Review Bulletin, Vol. 16, pp. 391‐7.
Slovensky, D.J. (1996), “Quality assessment and improvement”, in Abdelhak, M., Grostick, S., Hanken, M.A. and Jacobs, E. (Eds), Health Information: Management of a Strategic Resource, WB Saunders, Philadelphia, PA, pp. 320‐57.
Smith, P. (2000), “A comment on the limitation of the logical framework method, in reply to Gaper, and to Bell”, Public Administration and Development, Vol. 20 No. 5, pp. 439‐41.
Snelson, E. (1992), “Quality assurance implications of federal peer review laws: the Health Care Quality Improvement Act and the National Practitioner Data Bank”, Journal of Quality Assurance and Utilization Review, Vol. 7 No. 1, pp. 2‐11.
Task Force on the Communicable Disease Control in the Baltic Sea Region (2004), “Logical framework for TB control”, available at: www.baltichealth.org (accessed February 2004).
Udenrigsministeriet (2004), “Health Care Project Tamil Nadu, India – Volume III – Women in development – Annex IV: Logical framework”, available at: www.um.dk/danida/ (accessed February 2004).
US News & World Report (1990), “America's best hospitals”, April 30, pp. 51‐85.
Van Matre, J.G. (1992), “The D*A*T approach to total quality management”, Journal of American Health Information Management Association, Vol. 63 No. 11, pp. 38‐44.
Wong, D.T., Barrow, P.M., Gomez, M. and McGuire, G.P. (1996), “A comparison of the Acute Physiology and Chronic Health Evaluation (APACHE II) score and the Trauma‐Injury Severity Score (TRISS) for outcome assessment in intensive care unit trauma patients”, Critical Care Medicine, Vol. 24 No. 10, pp. 1642‐8.
Evans, J.R. and Lindsay, W.M. (2002), The Management and Control of Quality, 5th ed., Thompson Learning, New York, NY.