Quality Management in Health Care最新文献

{"title":"Improving Emergency Department Performance Through Simultaneous Operational and Cultural Enhancements.","authors":"Stephen Behnke, William Krost, Aaron Sciascia","doi":"10.1097/QMH.0000000000000560","DOIUrl":"10.1097/QMH.0000000000000560","url":null,"abstract":"<p><strong>Background and objective: </strong>Emergency departments (ED) receive significant scrutiny regarding their function and processes, as the ED is typically the initial hospital entry point for patients. Process improvement initiatives have been shown to improve ED performance metrics. However, these initiatives are often carried out as individual projects rather than comprehensive program redesigns. Therefore, this study aimed to determine if a novel model created with the principles of design thinking improved patient experience and flow metrics in several EDs within a hospital system.</p><p><strong>Methods: </strong>A multi-faceted approach was developed focusing on both culture and performance within 7 EDs. The PEOPLE+ model was developed, which comprises 5 key areas of focus: philosophy, economics, operational architecture, providers, and leadership. The PEOPLE+ model served as the framework that prioritized all providers, supported staff, optimized patient care, and embraced adaptability and continuous improvement. Left without being seen (LWBS), left against medical advice, emergency medical services volume, diversion hours, visit volume, patient experience, admit volume, length of stay (LOS) discharged, LOS admitted, median door-to-provider time, patient door to provider time <30 minutes, total transfers, total boarders, and total boarder hours were compared 22 months before to 24 months post-implementation.</p><p><strong>Results: </strong>Following the partnership, there were statistically significant improvements in LWBS (-80.0%; P < .001), leaving against medical advice (-17.6%; P < .001), diversion hours (-95.6%; P < .001), patient experience (+250.7%; P < .001), LOS discharged (-24.2%; P < .001), LOS admitted (-16.9%; P < .001), median door-to-provider time (-55.2%; P < .001), and patient door to provider <30 minutes (+51.5%; P < .001). LWBS (-47.4%; P < .001), diversion hours (≤-84.6%; P ≤ .025), and median door-to-provider time (≤ -31.3%; P < .001) during the second, third, and fourth post-6-month time frames were significantly lower compared to the first 6 months following the partnership, whereas leaving against medical advice (≤-27.8%; P ≤ .013) and LOS discharged (≤ -12.8%; P ≤ .042) during the third and fourth 6-month time frames were significantly lower compared to the first 6 months following the partnership. Conversely, patient experience (≥ +36.5%; P ≤ .040) and patient door-to-provider <30 minutes (≥ +18.1%; P < .001) during the second, third, and fourth 6-month time frames were significantly greater compared to the first 6 months following the partnership.</p><p><strong>Conclusions: </strong>Changes to philosophic, economic, operational, leadership, and staffing models highlighted by provider ownership and direct provider involvement in developing and executing changes allowed ED performance metrics to significantly improve.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"249-258"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizational Restructuring Through the Scope of Healthcare Leadership.","authors":"John Aiden Brennan, Cheryl Green, Todd A Lane","doi":"10.1097/QMH.0000000000000583","DOIUrl":"10.1097/QMH.0000000000000583","url":null,"abstract":"<p><p>Healthcare organizations periodically restructure to meet the evolving needs of patients, changes in regulations, and financial pressures. Restructuring can induce organizational stress, disrupt workflows, and compromise quality if not managed properly. For this reason, adaptive leadership is required to guide reconstruction efforts while balancing human, financial, organizational, and quality-related factors. Despite the prevalence of restructuring in healthcare, there is limited writing on evidence-based strategies to improve care and sustain organizational change over a continuum. Fostering unity of purpose, appreciation of existing expertise, and clear communication are key components of successful restructuring within the healthcare industry. This commentary explores best practices as it relates to the scope of organizational restructuring.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"291-293"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Silos: Integrating Leadership, Informatics, and Evidence-Based Improvement to Advance a Learning Health System.","authors":"R Lynae Roberts, Timothy R Fowles, Douglas Wolfe, Sheralee Petersen, Tamara Moores Todd, J P Valin, Rajendu Srivastava","doi":"10.1097/QMH.0000000000000599","DOIUrl":"10.1097/QMH.0000000000000599","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"294-296"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Can We Leverage Experiential Learning Theory for Quality Improvement in a Learning Health System?","authors":"Mohammad Naqibuddin, Shannon Cole","doi":"10.1097/QMH.0000000000000601","DOIUrl":"10.1097/QMH.0000000000000601","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"297-300"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Scoping Review of Capacity Building for Quality Improvement in Hospitals: Key Themes and Methodological Insights.","authors":"Camilla Frosch Holmager Sloth, Louise Schlosser Mose, Pernille Tanggaard Andersen, Torben Knudsen, Charlotte Overgaard","doi":"10.1097/QMH.0000000000000542","DOIUrl":"10.1097/QMH.0000000000000542","url":null,"abstract":"<p><strong>Background and objectives: </strong>Addressing the complexities of health care quality improvement (QI) requires understanding the multifactorial aspects that contribute to capacity building in hospital settings. With escalating demands on health care systems, identifying factors that enhance QI capacity is crucial. This study aims to elucidate these factors and explore how they can be leveraged to improve QI initiatives in hospitals.</p><p><strong>Methods: </strong>We conducted a comprehensive literature review, searching databases including CINAHL, Embase, Medline, PubMed, and the Cochrane Library to identify key factors influencing QI capacity development. The Joanna Briggs Institute critical appraisal tool was used to assess the methodological quality of studies. NVivo software facilitated the coding and thematic analysis of extracted data, enabling the identification of key themes.</p><p><strong>Results: </strong>Analysis of 21 studies identified key factors for hospital QI capacity: (1) Accountability and priority setting, emphasizing clear responsibilities and strategic focus; (2) strategic management, aligning frameworks with QI objectives; (3) collaboration, highlighting the importance of synergistic efforts among stakeholders; (4) enhancing QI knowledge and experience, stressing continuous learning and experience sharing; and (5) QI project support, detailing the need for adequate resources and backing. These themes collectively provide a blueprint for advancing QI capacity in hospitals.</p><p><strong>Conclusions: </strong>This review highlights critical themes for enhancing QI capacity in hospitals, particularly the integration of accountability, strategic management, collaboration, knowledge enhancement, and project support. Recognizing the interconnected nature of these themes is vital for sustained improvements in health care outcomes. Future research should explore the role of organizational culture in optimizing QI initiatives.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"223-233"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Communication: Crafting Guidelines for Epic Secure Chat in an Academic Medical Center.","authors":"Escher L Howard-Williams, Elizabeth Dreesen, John Downs, Lauren Schiff, Cristie Dangerfield, Clare Mock","doi":"10.1097/QMH.0000000000000547","DOIUrl":"10.1097/QMH.0000000000000547","url":null,"abstract":"<p><strong>Background: </strong>Effective communication among health care providers constitutes a critical cornerstone for delivering optimal patient care. However, the achievement of efficient communication within patient care remains a challenge in modern medicine. While traditional paging systems have served as the primary means of communication in health care, they are limited to unidirectional communication. To address these shortcomings, bidirectional models emerged, seeking to enhance communication among health care partners. To foster improved communication, our institution implemented a 2-way secure messaging system, Epic Secure Chat. This introduction, however, occurred without tailored guidance on appropriate use, leading to confusion among health care staff regarding optimal, safe utilization of the new platform.</p><p><strong>Methods: </strong>Employing a system-wide survey to gather data from various in- and outpatient departments, we sought to comprehend the present state of affairs concerning the usage of this platform. The survey was distributed using a hierarchical email approach, beginning with Tier III Safety Huddle participants and cascading through departmental leadership at our institution. Department leaders further disseminated the survey to a wide range of clinical and administrative staff, including providers, nurses, pharmacists, technicians, and ancillary personnel, to ensure diverse role representation. Open-ended responses were analyzed using thematic analysis. The research team systematically coded and categorized responses to identify key themes, areas of consensus, and divergent viewpoints, enabling the extraction of meaningful insights into the use and perception of Epic Secure Chat.</p><p><strong>Results: </strong>The majority of survey respondents were physicians or advanced practice providers (56.54%) and nurses (31.78%), reflecting a predominantly clinical user base. Epic Secure Chat was widely used for interdisciplinary care coordination (34.07%) and 2-way communication (23.33%), though over 10% reported minimal use. While many valued its efficiency and ease of use, significant concerns emerged. Safety issues, including inappropriate use for urgent communication and lack of closed-loop messaging, accounted for 46.21% of feedback. Workflow challenges (34.70%) and compliance concerns (6.57%) were also noted. Despite these issues, 12.12% of responses highlighted positive impacts on team communication and workflow efficiency.</p><p><strong>Conclusion: </strong>These findings may serve as a model for other health care organizations seeking to implement or refine secure messaging systems. As communication technologies continue to evolve, it is essential to balance efficiency with safety, ensuring that tools like Secure Chat enhance rather than hinder clinical care. Continued evaluation and adaptation will be critical to achieving this balance and supporting both provider well-being and patient outcomes.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"284-290"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Call for Learning Health System Research and Commentaries.","authors":"Jane Banaszak-Holl, Jill Marsteller","doi":"10.1097/QMH.0000000000000605","DOIUrl":"10.1097/QMH.0000000000000605","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"213-214"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Sequence of Improvement: A Structured Step-by-Step Approach to Quality Improvement in Healthcare.","authors":"Marco Aurelio, Carlos Santos, Amar Shah","doi":"10.1097/QMH.0000000000000579","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000579","url":null,"abstract":"<p><p>Quality improvement in healthcare needs methods that balance rigor with usability, and the sequence of improvement offers a practical way for teams to work through complex issues. It moves from defining a problem to understanding it, shaping strategy, testing ideas, and embedding change, drawing on improvement science, Deming, systems thinking, and complexity theory while remaining accessible for everyday practice. More than 900 projects and thousands of staff have used it, creating a strong peer-reviewed evidence base. Applications include reducing pressure ulcers across an organization and improving the timeliness of serious-incident investigations, with progress monitored through statistical process control. Results were measurable: complaints completed on time rose from 30% to 54%, and pressure ulcers fell by 30%. Its impact depends on capable teams and supportive infrastructure. Future development could deepen systems analysis, strengthen quasi-experimental evaluation, use leverage-point and relational coordination theories, and integrate implementation science.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Silence to Systems: A System-Level Response to the Second Victim Crisis.","authors":"Misty Stone","doi":"10.1097/QMH.0000000000000565","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000565","url":null,"abstract":"<p><strong>Background and objectives: </strong>The second victim phenomenon refers to the emotional and psychological distress experienced by health care professionals following involvement in adverse patient events. Despite increasing awareness, institutional responses remain inconsistent, while support systems are often fragmented or even lacking. This presents significant implications for health care workers' well-being, patient safety, and organizational culture. This integrative literature review aims to (1) examine the experiences of second victims across health care settings, (2) evaluate current institutional support systems, and (3) propose a conceptual framework to guide more comprehensive and systemic responses to second victim distress.</p><p><strong>Methods: </strong>Guided by Whittemore and Knafl's integrative review framework, a comprehensive search of PubMed, CINAHL, PsycINFO, and Scopus was conducted for studies published between 2000 and 2024. The PRISMA guidelines were followed to screen and select relevant articles. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool, and findings were synthesized thematically.</p><p><strong>Results: </strong>Eleven studies met the inclusion criteria. Four central themes were identified: (1) emotional and psychological impact, (2) organizational culture and support, (3) coping and help-seeking behaviors, and (4) institutional responses and interventions. A novel conceptual model, The Second Victim Support Ecosystem, was developed to conceptualize the interconnected layers of second victim experiences and organizational responsibilities.</p><p><strong>Conclusions: </strong>Second victim distress is a critical, under-addressed issue that undermines provider resilience and patient safety. While some organizations have implemented promising interventions, a lack of standardization persists. This review introduces a layered conceptual framework and offers actionable recommendations to guide the development of comprehensive, system-level second victim support strategies.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Using Clinicians to Code the Actionability of Narrative Comments About Patient Experience for Quality Improvement.","authors":"Denise D Quigley, Zachary Predmore, Maria S Panayotou, Marc N Elliott, Ron D Hays","doi":"10.1097/QMH.0000000000000566","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000566","url":null,"abstract":"<p><strong>Background and objectives: </strong>Many healthcare organizations administer Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys and use both quantitative ratings and qualitative narrative comments. While narrative data offer rich insights into patient experience, their time-intensive analysis often limits systematic use in quality improvement (QI). Healthcare organizations often underutilize this data, reading comments and not analyzing them systematically. This study examined the feasibility and accuracy of engaging clinicians in systematically coding narrative CAHPS data for QI. We conducted a coding exercise using patient-level narrative comments and compared the inter-rater reliability of clinicians and experienced qualitative researchers.</p><p><strong>Methods: </strong>We partnered with a large, urban freestanding children's hospital that routinely collects Child HCAHPS data. Our six-person coding team comprised two experienced qualitative researchers, two pediatric inpatient physicians, and two pediatric inpatient nurses. Following standardized training on the coding process and a predefined codebook, the comments were coded independently. The coding framework included valence (positive, negative, mixed), identification of potential patient safety issues (safety flag), staff type mentioned (e.g., doctor, nurse), setting mentioned (e.g., emergency room), overall actionability (yes/no), and, if actionable, the level of action needed (individual clinician/provider or organizational). We calculated overall and pairwise inter-rater agreement (Kappa) to assess coding consistency across and between the three professional groups and for different code combinations to identify patterns.</p><p><strong>Results: </strong>Researchers had excellent inter-rater agreement (pooled Kappa = 0.88). There was very good agreement among clinicians (Kappa = 0.68), whereas nurses had good agreement (Kappa = 0.60). Valence and mentioned staff type were coded with high consistency across all groups. Agreement on the dichotomous 0/1 indicator of actionability (yes/no) was higher than for the three-level coding of actionability (not actionable/actionable at provider-level/actionable at organizational-level). Notably, nurses displayed slightly higher agreement than physicians, whereas researchers were consistently more concordant than both clinician groups. Nurses also demonstrated the strongest sensitivity in identifying potential patient safety issues within the narrative comments.</p><p><strong>Conclusion: </strong>Our findings suggest that training nurses to code narrative CAHPS comments for valence, mentioned staff, overall actionability, and patient safety flags is a feasible and potentially effective strategy for QI. This focused coding approach, implemented regularly (e.g., quarterly), could efficiently generate a substantial dataset for integration into routine QI initiatives and staff meetings.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}