INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE最新文献

{"title":"Safety attitudes in hospital emergency departments: a systematic review.","authors":"Naif Alzahrani, Russell Jones, Amir Rizwan, Mohamed E Abdel-Latif","doi":"10.1108/IJHCQA-07-2018-0164","DOIUrl":"10.1108/IJHCQA-07-2018-0164","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this paper is to perform and report a systematic review of published research on patient safety attitudes of health staff employed in hospital emergency departments (EDs).</p><p><strong>Design/methodology/approach: </strong>An electronic search was conducted of PsychINFO, ProQuest, MEDLINE, EMBASE, PubMed and CINAHL databases. The review included all studies that focussed on the safety attitudes of professional hospital staff employed in EDs.</p><p><strong>Findings: </strong>Overall, the review revealed that the safety attitudes of ED health staff are generally low, especially on teamwork and management support and among nurses when compared to doctors. Conversely, two intervention studies showed the effectiveness of team building interventions on improving the safety attitudes of health staff employed in EDs.</p><p><strong>Research limitations/implications: </strong>Six studies met the inclusion criteria, however, most of the studies demonstrated low to moderate methodological quality.</p><p><strong>Originality/value: </strong>Teamwork, communication and management support are central to positive safety attitudes. Teamwork training can improve safety attitudes. Given that EDs are the \"front-line\" of hospital care and patients within EDs are especially vulnerable to medical errors, future research should focus on the safety attitudes of medical staff employed in EDs and its relationship to medical errors.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"32 1","pages":"1042-1054"},"PeriodicalIF":1.0,"publicationDate":"2019-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48069996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An innovative medical consultation model in mainland China.","authors":"Xiao Ping Xu, D. Ke, D. Deng, S. Houser, Xiao Ning Li, Qing Wang, Ng Chui Shan","doi":"10.1108/IJHCQA-02-2017-0033","DOIUrl":"https://doi.org/10.1108/IJHCQA-02-2017-0033","url":null,"abstract":"PURPOSE\u0000The purposes of this paper are two-fold: first, to introduce a new concept of primary care consultation system at a mainland Chinese hospital in response to healthcare reform; and second, to explore the factors associated with change resistance and acceptance from both patients' and medical staff's perspectives.\u0000\u0000\u0000DESIGN/METHODOLOGY/APPROACH\u0000A survey design study, with two questionnaires developed and distributed to patients and medical staff. Convenience and stratified random sampling methods were applied to patient and medical staff samples.\u0000\u0000\u0000FINDINGS\u0000A 5-dimension, 21-item patient questionnaire and a 4-dimension, 16-item staff questionnaire were identified and confirmed, with 1020 patients (91.07 percent) and 202 staff (90.18 percent) as effective survey participants. The results revealed that patient resistance mainly stems from a lack of personal experiences with visiting general practice (GP) and being educated or having lived overseas; while staff resistance came from occupation, education, GP training certificate, and knowledge and experience with specialists. Living in overseas and knowledge of GP concepts, gender and education are associated with resistance of accepting the new practice model for both patients and staff.\u0000\u0000\u0000ORIGINALITY/VALUE\u0000There are few Chinese studies on process reengineering in the medical sector; this is the first study to adopt this medical consultation model and change in patients' consultation culture in Mainland China. Applying organizational change and process reengineering theories to medical and healthcare services not only extends and expands hospital management theory but also allows investigation of modern hospital management practice. The experience from this study can serve as a reference to promote this new consultation model in Chinese healthcare reform.","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"32 7 1","pages":"1055-1071"},"PeriodicalIF":1.5,"publicationDate":"2019-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/IJHCQA-02-2017-0033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44186128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of safety culture in healthcare institutions: case of an Algerian hospital.","authors":"Assia Boughaba, S. Aberkane, Y. Fourar, M. Djebabra","doi":"10.1108/IJHCQA-09-2018-0229","DOIUrl":"https://doi.org/10.1108/IJHCQA-09-2018-0229","url":null,"abstract":"PURPOSE\u0000For many years, the concept of safety culture has attracted researchers from all over the world, and more particularly in the area of healthcare services. The purpose of this paper is to measure safety culture dimensions in order to improve and promote healthcare in Algeria.\u0000\u0000\u0000DESIGN/METHODOLOGY/APPROACH\u0000The used approach consists of getting a better understanding of healthcare safety culture (HSC) by measuring the perception of healthcare professionals in order to guide promotion actions. For this, the Hospital Survey on Patient Safety Culture questionnaire was used in a pilot hospital setting where it was distributed on a number of 114 health professionals chosen by stratified random sampling.\u0000\u0000\u0000FINDINGS\u0000The results showed that the identified priority areas for HSC improvement help in establishing a trust culture and a non-punitive environment based on the system and not on the individual.\u0000\u0000\u0000ORIGINALITY/VALUE\u0000Safety is recognized as a key aspect of service quality, thus measuring the HSC can help establish an improvement plan. In Algerian health facilities, this study is considered the first to examine perceptions in this particular area. The current results provide a baseline of strengths and opportunities for healthcare safety improvement, allowing the managers of this type of facilities to take steps that are more effective.","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"32 7 1","pages":"1081-1097"},"PeriodicalIF":1.5,"publicationDate":"2019-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/IJHCQA-09-2018-0229","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47430619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality improvement in hospice settings: perceptions of leaders.","authors":"Jitendra Singh, Brandi Sillerud, Marah Omar","doi":"10.1108/IJHCQA-04-2019-0084","DOIUrl":"https://doi.org/10.1108/IJHCQA-04-2019-0084","url":null,"abstract":"PURPOSE\u0000The purpose of this paper is to explore and examine attitudes and perceptions of leaders on application of quality improvement (QI) strategies in a palliative and hospice care organization.\u0000\u0000\u0000DESIGN/METHODOLOGY/APPROACH\u0000This study employed qualitative research methodology where leaders working in a hospice and palliative care organization were invited to participate in 45-60-min-long semi-structured interview. Interviews were recorded and transcribed verbatim. Qualitative content analysis was utilized to analyze the data collected during participant interviews.\u0000\u0000\u0000FINDINGS\u0000Seven leaders participated in the interviews. Five themes were developed from data analysis: patient-centered care; continuous QI; leadership involvement and commitment; communication as a foundation for QI; and perceived barriers. Data analysis suggests that use of QI approach in palliative and hospice care enhances the quality of care provided for patients, and can help improve patient satisfaction.\u0000\u0000\u0000PRACTICAL IMPLICATIONS\u0000Because there is a paucity of research on implementation of QI strategies in hospice and palliative care settings, this research can have wide practical implications. This research can provide useful practical tips to leaders as they work on implementing QI projects in their organization.\u0000\u0000\u0000ORIGINALITY/VALUE\u0000This manuscript can be of value to leaders, administrators and academicians who are interested in applying QI principles to healthcare processes especially in palliative and hospice care settings. Ability to work with others, solid communication and involvement of employees from all levels can help in streamlining current systems of care.","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"32 7 1","pages":"1098-1112"},"PeriodicalIF":1.5,"publicationDate":"2019-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/IJHCQA-04-2019-0084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44781266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of physician associate delivered virtual outpatient clinic.","authors":"Daniel Meehan, A. Balhareth, Madhumitha Gnanamoorthy, J. Burke, D. McNamara","doi":"10.1108/IJHCQA-09-2018-0233","DOIUrl":"https://doi.org/10.1108/IJHCQA-09-2018-0233","url":null,"abstract":"PURPOSE\u0000The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and considering new processes all have a role in improving delivering these services. The purpose of this paper is to evaluate the safety of a physician associate (PA) delivered virtual outpatient department (VOPD) consultation service that was established in a General and Colorectal Surgery Department at an Irish teaching hospital.\u0000\u0000\u0000DESIGN/METHODOLOGY/APPROACH\u0000A series of low-risk surgical patients were referred by senior surgeons to a PA delivered virtual clinic (VOPD). Medical records belonging to half the included patients were randomly selected for review by two doctors three months following discharge back to primary care to confirm appropriate standards of care and documentation and to audit any recorded adverse incidents or outcomes.\u0000\u0000\u0000FINDINGS\u0000In total, 191 patients had been reviewed by the PA in the VOPD with 159 discharged directly back to primary care. Among the 95 medical records that were reviewed by the NCHDs, there were no recorded adverse incidents after discharge. Medical record keeping was deficient in 1 out of 95 reviewed cases.\u0000\u0000\u0000PRACTICAL IMPLICATIONS\u0000Using a PA delivered VOPD consultation appears to have a role in following up patients who have undergone low-risk procedures irrespective of age or co-morbidity when selected appropriately. This may assist in reducing the demand on outpatient services by reducing unnecessary return visits, thereby increasing the capacity for new referrals.\u0000\u0000\u0000ORIGINALITY/VALUE\u0000While there are reported examples to date of virtual clinics, these relate to services delivered by registered medical practitioners. Here, the authors demonstrate the acceptability of this model of care in an Irish population as delivered by a PA.","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"32 7 1","pages":"1072-1080"},"PeriodicalIF":1.5,"publicationDate":"2019-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/IJHCQA-09-2018-0233","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44885296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Global call for action on infection prevention and control.","authors":"Gertrude Sika Avortri,&nbsp;Juliet Nabyonga-Orem","doi":"10.1108/IJHCQA-03-2018-0063","DOIUrl":"https://doi.org/10.1108/IJHCQA-03-2018-0063","url":null,"abstract":"<p><strong>Purpose: </strong>Healthcare-associated infections (HAIs) constitute a major threat to patient safety and affect hundreds of millions of people worldwide. The World Health Organization in 2016 published guidelines on the core components for infection prevention and control (IPC) programme. This was in response to a global call for focused action. The purpose of this paper is to examine and promote understanding of the tenets of the IPC guidelines and highlight their implications for implementation in low-income countries.</p><p><strong>Design/methodology/approach: </strong>Drawing from personal experiences in leading the implementation of health programmes as well as a review of published and grey literature on IPC, authors discussed and proposed practical approaches to implement IPC priorities in low-income setting.</p><p><strong>Findings: </strong>Availability of locally generated evidence is paramount to guide strengthening leadership and institutionalisation of IPC programmes. Preventing infections is everybody's responsibility and should be viewed as such and accorded the required attention.</p><p><strong>Originality/value: </strong>Drawing from recent experiences from disease outbreaks and given the heavy burden of HAIs especially in low-income settings, this paper highlights practical approaches to guide implementation of the major components of IPC.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"32 6","pages":"927-940"},"PeriodicalIF":1.5,"publicationDate":"2019-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/IJHCQA-03-2018-0063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37139259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An assessment of education, in-service training and tenure prolongation as methods for enhancing nursing performance.","authors":"Nestor Asiamah,&nbsp;Henry Kofi Mensah,&nbsp;Ben Ocra","doi":"10.1108/IJHCQA-07-2018-0190","DOIUrl":"https://doi.org/10.1108/IJHCQA-07-2018-0190","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this paper is to provide an empirical basis for considering in-service training, tenure prolongation and continuing education as methods for enhancing nursing performance.</p><p><strong>Design/methodology/approach: </strong>A self-reported questionnaire was used to collect data from 532 nurses, who were selected using the simple random sampling method from ten hospitals in Accra North, Ghana. Confirmatory factor analysis (CFA) was used to test the study's hypotheses.</p><p><strong>Findings: </strong>The resulting model is of good fit at 5 per cent significance level (<i>χ</i>²=1.492, <i>p</i>=0.222), with in-service training found to be the ultimate method for enhancing nursing performance. The fitted CFA model also shows that in-service training is positively associated with education and tenure at 1 per cent significance level (<i>p</i><0.001). The overall evidence suggests that training, continuing formal education and tenure prolongation are methods for improving nursing performance.</p><p><strong>Originality/value: </strong>Apart from its contribution to the literature, this study applies validated primary data to empirically identify key methods for enhancing nursing performance.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"32 6","pages":"910-926"},"PeriodicalIF":1.5,"publicationDate":"2019-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/IJHCQA-07-2018-0190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37403424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing interruptions during medication preparation and administration.","authors":"Alberto Mortaro,&nbsp;Diana Pascu,&nbsp;Serena Pancheri,&nbsp;Mariangela Mazzi,&nbsp;Stefano Tardivo,&nbsp;Claudio Bellamoli,&nbsp;Federica Ferrarese,&nbsp;Albino Poli,&nbsp;Gabriele Romano,&nbsp;Francesca Moretti","doi":"10.1108/IJHCQA-12-2017-0238","DOIUrl":"https://doi.org/10.1108/IJHCQA-12-2017-0238","url":null,"abstract":"<p><strong>Purpose: </strong>According to literature, interruptions during drug administration lead to a significant proportion of medication errors. Evidence on the effectiveness of interventions to reduce interruption is still limited. The purpose of this paper is to explore main reasons for interruptions during drug administration rounds in a geriatric ward of an Italian secondary hospital and test the effectiveness of a combined intervention.</p><p><strong>Design/methodology/approach: </strong>This is a pre and post-intervention observational study based on direct observation. All nurse staff (24) participated to the study that lead to observe a total of 44 drug dispensing rounds with 945 drugs administered to 491 patients in T0 and 994 drugs to 506 patients in T1.</p><p><strong>Findings: </strong>A significant reduction of raw number of interruptions (mean per round from 17.31 in T0 to 9.09 in T1, <i>p</i><0.01), interruptions/patient rate (from 0.78 in T0 to 0.40 in T1, <i>p</i><0.01) and interruptions/drugs rate (from 0.44 in T0 to 0.22 in T1, <i>p</i><0.01) were observed. Needs for further improvements were elicited (e.g. a greater involvement of support staff).</p><p><strong>Practical implications: </strong>Nurse staff should be adequately trained on the risks related to interruptions during drug administration since routine activity is at high risk of distractions due to its repetitive and skill-based nature.</p><p><strong>Originality/value: </strong>A strong involvement of both MB and leadership, together with the frontline staff, helped to raise staff motivation and guide a bottom-up approach, able to identify tailored interventions and serve concurrently as training instrument tool.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"32 6","pages":"941-957"},"PeriodicalIF":1.5,"publicationDate":"2019-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/IJHCQA-12-2017-0238","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37139260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leadership styles' influence on the quality of nursing care.","authors":"Aladeen Alloubani,&nbsp;Laila Akhu-Zaheya,&nbsp;Ibrahim Mubarak Abdelhafiz,&nbsp;M Almatari","doi":"10.1108/IJHCQA-06-2018-0138","DOIUrl":"https://doi.org/10.1108/IJHCQA-06-2018-0138","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this paper is to investigate managers' leadership styles, from the perspective of registered nurses, and its effects on the quality of nursing care in both the private and public healthcare sectors. An additional aim is to assess the relationship between leadership styles and particular organisational outcomes.</p><p><strong>Design/methodology/approach: </strong>The sample for this quantitative research study was comprised of 400 respondents, among which 50 were nurse managers, 150 were staff nurses and the remaining respondents were patients. Two questionnaires were used in this study: the multi-factor leadership questionnaire (MLQ) 5X short and a patient satisfaction with nursing care quality questionnaire (PSNCQQ).</p><p><strong>Findings: </strong>A positive correlation was found between the transformational leadership style with leadership outcomes and the quality of nursing care (<i>r</i>=0.811**, 0.759**, 0.789** and 0.877** for extra effort, job satisfaction, leader effectiveness and quality, respectively).</p><p><strong>Practical implications: </strong>Although the sample study was extensive, a possible limitation is that the research utilised convenient sample who are working in the private and public healthcare sectors thus limiting the generalisability of the study.</p><p><strong>Originality/value: </strong>This study was proposed as a baseline for upcoming studies in areas of education, nursing practice, research and quality. Moreover, this study was expected to be imperative to the hospital's management, in order to improve the current level of leadership, education models and advancement programs for the healthcare sector's senior staff.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"32 6","pages":"1022-1033"},"PeriodicalIF":1.5,"publicationDate":"2019-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/IJHCQA-06-2018-0138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37139261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality assurance as a foundational element for an integrated system of dementia care.","authors":"George A Heckman,&nbsp;Lauren Crutchlow,&nbsp;Veronique Boscart,&nbsp;Loretta Hillier,&nbsp;Bryan Franco,&nbsp;Linda Lee,&nbsp;Frank Molnar,&nbsp;Dallas Seitz,&nbsp;Paul Stolee","doi":"10.1108/IJHCQA-07-2018-0187","DOIUrl":"https://doi.org/10.1108/IJHCQA-07-2018-0187","url":null,"abstract":"<p><strong>Purpose: </strong>Many countries are developing primary care collaborative memory clinics (PCCMCs) to address the rising challenge of dementia. Previous research suggests that quality assurance should be a foundational element of an integrated system of dementia care. The purpose of this paper is to understand physicians' and specialists' perspectives on such a system and identify barriers to its implementation.</p><p><strong>Design/methodology/approach: </strong>The authors used interviews and a constructivist framework to understand the perspectives on a quality assurance framework for dementia care and barriers to its implementation from ten primary care and ten specialist physicians affiliated with PCCMCs.</p><p><strong>Findings: </strong>Interviewees found that the framework reflects quality dementia care, though most could not relate quality assurance to clinical practice. Quality assurance was viewed as an imposition on practitioners rather than as a measure of system integration. Disparities in resources among providers were seen as barriers to quality care. Greater integration with specialists was seen as a potential quality improvement mechanism. Standardized electronic medical records were seen as important to support both quality assurance and clinical care.</p><p><strong>Practical implications: </strong>This work identified several challenges to the implementation of a quality assurance framework to support an integrated system of dementia care. Clinicians require education to better understand quality assurance. Additional challenges include inadequate resources, a need for closer collaboration between specialists and PCCMCs, and a need for a standardized electronic medical record.</p><p><strong>Originality/value: </strong>Greater health system integration is necessary to provide quality dementia care, and quality assurance could be considered a foundational element driving system integration.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"32 6","pages":"978-990"},"PeriodicalIF":1.5,"publicationDate":"2019-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/IJHCQA-07-2018-0187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37403426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}