Buttigieg Sandra Catherine, Dey Prasanta Kumar, Cassar Mary Rose
Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta.
Int J Health Care Qual Assur. 2016;29(2):123-40. doi: 10.1108/IJHCQA-04-2014-0040.
The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A & E) unit of a Maltese hospital.
DESIGN/METHODOLOGY/APPROACH: The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients' requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A & E unit of the hospital.
The major and related problems being faced by the hospital under study were overcrowding at A & E and shortage of beds, respectively. The combined framework ensures better A & E services and patient flow. QFD identifies and analyses the issues and challenges of A & E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A & E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A & E unit. PRACTICAL/IMPLICATIONS: The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives.
ORIGINALITY/VALUE: Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A & E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.
本文旨在开发一个以患者为中心的综合分析框架，以提高马耳他一家医院急诊科的护理质量。
设计/方法/途径：本研究采用案例研究方法。首先，进行了全面的文献综述，以研究医疗质量管理的各种方法。其次，使用质量功能展开（QFD）和逻辑框架法（LFA）相结合的方式开发了一个医疗质量管理框架。第三，将所提出的框架应用于一家马耳他医院以证明其有效性。所提出的框架有六个步骤，从识别患者需求开始，到实施改进项目结束。所有步骤都是在该医院急诊科相关利益相关者的参与下进行的。
所研究的医院面临的主要及相关问题分别是急诊科过度拥挤和床位短缺。综合框架确保了更好的急诊科服务和患者流程。QFD识别并分析了急诊科的问题和挑战，而LFA有助于制定医疗质量改进的项目计划。实施所提出的质量改进计划的重要成果是减少住院人数、加快患者流程、进行专家分诊以及缩短急诊科的等待时间。需要增加急诊顾问覆盖范围并加快首次重大医疗接触，以便有效解决这些问题。总体而言，QFD和LFA相结合的方法对于解决急诊科的护理质量问题是有效的。
实际应用/启示：由于其灵活且用户友好的方法，所提出的框架可以很容易地整合到任何医疗部门以及整个医疗系统中。它可以成为六西格玛和其他质量举措的一部分。
原创性/价值：尽管QFD已在医疗环境中广泛应用以提高护理质量，但关于将QFD和LFA结合起来以识别问题、确定优先级、得出改进措施并实施改进项目的研究却很少。此外，没有关于QFD在急诊科应用的研究。本文弥补了这些空白。此外，关于马耳他医疗系统的文献也很少。因此，本研究有助于展示马耳他的急诊护理质量。
