How did healthcare professionals define patient engagement in quality management? A survey study.

BACKGROUND: Patient and family engagement (PFE) can positively impact the patient experience and care process outcomes. There is no unique type of PFE, and the process is usually defined by the quality management department or professionals responsible for this process in the hospital. The objective of this study is to define PFE in quality management based on the professional's perspective. METHOD: A survey was carried out with 90 professionals from Brazilian hospitals. There were two questions aimed at understanding the concept. The first was a multiple-choice question to identify synonyms. The second was an open-ended question to develop the definition. A content analysis methodology was employed by applying techniques for thematic and inferential analysis. RESULTS: Three words were classified as synonyms by more than 60% of respondents: involvement, participation, and centered care. The participants described patient participation at both the individual (related to the treatment) and organizational levels (related to quality improvement). The PFE in the treatment is related to the development, discussion and decision-making about the therapeutic plan, participation in each step of care, and knowledge of the institution's quality and safety processes. At the organizational level, engagement in quality improvement includes the involvement of the P/F in all processes of the institution, from strategic planning to the design or improvement processes, as well as active participation in institutional committees or commissions. CONCLUSION: The professionals defined engagement in two levels (individual and organizational) and the results suggest that their point of view can influence the practice in the hospitals. Professionals of hospitals that implemented mechanisms of consult defined PFE more in the individual level. On the other hand, professionals of hospitals that implemented mechanisms of involvement considered PFE more focus in the organizational level.

How do hospitals engage patients and family members in quality management? A grounded theory study of hospitals in Brazil.

BACKGROUND: Patient and family engagement (PFE) is considered an essential element of the transformation of the healthcare system. However, it is characterised by its complexity and a small number of institutions that have implemented the mechanisms of engagement. OBJECTIVE: To understand PFE in quality management (QM) in the hospital environment. DESIGN: A qualitative approach was guided by the grounded theory based in Straussian perspective. Data were gathered using semistructured interviews. The coding was performed by excerpts, using an inductive approach and the constant comparison technique. SETTING AND PARTICIPANTS: A total of seven Brazilian hospitals were selected based on the theoretical sampling technique. RESULTS: A total of five categories emerged, namely: patient partner, mechanisms of engagement, internal structure for engagement, maturity of the QM system and openness to change. Externally, three contextual factors can impact the engagement: the local health system, the profile of the community and the change in access to the information. At the centre of the change is the balance in power relations between patients and professionals, the sharing of information from the hospital and a proactive attitude towards improving services. CONCLUSIONS: The PFE involves a cultural and process change. Cultural change is represented by 'openness', that is, openness to learn, to listen and to consider new perspectives. The change in processes is in turn characterised by the phrase 'test and venture' because the model to be adopted may be different between hospitals. The patient's perspective allows actions to be driven towards what really matters to them, ensuring quality of service and safety, obtaining a new perspective to understand and solve problems, and stimulating a sense of urgency, more empathy and compassion in professionals.

Using patient feedback to drive quality improvement in hospitals: a qualitative study.

OBJECTIVES: Although different forms of patient feedback are available, their use in hospital management is still limited. The objective of this study is to explore how patient feedback is currently used in hospitals to improve quality. DESIGN: This is a qualitative exploratory multiple case study. Data collection included nine interviews, of an average duration of 50 min, conducted between March and June 2019. Additionally, a document and secondary data analysis were performed. SETTING: This study was conducted in three Brazilian hospitals selected for their solid patient feedback practises. PARTICIPANTS: Managers from the customer service, quality, nursing, operations, projects and patient experience departments of the three hospitals. RESULTS: Despite literature suggesting that organisational objectives regarding patient feedback are not clear, data show that there is managerial concern regarding the promotion of an environment capable of changing according to patient feedback. In these instances, organisational processes were structured to focus on patients' feedback and its receipt by the staff, including a non-punitive culture. Several patient feedback forms are available: voluntary events, patient surveys and informal feedback. Instruments to measure patient feedback focused on specific aspects of healthcare, to identify and clarify the problems for addressal by the management. The net promoter score was the main strategic indicator of patient feedback, used to assess the impact of improvement action. CONCLUSIONS: The hospitals had established objectives that valued the patient's perspective. Involvement of the health team, availability of different channels for feedback and the use of quality tools are considered a good basis for using patient feedback to drive quality improvement.

Evaluating the impact of accreditation on Brazilian healthcare organizations: A quantitative study.

OBJECTIVE: The aim of this study was to evaluate the impact of accreditation programs on Brazilian healthcare organizations. DESIGN: A web-based questionnaire survey was undertaken between February and May 2016. SETTING: Healthcare organizations from the Federal District and from 18 Brazilian states. PARTICIPANTS: The quality managers of 141 Brazilian healthcare organizations were the main respondents of the study. INTERVENTION: The questionnaire was applied to not accredited and accredited organizations. MAIN OUTCOME MEASURES: The main outcome measures were patient safety activities, quality management activities, planning activities-policies and strategies, patient involvement, involvement of professionals in the quality programs, monitoring of patient safety goals, organizational impact and financial impacts. RESULTS: The study identified 13 organizational impacts of accreditation. There was evidence of a significant and moderate correlation between the status of accreditation and patient safety activities, quality management activities, planning activities-policies and strategies, and involvement of professionals in the quality programs. The correlation between accreditation status and patient involvement was significant but weak, suggesting that this issue should be treated with a specific policy. The impact of accreditation on the financial results was not confirmed as relevant; however, the need for investment in the planning stage was validated. CONCLUSIONS: The impact of accreditation is mainly related to internal processes, culture, training, institutional image and competitive differentiation.

Envolvimento dos pacientes no gerenciamento da qualidade dos serviços de saúde / Patient involvement in quality management of healthcare services

Resumo Objetivo: Identificar o estágio de envolvimento dos pacientes nas Instituições de saúde brasileiras, nos programas de melhoria da qualidade e segurança. Métodos: Abordagem quantitativa, através de uma pesquisa de avaliação com 141 Instituições, localizadas em 18 estados e no Distrito Federal, no período de fevereiro a maio de 2016. Para coleta dos dados foi aplicado um questionário pela web, utilizando o software de questionários e pesquisas SurveyMonkeyÓ. No questionário, além das perguntas para caracterização das Instituições e dos respondentes, sete perguntas foram relacionadas às atividades de participação dos pacientes nos processos de gerenciamento da qualidade. Resultados: As atividades realizadas pela maior parte das Instituições foram “pesquisa de satisfação dos pacientes” e “processo formal para comunicação com os pacientes em relação às suas dúvidas, sugestões e reclamações”. A média de atividades realizadas foi de 3,84 de um total de 7 atividades avaliadas. Conclusão: Considerando uma escala de 0 a 3, aproximadamente 70% das Instituições foram classificadas entre os estágios 0 (paciente não é envolvido) e 1 (participação na avaliação das metas de qualidade).

Abstract Objective: To identify the stage of patient involvement in quality and safety improvement programs in Brazilian healthcare institutions. Methods: A quantitative approach with 141 institutions located in 18 states and the Federal District, using an assessment survey from February to May of 2016. Data collection occurred via a questionnaire on the Web, using the SurveyMonkeyÓ online survey & questionnaire software. The questionnaire included questions to characterize the institutions and respondents, and seven questions related to the participation of patients in the quality management process. Results: The activities performed by most of the institutions were “patient satisfaction surveys” and “formal process for communication with patients regarding their questions, suggestions and complaints”. The mean number of activities performed was 3.84 out of the seven activities evaluated. Conclusion: Assuming a scale from 0 to 3, approximately 70% of the institutions were classified between stage 0 (patient is not involved) and 1 (participation in evaluation of the quality goals).

Is there any link between accreditation programs and the models of organizational excellence?

OBJECTIVE: To evaluate whether accredited health organizations perform better management practices than non-accredited ones. METHOD: The study was developed in two stages: a literature review, and a study of multiple cases in 12 healthcare organizations in the state of São Paulo, Brazil. It surveyed articles comparing hospital accreditation with the EFQM (European Foundation for Quality Management) model of excellence in management. According to the pertinent literature, the accreditation model and the EFQM model are convergent and supplementary in some aspects. RESULTS: With 99% confidence, one can say that there is evidence that accredited organizations scored better in the evaluation based on the EFQM model in comparison to non-accredited organizations. This result was also confirmed in the comparison of results between the categories Facilitators and Results in the EFQM model. CONCLUSION: There is convergence between the accreditation model and the EFQM excellence model, suggesting that accreditation helps the healthcare sector to implement the best management practices already used by other business sectors. OBJETIVO: Avaliar se as organizações de saúde acreditadas possuem melhores práticas de gestão do que as não acreditadas. MÉTODO: A pesquisa foi dividida em duas etapas: revisão da literatura e estudo de casos múltiplos com 12 organizações de saúde, localizadas no estado de São Paulo ‒ Brasil. Foram pesquisados artigos que comparavam a acreditação hospitalar com o modelo de excelência em gestão da EFQM (European Foundation for Quality Management), sendo que a literatura pertinente considera que o modelo de acreditação e o modelo da EFQM são convergentes e, ao mesmo tempo, complementares em determinados aspectos. RESULTADOS: Com 99% de confiança, pode-se afirmar que há evidência de que as organizações com acreditação obtiveram uma pontuação maior na avaliação baseada no modelo EFQM comparativamente às organizações não acreditadas. Este resultado também se confirmou na comparação dos resultados das categorias Facilitadores e Resultados do modelo EFQM. CONCLUSÃO: Há uma convergência entre o modelo de acreditação e o modelo de excelência da EFQM, sugerindo que a acreditação contribui para o setor de saúde implementar as melhores práticas de gestão já difundidas em outros setores de negócio.

Is there any link between accreditation programs and the models of organizational excellence? / ¿Existe una relación entre los programas de acreditación y los modelos de excelencia organizacional? / Existe uma relação entre os programas de acreditação e os modelos de excelência organizacional?

Abstract OBJECTIVE To evaluate whether accredited health organizations perform better management practices than non-accredited ones. METHOD The study was developed in two stages: a literature review, and a study of multiple cases in 12 healthcare organizations in the state of São Paulo, Brazil. It surveyed articles comparing hospital accreditation with the EFQM (European Foundation for Quality Management) model of excellence in management. According to the pertinent literature, the accreditation model and the EFQM model are convergent and supplementary in some aspects. RESULTS With 99% confidence, one can say that there is evidence that accredited organizations scored better in the evaluation based on the EFQM model in comparison to non-accredited organizations. This result was also confirmed in the comparison of results between the categories Facilitators and Results in the EFQM model. CONCLUSION There is convergence between the accreditation model and the EFQM excellence model, suggesting that accreditation helps the healthcare sector to implement the best management practices already used by other business sectors.

Resumen OBJETIVO Evaluar si la organizaciones sanitarias acreditadas tienen mejores prácticas de gestión que las no acreditadas. MÉTODO La investigación fue dividida en dos etapas: revisión de la literatura y estudio de casos múltiples con 12 organizaciones sanitarias, ubicadas en el Estado de São Paulo - Brasil. Fueron investigados artículos que comparaban la acreditación hospitalaria con el modelo de excelencia en gestión de la EFQM (European Foundation for Quality Management), siendo que la literatura pertinente considera que el modelo de acreditación y el modelo de la EFQM son convergentes y, a la vez, complementarios en determinados aspectos. RESULTADOS Con el 99% de confianza, se puede afirmar que existe evidencia de que las organizaciones con acreditación obtuvieron una puntuación mayor en la evaluación basada en el modelo EFQM comparativamente con las organizaciones no acreditadas. Dicho resultado también se confirmó en la comparación de los resultados de las categorías Facilitadores y Resultados del modelo EFQM. CONCLUSIÓN Existe una convergencia entre el modelo de acreditación y el modelo de excelencia de la EFQM, sugiriendo que la acreditación contribuye a que el sector de salud implemente las mejores prácticas de gestión ya difundidas en otros sectores de negocio.

Resumo OBJETIVO Avaliar se as organizações de saúde acreditadas possuem melhores práticas de gestão do que as não acreditadas. MÉTODO A pesquisa foi dividida em duas etapas: revisão da literatura e estudo de casos múltiplos com 12 organizações de saúde, localizadas no estado de São Paulo ‒ Brasil. Foram pesquisados artigos que comparavam a acreditação hospitalar com o modelo de excelência em gestão da EFQM (European Foundation for Quality Management), sendo que a literatura pertinente considera que o modelo de acreditação e o modelo da EFQM são convergentes e, ao mesmo tempo, complementares em determinados aspectos. RESULTADOS Com 99% de confiança, pode-se afirmar que há evidência de que as organizações com acreditação obtiveram uma pontuação maior na avaliação baseada no modelo EFQM comparativamente às organizações não acreditadas. Este resultado também se confirmou na comparação dos resultados das categorias Facilitadores e Resultados do modelo EFQM. CONCLUSÃO Há uma convergência entre o modelo de acreditação e o modelo de excelência da EFQM, sugerindo que a acreditação contribui para o setor de saúde implementar as melhores práticas de gestão já difundidas em outros setores de negócio.