Health and quality of care from older peoples' and formal caregivers' perspective

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

The relationship between TQM practices, quality performance, and innovation performance: An empirical examination

This empirical study examines the relationship between total quality management (TQM) and innovation performance and compares the nature of this relationship against quality performance. The empirical data were obtained from a survey of 194 managers in Australian industry encompassing both manufacturing and non-manufacturing sectors.

Caregivers as managers of subjective wellbeing: a homeostatic perspective

Background: This paper proposes that the adequacy of service delivery and caregiving to people who are disabled should be assessed using two criteria. One is the objective circumstance of living, which should be at a standard acceptable to the community at large. The other is a level of subjective wellbeing (SWB) within the normal range. Method: This latter criterion is a novel conception based on an understanding that SWB is homeostatically managed to lie normally within a narrow range of values. Results: People who have a disability are more likely than usual to have a fragile homeostatic system because of the additional life challenges imposed by their disability. Conclusions: The role of a caregiver is to provide resources and protection against strong threats to homeostasis, thereby ensuring that the person in their care has a normal-range level of SWB.

Development of high quality university web sites: benefits to users and the learning organisation

In recent years, the online delivery of educational material has received much attention by researchers. University web sites are being used to supplement the delivery of knowledge in traditional bricks and mortar environments or as stand-alone external courses. The function of a university web site also has broader applications that can provide strategic benefits to the organisation as a whole. An Internet presence based on a high quality, easy to use web site can provide universities with a credible, professional image. This is particularly important as students and other users of university web sites expect the same high level of quality in these sites as they do from the sites of commercial organisations. This paper explores the various roles that a web site can provide to benefit higher education organisations and their customers. In addition, the paper outlines the results of a study of university web site users that identifies specific web site design features that are considered essential for a high quality university site that will meet the needs of students and other stakeholders in a university environment. By adopting these design principles, universities will be able to improve the quality of their web sites and ultimately, increase user satisfaction. Moreover, an understanding of the various roles that a web site can perform will allow universities to fully utilise the benefits of developing and maintaining an online presence while retaining their traditional role as knowledge managers.

Ensuring quality during monitoring of the learning environment of government primary schools achieved through EUI-PDP for teachers and head teachers

A positive change in the learning environment in schools is visible through ongoing professional development of teachers and administrators. Monitoring the professional development program and providing support to teachers and administrators to transfer their learnings into the school environment ensures some measures of quality. Quality issues led to the launching of the Professional Development Program (PDP) for Primary School Teachers (PSTs) of Sindh by the United Educational Initiative (UEI), a consortium of five Governmental and Non-Governmental Organizations, working under the supervision of Education Sector Reform Assistance (ESRA). Implementation of the UEI-PDP in four districts of Sindh, is ensured by a team of professionals in each district. Recognising that capacity building of district education employees would improve the educational system in the country, 130 Master Trainers were selected, on merit, from the District Education Office for the training of 17,000 teachers and 3000 Head teachers/administrators over a period of two years. This paper developed the design of a Monitoring Process for a Professional Development Program for Primary School Teachers and Administrators. Data was collected through Pre/Post observations, Interviews, Questionnaires and Reports. Such tools make it possible for the monitoring teams to observe, to inquire further, and, along with the Managers, Master Trainers and School Support Team, seek to explain the progress of the program and take corrective action where indicated. Both formative evaluations as well as summative  evaluation techniques are utilized for evaluating the program. The monitoring process that assisted in formative evaluations is described. In order to assist in summative evaluation, data collected through the monitoring process was further developed to categorize the schools where teachers and head teachers are trained. It is hoped that the categorization of the schools may lead to further improvements in those schools which fall in the group for need improvement. It may also initiate further research as to reasons behind why some schools are in the good category and why others fall in the average category.

Development of an instrument to evaluate the quality of delivered information systems

Delivered information systems are an integral part of many organisations’ information technology infrastructure. Their dynamic nature creates new challenges, not the least of which is the need to measure the quality/effectiveness of these systems. Given the size of investment in these systems, it would be invaluable for business to formulate a fresh, simple, easy to administer, multi-dimensional instrument capable of measuring the quality of delivered information systems or applications. Such an instrument would provide a practical and efficient means to pinpoint areas that key stakeholders, ranging from end-users to managers, perceive as requiring attention. In this paper, we report on the development of one such instrument. This instrument addresses key areas of performance and uses multiple statements to enhance stakeholders’ understanding of these areas.

The reality of quality systems software : working for the machine, or smart people around the machine?

This case study-based research examines the outcomes of using quality system software (QSS) in terms of the support it provides to, and the constraints it imposes on, its users. The results indicate that QSS can help facilitate knowledge access and sharing, and to a lesser extent, facilitate communication. It can be an effective mechanism for initiating and managing changes to work processes. Although some writers have opined that information technology (IT) is another way of controlling workers, this was not evidenced in this study. Technical shortcomings did hamper performance of some tasks, and for some managers, extra work was involved.

Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers

• There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers.

• This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work.

• Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate.

• Three major themes emerged from interview data: planning for ward allocation, communication and professionalism.

• In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff.

• Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses.

• For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration.

• A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles.

• The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled – with the aim of providing quality patient care.

Quality in disability service - whose indicators?

The study identified indicators of disability service quality used by three stakeholder groups (service users, providers and managers) in order to develop an explanatory schema regarding stakeholders' perceptions of quality and its indicators. The different perspectives were identified and the emerging quality indicator framework had a complex socio-ecological basis.

Impediments to improvements in service quality in luxury hotels

Purpose – The purpose of this article is to identify the key factors that impede service quality delivery in the context of luxury hotels (four- and five-star properties) in Sydney, Australia.

Design/methodology/approach – The empirical dataset for this qualitative study was collected through 22 individual semi-structured interviews with senior hotel managers of ten luxury hotels in Sydney, Australia. The technique used for analysing the data was progressive comparative analysis, after which constant comparative methodology was applied. The key themes emerging from these techniques have been categorised to form conclusions.

Findings – Analysis of the data revealed a number of impediments to developing and maintaining distinguishable, superior service. These impediments fell into four broad areas: Budget constraints, Staff attitude, Lack of mentoring and High customer expectations.

Research limitations/implications – The limitations with the current study are primarily related to the scope of the research in terms of the number of hotel properties participating, and the fact that it incorporates the views of managers only. Furthermore, the focus of this study was on the hotel sector, and thus the findings cannot be accepted as being necessarily relevant and applicable to services across the tourism/hospitality industry as a whole. Future research needs to be conducted to incorporate the views of all stakeholders in service quality, including non-management staff and customers.

Originality/value – The findings of this research can inform hotel sector researchers and practitioners of identified impediments to service quality, whether current strategies are addressing these impediments and, if not, how strategies may be modified to address to achieve this.

The quality-of-relationship construct in IT outsourcing

This paper reports on the conceptualization and measurement of an important management controllable factor affecting the success of an information technology outsourcing (ITO) arrangement, namely Quality of Relationship (QoR). Attributes of the construct were identified from an analysis of the literature, and key attributes selected based on interviews with 29 managers in four pairs of client and supplier organizations. Construct validity of the resultant measure is assessed through comparison with qualitative interview data, and through tests of association between our measure and perceived overall ITO success. The results suggest that the ten indicators identified in the paper provide a valid measure of the quality of relationship that can be used by both client and supplier managers, and researchers, in assessing the health of an ITO relationship.

Assessing data quality issues in the Emergency Department through data and process mapping

Data and information quality is a well-established research topic and gradually appears on the decision-makers' top concern lists. Many studies have been conducted on how to investigate the generic data/information quality issues and factors by providing a high-level abstract framework or model. Based on these previous studies, this study tries to discuss the actual data quality issues with the operation-level and middle-level managers emerged during the emergency department data collection and reporting processes. By conduct data quality issues and business processes mapping, possible data quality issues are summarised under the well-known TOP model and the recommendations of data quality improvement are suggested.)

The mediating effect of internal service quality on employee turnover – empirical evidence from Taiwanese nurses

Informed by social exchange theory (SET) this study examines the role of trust in strategic alliances. Interviews were conducted with 17 participants who were strategic alliance managers in their organization. The study finds that trust is important to strategic alliance managers, and without it alliance managers would find it difficult to keep their alliance going. Trust is built over time, and based on the past experiences that the alliance manager has with their partner. The study found that prior networks, timely and appropriate communication and information exchange, fairness preservation and inter-firm adaptation were important in developing trust in the strategic alliance.

The development of a medication calculation competency and quality use of renal medicine e-learning program.

Medication calculation and administration are commonly performed nursing tasks. A consequence of this frequency is thepotential for a higher incidence of medication-related errors. One strategy to assess proficiency in medication calculation is an annual medication calculation competency quiz. Traditionally, these quizzes are done in paper form at an institutional level and require educators or managers to administer and mark the quiz manually by hand. This paper discusses the rationale, challenges and peer-review process associated with the development of an e-learning programme designed to assess proficiency in medication calculation and the quality use of renal medicines.