An Examination of Quality Service Perceptions in a Hotel

Perceptions of managers and employees on topics related to quality and quality service in a hotel were studied to define the term “quality” and the activity of "quality service" delivery, looking at differing definitions of the terms and the activity and the identification of problem issues relating to training, communication, recognition, and department coordination. Recommendations for action included changes in the training program, a reemphasizing of the incentive programs, the development of Quality Improvement Teams, improved communication, and increased service delivery leadership.

UK consensus project on quality in palliative day services: developing a quality indicator set using the RAND/UCLA appropriateness method

Introduction
Evaluating quality of palliative day services is essential for assessing care across diverse settings, and for monitoring quality improvement approaches.

Aim
To develop a set of quality indicators for assessment of all aspects (structure, process and outcome) of care in palliative day services.

Methods
Using a modified version of the RAND/UCLA appropriateness method (Fitch et al., 2001), a multidisciplinary panel of 16 experts independently completed a survey rating the appropriateness of 182 potential quality indicators previously identified during a systematic evidence review. Panel members then attended a one day, face-to-face meeting where indicators were discussed and subsequently re-rated. Panel members were also asked to rate the feasibility and necessity of measuring each indicator.

Results
71 indicators classified as inappropriate during the survey were removed based on median appropriateness ratings and level of agreement. Following the panel discussions, a further 60 were removed based on appropriateness and feasibility ratings, level of agreement and assessment of necessity. Themes identified during the panel discussion and findings of the evidence review were used to translate the remaining 51 indicators into a final set of 27.

Conclusion
The final indicator set included information on rationale and supporting evidence, methods of assessment, risk adjustment, and recommended performance levels. Further implementation work will test the suitability of this ‘toolkit’ for measurement and benchmarking. The final indicator set provides the basis for standardised assessment of quality across services, including care delivered in community and primary care settings.

Reference

• Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation; 2001. http://www.rand.org/pubs/monograph_reports/MR1269

What is best for Esther? Building improvement coaching capacity with and for users in health and social Care-A case study

While coaching and customer involvement can enhance the improvement of health and social care, many organizations struggle to develop their improvement capability; it is unclear how best to accomplish this. We examined one attempt at training improvement coaches. The program, set in the Esther Network for integrated care in rural Jonkoping County, Sweden, included eight 1-day sessions spanning 7 months in 2011. A senior citizen joined the faculty in all training sessions. Aiming to discern which elements in the program were essential for assuming the role of improvement coach, we used a case-study design with a qualitative approach. Our focus group interviews included 17 informants: 11 coaches, 3 faculty members, and 3 senior citizens. We performed manifest content analysis of the interview data. Creating will, ideas, execution, and sustainability emerged as crucial elements. These elements were promoted by customer focusembodied by the senior citizen trainershared values and a solution-focused approach, by the supportive coach network and by participants' expanded systems understanding. These elements emerged as more important than specific improvement tools and are worth considering also elsewhere when seeking to develop improvement capability in health and social care organizations.

Development and preliminary psychometric properties of the Care Experience Feedback Improvement Tool (CEFIT).

Objective To develop a structurally valid and reliable, yet brief measure of patient experience of hospital quality of care, the Care Experience Feedback Improvement Tool (CEFIT). Also, to examine aspects of utility of CEFIT. Background Measuring quality improvement at the clinical interface has become a necessary component of healthcare measurement and improvement plans, but the effectiveness of measuring such complexity is dependent on the purpose and utility of the instrument used. Methods CEFIT was designed from a theoretical model, derived from the literature and a content validity index (CVI) procedure. A telephone population surveyed 802 eligible participants (healthcare experience within the previous 12 months) to complete CEFIT. Internal consistency reliability was tested using Cronbach's α. Principal component analysis was conducted to examine the factor structure and determine structural validity. Quality criteria were applied to judge aspects of utility. Results CVI found a statistically significant proportion of agreement between patient and practitioner experts for CEFIT construction. 802 eligible participants answered the CEFIT questions. Cronbach's α coefficient for internal consistency indicated high reliability (0.78). Interitem (question) total correlations (0.28–0.73) were used to establish the final instrument. Principal component analysis identified one factor accounting for 57.3% variance. Quality critique rated CEFIT as fair for content validity, excellent for structural validity, good for cost, poor for acceptability and good for educational impact. Conclusions CEFIT offers a brief yet structurally sound measure of patient experience of quality of care. The briefness of the 5-item instrument arguably offers high utility in practice. Further studies are needed to explore the utility of CEFIT to provide a robust basis for feedback to local clinical teams and drive quality improvement in the provision of care experience for patients. Further development of aspects of utility is also required.

A cost-efficiency and health benefit approach to improve urban air quality

When ambient air quality standards established in the EU Directive 2008/50/EC are exceeded, Member States are obliged to develop and implement Air Quality Plans (AQP) to improve air quality and health. Notwithstanding the achievements in emission reductions and air quality improvement, additional efforts need to be undertaken to improve air quality in a sustainable way - i.e. through a cost-efficiency approach. This work was developed in the scope of the recently concluded MAPLIA project "Moving from Air Pollution to Local Integrated Assessment", and focuses on the definition and assessment of emission abatement measures and their associated costs, air quality and health impacts and benefits by means of air quality modelling tools, health impact functions and cost-efficiency analysis. The MAPLIA system was applied to the Grande Porto urban area (Portugal), addressing PM10 and NOx as the most important pollutants in the region. Four different measures to reduce PM10 and NOx emissions were defined and characterized in terms of emissions and implementation costs, and combined into 15 emission scenarios, simulated by the TAPM air quality modelling tool. Air pollutant concentration fields were then used to estimate health benefits in terms of avoided costs (external costs), using dose-response health impact functions. Results revealed that, among the 15 scenarios analysed, the scenario including all 4 measures lead to a total net benefit of 0.3M€·y(-1). The largest net benefit is obtained for the scenario considering the conversion of 50% of open fire places into heat recovery wood stoves. Although the implementation costs of this measure are high, the benefits outweigh the costs. Research outcomes confirm that the MAPLIA system is useful for policy decision support on air quality improvement strategies, and could be applied to other urban areas where AQP need to be implemented and monitored.

Evaluation of the quality of the teaching-learning process in undergraduate courses in Nursing

Objective: to identify aspects of improvement of the quality of the teaching-learning process through the analysis of tools that evaluated the acquisition of skills by undergraduate students of Nursing. Method: prospective longitudinal study conducted in a population of 60 second-year Nursing students based on registration data, from which quality indicators that evaluate the acquisition of skills were obtained, with descriptive and inferential analysis. Results: nine items were identified and nine learning activities included in the assessment tools that did not reach the established quality indicators (p<0.05). There are statistically significant differences depending on the hospital and clinical practices unit (p<0.05). Conclusion: the analysis of the evaluation tools used in the article "Nursing Care in Welfare Processes" of the analyzed university undergraduate course enabled the detection of the areas for improvement in the teaching-learning process. The challenge of education in nursing is to reach the best clinical research and educational results, in order to provide improvements to the quality of education and health care.

Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.

Modelo de inclusão digital para construção do conhecimento em qualidade de vida e atividade fisica

Universidade Estadual de Campinas. Faculdade de Educação Física

Confiabilidade da informação sobre hospitalizações por causas externas de um hospital público em São José dos Campos, São Paulo, Brasil

OBJETIVO: Conhecer a qualidade dos dados de internação por causas externas em São José dos Campos, São Paulo. MÉTODO: Foram estudadas as internações pelo Sistema Único de Saúde por lesões decorrentes de causas externas no primeiro semestre de 2003, no Hospital Municipal, referência para o atendimento ao trauma no Município, por meio da comparação dos dados registrados no Sistema de Informações Hospitalares com os prontuários de 990 internações. A concordância das variáveis relativas à vítima, à internação e ao agravo foi avaliada pela taxa bruta de concordância e pelo coeficiente Kappa. As lesões e as causas externas foram codificadas segundo a 10ª revisão da Classificação Internacional de Doenças, respectivamente, capítulos XIX e XX. RESULTADOS: A taxa de concordância bruta foi de boa qualidade para as variáveis relativas à vítima e à internação, variando de 89,0% a 99,2%. As lesões tiveram concordância ótima, exceto os traumatismos do pescoço (k=0,73), traumatismos múltiplos (k=0,67) e fraturas do tórax (k=0,49). As causas externas tiveram concordância ótima para acidentes de transporte (k=0,90) e quedas (k=0,83). A confiabilidade foi menor para agressões (k=0,50), causas indeterminadas (k=0,37), e complicações da assistência médica (k=0,03). Houve concordância ótima nos acidentes de transporte em pedestres, ciclistas e motociclistas. CONCLUSÃO: A maioria das variáveis de estudo teve boa qualidade no nível de agregação analisado. Algumas variáveis relativas à vítima e alguns tipos de causas externas necessitam de aperfeiçoamento da qualidade dos dados. O perfil da morbidade hospitalar encontrado confirmou os acidentes de transporte como importante causa externa de internação hospitalar no Município.

Como implementar uma diretriz - da teoria à prática: exemplo da profilaxia para Tromboembolismo Venoso

The objective of this manuscript is to discuss the existing barriers for the dissemination of medical guidelines, and to present strategies that facilitate the adaptation of the recommendations into clinical practice. The literature shows that it usually takes several years until new scientific evidence is adopted in current practice, even when there is obvious impact in patients' morbidity and mortality. There are some examples where more than thirty years have elapsed since the first case reports about the use of a effective therapy were published until its utilization became routine. That is the case of fibrinolysis for the treatment of acute myocardial infarction. Some of the main barriers for the implementation of new recommendations are: the lack of knowledge of a new guideline, personal resistance to changes, uncertainty about the efficacy of the proposed recommendation, fear of potential side-effects, difficulties in remembering the recommendations, inexistence of institutional policies reinforcing the recommendation and even economical restrains. In order to overcome these barriers a strategy that involves a program with multiple tools is always the best. That must include the implementation of easy-to-use algorithms, continuous medical education materials and lectures, electronic or paper alerts, tools to facilitate evaluation and prescription, and periodic audits to show results to the practitioners involved in the process. It is also fundamental that the medical societies involved with the specific medical issue support the program for its scientific and ethical soundness. The creation of multidisciplinary committees in each institution and the inclusion of opinion leaders that have pro-active and lasting attitudes are the key-points for the program's success. In this manuscript we use as an example the implementation of a guideline for venous thromboembolism prophylaxis, but the concepts described here can be easily applied to any other guideline. Therefore, these concepts could be very useful for institutions and services that aim at quality improvement of patient care. Changes in current medical practice recommended by guidelines may take some time. However, if there is a broader participation of opinion leaders and the use of several tools listed here, they surely have a greater probability of reaching the main objectives: improvement in provided medical care and patient safety.

Which one of these is not like the others? An inter-hospital study of the viscosity of thickened fluids

Engineering This investigation examined the rheological (viscosity and yield stress) and material property (density) characteristics of the thickened meal-time and videofluorscopy fluids provided by 10 major metropolitan hospitals. Differences in the thickness of thickened fluids were considered as a source of variability and potential hazard for inter-hospital transfers of dysphagic patients. The results indicated considerable differences in the viscosity, density, and yield stress of both meal-time and videofluoroscopy fluids. In theory, the results suggest that dysphagic patients transferred between hospitals could be placed on inappropriate levels of fluid thickness because of inherent differences in the rheology and material property characteristics of the fluids provided by different hospitals. Slowed improvement or medical complications are potential worst-case scenarios for dysphagic patients if the difference between the thick fluids offered by 2 hospitals are extreme. The investigation outlines the most appropriate way to assess the rheological and material property characteristics of thickened fluids. In addition, it suggests a plan of quality improvement to reduce the variability of the thickness of fluids offered at different hospitals.

Motivation and Benefits of Implementation and Certification according ISO 9001 – the Portuguese Experience

The aim of the research is to analyze the different aspects associated with the motivation and benefits of certified ISO 9001 companies in Portugal. A total of 426 certified Portuguese companies were surveyed. The response rate was equal to 61.03 percent. Our results suggest that the main motivation for certification were “improvement of quality”, “improvement of company image”, “marketing advantage”, “give empowerment to workers / capturing workers knowledge” and “cost reduction”. The main benefits that Portuguese companies have gained from the referred certification have been, among others, the improvement of “procedures”, beneficial effect on the “company’s image”, the improvement of quality products/services, increase of the “customer satisfaction”, improvement of “on-time delivery”; improvement the “morale” of workers’ increase in productivity and decrease of “production costs”, among others. The surveyed firms belong only to the Minho region of the north of Portugal. This paper aims to provide a contribution to the research related to the motivation and benefits associated to the quality management systems. The selection of the motives and benefits were validated through statistical analysis and the relationship between expected and perceived benefits was discussed.

Influence of strawberry jam color and phenolic compounds on acceptance during storage

The objective of this study was to evaluate the influence of the color and phenolic compounds of strawberry jam on acceptance during storage. Jams were processed, stored for 120 days and evaluated monthly for chromatic characteristics, total phenolic compounds, total anthocyanins (ANT), total ellagic acid (TEA), flavonoids and free ellagic acid (FEA), and sensory acceptance as well. Data were submitted to analysis of variance (ANOVA) and the means were compared by the Least Significant Difference (LSD). Cluster Analysis and Partial Least Square Regression (PLS) were performed to investigate the relationships between instrumental data and acceptance. Contents of ANT, TEA and redness decreased during storage. Other chemical characteristics and sensory acceptance showed a nonlinear behavior. Higher acceptance was observed after 60 days, suggesting a trend of quality improvement followed by decline to the initial levels. The same trend was observed for lightness, non-pigment flavonoids and FEA. According to PLS map, for consumers in cluster 2, acceptance was associated to jams at 60 days and to luminosity, FEA, and non-pigment flavonoids. For cluster 1, a positive association between flavor liking, jam at initial storage, and the contents of TEA and ANT was indicated. Jams at 120 days were positively associated to hue and negatively associated to color liking, for cluster 1. Color and texture were positively correlated to overall liking for cluster 2, whereas for cluster 1, overall acceptance seemed to be more associated to flavor liking. Changes in color and phenolic compounds slightly influenced the acceptance of strawberry jams, but in different ways for consumers clusters.

Adaptive deblocking filter for transform domain Wyner-Ziv video coding

Wyner-Ziv (WZ) video coding is a particular case of distributed video coding, the recent video coding paradigm based on the Slepian-Wolf and Wyner-Ziv theorems that exploits the source correlation at the decoder and not at the encoder as in predictive video coding. Although many improvements have been done over the last years, the performance of the state-of-the-art WZ video codecs still did not reach the performance of state-of-the-art predictive video codecs, especially for high and complex motion video content. This is also true in terms of subjective image quality mainly because of a considerable amount of blocking artefacts present in the decoded WZ video frames. This paper proposes an adaptive deblocking filter to improve both the subjective and objective qualities of the WZ frames in a transform domain WZ video codec. The proposed filter is an adaptation of the advanced deblocking filter defined in the H.264/AVC (advanced video coding) standard to a WZ video codec. The results obtained confirm the subjective quality improvement and objective quality gains that can go up to 0.63 dB in the overall for sequences with high motion content when large group of pictures are used.