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At least 829 records · Page 46Linked to original sources
PubMed2001

The balanced scorecard: an integrative approach to performance evaluation.

In addition to strict financial outcomes, healthcare financial managers should assess intangible assets that affect the organization's bottom line, such as clinical processes, staff skills, and patient satisfaction and loyalty. The balanced scorecard, coupled with data-warehousing capabilities, offers a way to measure an organization's performance against its strategic objectives while focusing on building capabilities to achieve these objectives. The balanced scorecard examines performance related to finance, human resources, internal processes, and customers. Because the balanced scorecard requires substantial amounts of data, it is a necessity to establish an organizational data warehouse of clinical, operational, and financial data that can be used in decision support. Because it presents indicators that managers and staff can influence directly by their actions, the balanced-scorecard approach to performance measurement encourages behavioral changes aimed at achieving corporate strategies.

Benchmarking↗
PubMed2001

Medication safety issue brief 6. Finding and using resources.

It's one thing to understand the theories of patient safety. But it's another thing to carry them out. One helpful method is to use a question-and-answer style tool to examine how your organization measures up. Several tools are widely distributed by organizations like the AHA. There's plenty of other advice available, much of it just a mouse click away (see Action Agenda on flip side of this brief).

Humans↗
PubMedDate not supplied

A unique approach for reducing specimen labeling errors: combining marketing techniques with performance improvement.

Challenged with persistent specimen labeling errors that were resistant to improvement efforts, our organization selected "reducing specimen labeling errors" as an indicator for a hospital-wide error reduction goal. Modeling quality improvement guidelines published in the institute of Medicine's report "To Err is Human, Building a Safer Health System," a multidisciplinary task force "error proofed" processes. The task force created new standards and crafted an implementation plan using an internal marketing strategy to change current practices and reinforce patient safety as a core value within our institution. This unique approach reduced errors by 41% and provided learning opportunities that will be valuable in more challenging patient safety initiatives such as medication error reduction.

Benchmarking↗
PubMed2004

Health care governance in the UK National Health Service.

The NHS Plan sets out a challenging agenda for modernising the UK National Health Service (NHS), governing the organisation's performance and improving and extending service provision. Good health care governance is an essential prerequisite for all modernisation effort. This article will explore the responsibilities and implications for health care boards, managers and clinical staff in providing assurances for health care governance. Health care organisation directors, executive and non-executive, all share responsibility for the direction and control of the organisation. They are required to act in the best interest of the patients, staff and the general public and have statutory obligations to provide safe systems of work under the Health and Safety Regulations. Each director has a role in ensuring openness, being honest and acting with integrity, taking responsibility for their own personal learning and development, constructively challenge and develop strategy and ensuring the probity of the organisation's activities.

Governing Board↗
PubMed2000

Implementation of antithrombotic management in atrial fibrillation.

The aim of the study was to assess the extent to which published recommendations on the antithrombotic management of atrial fibrillation had been adopted into clinical practice in a busy district general hospital, and the impact of clinical audit on subsequent management. In the initial audit, 185 consecutive patients with atrial fibrillation were studied using their case notes to identify any further clinical risk factors for stroke. A management algorithm stratified patients with atrial fibrillation into high, moderate, or low risk of stroke according to the individual stroke risk factors. For patients at high risk, the correct treatment is warfarin unless there are specific contraindications. For patients at moderate risk, the correct management is aspirin unless there are specific contraindications. Patients at low risk should receive no thromboprophylaxis. The clinical risks of stroke and thromboprophylaxis on discharge from hospital were recorded. An extensive education programme on stroke prevention in atrial fibrillation was undertaken. Six months later a further 185 consecutive patients with atrial fibrillation were audited. Overall, a large proportion (306/370; 83%) of patients were at high risk of stroke. In the initial audit, antithrombotic management was correct in 89 patients (48%). In the follow up audit, antithrombotic management was correct in 135 patients (73%) (p < 0. 00001). If this improvement in management were extrapolated to all hospital patients in the United Kingdom, approximately 1400 strokes/year could be avoided. Despite broad consensus in recent publications, antithrombotic management of atrial fibrillation remains imperfect, with many patients exposed to unnecessarily high risk of stroke.

Aged↗
PubMed1993

Management of malignant teratoma: does referral to a specialist unit matter?

The causes of geographical differences in cancer survival among regions of the UK are unclear. Population-based audit of management of patients with non-seminomatous germ-cell tumours (NSGCT) in the west of Scotland enabled us to assess the relative contributions to outcome of recognised prognostic factors, treatment centre, and protocol treatment. Data on treatment and outcome were analysed for 440 (97%) of 454 men with NSGCT diagnosed between 1975 and 1989. All but 11 patients were treated at tertiary referral centres; 235 were treated at a single unit (unit 1) and 194 at four other units (2-5). 99 men have died, 89 (20%) from NSGCT. Independent prognostic factors for NSGCT survival were extent of tumour at diagnosis (p < 0.001), 5-year period of diagnosis (from 1975-79 to 1985-89, p < 0.001), and treatment unit (unit 1 vs units 2-5, p < 0.001). Unit 1, which had the best survival rates, treated most patients overall (53%), including the majority (70%) in the worst prognostic category (poor-prognosis metastatic disease). The proportion of men receiving nationally agreed protocol treatment was higher at unit 1 than elsewhere (97 vs 61%, p < 0.0001). However, analysis restricted to men who received protocol treatment, adjusted for other important prognostic variables, still showed a survival advantage for this unit (relative death rate units 2-5 vs unit 1, 2.82 [95% CI 1.53-5.19], p < 0.001). These findings suggest that centralisation of treatment for NSGCT improves outcome; the benefit seems to be additional to any advantage resulting from protocol treatment.

Adult↗
PubMed1996

Communication--the vital link in best practice organisations. Case study: the Princess Alexandra Hospital Best Practice Communication Project.

The critical issue of communication has been addressed by the Princess Alexandra Hospital in Brisbane. The hospital commissioned a communications audit, benchmarked outside the health sector in the service industry, and designed and piloted communication strategies at an organisational level and in selected clinical settings. The communications models developed have emphasised the importance of planning, evaluation and flexibility to enable the modification of communication strategies to continually improve communication in the organisation. It is envisaged that regular communication assessments will be conducted with the use of audit tools which have been developed to compare results over time.

Communication↗
PubMed2006

NICE guideline for the management of head injury: an audit demonstrating its impact on a district general hospital, with a cost analysis for England and Wales.

OBJECTIVES: To answer concerns related to implementation of the National Institute for Clinical Excellence (NICE) guideline on the management of head injury by determining the impact on the workload of a district general hospital. Increased computed tomography (CT) was of particular concern (cost, radiation risk, and delivery constraints). METHOD: Retrospective audit of all patients attending the hospital's emergency department with a head injury over a three month period. Any reattendees for the same head injury episode were excluded but the need for CT was recorded. Case notes and electronic records were reviewed to determine whether the CT head or skull radiograph (SXR) was indicated in line with the NICE guideline. The workload was compared with an identical audit performed before the implementation of the NICE guideline. RESULTS: Of 17 472 patients attending the ED in 2004, 472 had a head injury. CT scan was indicated in 36, a significant increase from 2003 (p < 0.001). No SXR was indicated but two were performed, a significant decrease (p < 0.001). The admission rate was unaltered. The positive predictive value of NICE was 17.1% compared with 25% (p = not significant) for the authors' pre-NICE departmental guideline. CONCLUSIONS: This department has seen an increase in CT head requests since the implementation of the NICE guideline. This costs an extra 15,000 pounds sterling per 100 head injuries annually for this department, with an estimated 51.7 million pounds sterling burden for England and Wales. Further evaluation is required as there were only nine brain injuries in this audit population.

Costs and Cost Analysis↗
PubMed2001

Compliance programs: beyond billing and coding.

Ensuring the success of your compliance program means keeping your eye on more than billing and coding. The author highlights some issues on the horizon for compliance officers.

Confidentiality↗
PubMedDate not supplied

Internal and external auditing in health systems: an integrative approach.

Traditionally, auditors are apprehensive when it comes to auditing clinical decisions. A novel model might lead to better integration of auditors into the core activities of health system medical care, while creating common interests among all participants in the process.

Delivery of Health Care↗