Leela Masih

Augmenting nursing care quality and implementing change management in India: an amalgamated approach

BACKGROUND AND AIM High dependency on nursing care in healthcare delivery systems in recent times has made the quality appraisal of nursing care even more imperative for nursing administrators. This study demonstrates the utility of a two-phase technique to identify the most significant shortcomings pertaining to nursing care delivery in general wards of a tertiary care hospital. The same could be used to set priorities. METHODS The first phase involved the use of the Delphi technique facilitating the experts to identify the major problems. The mean rank score was used for grading the problems. The second phase of the study involved getting direct feedback from the ward nurses. The sample size was 147 at a level of significance of 5%. RESULTS Consensus was reached among experts on four problems that should galvanize nursing administration vis-à-vis quality improvement. The responses of ward nurses in the second phase gave a better insight into these problems. CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT Identifying the existing problems and fostering a team spirit among all stakeholders hold the key in strategizing quality improvement in nursing care. Nursing administrators worldwide, after making suitable situation-specific customizations, may use this approach to realize both these objectives.

Strategizing quality implementation in intensive care unit: a statistically-sound, novel approach using Delphi technique

Background: Ascendancy of Intensive Care Medicine in the realm of healthcare has made Continuous Quality Improvement (CQI) in Intensive Care Units (ICUs) most imperative for hospital administrators worldwide. Perspicuous identification of all clinical and non-clinical drivers warranting contemplation is the most arduous step in achieving the same. This study avers the effectiveness of a statistically-sound, novel approach using Delphi technique in identifying various drivers to be prioritized for strategizing CQI in the postoperative ICU of a premier tertiary care hospital in Asia. Methods: Three rounds of Delphi survey were initially planned. Mean Rank Scores (MRS) was used to rank the opinions in this study. Results: Statistically validated consensus was reached among expert participants on five drivers that should galvanize hospital administration vis-a-vis strategizing quality implementation in the post-operative ICU. Foremost among these was adequate staff that is tantamount to desirable staff-patient ratio (MRS: 9.4), and regular medical audit for sustainable quality in healthcare delivery (MRS: 9.1). Experts further concurred that communication skills of ICU staff (MRS: 8.9), continuous medical education and training of these staff (MRS: 7.6) along with perspicuous ‘Standard Operating Procedures’ (MRS: 7.1) were other points to be considered. Conclusions: With regard to the process of planning, identification of correct drivers holds the crux in strategizing quality implementation in any setup. Implementing change management is equally imperative. This approach can be used to realize both of these.