Terry Desombre

Gap analysis of patient meal service perceptions

The provision of food and drinks to patients remains a largely unexplored, multidimensional phenomenon. In an attempt to ameliorate this lack of understanding, a survey utilising a modified SERVQUAL instrument measured on a seven-point Likert scale was carried out on-site at four NHS acute trusts for the purpose of assessing the perceptions and expectations of meal attributes and their importance in determining patient satisfaction. The results of factor analysis found three dimensions: food properties, interpersonal service, and environmental presentation, with a high reliability (Cronbachs alpha from 0.9191 to 0.7836). Path analysis further established sophisticated causal relations with patient satisfaction. The food dimension was found to be the best predictor of patient satisfaction among the three dimensions, while the interpersonal service dimension was not found to have any correlation with satisfaction. Bridging the gaps that exist between perceptions and expectations can improve the quality of meal services for the purpose of maximising patient satisfaction and ultimately aiding in patient recovery.

Teamwork: comparing academic and practitioners’ perceptions

Teamworking is a multi‐dimensional concept which has gained recent popularity and some success in manufacturing, but there is little evidence that large numbers of firms in the service sector have espoused teamworking methods. This paper explores this dilemma by comparing academic perceptions of teamworking, through a review of the literature, with a study of the perceptions of practitioners. Although much has been written about group behaviour, the more recent literature on teamworking is inconclusive and is often derived from anecdotal rather than empirical research. Using information obtained from a recent study, this article suggests that the richness of the teamworking experience is not captured by some of the academic literature. It argues for a view of teamworking that is both grounded in the literature and which represents the views of managers and employees in the service sector.

Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data

BackgroundAnaemia is a known risk factor for cardiovascular disease and treating anaemia in chronic kidney disease (CKD) may improve outcomes. However, little is known about the scope to improve primary care management of anaemia in CKD.MethodsAn observational study (N = 1,099,292) with a nationally representative sample using anonymised routine primary care data from 127 Quality Improvement in CKD trial practices (ISRCTN5631023731). We explored variables associated with anaemia in CKD: eGFR, haemoglobin (Hb), mean corpuscular volume (MCV), iron status, cardiovascular comorbidities, and use of therapy which associated with gastrointestinal bleeding, oral iron and deprivation score. We developed a linear regression model to identify variables amenable to improved primary care management.ResultsThe prevalence of Stage 3–5 CKD was 6.76%. Hb was lower in CKD (13.2 g/dl) than without (13.7 g/dl). 22.2% of people with CKD had World Health Organization defined anaemia; 8.6% had Hb ≤ 11 g/dl; 3% Hb ≤ 10 g/dl; and 1% Hb ≤ 9 g/dl. Normocytic anaemia was present in 80.5% with Hb ≤ 11; 72.7% with Hb ≤ 10 g/dl; and 67.6% with Hb ≤ 9 g/dl; microcytic anaemia in 13.4% with Hb ≤ 11 g/dl; 20.8% with Hb ≤ 10 g/dl; and 24.9% where Hb ≤ 9 g/dl. 82.7% of people with microcytic and 58.8% with normocytic anaemia (Hb ≤ 11 g/dl) had a low ferritin (<100ug/mL). Hypertension (67.2% vs. 54%) and diabetes (30.7% vs. 15.4%) were more prevalent in CKD and anaemia; 61% had been prescribed aspirin; 73% non-steroidal anti-inflammatory drugs (NSAIDs); 14.1% warfarin 12.4% clopidogrel; and 53.1% aspirin and NSAID. 56.3% of people with CKD and anaemia had been prescribed oral iron. The main limitations of the study are that routine data are inevitably incomplete and definitions of anaemia have not been standardised.ConclusionsMedication review is needed in people with CKD and anaemia prior to considering erythropoietin or parenteral iron. Iron stores may be depleted in over >60% of people with normocytic anaemia. Prescribing oral iron has not corrected anaemia.

Teamwork in health care: Lessons from the literature and from good practice around the world

It is becoming more difficult to provide health care that meets the needs of patients within tight budget constraints. This article suggests that one way forward is to channel the energies of people more constructively to work as teams. Some definitions are shown for teams and teamwork, and four benefits suggested of effective teamwork: learning and development, resource management, task performance and communications. In each of these four areas, examples are given from the international world of health care of how teamwork can be achieved. Finally, it is concluded that teamwork can be difficult, but that it is worth pursuing.

Improving service quality in NHS Trust hospitals: lessons from the hotel sector

This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction.

Evaluating tools to support a new practical classification of diabetes: excellent control may represent misdiagnosis and omission from disease registers is associated with worse control

Aims:  To conduct a service evaluation of usability and utility on‐line clinical audit tools developed as part of a UK Classification of Diabetes project to improve the categorisation and ultimately management of diabetes.

The Identification of Important Intangible Resources in Hospitals

Abstract The current research literature has little on the understanding and use of intangible resources in hospitals, and given the importance of people in the delivery of health care organizations, the objective of this research was to identify what managers perceived to be the key intangible resources that were used in this setting. The supplementary objective was to explore whether known intangible resources were managed in any systematic way. A qualitative research approach was followed and this allowed for the identification and description of key intangible resources in the hospital setting. In particular we found that social capital and staff attitude were identified as important by hospital managers and clinicians. The findings contribute to current research as they theoretically allow the extension of the concept of intangible resources to the hospital sector. They also lead to a number of recommendations for the strategic management of intangible resources in hospitals, and other health care organizations.

Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network

BackgroundInternationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare.MethodWe set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops.ResultsWe identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR – Patients at risk of readmission and ACG – Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission.ConclusionsDespite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don’t change.

Evaluating tools to support a new practical classification of diabetes: Excellent control may represent misdiagnosis and omission from disease registers is associated with worse control

Aims:  To conduct a service evaluation of usability and utility on‐line clinical audit tools developed as part of a UK Classification of Diabetes project to improve the categorisation and ultimately management of diabetes.

Evaluating tools to support a new practical classification of diabetes: excellent control may represent misdiagnosis and omission from disease registers is associated with worse control.

Aims:  To conduct a service evaluation of usability and utility on‐line clinical audit tools developed as part of a UK Classification of Diabetes project to improve the categorisation and ultimately management of diabetes.