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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Quality Improvement in Health Care
Journal Basic Information
Journal DOI :
The Korean Society of Quality Assurance in Health Care
Editor in Chief :
Volume & Issues
Volume 5, Issue 2 - Dec 1998
Volume 5, Issue 1 - May 1998
Selecting the target year
Determinants of Quality in Outpatient Medical Service
Park, Sook-Hee ; Kim, Seok-Beom ; Kang, Pock-Soo ;
Quality Improvement in Health Care, volume 5, issue 2, 1998, Pages 176~189
This study was conducted to evaluate the subjective ideas about the determinants of quality in ambulatory care unit among outpatients and medical staff of a university hospital, and to compare the differences of the ideas, between patients themselves and hospital staff. A self-administered questionnaire survey was conducted covering 799 outpatients and 190 hospital staff in March, 1998. The questionnaire included general characteristics and 26 determinants of ambulatory care quality. The following are summaries of the findings: 1. Both of outpatients and hospital staff perceived, "Physician's knowledge" as the most important determinant of medical care quality. 2. In respect of 7 determinants related to physician's knowledge and skill, both outpatients and hospital staff perceived "physician's knowledge and skill" as important determinants. The scores of determinants such as, "Not doing unnecessary examinations", and "Assignment of adequate number of patients and duty schedule for the physician" were significantly different between outpatients and hospital staff. 3. In respect of 4 determinants related to doctor-patient relationship, both outpatients and hospital staff perceived "attention to patient's complaints" as the most important determinant. The scores related to the determinants such as "kindness of physician" and "explanation of treatment outcome" were significantly different between outpatients and hospital staff. 4. Among the amenities related determinants, "Modern facilities and equipments" were perceived as the most important determinant in both group. 5. In respect of 8 determinants related to non-financial accommodation, outpatients perceived, "Waiting hours for treatment" as the most important determinant, and hospital staff perceived, "Kindness of hospital staff". 6. In respect of 4 determinants related to financial accommodation, outpatients perceived, "Fare account of medical cost" as the most important determinant, and hospital staff perceived, "Increasing reimbursements". Further comprehensive research should be made on the evaluation of perceptions of medical care quality, both of outpatient and inpatient care, among patients and hospital staff. So good quality in medical care will be achieved based on clients' needs.
A Study on Quality Improvement of Medical Equipments
Kang, Hun-Hee ; Juh, Ra-Hyeong ; Kim, Jong-Soon ; Kim, Seo-Hwak ; Huh, Soo-Jin ;
Quality Improvement in Health Care, volume 5, issue 2, 1998, Pages 190~201
Background : Medical equipments take a very important role in diagnosis and treatment of disease in modern medicine and effective maintenance of the equipments is a necessary to provide a good health care to the public. After developing a new QC program for effective maintenance of medical equipments and practicing it for a year, we report the results of the new program. Methods : The maintenance data of 9 equipments in 8 categories including a CT Scanner were analyzed with regard to the parts responsible for most frequent failure and cause of the failure. After learning the most frequent failure part and cause of the failure, we developed a new QC program that emphasizes preventive maintenance of the most frequent failure part. We compared the number of failure per year and active rate of each equipment before and after the adoption of the new QC program. Results : The average number of failure per year per equipment was 20.7 before and it decreased by 43% to 11.9 after adoption of the new QC program. The average active rate of the equipments was 92.6% before and it increased by 3.2% to 95.8% after adoption of the new program. Conclusions : The practice of the new QC program appears very useful as it decreased the failure rate and increased the active rate of the equipments.
Analysis of Factors Affecting on Satisfaction of Pharmacy Service
Park, Seong-Hi ; Suh, Jun-Kyu ; Yoon, Hye-Seol ; Hong, Jin-Young ; Park, Gun-Je ;
Quality Improvement in Health Care, volume 5, issue 2, 1998, Pages 202~215
Purpose : To shorten processing time for variety of medical affairs of the patient at the outpatient clinic of a big hospital is very important to qualify medical care of the patient. Therefore, patient's waiting time for drug delivery after doctor's prescription is often utilized as a strong tool to evaluate patient satisfaction with a medical care provided. We performed this study to investigate factors influencing patient satisfaction related with waiting time for drug delivery. Methods : The data were collected from July 21 to August 12, 1998. A total 535 patients or their families who visited outpatient clinics of Inha University Hospital were subjected to evaluate the drug delivery time and the level of their satisfaction related, which were compared with those objectively evaluated by Quality Improvement Team. The reliability of the scale was tested with Cronbach's alpha, and the data were analyzed using frequency, t-test, ANOVA, correlation analysis and multiple regression. Results : The mean drug delivery time subjectively evaluated by the patient (16.1 13.0 min) was longer than that objectively evaluated (10.9 7.6 min) by 5.2 min. Drug delivery time objectively evaluated was influenced by the prescription contents, total amount or type of drug dispensed, etc, as expected. The time discrepancy between two evaluations was influenced by several causative factors. One of those proved to be a patient's late response to the information from the pharmacy which the drug is ready to deliver. Interestingly, this discrepancy was found to be more prominent especially when waiting place for drug delivery was not less crowded. Other factors, pharmaceutical counseling at the pharmacy, emotional status or behavior of a patient while he waits for the medicine, were also found to influence the time subjectively evaluated. Regarding the degree of patient satisfaction with the drug delivery, majority of patients accepted drug delivery time with less than 10 min. It was also found to be influenced by emotional status of the patient as well as kindness or activity of pharmaceutical counselor. Conclusion : The results show that, besides prescription contents, behavior pattern or emotional status of a patient, environment of the waiting place, and quality of pharmaceutical counseling at the pharmacy, may influence the patient's subjective evaluation of waiting time for drug delivery and his satisfaction related with the service in the big hospital. In order to improve patient satisfaction related with waiting time for drug delivery, it will be cost effective to qualify pharmaceutical counseling and information system at the drug delivery site or waiting place rather than to shorten the real processing time within the pharmacy.
Survey on Discordance Rate between Final Principal Diagnosis and Principal Diagnosis at Emergency Room
Kim, Kwang Hwan ; Seo, Sun Won ; Won, Si Yeon ; Park, Seok Gun ; Kim, Seung Yul ; Song, Hwa Sik ; Kim, Kab Taug ; Jo, Hey Kyung ; Bu, You Kung ; Lee, Hyun Kyung ;
Quality Improvement in Health Care, volume 5, issue 2, 1998, Pages 216~223
We surveyed the discordance rate of principal diagnosis made at emergency room(ER) & made at ward on discharge of the patients. Subjects were four hundred eighty cases who came to the ER of one third-line hospital from January 1, 1998 to January 31, 1998. The discordance rate was higher in patients admitted to medical department(8.2%) than surgical department(1.5%). If the patients were transferred to other department during hospital stay, discordance rate increased from 3.3% to 6.3%. In conclusion, discordance rate of principal diagnosis made at ER and made at ward was higher in patients with complicated problems. Medical record department should keep these findings in mind if it has a plan to support the management of ER record.
A Study on the Importance of Works Perceived by Quality Improvement Coordinators and Their Current Work Performances
Kim, Young Ju ;
Quality Improvement in Health Care, volume 5, issue 2, 1998, Pages 224~237
Background : This is an investigative study to analyse the importance of works perceived by Quality Improvement(QI) Coordinators and to evaluate their current work performances using the questionnaires developed by the investigator. Methods : The data were collected from 37 subjects over two weeks period from Oct. 1 to Oct. 17, 1998 and analysed by the descriptive statistics of SPSS program. The items of questionnaire are consisted of 13 work domains including 73 activities based on Quality Management(QM) Coordinator's job description of National Association for Healthcare Quality:data collection & analysis, communication, monitoring, evaluation, accreditation, tool development, policy development, program development, self development, education & trainning, system design, planning, and consultation & support. Results : 1) Of the performances in 13 work domains, the frequencies of the work performed were accreditation(89%), planning(88%), communication(83%), data collection & analysis(82%), monitoring(76%), policy development(72%), consultation & support (71%), education & trainning(70%), self development(68%), evaluation(63%), tool development(61%), program development(44%) and system design(43%) in order. 2) For the importances (1=not important, 5=very important), the policy development(4.46) scored highest then monitoring(4.42), planning(4.41), education & trainning(4.38), communication(4.35), evaluation(4.34) tool development (4.30), data collection & analysis(4.29), program development(4.22), consultation & support(4.22), accreditation(4.15), self development(4.05) and system design(3.98) in order. 3) There was a difference between the work performance and the perceived importance. The results showed the low performances in policy development, monitoring, education & trainning and evaluation which ranked high by the perceived importance and the high performances in accreditation, data collection & analysis, self development, communication and consultation & support which ranked middle to low by the perceived importance. 4) The reasons for low performances of QI Coordinators were the lack of clear assignment for the responsibility and allowed authority for work to QI Coordinators(30.8%), insufficient member of QI Coordinators(13.9%), lack of hospital director's interest(11.5%), low motivation of QI Coordinators (10.6%) and insufficient knowledge & experience of QI Coordinators (8.8%). Conclusion : Most works were perceived important by QI Coordinators, but there was a difference in the work performance. The works performed over 70% were related with accreditation, data collection & analysis, communication, planning and monitoring, on the other hand under 50% in performances were related with system design, program development, tool development and evaluation.
A Study on the Nurses' Thinking Skills and Problem Solving Abilities for Quality Management in Healthcare Services
Ko, Ja Kyung ; Park, Yon Ok ;
Quality Improvement in Health Care, volume 5, issue 2, 1998, Pages 238~256
Background : There have been many studies and efforts about quality management in health services, but these were not focused on the thinking ability of the personnel. In this study, We planned to define the relationship between Quality Management(QM) and thinking skill, and analyzed critical thinking skill and problem solving ability of the nurses for QM in healthcare. Methods : We surveyed 260 nurses in 3 hospitals by using questionnaires about thinking skills and QM from November 18 to 28, 1998. The response rate was 76.9%. We described and analyzed the data by descriptive statistics, t-test, ANOVA, Pearson correlation, and non-parametric Friedman test using SPSS Win 7.5. Results : This study revealed that 1) understanding level of QM concepts was very low and insufficient, 2) willingness to practice QM in healthcare was relatively high and affirmative, but the positive attitude taking part in the program of QM is very low(4.5%), 3) even though the necessity of QM was recognized, actual application of critical thinking skills and problem solving abilities is lacking, 4) the production of idea for QM was the most insufficient, and so the next of the problem solving process(QA cycle) was the same. Conclusion : Based on the above results, we can conclude that understanding the concepts of QM is very important to solve problems about QM in healthcare. For development of thinking skill to promote critical problem solving ability for QM in healthcare, it is necessary to improve curriculum of nursing education and teaching-learning methods of QM strategy and technique.
A Study for Safe Storage Time for In-house Sterilized Products in a Korean Hospital
Yoon, Kesook ; Kim, Jeong Hee ; Yang, Shin Hye ; Chae, Ji Yeun ; Lee, Young Mee ; Cho, Kyung Sook ;
Quality Improvement in Health Care, volume 5, issue 2, 1998, Pages 258~276
This study was conducted to justify the "prescribed shelf life" currently used in Samsung Medical Center and give recommendations based on scientific data to adopt for safe and cost-effective storage times for sterile goods Since the early 1970's, predetermined expiration dating policy has been used in Korea on all in-house sterilized products like any other countries; six months for the supplies wrapped in polyethylene peel pouches and two weeks for the rest. Recently, however, the studies suggest that current standards for preserving the sterility can be changing. It looks like we unnecessarily have too-short expiration date of sterilized supplies, that is far from being cost effective. Certainly, this research is an exciting project, especially in Korea, and will be leading and contributing to the paradigm shift of the conservative concept of shelf life for sterile supplies in Korean healthcare facilities. The major goal of this study was placed on the measurement of the recontamination time in packs wrapped in all kinds of wrapping materials used in S.M.C and stored in various conditions for periods ranging from three months to six months, and then develop a practical standard of "shelf life" based on the analyzed data. Objectives: To measure and compare the recontamination time of sterile packs among wrapppers and storage conditions, and develop a practical standard for the shelf life and storage conditions of sterile products. Samples and Method: The sterile integrity was investigated of the total 1,440 sterile sample packs containing gauze strip(
) we prepared and wrapped in nine wrapping materials (randomized reprocessed linens, linens reprocessed 99 times, linens reprocessed 120 times, new kraft paper, used kraft paper, new nonwoven fabrics, 6-time reprocessed nonwoven fabrics, new polyethylene peel pouches, used polyethylene peel pouches), and stored in four locations(closed cabinet of one of the typical wards, open shelf of one of ICUs, open shelf of separate storage room in ER, open shelf in OR), for three to six months, respectively in 1998. Each type of packs were opened weekly and the gauze strips inoculated into Brewer's thioglycollate broth at
for seven days. Results: There was no growth found for any types of the pack and storage conditions studied. Discussion: This study was conducted in an attempt to identify the possibility of extending the current shelf life for sterile goods we use in a sense of cost effectiveness. The findings suggest that we could extend our expiration dates, that means we can save a lot of materials and personnel time meeded for resterilizing, outdating, recleaning, wrapping, and reshelving. Then it will initiate a great reform in the field of healthcare in Korea, and now we are looking forward to this valuable revolution. We are going to continue this study and take all steps need to apply this new concept to our practice, and then trying to extend to other hospitals.
Job Satisfaction and Organizational Commitment of Quality Improvement Coordinators in General Hospitals
Park, Mi Hyun ; Cho, Woohyun ; Seo, Yong-Joon ; Lee, Sunhee ;
Quality Improvement in Health Care, volume 5, issue 2, 1998, Pages 278~294
This study was planned to provide basic data for activating quality improvement by genera hospital with more than 400 beds across the country, of which 65 coordinators answered. Main results of the study are as follows.. 1. Job satisfaction and organizational commitment by individual characteristics were compared. It was revealed that the sense of self-efficacy was related to job satisfaction positively. But job satisfaction and organizational commitment by locus of control showed no significant difference. 2. In terms of the characteristics of QI activities, the active participation of QI coordinators in QI planning process and smooth communication among hospital staffs were showed positive relationship to job satisfaction significantly. 3. Also support system was proposed as most significant variable related to the job satisfaction and the organizational commitment of QI coordinators. Especially support to QI activities by CEO's, seniors, and other hospital staff was a factor to enhance the job satisfaction and organizational commitment of QI coordinators. 4. In the aspect of organizational culture, culture which were tendency to be recognized high autonomy in their work and organizational identity strongly and to operate reasonable compensation system were related to job satisfaction and organizational commitment positively. The more formalized climate, supportive communication, cooperative teamwork and promoting creative/risk take behavior, it showed the higher organizational commitment. 5. For the aspect of QI job characteristics, QI coordinators' job satisfaction was high when QI office was arranged for independent department which was exclusively in charge of QI activities and their role is exclusively in charge of QI. It can be concluded that organizational support in the aspect of relation and finance and efforts of encouraging their motivation and providing on the job training program are need.
Development of Performance Evaluation Protocols for Physicians in a University Hospital
Kim, Chang-Yup ; Kim, Sunmean ;
Quality Improvement in Health Care, volume 5, issue 2, 1998, Pages 296~310
Background : Performance evaluation of medical care providers has become more important than before in Korea. Especially in university hospitals, job contents of medical staffs are so complicated that evaluation is not easily performed. In addition, in order that the feedback of evaluation be successful, acceptance of staffs to be evaluated is essential. This study is aimed at the development of items for evaluation and weighting of each item in one university hospital, and clustering departments by different weight given by medical staffs. Methods : Through resource group meeting. performance items were listed up by categories of education, research, medical services, and other activities in and out of the hospital. For each item, all the medical staffs were asked how important they thought, compared with publishing one original article. By factor analysis, the items in each category were grouped into a few subgroups. In turn, cluster analysis was done for the purpose of grouping departments by priority the medical staffs gave. Results and Conclusion : Among five major categories, medical staffs regard education, research, and medical services more important than other activities in and out of the hospital. Five categories consisted of two or three components. Departments in hospital were grouped into three. However, characteristics of each group was not clearly delineated. This result suggests that more comprehensive tool should be developed and applied in the process of performance evaluation in university hospitals.
QI Activities for Promotion of Patient's Satisfaction
Park, Yon-Ok ; Kim, Mi-Soug ; Ko, Eun-Geong ; Kim, Yeon-Jung ; Hong, Chang-Ho ;
Quality Improvement in Health Care, volume 5, issue 2, 1998, Pages 312~323
Background : Evaluation of patient's satisfaction is one of the most important aspects of quality improvement. If the patient highly satisfies with the medical service provided in the hospital, he/she will be likely to visit the same hospital again. Patient's satisfaction of a particular hospital is directly correlated with hospital profits as well as reputation in the community. For this reason, various kinds of survey measuring satisfaction level have been performed and many kind of QI activities for enhancing the profits as well as reputation in the community. For this reason, various kinds of survey measuring satisfaction level have been performed and many kind of QI activities for enhancing the patient's satisfaction. This study is to find the effect of hospital QI activities on the patent's satisfaction level. Methods: After questionnares were developed, survey of measuring satisfaction level was performed in August, 1998. On the basis of survey results, QI activities were carried out to attain the target point of 4.0 and subsequent survey was done in November, 1998. Results: With three main principles of "problem solving approach with kindness". "helping patient to participate in medical procedure with sufficient information", and "putting employees into practice of attitude with human respect", the average level of satisfaction was enhanced from 3.45 to 3.55 level. Also kindness level of employees was increased from 3.71 to 3.82. Level of dissatisfaction about insufficient explanation and unkind attitude was dropped from 69% to 48% and from 82% to 46% respectively. Conclusion: With the result of this study overall satisfaction level was enhanced. In order to keep these advantages a operation of Quality Improvement Task Force Team in each subject will be required.
A Strategic Quality Initiative and Its Opportunities to Improve Healthcare Environment
Tark, Kwan-Chul ; Park, Hyun-Ju ; Park, Chang-Il ; Kang, Jin-Kyung ;
Quality Improvement in Health Care, volume 5, issue 2, 1998, Pages 324~334
Background : Strategic planning is an organizationwide or systemwide, ongoing look into the future usually of 2~3 years, based on objective analysis of the current environment and trends, but it can incorporate both short-term and long-term goals. The strategic planning process includes external analysis, internal analysis, issue analysis, development of mission, vision and values, and lastly development of organizational goals and objectives. As a part of the strategic quality planning process, certain service lines, important organizationwide functions, or key processes supporting these functions can be prioritized to expedite and roll out certain strategic goals. This is called strategic quality initiatives. Methods : We organized a quality improvement team, a subgroup of 21st century vision planning corps of our medical center, and pursued QI activities for improvement of healthcare environment, particularly in the admission setting. We developed a strategic quality initiative based on the results of patient satisfaction surveys, and carried out functions of self-directed work team. Results : The strategic goal was to be the benchmark for peer group hospitals in Korea for providing cost-effective best-practice. The QI team included 3 medical doctors, 1 nurse, 1 social worker, and 1 QI consultant as well as many operational members to support services and quality initiatives met every Tuesday for 18 weeks. Outcome objectives were to improve patient satisfaction score. The issues included in the objectives were comfort, temperature, noise, cleanliness of the admission wards, quality and education of patient meals, matters regarding the admission process, and an appurtenant facility such as restaurant or convenience store. Every issue was discussed and recommendations, conclusions and opportunities were implemented. Conclusions : By developing a strategic quality initiative as a part of the strategic quality planning process, and pursuing a self-directed work team, certain sen/ice lines, important organizationwide functions, or key processes supporting these functions can be improved effectively within a short period. Strategic quality initiatives serve to support, or roll out, certain strategic goals that are relevant to performance improvement and development of specific measurable outcome objectives, and associated performance measure for each initiative. Each strategic quality initiative should include a statement of intent outcome objectives, and performance measures. We will come back with follow up of the strategic quality initiative, for improvement of healthcare environment, and results of patient satisfaction re-survey.