Indoor Air Quality in Healthcare Units—A Systematic Literature Review Focusing Recent Research

The adequate assessment and management of indoor air quality in healthcare facilities is of utmost importance for patient safety and occupational health purposes. This study aims to identify the recent trends of research on the topic through a systematic literature review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. A total of 171 articles published in the period 2015–2020 were selected and analyzed. Results show that there is a worldwide growing research interest in this subject, dispersed in a wide variety of scientific journals. A textometric analysis using the IRaMuTeQ software revealed four clusters of topics in the sampled articles: physicochemical pollutants, design and management of infrastructures, environmental control measures, and microbiological contamination. The studies focus mainly on hospital facilities, but there is also research interest in primary care centers and dental clinics. The majority of the analyzed articles (85%) report experimental data, with the most frequently measured parameters being related to environmental quality (temperature and relative humidity), microbiological load, CO2 and particulate matter. Non-compliance with the WHO guidelines for indoor air quality is frequently reported. This study provides an overview of the recent literature on this topic, identifying promising lines of research to improve indoor air quality in healthcare facilities.

Stakeholder views of the development of a clinical quality registry for interventional radiology: a qualitative study

Background Clinical quality registries (CQRs) can likely improve quality in healthcare and research. However, studies indicate that effective use of CQRs is hindered by lack of engagement and interest among stakeholders, as well as factors related to organisational context, registry design and data quality. To fulfil the potential of CQRs, more knowledge on stakeholders’ perceptions of the factors that will facilitate or hamper the development of CQRs is essential to the more appropriate targeting of registry implementation and the subsequent use of the data. The primary aim of this study was to examine factors that can potentially affect the development of a national CQR for interventional radiology in Norway from the perspective of stakeholders. Furthermore, we wanted to identify the intervention functions likely to enable CQR development. Only one such registry, located in Sweden, has been established. To provide a broader context for the Norwegian study, we also sought to investigate experiences with the development of this registry. Methods A qualitative study of ten Norwegian radiologists and radiographers using focus groups was conducted, and an in-depth interview with the initiator of the Swedish registry was carried out. Questions were based on the Capability, Opportunity and Motivation for Behaviour Model and the Theoretical Domains Framework. The participants’ responses were categorised into predefined themes using a deductive process of thematic analysis. Results Knowledge of the rationale used in establishing a CQR, beliefs about the beneficial consequences of a registry for quality improvement and research and an opportunity to learn from a well-developed registry were perceived by the participants as factors facilitating CQR development. The study further identified a range of development barriers related to environmental and resource factors (e.g., a lack of organisational support, time) and individuallevel factors (e.g., role boundaries, resistance to change), as well as several intervention functions likely to be appropriate in targeting these barriers. Conclusion This study provides a deeper understanding of factors that may be involved in the behaviour of stakeholders regarding the development of a CQR. The findings may assist in designing, implementing and evaluating a methodologically rigorous CQR intervention.

What do codes of ethics tell us about impartiality, and what is preferred at the hospital?

The impartiality of the interpreter has long been an important aspect of and an indispensable quality in healthcare interpreting. Official documents on professional ethics created by professional associations around the world refer to impartiality among the fundamental ethical principles to be adhered to. However, the conditions in the workplace and the background of the interpreter might pose significant risks to ensuring the implementation and adoption of ethics in the field. Furthermore, specific conditions of immigration and the quality (or the existence) of interpreter training in the required language combinations may play a role in either facilitating or impeding the implementation of ethical principles. As a country that has been receiving migrants for a relatively short time, Turkey lacks a code of ethics specifically drawn up for healthcare (or community) interpreters and this may well lead to problems in the field. Therefore, the primary objective of this study is to compare healthcare interpreters’ understanding of, preference for and exercise of impartiality with the prescripts of the codes applicable in other countries and to demonstrate how the principle of impartiality unfolds in healthcare contexts. The results of the study demonstrate that helping the patient was the main motivation of the interpreters in the field rather than being guided purely by impartiality. They reported being deliberately on the patient’s side to support them and to ensure that they obtained the required treatment, an approach which contradicts the codes of the associations in the countries that prefer “interpreting” rather than “mediation”. The analysis pointed to the fact that the meaning of impartiality is shaped by the system in which it is laid down. These results suggest that the codes and the attitudes of healthcare interpreters do not coincide as regards impartiality in a country where healthcare interpreting research and practice are emerging and training opportunities are scarce. They can serve as a useful reference point for policymaking and the professionalization of healthcare interpreters.

Building Quality from the Ground Up in a Cancer Center

The Institute of Medicine defines quality in healthcare as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. This concept is highly relevant for cancer care that involves patients with complex diseases in the setting of rapidly evolving treatment landscape that requires provision of appropriate services in a patient-centric and technically competent manner. This chapter uses the Donabedian model to review the structural, process, and outcome-based quality domains that lay the foundation for a robust system to measure, monitor, and improve quality of care at cancer centers. The infrastructure and personnel, systems, and culture needed for ensuring provision of high-quality cancer care are reviewed.

Patients’ Satisfaction by SmileInTM Totems in Radiotherapy: A Two-Year Mono-Institutional Experience

Background: Patient’s satisfaction is recognized as an indicator to monitor quality in healthcare services. Patient-reported experience measures (PREMs) may contribute to create a benchmark of hospital performance by assessing quality and safety in cancer care. Methods: The areas of interest assessed were: patient-centric welcome perception (PCWP), punctuality, professionalism and comfort using the Lean Six Sigma (LSS) methodology. The RAMSI (Radioterapia Amica Mia SmileINTM (SI) My Friend RadiotherapySI), project provided for the placement of SI totems with four push buttons using HappyOrNot technology in a high-volume radiation oncology (RO) department. The SI technology was implemented in the RO department of the Fondazione Policlinico Universitario A. Gemelli IRCCS. SI totems were installed in different areas of the department. The SI Experience Index was collected, analyzed and compared. Weekly and monthly reports were created showing hourly, daily and overall trends. Results: From October 2017 to November 2019, a total of 42,755 votes were recorded: 8687, 10,431, 18,628 and 5009 feedback items were obtained for PCWP, professionalism, punctuality, and comfort, respectively. All areas obtained a SI-approved rate ≥ 8.0 Conclusions: The implementation of the RAMSI system proved to be doable according to the large amount of feedback items collected in a high-volume clinical department. The application of the LSS methodology led to specific corrective actions such as modification of the call-in-clinic system during operations planning. In order to provide healthcare optimization, a multicentric and multispecialty network should be defined in order to set up a benchmark.

Impact of Accreditation on Healthcare Professionals' Knowledge on Quality Management

The aim of the present study was to assess the impact of accreditation in enhancing the knowledge of healthcare professionals on management of quality. A self-administered questionnaire was distributed to selected healthcare professionals in various hospitals in India predominantly from accredited hospitals. About 600 potential respondents were selected. A 40-item survey was designed and comprised questions on demographic data, knowledge of definition of general quality, healthcare quality and implementation of quality systems in hospitals, and the difference between various standards of measurement of quality in healthcare and quality in support functions. The knowledge of healthcare professionals significantly varies according to their designations, accreditation status of the work place, and their qualification. Overall, good knowledge on quality is suggestive of conceptual clarity among healthcare professionals regarding quality who either have exposure to hospital accreditation or are working in accredited hospitals.