Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde, 2006
Samenvatting Overheid en beroepsverenigingen hebben veel gedaan om de professionals beter te lat... more Samenvatting Overheid en beroepsverenigingen hebben veel gedaan om de professionals beter te laten samenwerken. ZonMw, de LHV en de NVAB hebben veertien regionale projecten begeleid, ZonMw heeft het netwerk Medwerk drie jaar lang gefinancierd en de minister van VWS heeft met ingang van 1 januari 2004 de verwijsfunctie van de bedrijfsarts geïntroduceerd. Ondanks deze inspanningen zijn er de laatste jaren sombere verhalen gepubliceerd over de kloof in cultuur en het onbegrip tussen bedrijfs-artsen en met name huisartsen.
To analyse the variation in the registration of hospital admissions across Dutch hospitals and de... more To analyse the variation in the registration of hospital admissions across Dutch hospitals and determine how this variation affects the Hospital Standardised Mortality Rate (HSMR). Retrospective, descriptive. We used data from the National Medical Registration (LMR), covering the records of all hospital admissions in 2005 in Dutch hospitals, to analyse the variation between hospitals in 3 variables: the number of secondary diagnoses, the percentage of unplanned admissions, and the percentage of non-specified diagnoses ('other diagnoses'). The impact of this variation on the HSMR was analysed by calculating the correlation between the HSMR and each of the variables. The correlation between the original HSMR and the HSMR without adjustment for these variables was also calculated. The variation in the percentages of unplanned admissions and admissions with a non-specified diagnosis was low. The variation in these two variables had a small or no effect on the HSMR. There was a c...
Samenvatting In haar brief aan de Tweede Kamer van 17 oktober 2006 kondigde staatssecretaris Ros... more Samenvatting In haar brief aan de Tweede Kamer van 17 oktober 2006 kondigde staatssecretaris Ross aan dat het gebruik van het zorgplan door AWBZ-instellingen onder de Kwaliteitswet komt te vallen. Handhaving van het gebruik loopt voortaan mee met het reguliere toezicht van de Inspectie van de Gezondheidszorg.1 De vraag is daarom interessant of en hoe instellingen het zorgplan gebruiken. De Inspectie
Patient satisfaction surveys are increasingly used for benchmarking purposes. In the Netherlands,... more Patient satisfaction surveys are increasingly used for benchmarking purposes. In the Netherlands, the results of these surveys are reported at the univariate level without taking case mix factors into account. The first objective of the present study was to determine whether differences in patient satisfaction are attributed to the hospital, department or patient characteristics. Our second aim was to investigate which case mix variables could be taken into account when satisfaction surveys are carried out for benchmarking purposes. Patients who either were discharged from eight academic and fourteen general Dutch hospitals or visited the outpatient departments of the same hospitals in 2005 participated in cross-sectional satisfaction surveys. Satisfaction was measured on six dimensions of care and one general dimension. We used multilevel analysis to estimate the proportion of variance in satisfaction scores determined by the hospital and department levels by calculating intra-class correlation coefficients (ICCs). Hospital size, hospital type, population density and response rate are four case mix variables we investigated at the hospital level. We also measured the effects of patient characteristics (gender, age, education, health status, and mother language) on satisfaction. We found ICCs on hospital and department levels ranging from 0% to 4% for all dimensions. This means that only a minor part of the variance in patient satisfaction scores is attributed to the hospital and department levels. Although all patient characteristics had some statistically significant influence on patient satisfaction, age, health status and education appeared to be the most important determinants of patient satisfaction and could be considered for case mix correction. Gender, mother language, hospital type, hospital size, population density and response rate seemed to be less important determinants. The explained variance of the patient and hospital characteristics ranged from 3% to 5% for the different dimensions. Our conclusions are, first, that a substantial part of the variance is on the patient level, while only a minor part of the variance is at the hospital and department levels. Second, patient satisfaction outcomes in the Netherlands can be corrected by the case mix variables age, health status and education.
In this study we present a bottom up approach to developing interventions to shorten lengths of s... more In this study we present a bottom up approach to developing interventions to shorten lengths of stay. Between 1999 and 2009 we applied the approach in 21 Dutch clinical wards in 12 hospitals. We present the complete inventory of all interventions. We organised, on the hospital ward level, structured meetings with the staff in order to first identify barriers to reduce the length of stay and then later to link them to interventions. The key components of the approach were a benchmark with the fifteenth percentile and the use of a matrix, that on one side was arranged along the main phases of the care process--the admission, stay and discharge--and on the other side to the degree to which the length of stay could be shortened by the medical specialists and nurses themselves or by involving others. The matrix consists of a wide variety of interventions that mainly cover what we found in published research. As a bottom up approach is more likely to succeed, we would advise wards that have to reduce length of stay to make the inventory themselves, using appropriate benchmark data, and by using the matrix.
Dealing with poor individual performance of healthcare professionals is essential in patient safe... more Dealing with poor individual performance of healthcare professionals is essential in patient safety management. The objective of the current study was to explore potential differences regarding experiences with impaired and incompetent colleagues between a broad range of healthcare professions. A survey of 10 legally regulated professions in the Netherlands on knowledge on dealing with impaired/incompetent colleagues, experiences with such colleagues, action taken upon an impaired and incompetent colleague and reasons for not taking action. We approached 4348 professionals, of whom 1238 responded (28.5%). One-third of the respondents (31.3%) had an experience with an impaired or incompetent colleague in the preceding 12 months, and 84% of these reported cases concerned incompetence. Even under the extreme assumption that all non-respondents had no such experiences, our results indicate that at least 9% of the total sample had dealt with an impaired or incompetent colleague in the pr...
To examine the impact of corporate structure and quality improvement (QI) activities on improveme... more To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate structure, QI activities and performance improvements on indicators. In total, 169 residential care homes for the elderly in the Netherlands. Change between 2007 and 2009 in client-reported and professional indicators. A middle-size corporate structure was associated with QI. The QI activity 'multidisciplinary team meetings' was positively correlated with the indicator 'safety environment' for somatic and psycho-geriatric care. The QI activities 'educational material' and 'direct work instructions' were associated negatively with the indicator 'availability of personnel' for somatic clients, but positively for psycho-geriatric clients. QI activities such as 'health plan activities', 'clinical lessons' and 'financial activities' had no relationship to improved performance. For psycho-geriatric clients mainly organizational QI activities were positively associated with QI. The mediating role of the corporate structure for performing QI activities appeared stronger for the change in client-reported than for professional indicators. This study reveals associations between QI activities and corporate structure and changes in indicator performance. A corporate structure was associated with improvement in client-reported indicators, but less on professional indicators, which assumes a central policy at corporate level with impact on client-reported indicators, in contrast to a more local level approach towards activities that result in QI on professional indicators. Tailoring QI activities at the right managerial level may be important to achieve improvement.
Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde, 2006
Samenvatting Overheid en beroepsverenigingen hebben veel gedaan om de professionals beter te lat... more Samenvatting Overheid en beroepsverenigingen hebben veel gedaan om de professionals beter te laten samenwerken. ZonMw, de LHV en de NVAB hebben veertien regionale projecten begeleid, ZonMw heeft het netwerk Medwerk drie jaar lang gefinancierd en de minister van VWS heeft met ingang van 1 januari 2004 de verwijsfunctie van de bedrijfsarts geïntroduceerd. Ondanks deze inspanningen zijn er de laatste jaren sombere verhalen gepubliceerd over de kloof in cultuur en het onbegrip tussen bedrijfs-artsen en met name huisartsen.
To analyse the variation in the registration of hospital admissions across Dutch hospitals and de... more To analyse the variation in the registration of hospital admissions across Dutch hospitals and determine how this variation affects the Hospital Standardised Mortality Rate (HSMR). Retrospective, descriptive. We used data from the National Medical Registration (LMR), covering the records of all hospital admissions in 2005 in Dutch hospitals, to analyse the variation between hospitals in 3 variables: the number of secondary diagnoses, the percentage of unplanned admissions, and the percentage of non-specified diagnoses ('other diagnoses'). The impact of this variation on the HSMR was analysed by calculating the correlation between the HSMR and each of the variables. The correlation between the original HSMR and the HSMR without adjustment for these variables was also calculated. The variation in the percentages of unplanned admissions and admissions with a non-specified diagnosis was low. The variation in these two variables had a small or no effect on the HSMR. There was a c...
Samenvatting In haar brief aan de Tweede Kamer van 17 oktober 2006 kondigde staatssecretaris Ros... more Samenvatting In haar brief aan de Tweede Kamer van 17 oktober 2006 kondigde staatssecretaris Ross aan dat het gebruik van het zorgplan door AWBZ-instellingen onder de Kwaliteitswet komt te vallen. Handhaving van het gebruik loopt voortaan mee met het reguliere toezicht van de Inspectie van de Gezondheidszorg.1 De vraag is daarom interessant of en hoe instellingen het zorgplan gebruiken. De Inspectie
Patient satisfaction surveys are increasingly used for benchmarking purposes. In the Netherlands,... more Patient satisfaction surveys are increasingly used for benchmarking purposes. In the Netherlands, the results of these surveys are reported at the univariate level without taking case mix factors into account. The first objective of the present study was to determine whether differences in patient satisfaction are attributed to the hospital, department or patient characteristics. Our second aim was to investigate which case mix variables could be taken into account when satisfaction surveys are carried out for benchmarking purposes. Patients who either were discharged from eight academic and fourteen general Dutch hospitals or visited the outpatient departments of the same hospitals in 2005 participated in cross-sectional satisfaction surveys. Satisfaction was measured on six dimensions of care and one general dimension. We used multilevel analysis to estimate the proportion of variance in satisfaction scores determined by the hospital and department levels by calculating intra-class correlation coefficients (ICCs). Hospital size, hospital type, population density and response rate are four case mix variables we investigated at the hospital level. We also measured the effects of patient characteristics (gender, age, education, health status, and mother language) on satisfaction. We found ICCs on hospital and department levels ranging from 0% to 4% for all dimensions. This means that only a minor part of the variance in patient satisfaction scores is attributed to the hospital and department levels. Although all patient characteristics had some statistically significant influence on patient satisfaction, age, health status and education appeared to be the most important determinants of patient satisfaction and could be considered for case mix correction. Gender, mother language, hospital type, hospital size, population density and response rate seemed to be less important determinants. The explained variance of the patient and hospital characteristics ranged from 3% to 5% for the different dimensions. Our conclusions are, first, that a substantial part of the variance is on the patient level, while only a minor part of the variance is at the hospital and department levels. Second, patient satisfaction outcomes in the Netherlands can be corrected by the case mix variables age, health status and education.
In this study we present a bottom up approach to developing interventions to shorten lengths of s... more In this study we present a bottom up approach to developing interventions to shorten lengths of stay. Between 1999 and 2009 we applied the approach in 21 Dutch clinical wards in 12 hospitals. We present the complete inventory of all interventions. We organised, on the hospital ward level, structured meetings with the staff in order to first identify barriers to reduce the length of stay and then later to link them to interventions. The key components of the approach were a benchmark with the fifteenth percentile and the use of a matrix, that on one side was arranged along the main phases of the care process--the admission, stay and discharge--and on the other side to the degree to which the length of stay could be shortened by the medical specialists and nurses themselves or by involving others. The matrix consists of a wide variety of interventions that mainly cover what we found in published research. As a bottom up approach is more likely to succeed, we would advise wards that have to reduce length of stay to make the inventory themselves, using appropriate benchmark data, and by using the matrix.
Dealing with poor individual performance of healthcare professionals is essential in patient safe... more Dealing with poor individual performance of healthcare professionals is essential in patient safety management. The objective of the current study was to explore potential differences regarding experiences with impaired and incompetent colleagues between a broad range of healthcare professions. A survey of 10 legally regulated professions in the Netherlands on knowledge on dealing with impaired/incompetent colleagues, experiences with such colleagues, action taken upon an impaired and incompetent colleague and reasons for not taking action. We approached 4348 professionals, of whom 1238 responded (28.5%). One-third of the respondents (31.3%) had an experience with an impaired or incompetent colleague in the preceding 12 months, and 84% of these reported cases concerned incompetence. Even under the extreme assumption that all non-respondents had no such experiences, our results indicate that at least 9% of the total sample had dealt with an impaired or incompetent colleague in the pr...
To examine the impact of corporate structure and quality improvement (QI) activities on improveme... more To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate structure, QI activities and performance improvements on indicators. In total, 169 residential care homes for the elderly in the Netherlands. Change between 2007 and 2009 in client-reported and professional indicators. A middle-size corporate structure was associated with QI. The QI activity 'multidisciplinary team meetings' was positively correlated with the indicator 'safety environment' for somatic and psycho-geriatric care. The QI activities 'educational material' and 'direct work instructions' were associated negatively with the indicator 'availability of personnel' for somatic clients, but positively for psycho-geriatric clients. QI activities such as 'health plan activities', 'clinical lessons' and 'financial activities' had no relationship to improved performance. For psycho-geriatric clients mainly organizational QI activities were positively associated with QI. The mediating role of the corporate structure for performing QI activities appeared stronger for the change in client-reported than for professional indicators. This study reveals associations between QI activities and corporate structure and changes in indicator performance. A corporate structure was associated with improvement in client-reported indicators, but less on professional indicators, which assumes a central policy at corporate level with impact on client-reported indicators, in contrast to a more local level approach towards activities that result in QI on professional indicators. Tailoring QI activities at the right managerial level may be important to achieve improvement.
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