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The purpose of this paper is to review how patient and public involvement (PPI) can contribute to quality improvement functions and describe the levels of PPI in quality improvement functions at hospital and departmental level in a sample of European hospitals.

Literature review and cross-sectional study.

PPI takes multiple forms in health care and there is not a single strategy or method that can be considered to reflect best practice. The literature reveals that PPI can serve important functions to support quality improvement efforts. In contrast, the assessment of actual PPI in quality improvement shows that PPI is low.

Findings are not representative of hospitals in the EU.

A diverse set of methods and tools that can be employed to realize PPI. Service providers should consider PPI at all stages, in particular in setting quality standards and criteria and in evaluating the results.

Contextualization of empirical findings with case studies from the literature that inform further practice and research on PPI.

The spotlight has recently been placed on managers’ responsibility for patient-centred care as a result of Mid Staffordshire NHS Foundation Trust failings. In previous research, clinicians reported that managers do not have an adequate structured plan for implementing patient-centred care. The purpose of this paper is to assess the perceptions of European hospital management with respect to factors affecting the implementation of a patient-centred approach.

In total, 15 semi-structured interviews were conducted with hospital managers (n=10), expert country informants (n=2), patient organisations (n=2) and a user representative (n=1) from around Europe. Participants were purposively and snowball sampled. Interviews were analysed using framework analysis.

Most participants felt that current levels of patient-centred care are inadequate, but accounted that there were a number of macro, meso and micro challenges they faced in implementing this approach. These included budget constraints, political and historical factors, the resistance of clinicians and other frontline staff. Organisational culture emerged as a central theme, shaped by these multi-level factors and influencing the way in which patient-centred care was borne out in the hospital. Participants proposed that the needs of patients might be better met through increasing advocacy by patient organisations and greater staff contact with patients.

This study is the first of its kind to obtain management views from around Europe. It offers an insight into different models of how patient-centred care is realised by management. It indicates that managers see the value of a patient-centred approach but that they feel restricted by a number of factors at multiple levels.

Health systems are changing at variable rates. Periods of significant change can create new challenges or amplify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability.

Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards.

Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy; accrediting agency management of the accreditation process, including the program’s framework; survey coordinators; survey team dynamics; individual surveyors; and healthcare organizations’ approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain.

Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.

The authors present the application of the López-Fresno approach in designing an integrated management system (IMS) for an aviation company to the development of an IMS in a government-run organization responsible for the medical evaluation of work disabilities. The purpose of this paper is to share the design process, with the intention of showing that this approach is applicable to other sectors and proposing generalization and applicability strategies to other smaller government entities.

The study involves two phases. Phase I applies the López-Fresno approach to design a basic IMS-I and ends with a European Foundation for Quality Management (EFQM) evaluation, whose suggestions were taken into consideration for the final design of IMS-II during phase II. The data were obtained from the organization's own functioning. There was a significant degree of personal involvement by the authors, external consultants and members of the management committee in areas ranging from the approach itself to the various components analyzed.

The approach led to a better use of human and material resources and produced various advances in both internal and external communication and significant progress in employee motivation in their dealings with users and stakeholders.

The study offers guidelines and recommendations for designing an IMS adapted to small, compact, administrative organizations that operate with stakeholders with highly disparate outlooks and interests, with different quality levels, in a context related to competitiveness and economic development.

Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected and analyzed internationally. The purpose of this paper is to address this knowledge gap by examining the lessons learned from health system reform and improvement efforts in 60 countries.

In total, 60 low-, middle- and high-income countries provided a case study of successful health reform, which was gathered into a compendium as a recently published book. Here, the extensive source material was re-examined through inductive content analysis to derive broad themes of systems change internationally.

Nine themes were identified: improving policy, coverage and governance; enhancing the quality of care; keeping patients safe; regulating standards and accreditation; organizing care at the macro-level; organizing care at the meso- and micro-level; developing workforces and resources; harnessing technology and IT; and making collaboratives and partnerships work.

These themes provide a model of what constitutes successful systems change across a wide sample of health systems, offering a store of knowledge about how reformers and improvement initiators achieve their goals.

Few comparative international studies of health systems include a sufficiently wide selection of low-, middle- and high-income countries in their analysis. This paper provides a more balanced approach to consider where achievements are being made across healthcare, and what we can do to replicate and spread successful examples of systems change internationally.

Capture, consumption and use of person-centred information presents challenges for hospitals when operating within the scope of limited resources and the push for organisational routines and efficiencies. This paper explores these challenges for patients with Acute Coronary Syndrome (ACS) and the examination of information that supports successful hospital discharge. It aims to determine how the likelihood of readmission may be prevented through the capturing of rich, person-specific information during in-patient care to improve the process for discharge to home.

The authors combine four research data collection and analysis techniques: one, an analysis of the patient record; two, semi-structured longitudinal interviews; three, an analysis of the patient's journey using process mining to provide analytics about the discharge process, and four, a focus group with nurses to validate and confirm our findings.

The authors’ contribution is to show that information systems which support discharge need to consider models focused on individual patient stressors. The authors find that current discharge information capture does not provide the required person-centred information to support a successful discharge. Data indicate that rich, detailed information about the person acquired through additional nursing assessments are required to complement data provided about the patient's journey in order to support the patients’ post-discharge recovery at home.

Prior research has focused on information collection constrained by pre-determined limitations and barriers of system design. This work has not considered the information provided by multiple sources during the whole patient journey as a mechanism to reshape the discharge process to become more person-centred. Using a novel combination of research techniques and theory, the authors have shown that patient information collected through multiple channels across the patient care journey may significantly extend the quality of patient care beyond hospital discharge. Although not assessed in this study, rich, person-centred discharge information may also decrease the likelihood of patient readmission.

This study aims at determining the influence of the competitive strategy types and organizational structure dimensions on Cost of Quality (CoQ) in Food and Beverage (F&B) small- and medium-sized enterprises (SMEs).

A survey questionnaire was sent to F&B companies in Greece and 307 responded positively and fully completed the questionnaire. The research model developed (consisting of the competitive strategy types, the organizational structure dimensions and CoQ) was tested using the exploratory and confirmatory factor analyses and the structural equation modeling (SEM) technique.

The findings indicated that cost leadership, centralization and formalization influence the CoQ positively and significantly. By contrast, differentiation does not influence CoQ.

The small sample of the responding companies operating in one country, the different F&B sub-sectors, the subjective perceptions of only one representative per company and the cross-sectional nature of the study are the main limitations of the present study.

This paper provides academicians and practitioners with a better understanding of the factors that influence the quality-cost level.

To the best of the authors' knowledge, this is the first study that examines the effect of competitive strategy and organizational structure on CoQ.