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Erschienen in: Administration and Policy in Mental Health and Mental Health Services Research 3/2013

01.05.2013 | Original Article

Challenges to Quality Assurance and Improvement Efforts in Behavioral Health Organizations: A Qualitative Assessment

verfasst von: Luis E. Zayas, J. Curtis McMillen, Madeline Y. Lee, Samantha J. Books

Erschienen in: Administration and Policy in Mental Health and Mental Health Services Research | Ausgabe 3/2013

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Abstract

Behavioral health organizations have been increasingly required to implement plans to monitor and improve service quality. This qualitative study explores challenges that quality assurance and improvement (QA/I) personnel experience in performing their job in those practice settings. Sixteen QA/I personnel from different agencies in St. Louis, Missouri, U.S.A., were interviewed face-to-face using a semi-structured instrument to capture challenges and a questionnaire to capture participant and agency characteristics. Data analysis followed a grounded theory approach. Challenges involved agency resources, agency buy-in, personnel training, competing demands, shifting standards, authority, and research capacity. Further research is needed to assess these challenges given expected outcomes.
Literatur
Zurück zum Zitat Alexander, J. A., Weiner, B. J., Shortell, S. M., & Baker, L. C. (2007). Does quality improvement implementation affect hospital quality of care? Hospital Topics, 85(2), 3–12.PubMedCrossRef Alexander, J. A., Weiner, B. J., Shortell, S. M., & Baker, L. C. (2007). Does quality improvement implementation affect hospital quality of care? Hospital Topics, 85(2), 3–12.PubMedCrossRef
Zurück zum Zitat Berwick, D. M. (1989). Continuous improvement as an ideal in health care. New England Journal of Medicine, 320(1), 53–56.PubMedCrossRef Berwick, D. M. (1989). Continuous improvement as an ideal in health care. New England Journal of Medicine, 320(1), 53–56.PubMedCrossRef
Zurück zum Zitat Crosby, P. B. (1979). Quality is free: The art of making quality certain. New York: McGraw-Hill. Crosby, P. B. (1979). Quality is free: The art of making quality certain. New York: McGraw-Hill.
Zurück zum Zitat Deming, W. E. (1986). Out of the crisis. Cambridge, MA: MIT Center for Advanced Engineering. Deming, W. E. (1986). Out of the crisis. Cambridge, MA: MIT Center for Advanced Engineering.
Zurück zum Zitat Donabedian, A. (2003). An introduction to quality assurance in health care. Oxford: Oxford University Press. Donabedian, A. (2003). An introduction to quality assurance in health care. Oxford: Oxford University Press.
Zurück zum Zitat Goonan, K. J., & Jordan, H. S. (1992). Is QA antiquated, or was it at the right place at the wrong time? Quality Review Bulletin, 18, 372–379.PubMed Goonan, K. J., & Jordan, H. S. (1992). Is QA antiquated, or was it at the right place at the wrong time? Quality Review Bulletin, 18, 372–379.PubMed
Zurück zum Zitat Harry, M. J. (1988). The nature of six sigma quality. Schaumburg, IL: Motorola University Press. Harry, M. J. (1988). The nature of six sigma quality. Schaumburg, IL: Motorola University Press.
Zurück zum Zitat Hermann, R. C. (2005). Improving mental health care: A guide to measurement based quality improvement. Arlington, VA: American Psychiatric Association Publishing. Hermann, R. C. (2005). Improving mental health care: A guide to measurement based quality improvement. Arlington, VA: American Psychiatric Association Publishing.
Zurück zum Zitat Hruschka, D. J., Schwartz, D., St. John, D. P., Picone-Decaro, E., Jenkins, R. A., & Carey, J. W. (2004). Reliability in coding open-ended data: Lessons learned from HIV behavioral research. Field Methods, 16(3), 307–331.CrossRef Hruschka, D. J., Schwartz, D., St. John, D. P., Picone-Decaro, E., Jenkins, R. A., & Carey, J. W. (2004). Reliability in coding open-ended data: Lessons learned from HIV behavioral research. Field Methods, 16(3), 307–331.CrossRef
Zurück zum Zitat Juran, J. M. (1992). Juran on quality by design: The new steps for planning quality into goods and services. New York, NY: The Free Press. Juran, J. M. (1992). Juran on quality by design: The new steps for planning quality into goods and services. New York, NY: The Free Press.
Zurück zum Zitat Kojania, K. G., & Grimshaw, J. M. (2005). Evidence-based quality improvement: The state of the science. Health Affairs, 24, 138–150.CrossRef Kojania, K. G., & Grimshaw, J. M. (2005). Evidence-based quality improvement: The state of the science. Health Affairs, 24, 138–150.CrossRef
Zurück zum Zitat Kuzel, A. J. (1999). Sampling in qualitative research. In B. F. Crabtree & W. L. Miller (Eds.), Doing qualitative research (pp. 33–45). Thousand Oaks, CA: Sage Publications, Inc. Kuzel, A. J. (1999). Sampling in qualitative research. In B. F. Crabtree & W. L. Miller (Eds.), Doing qualitative research (pp. 33–45). Thousand Oaks, CA: Sage Publications, Inc.
Zurück zum Zitat Kuzel, A., & Like, R. C. (1991). Standards of trustworthiness for qualitative studies in primary care. In: P. G. Norton (Ed.), Primary care research: Traditional and innovative approaches (pp. 138–158). Newbury Park, CA: Sage Publications. Kuzel, A., & Like, R. C. (1991). Standards of trustworthiness for qualitative studies in primary care. In: P. G. Norton (Ed.), Primary care research: Traditional and innovative approaches (pp. 138–158). Newbury Park, CA: Sage Publications.
Zurück zum Zitat Lee, M. Y., McMillen, J. C., Zayas, L. E., & Books, S. J. (2011). The quality assurance and improvement workforce in social services: An exploratory examination. Administration in Social Work, 35(3), 243–257.CrossRef Lee, M. Y., McMillen, J. C., Zayas, L. E., & Books, S. J. (2011). The quality assurance and improvement workforce in social services: An exploratory examination. Administration in Social Work, 35(3), 243–257.CrossRef
Zurück zum Zitat McMillen, J. C., Proctor, E. K., Megivern, D., Striley, C., Cabassa, L., Munson, M., et al. (2005). Quality of care in the social services: Research agenda and methods. Social Work Research, 29, 181–191.CrossRef McMillen, J. C., Proctor, E. K., Megivern, D., Striley, C., Cabassa, L., Munson, M., et al. (2005). Quality of care in the social services: Research agenda and methods. Social Work Research, 29, 181–191.CrossRef
Zurück zum Zitat McMillen, J. C., Zayas, L. E., Books, S. J., & Lee, M. Y. (2008). Quality assurance and improvement practice in mental health agencies: Roles, activities, targets and contributions. Administration and Policy in Mental Health and Mental Health Services Research, 35, 458–467.PubMedCrossRef McMillen, J. C., Zayas, L. E., Books, S. J., & Lee, M. Y. (2008). Quality assurance and improvement practice in mental health agencies: Roles, activities, targets and contributions. Administration and Policy in Mental Health and Mental Health Services Research, 35, 458–467.PubMedCrossRef
Zurück zum Zitat Miller, W. L., & Crabtree, B. F. (1999). Depth interviewing. In B. F. Crabtree & L. W. Miller (Eds.), Doing qualitative research (pp. 89–107). Thousand Oaks, CA: Sage Publications, Inc. Miller, W. L., & Crabtree, B. F. (1999). Depth interviewing. In B. F. Crabtree & L. W. Miller (Eds.), Doing qualitative research (pp. 89–107). Thousand Oaks, CA: Sage Publications, Inc.
Zurück zum Zitat Office of Manned Space Flight. (1966). Apollo reliability and quality assurance program. Washington, DC: NASA. Office of Manned Space Flight. (1966). Apollo reliability and quality assurance program. Washington, DC: NASA.
Zurück zum Zitat Palmer, R. H. (1991). Considerations in defining quality of health care. In: R. H. Palmer, A. Donabedian, & G. Povar (Eds.), Striving for quality in health care: An inquiry into policy and practice (pp. 3–58). Ann Arbor, MI: Health Administration Press. Palmer, R. H. (1991). Considerations in defining quality of health care. In: R. H. Palmer, A. Donabedian, & G. Povar (Eds.), Striving for quality in health care: An inquiry into policy and practice (pp. 3–58). Ann Arbor, MI: Health Administration Press.
Zurück zum Zitat Pande, P. S., Neuman, R. P., & Cavanagh, R. R. (2000). The six sigma way: How GE, Motorola, and other top companies are honing their performance. New York: McGraw-Hill. Pande, P. S., Neuman, R. P., & Cavanagh, R. R. (2000). The six sigma way: How GE, Motorola, and other top companies are honing their performance. New York: McGraw-Hill.
Zurück zum Zitat Parker, L. E., de Pillis, E., Altschuler, A., Rubenstein, L. V., & Meredith, L. S. (2007). Balancing participation and expertise: A comparison of locally and centrally managed health care quality improvement within primary care practices. Qualitative Health Research, 17(9), 1268–1279.PubMedCrossRef Parker, L. E., de Pillis, E., Altschuler, A., Rubenstein, L. V., & Meredith, L. S. (2007). Balancing participation and expertise: A comparison of locally and centrally managed health care quality improvement within primary care practices. Qualitative Health Research, 17(9), 1268–1279.PubMedCrossRef
Zurück zum Zitat Qualitative Solutions and Research [QSR]. (2006). NVivo (release 7.0), Qualitative data management software. Melbourne, Australia: QSR International. Qualitative Solutions and Research [QSR]. (2006). NVivo (release 7.0), Qualitative data management software. Melbourne, Australia: QSR International.
Zurück zum Zitat Roberts, J. S., Coale, J. G., & Redman, R. R. (1987). A history of the joint commission on accreditation of hospitals. JAMA, 288, 936–940.CrossRef Roberts, J. S., Coale, J. G., & Redman, R. R. (1987). A history of the joint commission on accreditation of hospitals. JAMA, 288, 936–940.CrossRef
Zurück zum Zitat Sederer, L. I., & Dickey, B. (1996). Outcomes assessment in clinical practice. Baltimore, MD: Williams & Wilkins. Sederer, L. I., & Dickey, B. (1996). Outcomes assessment in clinical practice. Baltimore, MD: Williams & Wilkins.
Zurück zum Zitat Sederer, L. I., & St Clair, L. (1990). Quality assurance and managed mental health care. Psychiatric Clinics of North America, 13, 89–97.PubMed Sederer, L. I., & St Clair, L. (1990). Quality assurance and managed mental health care. Psychiatric Clinics of North America, 13, 89–97.PubMed
Zurück zum Zitat Shortell, S. M., Bennett, C. L., & Byck, G. R. (1998). Assessing the impact of continuous quality improvement on clinical practice: What it will take to accelerate progress. Milbank Quarterly, 76(4), 593–624.PubMedCrossRef Shortell, S. M., Bennett, C. L., & Byck, G. R. (1998). Assessing the impact of continuous quality improvement on clinical practice: What it will take to accelerate progress. Milbank Quarterly, 76(4), 593–624.PubMedCrossRef
Zurück zum Zitat Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedure and techniques. Newbury Park, CA: Sage Publications. Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedure and techniques. Newbury Park, CA: Sage Publications.
Zurück zum Zitat Thomas, C. M. (1965). Quality assurance of remotely maintained equipment in a nuclear fuels reprocessing plant. No publisher listed. Thomas, C. M. (1965). Quality assurance of remotely maintained equipment in a nuclear fuels reprocessing plant. No publisher listed.
Zurück zum Zitat Walton, M. (1990). Deming management at work. New York: Plenum. Walton, M. (1990). Deming management at work. New York: Plenum.
Zurück zum Zitat Wang, M. C., Hyun, J. K., Harrison, M. I., Shortell, S., & Fraser, I. (2000). Redesigning health systems for quality: Lessons from emerging practices. Journal on Quality and Patient Safety, 32, 599–611. Wang, M. C., Hyun, J. K., Harrison, M. I., Shortell, S., & Fraser, I. (2000). Redesigning health systems for quality: Lessons from emerging practices. Journal on Quality and Patient Safety, 32, 599–611.
Zurück zum Zitat Zirps, F., & Cassafer, D. J. (1996). Quality improvement in the agency: What does it take? In P. Pecora, W. R. Seelig, F. Zirps, S. M. Davis (Eds.), Quality improvement and evaluation in child and family services: Managing into the next century (pp. 145–174). Washington, DC: Child Welfare League of America. Zirps, F., & Cassafer, D. J. (1996). Quality improvement in the agency: What does it take? In P. Pecora, W. R. Seelig, F. Zirps, S. M. Davis (Eds.), Quality improvement and evaluation in child and family services: Managing into the next century (pp. 145–174). Washington, DC: Child Welfare League of America.
Metadaten
Titel
Challenges to Quality Assurance and Improvement Efforts in Behavioral Health Organizations: A Qualitative Assessment
verfasst von
Luis E. Zayas
J. Curtis McMillen
Madeline Y. Lee
Samantha J. Books
Publikationsdatum
01.05.2013
Verlag
Springer US
Erschienen in
Administration and Policy in Mental Health and Mental Health Services Research / Ausgabe 3/2013
Print ISSN: 0894-587X
Elektronische ISSN: 1573-3289
DOI
https://doi.org/10.1007/s10488-011-0393-5

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