The development of a consensus definition for healthcare improvement science (HIS) in seven European countries: A consensus methods approach
, , y | 26 feb 2017
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Article Category: Original scientific article
Publicado en línea: 26 feb 2017
Páginas: 82 - 90
Recibido: 28 feb 2016
Aceptado: 29 ago 2016
DOI: https://doi.org/10.1515/sjph-2017-0011
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© National Institute of Public Health, Slovenia
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Participants’ fields of work in the Delphi study.
| Education, research | Management | Clinical practice | Public policy | Patient organisations | |
|---|---|---|---|---|---|
| 1st iteration (n=87) | 37% (32) | 29% (25) | 23% (20) | 7% (6) | 4% (4) |
| 2nd iteration (n=66) | 27% (18) | 39% (26) | 23% (15) | 5% (3) | 6% (4) |
Respondents’ involvement in HIS and differences between countries.
| Groups of respondents | 1stDelphi iteration | 2stDelphi iteration | ||
|---|---|---|---|---|
| Yes f (%) | X2 (p) | Yes f (%) | X2 (p) | |
| 21 (28.0) | 30 (45.5) | 21.181 (0.002) | ||
| 44 (62.9) | 31 (47.0) | 11.172 (0.083) | ||
| 32 (48.5) | 24 (26.7) | 2.614 (0.856) | 15.048 (0.020) | |
Results of countries look for the level of agreement with the definition as a whole and with its separate parts (a – f) in the 2nd Delphi iteration.
| N | M (SD) | England | Italy | Poland | Romania | Slovenia | Spain | Scotland | Chi-Square (p) | |
|---|---|---|---|---|---|---|---|---|---|---|
| Whole definition | 64 | 4.30 | 4.20 | 4.33 | 4.33 | 4.56 | 4.71 | 4.47 | 3.50 | 5.613 |
| 0.61 | (0.45) | (0.50) | (0.50) | (0.53) | (0.49) | (0.52) | (0.53) | (< 0.001) | ||
| Part a | 65 | 4.29 | 4.40 | 4.20 | 4.67 | 4.56 | 4.57 | 4.20 | 3.70 | 1.456 |
| 0.86 | (0.55) | (1.23) | (0.50) | (0.53) | (0.54) | (0.86) | (1.06) | (0.210) | ||
| Part b | 65 | 4.40 | 4.20 | 4.30 | 4.56 | 4.50 | 4.86 | 4.40 | 4.09 | 0.676 |
| 0.86 | (0.84) | (0.48) | (1.01) | (0.76) | (0.38) | (1.06) | (1.04) | (0.669) | ||
| Part c | 66 | 4.33 | 3.60 | 4.10 | 4.67 | 4.44 | 4.86 | 4.40 | 4.09 | 1.923 |
| 0.81 | (0.89) | (0.88) | (0.50) | (0.53) | (0.38) | (0.91) | (0.94) | (0.092) | ||
| Part d | 66 | 4.14 | 3.20 | 4.20 | 4.22 | 4.56 | 4.57 | 4.47 | 3.36 | 3.473 |
| 0.96 | (0.84) | (0.63) | (0.83) | (0.53) | (0.54) | (0.74) | (1.43) | (0.005) | ||
| Part e | 66 | 4.26 | 4.20 | 4.30 | 4.11 | 4.44 | 4.71 | 4.53 | 3.55 | 2.389 |
| 0.83 | (0.45) | (0.48) | (0.93) | (0.53) | (0.76) | (0.52) | (1.29) | (0.039) | ||
| Part f | 66 | 4.24 | 4.20 | 4.20 | 4.33 | 4.44 | 4.86 | 4.40 | 3.45 | 3.648 |
| 0.77 | (0.45) | (0.42) | (0.50) | (0.73) | (0.38) | (0.83) | (0.93) | (0.004) |
Results for the level of agreement with the definition as a whole and with its separate parts (a - f), and differences between countries in the 2nd Delphi iteration (N= 66).
| M (SD) | Chi-Square (p) | |
|---|---|---|
| Agreement with the definition as a whole, from the part a to the part f | 4.30(0.61) | 21.227(0.002) |
| Healthcare Improvement Science (HIS) is focused on safety, effectiveness, efficiency, timeliness, equity and continuous patient-centred improvement in healthcare (a). | 4.29(0.86) | 7.727(0.259) |
| HIS depends on valid and reliable knowledge from a wide range of sources, in both the academic sector and service sector in healthcare (b). | 4.40(0.86) | 7.611(0.268) |
| HIS is multidisciplinary in its approach, drawing both on biomedical and on social sciences (c). | 4.33(0.81) | 11.468(0.075) |
| Different factors, such as methodological frameworks for improvement, knowledge of healthcare professionals, patient involvement and innovation, support organizational culture, are factors that interplay with the approach (d). | 4.14(0.96) | 14.904(0.021) |
| HIS is thus an umbrella term for any action (practice, education, science and policy) that can lead to improved healthcare outcomes for people, better health system performance and also healthier communities (e). | 4.26(0.83) | 11.226(0.082) |
| HIS also demands flexibility and responsibility in understanding, in theories of knowledge, and in the use of research evidence in health care improvement strategy (f). | 4.24(0.77) | 16.761(0.010) |
Results for the level of agreement with the definition as a whole and with its separate parts (a - e), and differences between countries in the 1st Delphi iteration (n=87).
| M (SD) | Chi-Square (p) | |
|---|---|---|
| Agreement with the definition as a whole, from the part a to the part e. | 3.93(0.861) | 21.533(<0.001) |
| Healthcare Improvement Science (HIS) is the framework for achieving efficiency, efficacy and quality in health and social care (a). | 3.85(1.070) | 30.278(<0.001) |
| HIS depends on knowledge from a wide range of sources, not just research (b). | 4.15(0.958) | 7.921(0.244) |
| HIS is a link (connection) between numerous variables in clinical work and management/leadership work, such as: multi-disciplinary approach, patient involvement, patient safety, total quality management, change management, personal involvement of healthcare/social workers, personal development and responsibility, team work/group work, connections between practice-theory-problems-research, etc. (c). | 4.15(0.907) | 27.436(<0.001) |
| HIS is thus an umbrella term for all actions (practice, education, science and policy) that can lead to better health treatment outcomes (health), better system performance (care), better professional development (learning) and healthier communities (d). | 4.01(1.101) | 14.017(0.029) |
| HIS also demands flexibility and responsibility in our understanding, in our theories of knowledge, and in our use of research evidence in health care improvement strategy (e). | 4.26(0.767) | 7.319(0.292) |