This study examines the level of quality initiatives commitment among public hospital managers and its determinants in view of limited study :0 date and a decline in self-initiated quality initiatives activities in Sarawak, Malaysia. This is a cross-sectional study with universal sampling method conducted in all the Z1 public iwspimls in Sarawak. The study population were the senior, middle and lower level managers. The research wal was self-administered structured questionnaire. A total of 382 managers responded, corresponding ta a response irate of 8 7. 2%. As a complement, four focus group discussions were conducted, consisting 31 participants. It was found that the level of quality initiatives commitment 0f managers was generally high (mecm= 4.23, SD=O.45). The regression analysis indicated that empowerment, communication and procedural justice (promotion) accounted for 38.9%, 346% and 1.2% respectively of the variation in commitment level. Dissatisfaction with resources, top management commitment and peer influence are among others being identified by participants of focus groups as important determinants of quality initiatives commitment. It is strongly recommended that there should be greater empowerment of hospital managers, more structured and effective communication, greater transparency in procedure for promotion and commitment of resources to quality efforts.
Clinical pathways have been implemented in many healthcare systems with mix results in improving the quality of care and controlling the cost. CP is a methodology used for mutual decision making and organization of care for a well-defined group of patients within a well-defined period. In developing the CPs for a medical centre, several meetings had been carried out involving expert teams which consist of physicians, nurses, pharmacists and physiotherapists. The steps used to develop the pathway were divided into 5 phases. Phase 1: the introduction and team development, Phase II: determining the cases and information gathering, Phase III: establishing the draft of CP, Phase IV: is implementing and monitoring the effectiveness of CP while Phase V: evaluating, improving and redesigning of the CP. Four CPs had been developed: Total Knee Replacement (TKR), ST Elevation Myocardial Infarction (AMI), Chronic Obstructive Airways Diseases (COAD) and elective Lower Segment Caesarean Section (LSCS). The implementation of these CPs had supported the evidence-based medicine, improved the multidisciplinary communication, teamwork and care planning. However, the rotation of posts had resulted in lack of document ownership, lack of direction and guidance from senior clinical staff, and problem of providing CPs prior to admission. The development and implementation of CPs in the medical centre improved the intra and inter departmental communication, improved patient outcomes, promote patient safety and increased patient satisfaction. However, accountability and understanding of the CPs must be given more attention.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)