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Biomedical subjects

E Scrivens

Publications and source records attributed to E Scrivens.

At least 19 recordsLinked to original sources
PubMed1998

Widening the scope of accreditation--issues and challenges in community and primary care.

Accreditation systems first developed to improve the quality of hospital care. As health care systems move towards a greater emphasis on primary and home care, accreditation systems are developing to address quality in this more diverse sector. This is more problematic, since there is little agreement about the precise functions to be undertaken in non-hospital care and there is no uniform organizational structure. This paper addresses the issues raised in developing quality in these very different organizations and examines the progress being made.

Accreditation↗
PubMed1997

Primary care. Defining role.

There is no nationally agreed definition of nurse practitioners or of the training required. The extent of the need for nurses to take on doctors' work needs to be established. A clear training framework is required.

Health Care Surveys↗
PubMed1997

Putting continuous quality improvement into accreditation: improving approaches to quality assessment.

The accreditation systems of the United States, Canada, and Australia have been restructured to reflect the adoption by health services of the industrial model of continuous quality improvement. The industrial model of quality makes assumptions about management structures and the relation of process to outcome which are not readily transferable to the assessment of quality in health care. The accreditation systems have therefore had to adapt the principles of continuous quality improvement to reflect the complex nature of health service organisations and the often untested assumptions about the relation between process and outcome.

Accreditation↗
PubMed1995

Recent developments in accreditation.

Within the past five years, accreditation has been adopted in a number of countries. Accreditation, originally perceived as a vehicle to enable organisational development, is found to be increasingly of interest to wider publics including governments in regulating and promoting quality. The newer systems are based upon the experience of the mature accreditation systems of the Joint Commission in the USA, the Canadian Council on Health Facilities Accreditation and the Australian Council on Health Care Standards. The mature accreditation systems have demonstrated their responsiveness to the changing needs of the health care systems in which they operate. In the past decade, these accreditation systems have responded to the decline in the role of the hospital in health care delivery; the demands of governments and the public for greater information about quality of health care. They have also responded to pressure for greater knowledge of clinical effectiveness by introducing indicators of clinical performance and are looking to outcome measures.

Accreditation↗
PubMed1993

The bottom line.

Explore the source record for details and available documents.

Accreditation↗
PubMed1985

Measuring the impact of health interventions: a review of available instruments.

Interest in the measurement of the impact of health services has been increasing for three main reasons. Policy makers and service providers wish to be reassured that they are: (i) benefitting the public for whom the service is provided; (ii) in times of economic recession and limited resources, achieving the 'best value for money'; and (iii) given the need to make economies in health expenditures, maintaining standards of the health care. Recent developments in information for the evaluation of health services have tended to emphasis the control and monitoring of expenditure in preference to the control and monitoring of quality. There is concern that this might lead to adverse consequences for patients and for the health service as a whole in that the quality of services provided might deteriorate. Health interventions are considered to be successful if they result in a beneficial change in the health of the population for whom they are provided. If the health of the population is not improved, or maintained, questions are raised about either the appropriateness of the intervention in relation to health policies which have been selected, or about the quality of the care which has been provided. Because of this, it is necessary to monitor both the outcome of a heath intervention in terms of the change in the level of health of the population, and also to measure the quality and the effectiveness of the care provided. Health services research has, over the years, developed a number of different types of measures which can be applied to health services and has suggested a number of applications for such measures in terms of the impact on the health of patients and the general population and the quality and effectiveness of health services. The first section of this paper reviews a selection of measures for both health and the effects of health interventions and discusses their applicability as management tools. The use to which such measures are put obviously depends upon the type of decisions which they are to inform, which in turn are dependent upon the organisational level at which the decision is to be made, and the policy objectives of the service to which they relate. The second part of the paper discusses factors which must be taken into account when choosing measures to monitor the impact of the health services. In examining the suitability of a management tool, a measure must be proven to provide information which is universally acceptable and which conforms to a number of scientific standards.(ABSTRACT TRUNCATED AT 400 WORDS)

England↗
PubMed1983

Warning lights?

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Efficiency↗
PubMed1983

Disability and patient satisfaction with medical care.

The effect of patients' health status on their satisfaction with medical care should be well understood before individual providers of care are evaluated using patient satisfaction as a criterion. This paper examines how disability is associated with patients' dissatisfaction with medical care services provided by doctors in primary care. Measures of patient satisfaction developed by Roghmann and his colleagues using multidimensional scaling (MDS) were included in a survey of 1,245 respondents living in the London Borough of Lambeth. The measures included attitudes toward the medical profession (general satisfaction) and satisfaction with patients' own provider or regular source of care (specific satisfaction). Disability was assessed using a British version of the Sickness Impact Profile. Consistent with findings from other studies, the majority of respondents expressed satisfaction with most aspects of care, except for doctor availability in an emergency, preventive teaching, and aspects of communication. Replication of the MDS analysis on this study population yielded an overall measure of general satisfaction, and three submeasures of specific satisfaction labelled access, quality, and recent experience. These dimensions also emerged from a content analysis of responses to an open-ended question. Respondents with a higher level of disability were more likely to be dissatisfied with all three aspects of specific satisfaction. Other social and medical factors, such as sex, social class, medical conditions, self-rating of health, social support, and adverse life events, were significantly related to one or more measures of specific satisfaction. Because disability can influence satisfaction with medical care received from specific doctors or practice settings, attempts to use satisfaction measures for evaluating specific services or providers should distinguish between patient groups with different physical and psychosocial disabilities. Multidimensional satisfaction measures with both positively and negatively worded items anchored to recent and specific consultations would prove more reliable, valid, and useful in future studies.

Adolescent↗
PubMed1980

Patients First: in the light of the last six years.

Patients First has proposed a reduction in the number of health service administration tiers. Ellie Scrivens, lecturer in social administration and health services research in the department of community medicine at St Thomas's Hospital Medical School, welcomes this but feels there are contradictions and omissions to be rectified before reorganisation begins.

Community Participation↗