Addressing quality improvement in community speech-language clinics.

Abstract

Purpose of the study The local health Authorities and in general the administration of Health provision in Malta envisage the importance of the development of adequate mechanisms to monitor and audit services provided (Azzopardi-Muscat, 1999). Being part of the Health Department, the Speech Language Department (SLD) needs to adhere to these policies too. The aim of this research is to study the perceptions about aspects of quality from the customers (patients/carers) point of view, Speech Language Pathologists (SLPs) and Management of the SLD and provide recommendations for the development of quality assurance within the community Speech Language Services. Background Donabedian (1980) explained that in Health Services the interaction of service users and providers highlighted the importance of: Accessibility, Inter-personal interaction, technical management and continuity, these are further divided into structure, process and outcome.

Research Questions The following questions were investigated +:+ What is the current status of performance and how could this, through quality assurance, lead to a more effective and efficient service? +:+ Which are the important standards for Speech and language serVIces in the community to develop quality improvement? Data was collected by diverse qualitative research techniques (by triangulation). Semi-structured interviews were carried out with personnel in administration of the SLD and 16 service users whilst 3 focus groups carried out with 15 SLPs. Analysis The 3 categories of participants defmed quality in various ways, for clients quality meant: professionals provide services and their condition improved. Staff saw quality as having standards which are followed resulting in satisfied clients. Management considered the availability of resources which are used in an efficient and effective way for client satisfaction. Accessibility: Clients consider physical and geographic accessibility and flexibility of appointments important whilst staff and management consider communication and the environment as facilitating accessibility. Conflicting views emerged on initial appointments and opening hours although satisfaction was expressed together with possible unexpressed dissatisfaction due to missed appointments. In technical Management it was indicated that there were insufficient premises with poor environmental conditions in some places. Staff claimed the need for continuous

professional development. Unawareness of the Quality Service Charter by service users was evident, they expressed satisfaction and refrained from placing complaints. For the interpersonal process, Management asked for respect from authorities, staff wanted more manageable caseloads and users requested more involvement. Participants expressed the need for a complaints system and other policies. Continuity was reported to be maintained by a primary service provider system and users recognized service as important and recommendable. Missed appointments were considered by management and staff as a major deterrent to continuity and waste of resources. Conclusions and recommendations Implications for management are that: the QSC needs to be re-evaluated and developed further to satisfy basic requirements. Policies need to be developed to regulate aspects of service deliver and clinical practice. These include policies on admissions and discharge, staff monitoring, and continuous professional development. The setting up of a Structural Changes Steering and Action Committee is recommended to take responsibility of the problems related to structural issues. Setting up of a customer care unit involved in developing and carrying out internal and external customer satisfaction monitoring. MSc. Health Services Management August 2003 Key words: Perceptions of quality Community Speech Language Services Quality improvement/assurance