The commitment and evaluation of the quality management plan by professionals from accredited stem cell transplant centers in Spain

Abstract

The implementation of a quality management plan (QMP) is important in health-care systems. In a complex process such as SCT, which involves significant morbidity and mortality, any action that may contribute to improvement in the management and the results is advisable. In this sense, it has been demonstrated that the implementation of the Joint Accreditation Committee ISCT– EBMT (JACIE) standards has resulted in the improvement of SCT outcomes. The commitment of all the members of the SCT teams to the QMP is essential for its implementation and subsequent maintenance. Consolidation of a QMP should generate significant changes in the mentality and attitudes of the professionals; for example, holding more frequent team meetings and logging in incidents, nonconformities and errors are relevant to improving the quality of SCT. Greater collaboration among professionals of the SCT program and more fluid communication among the different teams involved allow continuous improvement in work dynamics. On the other hand, audits for evaluation of the satisfaction of professionals involved in SCT may be a good tool to evaluate their commitment and satisfaction with the QMP. Nine Spanish JACIE-accredited centers were contacted to evaluate the satisfaction of the SCT program members with the QMP. An anonymous questionnaire that included 17 items was distributed among staff members (healthand non-health-care providers) of the SCT teams. This survey included a descriptive section (workplace, age, gender, professional category), followed by a second part with 14 items assessing the QMP on a scale of 0–3 (0 = not, 1 = little, 2 = fairly, 3 = very) and the third section assessed the professionals’ involvement in the creation and review of quality documentation and in the reporting of errors and/or nonconformities. The hours dedicated to the QMP and the awareness of the team members related to the JACIE accreditation status in their centers were also evaluated. The answers were divided into two groups (Table 1): negative evaluation of the QMP included the answers ‘not’ and ‘little’, whereas positive assessment involved answers including the words ‘fairly’ and ‘very’. To evaluate the degree of involvement in the QMP in the previous 12 months, the number of quality reports/ nonconformities created and/or reported as well as participation in the development/review of documentation was determined. The demographic characteristics were described as median and range for quantitative variables and frequency and percentage for categorical variables. The univariate association between the answers and the study groups was analyzed using the chi-square and Fisher's exact tests when appropriate. Differences were considered significant with Po0.05. All statistical tests were performed using the SPSS statistical software (SPSS version 15.0, Chicago, IL, USA). Two hundred and eighteen surveys were obtained from nine Spanish JACIE-accredited centers, 77 (35%) being returned by hematology physicians (HP), 106 (49%) by nurse graduates (NG) and 35 (16%) non-medical staff (NMS). The item considered most positively by all the members of the SCT teams was the incorporation of the QMP in daily work, followed by the improvement achieved in the documentation and records (Table 1). Contrarily, the worst score corresponded to the training in SCT. The perception of improvement, information and training received in the QMP were significantly different among the different professional categories. Professionals also evaluated significant improvements in the amelioration in communication, the detection of errors or deviations, the management and recording of the documentation and finally the definition of the circuit since the implementation of the QMP. The lowest scores corresponded to SCT training by HP, QMP training for NG and communication among professionals by the NMS. The degree of staff involvement in the QMP is presented in Table 2. Involvement in the QMP was less than desired for all staff categories, as almost half of the professionals did not create any documentation or did not report any nonconformity. Only a small proportion of staff members actively participated in the QMP implementation and maintenance. With regard to the weekly hours dedicated to the QMP by the different professionals (Table 2), the NMS group dedicated more hours, followed by the NG and physicians. On comparing the number of hours per week spent in the elaboration or modification of documentation and records for the QMP, three groups were indentified: the first group included professionals with a falsely high perception of their contribution to the QMP (who considered that they had contributed to the QMP, but in fact, had not created any document or reported any deviation of the QMP); the second group, with the highest involvement, included professionals directly involved in the QMP (this group probably included quality coordinators and technicians) mainly constituted by NMS; and the third group with modest involvement in the QMP. There are reports in the literature that assess the degree of staff involvement in health-care-accredited organizations. However, to our knowledge this is the first study to analyze the perception of the professionals that belong to accredited SCT centers about their QMP. The results of this survey positively show that in general all the professionals involved in the SCT program evaluated the QMP as rewarding and were aware of how the program was implemented in their centers. In contrast, the degree of collaboration and involvement in the maintenance of the QMP varied greatly among professionals. One possible reason is that none of the nine departments was exclusively dedicated to SCT, with the professionals being directly involved in the treatment of malignant and nonmalignant hematological diseases. On the other hand, even if it seems logical that the main burden of tasks of quality management should correspond to the professionals specialized in quality, this is not sufficient. Professionals must understand that the management of quality should be transversally shared among all professionals instead of falling mainly on the professionals specialized in quality. The objective of an efficient QMP in SCT should be to obtain the commitment of all professionals involved Bone Marrow Transplantation (2014) 49, 990–992 © 2014 Macmillan Publishers Limited All rights reserved 0268-3369/14

DOI: 10.1038/bmt.2014.85

Cite this paper

@article{Jimnez2014TheCA, title={The commitment and evaluation of the quality management plan by professionals from accredited stem cell transplant centers in Spain}, author={M E Jim{\'e}nez and Christelle Ferr{\'a} and {\'O}scar Garc{\'i}a and Felipe de Arriba and Shinawe Jimenez and Andr{\'e}s Insunza and Marisa Calabuig and Alejandro Mantec{\'o}n and Juan Sanchez and Marta N Torres and Pascual Balsalobre and J Linio and A Rodr{\'i}guez Jim{\'e}nez and Evarist Feliu and J-M Ribera}, journal={Bone Marrow Transplantation}, year={2014}, volume={49}, pages={990-992} }