The Conceptual Underpinnings of Continuous Quality Management - Assignment Example

Critically Discuss the Conceptual Underpinnings of Continuous Quality Management and the Application of this Approach to Healthcare Introduction: The quality management is a concept that intends to establish a system that measures and manages services or processes. In healthcare, the service is patient care, and the purpose of quality management in healthcare, therefore, would be to establish a system that measures and manages patient care in a way that provides the best available care for all the patients. Since the system of quality management is designed to identify gaps in the service and also to follow operating processes and practices that aim to repair these gaps, the quality improvement system must be continuous and ongoing, and it is directed towards identification of opportunities and system problems that demand resolution (Westgard, 2004, pp. 32-57). Therefore, the quality systems in healthcare would ultimately fulfill a societal commitment of the health professions to the public. Although the concept of quality and the necessity of quality improvement concept is extremely pertinent in the healthcare industry, it is well known that much of the body of literature on quality improvement had its genesis in the manufacturing sector. This about past 10 years or so, the benefits of quality improvement have begun to be realized in healthcare, education, and other service industries. The science of quality improvement has evolved primarily from the work of scientists who tried to envisage the systematic approach to doing things in the right manner. There are very many ways of implementing the philosophical underpinning of the principles of quality, but one would know easily that different policies have most of the things in common and they complement each other (White, 2006, pp. 69-92). The basic concepts of quality have emerged from the works of industrial experts such as Phillip B. Crosby, Joseph M. Juran, and W. Edwards Deaming. These business experts have helped the policies of quality control to emerge in industrial management areas since the 1950s (Westgard, 2004, pp. 12-15). Crosby identified the specific approaches to quality assurance and described them in 14 steps, and these demonstrated his beliefs that quality is achieved through compliance with defined specifications of standards. Juran in 1988, proposed three approaches to quality. These are quality planning, quality control, and quality improvement. Quality planning refers to determining who the clients are, assessment of the clients needs, and services that addresses the needs and developing processes to address the needs. Quality control focuses on the evaluation of the performance of service in order to assess the difference between actual performance and goal. Quality improvement is a continuous process that establishes an infrastructure that supports this continuous process (James, 2005, p. 1-8). Deaming, on the other hand, emphasized the development of quality and its continual empowerment. Quality of care is a responsibility owed by healthcare professionals to those served. Knowledge of organizational systems, clinical medicine, general management, and statistics are vital to the management of quality. Quality of care measurement and management is are distinct bodies of knowledge which other professionals cannot share, and its has its own theories, concepts, methods, and techniques. By quality, it is meant that it would be subjective and objective, both. If a healthcare professional desires to understand the concept of quality as applicable to healthcare practice, he or she needs to have a thorough knowledge of the healthcare delivery system. In the area of healthcare and its management, quality of care is never achieved single-handedly. Therefore, healthcare quality is not solely the domain of the clinicians; the outcome of healthcare systems has consistently been demonstrated to be the resultant of interrelated systems of processes (Dlugacz and Stier, 2005, pp. 174-181). Quality management is an important management function. Good management theory applies to clinical quality management in the same way the principles of quality management apply to fiscal or industrial management. The process of quality management can be multifarious, and there is nothing absolute in the concept of quality. Thus, quality of care can be continuously improved. For a healthcare organization to survive, a good quality management system is vital (Pickens and Solak, 2005, pp 19-27). Therefore, it is expected that like all other members of healthcare team, the primary purpose of nursing would be to provide quality care to the clients. This would involve a constant endeavour to improve the care that is delivered. Nurses function as clinicians, team members in a multidisciplinary care team, and managers of care. Each role has specific responsibilities for quality performance and requires certain skills to achieve the desired level and standard of performance. The quality nursing care spells out these levels in a different form, but these explicitly benchmarks the requisite standards of practice that conform to quality management. These are maintenance of current knowledge base and competencies, development and possession of interpersonal skills with clients and coworkers, high level of caring and compassion that retains clients, skills of mutual decision making with clients and nurses, and ability to offer customized and individualized treatments. Quality improvement identifies situations when by application of continuous quality intervention approach, the structure and the processes are reexamined, improved, and followed with stringent adherence so the nursing teams can be more productive and functioning at a higher quality level (Gajewski, Hall, and Dunton, 2007, pp. 112-119). Thus, as expected, there would be development of a variety of regulatory and voluntary approaches to quality management. One can easily see that this approach would focus heavily on efficiency, effectiveness, and accountability. If total quality management and quality assurance processes are integrated and adopted as a clinical quality improvement system, this would result in continuous outcome measurement and management, thus needing continuous quality management in any healthcare system dedicated to delivery of quality healthcare to the clients. Translated into clinical terminology, quality measurement systems would in this way evolve into the integrated systems of healthcare that would be able to track and monitor the processes and outcomes of care across settings and providers (Mills and Walters, 2006, pp 20-25). The concept of quality management in healthcare is now evolving around total quality management and continuous quality improvement. Continuous quality improvement is not another model of quality assurance activity, it can be regarded as a management approach that supports and enhances the efforts of quality that focuses on improvement of care and service to the clients. When improvement over the existing level of care is in question, this invariably necessitates examination of the care processes and standards of service. It is clear from this discussion that quality assurance activities of monitoring and assessment enable identification and resolution of the problems associated with delivery of quality care. Continuous quality improvement, however, goes beyond the problem-oriented approach. The information that is gleaned from monitoring and assessment is used to continuously improve the process so that the defect is eliminated, and this can be applied in activities even when there is no problem. Therefore, continuous quality improvement is a proactive approach to quality healthcare (Greenslade and Jimmieson, 2007, pp. 602-611). How this can be implemented in the real case scenario? For such a concept of continuous improvement to succeed, quality must be a priority at all levels across the organization. Staff must be encouraged to improve care. There must be multidisciplinary and interdisciplinary review of systems and service that would inspire efforts to be generated focusing on improvement of systems and processes. Nursing is committed to professional excellence in providing the best possible care to the clients. The nurse as a quality manager, therefore, is responsible for continuously evaluating the quality and appropriateness of that care. Designing an extrinsic and systemic approach to monitor and improve care is easy, but implementing this changed approach is difficult. However, the impetus for this change has generated from legislation and government policy initiatives, economic consequences of substandard care and other factors, and from the nursing profession itself (Ronsten, Andersson, and Gustafsson, 2005, p. 312-321). The National Health Services (NHS) and Community Care Act of 1990, has a great role to play in formulation of this quality management system incorporated in the healthcare delivery systems. In this act, the managerial hierarchy of NHS has been divided into organizations responsible for purchasing healthcare on behalf of their local population, such as District Health Authorities, Family Health Services Authorities, and GP Fundholders, and organizations responsible for providing healthcare, such as, NHS Trusts and General Practices. Each year, the consumers and providers seek to agree contracts that categorically specify the activity levels, financial supports, and the quality of deliverable services. Clearly, the funding has been linked with quality and seeks to demand quality services against the cost. As a result of the consumer movements of 1970s and 1980s, the Patients’ Charter of NHS service users has publicized 10 key rights for all users and has specified nine standards of services that the NHS aims to provide to its consumers. This is a reflection of the fact that the clients are equally parts of the systems involved in healthcare, and they have reasonable rights to question the quality of the services offered in the community and in the hospital. The third extrinsic factor in the upsurge of quality improvement policies is The Health of the Nation white paper published by the British Government in 1992. This identifies five target areas of healthcare intervention to promote health and to reduce illness. These areas are coronary heart disease and strokes, cancers, mental illness, AIDS/HIV and sexual health, and accidents. NHS consumers are reviewing the public health policy in the light of these targets set by the Government and are consistently implementing introduction of quality links to the funding. The Chief Nursing Officer at the Department of Health has emphasized the key roles that the nurses must play in achievement of The Health of the Nation targets (Stanley, 2006, p 20-39). Nurses are central to the physical, psychological, social, emotional, and spiritual, or in other words holistic care received by the patients and clients in the NHS. This concept equally applies to the care received in the independent practice sector. The main theme related to nursing in such care processes is that nurses are crucial in ensuring quality care and providing services that match standards of quality norms to the clients. Nurses are, therefore, responsible for delivering evidence-based care that contributes to achievement of such standards. Not only the professional code of conduct, but also the UK Government initiatives in improving NHS have been accomplishment of high quality care and care outcomes for the patients. This is termed as clinical effectiveness or clinical governance of late. DOH defines this concept as the extent to which specific clinical interventions would maintain and improve health and secure the greatest possible health gain for the available resources. A publication from DOH in 1998 states that quality is an important parameter, and high-quality care is considered to be a right for every patient in the NHS (DOH, 1998) (Nicol, 2003, p 16-35). To ensure quality in practice nursing, clinical governance has been deployed. Clinical governance is a system through which goals for quality health care and treatments are set, monitored, and delivered. This incorporates a process whereby certain individuals are held responsible for any shortcomings in achievement of standards of care. This is a clear indication and expectation of legal responsibility in relation to quality failures of the chief executive of the NHS, and this may transcend to all staff employed in the NHS (Attree, 2005, p. 387-396). To be able to employ clinical governance, NHS organizations and the staff need to monitor and improve quality in a number of ways. These include clear lines of responsibility and accountability for the overall quality of clinical care, a comprehensive programme of continuous quality improvement activities, clear policies aimed at managing risks, and procedures for all professional groups to identify and remedy poor performance. These provide a distinct indication that this system incorporates processes of quality improvement (Bishop, 2008, p. 3-5). Nurses are familiar with many processes associated with their functions that are part of the process of clinical governance. These are actually all quality improvement and monitoring measures, and these include dealing with and managing poor performance, risk management, clinical supervision, good management and leadership skills, reflective practice, and clinical audit. The other quality improvement policies that can be identified as parts of clinical governance are utilizing research findings in practice, professional development programmes for nurses, measuring performance against standards, and dealing with and learning from complaints by patients. One of the new requirements in the NHS is a quality manager who would be held responsible for all quality issues in care delivery. To ensure quality care and to ensure that changes are being incorporated in the system as an endeavour to implement findings from quality issues in practice, it is necessary that standard-setting and system-monitoring happens by NHS trusts at the local levels, and NICE and CHI perform these functions continuously (Braine, 2006, p. 56-65). Efficiency is defined as performance in such a way that money and resources are not wasted. This would result in gain of maximum benefit out of minimum effort. This can be termed as efficiency. There is a close relationship between quality and cost. At the level of service provisions, this has raised the concept that all parts of the health services demonstrate annual efficiency savings. Health care without quality may mean a high cost/low benefit care. This signifies poor quality of healthcare, may be in terms of overdiagnosis or overtreatment leading to excessive healthcare expenses even without professional liability or untoward consequences (Hurst, 2008, p. 370-381). Mortality and morbidity have been well known indicators of quality of healthcare. Poor quality in the form of misdiagnosis, mistreatment, or inadequate nursing care can increase mortality or morbidity, length of hospital stay due to treatment related complications, loss of income of the clients, thereby increasing the costs of healthcare to the individuals and the state. On the other side of the state of affairs, things are a little different. The basic cost issues related to quality healthcare should be considered in terms of cost implications. Establishing a system that takes care of quality and continuous quality improvement processes and structures needed for quality assurance involves cost. Managerial and clinical staff time also gets consumed in this process. There are also more cost involved in maintaining the whole system that includes quality improvement processes such as regular monitoring, evaluation, and audit. In the long run, this framework would lead to far greater cost savings (Mannion, Small, and Thompson, 2005, p. 377-386). For example, quality service provisions mean less compensation in litigations since less complaints would be there. There would be more patient satisfaction that, in turn, would increase staff satisfaction and morale. Better staff satisfaction and morale would have many cost saving implications such as less sickness, less absenteeism, better staff retention, less expense in staff development and recruitment (Lavin, Meyer, and Ellis, 2007, p. 74-83). The nursing profession has the highest goal of delivery of highest quality healthcare. The United Kingdom Central Council for Nursing, Midwifery, and Health Visiting or UKCC has published a code of conduct. Without going into the details of the code of conduct, it can be surmised that this deals with the scope of practice, standards of records and record keeping, standards for the medication administration, and framework for the exercise of accountability in professional nursing practice (Nicol, 2003, p 22-28). The aims of these codes are nothing but policies for quality management in nursing care. This would also help the nurses understand their specific responsibility and accountability for the delivery of quality nursing care. This means that the code of conduct and associated guidelines and standards identify the elements of nursing care that must be met to ensure quality and also to provide a baseline for measuring quality. Applying these policies, the nursing profession in the UK follows a framework of professional practice together with a structure for monitoring and controlling practice, although the impetus had initiated from legislative and economic pressures for quality management principles to implement quality practice (Russell and Fawcett, 2005, p. 319-326). Quality management in nursing is a set of techniques that assures management, maintenance, and improvement of standards in the efficiency and effectiveness of nursing care. Therefore quality management in nursing practice can be defined as process that controls the nursing processes and evaluates the degree of excellence in care delivery in terms of observable and measurable characteristics of delivered nursing. As mentioned earlier this is a two-toed process where it determines the extent to which the prefixed standards are being fulfilled by a particular nursing programme, and these findings and observations are used to make decisions about changes that are to be continually implemented to improve the quality standards in future practice. Both are mandatory together to ensure an accountable, quality-conscious healthcare nursing. The purpose of the evaluation would always be the same irrespective of the standards that may vary from area to area. In practice, nursing care of each patient would need to be individually planned dependent on care needs decided by a nursing assessment. The care given should be systematically recorded and subsequently reviewed to see how far the quality goals have been achieved (Minkman, Ahaus, and Huijsman, 2007, p. 90-104). A quality management process is implemented in practice by enabling a quality management review in an attempt to continually improve the prevalent quality. A problem-solving model can be of help in the review process. This consists of eight steps that are identification of values or basic philosophy or values, identification of standards and criteria outlined in the clinical practice guidelines, measurement of the degree of attainment of standards and criteria, interpretation of strengths and weaknesses by a SWOT analysis, identification of possible courses of actions, selection of a course of action, action, and review (François et al., 2005, p 234-239). In conclusion, quality management in nursing practice is an important tool to decide, assess, review, and implement the principles of quality control in healthcare delivery. As has been discussed in the essay, the structural framework deployed by the authority in nursing practice is quality conscious. Consciousness about quality in practice is an important element of standards of practice which all the nurses are exposed to by means of their training. Authorities and consumers consistently amend their standards of expectations, and therefore, a review process must be a part of this framework to identify lags or gaps, so the standards and quality can be modified by application of quality principles. Quality actually is a never-ending process that yields outcomes that need to be improved continuously to develop new standards of quality in practice, and nurses are ready to do that to improve their professional practice. References Attree, M., 2005. Nursing agency and governance: registered nurses perceptions. J Nurs Manag; 13(5): 387-96. Bishop, V., 2008. Clinical governance and clinical supervision: protecting standards of care. Journal of Research in Nursing; 13: 3 - 5. Braine, ME., 2006. Clinical governance: applying theory to practice. Nurs Stand; 20(20): 56-65. 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