Quality of Healthcare - Report Example

NAME OF THE UNIVERSITY DЕSIGN АND РRОVISIОN ОF А SЕRVIСЕ QUALITY OF HEALTHCARE Service Quality in Healthcare Industry NAME OF THE STUDENT: ADM. NO: COURSE NAME: COURSE CODE: LECTURER NAME 9/15/2012 DЕSIGN АND РRОVISIОN ОF А SЕRVIСЕ Part 1 1.1. Introduction The increasing expectations in relation to the performance of primary care, and great demands on primary healthcare professionals, is vital in realizing and supporting interventions within primary care backgrounds to increase quality of care and safety coverage (Bailie et al, 2007, p.67). Achieving healthcare improvements call for the collaborative effort among the health professionals to work as a team in their respective positions. It is imperative that standards for common practices promote quality enhancement and identify opportunities to initiate changes that will increase quality and safety for patients. According to Bodenheimer (2002, p.1775), quality improvement activities may encompass changes on daily operations of practice, for example work planning, opening and closing times, improving on customer care services and upgrading systems. Similarly, quality improvement may also entail activities specifically designed to improve clinical care or the health of the entire health practice, for example improving rates of immunisation, improving the care for patients with urinary tract infection or changing the systems utilized in recognizing risk issues for sickness that are mainly common in community healthcare practices. Part 2 2.1. Patients’ satisfaction/ customer’s- systems approach to quality and safety Research advises that unpleasant circumstances relating to medicines are exhibited in primary healthcare, where medication error are widely dominant among health professionals and that a attenuation in prescription errors needs a systems approach such as recall systems. However, there is a presumption for healthcare team to accentuate prescription errors as one of using wrong antibiotics for the organism, as a breach of standards by an individual. Gillies (2003, p.34) asserts that a system approach will help to identify illness contributing factors and management history, and recommends for a best cure against potential harm. This approach takes a complimentary role to competence of a person. In the healthcare systems, risk management entails all levels of an organisation that intend to create and maintain safe systems of care. Majority of systems used by the primary healthcare providers in Australia will vary, but comprise of monitoring and reporting systems, recall systems, practice audit systems and general professional improvement activities. Promoting culture of safety and quality in healthcare surroundings is a key pillar of the guidelines & standards of the Royal College of general practitioners. A patient safety culture recognises the certainty of error and keenly search for the establishment of patient protection. Quality improvement requires a joint effort from health professionals team, who should feel empowered to contribute to quality of care and safety (Bodenheimer et al, 2002, p.1777). The consistent utilisation of risk management systems assists to minimise clinical risk and make sure that practice errors are recognised and processes improved to lessen the chances of repetition. This put emphasis on the role for ongoing vigilance of self and others in regard to competence, performance and upholding the capacity to refer correctly. The developments in general medical practices like discovery of new medicines, use of latest technology and improved facts about efficacy and effectiveness, also imply that the risks to patients change. The figure below shows Patients’ satisfaction/ customer’s- systems approach to quality and safety/; Fig:Customer satisfaction trends and comparisons Source:Bailie, R., Dowden, M., Connors, C., Robinson, G. & Cunningham, J. (2007). Improvingorganisational systems for diabetes care in Australian Indigenous communities. BMC Health Serv Res, Vol.7, p.67. 2.2. Components of service quality in a healthcare The healthcare system in Alberta has utilized the latest technology in provision of medical services, such as E-health. For instance, the province has acquired latest tele-medicine system which prescribes drugs to patient based on the disease symptoms that are listed. This has relieved physicians some of their duties concerning prescription of medicines to patients. The hospitals around Alberta have also embraced computer based recall systems which comprise six basic parts that increases its effectiveness and efficiency. They include accountability and review, recall messages, follow-ups, media, education and set expectations, and SMS. This has made practice provider to be more accountable for this critical activity, and their records which show patients due to be recalled and those yet to pay visits. Recall messages are easily and correctly coded in the system, to show the care for health and general wellbeing of the patients (Bodenheimer et al, 2002, p.1778). For example, reminding patients the benefits of regular dental checkups is more effective than stating “this is a reminder”. 2.3. Recall systems in primary care A strong primary health care system is fundamental in ensuring that individuals and communities easily access health care at their convenient time. Recall refers to a system to make sure patients receive further medical advice on issues of clinical importance. A recall is mostly for abnormal results where it is vital that the patient return for a further diagnosis or observation. The rise in computerisation of Australian primary care for patient and data records has tremendously changed the way in which nurses operate and the way they relate with patients (Epping, 2004, p.299). E-health is perceived to be increasingly important in ensuring recall system efficiencies and improving quality of patient care. The rise in computer use in primary care has been described as responsible for enhancing quality of care and safety because of ease in accessing the largest electronic database of clinical information in the country. The types of recall and reminder systems may include postcards, letters, phone calls, emails, birthday cards, opportunistic screening such as home visits and SMS. 2.3.1. Guidelines for patient recall To promote quality of care and safety in primary care practice, patient recalls are based on four assumptions. First being that only patients who normally attend the care practice should receive recall notices, secondly, recall notification should only for a particular feature of ongoing care and/or particular preventive care. 2.3.2. The Importance of a Recall System for Medical Practices Patient reminder and recall systems in primary care settings are effective in improving quality of care. Medical practices may run into serious risk if patients are not recalled for follow-up need under medical protocols and even lose of revenues. The health professionals can easily develop a recall system by use of their computer system. Recalling patients for follow-up consideration is important, more than just good marketing, thus an imperative aspect of good medical care. In fact, a primary care may be courting for trouble in terms of possible malpractices issue if it does not bring some patients back. For example, assuming that gastroenterologist examined a patient who previously showed possible cancerous polyps. Professional modus operandi requires a doctor to re-examine on a regular basis. If the doctor does not recall such patient and later dies from colon cancer, an effective malpractice attorney will be surprised and inquire whether gastroenterologist had recalled the patient as the code of behavior for medical practitioner calls for. Many primary care practices have a simple recall system, where a receptionist or customer care peruses through the charts of patients listed for recall. But based on their busy schedule, the receptionist may fail to confirm if the listed people were actually recalled and whether they kept their appointments. Such system may collapse in case the receptionist quits such clinic or centre. A practice that uses computer billing system is the logical devise is ascertained to be highly effective for patient recall. The recall time and reason may be coded alongside patient’s fee slip, for instance, “recheck of polyps”. This allows safe keeping of information in the system, for in case patient visit and find the previous physician is absent, the one present will know tell the purpose of visit by referring in the computer. A practice system at Royal College Hospital is programmed to routinely print out recall letters and send SMS with a coded reason of recall. If appropriate the practice should sometimes send recall warnings to people who fail to honour the recall effort. An effective recall system helps in provision of better services by avoiding possible liability that could arise from failure of rechecks and also helps to increase practice income, thus to essential to be ignored. Healthcare research has encompassed latest advent in medical informatics like to send a recall before a follow up is done which is either in form of a phone call or SMS. One is advised to use different words and media at each follow up because of different preference of media by people. For office based patients, emails have been perceived to be appropriate media to use. In case email was used for patient recall, follow up is done by either SMS or phone call. The use of SMS is suitable because of its high success rates and immediate reply or confirmation. This is because people carry phones with themselves. Indeed, the utilization of latest technology such as E-health, tele-medicine and recall system has played a big role in simplifying responsibilities of medical staffs in provision of services thus enhancing quality in services rendered as well as minimizing waiting time for patients to be treated. 2.4. New ways of motivating healthcare staff to enhance quality service delivery Royal College Hospital embraces competitive motivational programs in recognizing the contribution of medical staff in their service delivery. Physicians and other medical staffs are remunerated an attractive package on basis of service availed by provincial management of healthcare. The provision of salary is deliberated on by provincial government and medical representatives at the province level. The provincial medication association is a medical staff grouping that airs grievances of its members and bargains for better terms of employment. To effectively motivate medical staffs, Alberta has embarked on equal distribution of responsibilities to avoid overworking of other practitioners. This seems to be a good intervention, as it relieves some doctors of the duties. Healthcare systems of specialization are introduced in the hospitals where a member of staff will get more involved in the field they can do best. The reimbursement mechanisms in Royal College Hospital are very competitive and it also entails other rewards besides salary for outstanding physicians and surgeons. Most hospitals allot some budget to help their staff advance studies, a move that has boosted the outcome of service delivery because of further trainings and competency among medical staffs. The news ways of motivation of healthcare workers have also be in of great importance in utilization of Medicare scheme funds. Contrary to what was previously evident with poor remunerated workers who used to overestimated service costs and held on patients to overstay in hospitals with an aim of reaping more pay from the systems. Such interventions by healthcare specialists used to pose a misuse of health funds, as a result straining scheme funds and sometimes, could impose extra charge to individual patient. The usage of latest technology in new medical devices has been paramount, as surgeons and physician use a number of latest devises to perform their duties, for example; a) Radiology The latest technology and devices used in imaging purposes for instance the CT scan have eased the work of physicians carrying out X-rays. The uses of MRI machines, still in imaging have made it possible to diagnose unnoticed conditions in human body. Example of the most recent radiology device uses dark-field x-ray images making the imaging much clear. The appropriateness and preciseness of latest x-ray is attributed to tireless efforts of technologists. The scans obtained are much clear and regulate radiation to make them safer for all users. For more safety on children, the scans may use magnetic resonance imaging (MRI). Comparing the latest radiology equipment with the ordinary one; Latest x-rays Traditional x-rays Elements Sophisticated optics Normal optics Image Very clear Blurred Medication Diagnose or spot minute fractures Diagnose normal fractures Result Safe and correct Correct and sometimes termed insecure Source: CUMC. Radiology devices and radioactive materials The latest x-ray devices can spot and make a diagnosis the beginning of osteoporosis, breast cancer and other intricate medication that requires radiology like cancer. b) Computers and software Nearly all devices used in emergency rooms at Royal College Hospital are computerized, with back up to safeguard the data loss. The software used is hi-tech and much effective for doctors. For instance, billing systems and devises for monitoring fundamental signals are networked to keep medical history of patients. Medical software in most hospitals around Australia, Canada and U.S. have played a major role in monitoring and controlling patients, all though regulated by Devices Directive to help in minimizing overdoses that have mostly been attributed by wrong coding, for instance in a radiology therapy device. This has also boosted the accuracy of emphasized in developing such devices. Types of medical software used in healthcare Device Uses Monitors Monitors use built-in diagnostic software. They help to interpret the sensor information of heart rate, blood pressure or breathing rate. Medication pumps Programmed by medical diagnostic software, to pump blood into a patient at a particular rate. X-ray computerized tomography Re-interprets x-ray data by forming readable images Pacemakers Measure exact time of cardiac rhythms Source: EUROPEAN COMMISSION DG HEALTH AND CONSUMER Some software is used for medical informatics, they help in storage and easy access of medical related information, and examples of such software are electronic medical record (EMR) and electronic health record (EHR). Other software may be incorporated or built-in computer to aid medication like Computer Aided Medical Diagnosis (CAD) which diagnoses illness by use of patient’s data entered into the system. The data may include symptoms of a particular disease, laboratory reports or x-ray findings. c) Medical robotics Majority of big hospitals in Alberta and other parts of Canada uses medical robotics which is the latest technology. They incorporate robotics in sensitive medical procedures to enable surgeons to carry out accuracy in surgical operation on patients. The robotic systems have been embraced in modern hospitals to help in surgical procedures. Robotic surgery has been introduced in most healthcares to overcome side effects of inaccuracy in surgery and make it easy to carry out open surgical procedure. The surgeon is able to use moving instrument like telemanipulator to perform actual surgery on patient while the robotic arms undertake the action. This has made it possible for any operation by surgeon no matter the location, because of remote control. The robotic surgery has been advantageous on patients as it minimize cases of tissue trauma that has commonly been associated with traditional surgery of piercing the flesh. Part 3 3.1. Design Requirement A descriptive qualitative research design method will be used in this research examination on staffs stress level in relation to healthcare physical environment. Researcher is aware on what naturally occurs in qualitative research is an appropriate strategy for research when the study is conducted in a naturalistic environment, without manipulation (Creswell, 2007). Being in the natural setting will allow the participants to easily expose their interests as from their lived experience as they reflect on their answers within the survey. The term "qualitative research design" in this study will seek to define the application of both exploratory and explanatory research methodologies in order to gain a deeper insight into the issues surrounding hospital physical environment (Cooper and Schindler, 1998). In reference to this, many researchers typically refer to a qualitative research design as being applied in both exploratory and explanatory research. Exploratory research is any research with small and/or poor samples designed to define ranges, identify language, develop clues or hunches, establish and test possible hypotheses (Laurel 2007; McBurney 2002; Vogt, 1993). On its end, explanatory research will be utilized to assist in the development of understanding, explanation, or interpretation. Explanatory research or interpretive research with focus groups uses an analyst rather than an interviewer or moderator (Vogt, 1993). The analyst internalizes the entire problem for deep understanding. That is, the analyst does not memorize or catalogue a set of subtopics, but lets the problem create a degree of psychological discomfort within itself that can be ameliorated by obtaining information about the subject (Laurel 2007). 3.2. Data Collection Procedure Respondents are asked to fill the questionnaire and read instructions on their own. McBurney (2002) declared that secondary data is information collected from former existing studies and literatures, gathered for the purposes other than the problem at hand. In essence, the main advantage of secondary as compared to primary data is that it is fairly inexpensive and can be gathered more quickly. Primary research is conducted from scratch. It is original and collected to solve the primary problem of the study. It is gathered and assembled specifically for the current research project. Primary data is information collected for the specific purpose at hand (Laurel 2007).Primary data for this research study was collected through questionnaires. Part 4 4.1. Evaluation As per the key research findings, it was observed that there was gender balance in the entire study with 53% of the respondent being men and 47% being women. This reflects equity in the organisation and society where women are accorded similar job opportunities. Similarly, the study also revealed that majority of young people were in actively involved in different management levels, with majority of them being in age bracket of 25-30 years, forming about 32%. This indicates that healthcare organizations nowadays are investing in younger people as far as quality service delivery is concerned. The findings of the study presented that the respondents who participated in the study bear the perception that luxury hotels offer a friendly working environment The Alberta healthcare sector encompass four pillars of health research, which include biomedical with 56%, clinical research 20%, health services research 13% and population and public health 11% as shown in the diagram below; Source: Royal College Hospital 4.2. Discussion 4.2.1. Issue of value in health care The issue of value in any health care unit or facility is important and entails the provision of quality services to patients. Primary health care is the part of the health system which is mostly used by many Australians healthcare organizations (HCOs). It is delivered in the community, outside of hospitals and covers a broad range of providers like practice nurses, general doctors, psychologists, pharmacists and community health workers. The increasing expectations in relation to the performance of primary care, and great demands on primary healthcare professionals, is vital in realising and supporting interventions within primary care backgrounds to increase value (quality) of care and safety coverage (Bailie et al, 2007, p.67). It is imperative that standards for common practices promote quality enhancement and identify opportunities to initiate changes that will increase quality and safety for patients. 4.2.2. Effort to improve value in health care Value improvement activities is a core stone in Royal College of General Practitioners may encompass changes on daily operations of practice, for example work planning, opening and closing times, improving on customer care services and upgrading systems. Similarly, quality improvement may also entail activities specifically designed to improve clinical care or the health of the entire health practice, for example improving rates of immunisation, improving the care for patients with urinary tract infection or changing the systems utilized in recognizing risk issues for sickness that are mainly common in community healthcare practices. The uses of recall systems are very vital in the creation of value in a healthcare sector. Majority of systems used by the primary healthcare providers will vary, but comprise of monitoring and reporting systems, recall systems, practice audit systems and general professional improvement activities. Promoting culture of safety and quality in healthcare surroundings is a key pillar of the guidelines & standards of the Royal College of general practitioners. A patient safety culture recognises the certainty of error and keenly search for the establishment of patient protection. Quality improvement requires a joint effort from health professionals team, who should feel empowered to contribute to quality of care and safety (Bodenheimer et al, 2002, p.1777). The consistent utilisation of risk management systems assists to minimise clinical risk and make sure that practice errors are recognised and processes improved to lessen the chances of repetition. The developments in general medical practices like discovery of new medicines, use of latest technology and improved facts about efficacy and effectiveness, also imply that the risks to patients change. To promote quality of care and safety in primary care practice, patient recalls are based on four assumptions. First being that only patients who normally attend the care practice should receive recall notices, secondly, recall notification should only for a particular feature of ongoing care and/or particular preventive care (Chreim et al., 2010). The third principle where recall should be utilized is to monitor patients with established diseases and the fourth ones is where there is an apparent compulsion of medical specialists to recall patients who fails to follow up abnormal tests. These patient recall principles are accentuated in the guidelines & standards of the Royal College of general practitioners. 4.3. Factors that add to the complexity of health care delivery and inhibit change 4.3.1. Retaining competent healthcare professionals In the present labor market, recruiting and retaining competent health care professionals can be a challenge. This shortage leaves hospitals and primary care overburdened and undermanned (Burns, Bradley, & Weiner, 2011). This also poses a threat to the quality of care received by patients. In circumstances where shortage of this magnitude persist for a long period, the health care system in the country may be crippled by disruptions in care provision in the quality and safety of patient care (Couzos & Murray, 2003). 4.3.2. Quality services One may believe that since Australian healthcare system generally take into account the guidelines and standards of the Royal College of general practitioners, offer high quality services, and thus the quality of care is high throughout Australia. Unfortunately, Condon et al (2001) argues that quality of health services varies from state to state and from provider to provider. But with a clear guidance of medical protocols, primary care practices are deemed to provide quality of care to patients in the country. 4.3.3. Leadership practices Leadership is widely considered to be an important element within new nursing and allied health agencies (Burns, Bradley, & Weiner, 2011). It is no longer tenable for clinicians to take for granted significance of effective leadership in healthcare surroundings. However, the sector has been short of transformational leaders to take value or quality of health care to the next level, thus majority of hospitals is still languishing behind in progress (Fagerstrom & Salmela, 2010). Conclusion In the present labor market, recruiting and retaining competent health care professionals can be a challenge. This shortage leaves hospitals and primary care overburdened and undermanned. This also poses a threat to the quality of care received by patients. In circumstances where shortage of this magnitude persist for a long period, the health care system in the country may be crippled by disruptions in care provision, decreased access in terms of care and deterioration in the quality and safety of patient care (Couzos & Murray, 2003). One may believe that since Australian healthcare system generally take into account the guidelines and standards of the Royal College of general practitioners, offer high quality services, and thus the quality of care is high throughout Australia. Unfortunately, Condon et al (2001) argues that quality of health services varies from state to state and from provider to provider. But with a clear guidance of medical protocols, primary care practices are deemed to provide quality of care to patients in the country. Bibliography Bailie, R., Dowden, M., Connors, C., Robinson, G. & Cunningham, J. (2007). Improving organisational systems for diabetes care in Australian Indigenous communities. BMC Health Serv Res, Vol.7, p.67. Couzos, S & Murray, R. (2003). Aboriginal primary health care: an evidence-based approach. 2nd edition. Melbourne: Oxford University Press. Condon, J., Warman, G. & Arnold, L. (2001). The health and welfare of Territorians. Darwin: Epidemiology Branch, Territory Health Services. Bodenheimer, T., Wagner, E.H. & Grumbach, K. (2002). Improving primary care for patients with chronic illness. JAMA, Vol, 288, pp.1775-1779. Epping, J.E., Pruitt, S.D., Bengoa, R. & Wagner, E.H. (2004). Improving the quality of health care for chronic conditions. Qual Saf Health Care, Vol. 33, pp.299-305. Gillies, A. (2003). What makes a good healthcare system? Comparisons, values, drivers. Oxon: Radcliffe Medical Press, p.34. Leonard, M., Graham, S & Bonacum, D. (2004). The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, Vol.13, No.1, pp.i85–i90. Nicholson, D., Hersh, W., Gandhi, T.K., Weingart, S.N. & Bates, D.W. (2006). Medication errors: Not just a few “bad apples”. J Clin Outcomes Manag Vol.13, No.2, pp.114–5. Pearce, C. & Haikerwal, M.C. (2010). E-health in Australia: time to plunge into the 21st century. Med J Australia Vol.193, No.7, pp.397–398. The Royal Australian College of General Practitioners. (2010). Computer security guidelines. 3rd Edn. South Melbourne: The RACGP. Vincent, C.A. & Coulter, A. (2002). Patient safety: What about the patient? Quality and Safety in Health Care Vol.11, No. 1, pp.76–80. Read More