Quality and Patient Safety - Research Paper Example

Quality and Patient Safety Background The core mission of health care facilities is to provide qualityhealth care services to patients while ensuring they attain and maintain patient safety. This is achieved by providing the right health care to patients at the right time in the right setting. Health care comprises of services, mechanisms and methods used to preserve health by managing and treating illness. It entails execution of preventive, curative and palliative interventions to promote health. Health can be viewed as the complete wellbeing of an individual in reference to their mental, physical and social wellbeing (Barker 33-46). Patient safety refers to the efforts undertaken by medical practitioners and health care institutions to curb adverse health care events caused by medical errors. It entails applying safety mechanisms learned from business and industry, educating providers and consumers about these mechanisms, developing new economic incentives and adopting innovative technologies and error reporting systems. However, the endemic concern created by medical error was not appreciated until in the 1990’s. In 1999, the Institute of Medicine (IOM) took the initiative of informing health care regulators, purchasers and professional societies about patient safety which was to be attained by development of health care safety programs for example aviation safety programs and mandatory reporting on occurrence of any adverse medical error event (Barker 33-46). The main root cause of medical error in most accredited health care organizations is inadequate communication between health care providers, medical practitioners, patients and family members. Also inappropriate assessment of the patients’ condition, inadequate training programs and poor leadership contribute towards occurrence of adverse health care events. Moreover, human factors such as fatigue, depression, pressure, unfamiliar settings and medical complexities like use of powerful drugs, prolonged hospital stay and complicated health care technologies increase the probability for medical error occurrence. Furthermore, poor planning and decision making strategies lead to occurrence of system failures like complication development due to an increase in nurse staffing because of an increase in the number of patients and cost cutting mechanisms adopted by the health care facility also contribute to poor health care execution (JCR 114-124). To increase public awareness on this predicament, this report will discuss various quality health care and patient safety improvement activities that have been employed in the health industry. Quality and patient safety encompasses various activities which seek to improve patient safety, efficiency of health care to be more patient-centered, equitable and timely. Most of these activities have been summarized in models used to improve quality and patient safety in health care institutions. Literature Review Health care facilities have taken the initiative of subjecting their physicians to a learning culture and team-based system approaches to enhance delivery of quality health care services that emulate patient safety. This is because physicians play an important role in the delivery of health care services. Therefore, their leadership and involvement in quality improvement activities is crucial to the success of implemented quality and patient safety programs. The learning culture and team-based system approaches provide a highly interactive course which utilizes case-based scenarios, problem solving models and performance improvement activities that portray real life situations (Barker 33-46). Moreover, the physicians are exposed to case-based patient incidents which emphasize on patient safety and ways of enabling them to effectively handle medical errors and adverse health care events. Physicians also learn quality improvement principles and measures which they use to identify health care areas that require reviewing and changing. Furthermore, the physicians develop the required attitude and skills to enhance quality and patient safety. Therefore, they are able to deliver high quality health care which is cost effective (Barker 33-46). Quality and patient safety strategies comprise redesign of the health care systems, patients payment modules that will motivate practitioners to provide high quality health care and formulation of quality improvement infrastructure to enhance patient safety and also provide mechanisms that will be used to evaluate the efficiency of implemented quality and patient safety strategies. This aims at achieving safety whereby patients are not subjected to injury but to effectiveness where health care services are based on scientific evidence whose end results will benefit patients (Barker 33-46). The quality improvement approaches should also be patient-centered i.e. they should respect and adorn to the needs, values and preferences that patients have. Moreover, they should maintain timeliness in that patients will not face unnecessary delays which may result into further deterioration of their health. These approaches should emulate equity in all geographical locations i.e. rural and urban sectors, socio-economic status, ethnicity and gender. Furthermore, the quality improvement approaches should emanate efficiency whereby resources will not be wasted thereby ensuring delivery of cost effective quality health care (Barker 33-46). Health care quality and patient safety can also be achieved through implementation of continuous quality improvement approaches which combine the traditional quality assurance methods with quality improvement approaches that health care organizations and systems emphasize on. These approaches focus on the process of attaining quality health care and patient safety by incorporating both internal and external health care benefiters. The approaches also enable health care organizations to keep on improving their quality and patient safety improvement approaches. Patient’s health care needs are becoming more and more sophisticated because of globalization. Therefore, hospital and other care institutions need to adopt the latest globalization elements like advanced technology (JCR 114-124). The health care units will thus be in a better position to accomplish their own and system wide quality and patient safety goals. This is because quality improvement approaches comprise of a dynamic and evolutionary process which entails implementation of sustained achievements of performance gains, greater innovation, creativity and concentrated efforts from clinicians, managers and policymakers. Most of the quality and continuous quality improvement approaches were first used in the Second World War to achieve high quality with use of low cost materials. However, the recently developed quality improvement models focus more on demonstrating the power of team-based process improvement (JCR 114-124). The PDCA Model The PDCA model was formulated by Walter Shewhart in the 1930’s. However, in the 1950’s it was improved by Dr. W. Edwards Deming, also referred to as the father of modern quality control. He later re-designed the PDCA model to PDSA in an attempt of clearly defining his recommendations on quality improvement. Therefore, the PDCA (Plan-Do-Check-Act) is also known as the Deming or Shewhart cycle, Deming wheel or PDSA (Plan-Do-Study-Act) model. It comprises of four basic principles useful in solving quality related problems as it enhances continuous improvement through repetition of the four basic principles. It is mainly used to achieve business process improvement because repetition of the four principles cycle perfects the operation process thus producing the desired output. Therefore, the model should not be visualized as a closed circle but as a continuous spiral loop (Watcher 34-40). Fig 1: Retrieved from (Watcher 34-40) Plan involves identifying necessary and appropriate objectives and processes that are needed to achieve prospective goals of the business i.e. establishing problems that are facing the organization and coming up with ideas for solving them. This ensures that the goals are accurately and fully achieved. The Do principle entails implementation of the identified processes to accomplish the stipulated objectives. This involves putting into test the ideas speculated to solve the problems the organization is facing. The implementation is first done on a small experimental scale first to eliminate any chances of disrupting the normal activities as the testing goes on. Check involves monitoring the implementation of the identified processes by comparing the progress or results achieved with the expected target of attaining the goals of the organization. This helps in establishing the differences or gap that exists between the outcomes and procrastinated results. Also if new problems crop up they are easily identified (Watcher 34-40). The Act principle involves analysis of the depicted gap to determine the root cause of the difference. This enables a competent decision making strategy regarding the type of change, place and time of implementing the change to eliminate the gap. The implementation occurs at a larger scale depending on the success rate of the experimental process. It also comprises of inclusion of other people that will or are affected by the changes, will benefit from the changes or whose cooperation is needed to enable large scale implementation of solutions. In case the experimental process was not successful, it is advisable to skip the Act principle and go back to the Plan principle to come up with new ideas of solving the problems. The PDCA model is used hand in hand with other continuous improvement and quality management tools and techniques to carry out the improvement activities such as use of flow charts, Pareto analysis, cause and effect diagram, on-job training, graphical analysis, control charts and process mapping among others (Watcher 34-40). PROFIT is another quality improvement approach implemented by organizations. This model is quite similar to the PDCA model as it is also used to solve problems and ensure a continuous quality improvement strategy. Its results are effective if it is consistently used. It is mostly used to enhance quality improvement during team working. The six acronyms represent (P) problem definition, (R) root cause identification and analysis, (O) optimal solution based on the root cause of the problem, (F) finalize how the corrective action will be implemented, (I) implement the plan and (T) track the effectiveness of the implementation and verify that the desired results are met (Watcher 34-40). The TQM Model Total Quality Management (TQM) is a quality improvement strategy used to increase the awareness of increasing quality in organizational processes. This quality improvement approach was established in the 1950’s but gained popularity in the 1980’s. TQM enables organizations to have improved effective processes at minimal costs by eliminating all chances for error occurrence re-work and customer dissatisfaction. This enables organizations to benefit from increased brand value, higher customer confidence, customer fulfillment and decreased marketing time among others. However, new costs which are unavoidable and are needed to enable effective implementation of TQM such as staff training are added (JCR 123-196). TQM also demands synergized employees, that is, all employees should take part in improving the quality of organizational processes. This ensures that the core concepts of quality are implemented from the initialization of the organizational process throughout to the output. Therefore, TQM places strong focus on process control and measurements to ensure continuous quality improvement. TQM comprises of eight key elements categorized into four groups; foundation, bricks, binding mortar and roof. Foundation comprises of ethics, integrity and trust fostering openness, sincerity and fairness. Ethics stipulates guidelines that every employee should abide by while on duty, integrity refers to the values, morals and honesty that customers expect to be emanated by employees while trust is achieved by the combination of ethics and integrity. Trust encourages commitment from all members by empowering them, customer satisfaction and enables implementation of decision making strategies which can be appropriately employed in all levels of an organizational structure thereby building a cooperative environment (JCR 123-196). Bricks comprise efforts which support the foundation elements such as training employees to increase their competence towards implementing the TQM strategy. Team working which involves formulation of teams to undertake various operations of an organization. This enables the organization to solve problems more effectively and at a quicker rate and gain permanent improvement on the organization’s processes and operations. Organizations can either form quality improvement teams (QITS) which are temporary (exist for a period of three to twelve months) and only formed to deal with a specific problem which usually re-occurs. Problem solving teams (PSTs) exist for duration of one week to three months and are supposed to solve certain problems by identifying the causes of the problems. Natural work teams (NWTs) comprises of skilled workers that share the same responsibilities and tasks. They implement the self management, quality circles and employee involvement team working concepts. These teams usually work for a period of one to two hours in a weeks time (JCR 123-196). Bricks also entail leadership efforts where the managers are supposed to establish an inspiring vision, install values to be followed and formulate decisions and directions that can be understood by all the employees. The third group is the binding mortar consisting of communication strategies. Communication is a vital link which binds together all the elements of TQM and it is achieved by establishment of a common understanding of ideas. Communication comprises of three directions; downward communication from the top management to subordinate staff members, upward communication from the employees to the top management and sideways communication which exists between different departments. The last group is the roof consisting of the recognition TQM element. Both employees’ and customers needs and wants require to be recognized thereby improving their self-esteem, productivity and quality of output (JCR 123-196). TQM comprises the use of statistical tools that are used to collect data. For instance, use of a flow chart which is a graphical representation of sequences, analysis steps and critical process points for control which explains the process used to solve problems. Checks sheets are used to organize data by category to show how many times a particular event takes place. Pareto diagrams represent data in a hierarchical order thereby enabling pressing problems to be solved first. Fish-bone diagram also known as the Ishikawa diagram but commonly referred to as the Cause and Effect diagram presents a relationship between variables. The cause of a problem is related to the effect it may cause thereby identifying areas where data should be collected and analyzed. Histogram comprises of a graphical representation of grouped data while scattered diagrams depict the relationship that exists between two variables. Control charts contain two limits; the upper (UCL) and lower (LCL) limits which control the processes of an organization to prevent them from falling on either the upper or lower limit (JCR 123-196). The Six Sigma Model This model was initially developed by the Motorola Company in 1986. It uses a combination of the statistical and quality management strategies to improve process outputs by eliminating causes for error occurrence. The model comprises the use of two methodologies that contain five phases. The DMAIC methodology used to improve existing business processes. The acronyms represents (D) “Define” i.e. definition of the problem, customer needs and project goals, (M) represents “Measure” which describes methods of collecting relevant data, (A) represents “Analyze” to determine the root cause of identified problems, (I) represents “Improve” entails establishment of activities to improve the capability of processes used by an organization and (C) “Control” use of systems to monitor the effectiveness of implemented activities. The DMADV methodology is used in projects creating process designs or new products. It is also referred to as DFSS (Design for Six Sigma). The DMADV acronyms represent Define, Measure, Analyze, Design and Verify (JCR 123-196). Model for Improvement This model was formulated by the Associates in Process Improvement to aid in acceleration of improvement. It has two parts; three fundamental questions and the PDCA model. The three questions outline the goals to be accomplished which should be measurable, time specific and define a certain portion of the population, processes or elements. The second question provides quantitative measures to determine the efficiency of activities implemented to help achieve the stipulated goals. The third question presents changes which will be implemented to ensure improvement. The PCDA model is used to test the effectiveness and reliability of the changes to be implemented (JCR 123-196). Fig 3: Retrieved from (JCR 123-196). The Chronic Care Model The Chronic Care Model was formulated by Ed Wagner to encourage high quality chronic disease management. This is a health discipline that had been heavily affected by medical errors and adverse health care effects. The chronic care model focuses on developing a productive relationship between patients and medical practitioners. The model comprises of six fundamental areas. The self-managed area which entails properly preparing patients to have a sense of responsibility of their own health by ensuring they play the central role of determining their care (Baker 33-46). The second area is decision support which mandates that treatment decisions be made in accordance to the guidelines that have already been proved to work. The third area is the clinical information system which comprises of a registry where details of patients are recorded. This enables easy tracking of information which is vital in treatment, management and prevention of chronic diseases. The fourth area is the delivery system design which entails clarification of the roles that physicians should undertake to ensure that patients receive high quality care which comprises of having a centralized up-to-date system that provides patient’s information when required and a standard follow up procedure. The fifth area is the organization of health care where quality improvement approaches should be incorporated into the culture and structure of the health care organizations. The sixth area is the community which entails formulation of community based organizations and programs which support and enable expansion of health care systems to people living with HIV/AIDS. The programs also offer preventive strategies that can be integrated into the health care system (Baker 33-46). Fig 4: Retrieved from (Baker 33-46) The Lean Model Lean model was established by Jim Womack a researcher at MIT’s international Motor Vehicle Program in the 1980’s. This model aims at maximizing the values of customers by using fewer resources and in the same process minimizes wastes. To achieve this, the Lean model focuses on optimization of goods and services unlike the other models which focus on improving the management of the organization. The model eliminates wastes along the entire value stream and creates processes that need less space, capital, time and human efforts. The responses of customers are thus achieved by production of high quality, low cost products at a faster rate by simplifying information management and making it more accurate (JCR 123-196). The HIVQUAL Model The HIVQUAL model has also been implemented to aid in development of quality health care infrastructure that supports ongoing efforts to improve the quality of HIV care. It was developed by the New York State Department of Health AIDS Institute together with the HIVQUAL consultants. This model focuses on structural programmatic level of the project level. It comprises two cycles; the program cycle which enables a sustainable HIV-specific infrastructure to be established and maintained and the project cycle which entails formation of teams to undertake certain quality improvement tasks (JCR 114-124). Fig 5: Retrieved from (JCR 114-124). The Human Factors Model This model involves development of factors and tools to achieve goals of an organization including human performance, technology design and the interaction humans and computers have. These factors describe the human brain and body and the surroundings humans interact with. It comprises five approaches which are equipment design i.e. the nature of the equipments humans are supposed to work with, the task design which involves automating some of the tasks done by humans, environmental design which involves the implementation of changes that will improve environmental factors such as temperature and light around the area where the task is to be carried out, training individuals involves improving the competence of employees mental and physical skills to improve the quality of the output and selection of individuals. This involves grouping people in accordance to their physical and mental strength of performing designated tasks (JCR 123-196). Problem Statement Quality health care and patient safety possess a huge challenge to health care institutions, practitioners and patients. Each person is entitled to receiving adequate, safe and quality health care. The universal declaration of human rights mandates that health care be considered as a human right; however, today health care is traded like other goods and services. This alienates the poor from gaining access to this provision. Health care is also faced with the endemic of patient safety. Incidents of patients harmed and killed by medical error has greatly increased to a ratio of about 1 harmed or killed patient due to avoidable health care errors to a total of 10 patients that undergo medical care in a day. Health care is also curbed with health illiteracy. Most patients do not understand the medication and directions that they are given. Patients that are hospitalized or are under a prolonged hospital stay have the highest percentage of health illiteracy. This is because they are mostly quite ill when seeking medical care thus they have a higher probability of making errors with medical directions and medications by not complying with the treatment being provided. This results to adverse effects because the patients may be harmed or die in the process. Furthermore, today there are many quack medical practitioners that have emerged with the main aim of making money unscrupulously. Most of them are incompetent and therefore places the lives of patients at more danger. However, there are other instances when health care facilities employ incompetent staff to deal with the overwhelming number of patients. Their aim is not to help more people by treating them, there are out there to maximize their profits without considering the effects the end results will have. Health care also faces shortage of resources resulting to implementation of poorly designed systems of health care which do not comply with efficient and effective health care that patients require and demand for. Evaluation To curb the above problems health care institutions and medical practitioners have already implemented quality improvement approaches. This section of the report will outline quality improvement approaches that have already been incorporated into the health care culture and those that have not yet been implemented but would be appropriate to ensure delivery of quality health care and patient safety. These models include the TQM model, model for improvement, chronic care model, human factors model and the HIVQUAL model. Other models that can be implemented include the lean model as it will increase the performance of health care institutions and work output of medical practitioners by delivering health care services that are in accordance to patients’ needs and safety (Watcher 41-51). The above models can be used hand in hand with the PDCA cycle to further improve the quality of health care and patient safety. Rationale The quality improvement approaches enable regular improvement of quality and patient safety processes and practices through clear identification of problems, their root causes, formulation of ideas, changes to be implemented and their evaluation. Medical practitioners learn quality improvement principles and measures which they use to identify health care areas that require reviewing and changing. The physicians also learn quality improvement principles and measures which they use to identify health care areas that require reviewing and changing. Although the quality improvement approaches are effective, there can have negative impacts if not appropriately implemented. For instance, the TQM and PDCA model can result to wastage of resources. Analysis By implementation of the quality improvement approaches individuals regardless of their economic power or geographical location to some extent are able to receiving adequate, safe and quality health care. This is because health care is now equitable and timely. Health care risks, medical errors and occurrence of adverse health care effects have drastically reduced especially in the surgery and treatment of chronic disease health care disciplines. Today patients are equipped with health care knowledge, a fact that has enabled a reduction in health care illiteracy. Patients are now in a better position of taking care of themselves by effectively following doctor’s prescriptions and directions. Universal health care legislations and regulations protect health care delivery from unscrupulous people whose aim is to only accumulate profits. However, the laws should be re-evaluated to ensure such mishaps are curbed because they are still on the rise especially due to increase in unemployment levels. Also more research on the quality improvement approaches should be conducted to enable implementation of quality and safety measures in health disciplines that have been ignored and those that still give minimal results. The quality improvement approaches have also enabled health care institutions to appropriately use the available resources in delivering safe and quality health care. Conclusion From the above it is quite evident that implementation of quality improvement approaches in health care system will result to execution of preventive, curative and palliative interventions that will promote health and patient safety. This is because quality and patient safety will encompass activities that are more patient-centered, equitable, timely and effective. Therefore, patients of any gender, from any location or economic class will get the desired health care services. Physicians will be exposed to case-based patient incidents which emphasize on patient safety and ways of enabling them to effectively handle medical errors and adverse health care effects. Physicians will also learn quality improvement principles and measures which they will use to identify health care areas that require reviewing and changing. Moreover, physicians will also learn quality improvement principles and measures which they use to identify health care areas that require reviewing and changing. Furthermore, the physicians will develop the required attitude and skills to enhance quality and patient safety thereby delivering cost effective high quality health care. Works Cited Barker, Anne. Advanced Practice Nursing: Essential Knowledge for the Profession. Sudbury, Massachusetts: Jones & Bartlett Publishers, 2008. Joint Commission Resources (JCR). Must-Have Information for Nurses about Quality and Patient Safety. Oak Brook, IL: Joint Commission Resources, 2007. Joint Commission Resources (JCR). Root Cause Analysis in Health Care: Tools and Techniques. 3rd Ed. Oak Brook, IL: Joint Commission Resources, 2005. Watcher, Robert. Understanding Patient Safety. NY: McGraw-Hill Professional, 2007. Read More