The Main Goal of Health Care Systems - Essay Example

Health Leadership and management Introduction The main goal of health care systems all over the world is to provide quality care to patients. Quality in health care services involves meeting the needs of patients fully, at the lowest cost possible and within the appropriate regulatory framework. The major focus of health care is to try to minimize the healthcare costs associated with poor quality of health care especially in the surgical wards. However, only a few health care organizations have developed effective models for delivering quality care. It is the responsibility of the quality improvement manager to ensure that patient receives quality care. It is imperative to develop a patient-centered care initiative directed towards improvement of care delivery in surgical wards (Sharon et al. 2006). A patient-centered care initiative should consider the preferences and morals of the patient, the state of the family circumstances, and their way of life. It should involve the patient and their families in the care delivery decision making process. Patient-centered care emphasizes on the important self-care aspects and conduct patient shadowing as well as providing patients with the equipments and assistance they require to carry out that responsibility. Patient-centered care should ensure that transitions between supplier, departments, and health care settings are respectful, coordinated, and well-organized. This patient-centered care initiative will be based on mutually useful partnerships among health care suppliers, patients, and families and has weighty implications for the planning, delivery, and evaluation of care (Tauzin 2006). This paper is going to seek ways in which St. Mary hospital will engage its medical staff members in defining and measuring their activities to ensure quality care delivery, instill the work culture with a competitive ethos, create networks to generate and disseminate knowledge of the linkages between activities, processes and outcomes and how these can be measured. Evidence-base for the Initiative Conventionally, care has been structured around the needs and desires of health care professionals and especially the surgeons. Despite the fact that the centrality of patients is considered as an essential principle in health care, reorganizing the hospital around the needs of patients will challenge most hospital-based organizations to significantly change a long-existing culture. This initiative call for the need for patients and their families to be involved in the overall hospital health care improvement initiatives. This patient-centered care initiative will see the hospital achieve its mission and goal, to provide quality care to patients (Safari 2006). Many research studies have verified that patients who perceived the care they got from hospital to be patient-centered experienced quick recovery, few diagnostic tests, emergency department visits and referrals and better emotional health than those who did not. Studies have shown that patient self care, especially for chronic diseases, is linked with improvement in health care and reduction in services utilization. One research demonstrated that patients who were involved in their care decision making process reported significantly higher levels of satisfaction with their decisions than those who did not. Research studies have demonstrated that patient-centeredness care hold enormous promise for improving quality of patient care especially for patients going through a surgery. Evaluations of physician-patient encounters reveal that most of these conversations do not meet the minimum requirements for informed decision making and employ of inventive approaches to involve patients in their own care. Involving patient in management of their own care has not become a custom for the physician care management process. A patient-centeredness care also plays an important role as lead to the use of appropriate preventive services in a sensible manner. When patients are involved in their own prevention needs, which with emphasize mostly on individual responsibility, they are able to campaign for their basic and secondary prevention needs (Casalino 2006). Research studies have recommended for the development of low-end, systems-based processes directed towards improving patient care in surgical wards, which in turn will lead to patient satisfaction. Patient studies also have indicates that most patients have not been satisfied with the kind of care they get in surgical wards. In a recent study in which 350,000 patients were interviewed, most of them felt that their values, preferences and needs were not respected when they were operated, where as, the majority could not be able to go through a surgery due to the high costs involved. All this happen simply because the patients and their families were informed or involved in their decision making care process and hence, this hindered the development of a mutually-respectful and reliable patient-physician relationship. Most medical staff communicate in a language that the patient cannot understand (Berenson et al. 2008). A research studies also indicate a lack of coordination and integration of care among doctors, nurses, families, patients, social workers and other health care workers. They also do not have a smooth transition between different medical staffs and phases of care. This study also revealed that most of these patients did not get emotional support before and even after going through a surgery. Research studies indicate that family member and friends of the patient going through a surgery are not involved in the process. It is imperative to involve family member and friends because they are the ones who will take care of the patient after being discharged in the hospital. Complications cases have been reported and some patients have been forced to go through another surgery because of improper care given at home (Pratt et al 2006). It has also been observed that most hospitals management teams do not empower their patients to be able to take care of their own needs by themselves. They do not educate or inform patients that it is important for them to take part their own care decision making process and self-management. Research studies have also indicated that the welcoming environment in most hospitals, especially for patients who are supposed to go through a surgery, do not give then the physical comfort necessary for to strengthen and support them. The physical space, initial personal interactions with the medical staff is unfamiliar, unwelcoming and intimidating (Rosenthal 2008). Current best practices Most organizations have not been able to successful implement their change strategies or initiatives. This is because they have failed to develop a proper change process based on a sound change theory. For successful implementation of this patient-centered initiative, we employ Kotter’s eight steps change process (Kotter and Rathgeber 2006). The first step will entail creating urgency for the need for change. This will involves creating awareness among all the stakeholders as regards the problem and the need for the change. This step acknowledges that change initiative will only succeed if the whole organization realizes that a problem exists and there is need for change. Open, honest and convincing discussion as regards patient-centered health care will be held with all the stakeholders. These discussions will aim at identifying the risks involved in providing poor quality health care to patients and the implications these risks have on the health care system and to the patients. I will also involve all the stakeholders in examining the opportunities which should be exploited to address the problem. In this way, many people will start talking and thinking about this change creating the urgency for the need for change. The second step will involves creating a powerful coalition for the change initiative. This will entails convincing the people that the change is for the better. To do this successfully, I will seek support from key personality within and outside the organization by forming a powerful team made up of all the departmental heads, service providers and suppliers, health professional board, health authority board and the government. This team will work together in creating a sense of urgency around the need for change. The third step will involve creating a vision for the change. There are many ideas and solutions which can into mind when we talk about a patient-centered care. For the people to understand and remember them, it is important to link these ideas into an overall vision. In this case, the vision is to promote the health and welfare of patients so that we can give them provides quality health care. I will encourage the change coalition to practice this vision statement frequently to be able to articulate this vision clearly and within the shortest time possible. To achieve this vision, a patient-centered initiative will be implemented (Kotter and Rathgeber 2006). Creating the vision only does not guarantee the success of the change initiative. We have to communicate this vision frequently to everyone involved in this change process. Apart from arranging for special meetings to communicate the vision, I will endeavor to talk about it at every opportunity that prevails itself and embed it within everything that I do to make sure that everybody within and outside the organization grasp it. A good leader leads by an example and not just by mere words. I will therefore make efforts to use this vision on a regular basis when making decisions and solving problems. In this way, I will demonstrate the kind of behavior I expect from the health care workers and also this idea for change will remain fresh on everyone’s mind; they will consider it and take appropriate action. After creating urgency for the need for change and communicating my vision, no doubt majority of the staff will support the change initiative that I have been promoting. The next step will be to identify the possible obstacles for the change initiative and remove them. If there are staff members who are still resisting the change, I will help them see the need for the change by arranging for more discussion with them. I will also rewards and recognize the staff members who will initiate the changes in their work practice. Since actual change takes times to be effected, it is important to plan for and create short-term wins to avoid loss of momentum and motivation. For people to continue participating in the change process, they need to see compelling evidence that their efforts are bearing fruit as early as possible. In this case, my short-term win will be after three months of the change initiative implementation where the health care provided to patient will have improved by 3%. This will help to keep up the level of urgency and to motivate the staff to carry on with the change initiative. However, it should be noted that short-terms wins pave way for the long-term wins and hence, we should not declare the change initiative as being successful based on these short-terms wins. On the centrally, we should use these short-term wins to build on the change initiative. In this stage therefore, I will analyze the actions which were undertaken to achieve these short-term success, that is, improvement in the health care provided to patients, and thereafter determine the areas that need further improvement. To build on this momentum, I will aim at improving the quality of care provided to patients by 6% in the neat 3 months. Lastly, I will anchor the changes in the hospital culture to make the changes stick. I will endeavor to talk about the progress and success of the change initiative at every chance that I get. The change ideas and values will be included in the hiring and training of new staff. I will also recognize and reward the key members of my change team and credit the contributions of the other staff. At last, I will create a plan for replacing key leaders of the change team as they move out of the organization to make sure that their legacy is not lost. This plan will involve training existing staffs who have the potentials for leadership. Business plan for the Initiative Quality improvement strategies should focus on processes which will lead to realization of improved patient outcomes. Such strategies should be more responsive and service-directed (Cruikshank et al. 2002). The following are the basic strategies that the quality improvement manager should consider implementing towards improvement of patients care in the surgical ward. Patient and family surveillance: The nurses should follow patients and their families to survey and record what really happens at each step of the care process to make sure that they adhere to the standards of effective care delivery. For example, they should ensure that patient safety hygiene is maintained when addressing the area that has been operated. This also gives the patients and family members the opportunity to express the problems which they encounter in the process of care delivery immediately they arise. The nurse therefore gets to know the patient and family perspective on the experience and is in a position to provide immediate solutions to their problems preventing development of complications (Sidorov 2008). Appropriate feedback and weekly care board meetings: After conducting a successful surveillance, the nurse should review the information and present his /her finding to the care board who work in the area where the surveillance took place. This presentation should include the observations made by the nurse, patient’s and family’s remarks and recommendations for change, which should be executed immediately based on this appropriate feedback. Members of the care board should meet weekly to discuss the observations made by nurses from their patient surveillance process and the feedback of the patient and family. Pre-surgery Visit: The Patients and their families should be encouraged to visit the hospital for at least 2 hours three weeks before the surgery. The visit should be based on wellness and not sickness and reducing anxiety associated with the surgery for both the patients and their families. There should also be a forum during this visit to educate the patients and their families to prepare them for hospitalization. This should also be taken as an opportunity for the patients to meet staff and other patients scheduled for surgery the same day. This should also involve a meeting with a social worker to discuss the discharge and home care plan. This should also be the time to schedule a follow-up meeting with the surgeon. This is also the best time to select an advocate or “coach” for the patient. This should also be the time to carry out routine testing before the surgery to make sure that every thing is perfect for the surgery to be done (Fiscella and Epstein 2008). The surgical process: The hospital should endeavor to offer a conventional procedure on the day of surgery which meets the needs of the patients and family. First and foremost, there should be a pre-surgical meeting in which the surgeon meets with the patient in the surgical holding locale to answer questions, give instruction and provide comfort, and situate the surgical site. The second step is the patient to meet the anesthesiologist to be taught the various anesthesia techniques and alternatives for managing pain after surgery. At this point the patient is ready to go through the surgery. There should be an experienced surgical nurse to assist the surgeon during the process. All the medical staffs should have extensive experience in the whole joint replacement process. This will lead to quality improvement; reduce unpredictability, waiting times and strain for the surgeon, nurses and other medical staff. The surgical team should use of antibiotic to prevent surgical site infections. The medical staff in the operating room should follow a standardized process during the surgery. This standardized process should encourage the staff to freely report any incidences of inconsistency during the operation (Anne-Marie et al. 2006). Quick rehabilitation: The rehabilitation process should begin that specific day of the surgery and should include both the patient and family members. In order to go back to normal activities, the patients should be encouraged to dress themselves with their usual clothes immediately they leave hospital. Physical and occupational therapists should assist the patients to get in and out of bed, move from the bed to a chair and vice versa, and help them to start walking. This should be done the same evening the patient leaves the hospital. Patients should also be encouraged to wear shoes and socks by themselves, with no limitations to choice of movement. Patient should be given physical and occupational therapy at least twice per day during their stay in hospital and should join in the group therapy in the on-unit gym. Before being discharged, the patients should be able to get in and out of bed and move from the bed to a chair and back safely (Rodriguez et al. 2009). Specialized Staffing: The surgery team, care team and the post-discharge team should be staffed with specialized team which is qualified to address both the emotional and therapeutic needs of the patients and families. A specialized staff will be maintained by developing a thorough and strict recruitment and promotion procedure. Staff should be recruited or promoted based on their educational qualifications, experience and competent levels. The hospital management team should set high qualifications standards to make sure that only eligible staffs are employed. The hospital management team should also make sure that it employs takes some of their medical staff from the local neighborhood as this will lead to creation of a diverse staff with sensitivity regarding patients’ background, culture and individual preferences (Digioia et al.2007). Patient –friendly physical space: The unit should be planned to make the patient feel comfortable, that is, feel at home. For example, all rooms should be equipped with televisions or computers which have internet. This unit should be fitted with a gym and fitness area as well as canteen for meals, which should operate for 24 hour in a day and 7 days a week. It should also have a special family community room which should have a kitchen and sitting room, for families and friends to communicate with their patient. This room should be fitted with swinging chairs, sofa sets, fully stocked refrigerator and a big screen television. This will create a sense of community as it provides a relaxing environment for the patient and families to interact. The patients can also come to this room to relax and enjoy themselves just as they would at home. Therefore, in this room, there should be a massage psychotherapist and massage seats for family members and staff (Bisognano 2007). Evaluation Plan The overall aim of the evaluation plan is to find out whether the Patient-centered initiative has achieved its intended goals and objective, that is, providing quality patient care. In order to determine whether this patient-centered initiative has been a success, a monitoring review process will be conducted for 600 patients who will have gone through a surgery in the year 2008. The indicators which will be used to measure the success of this initiative include the levels of patient satisfaction, the patient’s length of stay in hospital, functional status and conformity with standardized measures for infection and rates of infections (Barr et al. 2008). At the end of this program, it should be observed that most of the patients were highly satisfied with the kind of care they received in the hospital. They should feel that their values and preferences were respected and that their needs were satisfactory met. It should also be observed that most patients were able to afford and go through the surgery process. In terms of functional status, the initiative will be considered to be successful if the patients are able to walk without handheld help and if they can be able to get in and out of bed, move from the bed and into the chair and back at the time there are leaving the hospital. The patients should also not experience extreme pains when going through their postsurgical physical therapy even during the same day of surgery. Compliance with the standardize measures for infection control: It should be observed that the physicians were in a position to give patients antibiotics one hour before the surgery and were able to discontinue the use of antibiotics discontinued 24 hours after the surgery without the patients experiencing extreme pain. Moreover, it should be observed that the patient received appropriate antibiotics. The overall blood-borne infection rates, especially exposure prone operations, should have declined at the end of the program (National Nosocomial Infection Surveillance System Report 2004). Low length of stay: The length of stay in hospital should have reduced from the normal average of stay. For example if patient used to stay in hospital for an average of 4 days after the surgery, this should reduce to an average of 3 days. This program will be most successful if it is observed that more patients are being discharged immediately after the surgery than they used to be discharged before the initiative was started. Dissemination plan The key elements towards the dissemination of this patient-centered care initiative should involve development of an innovation center, care team, program priorities, staff training and expansion. Development of an Innovation Center: The Innovation Centre should be designed to provide technical assistance, training, research and education to support programs of the patient-centered initiatives. The Innovation Center should therefore house a training and education center which holds a mock patient room, surgery room, conferences and seminar rooms, computer-assisted recreation and office rooms. The research department should carry out research studies to find out whether patients are satisfied with the kind of care they receive in the hospital and if not, come up with recommendations which should be implemented to improve patient care. The training room should be used to train the staff, the entire care team, surgeons, nurses, therapists and social workers, on the appropriate model of treating patients well from their first experience to the last. The educational department should also come up with a mechanism which allow and encourage their staff to further their education by allowing then to enroll for evening classes. For example, diploma staff should enroll for degree studies, where as, graduate staff should enroll for masters’ studies and much more. It should even consider offering sponsorship for some of the staff members (Murphy and Nash 2008). Development of care team: There should be a thorough recruitment of surgeons, nurses, therapists and social workers to form a care team. The hospital management team should set a clear guideline which outlines the recruitment qualifications and requirements for each post. Only experienced and competent staff should be selected to make the care team. This care team should be dedicated to meeting and exceeding the needs of patients and families. It should also oversee that all the other staff adhere to the set standards and measures for patient care delivery. Development of program priorities: The needs of the patients in a patient-centered initiative should be prioritized so that those which are most critical should be met first. The following is a good example of how patients’ needs should be prioritized: To offer suitable, well-timed instructions to patients and families To avoid using exposure prone procedures when possible To use multimodal anesthesia and pain management methods To provide immediate rehabilitation process in order to promote quick recovery To elicit timely feedback from the patients’ and the providers’ perspectives To provide a conducive environment for learning and recovery To create a sense of community, contest, and cooperation among patients and between patients and families To encourage a recovery approach based on wellness rather than a sickness Expansion: The hospital management team should consider increasing the number of medical staff in the institution to make the implementation of this patient-centered initiative a success. For example, the hospital management team should employ additional staff to assist in patient surveillance process and monitoring review process. It should also employ more social workers to assist the patients to walk, get in and out of bed and move from the bed to the chair and back. The hospital management team should consider constructing more rooms to be used for relaxing, exercising and for patient to communicate with their families and friends (Moore 2006). Resources and skills needed: The resources needed for the implementation of this patient-centered initiative are as follows: Staffing: The hospital management should consider employing six full-time corresponding medical staff who should have great experience in clinical care, research and development, quality enhancement, technology and management. The hospital should also consider coming up with an intern program in which surgical nurse students from universities to aid in particular projects and process scrutiny. Costs: There are higher costs associated with implementation of this patient-centered initiative. This is because this initiative calls for the recruitment of additional medical staff, construction of more rooms and fitting them with the necessary equipment. The hospital management team cannot be able adequately meet these costs without relying on outside help. Therefore, the hospital management team will need to source for more funds from the government, donors and other well wishers. References Anne-Marie A. et al. 2006. Adoption of patient-centered care practices by physicians. The Commonwealth Fund, New York. Barr et al. 2008. Surgeon’s opinions on public reporting of hospital quality data. Med Care Res Rev; 65:655-673. Berenson et al. 2008 A home Is not A house: Taking care of patients at the center of Practice redesign. Health Aff (Millwood); 27:1219-1230. Bisognano M. 2007. New behaviors to see: inventive devices to enhance patient care. Presentation at the 19th yearly national meeting on quality improvement in health care; Orlando, FL. 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