Quality Improvement Initiatives - Research Paper Example

Quality Improvement Initiatives Introduction In the recent past, the health sector has been experiencing some drastic changes; these have been in terms of new medical complications or the needs of patients. This has necessitated health care institutions and other stakeholders to look for ways to improve the quality of the health care they give in order to meet the expectations of their clients. In addition, the regulatory bodies have been forced to adjust the threshold standards for health care in order to keep up with the changing needs. The changes that have largely inspired the need to improve quality of service in the health care include advancement in technology, the need to increase efficiency use of resources amidst the rising cost of health care, changing patient needs due to new infections or new guidelines. This paper will look at quality improvement initiatives in health care giving institutions, the needs and how the institutions have handled the problem. Quality improvement initiatives Quality in health care institutions is a product of a number of factors, which are related either directly or indirectly to health care procedures. These factors do not work independently but jointly to determine the quality of health care that an institution gives, therefore, the quality of health care will be affected depending on the number of factors that directly affect it. One of the factors that affect the quality of health care is management of health institutions; institutions that enjoy good management are likely to provide quality health care compared to the institutions with poor management. Institutions with visionary and proactive leadership who are genuinely involved in the affairs of the facilities they are in charge usually report higher levels of customer satisfaction in comparison to those whose leadership adopts a hands-off approach. This can be attributed to the fact that a leadership that is actively involved in running the affairs of the institution motivate other employees to work toward achieving the objectives of providing quality health care. However, some scholars argue that the management of health care institutions does not affect the quality of health care that is provided since they are not directly involved in treating or nursing the patients, therefore the people who affect the quality of care that patients receive are those who directly handle them such as nurses and doctors. The validity of this claim has been put into doubt since the motivation of the doctors and nurses depend on how the management handles their issue. For instance, doctors will only be able to give quality care to patients if the management provides them with the necessary facilities in addition to favourable working conditions. The ability of the health care institutions to meet the needs of the patients will depend on their ability to collect feedback from patients and implement it, which will in turn depend on the mechanisms that the management has put in place. Therefore, if the management does not collect feedback from patients or implement it, the quality of health care is likely to be compromised. Secondly, accurate and confidential records of patients’ visit to a hospital are vital in determining the services that a patient receives when he visits a hospital; they provide a record of previous visits helping the physician in knowing how to handle the patient. One of the issue is the availability of the patients records whenever they are needed; when patients are being treated, record of their previous visits are necessary to reveal their medical history and the type and dosage of medication that they received. When it is not possible to present those records to the patient or his physician, best quality practises in handling of the patient are compromised. Documenting a patient medical history and diagnosis should be done using a standardised structure and layout for easy access to the information. In the record, the date and time of the recording should be indicated in a chronological way to ensure smooth follow up of the patient’s progress. To make sure the medical records are accurate, a patients data should be entered in the records as soon as they are observed or narrated, failure to this may cause some information being omitted , underrated or exaggerated therefore leading to wrong diagnosis and therefore wrong medication. The Hippocratic oath that the medical professionals take also lead to ensuring that they do not divulge any information about their patients without prior authorisation by the respective patient to do so. In keeping medical records, health professionals are required to have undergone professional training on medical record keeping and have gone for adequate internship, this prepares the students well for the profession, which is demanding and needs high levels of professionalism and discipline. Medical regulatory bodies in various countries have rules and regulations that clearly guide medical record keeping through the guidelines that have been set. A good medical record keeper needs to be conversant with these regulations to avoid contravening them, which may lead to prosecution in a court of law or even deregistration from the profession. To be able to follow up on the progress of clients, the name of the most senior health official who was present when a patient is being seen should be included in the record, when a patient’s physician changes, the new physician’s name should be indicated. Furthermore where the records of a patient does not show any name of a physician who has previously treated him, then the next medical professional to examine him should explain why the name of previous physician(s) is not indicated. Storage of patients medical records is vital in ensuring those records are accurate and confidential. Medical records that are stored manually should always be under lock and key in an environment that is free from moisture or any material or insects that would otherwise damage the files. In the case of computerised medical files, the computer should always be protected from unauthorised personnel using it to access any information stored in it. Annotated bibliography Swayne, L. E., Duncan, W. J., & Ginter, P. M. (2012). Strategic management of health care organizations. John Wiley & Sons. This book focuses on strategic management of health care institutions using a global analysis of the industry and internal environment, it shows how managers of health care giving institutions are not focussed on short term goals but are more focussed on improving the quality of healthcare they for sustainability. Lynne J. Millward, Karen Bryan, (2005) "Clinical leadership in health care: a position statement", Leadership in Health Services, Vol. 18 Iss: 2, pp.13 – 25 This article conducts a review of leadership in National Health Services in UK and the Royal College of Nursing. The paper finds out that in order to improve health care delivery process, management is required to be effective in dealing with the workers while at the same time embracing transformational change leadership. HYRKÄS, K., APPELQVIST‐SCHMIDLECHNER, K. A. I. J. A., & KIVIMÄKI, K. (2005). First‐line managers' views of the long‐term effects of clinical supervision: how does clinical supervision support and develop leadership in health care?.Journal of Nursing Management, 13(3), 209-220. This study, which was conducted in Finland, was aimed at determining the effect of clinical supervision on first line managers of health institutions. It involved a group of first line managers from a university hospital who took part in the two-year clinical supervision interventions. The study found out that the first line managers thought clinical supervision would help them in running health institutions effectively. Rad, A. M. M., & Yarmohammadian, M. H. (2006). A study of relationship between managers' leadership style and employees' job satisfaction.Leadership in Health Services, 19(2), 11-28. The study was a cross sectional study that was conducted in Isfahan university hospital in Iran; it aimed at finding how different leadership styles affect employee satisfaction in health institutions. The study used leadership style that was focussed on employees and another one that was focussed on the task; the findings found out that employee were more satisfied when management was participative and employee oriented than when it was task oriented. John Edmonstone, (2011) "Developing leaders and leadership in health care: a case for rebalancing?", Leadership in Health Services, Vol. 24 Iss: 1, pp.8 – 18 This paper was aimed at describing the emerging patterns of leadership development in the health care sector, it found out that focusing on developing health care managers based on relationships and the context of the institution where that leadership would be applied was more effective than just developing individual leaders. Baker, G. R., & Denis, J. L. (2011). Medical leadership in health care systems: from professional authority to organizational leadership. Public Money & Management, 31(5), 355-362. This paper focuses on how engaging doctors and developing leaders in health care institutions is a major contributor to improving performance in these institutions. Studies in UK and US reveal that health care institutions have been attempting to introduce doctors to management of health institutions, a measure that has not changed the current state of affairs. The paper further explains the recent attempts by health institutions to improve on their performance by creating greater harmony between clinical and management goals, which is focused on improving the quality of health care that patients receive. Paans, W., Sermeus, W., Nieweg, R., & Van Der Schans, C. P. (2010). Prevalence of accurate nursing documentation in patient records. Journal of advanced nursing, 66(11), 2481-2489. The purpose of the paper was to describe how accurate nurses document information regarding their patients; it involved issues such as legibility of nurses’ notes, accurate interventions, accurate diagnosis, admission information and progress and outcome reports. The study found out that nurses were most accurate in recording admission information and they were least accurate in the interventions that were given to the patients. The study found it necessary to have a documentation system that links all steps involved in patients’ documentation from admission until they have full recovered. Pyper, C., Amery, J., Watson, M., & Crook, C. (2004). Patients' experiences when accessing their on-line electronic patient records in primary care. The British Journal of General Practice, 54(498), 38. This study was conducted in a health care institution where 100 patients were allowed to view their medical history, these patients were given questionnaires, which addressed issues such as accessibility of information and privacy among others. Most of the respondents in the study found errors in their record although they were not significant; they were concerned with confidentiality and security of their information including how the health professionals in the institutions use the records. Spies, T. H., Mokkink, H. G., Robbé, P. F. D. V., & Grol, R. P. (2004). Which data source in clinical performance assessment? A pilot study comparing self-recording with patient records and observation. International Journal for Quality in Health Care, 16(1), 65-72. The study was conducted to determine which data sources would be adequate to provide the needed information for accurate assessment of clinical performance; it was conducted in Netherlands among seven families. The study found out that medical records were not adequate to give adequate information for proper diagnostic, however physicians own personal assessment provided detailed information for proper assessment. Norén, G. N., Bate, A., Hopstadius, J., Star, K., & Edwards, I. R. (2008, August). Temporal pattern discovery for trends and transient effects: its application to patient records. In Proceedings of the 14th ACM SIGKDD international conference on Knowledge discovery and data mining (pp. 963-971). ACM. This paper presents a pattern discovery method that can be used to detect relationships between any pair of events, using this methodology in clinical context helps clinicians make prescriptions that are more accurate. Berg, M., & Harterink, P. (2004). Embodying the patient: records and bodies in early 20th-century US medical practice. Body & Society, 10(2-3), 13-41. This article explains how patients’ record keeping came into being in the United States of America and how it shaped the health institutions during that period Knaup, P., Bott, O., Kohl, C., Lovis, C., & Garde, S. (2007). Electronic patient records: moving from islands and bridges towards electronic health records for continuity of care. Yearb Med Inform, 34-46. This paper looks in to the trends in patient record keeping that have existed in the health sector and how electronic patient record keeping has improved this area Carpenter, I., Ram, M. B., Croft, G. P., & Williams, J. G. (2007). Medical records and record-keeping standards. Clinical Medicine, 7(4), 328-331. This article talks about how the structure of medical records has become important with electronic record keeping; it goes ahead to explain how the Royal college of physicians is working to set standards to guide this new form of record keeping. Pullen, I., & Loudon, J. (2006). Improving standards in clinical record-keeping.Advances in psychiatric treatment, 12(4), 280-286. This article looks at the problems that have faced the field of medical record keeping which range from poor maintenance and their accessibility, the article goes ahead to provide some recommendations which would help in improving medical record keeping. Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs, 24(5), 1103-1117. This article looks at the benefits that the electronic record keeping is likely to bring to the health sector; it compares this with the use of the technology in other sectors. The study finds out that the savings likely to come from adopting electronic health record keeping may run to billions of dollars annually. Problem facing the organization and how it can be dealt with The organization is faced with several challenges that have largely contributed to the decline in the quality of health care that it provides. These problems are as a result of laxity among the employees, poor record keeping by the medical record keepers and the inability of the institution to follow up on the patients to get their feedback. These problems have seen most of the patients look for alternative health institutions as they usually suffer from the same illnesses few days after leaving the hospital. In addition, the hospital has been incurring huge costs in operations without the desire changes in the quality of its services Recommendations Continuous quality improvement is a never ending programme that is designing at improving products and services that an organisation offers to its clients and is driven by data and feedbacks from clients, the programme is not driven by complaint or events, rather it is self initiating and aims to improve on the current quality levels. In a health care organisation, this means the management should keep on improving on the quality of health care offered to users continually based of the responses and suggestions from all the relevant stakeholders and not wait upon when complaints or bad incidents happen. Based on the information gathered from the continuous quality improvement and knowledge present within the organisation, new methods of practising can be built. This can be done through staff motivation or evaluation forums with the personnel in the organisation where they are allowed to give any information they deem relevant to the organisation without discrimination. The information retrieved from the continuous quality improvement assessments is shared and the organisations as a whole deliberates on the lessons that can be learnt from this information and how best to handle them as well as the personnel giving their views on how to go about the critical issues identified. As the organisation is not alone in the health care industry, the information got from the process can be related to other establishments within the health industry and how they have managed to overcome or improve similar or related problems, this can be tailored to the organisation based on the needs of the organisation. Secondly, the organization can adopt the six sigma strategy which is a mode of operation with tools and strategies that aims to improve efficiency in business by reducing the number of defects and errors to as minimal as possible. An organisation that is capable of implementing six sigma is that whose number of defects is 3.4 in one million products or services that are offered. Six sigma operates using two methods (DMAIC and DMADV) that each have further five processes that can be used to improve on hospital efficiency and increase on hospital profitability in our case. Six sigma was first used in the health care industry in 1998, drastic savings were made and efficiency and accidents in treating patients were minimised. The various instruments in six sigma are critical to improving efficiency in hospitals as they involve collecting feedback from health care users and staff on the quality of services offered in the organisation, collecting and analysing the data to identify the causes and effects of the challenges that are encountered in provision or receiving of health care. The information or the trends that are derived after data analysis are then used to improve the situation to the optimal levels, and then measures and controls are put in place to ensure any deviations in future are rectified before they can cause damages or defects to the customer. With efficiency improved, wastages such as idle staff or some hospital facilities that are underused will be put in to optimal use, thus ensuring that the hospital is operating at minimal costs level. The hospital will increase the volume of patients that can be served per day therefore increasing profitability since efficiency has also been maximised. Read More