The Urgent Need to Improve Health Care Quality - Essay Example

Name Tutor Course Date Majority of the citizens are in a position to access services of healthcare of high quality. However, in majority of the circumstances, the quality in healthcare which the patients acquire from qualified physicians is of substandard. This is in terms of excessive services resulting to the undermining of the quality associated with the care increasing the cost unnecessarily. Other instances are characterized by the provision of ineffective services in as far as the improvement of the outcomes of health is concerned. The provision of care of poor quality is a root cause of sicker patients, increased levels of disability, escalating cost of care and a reduced level of confidence with regard to this industry. The potentialities in as far as the improvement of high quality system of healthcare at national levels are a reality. There is a dire need for provision of the information in way that is understandable as well as reliable to assist the clients arrive at critical decisions with regard to their health (NSW Treasury Managed Fund 88) The decline in the quality of the provided healthcare is founded on some identifiable challenges related to under use of the plan, its overuse, misuse together with the use variation with regard to the services of the healthcare are concerned. It is important to note that the life of a human being is the most treasurable thing in the world (JM Clark et al 22). Service underuse concerns the issues of failure of the provision of highly required service that consequently brings forth additional complications including premature deaths in line with unnecessary costs. Services overuse refers to a situation in which unnecessary services may be provided. Their end results are the unnecessary costs consequently leading to some other high order complications that may undermine the much valued patient’s health. This is exemplified by the resistance arising from incorrect antibiotic prescription in the instances of the treatment of cold. The issue of services misuse may be indicated through the errors that have been committed during the process of delivery of the service responsible for the health care which is resultant to delayed process of diagnosis and in other cases, the diagnosis may be missed Quality Improvement is an integral part of ongoing management of clinical care delivery. It involves systemic investigations of working hypotheses about how processes might be improved. It relies on evidence from research to identify beneficial changes that may implemented in a localized health care settings (Horn 44). Evidence based medicine (EBM) is the judicious integration of individual clinical expertise with best available external clinical evidence from systematic research and patient values and expectations. Clinical expertise decides whether the evidence applies to individual patients. Often, however, routine practice fails to incorporate research evidence. Quality improvement aims at closing the gaps between research knowledge and clinical practice. CPI is a study methodology that includes tracking of medical care process factors, patient factors, and outcomes, providing information for the development of analytically based management protocols to achieve desirable outcomes over the continuum of care. It examines what actually happens in the care process and provides a basis for analyses of significant associations and relationships between process and outcome. It assists clinicians to be able to determine how and where they are to improve clinical decision-making and make systemic changes to provide safer, more effective patient-focused care. There are potential barriers to change in practice. These are related to lack of perception of relevance, lack of resources, short term outlook, conflicting priorities, difficulties in measuring outcomes, lack of necessary skills, inadequate or ambiguous evidence, perverse incentives and intensity of contribution required. Some of these can be addressed through education and thorough review of research. Routine practice usually fails to incorporate the research evidence in a timely manner and reliable fashion. Several quality improvement efforts are aimed at closing these gaps that exist between clinical research as well as practice. However, in contrast to the paradigm of evidence-based medicine, the efforts often proceed on the basis of intuition and anecdotal accounts of successful strategies for changing provider behavior or achieving organizational change. A clinical pathway is a tool which is used locally agreed clinical standards, and is based on the best available evidence, specifically for managing specific groups of patients. The pathway usually form part or entirely all of the records of the patients and allows the care given by members of the multidisciplinary team, together with the progress and outcome, to be documented. Variations coming from the pathway are then recorded. Analysis allows a continued evaluation of the effectiveness of clinical practice. Information, therefore, obtained is used to revise the pathway to improve the quality of patient care. Using of clinical practice guidelines which is based on the best available evidence has generally been fully welcomed, but the implementation requires a given specific action at a local level. The pathways facilitate the use of various guidelines by the multidisciplinary team, because they are locally accepted and are usually available in the patient's record when decisions are being made. Analysis of the causes of variation further encourages adherence to the available guidelines when they are clinically appropriate. Pathways are meant to provide care that focused towards the patients, as they constantly monitor quality as well as any deviation from the pathway identifies complications early. The plan of care is usually clearly defined and shared with the patient. And in some instances patients are involved in the development of this particular plan. Pathways also facilitate discharge planning because the median length of stay is defined (Greenhalgh 34). Through including these in the pathway, various changes in practice can rapidly be communicated to all the members of the multidisciplinary team. Analysis of variation from the pathway can be used to monitor areas of possible risk. Poor keeping of documents can fail to indicate whether a guideline has been fully followed. This can easily be addressed through introduction of the pathway. One other aspect of risk management is preventing the recurrence of untoward events. Pathways involve guidelines that ensure all health professionals are aware of potential risks as well as taking appropriate action to prevent them from recurring. Most clinicians who are involved in this process agree that the making changes that lead to improved outcomes need active involvement from senior medical staff. There also has to be a commitment from management to be able to provide resources to establish and run the program because time is needed to develop pathways and educate the staff members. Analysis of the variation from as well as regular revision of, the pathways is also important to maintain the improvements in clinical practice. The idea of pathways is usually based on sound values, but evaluation of their use is critical. Prevention and Treatment of Osteoporosis in acute spinal cord injury patients Fracture as well as bone densitometry data indicate that early bone loss interventions will be needed to prevent SCI osteoporosis. Dual energy X-ray absorptiometry (DEXA) indicates a rapid decline within the lower extremity bone mineral density resulting in osteopenia and susceptibility for fracture. Bone loss after SCI takes place rapidly below the level of the lesion as the result of increased bone resorption as well as impaired bone formation, thereby predisposing to hypercalcemia, hypercalciuria, renal calculi, osteoporosis, together with fracture. Bone loss in sublesional areas is likely to be as high as 4% per month in trabecular bone and 2% per month in cortical bone. The loss of bone peaks 3–5 months after SCI but loss is ongoing for approximately 2 year before clocking a new steady state. The execution of physical modalities for prevention as well as treatment of osteoporosis in acute spinal cord injury patients is likely to be resource intensive, cost–benefits and effective and resource allocation in the rehabilitation and community setting is also taken into consideration. A systematic review of the evidence for Prevention and Treatment of Osteoporosis in acute spinal cord injury patients concluded: Electrically stimulated muscle activation was elicited, and titanic effects were reproducible; however, there were no convincing trends to suggest that FES can play a clinically relevant role in osteoporosis prevention (or subsequent fracture risk) in the recently injured patient. Tilt-table standing for about 30 minutes, three times in a week for 12 weeks has a small effect on ankle mobility, and little or no effect on femur bone mineral density. This study provides no support for the practice of regular standing of patients with lower limb paralysis following spinal cord injury. Physiotherapists should not expect to see benefits on ankle mobility or femur bone mineral density from three months of regular standing. The use of alendronate has a positive resultant effect on bone mineral density in SCI patients and therefore represents a potential tool for prevention and treatment of osteoporosis in this population. SCI bone loss was stopped within all measured cortical as well as trabecular intraregional sites over 24 months with alendronate 10 mg daily. There is a requirement of the adoption and implementation of the Clinical Support System Program (CSSP) for the purpose of embedding the available evidence of the highest quality routinely applicable in the clinical practice. The application of CSSP is liable for bringing some improvements in healthcare systems over short periods of time. This has the implication that that there is the potentialities for the achievement of significant gains from the programs responsible for change in an effort of the transformation of the culture as well as the structure that is entrenched in the provision of care to the patients. Apart from changes in the local practice, CSSP has other admirable outcomes such as the generation of crucial messages applicable in the more broad system of healthcare (Safety & Quality Council 120). Treatment Approach Will Involve The Following Process: 1) Involve appropriate team members and formulate aims: Forming multidisciplinary teams includes: The core team that has a set of basic functions which relate to project design; and strategic decision-making to support the project team during implementation. the core group will include representatives from spinal cod injury rehabilitation physician, endocrinologist, nursing, allied health, physiotherapist and pharmacy, and others stakeholders. The project team whose practice is the project focus and includes all clinicians providing care to the patient cohort. Consumers need to be part of both the core team and the project team. While the core team guides the project and makes strategic decisions, it is important that ongoing consultation with the wider project team occurs. Ongoing consultation can occur through the representative nature of team membership. Individual members of the core team have a responsibility to liaise with their own constituency with respect to key project decisions This task will initially involve liaising with all interdisciplinary team and finding out about their osteoporosis knowledge and organizing education to inform them about the latest EBM management of osteoporosis management (Haines 112). The local agreement should be reached about the evidence base; and the wider project team has been consulted during this process. 2) Implementing the change: a) Involve staff (doctors, allied health and nurses) in developing the protocol or clinical pathway. b) Refer draft guidelines document (clinical pathway) to stakeholders for consultation. c) Document associated policies, procedures and protocols, as a basis for reviewing progress and achievements, to help track developments over time, and provide information to new members. d) Develop a protocol with appropriate and specific indications; inclusion and exclusion criteria; e) Develop an education program for target audience (medical, nursing, physiotherapy, occupational therapy and hospital managers) in the form of in-service sessions (staff centered) prevention and treatment of osteoporosis in acute spinal cord injury patients. Dissemination of the evidence to clinicians is one strategy to assist clinical teams. Consumers were informed about the evidence using leaflets. Continuous communication between our core team and the wider project team is important to sustain engagement. To keep people informed, we develop regular newsletters for wide dissemination on interesting aspects of the project’s activities; have regular presentations and meetings about the project. Measurement: Aims are to measure compliance, ensure implementation is sustained over time and that the intervention achieves the desired clinical outcomes. This is achieved by: a) Ongoing review of admissions to measure eligibility of patients managed as per protocol. b) Measuring non-compliance and assessing reasons for it. Offering feedback to users of the protocol. c) Processes of care (the percentage of admitted patients receiving prevention and treatment of osteoporosis in acute spinal cord injury patients within the targeted time frame, the percentage of patients reporting satisfaction with information provided). d) Direct clinical management (the percentage of patients eligible for prevention and treatment of osteoporosis in acute spinal cord injury patients who actually receive it). e) Outcome measures: such as reduced fractures, bone mass density measurement (DEXA scan) and monitoring any fractures in these patients. Direct provision of the necessary data by the clinicians involved in our project (e.g. entering project data into specific forms designed solely for project use). The data were depicted in a summary form that can be readily interpreted by busy clinicians, using graphical displays such as histograms. The feedback process includes passive and/or active strategies. Passive strategies involve dissemination of the summarized data (e.g. via fliers, leaflets, email) to the members of our project team. Active strategies involve face-to-face presentation of the summarized data to the team (e.g. Grand Rounds, departmental meetings, specially convened forums). Evaluation Through an ongoing assessment of the effectiveness of the changes with audits or surveys to help in evaluating adherence to process measures. Variation in the data from clinical pathway that we implemented needs to be fully explored. Identifying the reasons for any variation is an important first step in the process of practice improvement. The clinicians directly involved in providing care will have the greatest knowledge of the care processes and will be able to identify many of the specific solutions to address particular problems. Refining the pathway /protocol may be needed. There is much that our core team can do to support them. Once implemented successfully, the protocol will be revised regularly and modified where necessary, to take into account new research, new technologies, and results of evaluation of protocol outcomes. Most importantly, outcomes will be assessed to determine whether implementation of the protocol has produced the anticipated health outcomes. Publish implementation guidelines The change may be then ready for implementation on a broader scale in other rehabilitation department with a large percentage of spinal injury cases. Work Cited Legislative Council. The General Purpose Standing of Committee No 2: Handling of Complaints. Within NSW Health. UK: University of Calgary Press, 2004. Monash University: The Department of Epidemiology and Preventive Medicine. A study of Doctor’s views on how Hospital Accreditation can assist them provides Quality and safe care to consumers. Washington D.C.: National Academy Press, July 2004. NSW Treasury Managed Fund. TMF Guide to Risk Management – the RCCC Approach. London: Oxford University Press, 2005. Safety & Quality Council. Lessons from Inquiry into the Obstetrics & Gynaecological Services at King Edward Memorial Hospital UK: Prentice Hall Publishers, 1990-2000. AFRM Rehabilitation Medicine Indicators – Clinical Indicators – A Users’ Manual Version 3. 2002. Haines A, Jones, Implementing the findings of research. New Jersey. Oxford University Press, 1994 BMJ994; 308: 1488-1492. Sackett, Rosenberg, Gray, Haynes, Richardson, EBM: What It Is and What It Isn't. (Editorials) University of Michigan: Macmillan Publishers BMJ, 1996. Susan D. Horn, Clinical practice improvement: A new methodology for outcomes search. Nutrition, Volume 12, Issue 5, May 1996: 384-385. Greenhalgh T. How to read a Paper, the basics of evidence based medicine. BMJ books 2001 JM Clark et al. Physiological effects of the lower extremity functional electrical Stimulation in early spinal cord injury. 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