Health Services Management - Essay Example

? Health Services Management By Table of Contents Health Services Management By 1Course 1 Course Instructor 1 Date 1 Table of Contents 2 Six Sigma 4 LEAN thinking 6 Continuous Quality Improvement (CQI) 8 Quality Assurance (QA) 11 Conclusion 13 References 14 Introduction Management practices are techniques and methods, which an organization considers most effective and practical, and uses them to achieve its objectives and organizational goals, while making maximum utilization of organization resources. According to Nicholas & Reenen (2010), organizational management practices are the main reason for the differences in the productivity of organizations. Nonetheless, all organizations must have their own distinct management practices. This is because organizations are different in nature, and have varying goals and objectives (Basford & Slevin, 2003). Health care organizations are different in nature, as compared to other organizations, thus expected to have distinct management practices (Harris, 2006: Walshe & Rundall, n.d). However, healthcare organizations have imported most of their management practices from the corporate world. A survey conducted in the USA by Choufournier & St. Andre (1993) on 1,083 hospitals showed that 44% of the hospitals adopted different quality management methods from the corporate world, including continuous quality improvement, among others. Chassin & Galvin (1998) propose that health care organizations should develop their own management for increased effectiveness. This paper therefore, explores the argument that health care organizations are different therefore, should not import management practices from the corporate world. Reference is given to aspects of Six Sigma, LEAN thinking, continuous quality improvement, and quality assurance, which health care organizations have borrowed from the corporate world. This proposes the development of own management practices by health care system for realization of desired results in the management and quality of health care. Six Sigma In the past, the health care system has been operational without taking into consideration the factors of competition, increasing health care cost, and patient safety, among others. However, with increased competition in health care industry, these factors have gained great importance today, thus hospitals have realized the need to control their operational costs and offer quality patient care (Asubonteng, McCleary, & Munchus, 1996). Since competition has increased in health care industry, many health care organizations attempt to provide quality care to their patients at the lowest costs. However, it remains challenging for the administrators of health care organizations to consistently offer low costs to patients without compromising the quality of care (Bandyopadhyay, 2005). The Motorola Corporation incepted the six sigma quality improvement model in the 1980s, with the goal of measuring and improving the quality of products and services. The process is data driven, thus measurable. In this approach, in order to determine the baseline performance of a process, there must be data collection, which will be the basis of determining change in performance. This approach bases on statistics and facts, rather than history and the past. The Black and Green Belts, who are trained in quality problem solving, are responsible for application of six sigma model. The method applies the process of DMAIC (Define, Measure, Analyze, Improve, and Control). This together with DFSS (Design for Six Sigma) is applied to projects that are concerned with the development of new products or process, and the processes aimed at ensuring customer satisfaction, on budget and on time. Six Sigma has the capability of reducing errors, increasing financial gains, and increasing customer satisfaction. Since its inception, the Motorola Company realized great benefits, and this made other companies such as Xerox and General Electric to adopt the Six Sigma process (Koning et al. 2006). Although Six Sigma was originally used in manufacturing and service industries, the health care industry has previously incorporated this method in its management practices. According to Bandyopadhyay (2005), despite adopting this management approach in the past few years, the health care industry has not reported increased benefits from using Six Sigma. Pexton (2013) notes that the results of many studies conducted to determine the effectiveness of the Six Sigma approach in health care organizations show that about 62% of the adopted change initiatives fail. The health care industry continues to experience great challenges in using the Six Sigma method, as this was not originally designated for the industry. The major reason attributed to the failure for the health care industry to realize benefits in its adoption of Six Sigma approach mainly lies in the nature of the organization. The health care industry primarily deals with human beings, as opposed to the manufacturing organizations, which deal with machines. Therefore, unlike in machines, variability in humans is subtle and quite challenging to quantify. Therefore, in the health care organizations, it is challenging to leverage the data from Six Sigma to drive human behavior (Pexton, 2013). In the health care industry, there are four major indicators, which can be used singly or together to determine the performance level of an organization. These include customer satisfaction, service level, clinical excellence, and service cost. However, it is challenging to apply these four metrics in the health care setting. To apply the Six Sigma approach to health care organizations successfully, Bandyopadhyay (2005) argues that the approach has to be integrated with a cultural strategy for change acceleration and an effective mechanism for operations. Nonetheless, despite the challenges that face health care organizations in using the Six Sigma approach, some hospitals still utilize this approach in order to enhance the satisfaction of their patients. LEAN thinking Lean thinking was developed to improve the shop-floor performance of a manufacturer of automotive to a management approach that has both the sociotechnical and operational aspects. Joosten, Bongers & Janssen (2009, p. 344) define lean thinking as “An integrated operational and sociotechnical approach of a value system, whose main objectives are to maximize value and thus eliminate waste, by creating cumulative capabilities.” Value is the core aspect of lean thinking. Therefore, this ensures that the value-adding activities are enhanced, while the non-value activities, which are considered waste, are avoided. According to Joosten, Bongers & Janssen (2009), lean thinking is applied to the operations of an organization through the introduction of tools such as value stream mapping and 5S, which are essential for the creation of value. Health care organizations have therefore, incorporated these tools with the aim of achieving increased productivity, a reduction in waste in inventory, and reduced waiting times. These tools have however, not succeeded fully in realizing quality health care, or ending complications and infections in wards. According to Joosten, Bongers & Janssen (2009), lean thinking has not been highly effective in health organizations, because the approach focuses on the holistic and systematic view of process improvement. In health organizations, the application of lean thinking has to focus on a single process. This therefore, contravenes the principles of lean thinking, and has the effect of shifting problems to the next process, to which lean thinking has not yet been applied (Teich & Fauddoul, 2013). For instance, in mental health care, failure to ensure a timely outpatient follow-up after in-patient treatment results in more complications. Therefore, since health care processes are not integrated, the lean thinking might not be effective. This requires adoption of various strategies, which would ensure continuity between health care processes. Therefore, although the ward process is different from the outpatient process, when lean thinking is adopted, these two processes must be quickly diffused in order to form a total value system. Failure to achieve this will not ensure complete solutions to problems, thus there will be the emergence of additional problems (Joosten, Bongers & Janssen, 2009). On the operational level, the lean thinking approach is aimed at increasing improvements by lowering unwanted variations in processes. Variation is the difference in degree of a process when it is repeated. However, in health care, variation in most processes lacks. For instance, a surgeon does not perform surgery repeatedly on the same patient; neither does a psychologist consult with their patient more than once. Joosten, Bongers & Janssen (2009) note that although lean thinking might not apply directly to this natural variability in the health care organizations, this has been adopted to deal with the individual differences between patients and their needs and deliver patient cantered care. On the other hand, artificial variability in health care includes how the health care has been designed, thus, includes controllable factors. Therefore, when lean thinking is applied, this will realize non-value and value-activities in both natural and artificial variability. For instance, when scheduled admissions (artificial variability) contribute to overcrowding in hospitals’ ICU, as compared to unscheduled admissions (natural variability), then it is possible to identify and remove the non-value activities, thus boosting productivity. In health care, the applicability of sociotechnical aspects of lean thinking is quite limited. However, Joosten, Bongers & Janssen (2009) report that application of the sociotechnical aspects of lean thinking in health care organizations has resulted in considerable improvement in health care. For instance, these report enhanced patient turnover, improved opportunity for team work, and better communication between practitioners. However, this is not guaranteed for all cases where lean thinking is applied. Furthermore, it is quite challenging for the health care organizations to adopt the sociotechnical aspects of lean thinking effectively, as most have failed. Joosten, Bongers & Janssen (2009) note that this challenge is, because the process of adjustment requires the health care organizations to undergo a substantial transformation in their different aspects. In order for health care organizations to ensure effective adoption of different aspects of lean thinking, these have to uphold certain practices, which are essential for their adjustment. First, each employee must know their roles clearly. For instance, hospital administrators should leave the role of improving care processes to the professionals involved in care processes. Managers should concentrate on improving and developing the workforce, and creating a conducive environment for team work. Nonetheless, most managers have failed to embrace a shift in mind concerning their managerial roles in health organizations (Jones & Mitchell, 2006). Overall, although the application of lean thinking has considerable benefits to the health care organization if well adopted, this has failed to ensure steady and substantial positive changes. Therefore, there is need for increasing the role of lean thinking in order to achieve reasonable positive results. However, Koning et al. (2006) argue that this might be impossible to achieve unless the health care system undergoes a redesign. This will also require the health care industry to have patience, perseverance, dedicated professionals, and high quality leadership. Young & McLean (2009) argue that health care organizations should be cautious in applying lean thinking, as this might make it more difficult for health care to improve, considering the many challenges in adopting the approach successfully. Continuous Quality Improvement (CQI) This approach is also called Total Quality Management (TQM). Originally, CQM was used in the manufacturing sector. However, with the ‘quality movement’ that has swept different sectors, the non-manufacturing industry has borrowed this approach. The health care sector also started to adopt this approach gradually. Most health organizations have been forced to adopt this approach because of different reasons. First is the desire to enhance health care promotion practice. Secondly, there is expectations that in future, donors and the government will need the organizations they fund to have adopted quality improvement approaches in their management practices (Brannan, 1997). However, Kahan & Goodstsdt (1999) argue that although it is important for the health care organizations to ensure quality management, these must analyze the CQI, and identify its compatibility with the health sector. This is because; there are different concerns raised today regarding the application and adaptability of CQI to the health care sector. The term quality has different meanings for different persons. However, quality is overall considered to embody the notions of efficiency, consumer effectiveness, and satisfaction. In the health care organizations, the CQI refers to ‘a comprehensive management philosophy that focuses on continuous improvement by applying scientific methods to gain knowledge and control over variation in work processes’ (Tindill & Stewart, 1993). Practicing CQI’s principles involves the identification and improvement of problems and processes, and a repetition of the cycle. The adoption of CQI in the health care industry varies in different countries. While some health care organizations are still in infancy in their adoption of CQI to health promotion, others have an advanced adoption of CQI. The major components of CQI include customer satisfaction, the scientific approach, and the team approach. CQI emphasizes the importance of customers’ satisfaction. In health care organizations, a customer might be a patient, a colleague, or a payer. In addition, the scientific approach in CQI includes the elements of systems thinking, variation, data analysis, and benchmarking. All these elements help in providing a base for major decisions involving quality. Furthermore, the team approach in CQI emphasizes worker involvement, support from the management, and getting rid of artificial work boundaries. In health promotion, this encourages the inclusion of the people outside the organization, in the broader community, to teams in the health care organization (Babbar, 1992). Kahan & Goodstsdt (1999) note that the health care sector faces major difficulties in the implementation and practicing of CQI, because of different implementation and development obstacles. These include aspects of poor planning, lack of commitment from the managers, unsupportive organizational philosophy, and inadequate resources, among others. According to Kahan & Goodstsdt (1999), it matters that the health organizations are not manufacturing companies, and are not always service-oriented. This therefore, raises questions, as CQI was developed and adapted to the manufacturing of goods and later, to service provision. However, unlike products, which are individually oriented, health promotion is society or community oriented. Additionally, in CQI, customer satisfaction is core; however, in health care, it is challenging to determine customer satisfaction, as this requires careful examination. For instance, due to the different types of customers, with varying needs and interests in health care, there is always a conflict of interest, thus hard to determine customer satisfaction. However, CQI does not address the issue of conflict; therefore, this might not be effective in health care organizations, as these are faced with conflict as a major issue. Kahan & Goodstsdt (1999) also note that the effectiveness of CQI in health promotion has not been documented adequately. Therefore, this is a reason why health care organizations should hesitate before deciding to adopt CQI. This is unlike in the manufacturing industry, where major success has been reported on the use of CQI. Therefore, the adaptability and compatibility of CQI to health promotion remains a major concern, as this approach was initially designed to serve the manufacturing industry. Quality Assurance (QA) In some health care organizations, QA is used as an umbrella term under which CQI falls. However, there is a distinction between the two terms, as QA focuses more on results, while CQI focuses on processes, as well as outcomes. On the other hand, CQI is considered more progressive as compared to QA, because QA is more static in nature, and highly draws on standards. Most critics of QA base on the issue of standards to dismiss it. These are opposed to standards, citing the reason that, since QA requires an organization to reach the minimum required standards of quality; this might lead to organizations to have minimum aspirations. The history of QA dates back to the period after WW1. The purpose of this concept was to manufacture products and develop services that were of high quality. QA, like other approaches to management practices in health care, was originally designed for the manufacturing industry. Today, different other industries, including the health care organizations, have adopted QA and incorporated it into their management approaches. Nonetheless, QA includes the application of tools such as best practice, planning and achieving continuous improvements, and total quality and change management, among others (Merry & Crago, 2001). The health care sector has adopted the QA approach in order to assess the quality of their processes. Nonetheless, the adoption of QA in health promotion has led to varying results. While some hospitals have experienced a considerable improvement and effectiveness of health care and greater professional growth, among others, some hospitals have not reported the same impact. Therefore, the outcome of QA in health care organizations varies (Donabedian, 2002). According to Brown et al (n.d, p.12), QA can be defined as “that set of activities that are carried out to set standards and to monitor and improve performance so that the care provided is as effective and as safe as possible.” Health care organizations ensure quality through accreditations of hospitals, licensure, research, ethical standards, and standards of practice, among others. Mainly, these focus on the behavior and credentials of the health care practitioners. The three major components that make up QA include the assessment of patient care, utilization of objective criteria and standards, which are developed by peer-professionals to measure quality. Finally is the elimination of obstacles that hamper benefits of care. The main goal of adopting QA from the manufacturing sector in health care is to achieve measurable improvement in patient care, which can be attributed to the QA improvement action (Donabedian, 2002). Today, QA in health care is accepted as a way for patients and providers to evaluate the value of health care (Health Resources and Services Administration (n.d). However, according to McGlynn (1997), this approach has not helped health organizations to achieve fully their goals, with regard to health care quality. Quality assurance is highly data driven, and bases on data to determine quality. On the contrast, hospitals generate large volumes of data. However, the level of integration between the different departments is low; therefore, this makes it challenging for the data to undergo a transformation in order to gain meaning. This is because, for quality assurance to be successful, there must be an integration of data, which enables the establishment of quality indicators (Asubonteng, McCleary & Munchus, 1996). Therefore, the lack of effective integration of hospital data hampers the effectiveness of quality assurance. Conclusion This paper has explored different management practices in the health care industry. As seen, the different management approaches used in the health care industry are borrowed from the manufacturing industry. The quality management approaches explored in this paper include lean thinking, continuous quality management, Six Sigma, and quality assurance. Although these were originally used in the manufacturing industry, they were later adopted and integrated in the health care system for health promotion. However, an assessment of these approaches, including their effectiveness in the health care shows that their effectiveness is hampered by different reasons. Most importantly is the difference between the nature of manufacturing industry and the health care system. While the manufacturing primarily deals with products, the health care system focuses on human beings. Therefore, it might be challenging in ensuring the compatibility of management approaches from the manufacturing industry with the health care system. However, although the health care system has already adopted the management approaches originally used in the manufacturing industry, these fail to report a level of success that is equal to that reported in the manufacturing industry. Therefore, since the health care system is different from the manufacturing industry, including in its operations and processes, it is appropriate that the health care system designs its own distinct approaches to management practices. This might help the health care system to realize effectiveness in its management, as well as health promotion, as the new approaches to management will be aligned to the nature, functions, and processes of the health care system. References Asubonteng, P., McCleary, K. J., & Munchus, G. (1996). The evolution of quality in the US health care industry: An old wine in a new bottle. International Journal of Health Care Quality Assurance, 9(3), 11-19. Retrieved from http://search.proquest.com/docview/229614217?accountid=45049 Babbar, S. (1992). A dynamic model for continuous improvement in the management of service quality. International Journal of Operations & Production Management, 12(2), 38. Retrieved from http://search.proquest.com/docview/232355458?accountid=45049 Bandyopadhyay, J. (2005). The use of Sigma in Healthcare. International Journal of Quality & Productivity Management. 5 (1): 1-12. Retrieved from http://www.isqpm.org/2005%20Journal/Six%20Sigma%20Approach%20to%20Health%20Carel%20Quality%20Management-revised-1%20by%20Jay%20Bandyopadhyay%20and%20Karen%20Coppens.pdf Basford, N. & Slevin, O. (2003). Theory and Practice of Nursing: An Integrated Approach to Caring Practice. London: Nelson Thornes. Retrieved from http://books.google.co.ke/books?id=WCSunMx7EJ8C&printsec=frontcover#v=onepage&q&f=false Brannan, K. M. (1997). Total quality in health care. Production and Inventory Management Journal, 38(2), 69-73. Retrieved from http://search.proquest.com/docview/199923948?accountid=45049 Brown, et al (n.d). Quality Assurance of Health Care In Developing Countries. Retrieved from http://pdf.usaid.gov/pdf_docs/Pnabq044.pdf Chassin, M., Galvin, R. & National Roundtable on Health Care Quality. (1998). The Urgent Need to Improve Health Care Quality. JAMA. 280(11):1000-1005. doi:10.1001/jama.280.11.1000. Choufournier, R. L. & St. Andre C. (1993). Total quality management in an academic health Center, In Kahan, B., & Goodstsdt, M. (1999). Continuous quality improvement and health promotion: can CQI lead to better outcomes? Health Promotion International, 14 (1): 83-91.doi: 10.1093/heapro/14.1.83 Donabedian, A. (2002). An Introduction to Quality Assurance in Health Care. New York: Oxford University Press. Retrieved from http://books.google.co.ke/books?id=fDSriunx6UEC&printsec=frontcover#v=onepage&q&f=false Harris, M. (2006). Managing Health Services: Concepts and Practice. Sydney: Elsevier Australia. Retrieved from http://books.google.co.ke/books?id=yA2SR4DgU5wC&printsec=frontcover#v=onepage&q&f=false Health Resources and Services Administration (HRSA). (n.d). Quality Improvement. Retrieved from http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/ Jones, D. & Mitchell, A. (2006). Lean thinking for the NHS. Retrieved from http://www.lean.org.au/healthcare/uploadedFiles/1177226606031-1277.pdf Joosten, T., Bongers, I. & Janssen, R. (2009). Application of lean thinking to health care: issues and observations. International Journal of Quality Health Care, 21 (5): 341-347. doi: 10.1093/intqhc/mzp036 Kahan, B. & Goodstsdt, M. (1999). Continuous quality improvement and health promotion: can CQI lead to better outcomes? Health Promotion International, 14 (1): 83-91. doi: 10.1093/heapro/14.1.83 Koning, H. et al. (2006). Lean Six Sigma in Healthcare. Journal for Healthcare Quality. 28(2):4–11. Retrieved from http://dare.uva.nl/document/44174 McGlynn, E. A. (1997). Six challenges in measuring the quality of health care. Health Affairs, 16(3), 7-21. Retrieved from http://search.proquest.com/docview/204619125?accountid=45049 Merry, M. & Crago, M. (2001). The Past, Present and Future of Health Care Quality: Urgent need for innovative, external review processes to protect patients. Retrieved from http://www.tuvamerica.com/services/medical/articles/merry.pdf Nicholas, B. & Reenen, J. (2010). Why Do Management Practices Differ across Firms and Countries? Journal of Economic Perspectives, 24(1): 203-24. DOI: 10.1257/jep.24.1.203 Pexton, C. (2013). Measuring Six Sigma Results in the Healthcare Industry. Retrieved from http://www.isixsigma.com/industries/healthcare/measuring-six-sigma-results-healthcare-industry/ Teich, S. & Fauddoul, F. (2013). Lean Management—The Journey from Toyota to Healthcare. Rambam Maimonides Medical Journal. 4(2): 1-9. Retrieved from http://www.rmmj.org.il/userimages/258/1/PublishFiles/265Article.pdf Tindill, B. S. and Stewart, D. W. (1993) Integration of Total Quality and Quality Assurance. In Kahan, B. & Goodstsdt, M. (1999). Continuous quality improvement and health promotion: can CQI lead to better outcomes? Health Promotion International, 14 (1): 83-91. doi: 10.1093/heapro/14.1.83. Walshe, K. & Rundall, T. (n.d). Evidence-based Management: From Theory to Practice in Health Care. Retrieved from http://www.cebma.org/wp-content/uploads/Walshe-en-Rundall-Evidence-Management-From-Theory-to-Practice-in-Health-Care.pdf Young, T. & McLean, S. (2009). Some challenges facing Lean Thinking in healthcare. International Journal for Quality in Health Care, 21 (5): 309–310. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742395/ Read More