Quality Improvement in Health Care - Essay Example

Berwick's Theory of Continuous Improvement is that the problem in poor production of a group was not mainly of 'motivation or effort, but rather of poor job design, failure of leadership, or unclear purpose (Berwick, 1989).' It also maintains that real quality improvement is highly dependent on the continuous search for opportunities on the production process based on the existing data found within the processes themselves, to a point that even production defects and loopholes are turned into possible stepping stones toward quality development. Berwick laid out steps to practice the theory right. First, the leader should take the initiative in leading the quality improvement of the organisation. Second, substantial investments in quality improvement, such as in managerial time, capital, and technical expertise that will result in cost reductions in the long run, should be done; Third, re-addressing respect of management to its subordinates should be observed. Fourth, open and effective dialogue between patients and healthcare practitioners should be maintained. Fifth, though difficult to understand and to apply, modern technical tools, such as process flow analysis and control charts in quality management must be used in healthcare settings, Sixth, structured and refined managerial systems that organises quality for health care upgrades sensitivity to costs and inefficiency should be implemented. Specifying preferred methods of care without sacrificing standards of care should be observed falls under the seventh step. The eight and last step involves individual physicians in the effort of continuous improvement. With the poor service of the hospital in or case study, the hospital should devise a better procedure and system in its services. They should point out the defects that they have and act accordingly to solve these service problems. Personnel management particularly in recruitment of competitive staff and conducting of appropriate skills training play a vital role in improving the service quality of the hospital (Scally & Donaldson, 1998). Continuous learning of both the nurses and doctors are immensely important in upgrading their knowledge especially in prescribing medicines and drugs. 2. According to International Council of Nurses Code of Ethics, nurses have four main obligations: 'to promote health, to prevent illness, to restore health and to alleviate suffering (2006, p.1).' To do this, they should perform five steps in their routine jobs: assessment of their patient's condition, conduct nursing diagnoses, planning for the improvement of their patients' welfare, implementation of these plans to action, and evaluation of the quality of their service to their patients for future developments (Quan, 2006b). In Mrs. Osborn's case, we can see that the hospital has an organisational culture not conducive to healthy nursing practice. When Mrs. Osborn was admitted in the Accident and Emergency department, there was no clear admission policy that should have indicated which patient should be given medical attention first. They had not conducted proper procedure in assessing the condition of their patients. They should have taken their patients' vital signs, listen to their patient's complaints, and question health status. Instead of doing these, they were just idly referring her to others without finding out the gravity and nature of her condition. The nurses and even the doctors were not prompt in giving her immediate relief, because they have not diagnosed their patients properly. Another result of this neglect of proper diagnosis is their poor planning and execution of nursing their patients. False prescription due to clumsiness was evident in their services. Their procrastinations and lack of sense of urgency deterred them from applying the necessary steps to be taken. It took Mrs. Osborn several hours to be x-rayed, to be given appropriate medical attention and to be admitted in a ward, which, if only the hospital practices sound nursing practice, should have taken her more or less an hour. Moreover, the bruises she suffered by transporting her from different rooms in the hospital prove the slipshod nursing service and poor regard of patients' welfare. Lack of effective communication among nurses, doctors and other healthcare staff is the primary reason of the delay in x-raying Mrs. Osborn's ankle. Given that a nurse have referred her to the x-ray attendant or technician. The nurse should have known the condition of the x-ray machine either by inquiring the x-ray technician or by demanding a daily report of its availability and condition. If the machine is defective, the hospital should have a back-up plan (e.g. transferring the patient to a nearby clinic or hospital where x-ray is available). This will hasten the x-ray process and cut patient's waiting time. Another example of faulty communication line of the hospital is the delay of administering painkillers or appropriate medications. Mrs. Osborne had to suffer a lot of pain for an hour because of the delay of doctor's order. Nurses should be responsible in contacting the doctors about her condition or they should have consulted another doctor about her case. Lack of knowledge in complaints handling and management is another problem in the nursing system in the hospital. Instead of positively welcoming the complaint and act on it immediately, the ward manager has given Mrs. Osborn a glimpse of culture of blaming and lack of responsibility in accepting complaint. The ward manager should encourage feedback from Mrs. Osborn on a positive note, regarding the bad service that she experienced. He should also negotiate with her about what she thinks is the appropriate action for her case. Lastly, he should take the responsibility of solving the problem (Complaints Management Handbook for Health Care Services, 2005, p. 6). 3. There were several breaches in sound patient safety practice that we can observe in the Mrs. Osborn's case. One of them is the patient's susceptibility to be infected with communicative diseases and increased risk of accident due to her exposure to the attended patients at the Accident and Emergency department. At the age of 73, the nurses should be concerned about her safety despite her apparent good health. They should not risk the safety of patient under a very dangerous area, such as the Accident and Emergency department. Since her condition is not as critical and fatal as the patients that should be given urgent attention under this department, nurses should first position her in a safer place away from the hustle and bustle of the emergency room. The nurse could even refer her at once to a physician's clinic specialising in orthopaedics just to avoid potential health risks. Advising Mrs. Osborne of what rational action should she do on her condition was a wise move that should have been done by the nurses if they discovered that she was not familiar with hospital procedures. Careless attending and handling of patients is another safety issue that should have been addressed by the hospital staff. The delay for x-ray is an example for this. They should have promptly administered the necessary medications to alleviate her pain while waiting. Awareness on the danger of sloppiness in transporting patients using trolleys and other equipments should be taught to nurses is yet another proof of their carelessness. Nurses could even suggest to the hospital management to purchase ergonomically designed trolleys to minimise accidents in transporting patients. And in the case when injury has already been done, they should be responsible for the mistakes that they commit. Prescribing the wrong kind of drug because of carelessness is a very critical safety issue that should be addressed by the hospital administration. In Mrs. Osborn's case, the nurse has not consulted a doctor the moment he gave Panadeine instead of Panadol to her. He should have not done harm to his patient if only he asked a second opinion from others or if he consulted a doctor first before giving any medication to his patient (Quan, 2006a). 4. Dr. Berwick successfully adopted the principles of Deming and Juran, the proponents of Total Quality Management and designed it for healthcare services use. Continuous quality improvement's is based on two basic principles: First it focuses on the continuous improvement of "good guys" and bringing out the best in them. Second, it provides a "systematic improvement in processes by addressing the root causes of process problems" instead of putting weight on the "symptoms and individuals. (Melum, 1991, p.1)." Given Berwick's steps to give quality service to patients, the management of the hospital where Mrs. Osborn is admitted should initially lead in the commitment for healthcare quality. By recruiting good personnel the hospital management could have already manned its hospital with competitive and matured nurses and other healthcare professionals. Instead of pointing their fingers to the mistakes and failures of its lacklustre employees, the hospital management should have conducted skills training and opened its access to the information technology and existing data that would become their basis for quality improvement. It should also give them appropriate regard and value for their personnel (Scally & Donaldson, 1998). The management should also invest time, capital and technical expertise on improving quality. A good example of this is their investment on ergonomic trolleys and their establishment of additional space for old patients. Nurses and healthcare professionals should espouse an open and facilitative dialogue with Mrs. Osborn to assist her in her healing process especially so that she was not familiar with hospital procedures. They should attentively listen to her complaints in the light that they will learn from this and learn ways to improve the quality of their rendered services. They should also keep a record of cases of their previous patients together with the improvements they have made in their services by learning from these past experiences. They should improve the service process flow of the hospital by devising a strategy to smoothen it. They should have identified the key procedures that will cut a patients' waiting time tremendously. This includes ways on how to improve the service quality of the hospital by enhancing access to individual physicians in the process. 5. Quality care and patient safety is a growing concern in the medical community that various government and non-government organisations are tackling on these. In the United Kingdom the National Patient Safety Agency addresses patient safety by educating healthcare practitioners to practice patient safety. In the United States, improvement in quality care has been the primary concern of National Committee for Quality Assurance, a non-profit organisation. Physicians and healthcare practitioners formed the National Patient Safety Foundation where both health care practitioners and patients are fed with information on how to improve the safety of patients. They provide guidelines especially for the patients on how to be an active participant in promoting patient safety. This is very critical especially in cases where patients are clueless about hospital procedures, just as in the case of Mrs. Osborn. If only she know the rights and responsibilities of patients especially in commenting and complaining about her condition, she should have helped the healthcare practitioners in this hospital in observing quality service to their patients. 6. Clinical governance, bench marking, credentialing, and clinical pathways are essential methods performed to enhance service quality in a healthcare organisation. Observance of clinical governance, a system for clinical practice standard improvement composed of continuing education of healthcare practitioners, clinical auditing of clinical practice, clinical effectiveness, risk (including complaints) management, research and development, and openness to public scrutiny (Starey, p. 2), should have improved the system under which Mrs. Osborne's fracture is treated. This should have minimised the ineffectiveness and inefficiency of the process flow of treating patients in this hospital. Through benchmarking, the process of continually measuring the hospital's service performance against its major competitors and industry leaders (Glossary of Medical Terms, p.3), the hospital management should have been bothered about the level of their service if they compare it with others. Their competitive spirit could have driven them to improve the quality of their service. Credentialing, the process of checking a practitioner's credentials and references (Glossary of Medical Terms, p. 9), gives some assurance of the competitiveness and capacity of their staff in delivering quality service to their patients. Finally, a well-defined clinical pathway, which points out and formulates the sequencing of all elements of care required in a treatment process (Medicaid Demonstration Project, 1999, p. 9), organises the process flow of services that should have been rendered to Mrs. Osborn. With this, nurses could easily determine the procedure that should be followed to maximise the quality of their services while minimising the defects and mistakes in the process. References Complaints Management Handbook for Health Care Services (2005). Commonwealth of Australia: Australian Council for Safety and Quality in Health Care Berwick, D. (1989, January 5). Sounding Board: Continuous Improvement As An Ideal In Health Care. The New England Journal of Medicine. 320 (1). p.53-56. Retrieved September 4, 2006, from http://deming.eng.clemson.edu/pub/tqmbbs/health-care/apples.txt Galvin, R. (2004). 'A Deficiency Of Will And Ambition': A Conversation With Donald Berwick. Retrieved September 5, 2006, from http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.1/DC1 Glossary of Healthcare Terms & Abbreviations. (2002, July). New Jersey: New Jersey Hospital Association. Medicaid Demonstration Project Annual Report Fiscal Year 1997/98 (1999). Los Angeles: Los Angeles County Department of Health Services. Melum, M.M. (1991). How to make CQI work for you - continuous quality improvement of health care. Physician Executive. Retrieved September 4, 2006, from http://www.findarticles.com/p/articles/mi_m0843/is_n6_v17/ai_11647230/pg_1 National Committee on Quality Assurance. (n.d.). Retrieved September 5, 2006, from http://www.ncqa.org/index.htm. National Patient Safety Agency. (2006). 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