Health and Quality Care Administration - Essay Example

Continuous Quality Improvement (CQI) has several philosophical elements. These elements have to be present in order to indicate that an attempt at CQI is being undertaken. These elements include strategic focus, customer focus, systems view, data driven analysis, implementer involvement, multiple causation, solution identification, process optimization, continuing improvement, and organizational learning. Strategic focus is important in achieving CQI, it emphasizes on setting goals upon which the improvement process activities are based on. Through strategic focus it is ensured that all activities undertaken in the institution are aligned with the goals for CQI. Customer focus contributes to CQI because it emphasizes on the satisfaction of the customer in assessing the performance of the institution. The customer usually has high expectations of quality in healthcare service, and focusing on them in order to measure the performance of an institution is a sure way of establishing CQI. In order to assist in establishing CQI, systems view takes into consideration the entire system or process that gives the service or affects the results in the CQI process. It takes a holistic view of the system and determines where improvements need to be made in order to reach CQI. Data driven or evidence-based analysis contributes to CQI in the sense that it focuses on objective data in order to establish the status of the institution. It focuses on what the institution actually did or did not do to assist or deter it from establishing CQI. Implementer involvement takes into account the executors and owners of the system in order to understand the delivery of services. Through this element, the people involved in the implementation of the system are assessed on their role in reaching CQI. In establishing CQI, multiple causation takes into account all possible causes of phenomena seen in the institution. Through this element, it is possible to determine the causes of problems in an institution in order to ultimately avoid encountering these same problems in the future. Solution identification helps establish simultaneous improvements to what would have been independent functions in the system. Through solution identification, problems in the implementation of quality healthcare services which normally are diverse and independent of each other are addressed and solved as related items. In process optimization, precedents in the delivery of services are disregarded. Through this strategy, CQI is achieved because it disregards existing traditions in the delivery of services, and it focuses on what changes can be made in order to achieve CQI. Continuing improvement focuses on coming up with ways to improve the system regardless of satisfactory solutions already reached on existing problems. CQI is achieved through this element because the people involved are never satisfied with the heights that their organization has already reached. Through organizational learning, CQI is achieved because the growth of the institution is ensured by focusing on what it can learn from its activities and actions. The methodological or structural elements of CQI are the process improvement teams, the seven quality tools, parallel organization, top management commitment, statistical analysis, customer satisfaction measures, benchmarking, and redesign of processes from scratch. The process improvement team formulates different groups in order to solve and address the various problems in the organization. The seven quality tools (flow charts, cause-and-effect diagrams, histograms, run charts, check sheets, Pareto charts, and correlation analysis) are used in order to assess the degree of quality of services in the healthcare industry. The parallel organization is set-up as a separate management structure in order to determine the priorities of the organization and to monitor the strategies and tools used to achieve CQI. Top management commitment entails the installation of excellent and able leaders who can aggressively pursue utmost quality in healthcare delivery. Statistical analysis involves the use of different statistical tools in order to assess the performance of the institution and to reduce variance in the delivery of healthcare services. Customer satisfaction measures involve the use of research instruments in order to adequately assess the satisfaction of the customer at various levels and aspects of service-from the internal to the external customer. Benchmarking involves assessing the entire industry and discovering the best practices of various institutions. Once these best practices are identified, decisions are made on which practices are to be adapted to their own institutions. Redesign of processes from scratch requires an overhaul. In assessing changing and diverse customer needs, various institutions sometimes re-engineer their institution and the processes they apply in meeting customer needs. These methodological elements all have a unique and important role to play in achieving CQI. They occupy various functions from the technical, to the structural, to the philosophical. There are ten key lessons set forth by the National Demonstration Project on the improvement of the quality of health care. The first is that cross-sectional teams are available in improving health care processes. This means that there are people adept in addressing the diverse problems of any institution in order to improve the delivery of health-care services. Their skills can cross the technical aspects of the various disciplines involved in healthcare. The second lesson is that quality improvement tools can work in health care. It is possible to assess the quality of service and of health care. Assessing quality is not anymore just focused on equipment and industrial tools, there are now appropriate quality measures for health care services that accurately examine and determine how well healthcare services fare. The third lesson is that data useful for quality improvement abound in healthcare. This means that information needed for the improvement of healthcare services are now very much available. There are different tools and information which can be easily accessed in order to determine how healthcare services may be improved. The fourth lesson is that quality improvement tools are fun to use. Quality improvement tools are exciting ventures into undiscovered depths of healthcare service. They present new and exciting techniques that can help improve services, at the same time, help engage the interest of the users. The fifth lesson is that the cost of poor quality is high and savings are within reach. Poor quality healthcare services tend to cost more because they usually cause more damage, and efforts to repair these damages will cost both the consumer and the provider more money. Savings are also easily accessible to many consumers. Many patients can now avail of savings in order to ensure their access to quality healthcare services. The sixth lesson is that involving doctors is difficult. Doctors can either be traditional or be very liberal in their approach to health care. This makes dealing with them often difficult and complicated in achieving CQI. The seventh lesson is that training needs arise early. The importance of training members of the healthcare team is usually manifested early in the delivery of healthcare. The soonest possible time it is accomplished, the better for the provider and the consumer. The eighth lesson is that non-clinical processes draw early attention. Many consumers are fascinated by unconventional medicine. By this reason alone, many non-clinical processes gain immediate attention as soon as they are introduced into the healthcare service. The ninth lesson is that healthcare organizations may need a broader definition of quality. In order to achieve genuine and optimum levels of quality, some health care organizations need to be defined using bigger and broader definitions of quality. Finally, in health care as in any other industry, the fate of quality improvement is first of all in the hands of the leaders. Good leadership will help any organization reach its goals and even redefine its goals for quality. A firm and focused will in leaders can make the difference between success and failure in health care delivery. I would consider the second, fourth, seventh, and the tenth lessons to be the most important lessons learned. They are the most important because first and foremost, quality improvement tools which are now available in health care help measure and assess the performance of the institution in the delivery of healthcare services. Quality improvement tools represent the yardstick against which quality of healthcare is measured. In recognizing that quality improvement tools are easy to use, many healthcare providers can be engaged to embrace quality into their practice; to accept it and not to fear it; and to apply it into their practice. It is also important to learn that training needs arise early. In recognizing this, necessary adjustments in the establishment of capable and competent healthcare service providers can be made as early as possible. Finally I believe that it is very important to recognize the relevance and the vital role of capable leaders in the implementation of quality health care. It is very important to know that the success or failure of quality healthcare is very much dependent on the appointment of good and capable leaders into positions of authority in the health care industry. There is such a growing emphasis on clinical quality issues because of the various medical and technological advancements in healthcare. These advancements have brought about various issues in quality for updated and outdated medical techniques and processes. “These problems, which may be classified as underuse, overuse, or misuse, occur in small and large communities alike, in all parts of the country, and with approximately equal frequency in managed care and fee-for-service systems of care”(Chassin & Galvin). Many patients have been harmed as a result of these quality issues. And so many interest groups and concerned individuals are putting the issue of clinical quality into the spotlight. They contend that there is a need to “undertake a major, systematic effort to overhaul how we deliver health care services, educate and train clinicians, and assess and improve quality” (Chassin & Galvin). Clinical care is very important in Clinical Quality Improvement because it is the manifestation of healthcare service that is being measured by the quality care measures. It is the aspect in the CQI which is assessed and determined to be either within or outside the standards set by CQI regulators. Florence Nightingale first used outcome measures in the 1860s in order to determine quality of healthcare. She accomplished this by systematically gathering mortality rates from different hospitals. She analyzed the effects of improved sanitation and nutrition of patients on hospital mortality rates. Based on the outcome of patient conditions she was able to determine that the mortality rates of patients were affected by the improvements made on their nutrition and sanitation. Nightingale’s study on outcome measures emphasized the importance of looking into the stage and severity of the disease, the issue of two or more illnesses present at one time, the health illness and behavior of the patient, and economic barriers to receiving care. The mid-1900s brought about various researches in the establishment of criteria, protocol, and standards in order to measure quality. Various researches during this period yielded major differences in medical practice, unnecessary surgery, and preventable complications. These studies revealed the need to come up with quality of care measures. There was much discussion about the conduct of quality of care assessments-about who, how, and by what standards this assessment shall be carried out. Many clinicians also took issue with evaluation being carried out by non-clinicians or non-practitioners. Since the dawn of the 20th century, the task of performing quality care assessment on healthcare providers was delegated to doctors. They were deemed worthy and competent professionals in evaluating the performance of healthcare givers. The American College of Surgeons served as the formal organization authorized to assess the quality of care given by healthcare institutions. They implemented the Hospital Standardization Program as minimum standards in assessing health care service in hospitals. Initially, no hospital could measure up to the standards set by the program, although about 3000 hospitals were able to gain accreditation from the program by 1951. This program later became the Joint Commission on the Accreditation of Hospitals. Initially, the Joint Commission implemented the standards set by the ACS, however, their standards later expanded to cover administrative issues. It was later able to gain political acceptance when the issuance of licenses was given based partly on accreditation from the Commission. The Joint Commission was later succeeded by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) which covered not just hospitals but other healthcare organizations as well. Many hospitals and healthcare institutions based their quality improvement activities on the standards set by the Commission. In the 1980s, hospital quality assurance personnel were asked to identify problems, set goals, and focus on errors in order to improve the quality of services. The entry of various medical advancements like computers and sophisticated equipment made great impact on the need to conduct quality care assessments. In the 1980s, the Healthcare Financing Administration began releasing the mortality rates of hospitals to the public. Their method in assessing had major flaws and prompted many hospitals to defend themselves against these mortality rates. At about the same time, the New York State Department started gathering clinical data about patients undergoing Coronary Artery Bypass Graft (CABG). Their data was released to the public, and gained numerous negative reactions from practitioners and hospitals. Questions about accuracy of results, patient-specific, and surgeon-specific data were brought out. Various improvements on the conduct of these studies have been improved throughout the years. And now, many hospitals have adapted the practice of posting mortality rates and other relevant statistical data concerning their practice over the internet and through annual reports released to the public. At present, various websites now publish statistical and outcome of quality measures from hospitals and other healthcare institutions. Healthgrades.com has started publishing hospital ratings since 1999. The 21st Century has also ushered in other assessing organizations like the Institute of Medicine that focus on patient safety issues aside from the other standards set forth by the JCAHO. Outcome measures were only considered a priority by the United States until recently because there were political as well as technical problems in measuring the quality of healthcare. The problem of the standards upon which quality will be measured was the initial problem seen by healthcare practitioners. In order to solve this problem, doctors were assigned to assess the quality of healthcare in hospitals. This practice did not gain support and acceptance until the 1950s when more hospitals sought to gain approval and commendation from the JCAHO. However issues on the standards set by the commission were still questioned by some practitioners and hospitals. The standards were criticized for not indicating how potential problems in the hospital and healthcare service were to be identified and addressed. As a result, the hospitals focused on the standards set by the JCAHO and not on how problems in hospital quality would be resolved. When the 1990s and the 21st Century brought forth technological advancements and changes in practice, the need to establish and adhere to outcome measures gained complete and comprehensive notice from the healthcare industry. Questions on the quality of service of various institutions were emerging and this prompted the government and the public to take a more active role in assessing the quality of healthcare services. Information technology has also prompted various hospitals and healthcare institutions to consider upgrading their services and outcome measures. Consumers have also taken a more active role in healthcare service; they now take time to determine which hospitals deserve their patronage. They are more discerning in their choices. This discerning consumer led many hospitals to become more interested in the outcome of their services. They have become more conscious about how well they do their work, how their patients fare, how many die, how many live. Various professional societies have also taken upon themselves the task of looking into the outcome of healthcare services in hospitals and healthcare practitioners. Through their own standards, they now evaluate and assess the quality of care given by healthcare institutions. Various insurance companies also look into information related to outcome of healthcare service in hospitals and healthcare providers. From outcome measures, they determine cost of insurance and coverage. Other regulators, organizations, and potential employees also look into outcome of health care services in various institutions. From these reports, they decide patronage, employment opportunities, endorsement and accreditation. The measurements and statistical analysis used in quality improvement process are flow-charts or diagrams, cause-and-effect diagrams, check sheets, Pareto diagrams, histograms, run charts, regression analysis, and control charts. Flow-charts present a visual or pictorial representation of the system. They trace the progress of the system from start to finish. Cause-and-effect diagrams present the relationship of one event with another. It shows a clear aftermath of how the system and process evolved from one point to another. It is usually used in presenting the results of brainstorming sessions. The use of check sheets entails counting the frequency of activities or outcomes. In this method, the observer simply records the frequency of observations in the check sheet. The Pareto diagram is a vertical bar chart. Each bar represents the frequency of a particular item in the observation. It also represents a cause and effect matrix. A histogram is also a bar chart; however it presents data in a way that displays the nature of the distribution. Run charts help answer the question of “Are we doing better?” It allows for a comparison from where one was to where one is now. Regression helps assess current concepts and suggests new ideas based on the success of suggested hypothesis. Regression analysis provides a way of looking for unknown or ignored correlations and associations crucial to decision making. Last, but not least, control charts help measure quality based on control variables or through the use of upper and lower limits. Variation or variance is the point from which a process steers away from the norm. In applying this concept to health care, variation represents the difference that each patient has with other patients. These variations affect how the quality of healthcare service is measured. In order to come up with more accurate statistical results and measures, these variations need to be reduced. In order to anticipate the efficient delivery of healthcare services, the administration needs to be one-step ahead; it needs to anticipate the needs of the patients. In order to do this, the healthcare providers need to come up with more reliable answers. Variances in patient needs and responses have to be reduced. Variation should be controlled in order to achieve improved quality of healthcare delivery. There are internal customers in the organization. In the healthcare organization, the physicians, the nurses and the pharmacists are three possible internal customers. Three possible external customers would be patients, insurance payers, and healthcare regulators. The internal customers work “within the organization and receives the output of another employee” (Kelly-Heidenthall, 2002, p 380). The external customers are outside the organization and are recipients of the output of the organization. One cannot exist without the other. The internal customer labors to service the needs of the external customers, and the external customers benefit from the services given by the organization. Reference Chassin, Mark & Galvin, Robert. The Urgent Need to Improve Health Care Quality. 1998. Journal of the American Medical Association. 13 September 2008 from “Continuous Quality Improvement”. 1 May 2006. American College of Surgeons. 13 September 2008 from Kelly-Heidenthall, Patricia. Nursing Leadership & Management. New York: Thomson Delmar Learning, 2002 Harrigan, MaryLou. Quest for Quality in Canadian Health Care: Continuous Quality Improvement. 2000. Health Canada. 13 September 2008 from McLaughlin, Curtis & Kaluzny, A. Continuous Quality Improvement in Health Care, 3rd Edition. New York: Jones & Bartlett, 2005 Read More