Continuous Quality of Health Care the Pros and Cons - Research Paper Example

Continuous Quality of Health Care and the Pros and Cons al Affiliation Continuous Quality Improvement in health care is one of the most essential processes that are not only adopted by the health care systems, but also institutions, organizations and industries. It is therefore regarded as a tool used to improve the services offered by afore mentioned departments. It entails a systematic approach to data collection and subsequent analysis of the data, in order to identify the opportunities available to improve the organization for better deliveries and customer satisfaction. This essay aims at shedding light on the issue of Continuous Quality Improvement in health care and the advantages and disadvantages that come with it. Most health sectors respond to the recommendations on quality and have invested in teams that are geared towards Continuous Quality Improvement. Although the process is enhanced by various situations, there are also issues that tend to inhibit the process though arguably with less impact. It is recommended that despite the challenges, the process of quality improvement should progress and the concerned authorities should do as much to reduce the inhibiting factors. Keywords: Continuous Quality Improvement, Health Care, Quality Introduction Quality of health care is a core value for the medical personnel. Medical professionals have shown their commitment in quality health care through participation in various boards such as hospital quality committee and board certification. Mclaughlin and Kaluzny (2006) refer to Continuous Quality Improvement as “a structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations” (p. 3). Quality improvement provides an approach and procedure used at various times for performance improvement initiatives, undertaken by setting up some respective institutions such as the one given by Mclaughlin and Kaluzny (2006). These include localized improvement efforts, organizational learning, process engineering, evidence based medicine and management. Localized improvement is applied when a need to develop a specific process occurs; organizational learning is for the purpose of documentation and implementation of results. Process engineering comes into action when there are internal and external resources to be used to make changes. Evidence based medicine and management has it that there should be examination of professional literature and internal experience during the selection of the best clinical and management practices. Emphasis on quality has increased in the society, as organizations too have embarked on continuous quality management. The driving reasons include need to control finance, customer control, official recognition requirements, as well as increased pressures from both the employers and the payers. Mclaughlin and Kaluzny (2006) further highlight the strategies for Continuous Quality Improvement. These are: Competition. Process improvement. Conformance to requirement. Reasons for Health Care Improvement To conform to the rapidly changing external environment. Improvements made are in such a way that they understand and adapt to this kind of environment. Managers and clinicians need to be empowered so that they can improve. To ensure that customer preferences are considered and that the health system ensures that patients and providers are included in the process. Development of a system that goes beyond professionalism. Implementation of an ongoing process of change and adaptation. Plan mechanisms that ensure best practices are implemented and continued organizational learning. Health care improvement involves the willingness to study the existing health care process and setting the procedure of combining administrative knowledge, together with data collection mechanisms and consequently making an analysis. It is observed by Mclaughlin and Kaluzny (2006) that “Continuous Quality Improvement inherently increases the dignity of the employees involved because it not only recognizes the important role belonging to each member of the process improvement team” (p. 8). It is by no surprise that organizations that have resolved to the Quality Improvement Mechanism often record improvement in their moral. Once the quality is high, the workers are so much impressed and their pride is so high regarding the work they are doing. They can even go far receiving recognition beyond regions. Sollecito and Johnson (2011) say that “in recent years, the emphasis on quality has increased at the societal level” (p. 5). Estimates made for the nonconformance involves identifying and assignment of values of unnecessary costs due to wastes such as the cost wasted, while identifying errors and correcting them. Continuous Improvement in other words can be taken to mean adding value, a side ensuring achievement of highest quality. There is greater accountability and transparency that would ease the process of evaluating the initiatives set through the Continuous Quality Improvement department. According to Sollecito and Johnson (2011), the concept of health improvement has in recent years experienced a resurgence; they say that “several leading experts propose refocusing on quality and accountability simultaneously” (p. 6). Advantages of Continuous Quality Improvement in Health Care Intrinsic motivation Majority of nurses and other health workers are in full support of the concept of quality care and are always eager to witness various improvements. Furthermore, they participate in the meaningful construction of quality improvement process. As McLaughlin and Kaluzny (2006) say, “allowing personnel to work on their own process, permitting them to do the right thing, and rewarding them for that behavior is almost sure to increase intrinsic motivation in employees, if done properly” (p. 10). Therefore, encouraging the nurses to participate in health care quality improvement would raise their morale. Quality improvement needs data collection and analysis to provide the check level and decision points on where improvement is needed. One such plan is to engage staff in data collection. The advantage of this system is that the employee is given the chance to collect data at the same time he or she is on the daily duty. Leebov (2003) argues that “the data collection experience itself motivates staff members to take whatever steps they can to improve performance, either by improving their own performance or by suggesting improvements that will better satisfy their customers” (p. 61). Arresting the intellectual workforce While it has downed to the industrial managers that their workers have better understanding of the industrial work than they do, it would be advantageous to also realize that nurses know much more than what has been provided by the management, and therefore their leading authorities have resolved to allowing them to apply their knowledge and insight to the health process. McLaughlin and Kaluzny (2006) having noted this observation argued that “this is true in health care, where the professionals employed by or practicing in the institution control the technological core of the organization” (p. 56). Indeed, management that does not take advantage of such kind of realization is doomed to fail. Through continuous health care improvement, the health management has come to make better use of its workforce, especially the nurses, and they have had the opportunity to exercise their profession, as well as apply their specialized knowledge within the hospital and nursing environments. Performance of key processes An organization often measures the performance of important functions at the lower levels, reason being that this is the region that has the greatest impact on customers perceptions of the characteristics that are most meaningful to them. Leebov (2003) observes that “patients value timelessness of service; the organization might measure the timeliness of several key processes such as discharge, nursing services and so forth” (p. 55). This key attribute of an organization is achieved through Continuous Quality Improvement and is important to ensure that patients remain satisfied with the services rendered by the organizational nurses. Continuous check on performance ensures satisfaction with the department, there is constant check on the feedback concerning performance output significant to the nursing department. The most monitored processes are the response time to regular requests for maintenance, time taken to respond to a stat request, and the response time to nursing questions or complaints. Through the performance check, one would be able to routinely ascertain the significant quality attributes. Again at the lowest levels, nurses would be able to have important steps in the processes and critical control points. An example given by Leebov (2003) is the time taken by the receptionist to log onto an order and convey it to the supervisor for further delegation to the appropriate person (p. 56). simple parameters that could be used by such departments are the continuous check on completeness of medical orders by nurses without the need for clarification, legibility of orders, the level of appropriateness of stat orders, and the courtesy of nurses when on telephone contacts. Reduction of managerial overhead Through Continuous Quality Improvement, many companies have been able reduce the layers of management because introduction of workgroups has taken over most of the responsibilities that had previously been undertaken by the management. The redesigned work done and distribution of workforce has led to reduction of the required work specialists, as well as overhead staffs. It is reported by McLaughlin and Kaluzny (2006) that “the new investment in Continuous Quality Implementation is a catching- up process for the lack of process oriented staff that are involved in process in most other industries” (p. 56). Health care institutions are among the organizations that have already registered limited number of staff positions, the reason being that corporate staffs seem to have more knowledge than the professionals. The balance in management can be achieved through the process of continuous health care quality improvement. Capacity increment In health care systems, management can lack enough knowledge of the technological integral of many activities. For example, in the case of management representation, professionals are restricted to one area where they have full knowledge. This can be translated to show case the use of nurses nursing environments. Continuous Quality Improvement vastly improves the effective capacity of the organization, as it examines processes and implementation of change. An essential characteristic of Continuous Quality Improvement is that as the name suggests, a continuous process, quality achieved in health sector is as a result of a high level of commitment regarding the ongoing evaluation, and improvement of patient results (Alexander, 2011). According to the Continuous Quality Improvement, it is assumed that an outcome can never be optimized, but can continually be improved. A further attribute of CQI is that it lays an emphasis on improvement of interdisciplinary functions, but not personal. In this regard, Alexander (2011) suggests that “applying this concept to infusion nursing requires that all factors contributing to the quality of care be examined” (p. 29). There have been large variations in health care systems whereby they have slowly translated into missed chances for improvement. In the medical field, if such errors are removed, the requirements for professionalism and responsiveness have become so much extensive. This observation has been echoed by Sollecito and Johnson (2011) who say that “this sea change goes well beyond concerns about malpractice insurance, to issues of clinical governance, professional training, certification, and continuity of care” (p. 25). Economic good The question of finance has well been in the public domain as far as the health sector is concerned. However, due to reforms in the health care systems, financial institutions have adopted and implemented the reform initiatives and the review and reorganization of the National Health Service has extensively led to saving of large amounts of money (Sollecito & Johnson, 2011). Organizations in the industrial sector have contributed to the growth registered in health sector; due to this, the health sector has been labeled to as corporations, its goals being creating larger hospital systems. Mass personalization Personalization has been defined by Sollecito and Johnson (2011) as “an evolutionary concept that is not only having an impact on how industries deliver products and services, but also how organizations are structured” (p. 32). This can well be blended into the health sector as it is directly related to Continuous Quality Improvement; this is due to its main focus of promoting customer satisfaction. Evidence based practice is part of CQI and states that the moves in using evidence based practice include evaluation of the best data presented, as well as making individual judgment and observing patients preference, while making the final judgment. As health care grows, personalization goes past the limits of patients having access to medical information. As noted by Sollecito and Johnson (2011) “it relates directly to medical strategies and emerging science for providing higher quality, safer, more personalized treatment” (p. 34). CQI philosophies and processes have evolved within health care. Sollecito and Johnson (2011) note that “a series of broad based approaches have evolved and proven to be successful across a range of health care settings” (p. 35). With this, it can be said to be an approach within which a specific method can be applied. The two most notable methods under this category are the Plan Do Study Act (PDSA) cycle and the Quality Improvement Collaborative. Both strategies have proved to yield success in the health sector, given a variety of improvement methods. Disadvantages of Continuous Quality Improvement in Health Care Professional responsibility In many cases, the health care system is likened to the cottage industry due to its bias towards treatment instead of prevention. It also has a monopoly towards its access and implementation of technical knowledge (Sollecito & Johnson, 2011). It is reported that the public have rendered their criticism towards the weakness of the professional system towards its effort to improve the quality of care. The claims points towards extra professional autonomy. Sollecito and Johnson (2011) list them as “protectionist guild practices such as secrecy, restricted entry, and scapegoating; lack of capital accumulation for modernization; and economic self-interest as major problems” (p. 7). Difficulty in organizing clinical guidelines Nurses quite often have tight schedules due to the nature of their duties; they are one of the busiest personnel in the health sector. Managing a schedule concerning the process of continuous quality improvement proves to be very difficult since it will greatly inconvenience the nurses. It has been observed by Mengel and Fields (1996) that “guidelines have met with some resistance by practicing physicians, some of whom call them “cookbook medicine”” (p. 459). Cumbersome process The process of Continuous Quality Improvement involves the participation of many characters. The employees may have a mixture of experienced and inexperienced health workers, those still learning the job have to rely more on the senior colleagues; at the end, all these render the whole process cumbersome. Health sectors like any other organizations have one of their goals to improving the performance of the organization; this calls for total participation of the organization, management and workers inclusive. It has been noted by Gingerich and Ondeck (1996) that “many organizations comment that the process seems cumbersome and confusing, they cite resistance among staff until the first project team works through the process and experience success” (p. 196). Economic self interest If there has been a detracting character to development is working with people who have self-interests in their hearts, more than the interest of the people and the society. It was once suggested by Millenson that “even with all the public concern about medical error and patient safety, improvement cannot occur without both institutional will and professional leadership” (as cited in Sollecito & Johnson, 2011, p.8). Jan et al. (2005) suggests that self-interest has to be replaced by internalized values of professional ethics. This argument urges those selected to participate in quality improvement to put aside personal greed at the expense of the patients. To further insist on negation of this practice, Ballard (2013) calls for change in behavior by those who have a lot of personal interest. He argues that “quality improvement often calls for independent physicians to engage in organizational issues that are not clearly connected to their own time and financial needs” (Ballard, 2013, p. 34). Political influence The process of continuous quality improvement has come through thick and thin. Sollecito and Johnson (2011) observe that “many health care processes have developed and expanded in a complex political and authoritarian environment, acquiring the patina of science” (p. 8). Political influence in the process of an organization is very dangerous because it may not be predicted the direction to which it can go; politics can be easily swayed depending on the government. Politics have a role in health care, since they provide legislation; this influences the direction of health care and how health care is being provided. Nurses are at some point forced to apply political pressure so that they can achieve the improvement they desire (Stainton, Hughson, Funnell, Koutoukidis & Lawrence, 2009). It calls for a political stand for research proposals to get funding (Mason, Leavitt & Chaffee, 2013); though this argument has it that science and politics are one, it affects the process of quality improvement. Conclusion Continuous Quality Improvement is a vital process in health care. This is because it generally leads to improvement of services delivered. The process however has its advantages and its disadvantages as discussed in the paper. However, despite the disadvantages and inhibiting factors, the process should progress. Reference List Alexander, M. et al. (Eds.). (2011). Infusion Nursing: An Evidence- based Approach. Amsterdam: Elsevier Health Sciences. Ballard, D. J. (2013). Achieving STEEEP Health Care: Baylor Health Care System’s Quality Improvement Journey. Florida: CRC Press. Gingerich, B. S. & Ondeck, D. A. (1996). Home Health Redesign: A proactive Approach to Managed Care. Burlington: Jones & Bartlett Learning. Jan et al. (2005). Economic Analysis for Management and Policy. New York: McGraw-Hill International. Leebov, W. (2003). The Health Care Manager’s Guide to Continuous Quality Improvement. Bloomington: iUniverse Publishers. Mason, D. J., Leavitt, J. K. & Chaffee, M. W. (2013). Policy and Politics in Nursing and Healthcare-Revised Reprint. Amsterdam: Elsevier Health Sciences. McLaughlin, Curtis P. & Kaluzny, Arnold D. (2006). Continuous Quality Improvement in Health Care: Theory, Implementations, and Applications. Burlington: Jones & Bartlett Learning. Mengel, M. B. & Fields, S. A. (1996). Introduction to Clinical Skills: A Patient-Centered Textbook. New York City: Springer. Sollecito, W. & Johnson, Jullie K. (2011). Mclaughlin and Kaluzny’s Continuous Quality Improvement in Health Care. Burlington: Jones & Bartlett Publishers. Stainton, K., Hughson, J., Funnell, R., Koutoukidis, G. & Lawrence, K. (2009). Tabbner’s Nursing Care: Theory and Practice. Chatswood: Elsevier Australia. Read More