Legal, Ethical, and Risk Aspects in Total Quality and Risk Management - Essay Example

Legal, Ethical, and Risk Aspects in Total Quality and Risk Management Legal, Ethical, and Risk Aspects in TotalQuality and Risk Management Introduction As is the case with all other service providers, healthcare also aims at being as effective as it can be. The only way that this can be achieved is through quality improvement and managing risks which may hinder the attainment of the said goal. Quality improvement simply means upping the currently provided services so they become better or introducing innovated ones. Risk management on the other hand is mandated with countering the uncertainties which may emerge from environmental, safety, health, financial, or clinical factors. The implementation of quality improvement and risk management is achievable by devising programs or plans which guide their application. These plans need to first of all identify the areas of risk plus those requiring improvement, then find the solutions which may best fit the situations. The following research study conducts an analysis which focuses around the legal, ethical, and risk aspects of a healthcare setting, and from the observations designs a plan which addresses them towards managing risks and improving quality. Why quality improvement and risk management programs are necessary The reason why quality improvement is so important in healthcare lies in the discovery that what people assume about the quality of health care in the United States being perfect is wrong. This is chiefly supported by recent occurrences which pointed at the failure of the providers to sufficiently meet the needs of patients (McLaughlin & Kalunzy, 2006). This is made worse by the fact that about 12 percent of the total GDP in the U.S. is channeled towards health care. In a summary, the quality of health care does not match with the spending cast upon it. With these facts in mind, this research paper will highlight some areas of weakness in the United States health care system. The weaknesses will be analyzed and the best solutions towards them suggested. These suggestions if implemented, will better the reputation and effectiveness of the general health care system. Risk management on the other hand, refers to the disciplines which can be applied in reducing an organization’s chances of operating at a loss. A loss in this case refers to the operation (profits) aspect, and reputation/ achievement as well. In risk management, the activities applied are proactive, being implemented to counter potential loss. As such, risk management in healthcare is all about damage control. Risks can emerge from the following contexts of health care; future policies, existing policies, patient safety, medical blunders, federal regulations, and finally legislations which affect the field in general. It is therefore mandatory that a health care organization comes up with a risk management plan to prevent these negativities from occurring. The best form of risk management programs should be organization-specific since risks may vary from organization to the other (Carroll, 2011). This research study will highlight the most common risks in health care, and thereafter create a mitigation plan which should counter the mentioned risks. Recently, health care managers have resolved to create an “alliance” between risk management and quality improvement. This is so because the two aspects correlate and are inseparable. This decision was reached upon after it proved sufficient that in solving either of the tow, the other aspect showed some improvement as well. In a nutshell, the two complement each other. For instance, lack of a risk management plan leads to failure, which can manifest itself as poor quality care. On the other hand, poor quality care is a risk in itself in that it endangers the overall performance and achievement of an organization (ECRI, 2009). The following section creates a risk management/ quality improvement program. It seeks to monitor health care outcomes, management, outcomes, and overall accreditation while considering the mission, culture, and strategic direction of an organization. Risk management Program This risk management program is intended to foster the visions of health care as they pertain to property, operational, clinical, patient, and employees’ risks. All these are geared towards ensuring effectiveness, thus dissemination of health care services. Any health care institution is driven by the universal mission of health care which is to deliver high quality services to everyone. In it, the risk management program dictates that safety and effectiveness are everyone’s responsibility and as such, incorporates each and every stakeholder concerned with health care. The first principle of the risk management program is creating systems which record and report potentially unsafe conditions, near misses, and adverse events. In reporting, there may be external as well as internal reporting. External reporting may represent regulatory, voluntary, or governmental agencies. This reporting is important in that potentially harmful event or conditions can be identified and corrected before damage occurs. If mitigation is impossible within the organization, external help can be sought (Wan & Connell, 2012). Closely related to reporting is the collection of data for analyses. Collection of data is important in that performance of processes can be used to monitor, thus reveal potential sources of adverse occurrences. This can be done by, say, analyzing data which led to the emergence of a certain adverse event. By recognizing the causal factors of such events, proactive action can be put on standby. This can be better put as sufficient emergency preparedness. The third principle of this program is to ensure compliance with reporting requirements, data collection, and all other accrediting agencies as dictated by regulatory and/ or federal agencies such as the Joint Commission on Accreditation of Healthcare Organization (JCAHO) or the National Committee for Quality Assurance (NCQA). These can be effective in decreasing lawsuits being filed against the organization which may result in hefty fines, banning, or tainting of its reputation (Jones, 2007). The fourth principle is the provision of educational/ training programs to the hospital staff regarding risk management and safety. When the staff participates in such trainings, they become aware of how to identify or minimize the emergence of risks. Additionally, they learn to control the effects which may emerge from risks materializing. In matters of safety, training would be essential in preventing harm which results from either accidental or professional mistakes. Professional blunders may arise from wrong diagnosis, under-treatment, wrong treatment, delay, ignorance or over-treatment to mention but a few. Accidental (physical) blunders mostly occur due to illiteracy with handling equipment, or access to unsafe areas by non-staff. If safety is ensured by training and monitoring, such can be prevented. The fifth principle is creation of mutual trust between staff, providers, and patients. This is important in that all these parties can share their problems and concerns. Communicating concerns amongst them without fearing retribution can be important in the revelation of would-be problems. These steps require regular assessments and surveys to be conducted amongst the three parties. The final guideline in this program is constant monitoring of all inclusive processes and activities within the organization. Normally, all processes have roadmaps created before they are initialized. Such monitoring is important in that in the event that a slight derailment from the roadmap is observed, changes can be made before damage occurs. Again, it would be important in the recording of what successfully resolved an issue. For instance, tracking patient progress is important in two aspects; first, it would ensure that they stick to the say, prescribed treatment. If the treatment succeeds, then that can be recorded and used in treating similar cases. The other aspect is that if a blunder had occurred during treatment or diagnosis, corrections can be made before excess damage occurs. Such corrective action would prevent legal action against the organization such as lawsuits, or overall negative reputation owing to low quality services. Sources of influence in the delivery of health care services Social influence Several social aspects may impact on health care dissemination with regards to quality improvement and risk management. The first is lifestyle choices of the people. This factor influences the acceptance or denial of say, a new proposed health reform. For instance, it would be challenging to convince people, from wealthy backgrounds to avoid fatty foods, or limit their intake of meat. The other determinant social factor is the attitude of the involved persons. For instance, in a health care setting, it would be hard to implement training programs if the staff are not ready to accept changes. Again, the flexibility of the staff to accept change would increase the chances of them accepting the trainings. The third social factor is public opinion. This would apply in closely-knit societies such as where religion is highly recognized. If a new medicine strategy is announced and the overall opinion offered is against it, then its effectiveness would be largely reduced. The final social aspect is the environment in which the health care facility is located. If its location is the first world, it would be easier to implement technological programs or strategies as compared to regions which have no idea concerning technology (Keam, 2010). Cultural influence Culture may affect the same in two aspects; the patients’, and the organization’s as well. On the organizational context, risk management or quality improvement strategies would be determined by the feasibility if the staff to accept or deny the changes. If the cultures of an organization are not open to change, it would be challenging to implement such. On the other hand, an organization which is open to change would be much easier to work with in implementing the recommended changes or programs. In the patients’ context, their cultures would also influence the effectiveness of the same. For instance, it would be challenging to try and impose programs of broadening medical coverage to cultures that are opposed to clinical treatment, that is, those who believe in traditional medicine or religious healing. Political influence The type of governmental regulations may, or may not hinder the implementation of certain risk management or quality improvement strategies. This reflects on the compliance role as stipulated in the risk management program. In short, if an element meant for either risk or improvement contradicts with a federal policy, then implementing it would be illegal. That is a determinant. The stability of a government affects risk management and service improvement. In application, an unstable government may be unable to acquire supplies for the medical fraternity. This would in turn limit the performance of health care programs in the event that the unavailable items were part of an implementation program. Finally, tax policies would affect the costs of required items such as trainings or supplies. If the tax policies exploited the costs of acquiring such, then here would be limited supplies, thus limited effectiveness of the risk management or quality improvement strategies. Health care professionals and stakeholder roles and responsibilities in quality and risk management Health care professionals Health care professionals and stakeholders have roles in quality improvement and risk management. Healthcare professionals have the roles of creating effective channels of communication between all the involved parties. This is because they are the central players in the chain and can inform the others easily. In creating communication channels, health professionals ensure that the proposed strategies of risk management and quality improvement are well-explained to the deserving persons. Second, they have the responsibility of providing access to all the information required in implementing such. It is only by providing information that analyses can be conducted and the right conclusions made from them. Finally, those in management should provide conducive environments for the implementation of the risk management strategies as well as improvement programs. These include preparing their staff for changes or overall alterations required for the implementations. Other stakeholders Governments are one of the main determining stakeholders. This is mainly because they regulate the implementation of all health care activities. They should ensure that their regulations do not violate providers’ intended programs which are aimed at improving service quality or regulating risks. They should be flexible and invite negotiations when necessary. Patients as stakeholders should be open to explanations from professionals regarding planned or implemented risk management and service improvement programs (Nash & Goldfarb, 2006). Communities have roles as well. They should advise their members on the importance of strategies implemented by health care providers and thereof explain the importance of such. For instance, if they are advised to allow their children to be vaccinated as a prevention measure against an ailment, they should not be kept back by factors such as culture or public opinions. The organizations related in any way to health care, be they contractors, suppliers, inclusive of health care organizations, should align their objectives to support quality services and risk management. To enable these, they should relate their objectives, visions, goals and missions to the overall vision of health care which is the provision of health care to everyone everywhere. Health care policy, reimbursement, and regulatory requirements that affect quality and risk management Health care policies guide the directions taken towards the achievement of specific goals. These policies can either restrict or enhance quality improvement and risk management. In health care, some aspects such pharmacy is guided by pharmaceutical policies. These policies determine, for instance, which drugs can be directly sold to the public. If a pharmacy decides to implement programs which do not contradict any of the set policies, then they stand better chances of successfully implementing their risk management or quality improvement programs. Reimbursement in health care refers to the compensation offered after provision of health care services. This too, has an effect on quality improvement and risk management. In the U.S., the reimbursement policies are controversial in that the health professionals feel that the reimbursement offered in not equivalent to the duties they command. This relates to the overall feeling that the allocation set aside for health care alone is insufficient. The effect that under-reimbursement may have on health care quality and quality improvement is that one; the practitioners may be discouraged to continue with their offerings. This would in turn cut down their morale of providing quality health care or even bothering with mitigating risks and improving quality (Klepper, 2011). Regulatory requirements such as federal, legal, or agency requirements significantly impact on these two aspects. They guide health care practitioners on how to conduct their practices. Other regulations require health care providers to acquire authorizations such as operating licenses or accreditations for them to qualify. They also set the operational standards of health care facilities. On the enhancing side, these regulations may demand of standards or directions of health practice which add up to better services through improving the existing ones. On the restricting side, they may prevent health care providers from implementing some strategies in the event that they seem to contradict their demands. The final aspect affecting quality improvement and risk management is ethics. Ethics determine the acceptability of actions by eliminating their expected effects to others. In health care, work ethics are the most crucial in determining these two. First of all, all the elements discussed herein, such as monitoring, evaluating, or providing required information to be used in devising improvement programs depend on the direct professionals. If they do not observe work ethics, then they might look down on proposed or necessary programs or activities required in the achievement of the above (Morrison, 2010). On the contrary, a workforce who considers ethics is likely to be more successful in adopting and implementing risk management and improvement strategies. The most important strategy in implementing health care risk management and quality improvement is analysis of data, both externally and within an organization. The sources of such information are the health professionals and may include previous neutralized cases, patient information, follow-ups made, observations from research, surveys, questionnaires, and information shared amongst multiple related health organizations. The data should be availed to the proposed, implemented so that they can compare, derive trends, or reveal sources of weaknesses or strengths. The acquired data should be used in two ways. In the case of risk management, past causal factors can be avoided. Additionally, methods previously applied, and which succeeded, can be borrowed and applied in future. In quality improvement, data such as patient complains or faults in management can be used to highlight the areas which need the improvement. In short, the collected data plus analyses condensed from it should be used in processing the guidelines for the quality improvement or risk management programs (Andersen, Fagerhaug & Beltz, 2009). Finally, that is after data has been collected, analyses conducted and derivations made, the implementation programs can be created. The idea is to use data applied in recent cases, or data revealing causes of low quality to create proactive measures or provide better services in health care. This prevents following wrong, uninformed directions, acting without knowledge, and generally provides grounds for processing of a roadmap towards implementation. An effective strategy for administering the two should therefore have evidence to support its cause, should have a clear objective, have a clear roadmap towards implementation, have options in the event that one aspect fails, and consider all protocols that are bound to be affected by their implementation. Finally, such strategies should have strategies of evaluating and monitoring the progress of the implementation. Through such, it will be possible to identify areas of weakness and correct them, improve others, and most importantly tell whether the program is on track towards achievement of the quality improvement or risk management objectives. References Andersen, B., Fagerhaug, T., & Beltz, M. (2009). Root Cause Analysis and Improvement in the Healthcare Sector: A Step-by-step GuideI. ASQ Quality Press. Carroll, R. (2011). Risk Management Handbook for Health Care Organizations. John Wiley & Sons. ECRI. (2009). “Risk Management, Quality Improvement, and Patient Safety. Risk and Quality Management Straegies 4”. (2), 1-17. Jones, S. (2007). “Combining disciplines: Making the connection between compliance, risk, and quality management”. Journal of Health Care Compliance, 9(3), 5-12. Keam, S. (2010). “Social Inequalities: Do they Matter to Health Care Managers?” The Quarterly. Retrieved on 16 August, 2014 from http://www.racma.edu.au/index.php?option=com_content&view=article&id=345:social-inequalities-do-they-matter-to-healthcare-managers&catid=28:the-quarterly-september-2011-&Itemid=54 Klepper, B. (2011, May 3). “Fixing America’s Health Care Reimbursement.” Kaiser Health News. Retrieved on 16 August, 2014 from http://www.kaiserhealthnews.org/Columns/2011/March/030311klepper.aspx Mclaughlin, C., & Kalunzy, A. (2006). Continous Quality Improvement in Health Care: Theory, Implementations, and Applications. Jones & Bartlett Learning. Morrison, E. (2010). Ethics in Health Administration: A Practical Approach for Decision Makers. Jones & Bartlett Publishers. Nash, D., & Goldfarb, N. (2006). The Quality Solution: A Stakeholder’s Guide to Improving Health Care. Sudbury MA, Jones Bartlett Publishers. Wan, T., & Connell, A. (2012). Monitoring the Quality of Health Care: Issues and Scientific Approaches. Springer Science & Business Media. Read More