Quality and Rules For the Provision of Medical Services - Term Paper Example

Name: Institution: The Assessment of Health Service Quality from the Patient's Perspective Abstract The main aim of health care service delivery is to provide first class services to their patients and to always give patients first priority. However, the challenge that arises is defining the parameters of patient’s point of view with regards to the quality of healthcare. This research focuses on a patient’s values, preferences and expressed needs by recognizing their likes and meeting basic requirements affordable by health care. Emphasis will be laid on patient’s satisfaction on resources they channelled towards getting better healthcare. Communication and education as a parameter ensures positive progress of health and well-being. Focus will also be laid on coordination and integration of health care where various mechanisms and structures in place responsible for the supervision and implementation of the set policies and standards will be analysed. Personal comfort as a parameter will highlight the treatment process and whether it is up to standard (Bowling, 2009). As regards to Patient’s alleviation of fears and anxieties, this paper considers the general view of patients as well as their opinions. A focus will also be shed on what aspects in the health service contribute to making patients more at ease and take away their fears will be considered. The quality of health service as assessed from a patient’s point of view basing the argument on how the service is perceived by the patient will form part of this study. To add on this, the paper will also focus on the involvement of family and friends. What role do they play as regards the quality of health service; this may be considered in terms of their contribution to improving the service or degrading it as well Introduction Health service quality has emerged as an area of concern mainly due to the increasing cases of negligence in the health system. Many institutions in an attempt to improve on the quality of service have gone ahead and introduced reports which assess the quality of services that they receive (Boyette, 2010). This however has turned out to be ineffective since the problem continues to persist with a constant reduction in the quality of service provided to patients. It is because of this that this study was conducted in order to obtain a direct opinion from the patients on this particular matter. This paper analyses the quality of health service using the opinion obtained from the patients directly in order to ascertain its quality. The perception of the patients is crucial in ascertaining the quality of service mainly because they are the parties directly affected by the issue and use of reports only favours the management of these institutions which most often are more focused on improving and maintaining their outward public image at the expense of the patients; as a result, they are capable of manipulating the reports in order to favour their institutions. This particular paper shall provide an insight on the various concepts that need to be analysed when assessing the quality of health service and in the end provide a valid and conclusive recommendation on how to improve the quality of health service. Scope Statement This research project limits its statistical and analysis of data and responses based on a selected public hospital and a selected private hospital in the assessment of their opinion on the various deliverables in trying to assess health service quality. General Statement Health service quality has been a basis upon which various health care facilities compete, hence in this case, a patient’s perspective derived from the real experiences can help determine where the loop holes are, what needs to be improved and what needs to be maintained. Methods of Data Collection Sampling The study sample was carried out in both the private and public hospital. The hospitals were selected on the basis of their proximities to the researcher. Another factor that was considered in the selection of the hospital was their proportionalities in terms of size. The study involved adult patients aged 18 years and above and who had been admitted in the hospital for at least the whole day and who were in a position and were willing to participate. Survey Instrument: Questionnaire The study used questionnaires as a mode of collection of data. The questionnaire was divided into two parts: one dealing with the social and demographic details of the patient. The second part of the questionnaire was examining the patient with regards to the 6 parts based on the parameters that were in question that is: Respect for Patient’s values, preferences and expressed needs (4); Communication and Education (4); Physical comfort (4); Emotional support and alleviation of fears and anxieties (4); involvement of family and friends (4); coordination and integration of care (4); Analysis The questionnaire has been put to test in different environments and there is a probable increase in dimensions in which assessment of quality health care can be categorized. In the obtaining of information from the public hospital, the research made use of factor analysis determining the service quality dimensions according to the patients’ perspective. Likert five point scale was used, with the following deliverables used; ranges from strongly disagree (1) to strongly agree (5) to assess the patients expectations and satisfaction levels. Data analysis was done by software called SPSS version 17.0. Exploratory factor analysis (EFA) was used in determining the quality of dimension of healthcare services. Wilcoxon test was used in comparison of patients’ “expectations” and “views” scores. Results Social and Demographic sample data Variables N % Gender Male Female 450 533 45.8 54.2 Age 61 178 169 288 145 263 18.1 17.2 23.2 14.8 26.8 Education level Illiterate Primary and Secondary School Academic degree 64 441 478 6.5 44.9 48.6 Dimensions of hospital service quality mean scores for patient’s expectations, views and quality gaps and Wilcoxon test results Dimensions and Items Factor loading Mean perception score Mean expectation score Mean quality gap scores respect for patient's values 0.59 4.05 4.93 -0.88 communication and education 0.56 4.04 4.94 -0.89 coordination and integration of care 0.62 4.08 4.92 -0.84 physical comfort 0.51 4.11 4.92 -0.81 emotional support 0.65 4.10 4.92 -0.82 involvement of family 0.25 4.09 4.92 -0.83 Patients’ values, preferences and expressed needs Patients’ preferences are vital should be taken into consideration when administering health care services to them. Doctors should employ preference sensitive techniques in caring and administration of treatment to patients for examples choice between lumpectomy method and Various available options should be availed to patients to help them choose the methods they value most in situations where there are consideration to make in light of a variety of option present at doctors or nurses disposal. Up to date facilities and technology should be employed in administering treatment to make patients feel the value for their resources employed in seeking treatment at a treatment facility be it a hospital or clinic. Different patients are driven by different values and principles. It is important for medical personnel to understand and respect patients values, There are those patients who value their privacy and cannot therefore accept to be seen by their doctors or nurses without clothes, such patients should be allowed to conduct their private issues privately without interference or without infringing on their privacy. The health centre should be driven by values that aim to improve healthcare for their patients. Many patients usually indicate the need for their needs to be acknowledged and recognized by doctors, nurses, fellow patients and other people they come into contact with. Patients require an ambient atmosphere for them to convalescent without disruption of any kind, an atmosphere giving them hope of a quick recovery and for things to go back to normalcy. Such an environment should give a glimpse of a good life quality without much hustle. There is need for patient involvement in decision making as far as medicine form administration is concerned, some patients prefer oral administration because of allergy to injection while other prefer administration by injection. Such concerns raises by patients should be addressed to make them feel that their opinions are put into consideration in decision making. Patients should be treated with utmost dignity and their autonomy ought to be respected. Their rights and freedom should not be violated in any way as any reaction exhibited by patients tends to work against their recovery process, for instance patients fit enough to walk around should be allowed to stroll within healthcare facilities with supervision of staff to keep them active and feel wanted. Communication and education Doctors should be in constant communication with their patients to be able to speak and understand the language of the patient, doctors and nurses should be imparted with proper expression and communication skills to have the ability to choose words carefully and at the same time pass the write message to different patients, different patients have different literacy levels, doctors should establish good channels of communication to be in a position to understand patients from across the divide. The so called “knowledge paradox” or in other terms the “expertise paradox” often characterized by professionals, doctors inclusive, should not victimize doctors in a healthcare that focuses on providing better health care. Patients should be given a chance to express their opinions and feelings towards both the care received and pain, using the information it would be possible to reliably tell the how much the patients like their services and their progress in responding to treatment, doctors should maintain direct eye contact with their patients while listening, it gives patients assurance being attentive and listening and also empathy on the part of a doctor, a doctors should let his/her patient know what is on their mind by clear explanation of the same and verify that the patient has understood whatever it is that a doctor said and its importance to the patients progress to full recovery. Education is a key to success in many fields, medicine inclusive, patients should be educated on better health practices by doctors and nurses via channels e.g. hospital websites, hospital books, web based health library. Health facilities ought to invest in websites to provide technologically survey patients with health education aimed at improving standards and quality of healthcare even in absentia of medical personnel. Education should also be provided to patients inform of video and audio files. video file give patients a visual view of basic things to be done e.g. first aid in video is more likely to equip patients with better skills because observation is better that just hearing, observation reinforces learning, patients feel that they are getting good information and better services form the specific health service provider. There is need for organizing workshops for patients with ailments that can be prevented to give them information and education on preventive measures that can be taken to avoid infection of the same, for example workshop on prevention of infection of human immune deficiency virus/acquired immune deficiency syndrome(HIV/AIDS) in third world countries. Patients should be educated on drug use to take the drugs instructed to in correct dosages. Co-ordination and integration of health care services. With the regards to co-ordination and integration of health services, the patients interviewed responded in both the private and public hospital responded with the following sample statistics: 4 out of 6 of the respondents in the public hospitals gave their own view and this was in response to that there is sufficient co-ordination and integration of health services. In the private hospitals 6 out of 6 of the in-patients admitted to the hospital confessed as having a proper and coordination and integration of health services (Donaldson, 2009).. Co-ordination and integration of health care services entails having a variety of services offered in the health unit, the monitoring of the efficient operation of the services and all aiming at attaining the hospitals objective of offering better services to the patient. It is also ensuring that all sections of the hospital, including the various departments in the hospital. It was noted that there was well coordination since on arrival to the health centre by a patient; the first place of interaction was the customer care desk where the patient is given directions to the specified department. There is generally a standard procedure expected to be followed by patients that are being admitted in a certain hospital (Graham, 2010). For instance, depending on the patient’s condition or situation, the activities or procedures and processes are sufficiently followed until treatment is offered. These procedures vary from one health unit to another depending also on its size. A medical doctor with his or her own private hospital may play all the roles of cashier, pharmacist, and receptionist but in a well-structured hospital system, you may be required to pass through the customer care desk, who then gives you a general direction to the cashiers where they charge a consultation fee. From there you, at be required to pass to the doctors secretary who enters you in the hospital records by creating a patients account if you are a first time visitor to the hospital (Hancock, 2010). You may also be required to pass through another section of the hospital where a description of your previous medical history before now being allowed to go and consult the doctor. The doctor will not need to ask you whether you have been ion the hospital or not, he will, simply request for an identification number provided by the hospital and then looks at the previous medical history and the stated medical problem. He only needs to ask the relevant information then administers treatment, posts to the pharmacy department the prescriptions and to the finance the amount, you are charged. A certification from the finance department therefore enables one to be able to pick the required dosages. It is with regards to the ease with which the interviewed patients were able to pass through the whole stages without any inconveniences. Female patients gave a more positive response while the male patients complained of the unfair treatment at some departments, neglect and it was therefore concluded at some times, there is always preference attributed to gender, where feminine patients are given more preferences. However other than that major drawback, all the various departments all jointly collaborate with the sole aim of providing good services to its patients (Nordenfelt, 2011). Physical comfort All the patients who were interviewed and were in private hospitals said that the level of comfort accorded to them was superb while the ones admitted in the public hospital responded as saying; 5 out of the 6 respondents agreed that the level of comfort was attributed to the amount of money you have paid, as the common saying goes that comfort is expensive. Most patients who resort to public hospitals are of average to low income hence to them physical comfort is always not a priority and that most of the public hospitals are usually densely populated therefore providing less room to fit finer facilities to enhance comfort. The findings of the research also depict that 2 out of the 6 of the patients admitted in the public hospitals confirmed that the condition was pathetic as compared to the 4 who remained who said they could bear with the situation. At a point, when there is an overflow of patients and there is limited space in the wards, the patients would share beds and that they would also sleep in rounds. At extreme instances where there was completely no bed space, the patients resorted to sleeping and resting on the corridors of the hospitals (Markson, 2008). Emotional support and alleviation of fears and anxieties The health care service quality when assessed basing on emotional support and alleviation of fears and anxiety tends to reveal various aspects in the health care sector. As much as there are different reports that provide information relating to patients’ experiences and their opinion to these matters, the question that arises is the accuracy and reliability of these reports. Most of these reports are merely what the sector wants the concerned parties to know rather than the true and actual opinion of the patients. There has not been a unanimous consensus on the matter hence the need to narrow down on the aspect of emotional support as well as alleviation of fears (John, 2012). Patients go to hospital in need of medication due to various forms of ailment. Some of the diseases are curable whereas others are not. While in hospital, these patients are under the care of the medical practitioners and it is their duty to handle the patients in the best way possible. However, this has not been the case. Different studies have shown that most of the patients in the hospitals other than their ailments, do suffer from lack of emotional support. Emotional support basically refers to an act of encouraging a given personality to improve in his condition as well as developing an attitude in his mind that he will be better gradually. It means being there for someone when needed. Patients especially those with long term ailments and fatal diseases need this support the most. Research conducted in most health service facilities has shown various responses to this subject matter, but all point out to one aspect of inadequate emotional support. Critics have argued that medical support is the paramount service to be provided in the hospitals and that emotional support is only an option to the medical officers, but however if this were the case then a significant number of the patients will lose their lives not from lack of medical attention, but due to the tendency of giving up. If a patients for instance one who is infected with HIV virus lacks emotional support and concedes to the realty that he will die someday, this will greatly demoralize him and he may see no sense of maintaining a balanced diet, exercising regularly and eating healthy foods since he is already resigned to the fact that someday he is going to die. It is therefore important that the medical practitioners to add emphasis on supporting the patients emotionally as this have been absent. Patients have clearly stated that there is absence of emotional support and hence it would be correct for one to conclude that due to the absence of emotional support, the quality of health care is rather low from the patients’ perspective (Heath, 2008). Other than emotional support, the patients also need to dispel off their fears in order to provide them with ample time for recovery. Patients’ fears may vary significantly depending on the social status as well as the responsibilities that they are undertaking. Their fears may include the thought of who would take care of their children in case they die, who would take over their business, who would pay for the medical bills and also what are the chances that they will get well. All these questions tend to weigh down the patients and if in the health care facility the medical officers are busy and ignorant on these fears, the patients may be forced to live with these fears and keep to themselves exposing them to further medical complications such as high blood pressure and even ulcers. Just like any other community, individuals in a medical institution need to be helped to ignore their fears and calm their minds in order to allow their body system to respond well to the medication being provided to them. The other important aspect of assessment of quality of health care service is the involvement of family and friends. It is the collective responsibility of close friends and family to help and support the patient in question. This will also help in contributing to an improvement of the general service quality in the health sector. The quality has been considerably low mainly due to lack of a synchronized and well-designed system in these institutions that will help to ensure that all the relevant affected parties contribute towards improvement of the quality of health service. Most patients tend to lay much burden and blame to the medical officers for negligence. This might be true, but however, other parties such as friends and family should also provide their assistance in order to facilitate improvement the quality standards of the institution. Given that a significant percentage of patient tend to concur with the fact that the standards in the quality of service in health are low, it is prudent that strict measures be introduced to regulate as well as monitor the actions of related parties in order to ensure that each one of them acts responsibly with the sole aim of improving the quality of health care service (Greenhalgh, 2009). Conclusion Health service quality is an important aspect of the economy since it greatly contributes to its growth. This therefore necessitates the need for the sector to be given maximum attention in order to improve on its operation in terms of service delivery. It is important for the medical practitioners and all other relevant parties to combine their efforts and improve the negative image that the patients have regarding the quality of service. References An Assessment of medical care quality in the Texas Department of Mental Health and Mental Retardation hospitals and schools, 1974-1975. (1976). Austin, Tex.: The Foundation. Bowling, A. (2009). Measuring health: a review of quality of life measurement scales (2nd ed.). Buckingham: Open University Press. Boyette, C. B. (2010). Exploring the effects of total quality management/continuous quality improvement educational inservices on customer perception of a wellness center's service orientation. Geneva: Phoenix Publishers. Donaldson, M. S. (2009). Measuring the quality of health care. Washington, D.C.: National Academy Press. Graham, N. O. (2010). Quality assurance in hospitals: strategies for assessment and implementation (2nd ed.). Rockville, Md.: Aspen Publishers. Greenhalgh, T. (2009). Diffusion of innovations in health service organisations a systematic literature review. Malden, Mass.: Blackwell. Heath, S. W. (2008). Risk management & medical liability a manual for Indian Health Service and tribal health care professionals (2nd ed.). Rockville, Md.: Indian Health Service. Improving value in health care measuring quality.. (2010). Paris: OECD. John, J. (2012). Consumer, patient perception of the quality of health care service delivery. New York: World Health Organization. Markson, L. E. (2008). Accountability and quality in health care: the new responsibility. Oakbrook Terrace, Ill.: Joint Commission on Accreditation of Healthcare Organizations. Monitoring quality of nursing care. (2010). Bethesda, Md.: U.S. Dept. of Health, Education, and Welfare, Public Health Service, Health Resources Administration, Bureau of Health Manpower, Division of Nursing. National audit of end-of-life care in hospitals in Ireland, 2008/9: dying in hospital in Ireland : an assessment of the quality of care in the last week of life.. (2010). Dublin: Irish Hospice Foundation]. Nordenfelt, L. (2011). Concepts and measurement of quality of life in health care. Dordrecht: Kluwer Academic Publishers. Orrell, M., & Hancock, G. (2010). CANE - Camberwell Assessment of Need for the Elderly: a needs assessment for older mental health service users. London: Gaskell ;. Preparing a health care workforce for the 21st century: the challenge of chronic conditions.. (2012). Geneva: World Health Organization, Noncommunicable Diseases and Mental Health Cluster, Chronic Diseases and Health Promotion Dept.. Primer on indicator development and application: measuring quality in health care. (2010). Oakbrook Terrace, Ill.: Joint Commission on Accreditation of Healthcare Organizations. Quality Improvement for Mental Health Mental Health Policy and Service Guidance Package.. (2013). Geneva: World Health Organization. Romeis, J. C., & Coe, R. M. (2011). Quality and cost containment in care of the elderly: health services research perspectives. New York: Springer Pub. Co. Stahl, M. J. (2012). Encyclopedia of health care management. Thousand Oaks, Calif.: Sage Publications. Webster, C. (2012). The National Health Service: a political history (New ed.). Oxford: Oxford University Press. Read More