Clinical Effectiveness and the Limitations of Health - Assignment Example

Activity Name Institution Using the readings provided and your own research, provide examples of how evidence based health care practice (EBP) may improve clinical effectiveness and describe the limitations and criticisms of EBP. Health care refers to the process of diagnosing, treating and preventing diseases, illnesses, injuries as well as mental and physical impairments in human beings. Health care is a very important factor in human life. It is therefore important that every health center and health ministry and health department work towards ensuring safe and quality health care to all the patients. Health care generally constitutes both personal and public health. Various researchers have found out that, for health institutions to administer quality improvement and safety health care, it is important to conceptualize health care in dimensions of quality and domains of safety health care. This report discusses Clinical effectiveness and efficiency as dimensions of quality health care and how they are enhanced by Evidence based health care practice. Clinical effectiveness is achieved when health care provides services based on scientific knowledge to those that can benefit and refraining from providing the same services to those that does not benefit. When health care services are provided effectively avoiding wastage of resources, i.e. equipment, supplies, ideas and energy, then clinical efficiency is achieved. Evidence-based medicine commonly refers to the careful, clear, and sensible application of modern best evidence in making decisions concerning the individual patient’s care (Timmermans and Mauck, 2005). Evidence-based care has the following effects to effectiveness: Evidence-based practices aligns health care to scientific standards of evidence, which is a means of determining the efficacy of clinical practices. Clinicians applying EBM are able to access objective experiences of different researchers employing recognized scientific standards of proofs and relating these evidences to an examination of the patient’s perspective as well as the practitioner’s clinical knowledge skills. Enhanced efficacy should also stimulate increased efficiency by letting practitioners and health institutions to sift unusual resources away from clinical practices that are ineffective and toward conclusively agreed effective practices. EBM also promotes greater uniformity by restraining peculiarities in certain clinical techniques or in the rate of performance of clinical procedures. Besides, EBM molds well-informed patients and clinicians through provision of collectively and publicly agreed-upon and available information regarding options of treatment. Guidelines empower clinicians to make counter managerial decisions and change those practices that are not in line with the patients’ best interest. Clinical practice guidelines are commonly regarded as tools for care evaluation and cost-cutting measures execution. Finally, EBM provides a scientific foundation for public policy amendment. On the critical side of the use of EBM, Instead of revolutionizing care, it threatens to cause immobility and insipid uniformity, derogatorily termed as “cookbook medicine”. EBM may also lead to lower safety standards by deskilling clinicians. Instead of employing clinical standards, the practitioners may be stimulated to follow procedures that treat all patients as basically similar. Clinicians will therefore be inadequately furnished to deal with the differences between patients they will encounter in actual clinical situations. Even more challengingly, old-fashioned health care specialists may be substituted with less skilled employees, who may not be able to operate effectively in diverse circumstances (Isaacs and Fitzgerald, 1999). What are the benefits of and barriers to patient centered care? In your answer include discussion about how a patient’s cultural background may make a difference to their experience of health care. Patient centeredness in relation to the dimensions of quality health care refers to providing health care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions (Cleary, 2003). In as much as this dimension ought to be enforced to enhance quality of health care, there is reluctance by practitioners to do so. This is a model placing the patient at the center of health care delivery and relaying actions in a certain process i.e. the right person performing the right task at the right time. This shows that the model improves steadiness of care and incorporation of health specialists cooperating on behalf of the patient, by reducing the patients’ movements in the hospital, offering self-sufficiency to patients as well as supporting the staff to strategize and implement their work in the means most considerate to patient needs. The patient centered model also shows a precise response to every patient’s need, necessities and inclinations. Furthermore, it offers abundant opportunities to access information and participate in care decision-making to the patients. Besides, PCC provides more rounded care; improves skills of communication between the patients, their relatives and their providers; diverts body care emphasis to total care; enables a group approach; and enables replication, acquisition and exchange of skills and abilities between health specialists (Coulter and Cleary, 2001). Having analyzed various advantages of the patient centered care; the model is bound to have its own limitations during delivery. Its main demerits include: A lack of explicit accounts for measurable patient behavior and outcomes of the patient; the condition for operational alterations at the organizational and practice levels. These can be complex; there is a demand for enough time and more human and physical resources to care for patients (Coulter and Cleary, 2001). From the above explanation, it is evident that the care given to the patients will – to a greater extent – be influenced by the cultural background of the patients. For instance, taking a scenario of Jing sheng – an old man aged 80 from Chinese culture admitted in a health center in America. This patient will feel alienated if his care providers and other patients in his ward cannot communicate in Chinese language. Many things he would want to communicate to the clinician he can trust. There will be a need for an interpreter hence no privacy. Old men from the Chinese land may feel contempt to talk of their private issues to young-lady-practitioners. This also will affect the communication between him and the care takers if a number of them are ladies. A patient from the Chinese background will not be comfortable if he is offered American dishes at the hospital. This means that the hospital will need to acquire clinicians from different parts of the world, non-staff employees to offer services according to the cultural needs of the patients. This is very expensive to acquire, making it difficult for health centers to fully adopt the patient centered care practices. What are some of the barriers to change that organizations will need to address in order to ensure the effective adoption of clinical governance within the organization? What do you think are the challenges for leaders in achieving successful change? The discussion follows from the following articles: Amalberti, R., Auroy, Y., Berwick, D. and Barach, P. (2005) ‘Five System Barriers to Achieving Ultra-safe Health Care’, Annals of Internal Medicine, 142, pp. 756 – 764. PUN213: Introduction to Quality in Health Care Module Two67Semester 1, 2014 QUT, School of Public Health http://www.annals.org/content/142/9/756.full.pdf+html Buetow, S. A. and Rolan, M. (1999) ‘Clinical governance: bridging the gap between managerial and clinical approaches to quality of care’, Quality in Health Care, 8, pp. 184 – 190. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483653/pdf/v008p00184.pdf Carroll, J. S. and Quijada, M. A. (2004) ‘Redirecting traditional professional values to support safety: changing organizational culture in health care’, Quality and Safety in Health Care, 13, ii16 – ii21. http://qshc.bmj.com/content/13/suppl_2/ii16.full.pdf Coye, M. J. (2001) ‘No Toyotas in Health Care: Why Medical Care Has Not Evolved To Meet Patients’ Needs’, Health Affairs, Vol. 20, No. 6, pp. 44- 56.http://content.healthaffairs.org/cgi/reprint/20/6/44 Degeling, P. J., Maxwell, S., Iedema, R. and Hunter, D. J. (2004) ‘Making clinical governance work’, British Medical Journal, Vol. 329, pp. 679 – 682. Access through the QUT Library http://www.bmj.com/cgi/reprint/329/7467/679 Clinical governance is a very important factor in any institution offering health care services. Clinical governance is conceptualized in elements ranging from clinical effectiveness to management of governance and safety risks to patient focus and public involvement in making decision making or policy making. Pressure for organizations to experience improvement on management, group and individual performance with respect to safety and quality health care needs a number of things to be altered in an organization. This will range from several individuals working in the organization to change their methods of offering services, going above the past role limits or job duties, taking on more responsibilities and roles as well as adopting work methodologies which might not be as comfortable as in the past. It is not likely that all the employees and leaders will accept this since many health care specialists mostly find such changes as disruptive hence many tend to resist the change. Some of the reasons why the employees will resist change include: Personal interests, mistrust, complexity of the proposed change, several different evaluations and assessments from those advocating for that change, e.g. benefits and costs assessments and the level of change tolerance. It can be proven that traditional cultures on health care are well embedded (Carroll and Quijada, 2004). This means it is difficult for the leaders to foster this strategy. There are, however, genuine reasons as to why this is difficult in relation to modern approaches to the execution of clinical governance. Leaders find it difficult to enforce clinical governance where the changes associated with the change affect the organizational cultural practices. Another factor comes in the risk management. Medical risks are not homogenous therefore becoming difficult to rate their impact. Despite a number of the risks being similar, e.g. treatment of cancer, the risk of the patient succumbing to the disease is not accurately measurable. Another challenge the leaders experience in enforcing governance is determining what to enforce putting into consideration that efficiency is affected by the severity of the diseases, the medical decision and human power implementing the selected therapy. There is a general difficulty in remaining competitive i.e. offering quality health care services and maintaining accountability. Emerging medical research groups that prove wrong stability required for the use and improvement of management care also to a great extent affect governance. (Buetow and Rolan, 1999). Clinical governance is deterred from providing total outcome by a number of barriers. The main obstacles to clinical governance include: lack of commitment in the organizational duties and responsibilities; lack of clinician willingness to adopt the change; insufficient knowledge and disseminating systems; ineffective communication; role ambiguities, principally associated with the number of various organizations and frameworks carrying out governance activities; and technical matters such as timeliness of disseminating and incorporation of the variety of organizational schemes and procedures which lead to organizational governance; the political environment; demands pressure; expectations of the public and insufficient resourcing (Buetow and Rolan, 1999). Reference List Buetow, S. A. and Rolan, M. (1999). Clinical governance: bridging the gap between managerial and clinical approaches to quality of care, Quality in Health Care, 8, (p.p184 – 190). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483653/pdf/v008p00 184pdf Carroll, J. S. and Quijada, M. A. (2004). Redirecting traditional professional values to support safety: changing organizational culture in health care, Quality and Safety in Health Care, 13, ii16 – ii21. Retrieved from http://qshc.bmj.com/content/13/suppl_2/ii16.full.pdf Cleary, P. D. (2003). A Hospitalization from Hell: A Patient’s Perspective on Quality, Annals of Internal Medicine, 138, pp. 33 – 39. Retrieved from http://www.annals.org/content/138/1/33.full Coulter, A. and Cleary, P. D. (2001). Patient’s Experiences With Hospital Care In Five Countries, Health Affairs, Vol. 20, No. 3, pp. 244 – 252. Retrieved from http://content.healthaffairs.org/cgi/reprint/20/3/244 Isaacs, D. and Fitzgerald, D. (1999). Seven alternatives to evidence-based medicine: British Medical Journal, Vol. 319, p. 1618. Retrieved from http://www.bmj.com/cgi/reprint/319/7225/1618 Timmermans, S. and Mauck, A. (2005). The Promises and Pitfalls of Evidence-Based Medicine: Health Affairs. Vol. 24, No. 1, (pp. 18 – 28). Retrieved from http://content.healthaffairs.org/cgi/content/full/24/1/18 Read More