Health and Social Care - Coursework Example

HEALTH AND SOCIAL CARE Introduction The healthcare industry has been delving in practices that were previously common only to the corporate world. Working on quality improvement through practices such as sigma six, continuous quality improvement, lean thinking and quality assurance have been utilized in attempts to incorporate management practices into health services. The purpose of this paper is to offer a discourse as to the management practices in health service that have imported their specifics from the corporate world (Anderson 2001, 219-232). Particular focus will be given to the approaches that are used in quality management such as continuous quality improvement, quality assurance, lean thinking, and sigma six. Just as organizations have come to witness, health organizations have also learnt of the advantages of focusing energy on quality since it will ensure that health care services are provided with the use of scarce resources that will be utilized in effective and efficient ways. In the absence of quality, there is little trust that is accorded to the effectiveness of particular health system. Following in this line of thought, putting effort in integrating corporate practices that will ensure that the services provided by a particular health system are better is a logical step for healthcare systems to take. In the context of this paper, the following definitions will be used: Health care professionals: this term refers to nurses, doctors, dentists and midwifes who are registered and permitted to carry out their practices medically (Ministry of Social Affairs 2005, 3). Health services: these are the various activities that professionals in health care engage in to fulfill functions such as treatment and diagnosis of diseases, prevention of diseases and other activities that will help them in prevent the deterioration of health in their patients (Ministry of Social Affairs 2005, 3). Patient: a person who uses a healthcare service regardless of whether they are healthy or sick (Ministry of Social Affairs 2005, 3). Quality: the degree or extent to which certain set of characteristics that is inherent fulfills certain requirements (Ministry of Social Affairs 2005, 4). Quality assurance: this is the specific part of quality assurance that involves that provision of confidence that the requirements needed for quality are fulfilled (Ministry of Social Affairs 2005, 4). Quality management: these are certain activities and practices that are aimed at directing efforts and controlling the processes and activities that have been aimed towards an organization’s realization of issues that regard quality (Ministry of Social Affairs 2005, 4). Body Continuous Quality improvement Continuous quality improvement (CQI) is among the choices that most organizations make towards promoting quality and it has recently been adopted in health promotion. The main goal for healthcare service providers when they adopt this method is to fulfill the desire they have to improve health service provisions subsequently improving their chances of fulfilling health promotion goals. In addition, health care organizations are gradually adjusting to the provisions that are in place or those that may be soon put in place by governments and other sponsoring bodies that will make the adoption of CQI a mandatory requirement (Kahan and Goodstadt 1999, 83-90). The continuous improvement that is an integral part of the processes that are involved in CQI is a reference to a comprehensive management philosophy whose implied and practiced focus is on an improvement that is continuous and this can be ensured by applying scientific methods for the purpose of gaining knowledge and control over the different processes that take place during a certain work function. The processes that are involved when applying CQI are characterized by a cycles and plans that are used in a continuous way. In the process of coming up with these cycles of CQI, the first step is usually to plan a design for the change or modification that is to be achieved in terms of improving the process of health service provision. After the plan of the design has been made, the next step involves implementing the change that has been designed (Kahan and Goodstadt 1999, 83-90). Following this application, the negative and positive outcomes of the change are observed after which there will be an actionable decision made about either adopting or abandoning the change that was designed. In this step, a decision can even be made to start he cycle all over again under certain different environmental conditions to modify or alter the results from the ones that had been observed initially. The cycles that could be followed by CQI are not constant and could be changed by an organization depending on the outcome that they desire or on previous experience with certain CQI processes. Another cycle that could be followed begins with the identification of a desired outcome followed by the decision on which population to focus on who could be a certain group of patients or all the patients at a certain hospital. The third step involves deciding on the measurement tools that will be used to establish whether the change was successful or not. After this, the cycle gets to a point where the players are to identify the modifications or alterations that they may make to the final result before finally implementing the change (Kahan and Goodstadt 1999, 83-90). CQI has component that are present or that need to be present for the approach to be successful or to stand the chance of being successful. These components include customer satisfaction, team approach and the scientific approach. Though CQI presents an effective corporate quality management practice that can be used in health service, it is not devoid of difficulties which range from lack of commitment on the part of the management to an unsupportive organizational philosophy and lack of resources needed to apply the approach. Quality assurance and CQI Quality assurance is sometimes also used when referring to processes that are meant to bring about or initiate CQI. It is however important to note that quality assurance is more focused on achieving outcomes while CQI is more focused on the processes that are to bring about a certain end. Since the focus is more on the processes, CQI has been a preferred choice as it is considered to be more progressive than other methods of achieving quality in the healthcare service such as quality assurance (Kahan and Goodstadt 1999, 83-90). On the other hand, quality assurance not preferred mostly because it relies on standards for achieving its goals, the main argument that is often given against standards is that they only demand or require that a certain minimum level of the goal that has been set to be reached such that the organization involved on attempting to achieve quality improvement will push to attain a minimum level of the goal that has been set. The relationship between quality assurance and CQI has been probed often with most coming to the conclusion that CQI is better than quality assurance and that it will come to render quality assurance redundant (Kalda and Lember 2000, 59–63). This is mainly because CQI is not restricted or governed by standards allowing for the opportunity to achieve what is beyond the standard that has been set. For instance, a hospital that wants to improve its health care services governed by certain general standards that are not applicable to it but CQI will allow the chance for the hospital to set its own goals based on standards that has been configured from within the healthcare institution. However, quality assurance is not always discouraged s some literature even views it as a compliment to CQI in that the two can function to complement each other and achieve a certain desired result. Quality assurance The provision of medical services has, with time, become inseparable from quality assurance. There are certain standards that govern the quality of products and services that health care professionals are obligated to provide their clients with (Ministry of Social Affairs 2005, 5). The focus that is placed on achieving these qualities has been varying over periods of time. The focus of quality assurance has mostly been towards the guidelines that health care professionals are meant to follow in the carrying out of clinical practice and diagnostic guidelines. Developed countries have experienced better and more successful run ins with quality assessment and quality assurance (Kalda and Lember 2000, 59–63). However, the same cannot be said for developing countries where most of the efforts that have been put towards implementing quality assurance in healthcare service have been less sustained. There is s widespread deficiency in least developed countries in terms of the management system that has been put in place. The objective of quality assurance practices is to establish a process that will help health care professionals in their daily on goings to comply with and recognize the quality standards that are required in the provision and management of services. The problem that most health care institutions often face when it comes to implementing quality assurance is that it is not often feasible for some of them and especially those in developing countries (Bouchet 2004, 15–18). Some of the standards that have been set mat require for them to have certain equipment and services at their disposal which may not be a realistic demand for some developing countries. In essence, the quality that is demanded form healthcare professionals may present a greater challenge for them to fulfill especially if they are in an area with little financial support from the government or other interested bodies. Lean thinking Organization and hospitals have been making many strides in improving efficiency and most of these efforts have been futile with the approaches lacking in certain areas that may make them focus on the wrong area or make the entire process a futile attempt. There are various conditions that highlight the need and requirement of lean thinking in healthcare institutions and organizations (Balle and Re´gnier 2007, 33–41). In most healthcare organizations, there is little to no work or activity that is directed towards achieving quality from the perspective of the patient in that there is little work that is engaged in for the purpose of meeting the patient’s needs. Value adding activities rarely focus on improving this value in such a way that the patient witnesses the impact of this improvement. As a result, if one of these activities is improved, it will have very little impact on the overall result that is often witnessed. In addition, the improvement of value adding activities in isolation means that the organization is addressed as w whole and the process of improving the one activity will have little to no effect on the overall perceived efficiency of the organization. This implies that the process needs to be approached from an all inclusive approach so that the effect of the change can be effectively felt throughout the organization. For instance, if a hospital improves its services by including a faster and better pathology machine, it means that the specimen being tested gets to wait longer at a different stage of the process. The focus of lean thinking is such that the effort that is put on improving the things that are of concern to the patient and the clinicians as they are both part of the hospital (Nelson-Peterson and Leppa 2007, 287–294). Lean thinking is somewhat similar to CQI in that the focus of the efforts is on the internal benchmarks that the organization has set for itself due to the fact that external ones often focus on the improvement of services indirectly. This means that the approaches that are used in lean thinking approaches are informed by and not based on standards. Lean thinking approaches are set and led locally and need to be part of the organizational strategy. It cannot be imposed successfully from the outside. Some of the significant challenges that need to be addressed by healthcare organizations include deficits in the financial department, infections that are acquired from the hospital and the chances of avoiding injury or death, constraints that are presented by problems in capacity accusations that come about from endemic inefficiency and political and public concerns that are raised about costs and waiting lists. These problems are inevitable and have to be experienced by hospitals at one point or another. They are common occurrences in the healthcare industry. It is fortunate that these problems can be solved to a certain degree making it possible to improve the overall quality of a certain area. The improvement of quality will manifested through better healthcare delivery and improvements in patient care (Ben-Tovim et al 2007, 10–15). Quality improvement will result in less stressful work environments, job satisfaction and boosts in the efficiency and productivity of the hospital. This result is pleasing to the hospital staff, the patients, health care professionals, politicians and tax payers. Lean thinking presents the healthcare industry with an approach that will see to it that the result that pleases everyone is attained without injecting massive amount of cash into the purchase or development of new infrastructure. Lean is essential is a health care service provision as it is instrumental in the successful and strong practice. Lean is also a better option because lean has undergone research and application in the healthcare sector owing to the increasing need to have an approach that leaves the patient satisfied (Fillingham 2007, 231–241). In employing this approach, bottlenecks are facilitated at every point to provide patients with an avenue to express themselves and be heard. There are always varying comments and references that are presented by patients and in order to gain a better understanding of the causes and scales of the variability that are witnessed. Lean has been tried and tested for its efficiency and function in improving the methodology of doing work. From the time of its adoption into the healthcare industry, it has been gradually and inexorable spreading to different health institutions resulting it its fine tuning and adequate testing as well being demonstrated and proven to be successful. In a case where a hospital may be experiencing financial deficits, ward redundancies and closures, lean would not be a short term savior (Joosten, Bongers and Janssen 2009, 341–347). It is, therefore, not preferable choice for those who wish to have their solutions immediately since it provides an approach that will be assistive in avoiding medium and long term deficits. This characteristic of lean is due to the fact that principles that may be put across by lean thinking take a relatively longer time to implement and embed into the system because they need the people involved to exhibit positive commitment which takes some time before it is made effective. Six sigma Unlike lean thinking that focuses on dissolving a problem, Six sigma is an approach to improving the products and services that are offered by an organization by eliminating or getting rid of defects thus reducing the variations of processes (Antony, Antony and Taner n.d., 1-8). It is a powerful business strategy that has been experienced for about two decades and has been growing into the healthcare industry for the past five years. The approach works by reducing some of the mistakes and defects that are made in certain processes and consequently making the position of a healthcare institution better by increasing the financial gains that the organization experiences. In the context of healthcare provision, a human being is the executer of the processes of delivery of patient care. This makes it a challenge to identify and change the variability that is experienced. Quantification and identification of the variability that is in the industry is a bigger challenge still. Similar to lean thinking and CQI, the focus of six sigma is on the needs and satisfaction of the patient or the client. The characteristics of six sigma were developed by Motorola as it is the company that developed the approach. These characteristics can be applied to the health care context (Jaap van den, Ronald and Vermaat 2004, 416-124). One of the characteristics is that the methodology that is used is informed and driven by data. In addition, very strong emphasis is placed on the expectations and needs of the customer. Any defects and errors and eliminated if they result in or exhibit process variation that is unaccepted. Other than that, the process that is used to get to the root cause of a problem is structure thus, the process is done through DMAIC (define measure analyze improve and control). Another characteristic is that there are powerful non-statistical and statistical tools are used in a sequence that is consistent with the DMAIC method and process. The emphasis of the end result is on saving hard currency from projects whose alignments are consistent with the strategic objectives of the businesses and processes that the organization is involved in. the projects and processes that are involved in Sis sigma will not commence unless the cause or the bottom line of the problem has been identified because the focus of the process will be based on the problem that has been identified (Taner, Sezen and Antony 2007, 329-340). Measurements are used in six sigma with the aim of improving the process of caring for patients. This is a challenge, especially when it comes to measuring matters and issues that do not have the appropriate tools specified or developed for their measurement. For instance, it may be hard to measure the happiness or satisfaction that a patient has with the facility, especially if they are unable to communicate effectively. Conclusion Quality healthcare service provision is a broad issue that has no constant variable. The consistency of health issues comes from everyone being after a common end of adequate functionality, good health and wellness. Understandings of healthcare quality will no doubt continue to alter and include wider parameters such as those that are contained within the corporate world. The health and pleasure of patients cannot be accurately measured or predicted since there are many aspects that determine it. However, the indicators of quality health can help one make necessary changes to improve health. Also, statistics can be used to determine whether a healthcare organization is improving its health status or lagging and point to specific problems to be dealt with in a broader and holistic sense. The achievement of optimum qualities of healthcare services can be made easier by the early laying of foundations and embedding principles that will make it simpler for healthcare professionals to practice activities that ensure quality health care provision. By treating people as unique individuals, care providers will be in a better position to help them get healthy faster. Every person’s experience is unique and these experiences determine how the individual relates to aspects of good health (Kelley and Hurst 2006, 11-18). Care givers in the healthcare profession should take into consideration the safety and satisfaction of patient in the activities and approaches that they employ to help patients get better. References Anderson G, Hussey. “PS: Comparing health system performance in OECD countries.” Health Affairs (Millwood) 20. (2001): 219-232. Antony, Jiju, Antony, Frenie and Taner, Tolga. “Six Sigma in Healthcare Industry : Some Common Barriers, Challenges and Critical Success Factors.” 1-8. n.d. http://www.sixsigmascotland.co.uk/Six%20Sigma%20in%20Healthcare%20Sector%20-%20Public%20Service%20Review%20Jou..pdf (accessed September 13, 2011) Ben-Tovim D, Bassham J, Bolch D et al. “Lean thinking across a hospital: redesigning care at the Flinders Medical Centre.” Australian Health Review. 31 (2007). 10–15. Balle,´ M and Re´gnier, A. “Lean as a learning system in a hospital ward.” Leadership Health Service. 20 (2007). 33–41. Bouchet, B. “Quality of Health System Policy and Strategy Development in Estonia.” Trip report. December (2004):15–18. Tallinn, Estonia Fillingham, D. “Can lean save lives”. Leadership and Health Service. 20 (2007) 231–241 Jaap van den Heuvel1, Ronald J. M. M. Does and Vermaat, M. B. (Thijs). “Six Sigma in a Dutch Hospital: Does It Work in the Nursing Department.” Qual. Reliab. Engineering International 20 (2004): 419–426 Joosten, Tom, Bongers, Inge and Janssen, Richard. “Application of lean thinking to health care: issues and observations.” International Journal for Quality in Health Care. 21.5 (2009): 341–347 Kahan, Barbara and Goodstadt, Michael. “Continuous quality improvement and health promotion: can CQI lead to better outcomes.” Health promotion international. 14.1. (1999): 83-90. http://www.idmbestpractices.ca/pdf/CQI.pdf (accessed September 13, 2011) Kalda, R and Lember, M. “Setting national standards for practice equipment. Presence of equipment in Estonian practicies before and after introduction of guidelines with feedback.” International Journal of Quality Health Care. 12 (2000): 59–63 Kelley, Edward and Hurst, Jeremy. “Health Care Quality Indicators Project Conceptual Framework Paper.” OECD Health Working Papers. 23 (2006): 11-18. http://www.oecd.org/dataoecd/1/36/36262363.pdf (accessed September 13, 2011) Ministry of Social Affairs .“Quality Assurance of Health Services in Estonia”. 2005. http://ee.euro.who.int/Quality_assurance_of_health_services_in_Estonia.pdf (accessed September 13, 2011) Nelson-Peterson, D and Leppa, C. “Creating an environment for caring using lean principles of the Virginia mason production system.” Journal of Nursing Administration. 37 (2007). 287–294. Taner, Mehmet Tolga, Sezen, Bulent and Antony, Jiju. “An overview of six sigma applications in healthcare industry.” International Journal of Health CareQuality Assurance, 20. 4 (2007): 329-340 Read More