Analysis of Health Care Quality and Safety - Essay Example

Analysis of healthcare quality and safety Name of the Student: Name of the Instructor: Name of the course: Code of the course: Submission date: Analysis of healthcare quality and safety Introduction It is imperative to note that the characteristic of ideal governance of the healthcare system is the demonstration that it is efficient, effective and of high quality to the users, funders and the wider community. Towards achieving these features, diverse countries around the globe have undertaken different approaches aimed at ensuring quality as well as enhancing safety standards in healthcare services (Tabrizi et. al., 2011). In diverse industrialized countries, Hilless and Healy (2001) and Australian Institute of Health and Welfare (2004) revealed that these countries including Australia have been seeking mechanisms to enhance the quality of their healthcare, most specifically, to make it more safer and effective. Despite the fact that Australia compares well in the international spectrum in regard to healthcare and health outcomes, there has been increased attention on both quality and safety issues. Although there have been concerns about out-of-hospital healthcare, most of the aforementioned attention has been focused on hospitals based on the high level of data availability as well as keeping in mind that the implications of medical errors tend to be of a greater magnitude. These efforts have seen the development and growth of various interventions aimed at improving healthcare quality and safety in the Australian system. Nonetheless, despite decades of commitment by professionals in the healthcare sector to quality and safety in the healthcare industry, the achievements of the system and processes to achieve the goal of safe practices have continued to be problematic. Against this backdrop, this paper will describe the achievements that have been made towards improved patient safety in the last two decades. Additionally, it will provide an analysis of barriers to achieving 100% safe health services. The achievements made towards improved patient safety in the last two decades There have been diverse achievements which have been realized in regard to the improvement of patient safety in the last two decades. Firstly, it is imperative to note that in the past, the concept of safety was divorced from the tenet of quality in healthcare. Subsequently, the explicit reference to patient safety was extensively missing from the early quality frameworks which resulted to increased prevalence of health safety issues not only in Australia but in other parts of the globe. This is best epitomized in the US whereby Utah and Colorado hospitals, 6.6% of adverse events culminated to death when juxtaposed with 13.6% in New York hospitals. Studies revealed that more than half of these adverse events emanated from medical errors which could have been prevented (National Academy of Sciences, 2013). Nonetheless, the last two decades have seen the government, members of the public as well as the healthcare providers becoming cognizant of the wide alley of the risks which are associated with healthcare provision. This has predominantly been through the publication of shocking statistics which quantified the error rates which occur in diverse healthcare facilities as well as the risks to the patients of extreme results occasioned by these unanticipated errors. Additionally, the high publicization of failures of medical regulations has also played a key role towards the integration of safety in the quality framework. Subsequently, recent definitions of healthcare quality now encompass safety as a core prerequisite and dimension for quality, for instance, definitions by Walshe and Boaden, (2006) as well as Moss and Barach (2002) among others. This has resulted in the wide recognition among the health practitioners, policy makers as well as scholars n diverse realms of academia that the improvement of the healthcare quality will necessitate total systematic change and that none of the proven problems had been unearthed or resolved through extensive national safety and quality processes or accreditation (National Academy of Sciences, 2013). Additionally, the ‘patient safety movement’ has been central in the adoption of learning, approaches and tools from the quality management movement as well as from organizational psychology in regard to ‘human factor. Based on the above evidence, it is plausible to infer that the general step of incorporating safety into quality frameworks has been a fundamental achievement made towards improved patient safety in the last two decades. The other achievement which has been evident towards improved patient safety in the last two decades has been increased cooperation between the stakeholders in the healthcare industry. Thus, there has been effective teamwork in healthcare which is characterized by effective liaison and inter-agency cooperation, thoroughness and attention to details as well as listening to all the clinical team members, relatives and patients. This is founded on the cognition of the fact that active cooperation and involvement of all staff among other stakeholders in the healthcare industry is imperative for the improvement and effectiveness of quality and safety efforts. Moreover, it is important to note that Australia has also entered into more formal relationships with other countries in the region. This has culminated in the signing of a memorandum of understanding on health cooperation aimed at providing a framework to enhance responses to regional health challenges (Healy et. al., 2006). This can also be perceived as a major achievement in the cooperation efforts which are integral in the journey towards improved patient safety in the recent times. The third achievement is related to the successful identification and transfer of knowledge to the health setting from other high risk industries by experienced individuals. This has been extensively derived from investigations of devastating disasters, for instance, chemical and nuclear spills, airplane crashes, outbreak of infectious diseases as well as experience from high reliability organizations which rarely experience safety issues. This can be viewed as a major achievement in the efforts towards safety among the patients in the last two decades based on the fact that safety standards and policies from these organizations have been incorporated in the healthcare operations. The impact of this integration has been key in informing the clinical risk management efforts in different healthcare facilities and thus this can be perceived as a major achievement made towards improved patient safety in the last twenty years. The last achievement which will be explored in this section is the one related to clinical governance and ‘safety culture’. Different scholars, for instance, Krause and Hidley (2009) have described how medical errors are bound to more frequently occur in situations where the providers must deviate from procedures or when there is weak definition or non-existence of procedures. In case of such situations, these scholars have alluded to the fact that safety climate and organizational culture are key in guiding the decision making behavior. Towards this end, most healthcare facilities have been able to forge an organizational culture underpinned by safety with the help of good clinical governance. This has been a major achievement which has been central in the aspiration towards improved patient safety in the last two decades. All the achievements outlined in the preceding analysis have been fundamental in the evolution towards improved patient safety not only in Australia but also in several other countries around the globe. Nonetheless, it is paramount to point out that this has not been without barriers which have hindered the achievement of 100% safe health services. Some of these barriers are analyzed in the subsequent section. Barriers to achieving 100% safe health services One of the most noted barriers by different scholars, for instance Walshe and Shortell, (2004) among others is the dominant or traditional healthcare culture, or the set of cultures among the healthcare professions. In this case, some the medical practitioners are still rooted in the traditional healthcare culture which divorces safety from the overall quality of the healthcare services. The basic inclination towards this traditional paradigm has been a major barrier towards the achievement of total safety in the delivery of healthcare services. Additionally, it is imperative to note that from a historical perspective, health care managers as well as policy makers have been extensively concerned about the dimensions of access and efficiency as opposed to safety. In this case, the clinicians have predominantly defined quality from a technical dimension and with technical aspects like content of the care which is provided, technical outcomes as well as the generic conformity with professional standards. Thus, the continuity of the above trend has been a central barrier towards the achievement of 100% safe health services. This based on the exclusion of safety from the technical definition of quality by clinicians in different healthcare facilities around the globe as outlined above. The other barrier is related to clinical governance. This is whereby most of the healthcare facilities have been predisposed to undesirable clinical governance practices characterized by lack of commitment at the organizational level, ineffective communication, inadequacy of information and reporting systems as well as inadequate resourcing among other tenets. This has been detrimental towards the attainment of 100% safe health services based on the fact that the clinical governance practices and operations play a central role in entrenching safety in the quality frameworks of various healthcare facilities. It is also imperative to be cognizant of the fact that just like any other change process in different organizational set-up, the efforts to integrate safety standards in the quality frameworks in different healthcare facilities has been confronted by extensive resistance. This is founded on the backdrop that in most cases, healthcare practitioners view change as being disruptive and thus their resistance to changes aimed at instigating increased safety are inevitable. Some of the rationales of this resistance include misunderstanding of the proposed change, self-interest, differences in evaluation, lack of trust and low tolerance to change among other reasons (McSherry and Pearce, 2007). Thus, the high level of resistance, mostly from the clinicians with a traditional paradigm previously mentioned has been revealed as a major barrier towards the achievement of 100% safe health services. This is with evidence pointing to the fact that traditional cultures are still deeply entrenched, which proves problematic in the efforts to shift the inherent paradigms. The other barrier is related to the differences in approaches to quality among the stakeholders in the healthcare sector. This is based on the fact that there are some apparent differences in the ways different individuals and collectives in diverse professional groups approach quality. This is partially responsible for the slow progress towards the realization of total safety in health services. This is because such differences are key in limiting the level of cooperation and coordination among these individuals and professional groups in the healthcare sector. The last barrier which will be explored in this section is related to complexity of health services delivery. This is founded on the fact that health care basically occurs in a complex and sophisticated environment which is extensively characterized by interaction between a wide alley of factors, for instance, the disease process, policies and procedures, hospital and community setting, infrastructure and equipment among other factors (Fletcher, 2000). Additionally, delivery of health services entails the input of a wide range of stakeholders, for instance, the medical practitioners, government agencies, medical insurance companies and the policy making bodies. All these stakeholders have different perspectives in relation to safety and are governed by distinct rules and procedures. This complexity generates extensive bureaucracy in the delivery of healthcare services as well as non-coordination in the delivery of services to the patients which creates an extra barrier towards the realization of 100% safe health services. Conclusion The preceding analysis has evidenced that diverse countries around the world have undertaken different approaches aimed at ensuring quality as well as enhancing safety standards in their healthcare services. This review has also explored different achievements that have been made towards improved patient safety in the last two decades. These include but not limited to the general step of incorporating safety into quality frameworks as well as increased cooperation between the stakeholders in the healthcare industry among others. Lastly, it has analyzed the barriers to achieving 100% safe health services which include the dominant or traditional healthcare culture, complexity of health services delivery and differences in approaches to quality among the stakeholders in the healthcare sector among other barriers. References Australian Institute of Health and Welfare (2004). Australia’s Health 2004. Canberra: Australian Institute of Health and Welfare. Fletcher, M., (2000). The Quality of Australian Health Care: Current Issues and Future Directions. Occasional Papers: Health Financing Series Volume 6, Canberra: Commonwealth Department of Health and Aged Care. Healy, J., Sharman., E, & Lokuge B. (2006). Australia: Health system review. Health Systems in Transition, 8(5): 1–158. Hilless, M & Healy, J. (2001). Health Care Systems in Transition: Australia. Copenhagen: European Observatory on Health Care Systems. Krause, T. R. & Hidley, J. H. ( 2009). Taking the Lead in Patient safety, How Health Care Leaders Influence Behaviour and Create Culture. Hoboken, New Jersey: John Wiley & Sons. McSherry, R. & Pearce, P. (2007). Clinical Governance, A Guide to Implementation for Healthcare Professionals, Oxford: Blackwell Publishing. Moss, F. & Barach, P. (2002). Quality and Safety in Health Care: a time of transition. Quality and Safety in Health Care, 11: 1. National Academy of Sciences (2013). To Err is Human: building a Safer Health System. Retrieved June 10th, 2013 from http://www.nap.edu/openbook.php?record_id=9728&page=1 Tabrizi, J.S. et. al.,(2011). Advantages and Disadvantages of Health Care Accreditation Models. Health Promotion Perspectives, 1(1): 1-31. Walshe, K. & Shortell, S. M. (2004). When Things Go Wrong: How Health Care Organizations Deal With Major Failures. Health Affairs, 23(1): 103 – 111. Walshe, K. & Boaden, R. (Eds) (2006). Patient Safety, Research into Practice, Maidenhead, Berkshire: Open University Press. 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