Integrating Quality and Strategy in Health Care Organizations - Literature review Example

Pressure Area Care Name: Institution: Pressure Area Care Healthcare institutions including hospitals, healthcare centers, and dispensaries play an important role in any society. They provide services and products to ensure physical and psychological wellbeing of people. They also offer services to protect the society against prevailing risks to public health brought about by changes in lifestyle and environmental conditions. In providing these services, these institutions are required to observe care and ascribe to established code of ethics to ensure safety and quality of their services. They are required to ensure that any risk related to their services and products is kept to an unacceptable level (University of California at San Francisco, 2001). This requirement calls for a need of mechanisms or strategies to monitor and evaluate performance of resources of healthcare institutions to guarantee their efficiency and effectiveness. Delivery of services in these institutions is dependent on many factors including human resources, equipment, clinical procedures, and relevant strategies. For example, a number of healthcare professionals including registered nurses, doctors, and pharmacists may be involved in pressure area care: frequently changing position of a bed-ridden patient to minimize risks of bed sore or pressure ulcer (ICCMU, 2011). In this case, it is important to collect and analyze data to determine safety and quality of the care. The type of data collected varies based on the type of expected measurement: outcomes, process, and balancing (Donaldson, 1999). Among these three types, process and outcome data plays a significant role in improving quality of healthcare services and safety of patients. Process data refers to information used to measure and evaluate safety and quality of a system (Lighter & Fair, 2004). It may comprise of statistics, facts, narrations, and opinions collected with regard to a system suspected of causing or contributing to unexpected harm to patients. A system comprises of components including resources and activities directly linked to the negative outcome under consideration. It may consist of a clinical procedure, administration of particular medicine, use or operations of a particular medical equipment, working environment, and communication between relevant healthcare professionals. For example, in the case of pressure area, an example of process data may involve the frequency in which the sleeping position of a bed-ridden patient, who developed a pressure ulcer on the lower abdomen, was changed (Lyder et al., 2001). In this example, the system under investigation is a clinical procedure: changing of position of the bed-ridden patient. The process data of interest is the number of times or frequency of the changes. Various strategies can be employed to gather the data including collecting statistics from relevant clinical records and interviewing registered nurses responsible for taking care of the affected patient. These characteristics demonstrate the significance of process data in ensuring patient safety and quality of care in healthcare institutions. The major reason for collecting process data is to improve quality of components of a healthcare system and hence, minimize risks of negative consequences to patients (Nieva & Sorra, 2003). A health system comprises of many components that work collaboratively to ensure wellbeing of patients. These components may include procedures, activities of the different types of healthcare professionals, prescription drugs used in treatment of health problems, and so on. This interconnectedness makes it impossible to determine quality of a healthcare system without a way to measure and evaluate its performance. Collection of process data presents an effective way to measure, monitor, and facilitate evaluation of a system to determine possible areas of improvement. The process data tracks performance of every component related to a healthcare system. Consequently, it facilitates identification of unsafe components, responsible for an unexpected negative outcome, which require improvement to ensure delivery of safe, quality services to patients (Ferrer et al., 2008). For example, in pressure area care, process data on changing sleeping position of a patient (who has developed a pressure sore) can assist a healthcare institution to identify the most appropriate way to improve the system. Besides frequency of changes, other process data, in this case, may include sleeping positions, types of beddings, level of supportive care offered to the patient, and so on. Collection of these forms of process data can help an institution determine areas that need to be improved to prevent patients with similar health conditions from developing pressure sore. These areas may include increasing frequency of the change, not allowing patients to sleep in some body positions, changing beddings, or changing level of supportive care. The rationale of collection of process data may also involve other purposes related to improvement of service quality. According to Vincent (2004), process data can be used in system analysis to isolate root causes of a negative health care incident. The interrelated nature of components of a healthcare system involved in delivery of a particular service may present challenges in determining the component responsible for a negative outcome. For example, a pressure area system comprises of doctors, registered nurses, pharmacists, laboratory technologists, beds, beddings, clinical procedures, and so on. This implies that a pressure sore in one of the bed-ridden patients could be caused by deficiencies or weakness inherent in one or some of the components. Consequently, an analytical technique is required to determine the component responsible for or the root cause of a negative consequence on a patient; in this case, pressure sore. The most appropriate technique includes the system analysis approach: analyzing every component and its relationship with other components to determine weak ones and ways to improve the weaknesses (Vincent, 2004). In this analysis, collection of process data about the components provides a means to effectively isolate the root causes. It facilitates continuous monitoring, measurement, evaluation, and determination of the component or components that require improvement to ensure safe, quality care to patients. This helps healthcare institutions ensure sustainable, safe delivery of quality services to patients. As Rubin, Pronovost, and Diette (2001) observe, process data can be used to give feedback for efforts taken by healthcare institutions to maximize patient safety and improve quality of services. In pressure area care, healthcare institutions adopt a wide range of strategies and components to enhance quality and safety of their services. They adopt internationally accepted standards to guide development and implementation of pressure area care procedures and services. They also equip their pressure area care departments with necessary resources to meet needs of respective communities. In addition, they also develop and implement policies to ensure that their services conform to respective legislations and professional code of ethics. They also continuously monitor, evaluate, and improve their services to meet changing market demands, acceptable safety and quality standards, and needs of their clients. In all these efforts, healthcare organizations require some form of feedback to determine success of their initiatives. Bradley, Holmboe, Mattera, Roumanis, Radford, and Krumholz (2004) observe that process measures or collecting process data presents one of the most effective mechanisms for the institutions to obtain this feedback. These measures collect and record data on how these efforts are implemented. For example, data can be collected on how a particular clinical procedure (for example, changing position of a bed-ridden patient) in the pressure area care conform to established standards, professional code of conduct, or relevant health care legislations. Through process data, the organizations stand in a better position to determine whether a process is being implemented as required. It is also possible to determine whether level, characteristics, or parameters of a particular initiative contribute towards improving safety of patients and/or quality of services to the patients. Therefore, collecting process data provides feedback that can be used to obtain a holistic view of quality improvement processes in healthcare organizations. In contrast, the rationale of outcome measures or collecting outcome data is limited to identification of a need for quality and safety improvement or process measures. Outcome data refers to statistics, opinions, and/or narrations collected about a particular health result (Newhouse & Poe, 2005). It does not only involve data on negative outcomes, but also positive outcomes. In comparison to process data, it can be collected through various methods including patient surveys, interviewing healthcare practitioners, mining facts from clinical records, extracting data from health statistics bureaus, and interviewing members of a society served by a particular healthcare organization. Examples of negative outcome data may include number of injuries and deaths due to a particular health problem in a society. By contrast, positive outcomes may include customer satisfaction and number of patients who have successfully undergone a particular clinical procedure (Barzi, Mikhail, & Shabot, 2012). In pressure area care unit, a good example of outcome data includes the number of bed-ridden patients who develop bed sore while in the unit. The pressure sore being a negative consequence, this data would be also a negative outcome data. These characteristics demonstrate that outcome data is mainly used to improve quality of services in two different ways: establish a need of improvement efforts and trigger process measurement (Lilford, Mohammed, Spiegelhalter, & Thomson, 2004). A negative outcome data shows a need for a healthcare organization to improve relevant system. It may indicate likelihood of inefficiencies or weaknesses inherent in the respective system. According to Bratzler and Hunt (2006), these weaknesses may due to design, implementation, or enforcement of the healthcare system. For example, a high number of bed-ridden patients with pressure sores would suggest that the pressure area care system needs improvement. In this case, the system is exposing patients to unacceptable levels of harm. Therefore, the respective healthcare organization would be interested in minimizing the number of affected patients. This goal to minimize number of cases would form the basis of improvement efforts of the organization. This implies that outcome data can only be used to direct efforts to enhance safety and quality of health care services, but not to identify or determine appropriate quality improvement initiatives. Outcome data is greatly dependent on a system’s component or components and hence, it can be used as a basis of process measures. To a larger extent, processes within a healthcare system influence the nature or characteristics of relevant outcomes. Therefore, collecting outcome data can present good feedback to determine the level and amount of process data to collect (Jamtvedt, Young, Kristoffersen, O’Brien, & Oxman, 2003). It can also provide important insights to guide the process of determining the exact process or components that need monitoring and evaluation. For instance, a pressure ulcer in a bed ridden patient can occur due to many components or factors including hypoxemia, restlessness while sleeping, sleeping in one position for extended period, and so on (ICCMU, 2011). Therefore, outcome data on the pressure ulcer can help an organization determine related processes require measurement and evaluation of their performance. It can also assist in determining process data to be collected: frequency of changing sleeping positions, types of beddings, design of the beds in the pressure area care, and so on. Therefore, outcome data can be used to facilitate the process of identifying and collecting process data related to a particular negative outcome in healthcare organizations. In conclusion, process and outcome data plays a significant role in improving quality of healthcare services and safety of patients. Process data refers to information used to measure and evaluate safety and quality of a system. It may comprise of statistics, facts, narrations, and opinions collected with regard to a system suspected of causing or contributing to unexpected harm to patients. In comparison, outcome data refers to statistics, opinions, and/or narrations collected about a particular health result. For example, in a pressure area care unit, outcome data and process data can be collected with the regard to the process of changing sleeping position of a bed-ridden patients who developed pressure ulcers while in the unit. In this case, process data could be frequency of the changes, while outcome data could be number of patients with the bed sores. Even though both types of data can be used for improvement of safety and quality of healthcare, rationale for collecting process data is wider than that for collecting outcome data. Process measures can be utilized to improve quality of components of a healthcare system; in system analysis to isolate root causes of a negative health care incident; and used to give feedback for efforts taken by healthcare institutions to maximize patient safety and improve quality of services. In contrast, outcome data is mainly used to identify a need of improvement efforts, and trigger process measurement. This implies that outcome data forms the basis of gathering process data. References Barzi, A., Mikhail, O., & Shabot, M.M. (2012). Integrating quality and strategy in health care organizations. Sudbury, MA: Jones & Bartlett Publishers. Bradley, E.H., Holmboe, E.S, Mattera, J.A., Roumanis, S.A., Radford, M.J., & Krumholz, H.M. (2004). Data feedback efforts in quality improvement: Lessons learned from US hospitals. Quality & Safety in Health Care, 13 (1), 26-31. Bratzler, D.W., & Hunt, D.R. (2006). The surgical infection prevention and surgical care improvement projects: National initiatives to improve outcomes for patients having surgery. Clinical Infectious Diseases, 43 (3), 322-330. Donaldson, M.S. (1999). Measuring the quality of health care. Washington, DC: National Academies Press. Ferrer, R., Artigas, A., Levy, M.M., Blanco, J., González-Díaz, G., Gornacho-Montero, J., …, Torre-Prados, M.V. (2008). Improvement in the process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA, 299 (19), 2294-2303. ICCMU. (2011, Mar. 3). Pressure area care. Retrieved from http://intensivecare.hsnet.nsw.gov.au/pressure-area-care. Jamtvedt, G., Young, J.M., Kristoffersen, D.T., O’Brien, M.A., & Oxman, A.D. (2006). Audit and feedback: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, 2, CD000259. Lighter, D., & Fair, D.C. (2004). Quality management in health care: Principles and methods. (2nd ed.). Sudbury, MA: Jones & Bartlett Learning. Lilford, R., Mohammed, M.A., Spiegelhalter, D., & Thomson, R. (2004). Use and misuse of process and outcome data in managing performance of acute medical care: Avoiding institutional stigma. Lancet, 363, 1147-1154. Lyder, C.H., Preston, J., Grady, J.N., Scinto, J., Allman, R., Bergstrom, N., & Rodeheaver, G. (2001). Quality of care for hospitalized medicare patients at risk for pressure ulcers. Arch Intern Med, 161(12), 1549-1554. Newhouse, R., & Poe, S. (2005). Measuring patient safety. Sudbury, MA: Jones & Bartlett Publishing. Nieva, V.F., & Sorra, J. (2003). Safety culture assessment: A tool for improving patient safety in healthcare organizations. Quality and Safety in Health Care, 12 (S2), ii17-23. Rubin, H.R., Pronovost, P., & Diette, G.B. (2001). The advantages and disadvantages of process-based measures of health care quality. International Journal of Quality in Health Care, 13 (6), 469-474. University of California at San Francisco. (2001). Making health care safer: A critical analysis of patient safety practices (AHRQ Publication 01-E058). Rockville, MD: Agency for Healthcare Research and Quality. Vincent, C.A. (2004). Analysis of clinical incidents: A window on the system not a search for root causes. Quality & Safety in Health Care, 13 (4), 242-243. Read More