Quality Management in Health Care - Case Study Example

Introduction Most of the management practices used in healthcare organizations are borrowed from those used in companies in other industries. For instance, methods used in quality management such as lean thinking, quality improvement and Six Sigma have been taken from the manufacturing industry. Although healthcare borrows its management practices from those practiced in other sectors or industries, health services are different in such a sense that they require different management practices to be applied (Willis, Reynolds & Keleher, 2012). The first difference in health services is the definition and management of quality. Quality in health services has two principal dimensions; access and effectiveness (Low, Hattingh & Forrester, 2009). The question asked in health care is whether patients get the care that they require and whether the care is effectiveness. Effectiveness in healthcare has two components; effectiveness of inter-personal care and effectiveness of clinical care. These elements are normally discussed in terms of processes of care, structure of healthcare system, and outcomes of the care provided (Sorensen & Iedema, 2008). Health services quality In health services, unlike in manufacturing industries, quality is related to individual patients and the concept of quality is only meaningful when applied to users of health care. Quality in health care, just like in other service industries, is hard to measure in the sense that it is related to the customer perception and customer satisfaction. Heath services are deemed as of high quality only when high customer satisfaction is achieved. Quality management in health care, therefore, involves establishing standards and guiding principles that are aimed at achieving customer expectations in the service provision (Lewis, 2003). The quality of health care services is also not predetermined because it evaluated at the point of delivery. Health services can be adjusted according to the desires of the client to make sure that maximum satisfaction is achieved in the end. This means that applying the quality management practices normally practiced in other manufacturing industries to health services can be challenging and result to problems in the delivery of quality health services to patients (Willis, Reynolds & Keleher, 2012). Funding in healthcare Health care is also different with regard to funding. Unlike other industries, health services are funded through a number of funding forms. The first funding form in health care is Medicare (Gillies, 2003). Medicare is a publicly funded health care scheme that is employed in countries, for example, the United States and Australia. Medicare is the main funders of health care funding basic health care for citizens in countries that use it (Gillies, 2003). Medicare ensures that citizens get subsidized medical services from health professionals, nurse practitioners, medical practitioners and eligible midwives. The Medicare scheme is funded by the Medicare levy and taxes. Funding of health services is, therefore, different from other industries, which depend on funding from companies’ owners, shareholders and funding from loans. The only disadvantage with Medicare is that the scheme is accessible only to permanent residents of the countries that use it. People living temporarily in these countries are not eligible for this type of funding (Sorensen & Iedema, 2008). Another form of health care funding is social health insurance. Social health insurance mainly involves workers where the government compels employees to take up medical insurance covers. This is done through employers where employers make contributions towards an established insurance program. Unlike other industries where services or products are paid for at the point of sale, health services are prepaid, and when the services are needed, they are provided at a subsidized cost or for free depending on the scheme of payment (Australian Institute of Health and Welfare, 2012). However, cases where people pay for health services directly at the point of provision. For instance, the unemployed people are not eligible for the social health insurance scheme and therefore are needed to pay for the medical services provided to them. People can also take their own personal medical insurance covers to help them to finance their medical expenses as they arise. The payment of medical services through insurance schemes and Medicare means that health services are financed differently as compared to other industries (Clinton, 2004). Human resource management Apart from funding, another crucial input in health care is a human resource. Health care, unlike other industries, rely heavily on human resource to provide the needed services. Although other industries rely on human resource to implement various operations in the organizations, the human resource takes center stage in health care in the sense that without human resource; nothing takes place in health care organizations (McMurray & Clendon, 2011). Management practices such as lean thinking do not apply in health services settings because it is hard to provide health services using machines such as computers (Lewis, 2003). Other resources needed in health care include medical equipment and medical facilities. Changes in health care in terms of who does what, therefore, requires reforms in policies related to production of health worker inputs like education and training of health workers. This also includes changing or creating other training programs, increasing spaces in medical schools so that more physicians or nurses can be trained to cater for the emerging medical needs, introducing new programs due to arising needs that need new types of workers, and access to capital equipment like vehicles (McMurray & Clendon, 2011). Marketing in health care Marketing in the health industry does not vary from the marketing of businesses in other organizations. The principles which are used in other industries such as competitive research, budgeting, marketing strategies, branding, tactics, implementation processes, tracking processes and media options are used in health care organizations, hospitals and the private health organizations (Australian Institute of Health and Welfare, 2012). Notwithstanding the differences, there are also many ways in which marketing of health services is done in a different way from the promotion in other organizations. The first difference is business training. Most businesspeople in the health industry have little or no training in business, experience or education which can help them in starting and running their first health care business. Most owners and employees of health care businesses prefer to view their establishments as a profession, career or a calling rather than an enterprise. What motivates that people to be drawn to an occupation in health services is different and contradictory to the motivation that makes people be drawn to a career in business (Sorensen & Iedema, 2008). Because healthcare owners lack knowledge in marketing as well as businesses laws, tactics and strategies in their training and education, they are normally disadvantaged from the start of their business. Such owners normally struggle through the trial and error, sometimes making tragic mistakes on the way that negatively affect the business, to compensate for their non-existence of business knowledge and training (Harris, Society for Health and Administration Programs in Education., & Australian College of Health Services Executives, 2006). This makes it very hard for them to succeed in business because they do not know what they are supposed to do to succeed, and they are also not aware of the knowledge they lack. Health care professionals are also normally more concerned about their reputation. Health care practitioners normally try to preserve their reputation by doing what they see as right so that their colleagues in other health care organizations are not offended by their actions rather than try to attract more customers to their facilities (Sorensen & Iedema, 2008). Although it can be argued that for most of the referral-based health care specialists, other health care practitioners and professionals are their major customers, the worry of most healthcare professionals is their reputation as seen by other professionals who are normally their competitors (Low, Hattingh & Forrester, 2009). These professionals are always of the view that if they market and advertise their businesses, their colleagues in other health care organization will think that they are struggling to make it in the market and are, therefore, desperate. This is particularly common among the older and mature health care providers who started the practice before marketing and advertising in healthcare were prevalent and common as it is today (McMurray & Clendon, 2011). Due to lack of business knowledge, experience and training, these practitioners normally fail to realize that there other ethical and professional methods, tactics and strategies that they successfully use so that their reputation is preserved as well as they achieve the competitive advantage needed in the market. They also do not know that such methods can enhance their reputation with their colleagues instead of destroying it (Clinton, 2004). Government regulation Health care is also different from other businesses in other industries in view of the regulations imposed on health care organizations. Healthcare providers are required to obey or respect the advertising and marketing rules set by the state licensing board (Clinton, 2004). Although the licensing boards do not have the legal power and authority to prohibit the owners of health care businesses from promoting their businesses, they can establish limiting rules, which are applied to advertising and marketing (Sorensen & Iedema, 2008). Several health care professionals and owners are afraid of the boards, and they understandably get frightened by the authority wielded by the boards that allow them to approve and punish health care providers for violating the set guidelines. This has made many health care professionals and owners to avoid marketing their businesses altogether that has made them lose out on all the benefits of ethical and effective marketing. However, what these professionals fail to realize is that although each state and profession establish its guidelines and regulations, a careful study of most of the advertising and marketing guidelines will reveal that they prohibit or restrict the most basic unethical or illegal practices (Daly, Speedy & Jackson, 2009). In essence, one is not supposed to present information in their promotion that is misleading, is false or on that misinforms the public. One is also not supposed to vilify a professional competitor or colleague directly. However, the trickiest rule that is normally forced by many medical boards is; health care professional or practitioner is not supposed to state information in their promotion that will make them look better their competitors in other health care organizations (Longenecker, 2012). The presence of this guideline in the regulations imposed by the board presents a harder situation for health care professionals, practitioners and owners who wish to advertise their businesses. This constraint is also the root of most legal claims, protests, and disagreements, which are associated with advertising and promotion by health care providers. This restriction is difficult for many health care professionals, and one that is hard to observe since the essence of marketing is to portray one’s business or skills as the best for the targeted customers. Trying to endear yourself or your business to potential customers without creating the sense of comparison with competitors is very hard (McMurray & Clendon, 2011). Such restrictions in marketing have an impact on the management practices used in health care organizations. For instance, many health care professionals and organizations try to avoid problems by laying emphasis on promoting the health services that they offer and what they can do or have experience in and can provide well. This means that management practices that are aimed at achieving competitive advantage over other competitors are not applied in health care organizations of the possibility of violating the set regulations (Clinton, 2004). Apart from the marketing and advertising regulations that health care professionals and owners are supposed to adhere to, they are also supposed to obey the Medicare guidelines and guidelines of other health care insurance schemes. The guidelines of Medicare and rules set by other insurance schemes in healthcare limit the capacity of health care professionals, specialties and owners to offer price discounts and other related special offers to customers. Since people are used to hypes and inflated declarations in most advertisements, sellers in most companies and industries use the initial offers to allow customers to take a low risk of trying out the products being presented by a new company (Daly, Speedy & Jackson, 2009). These marketers normally offer the initial products or services at a much-reduced price or for free. This encourages customers to allow the new business to impress them with its products. In health care, initial offers to patients are restricted. There are legal limitations that are associated with Medicare rules. The Medicare rules prohibit medical professionals from offering price waivers or price discounts to patients for the health care services offered to the patient and which are covered by Medicare whether the patient is eligible for Medicare or not. However, there are health care services that are normally provided for free and also have no associated insurance billings (Daly, Speedy & Jackson, 2009). Such services are given to citizens ad public services and they include cholesterol screenings, free blood pressure screening, free educational seminars in educational matters, among others. Such services are usually allowed by law. For services, which are not under Medicare or any other health care insurance scheme, initial offers are common. A good example is cosmetic and plastic surgeons. Providers of these services offer free consultation services to potential customers. Apart from the legal restrictions, most health care providers and professionals have an emotional barrier which makes them to avoid using introductory offers to lure potential customers to their health facilities. Many health care professionals feel that this form of promoting their businesses is unprofessional and that it makes them appear as offering low-quality services to their patients (McMurray & Clendon, 2011). It is due to these legal and psychological restrictions and barriers that make health care different from other businesses and which make it hard for the management practices used in other industries hard to apply in the healthcare sector. The other difference in healthcare as compared to other organizations in other industries is about profitability. Profitability in health care is a dirty word. Most health care professionals do not like the idea of referring to patients as customers or consumers. This is different from other businesses that view people who use their products or services as customers. Although collections and billing are a necessity in business, health care organizations are reluctant to acknowledge such practices (Clinton, 2004). Health care organizations always want to centre their practices or activities on altruistic principles like charitable missions and charity care. Such attitude towards profitability makes it hard for health care organizations to adopt management practices that aim at achieving high returns, as this will be viewed as unethical and immoral by other health organizations and health professionals. This means that using management practices that emphasize on profitability cannot be used in health care because such practices will be viewed as dirty, unethical and immoral (Daly, Speedy & Jackson, 2009). Work in health care is also very varied. The health care sector has different sections with each section having a different kind of work that need to be accomplished. For instance, the work needed to be carried out by a doctor is different from the work needed to be carried out by a nurse. Similarly, the work of a pharmacist is different. There is also no way a worker in one section can be used in another section. In addition, work in health care is not repetitive in the sense that no patients have the same medical condition (Willis, Reynolds & Keleher, 2012). This means that each patient requires a different kind of medical care. This makes it hard for the management practices that are used in industries where work is repetitive and unvarying to be used in the health care industry. Management practices such as scheduling of resources and inputs, for instance, are not applicable in this situation since there are no fixed inputs and resources that needed for each day’s activities. Rather each day needs different inputs and resources depending on the conditions of the patients on a particular day (McMurray & Clendon, 2011). Mobility of employees in health care is also difficult since each section requires workers with certain specialized skills. This means that workers remain in a certain limited area of work. The degree of professionalism in health care is high, and employees needed in this sector are the skilled. The management practices used to manage such professionals is, therefore, different from the ones used to manage unskilled or the semi-skilled workers (Australian Centre for Health Research, 2011). Tasks in health care are also well defined. Each employee has a specific task to accomplish. Supervision and management of such professionals is, therefore, easy since it involves looking at a certain part of the task to see if it has been accomplished and if not, to trace it to the responsible professional. The definability of tasks in the health care makes it to be different from other industries where, in some cases, definability is not so distinct (Daly, Speedy & Jackson, 2009). Conclusion Although management practices used in other industries are applied in health care, there are a number of differences in health care that sets it apart from other industries. They include lack of business knowledge, training and education for health care owners, the need to conform to Medicare rules and regulations, lack of mobility for employees, and the view among health professionals that health care in not a business but a calling. This makes it hard for management practices used in other industries to fit the health care industry. This means that the health industry needs different management practices that will make it successful. References list: Australian Centre for Health Research. (2011). Health care in Australia: Prescriptions for improvement. South Melbourne, Vic: Australian Centre for Health Research. Australian Institute of Health and Welfare. (2012). Mental health services: In brief 2012. Canberra: Australian Institute of Health and Welfare. Australian Institute of Health and Welfare. (2012). Palliative care services in Australia 2012. Canberra: Australian Institute of Health and Welfare. Clinton, M. (2004). 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Chatswood, N.S.W: Elsevier Australia. Sorensen, R., & Iedema, R. (2008). Managing clinical processes. Sydney, N.S.W: Elsevier. Willis, E., Reynolds, L. E., & Keleher, H. (2012). Understanding the Australian health care system. Chatswood, N.S.W: Churchill Livingstone. Read More