Evidence-Based Quality Management in a Home Health Organization - Case Study Example

Evidence-Based Quality Management in a Home Health Organization Name Institution Evidence-Based Quality Management in a Home Health Organization Introduction Home health services fall under the benefits of Medicare consisting of part time and the medically skilled care services such as nursing, occupational therapy, speech language therapy, and physical therapy ordered by a physician. Within Australian context, the Department of Human Services and Department consider quality health care for the Australians with Medicare a priority. As a result, the country adopted various domains guide the missions of the home health organizations including effectiveness, which relates to the provision of the care processes and achievement of the outcomes supported by scientific evidence. Other domains include efficiency relating to maximization of quality of complete unit of the health care delivered, equity, which relates to provision of health care with equal quality to those considered different in their personal features from clinical conditions, patient centeredness relating to the needs of the patients, preferences, support, and education. Moreover, the domains also involve safety, which relates to the actual bodily harm and timelessness, which involves acquisition of the required care while reducing the delays. From such background, the essay would focus on KinCare, which is considered the leading provider of various services associated with in-home health and well-being services to people living with disability and older people (KinCare, n.d). Margaret Howie, a Registered Nurse, founded the institution in 1991 with a passion of ensuring that older people acquire the highest standards of care and support. In a bid to improve, the quality of services provided especially the in-home care and nursing services, KinCare Group acquired the Stanhope Nursing Service and Private Care Australia. The institutional capabilities within the Home Care Division are complemented with the organizational Registered Training Organization (National College Australia) and the TeleResponse service (TeleResponse Australia). The aim of the organization is to ensure that in future people offered the choice of remaining at home instead of visiting the hospital or the residency facilities (KinCare, n.d). Such breakthrough in in-house health and personal care could assist people in avoiding unnecessary hospitalization and maintenance of greater personal independence. Additionally, KinCare supports patients in linking their personal health and wellbeing to their passions in life. The organizational staffs are subject to thorough reference checks and criminal records undertaken by the Australian Federal Police. Moreover, the institutional policy requires the staffs to undertake the ongoing professional development and training which are subject to the spot checks and the regular formal appraisals. The responsive teams of KinCare deliver well-timed services to different clients and ensure adequate communication with the customers whenever there is change (KinCare, n.d). For quality services, the organization utilizes the Australian Business Excellence framework guiding its quality management systems (QMS). Consequently, the organization was one the early community care institutions to achieve the required certification for ISO 9002:1996 and ISO9001:2000 (KinCare, n.d). KinCare aims at growing sustainably and evolve successfully in meeting the opportunities and the challenges associated with the growth of health, disability, and the Australian aged care sector. For the institutions to offer home health services, Australia requires such institutions to meet various safety regulations, access of information and privacy rules, and ethical practice standard. However, it is vital to note that health institutions use different data collection and reporting methods with factors such as quality and cost prompting collection of additional data (Arney & Scott, 2010). As a growing institution, it is important to create a data collection and monitoring method that would ensure improvement in the quality of services provided by the organization. Organizational Structure: Source (KinCare, n.d) Home Health Services and Quality Home health institutions play important roles in ensuring adequate provision of nursing services, home health assistance, and one or more services associated with physical and occupational therapy and social services. KinCare, as a health home institution, participates in various Australian Medicare programmes and several health insurance programmes such as home health benefits. With the rapid expansion of the institution, Margaret focused on professional management and administration, which led to employment of Jason Howie as the General Manager and shared organizational commitment to ensuring the provision of quality care. As a Chartered Accounted experienced in auditing, Jason invested greatly in organizational personal, quality system, information technology systems, and management systems. To ensure provision of reliable and quality services, KinCare acquired small provider in the ACT that allowed it to commence provision of Veterans’ Home Care services. Moreover, to deliver nationally recognized qualifications, KinCare has a Registered Training Organization, National College Australia. Through the years, the National Council Australia has expanded contributing to provision of training for not only the organization but also other non-profit organizations, churches, and private entities. The Quality Manager of KinCare play significant in the development and monitoring programmes aimed at achieving the required quality of care. Moreover, the institution focuses on specialized programmes for nurses that support patients at home. Most of the nursing needs of patients are met at the comfort of their home, which sometimes saves them from extra trips to the hospital or doctors. The research and development programmes at the institutions ensure that the services offered are up to the current standard, which KinCare achieves through planning and systematically designing the appropriate care programmes. To ensure adequate efficiency and reliability in the services provided, the institution has a TeleResponse programme for proper communication with the patients. As a result, KinCare boasts of high efficiency and risk management programmes that are suitable within the healthcare sector. The programme aim to develop consistent frameworks to underpin the quality monitoring of the home health care, collating the intelligence of provided quality services, and carrying out the quality of the monitoring methods used (Dalby & Hirdes, 2010). At KinCare, quality monitoring process aims at ensuring that the institution meets the defined the results for its patients. Organizational management values the views of both employees and stakeholders in a bid to ensure provision of services that meet specific needs of the patients. In quality improvement, the role of the general manager is to approve and monitor on annual basis the established mechanisms of improving quality. Through the years, there has been increment in the number of home health institutions in Australia, which raises questions on the quality of services provided. With unclear regulations guiding the activities of these institutions, monitoring the quality of services within the sector is becoming complex (Families USA, 2014). Besides the increasing volume of information generated, there is laxity in the regulatory agencies, which makes various methods of measuring quality important drivers of quality in home care institutions. The major concern of KinCare is the quality of healthcare; therefore, measurement of the quality of services provided would assist in assessing the effectiveness of services provided and controlling the expenses. The recent initiatives by the Department of Health stressing on the quality of services offered in home care institutions made consumers aware of the quality initiatives. Quality measurement within the healthcare spectrum is a process that uses data in evaluating the performance of health plans and the healthcare providers against legally recognized quality standards. The measures could take various forms in evaluating care across full range of healthcare settings. Measuring the quality of healthcare is a vital step towards enhancing the quality of healthcare services (Skinner & Hanlon, 2015). Too often, the quality of home care that Australians receive is substandard. In addition, most patients usually receive proper diagnosis and care but about 55% of the time, variability in healthcare quality, outcome, and access usually persist. Recent researches reflect the chronic misuse, underuse, and overuse of services. In addition, there is usually fragmentation, overlaid complexity, and uncoordinated in the delivery of home care services. Clinical Corporate Governance The role of the Managing Director of healthcare institutions lies in the assurance of quality of services provided with subcommittees overseeing clinical governance in the institutions. On the other hand, the non-executive directors act as important independent advisors to organizational board. The subcommittee would be responsible for institutional strategic development of clinical; governance. With availability of the Managing Director in the subcommittee, is enough evidence of significance of clinical corporate governance in the institution. However, it is vital that a clinician leads the clinical governance since it involves clinical practice and governance to be responsible for coordination and monitoring of the home care, provision of support to others staffs, and undertaking the role of reviewing the progress against organizational specific objectives. Moreover, the clinical lead needs to establish in turn the multidisciplinary teams of clinicians with an aim of monitoring usual development associated with clinical governance and ensure adequate provision of the necessary support of making such a reality (Dunbar, Reddy & May, 2011). Considering the fragmented nature of the communal home care facilities, establishment of clinical governance could be a challenge. The key successes factors include involvement of the staff, support, and development throughout the process. For the KinCare, the structure would be the Clinical Governance and Education Teams reports to the Primary Care Board and the Executive. In Australia, the major consideration involves alignment of every component with the policy of the government especially the devolution to the Local Health Districts, accountability, transparency, and strengthening of the clinical engagement. The guiding principle is that each person and decision within the Australian health sector needs to focus on the best outcome for the patients. Within the Australian governance structure, there is a provision for the unclear allocation of the responsibilities, linkages, processes, and transparency in accountability between all the Australian healthcare providers (Wickramasinghe & Gururajan, 2016). To have effective clinical governance, KinCare should consider various design factors in its governance model in supporting the clinicians and patients achieve effective health care. These factors include local flexibility and responsiveness requirement of healthcare services in engaging with the patients, best meet the requirements of the patients, and building connection across the home care community sectors; the clinicians need to engage in designing the models of care and decision making for both the local and wide policies. Moreover, it is vital to focus on evidence based policy and effective information system in supporting the best practices, management, and performance; ensuring accountability at all the levels for performing against the validated standards; and focusing on the effective information and communication mechanisms in supporting the delivery of services and empowering the patients. Evidence-Based Management for Quality Management It is important that the nurses are vigilant for the possibility of various errors associated with medication within the home healthcare environments while recognizing various risk factors. Technology often provide numerous opportunities in improving communication with the patients, to ensure provision of accurate information to the patients, educating the patients on their medication, and monitoring different regimes of medication (The University of Scranton, n.d). The most effective method is paying attention to at-risk patients; hence, proper and accurate documentation and review of each patient’s medication is important. Several researches indicate that frequent medication review and collaborating with the other members within the healthcare sector would assist in the prevention of adverse events associated with poor management of medication. Initially, KinCare used its subjective information in establishing the quality of care it provides and believed that it was providing quality care with its outstanding staffs. However, with the emphasis of the Department of Health on provision of quality healthcare services, the institution faced several challenges in improving the quality of services it offers considering that it had little qualitative information. As a result, the institution had to evaluate several aspects of its performance including clinical, financial, and risk management. However, with limited data, evaluation of the effectiveness of home healthcare might be difficult. Moreover, it is important that the healthcare managers adopt evidence-based management as the exemplary decision making process. However, there are assumptions underlying the advocacy of the practice including the decisions based on the evidence would yield the anticipated results, the yielded results are can be generalized across the organization, and the evidence is subjective and considered context free. Several evidence on the evidence-based management are usually based on the conceptual arguments considering that it constitutes the best practice considering that it has no empirical research demonstrating its effectiveness. Considering the complexity of the decision-making process within the home healthcare setups and differences in these institutions, the decisions do not necessarily contribute to the expected results, which might not be replicable across the institutions. Thinking about the Problem With increasing stress by the Department of Health for home healthcare institutions to improve the quality services offered, KinCare had to focus on the mechanisms of improving quality. As a result, the institution focused on creation of better model of monitoring the quality of services offered that would ensure that the organization is consistent while presenting, communicating, and monitoring various quality measures across the institution. The quality of services offered depends on quality of data that the institution has (Cruz-Cunha, Miranda & Goncalves, 2013). In KinCare, the stakeholders portrayed different views on their understanding of quality in regards to the amount of data available within the organization. With such confusion, it is vital to develop a quality model that would ensure compliance with the required regulations. Step 1: Formulating the Question As a Quality Manager and a Registered Nurse, KinCare placed me in-charge of developing the model that would assist in improving the quality of data used in the institution. However, the project would utilize the various mechanisms of evidence-based management practices in addressing the institutional concern. The management concern question could translate to: what are the better mechanisms of acquiring and utilizing data in meeting the diversely increasing needs of the management? Step 2: Using Australian Health Internet Sources in Acquiring Evidence-Based Performance Indicators While beginning to the address the issues raised by the management, I started by examination of different web-based sources which accessible easily and contain information on quality improvement. Through focusing on different websites on quality improvement, the results would ensure that the developed approach is consistent with the Australian quality improvement mechanisms and adequate alignment with the evidence-based management (Emerson, 2014). As a result, the research utilized different websites in defining various quality indicators, framing the research approach, and ensuring that the selected measures would be adequately consistent with various approaches of quality management. The Australian Safety and Quality Framework for Health Care: The website http://www.safetyandquality.gov.au/national-priorities/australian-safety-and-quality-framework-for-health-care/ tends to describe the vision of having a safe quality of care for all the Australians. Moreover, the websites sets out various actions required to achieve the vision of offering quality services. According to the framework, there are three core principles that ensure safety and provision of high quality care. These principles include offering healthcare services considered consumer centred, healthcare driven by information, and proper organization for safety. In November 2010, the Health Ministers endorsed the framework as the Australia’s national safety and quality framework. According to the framework, there are 21 areas for actions that every person within the Australian health system could take in a bid to improve safety and quality of the care in all the healthcare settings over the next decade. However, the management should use the framework as its basis of strategic and operational safety and quality plans; the framework could as be used in the provision of mechanism for refocusing on the institutional current safety and mechanism of quality improvement and designing the objectives for improvement of health services. Moreover, the KinCare could used the framework as guide for its reviewing investments and research in quality and safety and as a platform of promoting the discussions with the patients, managers, clinicians, and policy makers on the mechanisms of forming the best partnership of improving the safety and quality of the services offered. The Framework is applicable in all the parts of healthcare system in Australia and usable primarily within community and acute healthcare providers in improving, regulating, and advocating for the safety and quality within the healthcare system. The framework supports the model as it ensures improvement in performance and quality of services offered which is compatible to the objectives of KinCare. Australian Commission on Safety and Quality in Health Care: the website http://www.safetyandquality.gov.au/our-work/information-strategy/indicators/ tends to highlight different indicators of safety and quality. The commission’s objective include improving the quality and safety within the national health data standards and indicators; driving improvement in the safety and quality at the local levels by fostering the supportive feedback; and improving the transparency and accountability in the method of reporting healthcare safety and quality. The commission highlight some of the quality indicators including hospital-acquired complications, hospital-based outcome indicators (core), patient safety reporting for hospitals, patient experience surveys in hospitals, and indicators for Australians clinical standards. For the model, the research would focus on hospital-based outcomes indicators. The Health Ministers, in November 2009, endorsed the recommendation from the commission of routinely monitoring and reviewing the succinct sets of indicators within the healthcare sectors. The hospital-based outcomes are producible using jurisdictions and healthcare ownership groups holding the source data and the report issued back to the healthcare institution. According to the commission, the safety and quality value lies within the development of the report-review-act cycle on the routinely basis through focusing on the supply of timely and targeted data back to the health institution. The report-review-act cycle is vital for KinCare as it would ensure quality in the data generated and applied within the institution. The Australian Council on Healthcare Standards (ACHS): the website http://www.achs.org.au/media/69305/risk_management_and_quality_improvement_handbook_july_2013.pdf contains Risk Management and Quality Improvement Handbook aimed at complementing the ACHS’s EQuIPNational programmes through provision of information to assist different healthcare institutions in developing their Quality Improvement Plan and Risk Register. Incorporation of these programmes would assist in complying with both EQuIPNational and the National Safety and Quality Health Service (NSQHS) Standard programme. The programme highlights 15 standards; however, for the model, the research would focus on Governance for Safety and Quality in Health Service Organizations. Improvement in the quality of data are directed to the provision of structured framework meant identifying, analyzing, treating, monitoring, and reviewing various opportunities. Continuous improvements in the quality of healthcare services provided are data driven. Therefore, it depends on the relevant information provided to the organizational management and clinicians. It is vital that the data and information provided reflect the issue that is significant to the organization instead of the process of data and collection of information. The report from the organizations supports some of the practices used in KinCare; however, from the report, it is important that the data provided reflect the challenge faced by the organization. Step 3: Selection Criteria for Quality Measures There are several measures that applicable within the KinCare’s context; therefore, it was significant to arrange meeting with the organizational management in a bid to explore further the issues affecting the institutional performance. Considering the huge amount of information within Australian context on the mechanisms of improving quality within the healthcare sector, it was significant to narrow the organizational problem, which is achievable through working the management (Wickramasinghe, 2013). The aim of the meeting was to assist in defining quality and associated indicators from organizational perspectives. Such practices would ensure proper alignment of institutional vision, objective, and values with the developed model to ensure that the KinCare remains compliant with different legislations and continues satisfying the needs the needs of the patients while ensuring sustainable utilization of resources. As a result, it was significant to use organizational initiatives in deriving the questions that reflect quality indicators from institutional perspective. The key questions that would assist in narrowing down the indicators from institutional concept include: 1. What is institutional understanding of quality data? 2. What are the indicators that show that the institution either measures or reports its progress in the right or wrong manner? 3. Do the organization indicators meet the needs of the stakeholders in term of relevancy, utilization, validity, and reliability? 4. Do the indicators reflect the standards set by the authorities? 5. Are the organizational data able to assist in achieving the mission, values, and vision of the organization? 6. Are the available data applicable within all KinCare’s institutions? From the raised questions, it is would be important to derive organizational understanding of quality data and align the developed model with institutional mission, vales, and vision. Besides, it would be important to considered different methods of presenting the data to ensure applicability across the organizations managed by KinCare. Moreover, it is significant that the data is shared across the institution to avoid confusion on matters associated with quality. Step 4: Defining the Quality Measures Quality measurements could be used in improving institutions healthcare services through prevention of overuse, underuse, and misuse of the healthcare services while ensuring the safety of the patients. Moreover, it is applicable in driving improvement, measuring and addressing different forms of disparities on the manner the organization offers care and health outcomes, and assisting the patients in making informed choices regarding their health. The emerging quality measures could be classified in different groups including: Customer Management: from health perspective, customers are patients, referral sources, and employees. It is important to provide quality services based on timely delivery of services, reliability, high efficiency, and effectiveness in a bid to meet the ever-changing needs of the customers. Therefore, the institution needs to focus on establishing a feedback mechanism of integrating the needs of the clients for provision of quality services. Clinical Management: effective management in clinical management involves reliability and credibility of the information that provide answers to certain scientific questions raised. In health, the management practice determines the outcomes of service delivery and compliance with different regulations within the healthcare sector. Moreover, the effectiveness of the applied management style often determine the quality of services offered to the patients, mechanisms of utilizing the resources, and the existing gaps in service provision. Operational Management: it involves planning, organizational, and supervisory roles in the provision of various healthcare services. Hence, the latter is delivery-focused and ensures that the institution successfully with an aim of turning the inputs to outputs efficiently. The inputs represent various institutional materials, human resources including the staffs, and technology. Moreover, operational management also involve fiscal viability and different business practices. Risk management: in healthcare, risk management is more important compared to the others sectors. Risk management is important assists in prevention and mitigation of financial losses; however, in health, it could mean life and death (Moskowitz, 2015). Risks are prevalent to the staffs, institution, and patients which makes it significance to have qualified and proficient healthcare risk managers to undertake the assessment, development, implementation, and monitoring of the risk with an aim of minimizing the level of exposure. The developed measures for all the management practices were tested. Moreover, the measures were compared with organizational mission, vision, and values and determined the category in which the each measures fall in a bid to match the model with the regulatory standards. These practices aim at providing validating check throughout the development process. Step 5: Finalized Quality Measures and Quality Improvement Thresholds Operation Threshold Compliance Level Threshold Criteria High 90% or greater than the external threshold for benchmarking Critical for the safety of the staffs and patients Critical to ensuring quality and safety outcome for the patients Quality processes controlled by various regulations Medium 85% or greater than the external threshold for benchmarking Uncontrolled factors through regulations but vital to the clinical practice Coordination and communication practices and indicators Low 80% or greater than the external threshold for benchmarking Uncontrolled indicators through regulations and less significance for clinical practice With the rising concern for quality within the healthcare sector, quality data is becoming important for KinCare and other healthcare institutions especially since the use of electronic information has been on the rise as well. Such improvements are emphasizing on organizational performance in compliance with regulations (Wickramasinghe & Gururajan, 2015). Consequently, organizations have to continue focusing on information they considered important; develop accurate and quality data for the stakeholders, and employ adequate measures of monitoring the quality of information collected and reported. Step 6: Summary Customer Threshold Activity Purpose Source Threshold Frequency Written satisfaction To monitor and evaluate the satisfaction of the customers with consideration of indicators of care Sampled data from the institution’s discharge records Quarterly changes in the threshold based on the national benchmark Quarterly Written satisfaction survey To monitor and evaluate various levels of satisfaction through focusing on important services offered by the organization Information from customers’ feedback and data from internal audits 90% overall satisfaction Quarterly Quality concern Methods of reporting the information and quality of information available for the consumers Suggestion forms for the levels of customers’ satisfaction Adjustments made depending on the emerging trends At least one in a year Clinical Threshold Activity Purpose Source Threshold Frequency Referrals To determine and analyze the quality of treatment and data for comparison with other institutions The data submitted to the Department of Health or retrieving from organizational database Comparison to the local and national thresholds Quarterly References Arney, F., & Scott, D. 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