Introduction to Quality in Health Care - Assignment Example

Introduction to Quality in Health Care Assignment Workbook Workbook Activity 1 Compare and contrast the essential features of the Deming, Juran and Ishikawa approaches quality management. Juran opined that customer satisfaction is the objective tat should drive quality control. He stated that the performance of a product should meet the customers satisfaction. Consequently, he believed that quality should be the determinant for the fitness to use an individual product, thus, "Quality is fitness for use". He stated three methods for managing quality in sequence that includes: Quality Scheduling Quality Regulation Quality Development Juran also believed that a “few things are important, but the remainder are inconsequential" aptly named the Pareto principle. Deming stated that a good quality management is ground on efficiency of the administration sequence which includes the process of; planning, implementing and making necessary adjustments to improve on the product. This cycle is hinged on satisfaction of the customers. He theorized that predictability and uniformity of the standards set by the company should never be compromised. Therefore, customers will highly depend on standards set by the company. Deming believed in a system which has four key themes: System approval Increased awareness of distinctions The basis of information used Understanding of different attitudes Finally, Ishikawa defined quality management in two ways. First, he stated quality as the inherent quality of the product and secondly he opined that quality was seen in the following areas of organizations operation e.g. information, provision of service, operations, separation of jobs, organization structure, organizational policy and the entire workforce. In a nutshell, he believed in the improvement of quality of all cadres of the company. He was guided by "concept of real and alternative features of a product" (Saraph, Benson, & Schroeder, 1989) 1.2 How do these approaches differ from quality control and quality assurance, activities traditionally used in industry to ensure production quality? These methods are premised on the idea of continuous and steady quality improvements at whole levels of the production process. This adjustment is not limited to the products only but also the technology employed, workers and management involved in the process thereby having a wholesome quality development. In the traditional production set up. Quality control was based on the final output rather the process involved. This means that the activities undertaken before the outcome could be inefficient. This will result in more money and time being employed to undertake a certain project which limits the profits gained from such ventures. 1.3 The Toyota Total Production System (TPS) utilises a range of quality strategies attributable to these and other quality ‘gurus’. What are the key elements of the system? How are they integrated? The TPS method is categorised as: Consistent development Holding individuals in high esteem This consistent development can still categorised into: 1. Incorporating a lasting dream that inspires audacity and innovation. 2. Constant upgrade (Kaizen): Upgrading should be consistent and durable which fosters further expansion. 3. Genchi Genbutsu: Identifying the genesis of a weakness and coming up with a solution. The ethics shown above are all fundamental for the success of a TPS, thus every member of staff is involved in preserving the quality reputation of Toyota products. This leads to more competency and productivity. 1.4 Toyota has been widely regarded as a leader in quality management for decades and yet since 2009 Toyota has been in serious trouble over quality control, issuing recall notices for millions of vehicles. Explain possible reasons for this failure. In the period 2009-2010, Toyota experienced a sudden surge in demand for their automobiles. They increased production without a substantial addition in the number of workers. This left the workers exhausted from the increased demand in a short period. Consequently, employees were not able to raise an alarm over faulty parts like the faulty pedals that were installed in the Prius in 2009-2010. Hence, a similar part was used on the next vehicles without notice of defaults. The shortage of employees with increasing demand led to more stress on the current workforce. This shortcoming could have been addressed by expanding the workforce in tandem with the demand. (Peter Alford, 2010). 1.5 From the readings provided: a) what is health care quality? B) Why do these authors consider quality improvement an important aspect of health service management? C) What are the necessary conditions required for quality improvement? a) Health care value is the extent to which a person derives fulfillment from healthcare services provided. The satisfaction is stated in the following metrics; a sense of healing from the procedure and accurate analysis of a disease. (Luce, Bindman, & Lee, 1994). b) The authors take quality enhancement as a key plank of consistent development of health service provision as endless upgrading of the services and medical products provided. The driving force behind constant development is to identify more prospects for improvements. The constant progress enhances more satisfaction from the patients and reduction in resources involved in health service provision. (Carey & Lloyd, 1995). c) The circumstances that define the interventions to be taken hinge on subject matter at hand. The best environment is when there are shortcomings in the process, more money is wasted and a lot of time wastage. The interventions should take the most efficient matrix which maximizes the standards and minimizing on wastages. Situations that prefer such interventions include internal inventories, workers remuneration and outside factors like technological advancements and insurance company. When the situation is identified a solution is sought out immediately. (Carey & Lloyd, 1995). Workbook Activity 2. 2.1 What are adverse events? Adverse events are damages arising from a therapeutic procedure which pose a risk to the patient. The risks involved can translate to physical injury to a patient. The injuries mainly stem form extended admission to the hospital, terminal conditions, and incapacitation during hospital discharge. Adverse events can arise from therapeutic procedures at the health centre which can be prevented or they are not avoidable. (Garrouste-Orgeas et al., 2012). 2.2 Use the readings provided to describe the commonest types of adverse events. Why do you think there is variation across the studies in the types of adverse events described? A medical error causes the most common type of adverse event, usually wrong diagnosis, followed by professional negligence. Mismanagement of medical records can lead to an adverse event due to mismatching of patients details or losing the files altogether. Medical equipment failure is also a contributing factor to adverse events. The variation in studies of adverse events is because there are different areas in health facilities where a marginal error can trigger major catastrophes. This change is compounded by the fact that health facilities are located in different localities. For instance, an adverse event in a developing country like Kenya will be different from that of a country like United Kingdom. This is dependent on the structure of an organisation in the health facility e.g. resource availability, error for reporting and staff trainings. 2.3 Are all adverse events preventable? Explain your answer and provide examples of preventable and non-preventable adverse events. Most of the adverse events are avoidable, but others are beyond human control. An example can stem from surgical site infection. Despite the fact, that policies are adhered to religiously, there is a 10% chance of patients incurring infections during colon surgery. Additionally, a patient undergoing chemotherapy due to leukopenia is susceptible to infections. The dilemma usually boils down to whether to treat the patient and increase chances of infection or not treat them and succumb to the cancer. Preventable medical errors include: Undertaking the wrong procedure on a patient. Leaving an alien item in patient’s body after therapeutic process. Mismatch of an organ for transplant or the blood to be used. Prescribing incorrect medicines to an ill person. Contamination of operating spot due to lack of usage of antibiotics. Pressure sores are leading to ulcers. Non-preventable medical errors include: An allergy was occurring in a patient after taking an antibiotic that initiates an adverse drug reaction. Contamination arising from a dark chemotherapeutic drugs. Drug-Drug Interaction (DDi’s). The mixtures of different drugs used to treat a disease may boomerang on the patient with fatal effects. In any medical procedure research has not indicated that nor does specific medicine or equipment provide a perfect medical intervention in treatments. Some of the objectives of medicine are not preventable (Thomas & Brennan, 2000). Workbook Activity 3. 3.1 Use a table format to identify common themes or contributing factors to the adverse events described in the Bristol, Bundaberg and one other report. Health facility Causes of adverse events Bristol Institutional shortcomings, structure and ethics. Leadership weaknesses and poor ambitions at the management structure. Lack of proper cooperation culture. Inadequate resource allocation to the hospital departments. Inadequate support for clinical audit. Audit statistics information obtained from financial and eminence issues are not acted upon. Poor evaluation methods and recording improvement in quality assurances (Walshe & Offen, 2001). Bundaberg Staff authorizations are not monitored by the medical agency. Inconsistencies in teaching methods; a medical specialist trained within and outside the country have different skillsets. This creates a lack of uniformity in the field of practise. Some of the specialists do not participate in scientific routine administration practice thus creating more inconsistencies in training. King Edward Memorial Hospital Medical mistakes from oversights thus not realisiung a fatal condition in time. Poor record keeping that results in capturing of less information about a patient which is paramount to continuous service provision. Junior practitioners are not accorded the necessary support to deal with challenging cases. Untrained nurses are requested to look into complex cases. Poor synchronization between departments and the health staff. Inquiries highlighted substandard scheduling of service provision(Mclean & Walsh, 2003). 3.2 Why are causal factors associated with adverse events identified as either systems or individual issues? Why are contributing factors classified as either system or individually based? Organizing the adverse events into system or individual factors helps an analyst identify whether a wholesome change is needed or just an individual. An individual error can occur when a certain surgeon performs an operation he is not skilled in. This can result in an adverse event. A remedy for the situation is to report the practitioner to the Medical Council that will determine if they will be trained further or deregistered. Comparatively, if poor auditing is done in a hospital system to investigate adverse outcomes like an unexplained infection in a particular ward or a suspicious death can contribute to catastrophic negative outcomes. This can be probably attributed to the presence of a resistant virus causing the infections. It is imperative to determine if an infection was contracted in the hospital or the community. Testing the resistance of the virus to different antibiotics can explain the diseases. Normally, a community-acquired infection is less resistant in comparison to the hospital one. Continuous reporting of instances of resilient infections is important to check whether the right analytical procedure was followed. This involves all the hospital employees and counterchecking if certain parts of the hospital are properly sterilized. This occurrence will require an organizational change against a personal change. Therefore, it is crucial to classify it because the application of programmes to address such shortcomings arising from individual or organizational weaknesses. (Reason, 1995). 4.3 All of the hospitals that were the subject of inquiries were subject to formal accreditation. Why were the problems identified during the surveys not recognized through accreditation? The certification process for a hospital takes a long period and is given for a number of years. This means that at the time of application for certification the hospital might meet the required standards set by the accrediting body and maintain the standards. During the intervening period, the accrediting body might not need to audit the standards during registration time. Therefore, if an inquiry established due to an adverse effect without plausible reason would unearth serious deficiencies. The survey recommendations are then acted on to fix the anomaly. Accreditation meanwhile is a general application to check if a particular health facility meets the safety and quality services as outlined on agreed national and International standards. It does not usually delve into specific details of operations and procedures; hence missing on some problems. Workbook Activity 4 4.1 What is a ‘blame free’ culture? This is an environment that inspires the staffs in a health care facility to report errors encountered in the workplace, confidentially without the anxiety of being reprimanded. This allows them to learn from the experiences and accept responsibility. It relies on the fact that even the most skilful and professional people can make blunders as long as they take responsibility and learn from it rather than apportioning blame. It recognizes that a majority of unsafe procedures are frank errors are not worthy of any blame. It also considers that such faults are not made on purpose and there is no benefit of punishing such actions. (Collins, Block, Arnold, & Christakis, 2009). 4.2 How is a ‘blame free’ culture different from a ‘just culture’? Why is the distinction important? A just philosophy is a value which states the persons tangled in a certain procedure are not castigated for their activities, resolutions and oversights as long as it’s consummate to their capability and education. Nevertheless, carelessness, deliberate damages and destructive acts are not accepted. The difference is significant because a blame-free culture has two fundamental flaws. 1. It avoids confronting persons who intentionally take risky actions. 2. This philosophy proves to be a challenge in defining accountable and non-accountable procedures. Just values promote taking responsibilities for one’s action and thus reduce chance of the common faults occurring which would be seen in a blame-free culture(Lilleyman, 2005). 4.3 Why does Berwick believe that traditional approaches to quality control and quality assurance contribute to a ‘blame culture’? Traditional methods of quality control and quality assurance are keen on the hospital meeting the laid down standards rather than concentrating on the upgrading of such activities. This method accepts that most works stations produce poor performances and that some tolerances should be built for a predetermined result. Quality assurance and quality control are ongoing activities that should not be taken as goals to be achieved. Sometimes these rules are outdated and can be low, thus following such standards without evaluation and can pose a serious risk. It is paramount that when adjustments are made to the systems, further analysis is advisable to see the effects of such changes in the entire organization so as to be consistent with the other departments. From the preceding it is conclusive to state that obtaining the results set out can make one note the efficiency of a health facility. Therefore, when things are not running properly in a workplace the workers may start apportioning liabilities for the inefficiencies. (Tindill & Stewart, 1993 ) 4.4 Why are doctors in particular likely to self-blame? A physician is the ultimate decision maker when it comes to a patient’s diagnosis and other health service provisions. Thus, when something does not work out they question their abilities. This can lead to them faulting themselves and disgraced at the same time. Research has indicated that even when a minor slip up occurs, some doctors are reported to have emotional responses to anger, shame and frustration. It is possible that if the doctor had discussed with his/her colleagues they might have detected certain errors in a procedure or discover that some faults are not preventable the feeling of culpability should not burden them. Research has indicated that when a doctor talks about their activities during a health care procedure, they get to understand that every person has a weakness and this boost their confidence and ultimately work output. (Maslach, 2003). 4.5 What quality improvement and quality management activities require an ‘open’ or ‘just’ culture to be effective? These factors are outlined below: Instances when the hospital staff can present certain flaws in the institution without fear of a reprimand. A culture of non-discipline of workers who report these flaws should be cultivated in the health care centers. This will inspire learning among the health care providers, since they will be at a liberty to share information freely and discuss with their superiors on possible solutions. Public confession of inherent weaknesses in the institutions that detect them, will improve the credibility of the health center. This is viewed as the first step towards transforming any challenges that are in the system to opportunities. An aura of confidence is inculcated into the workers in a healthcare center, as they adhere to the laid down rules and regulations that dictate their professions. In the work environment the practioners will be enthusiastic about their jobs thereby delivering exceptional services to the patients. Consequently, they will be proactive in sharing their weaknesses with fellow health workers who can offer insightful advice in relation to undertaking their duties, hence providing the best care possible. (Davies, Nutley, & Mannion, 2000). Workbook Activity 5 5.1 The use of evidence-based health care is often cited as a means of ensuring clinical effectiveness. (McSherry and Pearce, 2007; Wolff and Taylor, 2009). Using the readings provided and your research, provide examples of how evidence-based health care practice (EBP) may improve clinical effectiveness and describe the limitations and criticisms of EBP. (No more than 500 words) Evidence-based healthcare is a method that is targeted at reducing discrepancies and regularizing clinical practice in order to minimize mistakes. It is defined as a clear, sensible and a reliable usage of drugs according to indications to improve the upkeep of ill persons. It includes the submission of singular medical skills along with therapeutic evidence from the methodical evaluation. Some of the examples of EBP include: In 2005 a Randomised control trial (RCT) was conducted into the effects of steroid treatment and was found to be useful. Health guidelines that have been implemented to control public smoking have reduced the deaths associated with secondary smokers. In 2010 another research revealed that a simple blood test can be used to treat patients alleged to have bowel cancer in comparison to invasive colonoscopy At the onset of the HIV scourge, it was a hazardous virus that killed many people. After sustained research and evidence based experience. The virus spread and fatality has been contained. The previous illustrations have indicated that EBP is a reliable technique that can be used to upgrade clinical practices in hospitals. This method saves on resources and takes a short period to actualize. On the other hand, this technique has a few disadvantages as stated below: limitations that are outlined below; A randomized control trial is the main method used to undertake critical study on treatments offered to the patients. These studies might be compromised by the funding organisations to suit their needs, ultimately, it becomes irrelevant. Conducting RCT’s is an expensive process. There is a vast divide between the time RCT’s are done and when they acted on. The impacts of treatment arising from an RCT might be the opposite of the expected outcome because some of the data might not be passed the doctors and public at large. The environment and metrics used for a certain EBP differ greatly, therefore a research from a certain locality might not be applicable in another setup. RCTs are not conclusive since they do not reach to everyone in a certain population. Therefore, people with unique characteristics might be left out. 5.2 There is general agreement about the need to place patients at the centre of their care, and at the centre of the health system. At the same time there is also agreement that health care organisations and health care professionals find this difficult. What are the benefits of and barriers to patient-centred care? In your answer include discussion about how a patients cultural background may make a difference to their experience of health care. (No more than 500 words) Patient-centered health care is defined as the management and care patients receive from health experts and in which an individual is at the apex of their clinical care and therefore decisions and preferences are respected. Some of the benefits of patient-centered health services include: Patients are more gratified during their healthcare period because they become key persons in the process. In case the procedure becomes erroneous they are keen on taking responsibility. Patients become less apprehensive when undergoing treatment as they feel they are part of the procedure from the onset. The health care providers become more contented with their work as they consult more with the patient. Therefore, they are less remorseful when a procedure does not go according to plan. Disadvantages of patient-centered health care include: Patient centered care is a long procedure and takes more resources to see to fulfillment. This is because patient’s advice is not professional but based on intuition. Some doctors get the impression that their independence to take care of the patient according to their skill sets is limited. Miscommunication between the patient and physician e.g. due to language barrier make this method of treatment an arduous one. Cultural beliefs and customs may make a patient prefer a treatment that is not in line to their illness, thereby exacerbating the fatality. The cultural background of a patient influences the individual’s healthcare experience. It is thus vital to comprehend the beliefs of a patient according to their social norms. An example in a country where women favor being treated by female doctors, therefore being examined by a male doctor can be challenging (Pelzang, 2010). Workbook Activity 6. From your chosen readings what are some of the barriers to change that organisations will need to address in order to ensure the effective adoption of clinical governance within the organisation? What do you think are the challenges for leaders in achieving successful change? (No more than 500 words) The barriers standing in the way of effective clinical governance are outlined below: Poor information and reporting systems can lead to bad clinical outcomes. The method of communication delivery worsens the situation of a health system. Duplication of duties among the agencies tasked with clinical management makes the field become non-streamlined. Doctors usually prefer using tools and equipment they are accustomed to. They are averse to changing their techniques due this familiarity, thus hindering proper medical care Government policies that manage the health ecosystem have different viewpoint hence interfering with proper medical care. Poor funding of health systems against a high population demand diminishes the quality of healthcare provided to patients. Bureaucracies in big health institution s become a hindrance to better clinical management. This is because it takes time for departments to act on certain reports or delays in procuring essential staff. The agencies that are responsible for control of clinical practices are supposed to undertake internal assessment of their progress. If they don’t partake the exercise, they might put the entire health system into disrepute. This lowers the standards of healthcare in the country(Buetow & Roland, 1999). The most challenging healthcare decisions is to reinvent the outdated health service practices. 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