The Conceptual Components of the Paradigms of Quality Management - Dissertation Example

Essay Describe the conceptual components of the paradigms of quality management and risk management. Include in your discussion the relevant objectives of quality management and risk management, and identify any stakeholders. Identify at least one of the differences in the paradigms. Quality management, as a concept spans the notions of planning, control, assurance and improvement in the quality of a product or service. It is the process of identifying needs, and finding responses that would meet them; closely determining that the necessary criteria are consistently met; and providing subtle but regular enhancement in the quality of an item or service, so that there are lesser and lesser flaws on delivery. The particulars of how each of these terms is interpreted are specific to the industry or business in question. Risk management, on the other hand, is the process of identifying, assessing and peritonising the risks to efficient functioning within a system. The essence of risk management is improvement in the value of the end result by being flexible yet systematic; transparent and inclusive of all factors and circumstances; integral to the analytical process, but able to provide solutions specific enough to the given problem. Possible the most important factor is that it should be able to evolve continuously to meet changing needs. Stakeholders in both processes involve individuals and organisation on both sides of the process; the providers and the recipients. While both processes – Quality management and Risk management are essential for ensuring smooth operations, and thus have a number of overlaps in their core principles; they ad differ on one significant account. Quality Management focuses on the end result and the extent to which error may be avoided in the deliverables; while risk management focuses on the extent to which already occurred errors may be rectified and repeat ion be avoided. References: Cianfrani, C.A., West, J. E. (2009). Cracking the Case of ISO 9001:2008 for Service: A Simple Guide to Implementing Quality Management to Service Organizations (2nd Ed.). Milwaukee: American Society for Quality. pp. 5-7 Covello, V. T., Allen, F. H. (1988). Seven Cardinal Rules of Risk Communication. Washington, DC: U.S. Essay 2 Continuous quality improvement (CQI) is embedded in patient safety-the ability to learn from mistakes and take actions to prevent the mistakes from re-occurring. Identify and explain how principles of CQI reduce the risk of harmful medical injuries. Tindill and Stewart (1993) have defined CQI as “A comprehensive management philosophy that focuses on continuous improvement by applying scientific methods to gain knowledge and control over variation in work processes”. Baker (1997) gives the steps to using CQI. The first step is to identify the desired outcome, the second to identify the population or group of interest, the third is to verify that a change will lead to improvement; and the fourth step is to establish what this change will be. Thus, the process of CQI uses a scientific approach applied to the functioning of the entire team in order to provide satisfaction. In the health care system, providing satisfaction implies reduced cases of failures and mistakes and enhanced care – providing ability. This would entail continuous monitoring of activities in order to detect any mistakes or injuries that occur during the process of treatment. Once identified, it is necessary to verify whether the incident is an isolated occurrence, or whether there is a need to address the problem with more attention. This could be done by checking past records of the particular employee, of the entire category of staff, and by testing knowledge of procedures in order to identify the reason for the mistake. When the investigation brings out a concern not previously known; it becomes necessary to address it - either through changing or modifying equipment; running training and refresher courses, or some other means. The changes that are recommended by the process of CQI are applicable to the entire group under scrutiny; and thus, leads to enhanced functioning. Because of the objective manner in which the process is carried out, it is safe to say that as further information is received; the process evolves further into a more sustainable and efficient one. The end goal is to provide satisfaction to customers – in this case, recipients of medical care. And when the process systematically identifies and suggests changes for every problem as it occurs; the result is a lower rate of medical injuries; and increased and more efficient care giving. References: Al-Assaf, A. F. (1993) Introduction and historical background. In Al-Assaf, A. F. and Schmele, J. A. (eds) The Textbook of Total Quality in Healthcare. St Lucie Press, Delray Beach, FL, pp. 3–12. Buccini, E. P. (1993) Total quality management in the critical care environment: a primer. Critical Care Clinics, Vol. 9, 455–463. Chassin, M. R. (1996) Improving the quality of care. New England Journal of Medicine, 335, 1060–1063. Berwick, D. (1989).Continous Improvement as an Ideal in Health Care. New England Journal of Medicine, 320(1):53-6. Essay 3 Healthcare has not obtained high-reliability status. What is meant by high-reliability organization? What are the characteristics of such organizations and what is their application to the healthcare setting?  Any organisation that succeeds in avoiding major problems and catastrophes under conditions that lend themselves to the risk of accidents on a normal basis is daubed an HRO or High Reliability Organisation. These organisations are known for their ability to put fourth maximum production with minimum mistakes and problems in spite of conditions being such that the occurrence of problems is a natural and regular condition. HRO’s are distinguishable from non HRO’s on the basis of some significant characteristics. These are, a tendency to be preoccupied with failure, and ways to avoid it, a tendency to go into the depth in understanding a problem situation, and not simplify the explanations for the said problems, a special sensitivity towards the running of operations properly, a committed stance to being resilient and rising above all challenges presented and a distinct deference to expertise in any field. In the health-care industry, this would mean a continuous and pervasive need to identify and avert failure at providing the needful care as well as ensuring that all process of care run smoothly for each patient that needs them. It would involves the analysis of a problem as it is presented and trying to understand the reasons for its occurrence as well as means to ensure that it does not re-occur. It also involves the health-care organisation focusing of developing means to cope with a challenge in care as it occurs and rectify the situations with least possible harm to the patient. It would also involve a tendency to learn from experts and respect knowledge in the organisation’s bid to become High – Reliability. References: Weick, K. E., & Roberts, K. H. (1993). Collective Mind in Organizations: Heedful Interrelating on Flight Decks. Administrative Science Quarterly, 38, 357-381. Schulman, P. R. (1993). The Negotiated Order of Organizational Reliability. Administration & Society, 25(3), 353-372. Essay 4 Risk is inherent in health care. Compare and contrast the processes of root cause analysis and failure modes and effects analysis. What is the relationship of each to risk management? Health care is both given, and received by humans; and thus, there is always the possibility of an error. Given all the care that it is possible to take with a particular patient; there is always – if minimal – chance for error. At times, these mistakes prove fatal; but most often they are passed by since they leave no particular long term effect. Root Cause Analysis (RCA) and Failure Modes and Effects Analysis (FMEA) are two different ways of examining mistakes made in the process of providing care, and find means to reduce these mistakes, or eliminate the reasons for mistakes. Root Cause Analysis is put into action after an incident or mistake has occurred. The process is an impartial way of identifying the reasons for the mistake. It attempts to analyse what caused the mistake as well as how this mistake was made. Thus, it can provide us with valuable information that can be used to isolate problems and rectify them. Failure Modes and Effects Analysis on the other hand, is a prospective method that attempts to test process variables from a multi-specialty perspective and list all the possible outcomes; with a special emphasis on those outcomes that are less than desirable. Thus, it is possible to identify crucial elements that need addressing, and this can help in reducing the chances that a mistake occurs. Risk Management in a hospital involves finding responses for risk situations or mistakes by identifying means to correct them or replace them. Thus, an optimal system would run an FMEA for all crucial processes beforehand and would find ways to eliminate all sources of risk to a patient. If, in spite of this care, an incident does occur, the RCA is used in order to identify peculiarities about the situation, and find ways to incorporate this new knowledge so that the chances of this occurring again are significantly reduced. References: Kohn L.T., Corrigan J.M., [eds.] (1999). To Err is Human. Building a Safer Health System. Washington, DC: National Academy Press. Wald H. S. (2001). Root cause analysis. In: Shojania KG, McDonald KM, Wachter RM, eds. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence Report/Technology Assessment No. 43, AHRQ Publication No. 01-E058. Woodhouse S, Burney B, Coste K. (2004). To err is human: improving patient safety through failure mode and effect analysis. Clinical leadership Management Review.18:32-6. Essay 5 Identify and describe the patient safety initiatives from at least three regulatory organizations (either federal- or state-based). Include in the discussion the nature of the problem that each initiative addresses. Is there evidence of the effectiveness of the activity?  Some government run regulatory organisations that interest themselves with Patient Safety Initiatives are: 1. National Forum for Health Care Quality Measurement and Reporting. The forum has the onus of determining tools for measuring quality that may be used by a variety of providers and consumers. Along with other federal agencies, the Forum has been cited as a key element in the reduction of medical errors across the board, and an increased attention to the details of patient care. 2. The Agency for Healthcare Research and Quality The AHRQ has been a formidable name in the research into quality of health care for a long time. Recently, it has been reauthorized to sponsor research into the frequency of and reasons for errors in medical practice. The Agency also looks into issues of health care quality and into issues of facility over or under use. A lot of the initiatives taken have turned in eye-opening and useful results and recommendations under the Agency’s efforts. 3. The Department of Veterans Affairs (VA) The department has undertaken to install computerized physician order entry systems in all the 172 hospitals they run; and have thus benefited over 11 million users. This new system has ensured that errors in directions have been significantly reduced; and that information is more easily accessible. They have also established the use of computerized medical records in the hospital, so that all patient information can be kept complete and is easily updated regularly. This ensures that doctors and technicians have all necessary information at all times. The Error report system that the VA has created as well as the centres for Inquiry have put forth a number of recommendations that have been found effective in reduction of errors and enhancement of service quality. References: Tamuz M, Harrison MI (2006). Improving patient safety in hospitals: Contributions of high-reliability theory and normal accident theory. Health Service Residential. Vol. 41: 1654–76. Pham H.H., Schrag D., OMalley A.S., Wu B., Bach P.B. (2007). Care patterns in Medicare and their implications for pay for performance. New England Journal of Medicine. 356 (11): 1130–9. Essay 6 Compare patient safety initiatives from at least three non-governmental organizations. Include in the comparison the nature of the problem being addressed, how long the organization has been involved and current initiatives.  Non-government organisations have been major players in establishing Patient Safety Initiatives over the years. Some significant ones are: 1. American Society of Medication Safety Officers This non-profit organisation was started in 2006, and has provided a forum for communication and education among its members – the people responsible for the safety measures adopted by health-care organisations. The ASMSO has been responsible for providing leadership and structure to its members and has encouraged them to examine a variety of pharmacological options and the safe means to use them with optimal results. It has provided representation to individuals who develop the norms that best define the same. 2. National Quality Forum Since 1999, this non-profit organisation has been instrumental in implementing a nation-wide measurement of quality management and reporting in health care. Significant in its focus are the elements of error rates, preventive care and unnecessary procedures. It has established Member counsels that design and apply policies for areas of concern. Since 2003, the NQF has endorsed the use of 30 Safe Practices that are believed to be extremely effective. They also have a number of on-going projects that aim to improve the care processes. 3. Institute for Healthcare Improvement This non-profit organisation has been working towards an attitude change for improved health care in different parts of the world. Since inception in 1991, the Institute has developed and trained in a number of programs that are aimed at helping health-care organisations improve patient care and management processes. These programs are aimed at professional working with individuals and communities, as well as those working in preventive care. 4. National Patient Safety Foundation Founded by the American Medical Association in 1996, this organisation has the responsibility of providing support for research, training and education for professionals and scientists. The foundation has also run the Annual Patient Safety Congress since 1998 and also publishes the Journal of Patient Safety. References: Tamuz M, Harrison MI (2006). Improving patient safety in hospitals: Contributions of high-reliability theory and normal accident theory. Health Service Residential. Vol. 41: 1654–76. Pham H.H., Schrag D., OMalley A.S., Wu B., Bach P.B. (2007). Care patterns in Medicare and their implications for pay for performance. New England Journal of Medicine. 356 (11): 1130–9. Essay 7 There are numerous reasons why healthcare has been resistant to fully adopting evidence-based practices. Provide a discussion that examines two of the reasons to such resistance. Evidence Based Practices are those health-care behaviours that are adopted for their empirically validated value. These techniques, processes and skills undergo scientific scrutiny to determine their value in specific conditions. Thus it is possible for a health care professional to choose practices that have been established as useful with the specific population they are dealing with. In spite of the value that Evidence-based practices bring to care giving, there are some major hurdles that provide resistance to their ready acceptance. Significant among these are the inability to properly understand statistical terms, and an inadequate or improper understanding of jargon that is typically used in research articles. Statistical terms and procedures are often explained using language that most people are not understood. There are no clear black and white situations; and this can cause a lot of distress to someone unfamiliar with how to interpret them. Jargon, on the other hand is something that some caregivers may be familiar with; but due to the continuous changes and evolution of the terminologies and sociological understanding; even the experienced care giver may be faced with terms they are not familiar with. Most care givers are highly trained in the activities they perform; but are not trained to evaluate research material and draw conclusions from the same that they can apply to their own work. This creates a problem when they are faced with research papers that use statistical terms and jargon, or technical words that they are not used to. Often they become concerned about misinterpreting the research available and so put off using it to improve their functioning. These concerns need to be addressed if care givers are to become comfortable with using evidence-based practices in everyday functioning. References Patrick A. Palmieri, et al. (2008). The anatomy and physiology of error in adverse healthcare events. Advances in Health Care Management 7: 33–68. doi:10.1016/S1474-8231(08)07003-1. Thomas, Eric J. MD, MPH, et al. (2000). Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado (Abstract). Medical Care. 280 (38): 261–271.doi:10.1097/00005650-200003000-00003 Essay 8 Identify one of the patient safety practices reviewed in “Making Health Care Safer” under the AHRQ section of the Patient Safety Resource Centre. Discuss the patient safety target the practice is intended to address.  •What is the evidence behind the intervention?  •Is there more current evidence of the effectiveness of the practice?  One of the significant safety practices mentioned by the AHRQ is the use of Computerized Physician Order Entry (CPOE). These are also supported with Clinical Decision Support Systems. This process was recommended when it was found that a number of the errors in treatment with medicines involved Medication errors and adverse drug events. These seem to stem particularly from the process of ordering drugs. Typically found errors include the mistaken ordering of drugs; wrong dosage, missing doses, or incorrect frequency and incorrect route of administration. Given the number of mistakes that can be traced back to a mis-perception of the intended drug use; it is believed that there should be significant improvement when using a process designed to reduce errors. Computerised order forms help keep information accessible and easily retrievable. Thus, it is possible to cross verify at various stages, and the chances that the drug administered t the patient will be the intended one, in the intended dosage with the proper frequency. The decision support systems run an analysis of the ideal events and validate the recommendations and decisions of doctors; and can also be used to verify the validity of a decision at multiple stages. There is evidence to suggest that these systems do help prevent a number of errors and thus, enhance health care experiences of patients. References: Folli H.L., Poole R.L., Benitz W.E., Russo J.C. (1987). Medication error prevention by clinical pharmacists in two childrens hospitals. Pediatrics. Vol.79:718-722. Patrick A. Palmieri, et al. (2008). The anatomy and physiology of error in adverse healthcare events. Advances in Health Care Management. 7: 33–68. Wilson R.M., Runciman W.B., Gibberd R.W., Harrison B.T., Newby L., Hamilton J.D. (1995). The Quality in Australian Health Care Study. Medical Journal of Australia. 163 (9): 458–71. Essay 9 Review at least one source that describes the costs of adverse events and then find an actual or proposed patient safety solution. Identify and evaluate the economic consequences of implementing the safety solution.  Mello et. al. (2008) have documented the costs of medical errors; in both personal and financial terms. They estimate that medical errors cost the systems a minimum of $17 billion each year. Most of these costs, though, are shifted to other players; especially those handling insurance. The researcher studied discharge records in a bid to identify the extent of medical errors, and the average cost per error. It was found that hospitals do externalise the costs of even negligent injuries up to about 70%; and absorb the rest. Hospitals particularly absorbed costs in terms of legal malpractice suits; and passed on the costs for medical actions performed to rectify situations. Using the Pay For Performance initiative should help bring down the high costs incurred by medical errors. Failure Modes and Effective Analysis should be helpful in identifying the areas of concern beforehand; so that the organisation has a clear idea of what needs to be rectified in their functioning. The Pay For Performance structure consistently rewards for well executed care; while penalising for negligent situations by withholding payment. Initially, this would not affect costs much, as outlay is necessary for the administration of this initiative; but in the long run; costs in malpractice suits, and unnecessary procedures should cause significant saving. The health care system would also save a significant amount in utilisation costs of procedures and technicians due to reduced error repairs. References: M. M. Mello, D. M. Studdert, E. J. Thomas, et al., (2007) Who Pays for Medical Errors?: An Analysis of Adverse Event Costs, the Medical Liability System, and Incentives for Patient Safety Improvement. Journal of Empirical Legal Studies. Vol. 4(4):835–60 The Institute of Medicine (2006). Preventing Medication Errors. The National Academies Press. Retrieved 2011-08-10. Essay 10 Evaluate the role of healthcare payers and the pay for performance measure movement that is currently underway. What is the basis for this movement? How can organizations use this information? The Pay For Performance movement is an attempt in Medical Insurance to use rewards and punishments as a means of enhancing the quality of care provided by individuals and organisations associated with patient wellbeing. This initiative attempts to draw away from the old fee-for service model of managing the financial side of healthcare and replacing it with a rewards based model that rewards the individual or organisation caregiver who performs effectively and ethically while penalising those that make mistakes, commit errors in practice or are discovered to be indulging in malpractice. This new initiative was initially started in the USA and Britain; has been studied and there have been reasons to believe that it is effective when targeting specific outcomes and efficiency levels. The key elements of this initiative are to provide rewards for exceptional practice while providing disincentives like withholding of payment for malpractices or errors. Although initial studies have not shown any savings in cost – as the administrative needs for this initiative needs to be factored in – there may be reason to believe that long term reduction in costs accrued from malpractice suits, providing rectification for errors and due to reduction in unnecessary procedures will be significant in meaning if not finances. The information collected from the studies on Pay For Performance have shown a gratifying shift towards lowered errors; something that organisations would be interested in. A concern raised by the studies – that organisations much guard against – is about the tendency to reject patients who would affect the outcome numbers, and to not engage in potentially risky procedures; sometimes at the cost of the patient. References: Meredith B. Rosenthal, PhD; Richard G. Frank, PhD; Zhonghe Li, MA; Arnold M. Epstein, MD, MA (2005). Early Experience With Pay-for-Performance: From Concept to Practice (abstract). JAMA 294 (14): 1788-1793.  doi:10.1001/jama.294.14.1788.PMID 16219882 M .B. Rosenthal and R. G. Frank (2006). What Is the Empirical Basis for Paying for Quality in Health Care?. Medical Care Research and Review 63 (2): 135–57. doi:10.1177/1077558705285291. Essay 11 Patients, clinicians, healthcare teams, healthcare organizations, healthcare payers, policy makers, governmental organizations, professional associations, schools of education, and others all have roles and responsibilities for ensuring that patient safety is a priority. Select two of the stakeholders and discuss their role and responsibilities as they pertain to a safer healthcare system. While all players involved in the process of providing health care agree on the importance of patient safety; they may sometimes find themselves in conflict when attempting to reach the same goals. In order that such situations do not occur, it is necessary that all players need to be equally committed to clarifying their stakes and aims so that the patients receive the optimal care and treatment. Two stakeholders who are not often in focus are the schools of education, and the patients themselves. The schools and colleges that educate health care providers have a responsibility of not only imparting knowledge about techniques and medical procedures; but also to develop an attitude that puts patient safety above all other goals. These institutions need to realise that while they are turning out professionals who are required to focus on logistics and objectivity and scientists who want to stretch the boundaries of knowledge of human health; none of this can happen at the cost of a patients safety and comfort. Responsibility also lies with regular educational institutions; and it is important that basic values of safety and wellbeing and concern for others need to be inculcated by schools in children right from elementary school. The patient, on the other hand, is often forgotten in this equation as he / she is the receiver of health care. Rarely are patients passive recipients of health care; and it is important that they take responsibility for actions that help or impede their own recovery. It is necessary to remember that a professional can only do so much unless the patient co-operates, trusts the professionals, and follows instructions. References: Pink G.H., Brown A.D., Studer M.L., Reiter K.L., Leatt P. (2006). Pay-for-performance in publicly financed healthcare: some international experience and considerations for Canada. Healthcare Papers 6 (4): 8–26.  Patrick A. Palmieri, et al. (2008). The anatomy and physiology of error in adverse healthcare events. Advances in Health Care Management. 7: 33–68. Wilson R.M., Runciman W.B., Gibberd R.W., Harrison B.T., Newby L., Hamilton J.D. (1995). The Quality in Australian Health Care Study. Medical Journal of Australia. 163 (9): 458–71. Essay 12 Locate and interview a patient safety officer (or other executive) from a healthcare organization. Ask them to explain how the organization has changed in the last 10 years in regard to patient safety. Summarize major and minor initiatives the organization has undertaken. What are his or her viewpoints on the future? Do you agree or disagree with his or her assessment? An administrative officer from a government run medical facility agreed to discuss her views with a request that she be kept anonymous. Basic elements of patient safety include the physical structure, which has been modified as per requirements that have been identified and verified. Special care has been taken to ensure that areas where patients move around on their own are developed with care, and are staffed with supervisors at all times. Locks and other safety features have been upgraded to ensure that patients can be safely contained, or evacuated as necessary. As regards medical care, newer and more precise technology has been incorporated as soon as feasible and newer drugs with lower side effects are used as soon as there is enough evidence to verify that it is truly better than the older, traditional option. Perhaps the most important feature mentioned is the practice of training all staff about relevant procedures extensively; with an emphasis on the reasons for various directives. It has been found that this additional information had been especially helpful in encouraging staff lower in the hierarchy to follow rules strictly. Over the next few years, this individual believed that quality control and effective practices will find their spotlight; and the use of scientific methods of identifying the best possible option will become commonplace. Already, much of the staff has become aware of the options available; and over the next few years, they may start using these techniques more often than not. The one concern mentioned was the cost of this shift, in terms of effort and time required. The officer admitted that not all staff are comfortable with the growing emphasis on continuous growth and development; and there would be difficulties as this becomes a part of regular functioning. References: Pink G.H., Brown A.D., Studer M.L., Reiter K.L., Leatt P. (2006). Pay-for-performance in publicly financed healthcare: some international experience and considerations for Canada. Healthcare Papers 6 (4): 8–26.  Patrick A. Palmieri, et al. (2008). The anatomy and physiology of error in adverse healthcare events. Advances in Health Care Management. 7: 33–68. Wilson R.M., Runciman W.B., Gibberd R.W., Harrison B.T., Newby L., Hamilton J.D. (1995). The Quality in Australian Health Care Study. Medical Journal of Australia. 163 (9): 458–71 Read More