Continuous Quality Improvement at Queen Mary Hospital - Report Example

Continuous Quality Improvement at Queen Mary Hospital Table of Contents Introduction 3 Discussion 3 Conclusion 13 Reference list 15 Introduction Continuous quality improvement (CQI) is a modern management concept which focuses upon undertaking improvement measures in the organization on a continuous basis. The primary assumption of the CQI technique is that, consumer needs are constantly changing. As a result, it becomes a necessity for firms to adopt new policies of functioning on a continuous basis.CQI also aims at reducing costs and time required for completing different function thereby making them more effective. CQI is a suitable strategy for reducing complaints which are associated with a number of different kinds of processes and services. CQI measures require the dedication of the entire organization. Organizations which are flexible to change and have innovative and proper management abilities can suitably implement CQI techniques. Majority of the organizations which adopt the CQI technique are seen to significantly improve their functioning and satisfy consumers in a better way. CQI therefore, facilitates meeting consumer needs with greater affectivity. Continuous measures of quality improvement facilitate the reduction of errors which a business makes in its daily operations. Defective gods and errors in providing services hamper the reputation and goodwill of firms to a very large extent. CQI facilitates the minimization of such errors. The technique also makes an organization adaptable to new technologies and thereby, achieves comparative advantage over competitors. CQI techniques are also seen to increase the morale of the employees (D. Wakefield and B. J. Wakefield 1993, 83-88) Discussion The Continuous Quality Improvement is described as a managerial philosophy which focuses upon the service quality by continuously examining, planning and implementing different strategies of improvement. CQI is a technique through which managers can continuously improve the quality of services through the implementation of scientific processes and control the variation of work processes. CQI strategies facilitate solving different issues associated with the quality of products or services and also the different processes which are associated with the same (Carman, et al., 2010, 283-293). CQI in healthcare was first developed in the U.S. where there occurred almost 80,000 deaths each year due to medical negligence. Other nations of the world also felt that immediate changes in the healthcare sector were necessary to prevent patient deaths due to negligence. This had prompted the U.S government to develop a Federal Agency of Patient Safety. Drastic cuts in government funds and the rising healthcare costs had forced the healthcare industry of Hong Kong to adopt new techniques of management. The CQI technique was adopted by the Hong Kong hospitals in the year 1995 as a strategy for improving performance while reducing costs. Queen Mary Hospital (QMH) was seen to adopt the CQM technique in order to reduce malfunctions and improve the services. QMH had established a unit which mostly catered to the needs of CQI. The CQI unit in the hospital was developed under the initiative of Dr. Seto Wing Hong and Ms Patricia Ching The hospital adopts the four step CQM model which was famous as FADE (Focus, Analyze, Develop and Execute). The model helped the hospital to improve the quality of services in two projects namely; Pre-operative skin preparation, Shaving and Pre-operative baths. The CQI unit facilitated the start up seminars, training and education in CQI, data collection in respect of quality improvement and the areas where quality improvement was necessitated, Identification of areas with quality problems and the implementation of quality improvement initiatives (Anderson, Cassidy and Rivenburgh 1991, 141-146). The CQI unit was also responsible for the improvements required as per the issues pointed out by the Clinical Audit Unit. The Clinical Audit Unit was established as a separate unit as auditors were often viewed with suspicion. The main objective of the Audit Unit was to fulfill the administrations requirement in respect of auditing reports. The problems identified by this unit were then submitted to the CQI unit. Implementing CQI strategies in the hospital was not an easy process. Most hospital in Asia did not give much importance to quality improvement as western hospitals did (McFadden, Stock and Gowen 2006, 326-347). The support from staff members and doctors was weak when CQI was first implemented at QMH. It was identified by Dr. Seto that the lack of awareness regarding CQI was the main issue. Most members of the hospital believed that their only concern was in respect of the health and wellbeing of the patients. Employees were not bothered about the quality of services. It was also not clear to many employees that CQI required manpower as well as the expertise. Hospital members were also unaware regarding the fact that CQI would improve their overall performance and thereby facilitate greater customer satisfaction. Getting doctors involved in the quality improvement process was also a major challenge. Since the prime function of hospitals was to treat patients, getting doctors involved in the quality improvement process was crucial. Doctors were indifferent and many of them worked on their own. The lack of training and awareness made doctors and nurse feel that CQI was unrequited. QMH was also very much territorial and had a number of walls within the organizational structure. The relationship amongst employees was seen to be extremely complex. Each employee was seen to be involved in their own level of autonomy. The hospital departments were not vertical or horizontal. They evolved from traditional practices. The training responsibility was mainly in the hands of Dr Seto and Ms Chnig, as they possessed the required certification and the skills for the same. Trainers must possess adequate credibility and capability in the healthcare sector. These aspects are met sufficiently by Dr Seto and Ms Chnig. Consultants and specialist from abroad were also invited for the training sessions. A number of lectures were delivered by Dr Seto and Ms Ching in order to generate more awareness regarding CQI. A few projects under CQI were undertaken by Dr Seto as he considered that empirical evidence would influence the members of the hospital to understand the importance of CQI and contribute towards the same. Accordingly, CQI was first implemented in the surgery and medicine units. The mission of the CQI unit was to establish similar measures in other areas of the hospital as well. One such area was to reduce the wastage in food at QMH. Accordingly, the Food Wastage Minimization project was developed. One of the significant challenges for the CQI Unit was to develop a model which facilitated in meeting the needs of all the projects. Through training and empirical evidences it was possible to generate greater awareness regarding the importance of quality improvement. The initiatives taken under the CQI mission was implemented through FADE. One of the critical reasons identified behind the implementation of CQI was the high number of surgeries which the hospital performed each month. Overtime through the empirical evidences obtained through the implementation and the ease of operations which the system brought into the hospital made many doctors, nurses and other employees of the hospital realize that CQI would be a suitable measure for improving the quality of work performed (Huq and Martin 2000, 80-93). The first CQI project which was implemented at QMH was a massive success. This led towards the implementation of 12 more projects and the development of 20 other projects in the pipeline stage. The implementation of the CQI led to a number of cultural changes within QMH. Hospital members realized that quality improvement helped in reducing costs and time required for different services. After the implementation of the first project and its high success in the organization, many other departments of the hospital realized the importance of quality improvement and were willing to become a part of it. Dr. Seto was successful in convincing the members of the hospital that the implementation of CQI would not only improve the service quality and reduce mistakes, but it would also facilitate reducing a significant amount of time required for different processes. Dr. Seto had approached each department in order to obtain a constructive feedback. Communication between the CQI units and other units of the hospital had significantly increased (François, et al., 2003, 47-055). Hospital units began to get convinced that a number of problem areas of the hospital could be effectively solved through the implementation of CQI. As more number of units began to show their interests in CQI, hospital management began to get convinced regarding the usefulness of CQI for establishing a proper work environment. Additionally it was observed that the hospital administrator communicated various issues to the CQI Unit. This was not observed to be a customary practice earlier. The success of the CQI implementation had led the Unit members to conduct a forum for the hospital authorities and other members. Almost 400 people were seen to attend the forum during which a number of factors associated with CQI were discussed. It had stated some of the important areas of change which QMH had experienced as a result of the implementation of CQI. It was stated that, support services of the hospital had significantly improved. Food delivering, streamlining the requests for repairs and delivering of basic hospital necessities were seen to significantly improve. Improvement in the service sector led to better customer satisfaction. Attendants gave the feedback that providing support services had become more methodological and it was also possible to maintain cleanliness while performing such services. CQI implementation has also led to the elimination of unnecessary processes. This facilitated the saving of finances which were being allocated for wasteful services (Weiner, Shortell and Alexander 1997, 491). A number of traditional service procedures were also challenged such as the pre-operative skin preparation project. Modern techniques and simpler systems were implemented in respect of such services which facilitated the saving of time and effort. CQI implementation has also seen improvement in the services provided to outpatients. Almost 7 to 11convinience shops were implemented which catered to the needs of outpatient services. Prior to the implementation of such shops, patients were required to wait for long durations to obtain all necessary clearances for leaving the hospital. There was also a shortage of staff in providing such services. CQI Unit had developed suitable strategies for countering such issues. The outpatient services were improved by allocating more staff for performing such duties. Also through proper record maintenance and swift movement of information, patient discharge formalities were carried out fast. CQI had led to the implementation of a clinical practice guideline for doctors so as to effectively eliminate tasks which were not required. For instance regular temperature checking, weight checking and urine screening was not required for all patients. It was observed that, there existed many practices in the hospital which were not required but were however carried out. CQI facilitated classifying the type of jobs which were required to be carried out on a regular basis for different patients based upon their illness or treatment requirement. The CQI projects were implemented by involving patients who had undergone general surgery. However, the Overall CQI was both process and patient oriented. The implementation of the CQI projects in the hospital resulted in an increase in the pre-operation baths from 55% to 93%. This was considered as a significantly high achievement. It was also seen that patient education and knowledge had significantly risen. The level of patient education increased from 13.7% to 88.9%. Almost 80,000 sets of Control Sterile and Supply Sets were saved during the year. Providing instruction to patients to bathe before surgery and the elimination of wound cleaning and shaving had facilitated the saving of 18 nurse-hours in a two week period. There was no increase in the infection rate of surgical wounds post implementation of the project. Through the implementation of the CQI techniques, much revenue could be saved as a number of processes required for fulfilling different tasks had reduced significantly (Shortell, et al., 1995, 377). This made the completion of different tasks swift and more prompt. CQI made it possible to increase investment in areas where quality improvement was necessitated. QMH overall services report post audit had portrayed a rise in customer satisfaction, reduced delays and timely completion of delays. The number of errors in the undertaken projects had also reduced as compared with the earlier circumstance. CQI has effectively inspired members of the QMH to undertake quality improvements in its future endeavors as well. Focus, Analyze, Develop and Execute (FADE) model is a suitable technique for achieving CQI motives. The first stage of FADE was to focus upon the identification of the issue. The identified issue in the hospital in respect of the project was shaving and bathing before surgery. It was considered that shaving and bathing before surgery was not required. The next stage in the FADE process is to analyze the issue. This includes obtaining data in respect of the patients and the records of stock usage. Patient survey reports revealed that very few patients were instructed to take bath before the operation. The usage of CSSD packs for ward skin disinfection was also taken into consideration. Ward disinfection was a common practice and CSSD sets were used for skin dressing and preparation. The developing stage of the FADE process considers the development of guidelines. The guidelines are formulated after going through the issues and strategy analysis. This section includes the formulation of recommendations (Wardhani, et al., 2009, 239-251). The CQI Unit members had recommended that all patients must take a bath before being operated upon. It is suggested that patients take bath preferably using a hibiscrub so as ensure thorough cleanliness. Hair removal will not be considered necessary for all types of surgery or operations, except only in cases where hair is considered as an obvious intrusion for the operating site. CQI Unit also suggests that hair removal must be done through clipping or depilation creams. Skin disinfection must be done only in the operating theatre and not in the ward. Skin disinfection is most effective when it is done right before the incision is made. The final stage of the FADE process is to execute. This process involves the implementation of CQI objectives in the project. In the project undertaken by the CQI Unit, staff education and system change implementation was considered highly necessary. Intensive staff education system involves providing lectures to staff and suitable training. The system changes include pre-operative shaving, use of hair clippers, discontinue skin disinfection in the ward, educating patients to have pre operation baths, providing written instructions to the patients, assuring proper preparation of skin in the ward and also in the operating theatre. The process also includes reporting events of faulty skin preparation without sidelining them. FADE was also considered as an important tool for achieving the Food Wastage Minimization. Food preparation was an important patient care service (LeBrasseur, Whissell and Ojha 2002, 141-162). It was observed that a number of complaints were received from patients in respect of the food portions served. The meals served to the female patients were considered to be big while that served to the male patients was seen to be too small. Many patients also complained that food served was indigestible and too solid for many elderly patients. The rice served was also undercooked. The data collected in respect of food wastage showed that almost 23% of the food served to the patients was getting wasted. Survey results showed that almost 228 kilograms of food was seen to be wasted each day. The situation was not to be taken lightly as almost a quarter portion of the food prepared was getting wasted. The survey conducted in respect of food wastage further revealed that rice was being cooked in the food department in an excessive manner. This led to the generation of excessive food. The food department kept cooking the same amount of food irrespective of the number of patients in the hospital. The equipments used in the kitchen were very old and quite big in size which often led to over preparation of food. The process followed in ordering food and distribution of the same was also seen to be highly cumbersome and led to many difficulties. The ward staffs were required to order food and other products through the Catering Services Unit. The food ultimately would get distributed through the main kitchen. A number of confusions and miscommunication would take place in the process. The food preparation process and minimization of wastage of food was seen to be of high priority and required immediate remedial measures to be taken upon. Through FADE, the CQI Unit planned to reduce the wastage of food in the hospital. The objectives in this respect included the reduction of food production and rice leftovers. It was also necessary to streamline the process of flow of work in the kitchen. Considering such aspects, the CQI unit planned solving the food wastage issue as it did for the pre-operative skin preparation process. The Unit made suitable plans for replacing the containers which were used in the kitchen. A suitable system was required to be put into place so that the main kitchen would directly receive orders from the wards. This would reduce the chances of miscommunication. The kitchen staffs were required to be timely informed regarding the admission of new patients and their discharge. They were instructed to cook as per the orders received. Over preparation of meals could be significantly avoided in this manner. It was also observed that, the kitchen staffs were not provided with timely and adequate information regarding the health condition and the food requirements of the patients admitted in the hospital. The CQI Unit suggested that the main kitchen would be informed from the ward staff directly regarding the dietary requirements of each patient admitted. The main kitchen was required making a note of these aspects and follow them accurately on a daily basis. The ward staff was required informing the kitchen staff on time if any changes was required to be made in dietary requirements. The kitchen staff members had raised a complaint with the CQI Unit that the negligence of the ward staff members was one of the primary factors behind food wastage. The CQI Unit on deeper investigation realized that, there existed significant amount of hostility between the ward staff and the staff of the main kitchen. In order to reduce such aspects and to develop team spirit, the CQI Unit has planned for special sessions for the employees of both units for describing to them the formal procedures of reducing wastage. The plans made for reducing food wastage by the CQI, through FADE is still in its inception stage. Most of the formal procedures suggested by the CQI Unit for reducing wastage is just on paper and is yet to be approved by higher authorities. The primary task of the unit would be replacing old and large kitchen equipments with compact ones. The next step would be to develop a suitable communication path between the kitchen and the ward staff for communicating food preparation requirements. Through such measures, the CQI is expecting to lower the wastage of food (Sales, Moscovice and Lurie 2000, 476-487). The full potential of CQI is yet to be achieved by QMH. It was observed that the CQI Unit faced a number of setbacks in its implementation plans. The members of CQI were yet to convince the nurses appointed at the operation theatre regarding the utility of quality improvement and the need for a special unit to meet the same. The resistance which came from the nurses was yet to be put off completely. The main reasons for their resistance was that they considered that the information based upon which the CQI unit made their formal plans were not logical. The nurses also believed that the data upon which the CQI members based their research was not valid. Moreover, the nurses appointed in the operation theatres were seen to follow similar types of procedures for a very long time especially in the case of pre-operative skin procedures. They were seen to remain uncomfortable with the implementation of new types of policies in respect of the same (Brush, et al., 2006, 379-385). The quality team however, did not refrain from implementing the procedures. Many nurses undertook the policies under peer pressure. The CQI Unit must consider training and informing the nurses that the quality measures taken would not lead to implementation of completely new processes. Majority of the process systems were likely to remain the same. Only minor changes would be implemented to improve the manner in which the services are delivered and to improve the quality of services. Through proper information dissemination, it would be adequately possible for the CQI team to convince the nurses (Kerr, et al., 2004, 247-256). Another major shortcoming faced was in respect of the physicians, specialists and surgeons. Physicians and surgeons were yet to be assured regarding the formal procedures implemented in the organization in respect of quality improvement. In the first week of the implementation of the project, there arose two cases of minor infection which had alarmed the doctors. Skepticism was raised amongst doctors, physicians and surgeons. The CQI unit had immediately drafted a review to the doctors regarding the incident and that the measures taken by them in respect of quality improvement were based on proper research studies. Proper information was also provided to them that the measures taken by the CQI Unit had seen valuable and positive impacts upon different departments. The CQI Unit encouraged the doctors to conduct a study themselves and get assured regarding the usefulness of quality improvement procedures. Initially, the CQI unit based the results of its project upon the number of wound infection rate. This was initially considered as an effective way of deducing and monitoring the impact of the projects undertaken. However, the CQI team soon came to the realization that such a measure would not be adequately helpful for monitoring the project as infections may arise out of a number of reasons apart from negligence or quality aspects. Illness or reaction to medicines can also cause infections. Therefore, in order to base the monitoring of the results of the projects implemented by the CQI Unit, alternative measures must be considered (Johanson, 2002, 351-365). One effective procedure was to utilize the data of the total number of skin preparation packs or sets which were used in the hospital. Although this was an effective procedure, the CQI Unit is yet to develop suitable procedures for monitoring the impact of the quality measures taken. It can be stated that, CQI is yet to convince many members of the hospital in respect of the benefits of the quality measures. The Unit must focus upon increasing the training measures and widely popularizing the positive impacts of the measures undertaken. Through the minimization of food wastage program, CQI aims to positively influence more members of the organization in respect of undertaking quality improvement measures. CQI must also focus upon encouraging doctors, nurses, physicians and surgeons to adapt to newer techniques. Many individuals refrain from undertaking new techniques as they consider that it might have negative consequences. It therefore becomes essential to train such individuals to understand the positive effects of quality improvements. Quality improvement does not necessarily mean to implement new policies. If existing policies are followed accurately and diligently, a large amount of mistakes can be avoided. Although CQI mainly focuses upon improving the processes, adequate training measures must also be taken in respect of reducing the relationship barriers which exists between the members of the hospital in different departments. Process changes usually induce changes in the culture of the hospital. Through training, it is possible for the CQI Unit members to propagate team spirit and remove communication barriers which exist between the different departments of the organization. CQI team develops plans of different projects based upon the complaints received. The team members do not carry out discussions and meeting with other hospital members for determining the procedures and plans for developing suitable systems for the development the projects (Patow, et al., 2009, 1757-1764). CQI techniques can be utilized suitably by different companies to gain maximum improvement in the formal systems and deliver supreme quality goods and services. Most organizations view CQI as a strategy of gaining competitive advantages over other firms. In today’s competitive work environment, it is necessary that business organizations frequently change their systems and procedures of working so that advantages like reduction in costs, decreased time required for production and development of new technologies can be achieved. CQI helps a firm to monitor existing systems of functioning and device ways for improving. If a firm is able to deliver better quality products at similar prices and in shorter lead time, a larger section of the target market can be attracted (Harper and Lattuca 2010, 505-527). Generally, organizations use the CQI model of quality improvement by identifying and describing the issues and strengths of the firm. The CQI models then used in appropriate ways for converting the issues of the firm into strengths. Different types of testing procedures are then carried out so that accurate information regarding the areas where change is necessitated so as to improve the quality of performance. It must be borne in mind that CQI may not necessarily be required to be implemented on the event of organizational issues. It may be implemented even if there are no perceived issues. CQI may facilitate a firm to implement changes so that existing systems of working can be improved further. Successful organizations believe in the fact that no system is such that it cannot be improved further. The scope of improvement always exists in a firm. The improvement may be related to processes, people and organizational policies. CQI also has facilitated the development of new systems in a manner such that new services and goods could be developed and delivered to the consumers. The success of CQI relies upon an organizational culture which is open towards change and remains proactive. Hence, CQI cannot be successfully implemented in organizations which are rigid and resist changing their traditional methods of operating (Dew 2007, 45-52). In the globalized business environment of today, an important consideration for firms is to develop business goals which not only meet its financial needs but also caters to the interest of the society as a whole. Sustainability is therefore, an important aspect of consideration for most organizations. Therefore, when firms formulate different types of quality improvement strategies, it is necessary to keep in mind the needs of the environment and the society of the present and the future. In the recent times, it has been observed that a number of universities and colleges in the U.S use the CQI technique for improving the quality of their services. Georgia Tech, Penn State University, Rochester University of Technology and Wisconsin are the few amongst them. In the Penn State University, the Demings systematic view of CQI is implemented. In this system, quality improvements are developed through the interactions which take place between suppliers, designers, output, processes and consumers. In the educational sector, it is identified that a significant way of improving quality of services is through improving the competencies which exists between students and by the development of a more responsive curriculum. Student performances can be improved by providing more detailed instructions, enhancing administrative efficiency and taking feedbacks into consideration while formulating important policies. CQI techniques adopted in most schools are based on such policies (Goldberg 2000, 701). Colleges such as the Fox Valley Technical College (FVTC), Wisconsin, have been pursuing CQI in their operational systems for more than seven years in a row. In FVTC, CQI objectives are implemented as a multitier program, focusing upon different departments. CQI decisions are taken and implemented in a manner to effect the entire organization. The CQI related projects in FVTC includes cafeteria improvements, teaching improvements, registration process improvements and the implementation of competency development in the graduate programs. The CQI system implemented at the FVTC is recognized as a true organization wide system. The college has reaped a number of benefits from the implementation of such quality improvement programs. The retention rate of students had improved dramatically. The performances of students in state and national level competition representing the college have been praiseworthy. Colleges and schools in the U.K are seen adopting the CQI techniques in a similar manner as they are adopted in firms and industries. A suitable example in this context would be the Aston University in Birmingham, U.K. Aston University considered looking into the aspect of quality improvement from the grass root level. The university administrators considered that, teachers and teaching styles are the main areas which require quality improvements. The CQI projects of Aston University include monitoring the student performances under each teacher and obtaining feedback from students regarding the teaching styles. The university management on the basis of their research had stated that student tend to perform better when teachers undertake an interactive form of teaching, They were of the opinion that practical trainings and teaching methods were likely to make it easier for student to understand theoretical concepts. Additionally, the university administrators also considered altering the systems associated with registration and admissions (Trummer, 2003, 91-102). Conclusion The above analysis of CQI technique provides the understanding that, achieving quality improvements is necessary to maintain consumer base and firm reputation. CQI is not only a technique which aims to achieve internal improvements of functioning, but it is also a system which facilitates a firm to achieve maximum improvement in the final good and services delivered to consumers (Scott, et al., 2002, 357-363). The adoption of CQI at QMH significantly proves that the system is suitable for increasing the effectiveness in the manner in which hospitals functions. The increasing number of causalities and patient complaints due to errors and miscommunication are commonly noticed in many hospitals. Such circumstances can be removed through the implementation of CQI techniques. The success of the CQI projects at the QMH has encouraged many other hospitals in Hong Kong to adopt the system. Quality management is believed to be a suitable measure by which many problems in the medical field can be reduced. Healthcare providers are seen to indulge in competitions on the basis of economic gains and neglect the qualitative aspects (Sower, et al., 2001, 47-59). Also, many hospitals are forced by government authorities to implement quality development without providing them with adequate training or explanations regarding the benefits of CQI implementation. As a result, it is observed that adoption of quality improvements are largely under pressure rather than informed. The lack of awareness regarding CQI and its benefits requires to be addressed so that services offered by the healthcare sector can be improved. It is also important to train doctors, physicians, surgeons and nurses directly by federal authorities regarding the benefits of CQI. Reference list Anderson, Craig, Bonnie Cassidy and Peggy Rivenburgh. "Implementing continuous quality improvement (CQI) in hospitals: lessons learned from the International Quality Study." International Journal for Quality in Health Care 3 (1991): 141-146. Brush John, Sharmini A. Balakrishnan, Joani Brough, Carl Hartman, Grace Hines, Deborah P. Liverman, John P. Parker, Jeffrey Rich and Nancy Tindall. "Implementation of a continuous quality improvement program for percutaneous coronary intervention and cardiac surgery at a large community hospital." American heart journal 152 (2006): 379-385. 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