Quality Management in Health Services - Case Study Example

Contents Contents 1 Introduction 1 Goals and objectives of the quality management program 2 Quality improvement and assurance activities 3 Structures and resources to support the program 4 Staff and stakeholders 6 Measuring and monitoring implementation and performance 7 Evaluation of the program 9 Conclusion 9 Introduction The report is a three year quality management program for a hospital. The health care quality framework against which the program will be based is total quality management. By definition, total quality management is seen as a means with which staff and their managers can continuously participate in the process of improvement of their services. In other words, this method of quality management ensures that hospitals combine both the management and quality aspects of their business in order to avoid loss or to boost the level of service provision. This method aims at integrating all health functions within an institution so as to ensure that organisational objectives can be achieved and consumer needs can be met. Goals and objectives of the quality management program The major goals governing this program will include: improvement of quality and enduring safety of employees and patients within a hospital. These goals were selected as a result of the growing body of literature highlighting lack of quality in hospitals and unmet patient expectations as being the major problems facing healthcare institutions. It would therefore be logical to work towards elimination of such challenges. The specific objectives governing this quality management program are to: 1. Reduce wastage in the hospital by thirty percent at the end of the three years 2. Improve safety levels by a third of what they were prior to the program 3. Halving the amount of time that patients spend before receiving treatment Resource wastage is a common problem in most hospitals as they may be operating without a clear cut quality strategy. Such institutions often find that they are injecting so many resources yet minimal results are being achieved. The essence behind this gaol is to ensure that all these wastage is redirected towards patient satisfaction. (Shaw, 1999) A number of media reports, internet blogs and other pieces of literature available in the public domain have highlighted the issues of safety in hospitals. Many health care practitioners have caused unnecessary pain, harm or even death to their patients and even their own employees. There is a need to ensure that such situations do not arise in the hospital chosen. It should be noted that most cases of patient injury are in fact avoidable and the risks they pose to hospitals or to the direct victims can cause substantial costs to them. There are numerous parameters that can be used to depict improved quality within the health care organisation chosen. Some of them include; speed of health care delivery, lower expenditure per patient or improved physician –patient interactions. The first parameter was chosen because it is one of the most pressing problems and it is also quite easy to measure. (Schiffler & Amon, 2000) Quality improvement and assurance activities Since the latter program will proceed for a period of three years then the following quality improvements and assurance activities will be carried out for a period of three months each until the end of the three years Activity Point of introduction Duration Carry out a TQM program campaign in the hospital 1st month 3 months Eradicate all defective equipment, drugs, facilities 4th month 3 months Examine statistics on patient waiting times, resource losses and potential hazards 7th month continuous Create new expectations for hospital suppliers 10th month 3 months Carry out problem identification in each hospital activity 13th month continuous Instate assessment through control charts 16th month continuous Instate on the job training 19th month continuous Create interdepartmental teams to deal with quality related challenges 22th month continuous Eliminate numerical standards for management 25th month 3 months Eliminate annual performance ratings – a barrier to continuous improvement 28th month 3 months Enrolment of more physicians 31st month 3 months Improve the hospital layout to include TQM aspects 34th month 3 months Introduce direct ways of communication with hospital staff (weekly meetings) to dispel fear of change to TQM 36th month continuous Structures and resources to support the program There will be three major parameters that will be encompassed in the quality management program in terms of structures and these include; Technological facilities Medical facilities Physical layout In terms of the technological facilities, there will be a need to possess material for training for instance the hospital will require TQM software. Aside from that technology will be applicable in almost all other phases. For instance, when receiving new hospital equipment or when recording some of the outcomes of quality improvement such as patient satisfaction. Besides that, technology could come in handy when carrying out some of the day to day activities of the hospital that may contribute towards the quality management goals. For instance, IT networks are essential in maintaining an efficient scheduling structure within the institution. (Roessner, 2001) Medical facility support structures will be an important aspect of this program because without them, quality management is impossible. Examples here include availability of efficient mechanisms when analysing patient samples, availability of high quality drugs and maintenance of defect free equipment. The physical layout of the hospital will have to be changed so as to incorporate these new changes. For instance, those departments that work hand in hand will have to be placed close to one another for instance radiology should be near the diagnostic department. Additionally since a number of interdepartmental teams will be working together, then the hospital needs to accommodate such teams by allowing for flexibility in movement. Managerial offices need to be placed near the departments with the highest quality level activities so as to ensure that there is constant communication between employees and their supervisors. Since employees will be the largest group to implement this total quality management program, then it is logical to have more of them in order to ensure success in the program. In other words, the hospitals will have to increase on the numbers of pharmacists, radiologists, physicians and the like. This is when there are more employees; doctors can spend more time with patients without inconveniencing others since there would be other colleagues to support them. It also implies that the employees will dedicate more time towards preventing wrong diagnoses and wasting resources. The hospital’s administration will go a long way towards making the latter changes. (Reed & Faust, 1993) Staff and stakeholders There are several responsibilities that staff/ stakeholders will be expected to carry out. Management will have to demonstrate strategic leadership. They will be expected to initiate, carry out and monitor the program. Their major challenge will be to ensure that all employees remain enthusiastic and focused on TQM by informing and reminding them about the whereabouts and benefits of this plan. Additionally, management will be expected to initiate team discussions between members so as to ascertain that every member understands their role in quality management. Besides this all members of the organisation i.e. those ones in radiology, casualty, laboratory analytics, information technology, dentistry, pharmaceuticals etc are supposed to work hand in hand to establish some of the potential problems that could crop up. In other words, these teams should largely dwell on solving challenges. Information Technology staff within the hospital will be expected to foster decision making criteria centred on data maintenance. Their work will be to streamline most of the statistical analyses carried out in determining potential problems and looking for solutions for dealing with them. (Couter, 2003) Physicians specifically will be expected to improve the way they deal with patients. Thy need to keep in mind the three specific gaols governing the total quality management program are: reducing patient waiting times, reducing wastage of resources and improving safety levels. Physicians will be expected to maximise time spent within confines of the hospital. This means that each moment spent on patients will be directed towards arriving at a diagnosis. Consequently, this will reduce waiting times for other patients that may be waiting in line. Aside from that, physicians will be expected to reduce wastages by giving treatments that require use of fewer resources. Also, they need to coordinate with other members of the hospital to ensure that safety levels are not compromised. Physicians can also achieve this latter gaol by being keen on the type of treatments that they select. Wrong diagnoses are one of the leading causes of hospital injuries and ailments. In this regard, physicians need to do more training on recent treatments and dangers that underlie some of them. This means that they need to be dedicated towards self improvement. Measuring and monitoring implementation and performance It is relatively difficult to measure some of the objectives laid out before because it is tricky to try and place a number on quality. However, the hospital still needs to have a general direction of where it is going. One way in which it can do this is by carrying out patient satisfaction surveys in different hospital departments. Here, patients can be asked about how much time they spent in waiting for a service, whether their diagnosis was comprehensive enough and whether they were subjected to any injuries, pain or harm while in the hospital. (Hyde, 2002) It should be noted that within the hospital environment, it may be difficult to define a clear cut method of measuring outcomes. TQM has worked in production oriented industries such as in the automobile industry because the productivity is easily calculated as the proportion of output over input. In this industry, outputs are much more diverse or more complicated since the types of yields are totally different. For instance, a patient can be discharged from hospital as a result of being treated or being in need of palliative care or when he or she decides to disobey his/ her doctor’s instructions. This implies that special emphasis needs to be given to the reasons behind patients’ actions. (Grimshaw, 2003) However, it can be argued that productivity is best understood by measuring the number of patient turnover within the hospital. If this number is found to have increased after the program, then it can be said that its objectives have been achieved. Most of the time, it may be necessary for an organisation to measure its performance by looking at its production in entirety. On the other hand, one cannot claim to have comprehensively dealt with quality improvement without looking at control mechanisms within the organisation under consideration. In the case of the hospital; the intensive care unit, the operation theatres, ambulance services, clinical pathology will all be assessed through different measures. For example, in the intensive care unit facility, outcomes will be analysed through higher patient intakes and amount of wastage, in ambulance services, outcomes will be measured by the number of lives that were saved and patients safety, in radio diagnosis, it can be measured by the increases in number of radiologists carried out and reduction in wastage. The outcomes will then be compared to the stated objectives which are thirty percent for wastage, thirty three percent for safety and fifty percent for wastage. (Shaw, 2003) Evaluation of the program The focus of this program is on continuous improvements in quality. Hospital functions and processes must indicate these very differences when they are being carried out. Quality data for the different sections of the hospital will be examined and if is found that these processes have not fallen in line with the outlined objectives i.e. 33%, 50% and thirty percent for the different parameters then the entire process will be examined so as to see how this can be reflected on individual performances. Conclusion There are a number of issues that will be essential in ensuring the success of the quality program. First of all, the quality management program will best be handled when it relates to aspects within the hospital. Besides this, failure to meet objectives can be brought about by several situations; it may be brought on by poor implementation of the total quality management program. In other situations, it may be propagated by limited time – there may be times when the plan can yield results in a period longer than three years. Aside from that, it will imperative to work hand in hand with quality experts if an exact problem cannot be identified for observed failures. But the most important aspect that needs to be adhered to is a high level of flexibility as the hospital to be open to frequent changes from time to time. References Couter, M. (2003). The European Patient of the future. Keynes: Open University Publishers Grimshaw, J. (2003). “Effectiveness of quality strategies.” Journal of safety and quality in health, 13: 303 Shaw, C. (1999). “Quality improvement within the UK.” Health care quality insurance, 5, 2: 11 Shaw, C. (2003). “Assessment in health care.” BMJ, 22: 851 Roessner, J. (2001). Curing healthcare. San Francisco: Jossey Bass publishers Reed, J. & Faust, L. (1993). “TQM in community hospital research.” Medical systems Journal, 17, 1, 17-24 Hyde, A. (2002). “Proverbs of TQM.” Public Management and productivity review, 16, 1: 37 Schiffler, A., Amon, U. (2000). A German Hospital case study of quality management in healthcare. Psychosomatics and Dermatology Journal, 1, 34: 112 Read More