Quality in Health Care Administration - Research Paper Example

 Contents Introduction 2 Case and Analysis 2 Customers within the Organization and Servicing Customers 3 Managing Customer Expectations 7 Organizational Culture and Quality 8 Organization’s mission and value statement 9 CEO - Effectiveness of Leadership and ability establish environment for Quality care 10 Quality Project- Positive and Negative aspects 11 References 13 Introduction For the purpose of this study, I interviewed my friend who works as the Manager-Patient Services in the healthcare sector in India, in a corporate hospital called Indraprastha Apollo in Delhi. The hospital is a tertiary care centre with 700 In patient beds. A summary of the interview and the case thus developed is presented below. Along with the response to each question on the topics discussed, an accompanying analysis from the Quality theory and Management Theory perspective is also offered on the related topic. Case and Analysis Position in the organization : Senior Manager- Patient Services Day to day responsibilities : The primary role of the Manager-Patient Services is to ensure that needs of all patients in the hospital are successfully met by effectively collaborating with the medical departments (pharmacy, diagnostics, laboratory, medical records department, nursing and therapy) and non medical (housekeeping, F&B, security, engineering, personnel, finance, IT and materials). The day to day responsibilities include: Planning, directing and coordinating operations for patient care management Defining patient care processes and implementing the same Recruitment, training and accountability for a 60 member team Measuring patient satisfaction Coordinating with external and internal customers Managing relationships with Consultants Working with housekeeping, F&B, Pharmacy and defining processes for seamless service delivery to in-patients Working with Consultants, Diagnostics and laboratory and defining processes for seamless service delivery to all out patients Managing Admissions and Billing services Customers within the Organization and Servicing Customers In the role of Senior Manager- Patient Services, customers include: External Customers: Patients and stakeholders like IT vendors, other agencies Internal Customers: Hospital Staff In order to provide quality care to external customers viz. patients, the service delivery process has to be made seamless. Both, while implementing a service for the first time, or improving existing service, based on customer feedback, the service delivery process is studied and changed. It involves defining and documenting the process, communicating and then implementing the same. This is followed by feedback to trigger control mechanism and make necessary changes to the process so that desired outcomes are achieved. Servicing the Customers- the steps involved 1. Define and document the service delivery process: Once a process has been identified which helps in service delivery, its is discussed with the key team members who are involved at the various stages of service delivery to understand the way the process works and brainstorm for ideas that could make it work better. It also helps in ensuring that their acceptance and willingness to implement the process is achieved without which even the best designed processes can fail. 2. Train the staff- Once there is acceptance on the process, it is documented and communicated to all team members. The staff who are the key members of the process, are then trained to work in accordance with process objectives to ensure that the desired outcomes are achieved. 3. Measure the outcomes against what was originally planned: this helps in analysing if the defined process is really working or not. Once implemented, the process is monitored and feedback is received to check whether the process is achieving its objectives at regularly defined intervals. For instance how much waiting time is involved in admitting the patient or what is the turn around time to receive discharge summary in wards or the turn around time for getting pharmacy to the wards once request is placed could be some of the objectives of the patient service delivery process and the process could focus on how the waiting time can be reduced and efficiency built on the system. 4. Implement changes and redefine the process. This is followed by a meeting with the process team to explain changes and follow this cycle again. Exactly the same steps are followed even in catering to internal staff like housekeeping or F&B. For instance, to ensure that pharmacy can quickly deliver medicines as soon as request is placed in the ward, a mutually agreed on process needs to exist between pharmacy and wards. They then follow this process and in case turn around times continue to be high the heads of department with the process team meet to identify the problem and redefine the process. Once the process is agreed on by all, it is documented communicated to all the process team members. Processes are changed based on the assessment of objectives achieved or any significant feedback from the staff. Analysis: The emphasis on process in service organizations is very necessary to ensure that service is consistent and seamless every time. Meisenheimer (1997) says that “quality can be defined as the provision of service that consistently meets or exceeds the sponsoring group’s mission, professional standards, and customer expectations. Each facility need sits own working definition of quality based on its mission statement”. Given that the product in the healthcare environment is a service, intangible and varying, its delivery dependant on the person who delivers it, the propensity for the delivery process to get marred by inconsistencies can be high. By documenting a process and training every member of the staff in adhering to its implementation, the hospital can hope to achieve quality levels that it promises to its patients. The need for well defined process in healthcare settings cannot be overemphasized due to its people dependence on service experience by customers. It is also interesting to observe that the way the processes are defined by the hospital are in line with the PDCA cycle as explained in the table below. Plan-Do-Check-Act A Problem Solving Process Steps (NCDENR, 2002) As applied to the above case PLAN Step 1: Identify The Problem Select the problem to be analyzed Clearly define the problem and establish a precise problem statement Set a measurable goal for the problem solving effort Establish a process for coordinating with and gaining approval of leadership The hospital identified an area that involved service delivery. It defined objectives. The fact that it focused on objectives rather than problems indicates a pro active approach by hospital to process mapping. It need not be remedial but good planning from the beginning can help in achieving the desired objectives without too many changes. The approval is not just from leadership in the hospital but also focus on the front line staff who are actually involved in delivering the process. Their buy-in is crucial to the success of the process as is top management’s support PLAN Step 2: Analyze The Problem Identify the processes that impact the problem and select one List the steps in the process as it currently exists Map the Process Validate the map of the process Identify potential cause of the problem Collect and analyze data related to the problem Verify or revise the original problem statement Identify root causes of the problem Collect additional data if needed to verify root causes Processes are mapped with inputs from core team. If there are problems on implementation of the process they are defined and identified through feedback mechanism and changes to process are made DO Step 3: Develop Solutions Establish criteria for selecting a solution Generate potential solutions that will address the root causes of the problem Select a solution Gain approval and supporter the chosen solution Plan the solution Solutions are brainstormed with inputs from staff involved in service delivery. Process communicated and staff is trained to implement the same. DO Step 4: Implement a Solution Implement the chosen solution on a trial or pilot basis If the Problem Solving Process is being used in conjunction with the Continuous Improvement Process, return to Step 6 of the Continuous Improvement Process If the Problem Solving Process is being used as a standalone, continue to Step 5    CHECK Step 5: Evaluate The Results Gather data on the solution Analyze the data on the solution  Achieved the Desired Goal? If YES, go to Step 6. If NO, go back to Step 1. Altered process is then implemented and the cycle repeated ACT Step 6: Standardize The Solution (and Capitalize on New Opportunities) Identify systemic changes and training needs for full implementation Adopt the solution Plan ongoing monitoring of the solution Continue to look for incremental improvements to refine the solution Look for another improvement opportunity Use of feedback mechanism and regular monitoring to ensure that the process is working, If it is failing then it is altered   Managing Customer Expectations On being asked whether the organization was meeting or exceeding the needs of its customers and what was being done if the needs were not met, the response was as given below: By and large the needs of the customers are being met and in fact being exceeded as can be seen from the customer satisfaction survey. Though one of the complaints has been related to delay in discharge. Despite the consultant having approved discharge, the time taken for the patient to leaves the hospital premises from the time discharge intimation is received, is too late. The reason being that most patients end up waiting for their discharge summary. Our department also manages a “Typing Pool” where handwritten discharge summaries are provided by doctors and typed and printed from the computer and the given to the patient. The various reasons identified that lead to delay in discharge are: Ward secretaries keep paging for residents/registrars to provide discharge summary but doctor is busy and is unable to attend promptly There seems to be shortage of staff in typing pool and typing of summary gets delayed In order to solve this problem there is an effort to diffuse the typing pool and move this staff to the wards. This staff can then both double up as ward secretaries and also type as the doctor dictates, instead of the doctor first writing, then the summary being typed and then again be checked by the doctor, retyped with corrections and then being signed by the doctor. It is believed that the process of diffusing the typing pool and providing immediate access to doctor to complete discharge summary will significantly improve process efficiency and customer satisfaction. Such a process will: 1. Be cost effective since no new materials will have to be provided and existing staff and resources will be better scheduled 2. It will do away with two time consuming steps in the process: doctor hand writes summary, it is typed and submitted to doctor for correction and then retyped. Since the doctor will be available in the ward, the process will be faster and there will be no need for handwritten summaries 3. The patient services department is also working with the Medical Superintendent to create certain templates for case types that could be used for discharge summaries. These templates will then only need to carry certain specifics of the patient while some data for the cases types can be common and stay as part of discharge summary template. Analysis: Having identified a problem related to customer dissatisfaction a simple and easy solution is identified of redeploying existing resources and changing the work pattern. Cost effective solution of not recruiting more staff but using the managing the existing staff’s schedule efficiently solves the problems. Even saving typing time through ready-made templates will contribute to the overall efficiency in Discharge Summary typing. Organizational Culture and Quality On being asked to describe the organizational culture towards quality and how it has evolved over the past the response was: In order to improve quality there is an emphasis in the organization to manage resources efficiently, be cost effective in the deployment of resources, implement staff training and make everyone conscious of their job objectives. Success in career for the staff is linked to how well they perform and how well they are able to achieve the objectives of their roles, which ensures that quality of work and thus overall patient care does not suffer. The organization believes motivated, committed and competent staff is the key for quality service. Besides there is a lot of emphasis on defining processes for service delivery by collaborating with core teams and then communicating and training the staff to achieve process objectives so that quality service can be ensured. Various training programmes are held to help the staff do their job better. These are related to working on the computer, how to increase efficiency, adopting a customer centric approach, managing customer grievances etc. Analysis: Healthcare, being a people driven area with staff as the channel for service, it helps to keep focus on the training and competency of staff. Not only that, motivated staff can ensure better service, so a compensation mechanism that is performance based and rewards good performance can improve the quality of staff in the hospital. Training staff on various customer service issues helps them improve their performance and therefore that of the hospital. It results in rewards for the hospital as well as the high performing staff. Organization’s mission and value statement On being asked the mission and value statement of the hospital, the response was that the Mission of Apollo Hospital as described by its Chairman is “to bring healthcare of International standards within the reach of every individual. We are committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity”. It value statement is : “constantly measuring our deliverables, we have succeeded in creating infrastructure that meets the needs of the future that incorporates the latest technology and provides superior healthcare delivery systems.”. The direction of the organization in the area of quality improvement is to focus on the people who deliver the service. So the idea is to attract the best doctors in the country and even try to bring back the Indian doctors who are working in foreign lands. Work towards continuous medical education (CME). For this purpose CMEs are conducted by Apollo Consultants for doctors in smaller towns. The hospital also endeavours to ensure that best technology is available for its patients and the hospital experience is easy and without hassles for which focus is on seamless service delivery processes. Analysis: Increasingly, it is seen that what distinguishes a hospital from others is not so much as best technology and best doctors (as more and more hospitals are able to afford this technology and able to work schedules with consultants) but the service experience. It can work as a differentiating factor in deciding the quality of service by a hospital. In its mission statement and commitment to achieving healthcare excellence, these ideas are captured. CEO - Effectiveness of Leadership and ability establish environment for Quality care On being questioned on the CEOs leadership and what was being done to stay cost effective and also provide quality care, the response was: The CEO of Apollo Hospital has a very participatory approach to leadership. It is not too autocratic to disregard the opinions and views of front line staff or people who are involved in directly caring for the patient, nor is it so lenient to make him indecisive. The CEO takes his role of providing customer service very seriously and all written feedbacks received from patients are brought to the CEOs desk. It shows his commitment to customer service. Instead of purchasing expensive software, the CEO has paid great attention to ensuring that a competent IT team is in place and the entire Hospital Information System (which is key to delivering quality patient care and networks all departments) is built by the in house team and some local vendors. It has been the most cost effective option used to achieve high quality results. There is also regular MIS generated especially for the CEO to monitor average length of stay, waiting time, customer complaints, Bed utilization, occupancy and staff overtime reports which are some of the quality indicators used to assess the hospital services and serve as performance measures for quality improvement. As pointed by Pollock (2002) “improving the delivery of care through efforts that are based on meaningful, accurate and measurable outcomes …performance measures for the purposes quality improvement” Quality Project- Positive and Negative aspects A key project taken up at the hospital was the implementation of Business Process reengineering. The positive aspect of this project was that it allowed every process head to assess existing processes, identify gaps and loopholes, and redesign the process for optimum patient care. The opportunity to be able to provide consistent quality care by streamlining service processes was a very positive thing about this project. The negative aspect was that not all members of the project team seemed to share the enthusiasm or really believed that it could make a difference to patient care. They felt that time was wasted in meetings while they could have been attending to their tasks. Perhaps the reason was that these people lacked process orientation or were not shown how these processes could add value in a tangible way. It was necessary not just to communicate what was being done but to communicate effectively, the need to take extra time from work and learn better ways to do our jobs. The one thing that I would have changed was to make this communication more effective and done one complete pilot on one process, measured outcome after implementation and shared with all other process teams to show that it really worked, and that if they could contribute to quality improvement through process reengineering, they could add a success story in their resumes. The importance of staff involvement has also been stressed by Meisenheimer (1997) who states that“ with the implementation of quality processes within an organization to improve services, personnel become motivated and more involved in identifying current practices and services and providing solutions”. According to AHA (2002) as measures of effectiveness should tell policy makers and the field if health care is doing the right things.  The measures of safety, timeliness, and patient-centeredness will tell us if we are doing them well.  References AHA (2002). Statement of the American Hospital Association before the National Committee on Vital and Health Statistics on The National Quality Report Measures and Plan. Retrieved December 2, 2007, from < http://www.aha.org/aha/testimony/2002/020725-tes-conlon-ncvhs.html> Meisenheimer, C.G. (1997). Improving quality: A guide to effective programs (2nd ed.) Aspen Publishers, Inc. Gaithersburg, Maryland. NCDENR (2002, March 31). Plan-Do-Check-Act A Problem Solving Process. Retrieved December 2, 2007, from < http://www.isixsigma.com/offsite.asp?A=Fr&Url=http://quality.enr.state.nc.us/tools/pdca.htm> Pollack, R. (2002).Regulatory Comment Letters. Retrieved December 2, 2007, from < http://www.aha.org/aha/letter/2002/020515-cl-nhpm.html> Read More