Quality Health Care Delivery - Essay Example

Introduction Quality health care delivery is an expansive umbrella that covers patient safety. In Sherwood and Barnsteiner’s (2012) view, quality defines the optimal balance between the likelihood of attaining excellence and attaining standardised values and norms. Quality is contingent on actors such as standards, or values and norms as the determinants of optimal possibilities. Safety is dependent on health care systems and implies freedom from injury by interacting with these systems. Safety and quality are critical in patient care as they prevent adverse outcomes such as injuries, medication errors, and even death (Twigg et al., 2010). This essay argues that quality and safety measures can achieve health care delivery that is framed on the culture of safety, and is centred on error avoidance and on learning from past errors by using incident reporting. Therefore this essay with firstly define the terms quality and safety and discuss the importance of quality of safety in health care organisations, and the implications of low quality for the health care organisation and the individual patient involved. Secondly, process and outcome data will be defined, who and why this data is collected will be explained, examples of data will be provided, and the methods of the collection of this data outlined. Lastly, the application of process and outcome data will be clearly highlighted via the analysis of falls and fall-related injuries. Definition of terms: According to the Australian Nursing Federation (ANF, 2009), nursing is a vital and essential component of healthcare delivery that should centre on ensuring quality of care in health institutions and positive health outcomes are upheld. Safety and quality are therefore critical components in patient care. The Australian Commission on Safety and Quality in Health Care (ACSQHC) suggests that the quality of health should be defined in terms of standards (ACSQHC, 2010). In Mitchell’s (2008) view, quality is the extent to which health services for populations or individuals enhances the possibility of desired health outcomes in consistency with existing professional knowledge. This definition is consistent with the quality indicators outlined by the ACSQHC, which are expressions of standards. Mitchell (2008) suggests that the quality indicators should be summated in 5D terms, namely dissatisfaction, disability, disease, death, and discomfort. Patient safety could be viewed as the avoidance of harm to the patients (Sherwood & Barnsteiner, 2012). Olds and Clarke (2010) noted that the term ‘error avoidance” implies ensuring freedom from preventable or accidental injuries that come about in the process of medical care. Safety and quality measures are the cornerstone to high quality healthcare in any health organisation. Consistent with Mitchell’s (2008) proposition, much of the work that attempts to define patient safety has focused on preventing negative health outcomes such as morbidity and mortality. Beer et al. (2011) view nursing as a critical component to the coordination and surveillance that minimises morbidity and mortality. Patient safety practices are therefore those processes that attempt to reduce the risk of adverse events linked to medical care in various conditions. Besides the likely case of harming the patients, preventable adverse healthcare incidents related to patient safety have critical financial implications for the patient, the health service provider, the insurer and the patient’s family (Hughes, 2008). For instance, researchers have estimated that the additional length of stay for post-operative sepsis due to poor quality and patient safety is averagely 11 days, costing $60,000 per patient. On the other hand, while in some circumstances there may be additional payment insurers make to the hospitals for such adverse incidents, it has been approximated to be considerably less than the overall cost of the resources used. Additionally, following the heightened discussion on pay-for-performance and mandatory reporting for particular adverse patient safety events, health service providers experience increased financial incentives to improve patient safety. Accordingly, understanding organizational dimensions that ensure patient safety is critical (Health and Human Services Health Resources and Services Administration [HRSA], 2011). To the healthcare provider, the implications may include increased length of stay, blocking of the beds, and cases malpractice lawsuit cases. The patient and his family may also suffer from psychological consequences such as anxiety and depression. Additionally, the psychosocial implications include inability of the patient to get back to work, to develop and sustain social relationships, and to pay bills (Ballard, 2008; Sherwood & Barnsteiner, 2012). A body of researchers have reached a consensus that scientifically valid measurements of performance can promote improved value in health care (ACSQHC, 2010b; HRSA, 2011). Measures such as pay-for-performance have been promoted. Additionally, the growth of performance measurement is accompanied by increased concerns on how these measures can ensure quality and safety in healthcare. These measures are vital in generating healthcare systems that promote outstanding results (Berenson, 2013). To this end, patient safety would involve creating operational systems and processes that reduce the possibility of errors while simultaneously maximizing the possibility of intercepting them whenever they happen. Accordingly, quality and safety is (a) patient-centred, (b) safe, (d) timely, (e) effective and (d) equitable. Patient-centred implies that hospitals have to provide care that is responsive and dignifying to the patient’s needs, preferences and values. Definition of terms: Structure, process and outcome are critical components for achieving and measuring safety and quality (Health and Social Care Information Centre [HSCIC], 2013). Within the context of quality and safe health delivery, structure is defined as the complex combination of processes, knowledge, and pattern of relationships aimed at achieving positive health outcomes (HSCIC, 2013). Process expresses a particular course of action or performance of an activity to attain a result. It also refers to doing something in order to determine or verify an outcome. On the other hand, outcome refers to data derived from the procedures aimed at achieving a particular aim. It is the product of process (Australian Nursing Federation [ANF], 2009). In respect to healthcare, outcome refers to the outcome of the healthcare interactions that produce the effects on the health statuses of the patients (Hostetter & Klein, 2011). The process data with regard to the healthcare systems provides information on the range of healthcare interventions within the healthcare institutions. Process describes the amount of time of interaction between the patients and the healthcare providers based on the standards of recommended care. It also refers to the patient experience measures which focus on elements of delivery of care such as communication (Hostetter & Klein, 2011). Who and why collect such data: A critical component of improving the safety and quality of care provided to patients includes gathering, analysis, and application of information concerning clinical performance in the organisation (Davino, 2011). Such information may be in the form of data on the clinical outcomes, operational performance, as well as the experience of the patients who receive care. Essentially therefore, all healthcare organisations need to have a clearly distinct set of safety and quality information gathered and packaged into meaningful indicators for the managers, clinicians and the executives. Clinicians play a critical role in the process, through accurate recording of information. Health outcome data are facts and statistics aimed at determining whether the healthcare providers are improving the health of the patients. It refers to the rates and counts of events associated with healthcare, including incidences of disease and death in a particular population (ANF, 2009). Health outcome data can offer information on the existing health status that is of concern to the community. At this rate, a significant indicator of health status is the degree to which a certain condition or disease happens in a population (HSCIC, 2013; Hostetter & Klein, 2011). A range of factors therefore influence the risk of diseases such as age, heredity, as well as lifestyle, including healthcare. The rate of the disease can be measured in terms of prevalence or incidence within a particular population. For instance, the population-based disease registry may have records of people who have been diagnosed with certain kinds of diseases that reside in a specific geographic region (Davino, 2011). Examples of this include the Australian Government Department of Health and Ageing and the Australian Institute of Health and Welfare registries which maintain a range of population-based disease statistics such as cancer, disease outbreaks, mortality rates, low birth rates and infant mortality rates (ANF, 2009). Collection methods: It is significant to identify the factors, including how the data should be collected and what data should be gathered, which have effects on the estimates of process data (Davino, 2011). Data can be collected through population surveys. However, such population-based registries do not merely exist for each health outcome (Calder et al., 2010). Additionally, hospital discharge data and health surveys can be used (ACSQHC, 2010). Once the data sets have been formed for others purposes, methods such as hospital billing can also be applied in estimating disease rates. Additional outcome data can be collecting from a health clinic or through a local survey, although it is significant that such issues like data completeness, accuracy and availability characterise the population of interest and that a comparison population can be used for each data source (Davino, 2011). Outcome data helps in setting up action plans to promote safety and quality in health delivery. Lack of outcome data can cause anxiety and frustration on the part of the patient, as well as the health practitioner, resulting in the delay of proper treatment, and preventable duplication of service delivery (ACSQHC, 2010b). Studies into safety and quality issues offer the basis for evidence-based processes of healthcare, identifying the changes needed for improvement of clinical practice and health outcomes. It also helps in reducing the risks and harms related to the delivery of healthcare (Calder et al., 2010). Adverse events are detectable through analysis of clinical incident reports or a medical records review. Example of such adverse events includes falls and fall-related injuries. Falls-related injury is among the leading adverse events of healthcare and thus will be used to illustrate the application of process and outcome data (O'Connor et al. 2009). Definition and consequences of a fall: Falls and the associated injuries may be encouraged by extrinsic or intrinsic factors. Intrinsic factors result from physiological causes while the extrinsic factors are encouraged by the hazards within the environment (Australian Commission on Safety and Quality in Health Care, 2009). Within the context of the non-hospitalised population, falls refer to an event resulting in an individual coming to rest accidentally on the ground due to an intrinsic event such as a stroke, injury or an overwhelming hazard (Handoll, 2010). This definition can be adapted for patient care to depict a fall as an accidental coming to rest at a lower level or on the ground, although not as a result of overwhelming external factors or spontaneous loss of consciousness, such as syncope (O'Connor et al., 2009). The International Classification of Diseases Nine Clinical Modifications (ICD-9-CM) views a fall as the unintended descent to the floor or extension of the floor with or without an injury. Australian Statistics: Accidental falls are among the most commonly reported adverse events in hospitals in Australia (and globally) that often lead to physical injury and in some circumstances death. In Australia, falls are also ranked as the leading cause of unintended injuries to the hospitalised patients, accounting for some 43 cases of reported adverse events (Cowan, 2010). According to a review of the falls in Australia by Hempel et al. (2012), falls also make up some 27 percent of the overall injuries related to non-admissions such as emergency department presentations. In acute hospital environments in Australia, falls are reported to vary from 2 to 7 falls for each 1,000 beds, translating to 4 falls each day, in a 500-bed healthcare facility, or about 1,400 falls each year (Hempel et al., 2012). According to Hempel et al. (2012), data regarding the high-risk clinical groups like patients with a stroke show that 46 percent of the patients fall at least once during their hospitalisation. These statistics show the significance of risk management for the prevention of falls. In particular, falls-related injuries are a leading cause of preventable hospitalisation and loss of independence among the elderly who are 65 years or older. Statistics by the ACQSHC show that one in every three hospitalised Australians aged 65 years and older experience a fall annually (Cowan, 2010). The events of the falls are compounded by greater vulnerability to severe injuries, infirmities, and death. Aside from the physical effects of the fall, patients along with their families may experience financial and physiological burdens. Patients experiencing a fall often develop trauma and trepidation of falling, leading to a functional decline as well as diminished mobility (Calder et al., 2010). This may result in social isolation from their family and friends as well as increased dependence on patient care. In particular, the loss of independence affects the patient’s capacity for self-care and prevents the patient from returning home. It may also result in discharge to a long-term care facility (Davino, 2011). Additionally, falls within the acute care setting lead to substantial health and economic costs to the patients, the hospitals and insurers, resulting from a prolonged stay, higher supervision levels, additional diagnostic procedures, possibility of litigation and possible surgery. According to Mant et al. (2012), the financial implication of falls is comparable globally. Patients who fall have double the hospital costs compared to the cost-matched patients who overcome the incidents of falls or do not fall. Overall, depending on the risk factors, falls have upsetting effects on the patients and their families, with between 33 percent and 60 percent of the falls resulting in injuries and some 15 percent leading to serious injuries (Hempel et al., 2012). Falls related to the delivery of health care are caused by various risk factors. These include the use of sedative-hypnotics or benzodiazepines, failing muscular strength, use of more than four prescription medications including psychotropic medication, environmental hazards, and postural hypotension such as inability to get out of a chair (Beer et al., 2011). Related studies have identified comobordities such as syncope, stroke, Parkinson’s disease, Alzheimer’s disease, and vitamin D deficiency (Twigg et al., 2010). Patient characteristics, such as the fear of falling or fallophobia have also been identified. Other risk factors include age, frailty, non-supportive footwear, and a faulty wheel chair. Insufficient nursing staff to monitor and handle the patients is also a risk factor (Patterson, 201). In Australia, emphasis on falls prevention has been compounded by the 2011 implementation of the National Safety and Quality Health Service (NSQHS) Standards. Today, falls prevention is prioritised and requires compliance with Accreditation Standard 10 'Preventing falls and harm from falls' (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2012). The standards delineate the criteria for prevention of falls with specific focus on quality, safety, and evidence-based nursing in respect to prevention of falls (ACSQHC, 2010). Process data: In spite of the heightened research activities focusing on prevention of falls over the last five years, reducing falls has remained a significant challenge that still eludes healthcare institutions in Australia. The outcome data provides data for clinical risk management to reduce the incidence of adverse patient events (Mant et al., 2012). Analysis data on general practitioner reporting, medical indemnity organisations, patient satisfaction reporting or surveys, insurers and consultative and coronial committee reports, offers an opportunity to detect the adverse events, assess their causes, estimate their likelihood and implications and take the necessary action in preventing their recurrence (Barnsteiner, 2011). Outcome data can be documented and used for identifying the risk factors and implementing the right interventions to minimise the falls risk. Studies have also indicated that screening all patients can successfully prevent the occurrence of falls (Mant et al., 2012). Data collected and documented from falls risk screening presents a scientific basis for identifying the individuals, especially the elderly, who are at increased risk of falls. Process data can be acquired through falls risk screening, which is a brief check to determine whether patients are at risk of falls and whether patients need more comprehensive assessment. Incident reporting can also be used to obtain process data (Calder et al., 2010). The risk assessment tools that can be used at this stage include community-based, computer-based and the Fall Risk Assessment and Management System. The Fall Risk Assessment and Management system is by far the most complex and widely used in Australia ((Mant et al., 2012). Other fall risk assessment tools include an electronic check-list for recording adverse events in hospitals. These tools help in systematically and comprehensively identifying individual patient risk factors. The outcome data and incident reports should then be stored in the hospital registry and feedback provided to the nursing staff. They can also be used in developing an action list for a patient’s daily care. Furthermore, the data can also be used in the nursing care plan (Mant et al., 2012). Conclusion In conclusion, quality and safety measures can achieve health care delivery that is framed on the culture of safety, and is centred on error avoidance and learning from past errors. Therefore, safety and quality are critical components in patient care. A critical component of improving the safety and quality of care therefore includes incident reporting measures that require gathering, analysis, and application of information concerning clinical performance in the organisation. Falls-related injuries are among the leading adverse events in Australia and thus were used as an example of how process and outcome data can be applied. Outcome data can be documented and used for identifying the risk factors and implementing the right interventions to minimise the risks. Studies have also indicated that screening all patients can successfully prevent the occurrence of falls. 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