Quality and International Accreditation in Health Care - Essay Example

Name: Tutor: Title: Quality and international Accreditation in Health Care Institution: Date: Table of Contents Table of Contents 2 13 2 Quality and international Accreditation in Health Care: Pharmacy 3 Abstract 3 PDCA (Plan, Do, Check, Act) 3 Donabedian Model 4 ISO 9000 5 Lean Methodology 7 Six Sigma 8 Bibliography 12 Quality and international Accreditation in Health Care: Pharmacy Abstract Quality improvement processes have been widely used for assurance of better quality products and increase of efficiency in production in healthcare. There are various methods that are used to eliminate errors and improve efficiency of production of goods and services. Various quality assurance processes have been discussed in this paper. The area of specialization is pharmacy PDCA (Plan, Do, Check, Act) PDCA method of quality improvement was developed in the 1920s. Majority of performance improvement models which are recognized have some of their foundation or relation to this quality improvement model. This model comprises of trial-and-learning methodology in which case a suggest solution or hypothesis for improvement is tested or made on small scale before an overhaul of the whole system is implemented. The first step in this model entails planning. The goals and the objectives of the process are established. Questions and predictions are made during this period. In the first step the staff is training and educated on the process. Unexpected observations and problems are documented (Kunkel ST, & Westerling R., 2006, p.127). The analysis of data is then carried out to establish any defects that exist. The third stage involves assessment of the impact of the change implemented and evaluates the degree of success alongside with the pre-set objectives or goals. The results are then compared to the prediction made. The lessons learnt from the whole process of quality assessment are documented. The changes to be made are then determined and the kind of action to be taken next is decided. The management of the organization has to act of what has been learnt throughout the process and gauge the possibility of repeating the same process but with some modification. There is need for a new plan being invested. The gaps identified in the process have to be worked on through implementation of the process all over again. Advantages Implementation of the model leads to improvement of reputation of the business. Workers are normally motivated by extra responsibility, involvement in making of decision and team work. Decrease of waste leads to lower costs. Disadvantages Initial introduction of the model in the organization is costly; disruption of prevailing methods and training of workers is very expensive. Benefits are attained after a long time. Workers may be reluctant to embrace the change since they feel less secure in their jobs. Donabedian Model Donabedian’s classic paradigm is used in assessment of quality care within Pharmacy department and is founded on three component approaches which include process, outcomes and structure. Avedis Donabedian who was a public health pioneer suggested the three aspects of quality which include processes, outcome, and structure. He was not of the ideas of applying measurement of outcomes as the sole measure of quality. Donabedian offered the first frame work for development of what is considered as a balanced set of indicators correlated to the medical care delivery. Processes involve activities that connect physicians, staff, and patients. Outcomes were used to measure quality and effectiveness in medical care (Jackson S., 2001, p.159). The improvement of processes automatically leads to improvement of quality of anticipated outcomes. Donabedian cautioned that measurement of outcome cannot be used to distinguish effectiveness from efficacy. The measurement of outcomes has to consider the context within which the processes were carried out. Advantages Reorganization of the structure of the healthcare can lead to attainment of efficacy and effectiveness. The model is good at determining the problem in the system. Disadvantages Irrelevant outcome measurement can lead to wrong interpretation of the effectiveness of a healthcare scheme. Entry of data of outcome can become part of everyday clinical entry and hence it makes the process to be very tedious. In this system analysis of data and feedback can be very tedious. Training staff and enlightens them on the model can take quite amount of resources and time. ISO 9000 International Organization for Standardization (ISO) was founded in 1947 being a non-governmental entity. In 1987, it applied the original 9000 series of voluntary technical standards to facilitate the maintenance and development of programs of quality control in the industry of ma: consistency in manufacturing via services and processes standardization to comply with and meet requirements of the market customer. In the year 1994, ISO performed additional changes to standards recognizing the delineation of services offered by product and industries sectors. In the year 2000, ISO performed major adjustments to the standards to make them more relevant to settings in healthcare and service, eliminating ISO 9003 and 9002 and consequently released ISO 9001:2000. ISO 9001:2008 recaptures the theme or process of ISO 9001:2000. The 2008 version brought about clarifications to prevailing ISO 9001:2000 requirements. There were no additional requirements that were added (Hallström, 2001, p.31). ISO 9001 is specifically for quality. It is a generic standards system management. This means that the standards can be used to any organization. Advantages of ISO 9000 The model has led to increased marketability of any business and credibility of business of business is increased. ISO 9000 has led to operational expenses reducing. Rigorous process in ISO 9000 registration has led to substantial reduction in shortcomings. There have been increased customer retention rates. The method has led to better methods of control. Customer satisfaction has increased tremendously. There has been also improvement of internal communication. The model has led to increased attractiveness and reduction of product-liability risk in Pharmacy department. It is common tool for standardization within the deapartment. Disadvantages In many instances, managers and owners do not have good interpretation of ISO 9000 certification process. Funding for establishment for quality system is inadequate and the process of achieving certification is expensive. Besides, there is heavy emphasis on documenting of ISO 9000 process of certification. Length of time used to complete the process can be very tedious. Businesses normal take a minimum of around fifteen months to complete the process until the audit stage. Lean Methodology Lean manufacturing is an approach of ‘back to basics’ which places the customer’s needs before anything else and follows five steps. In the first step value is defined as dictated by the customer, defined by the ability of the provider to deliver the right service or product at a price that is appropriate. In the second step the value stream is identified. This are the specific action’s set to bring a specific service or product from concept to completion. In the third step, value added steps are made from the start to the end. The customer has to pull the product from the supplier as opposed to pushing the products. In the final stage perfection of the process is pursued. 5S methodology ensures reduction of waste by improvement of visual management and workplace organization (Amaratunga, Haigh, Sarshar & Baldry, 2002, p.149).The 5S stand for Sort, Store, Shine, Standardize, and Sustain. Items are sorted out and frequently used kept close. Unneeded items are removed. The workplace is kept clean. Methods and processes are standardized to ensure consistency and items are placed in defined locations. Sustainability is provided through the 4Ss where leaders and supervisors can evaluate new standards to see if they are being followed through a plan of formal audit. Advantages Lean methodology leads to reduction of waste and high alignment of strategy. There is high speed of achieving benefit. There is longer time of sustainability. Disadvantages There is high requirement of management change. Higher cost and requirement dedication make the organization to invest lots of resources. There is high risk of early inexperience and scarcity of skills makes the model hard to implement. Six Sigma Six Sigma is a methodology that is customer-focused and data-driven quality improvement that reduces variation in processes result into defects. By attaining Six Sigma, rate of failure is minimized to around 3.4 defects (errors) per every million of opportunities, which means that, it is close to 99.9996% rate of success. Six Sigma was developed over a period of time by Motorola, General Electric, Hewlett-Packard, and the rest in the 1980s and 1990s. Six Sigma comprises of statistical methods with processes of quality used to create a new methodology. The knowledge is applied in improvement of process projects in an effort to enhance financials and satisfaction of the customer (Rigby & Litt, 2000, p.217). Tools applied in Six Sigma are not brand new. It appears new through its effort to improve projects of main business processes and clear responsibilities and roles for Champions, Executives, Master Black Belt, Green Belts, and Black Belts. Six Sigma comprises of five steps which include defining, measuring, analyzing, improving, and controlling-it is commonly referred to as DMAIC. Project and are nominated and evaluated. In the next phase a project is established. A mission statement is prepared explaining the projects goals and the problem identified. A team to work on the project is identified. In the measuring process step, the baseline measures of the prevailing performance are established. The symptoms of the problem have to be identified. The mission has to be modified to go with the required project. The next step involves analysis. The raw data is converted to information to give insight into the process (Grol R., 2001, p.2578). Causes of defects are highlighted at this stage. Improvement involves developing solutions to the identified problem, and changes are made to the process. The changes implemented are monitored to see if they are beneficial. The last stage comprises of the aspect of control. The processes are monitored to see whether they are yielding desired results. Advantages Six Sigma increases customer satisfaction and minimizes defects. It looks at innovative ways of increasing the delight of the customer. Six Sigma increases profitability, and even reduction in costs. Return on investment, stock value growth, and employment growth are realized through Six Sigma. The model focuses on variation in processes and narrows down on improvement of the final results (Hallström, 2001, p.31). Six Sigma focuses on the prevention on defects as opposed to fixing them. The model is focused on the whole process and training as the main part of management system. Everything good thing is emphasized and every wrong thing is eliminated. Disadvantages Focusing on reduction of defects by following 3.4 defects per million opportunities can occasion more time being used in places that are not profitable. Six Sigma focuses on the rigidity in the process and hence contradicting innovation which kills creativity. People refer to Six Sigma is a gimmicky and only rebranding of improvement techniques. It promotes outsourcing and encourages lack of accountability. Six Sigma requires skilled man force. Employee dedication and control is hard to accomplish. Time barriers have to be solved in the process. Comparison of the quality improvement processes. Quality Processes Cost of Execution Rate of Execution Level of Efficiency in the department Levels of Perfection Approval Within the department ISO 9000 Very High Slow High High Fast Six Sigma Low Slow High High fast Donabedian model Very high Fast High High Slow Lean methodology High Fast Low High Slow PCDA Low Slow High High Fast Explanation ISO 9000 takes a long time to execute, hence the high cost. There are many requirements that need to be met before reaching the level to be termed as ISO certified, and by then, the level of efficiency in the organization would have improved tremendously. It is a thorough review of processes. The cost of implementation of Donadedian model is equally high since it involves restructuring of the organization to review the processes that give desired outcomes. It is an effective method because it removes aspects in the processes that are not beneficial. Six Sigma has low cost of implementation since it only involves review of the process to eliminate chances of errors occurring. It is slow to execute since it entails very many aspects. Lean methodology calls for alignment of strategy and hence can cost a company a lot of money. However, the process is fast to implement following the five steps. PCDA involves many steps of perfection but cost the company nothing to follow them. Its execution is low due to perfection of the steps. Application of quality processes Pharmacy Pharmaceutical industry has not been left behind as far as quality assurance processes are concerned. Production and distribution of drugs forms a significant part of the healthcare sector that has to be taken very seriously. Advantages of implementation of good manufacturing practices and quality in management have been facilitated in the pharmaceutical sector following adoption of ISO 9000 quality assurance process. The standard is very important to the pharmaceutical industry and suppliers of packaging materials in the industry. Principles of good manufacturing practice are outlined as part of an ISO standard. Practices of good manufacturing concern quality assurance and quality control which make it possible for pharmaceutical companies to eliminate or minimize instance of errors, mix-ups, and contamination (Grol R., 2001, p. 2583). This standards offer protection to consumers from purchasing dangerous or ineffective products. ISO 9001:2000 declares consensus internationally on good practice and creates a benchmark that can be used for quality improvement, auditing, training, and certification. Bibliography Rigby KD & Litt JC., 2000, Errors in health care management: what do they cost? Qual Health Care, 9(4); 216-221. Kunkel ST, & Westerling R., 2006, Different types and aspects of quality systems and their implications. A thematic comparison of seven quality systems at a university hospital. Health Policy, 76(2):125-133. Grol R., 2001, Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction. Jama, 286(20):2578-2585 Amaratunga D, Haigh R, Sarshar M, & Baldry D., 2002, Application of the balanced score-card concept to develop a conceptual framework to measure facilities management performance within NHS facilities. Int J Health Care Qual Assur, 15(4):141-151. Hallström I., 2001, Quality improvement in the care of patients with hip fracture. Int J Health Care Qual Assur, 14:29-33. Jackson S., 2001, Successfully implementing total quality management tools within healthcare: what are the key actions? Int J Health Care Qual Assur, 14:157-163. Article Haya R. Rubin, Pronovost Peter, and Diete B. Gregory., 2001, The Advantages and Dis Advantages of Processed-Based Measures of HealthQuality. International Journal for Quality in Healthcare 13 (6): 469-474. Read More