Healthcare Quality and Safety Implementation

Organizational Context and Understanding of Quality and Patient Safety

To my organization, patient safety means ensuring that harm and any negative outcomes are minimized or eliminated in any health care (Flowerdew, Brown, Vincent, & Woloshynowych, 2012). Quality management systems are critical in promoting patient safety and minimizing the risk of adverse scenarios and medical errors. Accidents and complications are often witnessed in health care. Sometimes, they may result in fatalities. Nevertheless, it was not until the 1990s that healthcare settings began taking a keen interest in patient safety (Cunningham et al., 2012). Injuries and adverse medical events arise due to various reasons, including human error, technological faults, and system failures.

Flowerdew et al. (2012) assert that patient incidents account for 3 percent to 17 percent of patient injury. Despite statistics revealing a high rate of mortality due to injuries in health care, little effort has been made to rectify the scenario to guarantee quality health care services. According to Krein et al. (2010), most injuries result from system failure, as opposed to negligence by caregivers. Hence, in my organizational context, quality and patient safety should involve an embedded culture of striving to deliver eminent services that are devoid of injuries in line with Weaver et al.’s (2013) sentiments that a culture, which promotes quality and safety in health care, is critical. Systems should be checked regularly to ensure they are fit before being used.

The rationale for Resourcing and Implementing Quality and Patient Safety

In reality, a zero-injury level is impossible to attain. This situation reduces the concept of patient safety to the level of maintaining a bare minimum injury level (Wachter, 2012). Therefore, quality and safety related to the best outcomes that can be attained given the available resources and current knowledge. Quality improvement is a critical general practice, which takes into account organizational culture, systems, and clinical care. Feedback plays a key role in fostering creativity. This feedback is obtained from patients and staff members regarding the quality of services rendered. The feedback is then plowed into the service delivery.

The common challenge with quality and safety is the gap between what is understood to be best practice and the actual delivery of care (Morello et al., 2013). Quality improvement calls for the expansion of the existing knowledge regarding effective quality improvement within the organizational context. Identifying and implementing strategies aimed at improving quality care should be a priority in health care. Singer and Vogus (2013) argue that it is critical for policymakers, both at the national and organizational levels, to identify, which intervention strategies will work. Implementation timelines are also important in ensuring effectiveness. Dedication to quality and safety varies from one institution to another (Singer & Vogus, 2013). Hospitals that maintain a positive cultural and emotional approach to quality and safety appear to take serious efforts to promote quality and safety (Halligan, Zecevic, Kothari, Salmoni, & Orchard, 2014).

Frameworks and Options for Implementation

Adopting the appropriate framework requires adequate information regarding the context (Wachter, 2012). This section will present various frameworks that have been shown to work in the organizational context and thus can be effectively adopted in the current scenario.

Root cause analysis (RCA)

The Root Cause Analysis (RCA) was initially used in engineering. However, it has since been adopted in health care for the investigation of problems (Lationo et al., 2016). RCA aims to unearth the underlying causes of an event. Findings obtained are then used to design an action plan that if implemented can reduce future risk (Lationo et al., 2016). Investigators ask key questions aimed at eliciting further information regarding the situation (Watcher, 2012). Questions related to what occurred, why it occurred, and/or the proximate factors that could have contributed to its occurrence. The responses to these questions assist investigators in identifying obvious mistakes that led to adverse events for them (mistakes) to be avoided in the future. The final step of RCA involves providing recommendations based on the findings obtained with the aim of improving the system and processes (Lationo et al., 2016). However, some researchers argue that no sufficient evidence is available to show that RCA can contribute to patient safety on its own (Lationo et al., 2016). The solution to this challenge is often the use of multiple RCA processes simultaneously.

Plan-do-study-act (PSDA)

The PSDA method is widely used for rapid cycle improvement (Taylor et al., 2014). It has a cyclical nature, which enables planners to assess impact in small and frequent steps, as opposed to large and slow ones, before effecting changes on the entire system (Taylor et al., 2014). PSDA is used to establish a relationship between processes and their outcomes. Bollegala et al. (2016) suggest three questions to be asked before adopting a PSDA. The first question relates to the goal of the project. The second question relates to ways of determining whether the intended goal has been achieved. The third question interrogates the actions to be taken to achieve the identified goal (Bollegala et al., 2016). PSDA begins by determining the nature and scope of the challenge, as well as the changes that should be made. A plan for change is then created followed by the implementation of the change (Taylor et al., 2014). Results are implemented and measured against a key that determines success and failure.

Six-sigma

Originally, Six-Sigma was primarily used as a business strategy. It involves efforts to improve and/or monitor the process and design approaches to minimize wastage while increasing customer satisfaction and financial stability (Chiarini & Bracci, 2013). Process capability is used to determine improvement through a comparison of processes before and after the adoption of the Lean Sigma (Chiarini & Bracci, 2013). Six-Sigma involves two methods. The first method checks the process outcome while at the same time evaluating and calculating the defect rate. The second method makes use of estimates to predict process performance by comparing them with the existing tolerance limits. The second method is commonly used in analytical processes, which can be evaluated through an experiment.

The ‘define, measure, analyze, improve, and control’ (DMAIC) approach is one of the components of Six-Sigma (Chiarini & Bracci, 2013). DMAIC begins by identifying the project, then reviewing historical data with the intention of defining the scope. The second step involves the selection of quality performance where standards are identified and objectives defined. The implementation of the project is accompanied by a collection of data to be used in assessing the effectiveness of the project. Sometimes DMAIC is used conjunctively with PSDA for the best outcomes.

Specific, Measurable, and expected Benefits

In the United States, safety in health care is neglected compared to countries such as Australia. Low quality in health care is responsible for the death of nearly 44000 Americans each year. Other patients sustain lifelong deformities, which severely affect the quality of their life. Additionally, nearly $17 billion is lost annually because of medical errors (Kitson, Marshall, Bassett, & Zeitz, 2013). Therefore, one of the expected benefits of implementing quality and safety programs is to enhance safety in the health care setup. This agenda involves avoiding injuries when performing treatment on patients. Safety is an essential pillar of the nursing profession.

The benefit can be measured by observing the trend in deaths after implementing the quality and safety programs. The plan seeks to reduce the witnessed deaths from 44000 to 20000 or less. Standard procedures emphasize safety measures. Modern health care involves complex procedures, which increase the probability of errors occurring (Kitson et al., 2013). Therefore, these frameworks are expected to have an influence on the attitude toward medical errors and safety at large (Øvretveit, 2011). For instance, the reporting of errors and adequate education on safety are seen as effective ways of reducing medical errors. Training for caregivers should be combined with experience. According to Grove, Burns, and Gray (2014), training is not adequate if it is not combined with hands-on knowledge on how to approach safety measures.

Another expected benefit of quality improvement and safety measures is the attainment of effective and patient-centered care (Berwick, 2009). As the cost of healthcare increases, patients are paying more for treatment. Therefore, it is natural for the patients to feel the need to obtain the value for their money (Watcher, 2012). One way of ensuring patient satisfaction is modifying health care to become patient-centered. Patient-centered care is widely recognized as a dimension of quality health care (Kitson et al., 2013).

It can be measured by recording whether caregivers offer the necessary emotional support and physical comfort to patients while also involving the patient’s family and friends in the therapy process (Kitson et al., 2013). The staff members’ experience is also important in addressing the needs of patients, especially the ability to be caring and compassionate (Øvretveit, 2011). Marshall, Kitson, and Zeitz (2012) argue that caregivers should first feel cared for by the organization for them to extend quality care to patients. Therefore, patient-centered care is an overall culture of the organization since it is an individual effort by the caregiver. Studies conducted in recent times suggest that numerous benefits of patient-centered care. When practitioners, patients, and families work together, the quality and safety of healthcare improve while the costs decrease (Watcher, 2012).

Quality and safety frameworks lead to efficient and timely delivery of health care. With the implementation of the frameworks, time spent in the facility can be cut from 2-3 hours to less than 30 minutes. This benefit can be measured by recording the time the patients take before they are served. Wastage of equipment during medical procedures is common where there no properly designed procedures to be followed (Marshall et al., 2012). This situation leads to unnecessarily high costs of health care, yet the quality remains low. To avoid wastage and inefficiency, eminent care approaches are used. In addition, time wastage leads to unnecessary delays and longer stays at the hospital. Patients often find these delays frustrating (Moorhead et al., 2013). In extreme cases, delays may lead to higher mortality rates (Moorhead et al., 2013).

Therefore, quality care attempts to address time wastage by designing measures that encourage a quick turnaround for medical procedures. Quality care can also be designed to take into account cultural differences among patients. Culturally competent care requires providers to understand the cultural background of the patient to deliver quality care to them. Important aspects to consider include language differences and cultural beliefs regarding treatment. In addition, some diseases are prevalent in people from certain ethnicities, as opposed to being widely spread (Moorhead et al., 2013). Therefore, it is prudent for care providers to understand patients in the context of their background. Culturally competent care is recognized as more effective compared to the traditional form of care where the cultural background of the patient is ignored.

Risks associated with implementing Healthcare Quality and Patient Safety

The process of implementing quality and safety measures in health care is not without shortcomings. One of the major challenges involves identifying the non-medical factors that affect health. Black (2013) identifies complex healthcare systems as a major challenge in measuring the quality of healthcare. Different practitioners also approach quality and safety differently, a situation that results in a lack of uniformity (Chiarini & Bracci, 2013). Practitioners also battle with trying to understand whether a negative event was a mere aberration or it is likely to recur in the future (Chiarini & Bracci, 2013).

Lack of willingness to change is another challenge that affects the implementation of quality and safety measures. Changing the manner in which practitioners approach treatment and the way systems are designed to operate in an organization can be a difficult task. According to Krein et al. (2010), an organization’s readiness to change determines whether it will adopt quality and safety measures. Health organizations that view change as time-consuming and difficult to achieve are less likely to adopt quality improvement and safety measures relative to those that embrace a positive culture toward change (Krein et al., 2010). This case can prove difficult to hospitals especially if there are no mechanisms in place for carrying out a rigorous analysis of information. To manage this challenge, effective implementation of change should involve deliberate efforts to examine the current state of health care to establish areas that need improvement.

The Cost of Quality and Patient Safety

Financial expenses are one of the obvious costs associated with implementing quality improvement and safety approaches. The change will often require the organization to change its current systems, which is a costly process. However, failing to assure quality and patient safety may also have cost implications. For instance, the wrong diagnosis or unexpected death of a patient due to errors may attract lawsuits from the patients’ families. Hence, to reduce the chances of an error occurring, for instance, the organization may need to adopt advanced equipment and to replace the old ones (Chiarini & Bracci, 2013). Another cost arises from the need to offer training to the staff regarding quality care and safety. Accompanied by training is the need for behavioral change among practitioners. As observed earlier, it is not always easy to adopt a new approach to treatment in the organizational context.

High-level Plan

The first step to implementing change in the organization will be an evaluation of the existing standards of health care. This process will involve carrying out a survey on patients and staff members to gather their views. Feedback obtained from these stakeholders will be used to devise a quality improvement and implementation strategy for the organization. The survey should take between three and six weeks. The survey population will be about 300 hundred patients (having received treatment within the last three weeks) and all staff from different departments. Subjects of the study will be conducted through email and asked to fill an online questionnaire. After information is gathered and analyzed, the second step will involve designing the appropriate intervention strategy aimed at bridging the gap between the existing standards of care and the desired ones. Experts will be allowed between three and five months to formulate this intervention strategy.

Once the strategy is ready, the next step is to obtain the relevant equipment to ensure it is implemented. After the new equipment is in place, training on the staff will commence. The training will aim to not only show the staff how to use the technology but also to initiate behavioral change among the staff. The change in behavior will be a voluntary process for the staff. However, a reward criterion will be put in place to recognize promising care providers. Additionally, patients will be encouraged to post their views on the treatment given to them on the organization’s website. The information posted by the patient will often include the name of the caregiver who attended to him or her. This approach is expected to motivate caregivers to be more dedicated to extending quality care to patients. Overall, the time between when new technologies are acquired and when the active training of staff members stops should be about three months. The entire duration of implementing the change should be between twelve and fifteen months. Behavior-based change at the hospital will be a continuous process. Hence, frequent training will be carried out to ensure that practitioners are complying with the new strategy.

Investment Appraisal

Carrying out an appraisal of the recommendations is important to determine its cost versus benefits. The appraisal should be conducted after a reasonable duration has passed since the implementation of the recommendations. Cost-benefit analysis is important in informing decisions (Muennig & Bounthavong, 2016). The organization will compare the benefits accrued against the cost of sustaining the recommendations implemented. If the benefits outweigh the cost, the recommendations should be retained. However, if the cost of maintaining this new approach to quality improvement and safety outweighs its benefits, the organization will need to eliminate it. The organization will then need to conduct research to determine another suitable approach.

Reflection

As the cost of healthcare continues to rise, patients are demanding a higher quality of care. The budget allocated by the government toward health care has also increased considerably. Deliberate efforts are made to catch cost and quality in health care. Throughout the paper, I have demonstrated the various strategies adopted by different organizations to foster health care. The frameworks discussed include PSDA, Six-Sigma, and Root Cause Analysis. I have learned how each of these frameworks operates, including how each can be used to foster quality and safety in health care. In the past, quality and safety were treated as different tenets of health care (Watcher, 2012). However, these two aspects are currently combined to produce an all-around health care for patients.

Throughout the course, I have learned that different frameworks and tools are used for evaluating, implementing research findings, and converting them into effective practice. Quality and safety interventions have been adopted in health promotion programs such as pediatric courses and techniques that monitor diseases such as obesity, diabetes, and hypertension. Quality and safety models aim to guide the planning and assessment of evidence-based interventions, including their impact on the quality and safety of healthcare.

It is important to observe that the business world has shaped healthcare in many ways. As observed earlier, the Six-Sigma approach to problem identification and solution has its bearing in business. Many health facilities today seek to attain ISO 9000 standards of quality management. ISO standards were first designed for the business environment. However, they have been modified and incorporated into health care with the sole intention of promoting quality. The ISO 9000 has suggested a methodology for evaluating whether an organization has incorporated measures to foster customer satisfaction (Morello et al., 2013). Quality and safety frameworks are interested in encouraging organizations to strive in satisfying the needs of customers at all stages of the health care process. Therefore, each step calls for effective monitoring to guarantee strict adherence to the set conditions.

Quality management system (QMS) is recognized as an important tool in the implementation of permanent quality management aimed at raising the standards of care, excellence, and safety (Singer & Vogus, 2013). The QMS framework focuses on designing and adopting process approaches that lead to the development and improvement of quality care while also focusing on customer satisfaction. A health facility is said to be ISO-certified if it can provide services that match the patients’ needs while complying with statutory framework regarding safety and quality. Quality management approaches also advocate the continual improvement of health care delivery.

I have also learned the procedure of implementing quality and safety change in an organization based on different frameworks. However, these approaches appear to have a common approach to initiating change in an organizational situation. Before the project is implemented, a survey is conducted to establish the institution’s current position regarding quality and safety. Areas of concern include infrastructure, equipment, and the existing skills of the workforce in delivering quality and safe care.

The purpose of the survey is to identify gaps in the health care system with the intention of filling those loopholes. Next, an intervention approach is designed consisting of key steps to be taken during its implementation. Various enclosed documents are also prepared to assist in the implementation. The documents include the quality manual, the procedure to be adhered to, as well as the standard operating modus operandi. Orientation training is provided to the hospital staff, including the management, as a way of facilitating efficient implementation of the action plan. The organization often carries out these activities in coordination with stakeholders such as state agencies and peer institutions with similar programs. This collaborative approach is important since it helps the institution to benchmark from peer facilities with similar and successful programs.

I have learned that organizational change is not easy to achieve. It requires commitment on the part of the organization’s management and the staff. Behavior-based change particularly is viewed as being more costly relative to technology-based change toward quality and safety. I believe frequent training and motivation can play a key role in encouraging change on the part of the staff. Motivation can be rendered in the form of a reward system where practitioners who are showing efforts of adopting the new approach to quality and safety are rewarded. Another valuable lesson I have gained throughout the module is that patient-based care is important in promoting client satisfaction. Patients feel appreciated when the practitioner demonstrates care during treatment. This knowledge has taught me as a future health care practitioner that caregiving is not restricted to what is taught in class, but also involves skills like etiquette and compassion.

The knowledge gained in this course will be valuable for my future career as a health practitioner. I plan to work as a nurse for five years before starting my private health facility afterward. As a nurse, I would like to strive to offer the highest quality attainable with the available equipment and knowledge. In addition, I will focus on safety since I have learned that medical injury is the cause of death for many Americans today. I believe that if practitioners can demonstrate care when performing procedures on patients, the number of injuries and mortality would reduce. When I finally open my clinic, I will strive to operate it according to the ISO 9000 standards.

Additionally, I will research on the appropriate frameworks for quality and safety before implementing them. Healthcare delivery is an inherently complex process. This claim makes it difficult to deliver quality care in a consistent manner. It is often difficult to determine whether a strategy that has worked in a different setup will help in the current situation. Therefore, efforts that are aimed at improving quality and safety may prove effective in one setup, but not another. The finding is true for evidence-based treatment, which may work for some patients but no others. Finally, I will ensure my assistants are frequently trained to deliver quality and injury-free health care.

References

Berwick, D. (2009). What ‘patient-centered’ should mean: Confessions of an extremist. Health Affairs, 28(4), 555-565.

Black, N. (2013). Patient reported outcome measures could help transform healthcare. BMJ, 346(1), 167-168.

Bollegala, N., Patel, K., Bernstein, M., Brahmania, M., Liu, L., Steinhart, A. H.,…& Weizman, A. V. (2016). Quality improvement primer series: The plan-do-study-act cycle and data display. Clinical Gastroenterology and Hepatology, 14(9), 1230-1233.

Chiarini, A., & Bracci, E. (2013). Implementing lean six sigma in healthcare: Issues from Italy. Public Money & Management, 33(5), 361-368.

Cunningham, F. C., Ranmuthugala, G., Plumb, J., Georgiou, A., Westbrook, J. I., & Braithwaite, J. (2012). Health professional networks as a vector for improving healthcare quality and safety: a systematic review. BMJ Quality & Safety, 21(3), 239-249.

Flowerdew, L., Brown, R., Vincent, C., & Woloshynowych, M. (2012). Identifying nontechnical skills associated with safety in the emergency department: a scoping review of the literature. Annals of Emergency Medicine, 59(5), 386-394.

Grove, S. K., Burns, N., & Gray, J. R. (2014). Understanding nursing research: Building an evidence-based practice. Sao Paulo, Brazil: Elsevier Health Sciences.

Halligan, M. H., Zecevic, A., Kothari, A. R., Salmoni, A. W., & Orchard, T. (2014). Understanding safety culture in long-term care: A case study. Journal of Patient Safety, 10(4), 192-201.

Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of patient‐centered care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of Advanced Nursing, 69(1), 4-15.

Krein, S. L., Damschroder, L. J., Kowalski, C. P., Forman, J., Hofer, T. P., & Saint, S. (2010). The influence of organizational context on quality improvement and patient safety efforts in infection prevention: A multi-center qualitative study. Social Science & Medicine, 71(9), 1692-1701.

Marshall, A., Kitson, A., & Zeitz, K. (2012). Patients’ views of patient‐centered care: A phenomenological case study in one surgical unit. Journal of Advanced Nursing, 68(12), 2664-2673.

Moorhead, S. A., Hazlett, D. E., Harrison, L., Carroll, J. K., Irwin, A., & Hoving, C. (2013). A new dimension of health care: Systematic review of the uses, benefits, and limitations of social media for health communication. Journal of Medical Internet Research, 15(4), 85-86.

Morello, R. T., Lowthian, J. A., Barker, A. L., McGinnes, R., Dunt, D., & Brand, C. (2013). Strategies for improving patient safety culture in hospitals: A systematic review. BMJ Quality & Safety, 22(1), 11-18.

Muennig, P., & Bounthavong, M. (2016). Cost-effectiveness analysis in health: a practical approach. Hoboken, NJ: John Wiley & Sons.

Øvretveit, J (2011). Understanding the conditions for improvement: Research to discover which context influences affect improvement success. BMJ, 20(1), 18-23.

Singer, S. J., & Vogus, T. J. (2013). Reducing hospital errors: Interventions that build safety culture. Annual Review of Public Health, 34(1), 373-396.

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298.

Wachter, R. M. (2012). Understanding patient safety. New York, NY: McGraw-Hill Medical.

Weaver, S. J., Lubomksi, L. H., Wilson, R. F., Pfoh, E. R., Martinez, K. A., & Dy, S. M. (2013). Promoting a culture of safety as a patient safety strategy: A systematic review.Annals of internal medicine, 158(2), 369-374.