Define quality in health care and explain the key principles and characteristics of total quality management and continuous quality improvement in the health care context. In your answer include a brief discussion about how TQM and CQI approaches differ from industry, or business-based, quality management, and performance improvement methods. Refer to one of the following industry, or business-based, quality management, and performance improvement method; a) six sigma, b) lean thinking or c) a balanced scorecard in your discussion.
Safety and quality within health care and hospital settings are one of the most critical aspects that are important to patients and their families. Therefore, it has become a key focus of national health agencies and service providers, leading to the exemplification of these ideals by various health professionals. Safety and quality are inherently intertwined. While safety is the act of reducing the risk of harm or error in the provision of health care, quality is “the degree to which health services for individuals and populations increase the likelihood of desired health outcome” (Australian Institute of Health and Welfare, 2018, par. 4). Therefore, quality is defined by the value it brings to the patient and care process, including the aspect of safety discussed. Quality can include efficiency, accessibility, continuity of care, and consistency which are all important staples of excellence in healthcare management.
Total quality management (TQM) is essentially the comprehensive method of management that an organization uses to achieve its objectives based on its fundamental principles. TQM is associated with customer and employee satisfaction, process management, continuous improvement, and innovative leadership. TQM was implemented in the healthcare sector approximately in the 1980s due to its success in manufacturing. The goal was to increase productivity while reducing costs. However, it was difficult since many manufacturing-based aspects and tools of TQM were incompatible with healthcare. The key principles of TQM are increasing customer focus, continuous and total quality improvement control, training, and education, as well as empowerment and teamwork amongst employees (Al-Shdaifat, 2015).
The adoption of continuous quality improvement (CQI) in healthcare is a relatively recent occurrence. CQI uses analytics and statistics to evaluate the systems and processes within a healthcare environment. The techniques of CQI consist of statistical control: planning, doing, checking, implementation, and competitive benchmarking. However, for efficient CQI implementation and subsequent benefits, a strong organizational climate should be present that would be open and supportive of new initiatives. Many safety procedures and quality outcomes have an objective and statistical measure (McFadden, Stock, & Gowen, 2014). One such example, is hospital-acquired conditions (HAC), the rate at which each hospital attempts to lower. HAC rates have been proven to be associated with quality measures including better care for patients, the attention of medical staff, and strict procedures. Through CQI, elements that require improvement can be determined for the facility and implemented to increase the quality scores objectively.
Lean thinking is a quality improvement management model that began at the Toyota car manufacturing facilities and eventually spread to other sectors and industries. It is a philosophy but also an action plan which seeks to eliminate waste that does not provide value to the customer. It is a model of efficiency, that produces the basic necessary outcome at adequate quality while cutting costs, time, and waste. The differences between the lean management in industry and health care are difficult to identify since the model underwent specific iterations and adaptation to fit the unique contexts (D’Andreamatteo, Ianni, Lega, & Sargiacomo, 2015). However, some aspects are different from a quality management perspective. Organizational culture varies significantly in business and healthcare, as each carries the values and beliefs necessary to succeed. While it may be easier for businesses to cut waste and remove unwanted personnel and processes, healthcare settings are significantly more invested in the people factor, valuing each worker and every action serving the needs of a patient.
What is meant by the term ’patient safety’? Differentiate between safety in health care and patient safety. In the context of patient safety, what is understood by the term risk management, and what is its aim? Briefly discuss the approaches and/or tools that a health professional is likely to use when completing a risk analysis, and when thinking about how best to manage a high-risk situation.
Patient safety is an attempt to prevent human error and the occurrence of adverse effects during the delivery of health care. The complex nature of health care that utilizes new treatments, medicine, and technologies has made the treatment of patients more effective but also prone to error. Furthermore, the increased responsibilities, legal and social pressures, as well as co-morbidities, and the number of patients have all created more demands from the health care facilities. The system is under significant burden attempting to balance the provision of health care with economic and practical factors. The high-pressure and rapid environment in health care facilities creates the possibility of harm due to human and systemic error (Mitchell, Schuster, Smith, Pronovost, & Wu, 2015). Therefore, patient safety inherently attempts to enhance the quality of care while limiting instances of adverse events.
Safety in health care and patient safety are inherently intertwined and even considered indistinguishable by some organizations. However, the difference remains in focus. Patient safety is essential prevention of harm to patients, including minimizing the risk of adverse events and making safe the system of medical care delivery. Meanwhile, safety in health care is a more general approach that seeks to improve aspects of quality components that can affect the safety of anyone in the health care setting. It includes creating a culture of safety that seeks to prevent errors, improve training and processes to reduce any errors that may cause harm, and limit adverse events through exposure (Hignett et al., 2015). This culture should involve everyone in an organization, from patients to health care professionals and external staff.
Risk management is an ongoing process that seeks to evaluate risk and take appropriate measures to mitigate it through modification of clinical processes and plans. In simple terms, risk management attempts to minimize risk and harm to patients within health care environments which are complex and harmful if procedures are not followed. Risk can be strategic, operational, and project-associated. Risk management consists of several steps. Risks and dangers during the provision of care are identified. Furthermore, the factors which may influence or cause these risks are identified. Adverse events due to risks are identified and examined to draw the necessary lessons. Furthermore, measures are taken to prevent the recurrence of such events. Finally, a system is put into place through policy and regulation, at both local and national levels (Department of Health Western Australia, 2016).
Various health care institutions may have unique steps to risk assessment based on recommendations from national organizations. As the trend of quality improvement in health care shifted towards the patient experience, including safety, guidelines were created to implement risk assessment. Organizations and health professionals alike are encouraged to learn from errors and embrace a set of beliefs and values that would lead to safety in clinical practice. As the “learning” process occurs and changes are implemented, the risk assessment standard should be improved. There should be an inherent balance of risk, health benefits, and costs. The standards and lessons adopted in one area of risk management can be applied to other areas relatively well. Furthermore, management techniques and applied resources are available to ease any transitions. The understanding of risk and its assessment may be challenging from an internal perspective within the working environment. It is critical for health professionals of all levels to make an impact by communicating and adopting devised strategies, thus positively affecting patient safety and welfare.
In 2012 the Australian Commission on Safety and Quality in Healthcare implemented National Safety and Quality Health Service (NSQHS) Standards. Why were they developed and how have they changed over time? Identify and explain at least two legal or monitoring requirements incorporated in the Australian National Safety and Quality Health Service (NSQHS) Standards and explain how they enhance quality and safety in health care.
The National Safety and Quality Health Service (NSQHS) Standards were developed to protect patients from harm and enhance the quality of health care provision. The standards are a tool of quality assurance that seeks to create guidelines for safety and quality. The NSQHS Standards are expansive and comprehensive, covering a wide variety of health care factors, situations, and settings that have a high prevalence of adverse events. These include hospital-acquired conditions, medication safety, clinical communication, and prevention of falls or pressure injuries.
The NSQHS Standards were developed as a collaboration amongst all involved stakeholders in the health care industry, including the government, health professionals, and patients. Government agencies, both national and local, guided the process. Meanwhile, clinical experts, patients, caregivers, and even representatives from the private sector were involved. The standards are a large initiative, requiring a systemic and organization-wide change in clinical governance. A significant section of the standards also covers partnerships with consumers (patients) and preventing clinical deterioration. As the standards evolved, additional sections, requirements, and influential factors were added based on evidence data and trends in health care. For example, a patient-centered approach was added in the latest addition which discusses health literacy, culturally competent care, and other personal aspects that may be addressed to prevent harm to the patient (Australian Commission on Safety and Quality in Health Care, 2017b).
The process of development for the NSQHS standards began in 1995 when the Quality in Australian Health Care Study identified that upward of 16 percent of patients experienced adverse events. However, more than half of those were preventable (Australian Commission on Safety and Quality in Health Care, 2014). The focus suddenly shifted to improving patient safety in health care. In 2005, a national review recommended that the accreditation of health services should undergo reform to include new safety guidelines and quality improvements. In 2006, health ministers asked for the development of new standards to begin, which lasted until 2011 when the NSQHS were published in the first edition. These underwent consumer and public feedback and consultation. The primary areas of patient safety were identified and added. Eventually, a pilot program began in 38 health services. Eventually, the NSQHS standards were approved by the Commission due to the overwhelming amount of evidence and implemented as national policy. These standards have been used to assess more than 1,300 hospitals in Australia, improving quality and patient safety in all aspects (Australian Commission on Safety and Quality in Health Care, 2014).
The NSQHS Standards are a national policy that has the legal backing of the government and has a wide variety of monitoring tools. The first legal aspect is that any health care facility, including hospitals, day service providers, and even public dental offices are required to adopt these standards to receive a legal accreditation that allows the facilities to function. The standards have been released in numerous variations, including guidelines for small hospitals to ensure that all guidelines are followed.
Accreditation is required for legal purposes as well as being able to participate in medical, marketing, funding, and expansion opportunities. It guarantees that public health services are eligible and up-to-date on the standards of quality assurance. Accreditation is conducted by specific agencies approved by the Commission as well as international health care organizations. These agencies serve a monitoring aspect of NSQHS standards, conducting independent peer assessments of both new and established facilities. The assessment can identify any significant patient risks and report them to relevant government health departments and places the accreditation at risk (Australian Commission on Safety and Quality in Health Care, 2017a). These legal and monitoring mechanisms are meant to ensure the standards are met and enforced at all times while health care is provided in a facility.
References
Al-Shdaifat, E. A. (2015). Implementation of total quality management in hospitals. Journal of Taibah University Medical Sciences, 10(4), 461-466. Web.
Australian Commission on Safety and Quality in Health Care. (2014). The National Safety and Quality Health Service Standards in 2013: Transforming the safety and quality of health care. Sydney: ACSQHC. Web.
Australian Commission on Safety and Quality in Health Care. (2017a). The national safety and quality health service standards 2017 (2nd ed.). Sydney: ACSQHC.
Australian Commission on Safety and Quality in Health Care. (2017b). Information for health service organizations undergoing assessment to the NSQHS Standards. Web.
Australian Institute of Health and Welfare. (2018). 7.9 Australia’s health 2018: Safety and quality of hospital care. Web.
D’Andreamatteo, A., Ianni, L., Lega, F., & Sargiacomo, M. (2015). Lean in healthcare: A comprehensive review. Health Policy, 119(9), 1197-1209. Web.
Department of Health Western Australia. (2016). WA health clinical risk management guidelines. Web.
Hignett, S., Jones, E. L., Miller, D., Wolf, L., Modi, C., Shahzad, M. W.,… Catchpole, K. (2015). Human factors and ergonomics and quality improvement science: Integrating approaches for safety in healthcare. BMJ Quality & Safety, 24(4), 250-254. Web.
McFadden, K. L., Stock, G. N., & Gowen 111, C. R. (2015). Leadership, safety climate, and continuous quality improvement: Impact on process quality and patient safety. Health Care Management Review, 40(1), 24—34. Web.
Mitchell, I., Schuster, A., Smith, K., Pronovost, P., & Wu, A. (2015). Patient safety incident reporting: A qualitative study of thoughts and perceptions of experts 15 years after ‘To Err is Human’. BMJ Quality & Safety, 25(2), 92-99. Web.