identify aspects of quality improvement in healthcare.

Quality Improvement in Healthcare Paper

This paper will cover the quality improvement process in healthcare. It will also focus on the similarities and differences between the quality improvement plan processes that the Department of Veteran Affairs (VA) followed, against the quality improvement plan process listed in the book. The VA Hospital wanted to establish a quality improvement plan that would allow them to expand services and improve the quality of care being provided. The quality improvement plan must work in conjunction with the strategic plan in achieving the same goals for the organization. Managers can develop a quality improvement program to measure levels of performance.Quality Improvement in Healthcare Paper

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The relationship between the concepts in the book and the plan that was obtained on the VA’s improvement plan in quality of care has provided insight on how the VA uses the same concepts that have been around for years. They have structured these concepts to fit their patient population. Their patient population consists of veterans who have suffered from traumatic and psychological injuries from serving their country. The Veterans Health Administration, the second largest government-operated health-care system in the United States, has been actively engaged in quality improvement activities since 1990 (Rand, 2005). These activities have been implemented on both a system-wide and facility-specific basis. Some quality improvement efforts have been targeted to specific clinical services; others relate to the overall process of providing patient care (Rand, 2005). The VA uses the same quality management concepts that W. Edwards Deming had instilled.

The Quality Improvement (QI) Program is designed to provide a formal ongoing process by which the health plan, participating providers and practitioners utilize objective measures to monitor and evaluate the quality of clinical and administrative services, provided to patients. A quality improvement plan addresses both general medical and behavioral health care and services, defines and facilitates a systematic approach to identify and pursue opportunities to improve services and resolve identified problems. Healthcare providers must establish outcome measures to determine how they are going to monitor treatment effectiveness (McLaughlin & Kaluzny, 2006). There are three areas of care that managers can measure. The areas are structure, process and outcomes.Quality Improvement in Healthcare Paper

The first level of care that is stated in the book is structure. Structure is the resources available to provide adequate health care. VA hospital’s have an organizational structure that many other hospitals can replicate. The first phase of the Department of Veteran Affairs quality improvement plan was the introduction/purpose. The introduction/purpose explained why the VA wanted to improve the quality of care an services they were providing. Managers at this facility wanted to design a plan that provided a framework to systematically assess, evaluate and improve structure, process and outcome related to activities both in care and services. In order to accomplish this task managers will have to ensure there is a collaborative and interdisciplinary effort among VA healthcare providers. It is critical that managers allow staff to have input on the quality improvement plan as their recommendations can benefit the organization as well.

The second level of care that is stated in the book is process. Process is the extent to which professionals perform according to accepted standards. The Department of veteran Affairs hold their employees to the highest ethical and professional standards. VA medical employees follow a chain of command to ensure there is communication at each level. In order to implement the highest standards of care the VA has teamed up with Joint Commission. An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 17,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards (Joint commission, 2010). VA medical centers work in conjunction with Joint Commission to ensure they are providing quality service to veterans.

Joint Commission employs surveyors who are experts in their related healthcare field. These surveyors are responsible for conducting surveys of the various VA medical centers. There are various surveys conducted to measure the level of care the VA is providing. Joint Commission lets the VA know areas that are weak and may need reorganization to ensure quality care is being provided. The documentation of these processes will allow organizations to gather data that will be relevant in determining whether they are providing quality care. Processes are generally documented in patient records. Since the VA has a computerized record system they are able to track different types of data.Quality Improvement in Healthcare Paper

The third level of care that is stated in the book is outcomes. Outcomes are changes in the patient condition following treatment. The VA prosthetic department has been looking for ways in which the can measure the outcome of veterans receiving artificial limbs. VA staffs are required to follow up with patients that receive limbs to ensure they are effectively using the limb. The VA has done a remarkable job in documenting outcome measure in the veteran’s record. VA hospital mail surveys to patients so that they can provide veterans with questions that will help the surveyors determine the outcome measure for the level of care the veteran received. The overall goal of outcome measures is to provide data on quality of care.

Healthcare organizations currently demand information on cost, quality and outcomes as they negotiate contracts. In order to provide quality care organizations must negotiate contracts that will provide them with the quality products and service they need to provide patients with quality services. As new benefits were added, it was necessary to analyze whether they were worth what they cost. In some cases, it was necessary to evaluate the performance of providers in order to decide whether to offer certain types of care at medical facilities. Quality improvement in the health care industry can best be defined by examining the driving forces that are affecting the industry. The evolution of health care in this country is driven by a single purpose. How can health care organizations lower cost, raise quality, and still remain competitive? The implementation of patient-focused quality improvement programs are at or near the top of the list for the Department of Veteran Affairs in their efforts to lower cost (Rogers & Joyner, 2010).Quality Improvement in Healthcare Paper

Health care managers must have a way to measure patient satisfaction. There are various ways in which patient satisfaction can be measured. It is critical that managers get feedback from patients on the service or products they have received. One question we must ask is how should we measure patient satisfaction? First managers will need to understand the purpose of measuring patient satisfaction. Measuring patient satisfaction helps us to identify patients expectations. Expectations are important because patients judge the quality of the care they receive based on their internal standards of what defines quality. These internal standards are based in expectations. In addition, it allows us to learn about patients perceptions of our service. By understanding their expectations and perceptions, we can begin to bridge the gap between how health care providers and patients define quality service (Tarantino, 2004).

In conclusion healthcare managers that use the quality improvement process should focus on satisfying their internal and external customers. The satisfying of their internal and external customers can not be accomplished without the guidance and leadership of management. Management must communicate their expectations to junior level managers. Mangers must understand that the main goal of the organization is to provide quality services to patients and employees. When managers take care of their employees, employees will be motivated in taking care of patients. Quality improvement activities emerge from a systematic and organized framework for improvement. This framework, adopted by the hospital leadership, is understood, accepted and utilized throughout the organization, as a result of continuous education and involvement of staff at all levels in performance improvement (Business balls, 2009).Quality Improvement in Healthcare Paper

Improving Healthcare Quality
Improving Healthcare Quality Purpose The purpose of this paper is to identify aspects of quality improvement in healthcare. This research is conducted by examining and reviewing various literature regarding the definition and makeup of quality healthcare, need for improvements in healthcare, various quality measures or indicators and weighing the cost of improving healthcare quality. Defining Healthcare Quality

Before any discussion can take place regarding improving healthcare quality, an examination of the definition of healthcare quality must be conducted. There are legitimately varying perceptions of what is consider to be the critical dimensions of quality healthcare. These views on quality largely results from the perspective one adopts as a patient, healthcare provider, health care manager, purchaser, payer, or public health official. The same health care experience may be assessed differently depending upon the person’s role.

For example: ? The patient may view his or her experience with the health care system both by its outcome and personal feelings, such as whether the physician listened well, communicated clearly, and was compassionate as well as skilled in delivering healthcare services.

? A healthcare provider may view quality in a technical sense, such as whether an accurate diagnosis is made, whether a surgical procedure is performed proficiently and whether the patient’s health has improved.Quality Improvement in Healthcare Paper

From this view, quality is the difference between what is technically sound and possible, and the actual practice and delivery of healthcare services. ? The health care manager, payer, or purchaser (employer health plan, or government program) may want to know if the healthcare services provided are cost effective. ? Public health officials may want to know if resources are being utilized appropriately to optimize population health and provided equitably within the population.

Quality as defined in Clair G. Oppenheimer book, Improving Quality: A Guide to Effective Programs, is “. . . the totality of features and characteristics of a health care process that bear on its ability to satisfy stated or implied needs; a process or outcome that consistently conforms to requirements, meets expectations, and maximizes value or utility for the customer. For the customer: getting what you were expecting and more; for the supplier: getting it right the first time, every time. The Institute of Medicine of the National Academies (IOM), a not-for-profit, non-governmental organization whose purpose is to provide national advice on issues relating to biomedical science, medicine, and health, and to serve as adviser to the nation to improve health, defines healthcare quality as the “degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. ” (Retrieved July 11, 2009 from http://www. iom. edu). Further expounding the definitions provided, the IOM developed six dimensions of quality healthcare: 1.Quality Improvement in Healthcare Paper

Timeliness – refers to the length of time it takes to provide care to patients. For example, how long it takes a patient to receive a treatment or follow-up care once a breast mass is detected. Delays should be shortened to increase the efficacy of treatments and to ease the patient’s fears. 2. Safety – refers to the ability or need to avoid injuries that result from the provided care that is intended to help the patient. Injuries such as those resulting from administering the wrong drug or wrong dosage, incorrect diagnoses, etc. 3.

Effectiveness – the extent to which healthcare service is provided based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit, that is avoiding over-and underused of resources. 4. Equity – the extent to which quality care is provided without regards to a patient’s gender, geographic location, gender and socioeconomic status. 5. Efficiency – the extent to which equipment, supplies and energy waste is avoided. 6. Patient-Contentedness – the extent to which the patient’s preferences, values and needs are taken into account when providing healthcare service.

Care should be provided respectful of and responsive to the patient. Comparatively, in his book An Introduction to Quality Assurance in Health Care, Ave dis Macedonian provides seven components of what he considers quality in health care. Three of these components are included in the IOMs dimension of quality healthcare; effectiveness, efficiency and equity. The remaining four are: 1. Efficacy – the extent to which healthcare technology and science are able to bring about health improvements when used under the most ideal circumstances. 2.

Optimal – balancing the cost of healthcare improvements against the actual improvements, or in other words, by use of cost/benefit analysis ensuring that costs are not incurred which do not result in benefits do not exceed the cost or investment required. 3. Acceptability – the extent to which the expectations, desires and wishes of the patient and responsible members of their families are conformed to. There are five parts to the development of this definition: ? Accessibility – the ease with which patients can obtain healthcare ?Quality Improvement in Healthcare Paper

The patient-provider relationship – the extent to which the healthcare provider exhibits towards the patient personal concern, good manners, honesty, truthfulness, attention to the preferences of the patients, making efforts to provide explanations, patience, empathy, respectfulness and the avoidance of condescension. ? Amenities of care – the desirable aspects of the circumstances and/or environment under which healthcare is provided and includes cleanliness, adequate parking, convenience, privacy, comfort, restfulness, availability of refreshments, good food, etc. Patient preferences regarding the risks, cost and effects of care – recognition that the patient’s value of the consequences of care may differ for that of the healthcare provider and from patient to patient. Healthcare providers should take the time to explain to the patient the expected cost, risk and effects of alternatives and be guided by the informed opinions of the patients or responsible family member. ? Patient’s definition of fair and equitable As initially mentioned there are various legitimate definitions of what constitutes healthcare quality.

In developing this research paper, each of the definitions above will be utilized to address the issue of improving healthcare quality. The State of Quality Healthcare Surveys show growing concern over the eroding performance of the health care system. In November of 1999, the Institute of Medicine released a report entitled To Err Is Human: Building a Safer Health System, which concluded that 44,000 to 98,000 people die each year in hospitals due to preventable medical errors. In 2003 The National Committee for Quality Assurance (NCQA) released their first annual State of Healthcare Quality e port which found: More than 57,000 Americans die needlessly each year because they do not receive appropriate health care. The majority, almost 50,000 die because known conditions – high blood pressure or elevated cholesterol – are not adequately monitored and controlled. Others die or are at increased risk of death because they have not received the right preventative or follow-up care. [This is because] people with high blood pressure do not have it controlled, . . . people who have suffered a heart do not have their cholesterol levels monitored . . . and] smokers receive no advice to quit. Put simply, the healthcare system regularly fails to deliver care we know to be appropriate. (Nash & Goldfarb (2006) p 7-8) Although quality improvements have been made in some areas since that first report, the NCQA’s 2007 report illustrated significant room for improvement. In the area of medication management and prescription, the report found inappropriate use of some treatment medications, specifically antibiotics. Americans suffer an estimated one billion upper respiratory infections or common colds annually.Quality Improvement in Healthcare Paper

Colds are especially common among children, who suffer approximately three to eight colds a year. Because the common cold is most often viral, existing clinical guidelines do not prescribe the use of antibiotics as a treatment measure. Nevertheless, antibiotics are frequently prescribed to children with colds. Complications ranging from fevers and rashes to drug allergies, prolonged hospital stays and even death often arise from antibiotic treatment. Additionally, inappropriate antibiotic use contributes to bacterial resistance to antibiotics and represents wasted health care resources.

Annually $227 million is spent for inappropriate treatment for the common cold. The impact upon the elderly is just as damaging. Despite medical consensus that certain medications increase the risk of adverse effects to the elderly and should generally be avoided, these medications are still often prescribed to the elderly. One in 20 prescriptions filled by the elderly are for drugs deemed as “always avoid”. More than 1 in 10 filled prescriptions are for drugs that would rarely be considered appropriate.

Studies show that 21 to 37 percent of elderly patients had prescriptions filled for at least one potentially inappropriate drug and more than 15 percent had filled at least two. More than 40 percent of serious, life-threatening or fatal adverse drug events and 80 percent of adverse drug events in the elderly are avoidable. One study found that almost 3 percent of all elderly patients in a managed care organization suffered a preventable adverse drug event in a year. Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings.

Conservative estimates of extra costs due to potentially inappropriate medications in the elderly average $7. 2 billion a year. The 2007 State of Healthcare Quality report found in total between 38,300 and 88,900 avoidable deaths due to unexplained variations in care and avoidable hospital costs between $1. 9 and $3. 5 billion. Additionally, the report determined an estimated 51. 6 million avoidable sick days due to unexplained variation in care at a cost of lost productivity of approximately $8. 5 billion.

These findings alone suggests and supports the employment of continuous improvement measures in the quality of healthcare. Quality Indicators “In health care as in other arenas, that which cannot be measured is difficult to improve. Providers, consumers, policy makers, and others seeking to improve the quality of health care need accessible, reliable indicators of quality that they can use to flag potential problems, follow trends over time, and identify disparities across regions, communities, and providers. (Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions, 2007, p 4) There are a number of measures that have been developed or defined by various organizations, measures that are utilized to determine, adjust and/or improve healthcare quality. One such organization has developed and implemented quality indicators (QI) to assist providers, policy makers, and researchers in the analysis of data to identify variations in the quality of either inpatient or outpatient care; the Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ).Quality Improvement in Healthcare Paper

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The AHRQ’s aim is to improve the quality, safety, efficiency and effectiveness of healthcare and does so through researching: quality improvement and patient safety, outcomes and effectiveness of care, clinical practice and technology assessment, health care organization and delivery systems, primary care including preventive services, healthcare costs and sources of payment. The indicators defined by the AHRQ are used to measure various aspects of health care quality based upon hospital administrative data. The quality indicators or QIs are grouped into four modules: ? Prevention Quality Indicators (PQI) – used to identify ambulatory care sensitive conditions (ACSC) which are “preventable hospitalizations” or conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease. Despite these indicators being based upon hospital inpatient data, PQIs provide insight into the quality of healthcare outside the hospital setting.

For example, a diabetic patient may be hospitalized for complications associated with diabetes if their condition is not sufficiently monitored, if they do not receive proper patient education or if they do not manage their condition. Even though other factors outside of the healthcare system may result in hospitalization such as patient failure to follow treatment recommendations, or poor environmental conditions, PQIs are a good beginning point for assessing the quality of healthcare within a community and “serve as a screening tool rather than as definitive measures of quality problems.

They can provide initial information about potential problems in the community that may require further, more in-depth analysis. ” (AHQR, (2007), p 2) Despite the strengths of these indicators, there are a few weaknesses that should be considered. First, differences in socioeconomic status have been shown to explain a large part of the variation in some PQI rates across areas.Quality Improvement in Healthcare Paper

The intricacy of the relationship between socioeconomic status and PQI rates makes it difficult to delineate how much of the relationships are due to true difficulties in access to care in potentially under served populations, or due to other characteristics, unrelated to quality of care, that vary by socioeconomic status. “For some of the indicators, patient preferences and hospital capabilities for inpatient or outpatient care might explain variations in hospitalizations. In addition, environmental conditions that are not under the direct control of the health care system can substantially influence some of the PQIs.

For example, the COPD and asthma admission rates are likely to be higher in areas with poorer air quality. ” (AHRQ, p 17). Second, the question of whether effective treatments in outpatient settings would reduce the overall incidence of hospitalizations has not been adequately addressed. The degree to which the reporting of admission rates for ACSC may result in changes in ambulatory practices and admission rates also is unknown. Patients may be admitted who do not clinically require inpatient care or patient may not be admitted who would benefit from inpatient care. Inpatient Quality Indicators (IQI) – reflect quality of care inside hospitals including inpatient mortality for medical conditions and surgical procedures and comprises three types of measures: ? Volume Measures are indirect measures of quality based upon evidence suggesting that hospitals performing more of selected inpatient procedures may have better outcomes for those procedures. Volume indicators shows the number of admissions in which these procedures were performed. ? In-hospital mortality indicators measure death rates for selected common surgical procedures or medical conditions. Utilization indicators focus on the volume of selected procedures for which research has suggested issues of overuse, under use, or misuse. The weakness of these indicators is that they are based upon data which is collected for billing purposes and not research or measuring quality. Di spite the insight that may be offered from these indicators, they should not be used as a decisive source of information on the quality of health care. At least three limitations of administrative data warrant caution: ? Coding differences across hospitals.

Some hospitals code more thoroughly than others, making “fair” comparisons across hospitals difficult. ? Ambiguity about when a condition occurs. Most administrative data cannot distinguish unambiguously whether a specific condition was present at admission or whether it occurred during the stay (i. e. , a possible complication). ? Limitations in ICD-9-CM coding. The codes themselves are often not specific enough to adequately characterize a patient’s condition, which makes it impossible to perfectly risk-adjust any administrative data set, thus fair comparisons across hospitals become difficult.Quality Improvement in Healthcare Paper

In short, the AHRQ IQIs are a valuable tool that takes advantage of readily available data to flag potential quality-of-care problems. (AHRQ, 2007, p 18) ? Patient Safety Indicators (PSI) measures harm or adverse effects resulting from healthcare services. These indicators are defined on two levels; provider level indicators which measure preventable ill effects by patients who received care and the adverse effects within the same hospitalization, and area level indicators. Area level indicators measures all cases of preventable ill effects that occurred within a specific area. Pediatric Quality Indicators (PDI) like PSIs include provider level and area level indicators to identify potentially preventable complications but as they apply to pediatric patients, that is those under the age of 18 years. The measures and indicators developed by AHRQ are not exclusive nor do any of the indicators alone provide a complete quality assessment of healthcare systems. However, these QIs take advantage of existing data and data collections systems in place in order to develop areas of improvement and some bases of comparison between healthcare organizations, standards, benchmarks, etc.

Once areas of improvement have been identified by QI, the job of addressing those identified shortcomings may begin. Methods abound which addresses improving quality, such as Six Sigma, Total Quality Management, etc.. These may be employed within a healthcare setting with as much success as doing so in a manufacturing plant. Conclusion This paper sought to examine one side of the healthcare triad, quality. The other two being cost and access. However, by no means should one presume that quality or any of the three is more critical than the other.

In fact, improving healthcare quality will effect the cost of healthcare, which in turn will effect access to that quality healthcare. Just as, effecting cost will impact quality and access. Admittedly, this paper fails to address in detail the intricate relationship between these three factors – but acknowledges the existence of this relationship. Improving quality requires a clear definition of “health care quality” . Ideally, this definition is based upon identifiable and measurable scientific indicators but without disregarding other indicators such as patient satisfaction.Quality Improvement in Healthcare Paper

Managing Quality Improvement in Healthcare
Healthcare providers strive to improve service quality by implementing various quality management programs. Customers tend to seek for higher quality of care when choosing treatments, providers, and health plans. For healthcare organizations that desire to provide high quality care and compete in the global market, choosing a quality management program to implement is critical for performance and efficiency. Many studies have been conducted to analyze the effectiveness of such programs. Lean, Six Sigma and Total Quality Management (TQM) are three programs that will reviewed by three different case studies in efforts to understand them and to compare and contrast their capabilities.
Lean
In a qualitative study, Sobek (2011) identifies and articulates the critical success factors and strongest inhibitors to the implementation and sustainability of lean quality management practices within healthcare organizations. The study methodology consisted of a thematic analysis of literature, a cross-case analysis of medical centers that have attempted lean implementation, and a Delphi study conducted by a panel of experts in lean healthcare application. The findings showed that lean has been successful in healthcare and shows much potential. The two strongest success factors were widespread involvement of all key stakeholders and strong leadership support. Emphasis was placed on communication, training, problem solving, and standardizing for increased success with lean procedures. Despite the improvements shown with lean standards in the manufacturing industry, lean healthcare still faces many barriers.
Many healthcare facilities struggle with lean implementation and sustainability because of performance regression, difficulty in process, unrealistic expectations, culture change, time, and funding. The Delphi panel stressed the importance of regular performance measuring to ensure improvements are sustained. When staff understood the reasons behind the changes and how they improved the productivity and quality of care for patients, they were more likely to sustain the implementations. Developing a culture with the appropriate elements to support continuous improvement was seen as vital to see success with the lean methodologies.Quality Improvement in Healthcare Paper

Quality improvement is a basic goal that the management has to take into consideration during decision making. First, quality improvement methods outlined in this proposal intend to demonstrate hospital’s obligation to improve the quality of healthcare services that the institution offers. For a medical institution, poor quality of services would be disastrous to the organization since it would lower the output and reputation of the hospital. In this regard, the management has to prioritize quality improvement measures to improve healthcare services that the facility offers. Therefore, this proposal highlights the problems, which the hospital faces. It also proposes and discusses quality improvement measures that the hospital should implement to increase its growth, overcome numerous challenges it faces, and enhance patient’s safety.

The proposed quality improvement plan intends to fulfill several objectives. First, it aims to create a suitable setup, where allied healthcare professionals, physicians, and subordinate staff work in harmony to provide the much needed medical support at personalized level (Archbold, 2009). Second, the plan aims to advocate for advanced health services schedules and improve available healthcare and human resources to meet basic Medicare needs of patients in the area of coverage. Third, proposed plans will help the hospital to carry out its duties in a financially feasible and ethical manner without ignoring patients rights and needs. The proposal examines problems, which the hospital is experiencing to be able to propose better means of improving service delivery. This section focuses on specific areas, which create challenges to the health facility such as optimal care and patients satisfaction. As a result, this proposal considers growth of the hospital and patients safety.

Growth of the Hospital

Growth of the hospital is one of the challenges that the administration faces in providing healthcare services. As a result of growth, the hospital will experience various structural and administrative challenges that can jeopardize the provision of healthcare services to patients if not dealt with adequately (Solicitor & Johnson, 2011). The number of patients visiting the hospital will steadily grow, thus making administrating changes necessary. Moreover, this trend is coupled with continuous and systematic quality improvement initiatives that promote growth. In this case, quality improvement initiatives should focus on particular patient to facilitate service delivery. Moreover, support that healthcare service providers offer to patients should promote optimum outcome for patients. This practice will also ensure that the process adheres to norms of business practices in terms of effectiveness.

Challenges that the hospital faces due to its growth and development can be effectively dealt with through a number of initiatives. For example, the hospital will have to carry out clinical outcomes review, performance appraisal, peer-review, and variance analysis because these are the best techniques of quality improvement. Quality Improvement in Healthcare Paper

Patient Safety

The hospital has experienced a lot of issues with patient safety. In this case, most of these problems concern patients safety. This hospital has approximately five patients fall sick per week, medication errors occur frequently, and there is 25% rise in hospital-acquired infections. Therefore, patients safety should be given priority if the hospital aims to serve interests of the sick during service delivery. The improvement plan should focus on patients safety to increase their confidence in the hospital.

Proposed Quality Improvement Plan

Hospital’s quality improvement plan is dependent on mission and goals, which the medical facility intends to achieve. Therefore, healthcare programs should be executed in a way that meets several important conditions. They have to be effective, safe, patient centered, timely, efficient, and equitable.Quality Improvement in Healthcare Paper

Effective

Service provision in the hospital should be conducted in line with scientific knowledge and research findings. This means that services should be different, depending on the disease or patient and must be carried out in a safe way to prevent hospital-acquired infections.

Safe

Service provision should be carried out in a way that assures patients of their safety. In this situation, patients should not incur injuries during medical procedures, because the exercise is targeted at helping them. Safety of the patient must remain a priority as service providers implement their plans.

Patient Centered

Healthcare service that the hospital provides should have the patient at heart, meaning that it ought to be delivered in a responsible and respectful way that would as well guarantee patients safety. This would make individual patient feel valued and assured that physicians attend to his or her needs.

Timely

The quality improvement plan for the hospital should ensure that services are provided in a timely manner to prevent time wasting. This will ensure that the hospital reduces the number of delays, which can lead to death of a patient.

Efficient

Provision of medical care in the hospital should be done in a way that eliminates the excess wastes of available materials and human resources such as supplies, equipment, energy, and ideas. This is intended to improve the quality of life of patients and ensure efficient use of resources.

Equitable

This is a very important aspect of quality improvement in the hospital. Healthcare providers should carry out their work in a non-discriminatory way without considering patient’s gender, geographic location, ethnicity, socioeconomic status, and race (Arch bold, 2009).

On the other hand, the program aimed at improving quality of Medicare will comprise of several activities. First, every direct and indirect service that touches on patient’s health and satisfaction must be given priority (Kenney, 2010). This is important since it guarantees patient’s well being and preference of medical facility for his or her future healthcare needs. Finally, services must be provided in close consultation with affected people. Second, medication therapy should be provided in accordance with the recommended standard. This will improve hospital’s public image and reverse the trend of low patient turnover. Therefore, therapy should be provided in a professional way that upholds integrity of the patient. Third, risk assessment and management should be considered during implementation of strategy of quality improvement. The growth of the hospital increases the rate of risk it might experience, thus making it susceptible to challenges (Shaw, 2009). In this case, risk assessment measures that will detect risks and application of the necessary techniques to manage them will help the health facility to minimize challenges. Quality Improvement in Healthcare Paper

Effects of Implementing the Proposal

Effects that implementation of the proposal will have on at least three different stakeholders may vary depending on the ways these stakeholders will perceive the proposal. The main stakeholders include physicians, Medicare providers, and patients. These people differ significantly in their contribution and utilization of quality healthcare services.

Effects on the Physicians

Physicians are the experts, who diagnose various diseases and prescribe medication to patients. Improving the quality of healthcare means that physicians have to be effective and efficient in handling their patients. They also must possess impeccable knowledge and experience in medical practice (Chesterfield, 2012). Therefore, adopting quality improvement measures such as efficiency, effectiveness, equity, timeliness, safety, and focus on patients means that non-competent physicians will not have the opportunity to work in the hospital. The reason for this exercise is that it requires competency, good faith, and due diligence in delivering services.Quality Improvement in Healthcare Paper

Effects on Medicare Providers

The success of healthcare services relies heavily on the commitment and activities of clinical officers, nurses, and support staff, who are in close contact with patients most of the time. In this regard, improvement of the quality of healthcare in the hospital affects them because it requires more of their dedication, working for longer hours, and improving their relationships with patients (Chesterfield, 2012). Proposed measures such as efficiency, effectiveness, equity, timeliness, safety, and focus on patients mean that Medicare providers have to devote more time, ideas, and interest to achievement of hospital’s goals. This means that medical health practitioners cannot have more idle time, but they have to increase their attempts to innovate on ways of improving patient welfare.

Effects on Patients

Implementing the proposed quality improvement measures such as efficiency, effectiveness, equity, timeliness, safety, and focus on patients, the latter will be required to cooperate with healthcare providers and physicians (Chesterfield, 2012). Here, they would be expected to disclose all relevant information on their condition to facilitate the work of service providers. They will also be required to adhere to medication proposed by physicians. Quality Improvement in Healthcare Paper

Conclusion

In summary, quality improvement of healthcare services is necessary for the hospital because it increases the chances and pace of recovery for patients. The proposal indicated that improved quality of services will boost growth, reliability, and improve the image of the medical facility. Regardless of the problems that the hospital faces, quality improvement measures that the medical center should practice to increase its growth, include efficiency, effectiveness, equity, timeliness, safety, and focus on patients. In addition, these measures have to be implemented in a way that guarantees patients safety.

Managing quality in health and social care
Introduction:
The quality perspective is the major concerning area for the stakeholders. It leads towards the customer satisfaction and allow putting positive impact at the stakeholders. The quality should be the ultimate objective for the companies. In health and social care the meaning if quality is not just providing the appropriate services it includes each and every dimension of their operations which they provide to their customers. Here in current scenario special consideration has been paid to understand the impact of quality on stakeholders and their expectat

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ions regarding the quality (Fisher, 2005). Further the challenges in managing the quality has also discussed in current scenario.

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Task 1:

Q 1:

The external stakeholders have different perspective with respect to the quality and their concern also matters in terms of managing the quality at health and social care setting. The major importance is that the customers always focus on getting the high quality services form health and social care so hospital or health care setting can definitely align with their expectations and can bring appropriate changes into their operational dimensions. Getting the cure and quick treatment is the major expectation of customers. Another significant importance could be noticed with respect to the employees. The staff people are moreover concerned towards their safety and security at workplace. They demand such working environment which is disease free and is positive with the perspective of maintaining their health. Ahead the government and other regulatory bodies are concerned towards the adherence of legal and regulatory norms related to the set quality standards. Following the legal guidelines is something which is highly favorable for the purpose of meeting out the expectations of government and highest regulatory bodies. The industrial standards and compliance have their huge level of association with hospital’s infrastructure and installed equipment’s as well. The major importance of this perspective is that reputation among the stakeholders could build and trust factor of government and higher statuary bodies provide the vote for confidence form employees and customers too (Ki and Hon, 2012). Thus these significant aspects could be availed by health and social care setting.Quality Improvement in Healthcare Paper

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In NHS the role of external agencies and stakeholders is quiet immense in ensuring the availability of quality at workplace or their business practices. The stakeholders or external agencies build pressure upon health and social care workplace to show their reverence to follow all the set standards and procedures. It is something which works on every aspect and ensures the quality from each and every stakeholder’s perspectives. These external agencies could be apex body for the industry or regulatory associations. Further the research agencies also play a crucial role in ensuring the quality within the health and social care setting. It is clear that research firms provide ratings or ranking to the hospitals on various parameters. So quality is also one of the major considerable areas. It determines the level of operations for any hospital and it influences the organization to manage the quality. The research agencies publish the report at international or national level so that people can have access to these reports. Thus it helps on the ground of managing the reputation or brand value. Further the role of media couldn’t be neglected at this juncture. They actually make people aware about the quality standards of hospitals and NHS need to gain vote of confidence from media agencies (Improving Health Care Quality, 2002). Thus these are some external agencies or stakeholders who influence the quality as standard in healthcare organization.Quality Improvement in Healthcare Paper

Q2:

It has been observed at various instances that when an organization fails to ensure the maintenance of quality then it affect the stakeholders at very large scale especially employees and customers. Actually employees handle the patients directly and stay with them for the longer period of time. Thus the quality should be maintained as per their expectations else it can put negative impact on their health. But here it has been observed that due to bad quality measures the customers show their anger and fury only to employees. It creates trouble in creating the healthy working environment at premises and the relationship between staff and patients can’t be developed. Sometime employees may feel stressed due to high level of arguments and complaints from relatives or friends of patients. The level of problem that has been faced by patients due to poor quality is very high and immense. It is clear that the patients might feel de-motivated if the surrounding is not proper and quality of treatment is also not as per the expectation level. It is psychologically proven that when patients feel stressed and tensed then it reduces the recovery speed of patients and it slows down their capacity to react towards the treatment (Orwig and Brennan, 2000). Thus these are certain adverse impacts of reduction in quality over the stakeholder’s physical as well as mental health.

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Q3:

To evaluate the level of health and social care services it is essential to rely on various research technique or methods. These tools can provide helpful results if has been implemented in proper and effective way. The quality could be accessed through regular feedback sessions. It is something that can help on the ground of understanding the experience of patients and their associated people with respect to quality treatment provided by health care setting. The feedback could be taken feedback form or through questionnaire. It may consist of some normal questions that indicate towards the quality and services. The responses of stakeholders can provide the actual scenario about the level of health services. Another assessment technique could be the bench marking pattern. It is very simple to be adopted. It allows measuring the actual scenario with expected scenario and the differences can make familiar with efforts of healthcare to maintain quality. The bench marking could be done by comparing the external industry standards, competitor’s level or by comparing the legal compliance’s and norms. Both the techniques have power to generate reliable and valid results and most importantly the changes could be introduced, if required any (Proud love and Boa den, 2005). Thus feedback and bench marking are those two techniques that could be adopted at health and social care setting.Quality Improvement in Healthcare Paper

Q6:

To ensure the quality at care home the Sam is required to make alignment with the CQC standards and their guidelines. It is foremost method and procedure that will be adopted by the Sam. It helps on the ground of making the balance between external legal compliance and required norms and internal legal arrangement or quality facilities. This particular element can put positive impact at CQC and the suspension letter could be postponed or reversed. But it can’t be sufficient because the situation at care home is quiet worse and problematic. There is requirement of addressing the staff so that certain level of confidence could be inherited within them. The most appropriate system could be related to setting the patients grievances agencies. The set up of grievance department could be put into system. It can help in registering the problems of patients and in this way Sam could take action against various problems in effective manner. The set of grievance agency could be treated as most systematic and well organize system to deal with identified problems and challenges (Chesterfield, 2004). Thus in this way internal system and legal policies or work procedures could be imparted at care home by Sam.

Q7:

The most significant factors that can lead towards the quality of management or services are the competitor’s analysis. It is clear that the working procedure of competitors always influence to bring quality at own workplace. The policies and procedures that have been adopted by the competitors could be implemented by hospital or care home. Another factor that can also influence is the strict monitoring done by regulatory bodies like CQC conducts the regular inspection for Stanford care home. It is something which influences to attain the quality management at very large scale. The guidelines and suggestions of CQC could be followed and quality of services could be ensured. The list of factors includes the alliances or association with outside agencies. These agencies can guide the company on various dimensions and can help on the ground of bringing the required improvements. The research firms can provide the actual problems and at the same juncture can increase the familiarity of hospital with the solutions as well. Thus in this way the quality management could be attained through these factors.Quality Improvement in Healthcare Paper

Quality improvement is very crucial element that should gain huge priority by Stanford care home. There are various ways or techniques that can help on the ground of bringing the improvement in quality management. The foremost pattern is related to the adequate amount of resource management (Promoting effective communication among healthcare professionals to improve patient safety and quality of care, 2010). The resources that any hospital possesses must be utilized in proper way. The wastage could lead towards the unorganized organizational operations and can minimize the level of quality. Further the proper management of resources provides the leading edge and most importantly the competitiveness of care home could be increased. The utility of financial resources in effective manner could be helpful in various ways. Another technique to improve the quality is to provide adequate amount of training to the employees so that they can understand the urgency of delivering the quality services. Through training the Stanford care home can definitely increase the competency of staff people and patients can get excellent services. The dimensions or scope of training could be wide so that the huge knowledge and skill enhancement could be imparted within the organization. At last the principles of total quality management can’t be neglected by the Stanford care home. After reading the case study it has been found that the role of TQM could be immense in ensuring the high level of quality improvement. The fundamentals of total quality management could be followed by Sam so that the industrial norms could be followed (Lahiri, 2011). Thus in this way the Sam will improve the quality of care services in Stanford care home.

Q8:

Involving the service users means understanding their expectations from health care. It is highly significant element which must be taken into special consideration by the health care. The service users know that what they demand from the hospital so it can put positive impact at the efforts made by hospital to improve their service quality. For instance, if patients indicate towards any special quality or skill of any individual staff member that made them special and comfortable then those skills could be identified if the service users are involved into the health care or quality improvement process. The organization can try to build those skills and behavioral aspects in other staff members as well. Therefore it is one factor that shows the significance of involving the service users in health and social care. The service users or associated people with them can indicate towards the problematic and challenging areas of organization which are creating obstacles in improving the service quality. So it may help in bringing the appropriate change (Improving Health Care Quality. 2002). The opinions and viewpoints of customers is something that can definitely helps on the ground of improving the performance on the ground of quality measures. Therefore it could be mentioned that the role of service users is huge in making the health and social care innovative and quality driven hospitals.Quality Improvement in Healthcare Paper

Conclusion:
On the basis of above study it can be concluded that the role of quality is immense in engaging the stakeholders with health and social care settings. Further the role of external agencies in ensuring the implementation of quality service is also clear with the help of current report. Ahead the feedback and bench marking techniques are best way to understand the areas of concern in order to bring adequate amount of change in quality dimensions. The case study analysis helps in understanding the role of higher authorities and various factors to bring service quality improvement.

When it comes to public health, quality improvement is vital. According to Kane, Moran Harbormaster, Quality Improvement Plan refer to a continuous means of achieving improvements that are measurable when it comes to performance, efficiency, accountability and the quality of services necessary for a particular community requires in order to improve the health of the population. A good Quality Improvement Plan incorporates the processes put into place to ensure there is consistency in the quality delivered by the public health stakeholders (Kane, Moran & Armbruster, 2010). Being an integrative process, the Quality Improvement Plan requires constant revision so as to reflect on the achieved accomplishments, the organizational concern’s that have changed and the lessons one has learned in relation to the Public Health Department (Kane, Moran & Armbruster, 2010).

Foundational frameworks of Quality Improvement, QI

A framework is defined as a tool used to organize an organization’s perspective about the quality of health care (Meisenheimer, 2007). According to Meisenheimer (2007), a Quality Improvement framework is built upon more than one existing framework and these frameworks are determined by the focus provided in improving certain health care aspects including the rate at which a patient waits in order to get treated, the performance levels depending on the nursing care, and the rate at which immunization programs are conducted. These health care frameworks, which have been developed, include the Chronic Care Model. Another health care framework is HIVQUAL, which is responsible for improving the quality of HIV services rendered and supported by the HIV and AIDS bureau (Minkman, Vermeulen, Ahaus, & Huijsman, 2011).Quality Improvement in Healthcare Paper

Different definition of the quality of care of various health care stakeholders

Different health care stakeholders have various approaches regarding the quality of care. These approaches in the end transform into unusual evaluations of quality services provided. Stakeholders in the mental health care, which is one primary area, have diverse perceptions about the quality of health care. Even though this area of study does not require adequate research regarding the quality and stringent measures put into place, the diversity of views determines the rate at which the members determine the quality provided (Campbell, Shield, Rogers & Gask, 2004). One method used to define the quality of health care is consensus panel methods. These methods are useful in developing the quality measures in cases where the evidence produced becomes diverse and non conclusive (Campbell, Shield, Rogers & Gask, 2004). The other method is by means of a consensus panel. In this panel, each stakeholder including individual panelists and the panel members have different perceptions regarding this method of defining the quality of health care. This means there is no extensive research regarding the dynamics of this system thus the judgments of the stakeholders becomes hindered (Campbell, Shield, Rogers & Gask, 2004)

Roles of clinicians and patients in QI

Clinicians have a vital role in the implementation of a QI. This is because they are responsible for taking care of the patients and are responsible for improving the levels of health care at local and regional levels (Kongstvedt, 2012). In order to have an effect on a quality QI, clinicians ought to form better alliances with other stakeholders and adequate support in terms of infrastructure, learning programs and strong teams at the local level in order to improve the quality. Engaging clinicians working in every aspect of the health care and supporting them boost their morale thus enabling them to tackle their responsibility for excellent progression in clinical care at ease (Kongstvedt, 2012).Quality Improvement in Healthcare Paper

Patients have several roles in the improvement of a QI plan. One role is to ensure their safety while being attended to by the clinicians. This ensures the health care staff becomes quite active in serving the patients thereby reducing the rates of morbidity (Kongstvedt, 2012). The other role of the patient is to be at the forefront in advocating for good public reporting. Being good citizens, patients and clinicians ought to be responsible and accountable for everything they do and in the end; the performance of the health system and the hospital improves (Kongstvedt, 2012). By working together with the clinicians, the patients make sure that health care organizations improve the quality of services and safety of the organization.

Why is quality management needed in the health care industry?

One advantage of a good quality management is the fact that the patient health care is improved (Kane, Moran & Armbruster, 2010). The improved outcomes extend to include a decrease in mortality and morbidity rates, and an increase in the provision of the recommended screening facilities. The costs of failures, poor outcomes and errors become minimal as the quality management improves. The previous high costs incurred because of nonstandard systems reduce greatly because less expensive and reliable processes have been put into place (Kane, Moran & Armbruster, 2010). The other importance of a good QI in the health care is the improvement of communication systems. This means communication improves with the resources available both within the organization and outside the organization (Kane, Moran & Armbruster, 2010). A successfully implemented QI plan boosts good communication and aids in resolving critical issues.

What areas must be monitored for quality?

One of the areas that require monitoring for attainment of quality is the public health care sectors. This includes hospitals both private and public, the regulatory bodies, and the local public health care system.

Regulatory and Accrediting associations involved in QI and their roles

The National Joint Commission on Accreditation of Healthcare Organizations, the Federal and State Regulatory Framework and the Public Health Accreditation Board are professional bodies found in America responsible for ensuring quality of health care is accomplished (O’Leary, 2000). The role of the regulatory bodies is to set the basic standards that address the most important functions of an organization and ensure compliance with the standards. These functions include patient assessment, and the use of medication. The health regulatory bodies also encourage the health institutions to comply with their regulations by awarding of accreditation (O’Leary, 2000). An organization with good outcomes is reflected in the standards as opposed to one without good outcomes. The Public Health Accreditation Board is responsible for writing the stringent measures and standards, used to create and sustain the quality of improved health benefits (Kane, Moran & Armbruster, 2010). The PHAB is also responsible for updating, writing and the implementation of a sound Quality Improvement Plan to be used by a health department. The plan alongside the relevant health department’s rules and regulations provides a guide in to aid in implementing a sound and strategic plan (Kane, Moran & Armbruster, 2010).Quality Improvement in Healthcare Paper

Helpful resources and organizations that affect QI

While operating a health care, coming up with a list of practical resource guides would assist in ensuring quality improvement. The Physician Quality Reporting Initiative Toolkit is handy especially in assisting to come up with reports. It consists of preexisting educational resource materials and step by step worksheets that are designed to guide the user through the reporting process (Kongstvedt, 2012). The Agency of Healthcare Research and Quality, AHRQ provides specified quality health care information for each unique state, which aims at helping state officials understand the quality and disparities of health care within their states (Kongstvedt, 2012). A good AHRQ includes the strengths, opportunities for development and weaknesses of a particular state’s health care.

When it comes to public health, quality improvement is vital. According to Kane, Moran Armbruster, Quality Improvement Plan refer to a continuous means of achieving improvements that are measurable when it comes to performance, efficiency, accountability and the quality of services necessary for a particular community requires in order to improve the health of the population. A good Quality Improvement Plan incorporates the processes put into place to ensure there is consistency in the quality delivered by the public health stakeholders (Kane, Moran & Armbruster, 2010). Being an integrative process, the Quality Improvement Plan requires constant revision so as to reflect on the achieved accomplishments, the organizational concern’s that have changed and the lessons one has learned in relation to the Public Health Department (Kane, Moran & Armbruster, 2010).

Foundational frameworks of Quality Improvement, QI

Different definition of the quality of care of various health care stakeholders Quality Improvement in Healthcare Paper

Roles of clinicians and patients in QI

Foundational frameworks of Quality Improvement, QI

Patient-centred care is defined as ‘health care that establishes a partnership among practitioners, patients and their families (when appropriate) to ensure that decisions respect patients’ wants, needs and the preferences and that patients have the education and support they need to make decisions and participate in their own care’ [1]. This is increasingly being acknowledged as an integral part of evaluating health care; in fact, improving patient centredness is one of the six aims of the Institute’s of Medicines (IOM) Health Care Quality Initiative according to which health care should be safe, effective, patient-centered, timely, efficient and equitable. This focus is not entirely new and numerous contributions to the scientific and the grey literature have stressed the need to improve patient-centered care.

Yet, firstly, the reasons for a patient-centered approach from a quality improvement perspective are not always clear to all stakeholders. As such it might be difficult to realize working towards a common goal. Furthermore, quality improvement projects may put a focus only on a particular aspect of patient cent redness, say humanity of care; an important albeit not the exclusive rationale. Secondly, it appears that many quality improvement initiatives imply that adding a patient survey to existing performance measures will be sufficient to realize patient-centered care. While this may be informative, it may not be very effective. Moreover, there appears to be a selection bias towards a few established instruments capturing generic patient experience or satisfaction and thus ignoring some of the broader challenges in assessing patient cent redness. Thirdly, there are some important concerns with regard to common strategies to improve patient cent redness. These will be illustrated to avoid that well-intention ed strategies may in fact contribute towards widening existing gaps in patient cent redness.

Patient-centered care: a requirement for quality improvement?
The origins of patient cent redness in health care can be traced back to the Hippocratic oath; however, it was not until the 1950s that the concept of patient-centered care gained importance in medicine and health services research. At that time the excessive focus of medical care on disease processes as compared with illness experience raised a lot of concerns and Engel and Balint opposed the predominant biomedical model [2, 3]. Since then, the focus on patient-cent redness has continuously evolved in the literature and in recent years has been greatly emphasized in policy initiatives. The literature on strategies to improve patient-centered care is overwhelming and a review prepared by the Cochrane Collaboration highlighted that ‘patient-centered care is a widely used phrase but a complex and contested concept’ [4]. Therefore, I will give three simple arguments for a patient-centered approach from a quality improvement perspective: improving patient’s rights, improving health gain and contributing to organizational learning.Quality Improvement in Healthcare Paper

Improving patient’s rights
Patient’s rights embrace arguments of democratization (according to which a paternalistic relationship between patient and professional would contradict the notions of democratic societies), ope rationalized in hospital settings in terms of policies to ensure confidentiality, informed consent, information about treatment and care and issues related to professional-patient interaction [5, 6]. It is not a question whether such issues always lead to better empowerment, participation in health care or even contribute to outcomes—there are ends in themselves [7]. Frequently, these ends are not met. For example, Schoen et al. [8] assessed the experiences of patients with health problems and found that a considerable proportion of patients reported problems with lack of respect for patient’s preferences and involvement of family and friends, and more than a third of patients assert that risks of treatments or procedures were not or were only partly explained. Similar results were found by Coulter and Jenkinson [9] in a cross-European study of patient’s views on the responsiveness of health systems and health-care providers. Since patient’s rights have become an integral part of definitions of quality of care, quality improvement efforts should strengthen these rights.

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Improving health gain
In contrast to the argument above, the health gain perspective addresses the implications of patient-centered care on patient behaviour, recovery and outcomes. The evidence-base concerning health gain and outcomes spans from sociology, over psychology to medicine, nursing and rehabilitation sciences. Research suggests that patient cent redness is associated with better compliance, patient satisfaction, better recovery and health outcomes, augmentation of tolerance for stress and pain levels, reduced readmission rates and better seeking of follow-up care [10–13]. In a review of systematic reviews on three topics central to patient-centered care (interventions to improve health literacy, interventions to improve clinical decision-making and interventions to improve self-management of chronic diseases) Coulter and Ellins [14] report that a majority of reviews yielded positive effects in terms of improving knowledge, better experience of care, decreased use of resources and improved health behaviour and health status. The evidence for the effectiveness of informing, educating and involving patients in their care is substantial.Quality Improvement in Healthcare Paper

Organizational learning
Another rationale for patient-centered care is less prominent in the health-care literature, alas; it is an important focus from a quality improvement perspective. In short, in order for organizations to learn, personal context-specific knowledge needs to be transferred into codified systematic and formal knowledge. Knowledge-dependent organizations constantly revise knowledge at all organizational levels in order to inform process alignment, innovation, product development and service provision [15]. In hospitals, the patient’s knowledge has traditionally been ignored as a ‘production factor’, ignoring the potential contributions to assessing, improving and implementing work processes.

Research suggests that patients can contribute significantly to health-care improvements, in particular through their assessment of non-clinical aspects of care, their assessment of the care environment and their observations and experience with the care process [7, 11, 16, 17]. However, this information is not always gathered systematically, thus hospitals are missing relevant information for improvement projects. For example, while many hospitals carry out patient surveys, little is known to what extent professionals are aware of the results of patient surveys in their ward, or whether this information is used at all for quality improvement work [4, 18]. There are a number of reasons why patient survey data are not systematically used in quality improvement efforts, such as organizational barriers (lack of priority or supporting infrastructures), professional barriers (scepticism, resistance to change) or data-related barriers (lack of timely feedback or lack of specificity and discrimination) [19]. Notwithstanding, quality improvement efforts are well advised to overcome these barriers in order to include patient’s contributions in processes of organizational learning [20]. Quality Improvement in Healthcare Paper

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