Quality Improvement Part Final (combined)

[Student’s Name]

[Institutional Affiliation]

[Date]

 

Executive Summary

Quality management in the health care sector helps in improving the effectiveness of treatments and increasing the satisfaction of patients with the service. With an increasingly aging population and higher health care costs, quality management is gaining increased attention in the health care sector. This is because a healthcare system consists of small and large entities such as pharmacies, medical clinics and hospitals. However, there is a need to provide quality service in all these components so that the entire system can work properly (Kenagy, Berwick, & Shore, 1999).

The stakeholders in the health care sector have different perspectives regarding the quality of health care. Exploratory interviews have shown that due to the varying past experiences and expectations, definition of quality of care and the perceived power relationships between these stakeholders will be different. They will consider different parameters while defining the quality of the healthcare. Hence, one stakeholder will consider few parameters, and the other stakeholder will be evaluating the quality from the perspective of different parameters. And, hence, the definitions will keep on varying under such conditions.

In order to manage quality effectively, individuals and groups within an organization ought to have a clear understanding of their roles and responsibilities relative to QI. Every staff member has a role of ensuring that the objectives of QI set by the organization are met (Kawachi, Subramanian, & Almeida-Filho, 2002). All the contributions of the QI team are of great value. Even though the medical assistant may be working under the physician during the provision of patient care, his perspective and input within the QI team context is very important.

Introduction/Purpose

According to the Duke University Medical Centre website, Quality improvement is ‘a formal approach to the analysis of performance and systematic efforts to improve it (Kenagy, Berwick, & Shore, 1999). In the provision of providing quality healthcare services, the goal for the Duke University Medical Centre is to ensure that every patient receives quality healthcare service.

The mission, vision and strategic plan of the Duke University Medical Centre is to provide the highest quality healthcare to the communities it serves and while doing this, be an organization, which provides excellence in every encounter. Performance improvement is in line with these plans because it is through all these model implementation and quality initiatives that we can find quality improvement in the medical services as well as increased patient satisfaction in a given environment.

This report will provide a detailed report on the steps taken toward Quality Improvement at a given organization. It will define the goals and objectives to be met, followed by the QI activities undertaken, the processes implemented, the participation of the staff, monitoring and performance issues, and finally, will provide the annual evaluation.

Goals/Objectives

The QI goal is to ensure that, continuous quality improvement is achieved at all levels of the organization so as to assist in the attainment of its Mission, Vision and Values. The types of care or services provided by the organization, focuses upon timely delivery, accurate healthcare services, and proper attention to all the patients.

Scope/Description/QI Activities

An effective scope of the QI programs will integrate initiatives, improves performance and aligns units and resources (Fryer, Dovey, & Green, 2000). These measurements are aligned with the organization’s mission, vision and strategic plan as they all strive for continuous improvement of the healthcare service provision. The vision and mission for the Duke University Medical Centre is to provide quality healthcare services to all the people. In this process, the top-level management has designed a program that includes – presentations, self-assessment tools, reading assignments, group discussions, experiential activities, journal reflections, and other exercises which will help in boosting the performance of the entire organization. This will in turn improve the quality practices and overall patient satisfaction levels.

Data Collection Tools

The areas for potential improvement at Duke University Medical Centre are:

Patient care

Administrative services

For this purpose, the data will be collected with the help of following tools:

Observation schedule: An observation schedule is a form on which the observations of a phenomenon or object are recorded. This tool is used in research that employs observation method to study the behavior and interactions in a structured and systematic way.

Rating scale for Interviews: This is a recording form that is used for measuring a person’s attitude, aspirations and other behavioral and psychological aspects as well as group behaviors (Ku & Flores, 2005). It measures individual’s attitudes, aspirations, psychological and behavioral aspects (Ku & Flores, 2005).

Checklist/questionnaire: This consists of a prepared list of items in relations to a particular task or object. The presence of each item can be indicated by checking ‘Yes’ or ‘No’ or multipoint scale. It will collect information on the patient’s history, age, race, and ethnicity, etc.

QI Processes and Methodology

For implementing the QI plan at the Duke University Medical Centre, the Care Model methodology will be used. A good methodology for the improvement of performance should be oriented on results as well as the process through which the results are delivered. The care model focuses on both the results and the process since it deals with both, the patients and the care providers. This is because to achieve good results in patient care, the process of service delivery will also have to be good.

This methodology expects that the service should be thorough and appropriate, as per the needs and expectations of the patients or the end customers. In addition, the organization should also receive the feedback on the implementation of this model and its outputs from the patients. It will help in modifying certain parameters, which will further yield the best results for the organization. Customers are very important people in every organization and the care model is customer-focused in nature. By selecting this methodology, the organization will realize the needs of their customers and hence, will work toward incorporating them in their services.

Comparative Databases, Benchmarks, and Professional Practice Standards

In QI, quality indicators act as a guide to the evaluation of an organization’s performance. Performance should be evaluated continually as well as at the end of the projects carried out by the organization (Kenagy, Berwick, & Shore, 1999). Benchmarks are set programs and operations in order to carry out an organizational performance assessment. This can be achieved by undertaking some trial tests and standards in order to determine the effectiveness of the procedures being followed by the organization. The performance of the information technology within the organization is reviewed through such processes. Milestones, on the other hand, mark the end of a project or the end of a particular phase of a project. It is through this process that, there is continuous monitoring, evaluation and improvement of performance.

The three potential benchmarks and milestones from quality indicators that could be used for the current plan are as follows:

Future event benchmarks

System level benchmarks

Application benchmarks

The organization is also aiming at installing effective Quality Standards for all the medical practices within the organization. In order to ensure successful implementation of the new quality measures at a given organization, the following strategies will be implemented:

Conducting Conferences: Various kinds of meetings including short continuing educational events, workshops and hospital rounds should be conducted by the healthcare facilities (Kawachi, Subramanian, & Almeida-Filho, 2002).

Developing quality improvement teams: This is usually part of a larger strategic planning initiative by the facility in order to improve quality throughout the organization.

Creating employee suggestion programs: The healthcare facility employees may be asked to give suggestions on how to improve the quality of care/ services that the organization provides.

Audit and feedback strategy: This involves the auditing of practice charts by another healthcare giver/person, usually a similar practitioner, with the ability to provide feedback on performance to the individual being audited.

Promoting behavior change: There should be ways found to help the healthcare personnel change their practice behavior and performance since the improvement of quality in healthcare is influenced by the performance of the healthcare personnel.

Authority/Structure/Organization

Board of directors

They are accountable for the governance within the Duke University Medical Centre and will be involved in the development, review and approval of the QI plan. The chairman of the committee will also be responsible for certifying, by signing off at the end of the plan to acknowledge the committee’s full accountability in implementing and monitoring the QI plan (Malloch & Porter-O’Grady, 2005).

Executive leadership committee

Their role is to direct the establishment of multi-disciplinary committees i.e. both medical and administrative, whose mandate will be to evaluate and monitor the quality of patient care and solve the concerns for the support services. A quality improvement and a Utilization Management Committee are in existence. They are accountable to the Executive committee.

The executive committee directs the Duke University Medical Centre in their contracts to participate and co-operate with quality improvement activities as well as provide activity reports. These contracts are required in order to allow the Duke University Medical Centre access practitioner medical records and also to ensure confidentiality of medical records and member information.

The executive committee is responsible for the appointment of VP of medical management to act as a facilitator for all the CQI activities. The executive committee will ensure communication with the Quality Improvement Committee by membership of the QIC and also by receiving reports from the Quality Improvement Committee.

Quality improvement committee

This committee is responsible for the development of the plan. They will be reporting to the executive committee in regards to the QI plan development and progress throughout the year.

Medical staff

The nurses found in this category will accomplish chart review activities such as continuity of care, CPG audits, ambulatory record review, and patient safety audit, etc. as per the annual matrix. They will also provide staff education on identified concerns or deficiencies noted during every audit and bring it to the attention of the QI Director’s attention.

Middle management

They will include the lead clinician, clinical director and program director. They are critical to the improvement efforts being made. They will be involved in the development of annual QI plan and its implementation as well.

Department staff

These will include other clinicians, service providers and staff at the organization. All of them will be accountable in some way to the QI plan.

Communication

As far as communication is concerned, all the important initiatives on the Quality Management will be informed through mails to the employees at their work desks (Shaw, 2000). In addition, for the rest of the support staff, they will be informed by their supervisors. Urgent notices and important information will be shared through meetings, and the departmental head will be guiding the entire team during such discussions. He will be informing on various objectives, and will also provide an approach to achieve the same.

Education

All the staff members within the Duke University Medical Centre system will be responsible for attending the activities that will be implemented for the QI plan. Every employee will be educated in regards to this plan during an initial orientation and annually thereafter. Each employee will receive updated documents for educational purposes on any new changes or developments that might arise. The received materials will contain a description of the QI plan and how their responsibility fits into the plan depending on the employees’ job description.

Annual Evaluation

The QI plan will be evaluated annually so as to effectively achieve the Duke University Medical Centre goal of providing and managing the highest quality healthcare to the community they serve. The annual program evaluation will include:

A summary of all the activities that have taken place, any improvements made the modifications of care delivered projects in progress and any recommendations for the quality improvement plan. It will be compiled then and forwarded to the executive committee for action to be taken.

An analysis of the QI initiative results (Woodward, 2000)

An evaluation of the overall QI program effectiveness, including the progress towards influencing safe clinical practices. The Duke University Medical Centre will provide its physicians with a written notice of rules of participation, policies and procedures and any other rules that are directly related to participation decisions.

The impact of the process on the need for quality improvement program’s revisions and modifications.

Findings that will be used in the development of a yearly quality improvement work plan for the upcoming year.

Conclusion

It is necessary first of all to have a proper management team to look after all the QI initiatives at a given organization. The next important step will be to deploy proper techniques of communication and educating the employees of the organization (Fryer, Dovey, & Green, 2000). There is a need for the annual evaluation, both internally and externally, so as to judge the performance of the new initiatives. Further, the senior management needs to find out the challenges associated with the organization, and through proper strategic implementation, they need to overcome them.

The organization has a commitment to quality and gives importance of communicating this commitment, as well as the acknowledgement that the right organizational culture is essential for effective Quality Improvement. An effective quality improvement program can help make the lives of consumers and staff better.

 

References

Malloch, K., & Porter-O’Grady, T. (2005). The quantum leader: applications for the new world of work. Boston: Jones & Bartlett.

Altman, R.B. (2003). Complexities of managing biomedical information. OMICS, 7(1), 127-129.

Kenagy, J. W., Berwick, D. M., & Shore, M. F. (1999). Service quality in health care. JAMA, 281(7), 661-665.

Kawachi, I., Subramanian, S., & Almeida-Filho, N. (2002). A glossary for health inequalities. Journal of Epidemiol Community Health, 56, 647-652.

Fryer, G.E., Dovey, S.M., & Green, L.A. (2000). The Importance of Having a Usual Source of Health Care. American Family Physician, 62, 477.

Woodward, C.A. (2000). Strategies for assisting health workers to modify and improve skills: Developing quality health care -a process of change. Issues in Healthcare Delivery, 16-20.

Ku, L., & Flores, G. (2005). Pay Now or Pay Later: Providing Interpreter Services in Health Care. Health Affair, 24(2), 435-444.

 

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