Health care is a highly dynamic field that constantly evolves and reviews its core concepts. Naturally, with improvements in means of care delivery and the changing social and scientific standards, the understanding of the goals and objectives of health care were also reshaped. Among these changes are the definitions of and criteria for the quality of health care. Originally, the focus of the health care providers was on the provided services and the outcome of care.
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By extension, the quality of care was measured by collecting data on patient outcomes and assessing the ability of a provider to improve the customer’s health. However, over time the active role of patients as stakeholders in health care became recognized, which led to a shift in priorities. Two reasons are responsible for this. First, the initial focus on care outcomes missed an important point that the patients (rather than the process) are the intended audience, and thus their interests need to be considered. Second, a growing body of evidence suggested that positive perception, patient involvement in health delivery process, and customer-centered care is associated with a significantly higher success rate (Needham, 2012). Therefore, such expansion of quality management is both a logical and beneficial step for the providers.
Currently, three chief stakeholders are recognized as determinants of health care quality. Aside from the customers, whose role is detailed above, healthcare providers are interested in the quality of health care since its understanding assists them in addressing the shortcomings of their services and maintain integrity of their operations. The institutions which provide investments for healthcare organizations constitute the third major stakeholder. Providing them with relevant reports of quality care secures funding opportunities and, by extension, guarantees relevant supply of resources for the organization. Naturally, because of the diversity of pursued goals, definitions of quality of care may vary depending on the priority each stakeholder assigns for different metrics. Nevertheless, most of the modern ones are built upon the understanding that customer’s experience is central to the process. Viewed from this perspective, health care quality displays a similarity with service and manufacturing quality and can, therefore, be improved using the tools and methods which are known to be successful in these areas (e.g. lean philosophy or TQM).
The Purpose, Quality Measures, and Tools of HCAHPS
Nurses are among those closely involved in delivering and monitoring the quality of health care. Being an intermediary between the clinician and the patient and responsible for primary bedside care, nurses are directly responsible for communication between doctors and patients, proper delivery of treatment, organizational issues such as patient admission and discharge, responsiveness of institution’s staff, and infrastructural issues such as tidiness and quietness of the environment. Therefore, these areas are expected to be monitored for quality by nurse administrators. Importantly, the results of the assessment must be standardized to provide the possibility of data comparison on the regional and national scale.
For this reason, Centers for Medicare and Medicaid Services (CMS) developed a Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) – a unified tool for assessing the quality of care and generating universal set of metrics applicable on a national scale. HCAHPS is implemented via surveys which can be collected internally by an institution or use an approved survey vendor. The results of the survey are publicly reported, which is expected to create additional benefits for all stakeholders: provide customers with relevant information on the quality of services, help providers in locating shortcomings and identifying areas of improvement, and allow investors to monitor the results of investments and adjust their policies accordingly.
Institution’s Involvement with HCAHPS
Kendall Regional Medical Center is involved with HCAHPS as its main tool for assessing health care quality. It uses a standard survey which is implemented via mail with a telephone follow-up.
General Description of Data
The questions are illustrating core experiences such as communication with nurses and doctors, control of pain, timely delivery of care, delivery of information regarding medications and self-care after discharge, and cleanliness and quietness of their room (CMS, 2016).
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Comparison with State and National Averages
Compared to national average, the results indicate an overall under-performance in all of the assessed fields, two of which (pain control and doctor communication) being slightly above the Florida average (CMS, 2016). The summary rating is two out of five stars (CMS, 2016). Such setting requires a series of interventions to improve the situation.
The research of available literature allows us to conclude on the most efficient ways of improving the patients’ perception of quality. A study by McHugh and Stimpfel (2012) indicated the relevance of quality reporting by nurse practitioners as a viable tool for monitoring the state of health care in a hospital setting. According to the study, nurses are directly involved in care delivery and are therefore important carriers of firsthand information (McHugh & Stimpfel, 2012). Moreover, their reports were largely consistent with other assessment tools which are considered more verifiable and, therefore, reliable (McHugh & Stimpfel, 2012). Therefore, it is recommended for nurse administrators to establish communication channels which would allow data collection. Such data would be more up-to-date and would account for individual details which can be overlooked by more generalized tools such as HCAHPS.
Naturally, such initiative would be inefficient without commitment of the staff and the desire to contribute to the common goal. Therefore, sound leadership practices are required to improve the chances of successful monitoring. The research by Abdallah (2014) confirms this assertion. According to it, the reason behind uneven success of similar interventions in different establishments can be tracked to the presence of established leadership teams able to facilitate involvement of the employees, with design and relevance of interventions being secondary in importance (Abdallah, 2014).
As was mentioned above, some of the interventions common in service and manufacture industries can be applied to health care field. For instance, Needham (2012) suggested that the three Ps (People, Process, Product) framework is expected to improve the patient satisfaction scores. The main premise behind this assertion is the customer-centric nature of the majority of modern industries compared to the growing recognition of the concept in health care field (Needham, 2012). Cosgrove et al. (2013) elaborate on the idea by suggesting a series of initiatives for healthcare institutions aimed at waste reduction and eliminating unnecessary spending.
While visibly business-oriented, such approach is becoming gradually more relevant in the field since the financial performance is known to be directly connected to efficiency of the institution and, therefore, patient outcomes (Cosgrove et al., 2013). Finally, in the process of implementing suggested initiatives, it is important to acknowledge the necessity of adjustment to local conditions. A systematic review by Davidson et al. (2016) shows a relatively low success rate of interventions aimed at improving HCAHPS score by individual hospitals. The authors point to the narrow focus of most successful interventions and caution against homogenous approach of adoption of methodologies (Davidson et al., 2016). Therefore, it is recommended to precede the suggested interventions with a careful analysis of the setting and local specificities of Kendall Regional Medical Center’s stakeholders to improve the chances of success and eliminate unexpected barriers.
Abdallah, A. (2014). Implementing quality initiatives in healthcare organizations: drivers and challenges. International Journal of Health Care Quality Assurance, 27(3), 166-181.
CMS. (2016). Hospital Profile: Kendall regional medical center. Web.
Cosgrove, D. M., Fisher, M., Gabow, P., Gottlieb, G., Halvorson, G. C., James, B. C.,…& Toussaint, J. S. (2013). Ten strategies to lower costs, improve quality, and engage patients: the view from leading health system CEOs. Health Affairs, 32(2), 321-327.
Davidson, K. W., Shaffer, J., Ye, S., Falzon, L., Emeruwa, I. O., Sundquist, K.,…& Ting, H. H. (2016). Interventions to improve hospital patient satisfaction with healthcare providers and systems: a systematic review. BMJ Quality & Safety, 46(3), 512-537.
McHugh, M. D., & Stimpfel, A. W. (2012). Nurse reported quality of care: a measure of hospital quality. Research in Nursing & Health, 35(6), 566-575.
Needham, B. R. (2012). The truth about patient experience: What we can learn from other industries, and how three Ps can improve health outcomes, strengthen brands, and delight customers. Journal of Healthcare Management, 57(4), 255-268.