Introduction
Quality improvement implies a formal and methodological approach to the examination of practice performance and endeavors to enhance performance. Aggarwal et al. (2019) defined quality improvement as a procedural framework for solving operational challenges within an organization. In health care, quality management emphasizes preventive maintenance over total service maintenance. The structure, procedure, and outcome triad facilitates quality assessment in healthcare. Structure covers the administrative systems and technical prowess of professionals, such as skills and qualifications that influence healthcare delivery. The process facet encumbers the interactions between individual care components, while the outcome encompasses the restoration or recovery of survival and function. The key assessment areas of quality enhancement are cost, equity, efficiency, acceptability, efficacy, legitimacy, and optimality. Quality services in healthcare are patient-centered, equitable, timely, and efficient.
Risk Management Concept in Healthcare
Quality management in healthcare is transitioning from an anticipation of defects and errors to a consideration of the possibility of a perfect patient experience. For this reason, risk management systems adopt the prevention of errors rather than appraising defects when they occur. Risk management occurs under the auspices of the administrative and clinical frameworks that enable healthcare managers and professionals to identify, monitor, examine, mitigate, and circumvent risks (Pascarella et al., 2021. Ergo, patient-safety and error minimization combine to form the primary focus of risk management in the healthcare concept. The nascence of value-based care veers risk management in the direction of proactive rather than reactive healthcare management systems within the health ecosystem. However, the expansion of risk management’s relevance beyond medical liability and patient safety is slow because many providers still utilize traditional risk management approaches (Pascarella et al., 2021). Organizations are adopting a holistic approach of risk management called enterprise risk management (ERM) to expedite the transition from proactive to reactive frameworks. ERM blends traditional risk management concepts of patient safety and medical liability with organizational goals of risk aversion by considering operational, clinical, financial, strategic, legal and regulatory, technological, infrastructural and environmental, and human capital domains.
Decision-Making Procedures during Quality Management and Risk Management
Healthcare quality improvement and risk management relies on information regarding clinical conditions and intervention plans. Most of this information exists on health websites, and is readily available due to the internet’s pervasiveness. Regardless, it is difficult to determine the relevance of the information because of individual differences in response to medical intervention. Health professionals have the right information regarding medical interventions and treatments upon a consultation with patients. Access to patient information enables a professional to identify concern areas during decisions that affect service delivery.
A clash of personal values and patient autonomy due to cultural, religious and ethical differences is a main concern area. For example, patients have a legal right of refusing prescribed intervention plans that clash with religious beliefs. Healthcare professionals emphasize the patients’ needs during risk management and quality improvement decision-making procedures. Collaborative decision-making requires access to complete information about patients to determine the best course of action to improve service quality and avert risks. Evidence-based practice (EBP) provides a foundation that healthcare professionals may use to make decisions that guarantee quality care and avert risks. The strategy for guaranteeing consistent EBP decisions requires an incorporation of key care procedures for providers into specific organizational policies that guide the performance of healthcar3e professionals.
Risk Management Tools and Strategies
The collective risk assessment procedure in a healthcare organization targets risk identification and comprehension. The risk matrix method is a procedural approach that determines and ranks risks according to salience. The main advantages of the method lie in the opportunity to compare varying risks, knowledge over the threat requiring priority intervention, and reducing the likelihood of probable risks occurring. Threat severity and probability underpin the decision matrix risk assessment (DMRA) or the risk matrix method. However, DMRA can be inconsequential when professionals assign higher qualitative values to low quantitative risks. Similarly, the method lacks timeframe provisions for the risks and cannot provide objective risk categorization where the consequences are uncertain.
Root cause analysis (RCA) permits the discovery of root causes for problems to develop mitigation strategies. It allows collaboration because multidisciplinary teams work together (Singh et al., 2022). Through discussion, evaluation and appraisal, practitioners can determine feasible solutions. However, the method is reactive rather than proactive.
Quality Management Tools and Strategies
Total Quality Management (TQM) is a management strategy that covers individual and work procedures that emphasize patient satisfaction and optimization of organizational performance. The principles of TQM are freedom via control, education and training, continual improvement, teamwork and long-term commitment (Pascarella et al., 2021). The method addresses indirect operations such as management and direct medical services-diagnosis and treatment. The main disadvantage of TQM is limited re4search of its application in developing countries and smaller organizations.
The six sigma is a tool that allows continuous service improvement. This data driven approach of hospital management distinguishes variation causes from outcome measures of a process. The DMAIC (define, measure, analyze, improve, and control) and DMADV (Define, measure, analyze, design, and verify) methods permit enhancement of existing procedures and creation of novel care delivery frameworks respectively (Anthony et al., 2018). Regardless, the tool has several controversies because it may create rigidity and controversies.
Conclusion
Information exchange is a major challenge against risk- and quality-management decisions. Different organizations have varying information systems that delimit data exchange. Consequentially, healthcare organizations should seek to develop blended health information exchange systems using technology to allow remote access of patient information. Rigidity among organizational members can compromise the actualization of the decisions due to resistance. Training programs can minimize the resistance.
References
Aggarwal, A., Aeran, H., & Rathee, M. (2019). Quality management in healthcare: The pivotal desideratum. Journal of Oral Biology and Craniofacial Research, 9(2), 180–182.
Antony, J., Palsuk, P., Gupta, S., Mishra, D., & Barach, P. (2018). Six Sigma in healthcare: A systematic review of the literature. International Journal of Quality & Reliability Management, 35(5), 1075-1092.
Pascarella, G., Rossi, M., Montella, E., Capasso, A., De Feo, G., Botti, G., Nardone, A., Montuori, P., Triassi, M., D’Auria, S., & Morabito, A. (2021). Risk analysis in healthcare organizations: Methodological framework and critical variables. Risk Management and Healthcare Policy, 14, 2897–2911.
Singh, G., Patel, R. H., & Boster, J. (2022). Root cause analysis and medical error prevention. StatPearls Publishing.