Quality Tools
This assignment deals with the demonstration of concepts, trends as well as application of quality/risk management strategies in healthcare. In dealing with this objective, the assignment starts with explaining two quality tools, namely; improvement tools like six sigma, and an evaluation tools like Audit.
Six Sigma Improvement Tool in Healthcare
Originally, six sigma concepts were introduced by Motorola for QI purposes. The tool implies to a quality measure which aims at achieving perfection as well as elimination of errors. The program is considered as being customer driven, as it emphasizes more on decision making process after a thoughtful quantitative data analysis and prioritizing on the reduction of costs. This tool is similar to good medical practice that was being used during Hippocrates. In the process of developing six stigma approaches, the hospital has to ensure that it has C-level sponsors; come up with a project team, made up of individuals with statistical as well as content knowledge. During six stigma approach development, the hospital has to look for “Green Belt, Black Belt or Master Belt designed to mentor the project.” (Harry, 1997) In case there are no trained personnel, then it has to ensure that it has trained some.
Another step is stating a project funnel, which will enable the company to identify the project. When developing the program, it is good if the healthcare organization can select a project that is prioritized in the organization to ensure that resources are allocated. This is based on the fact that, the healthcare has to develop a realistic project and ensure that needed resources are available. The hospital will also have to provide required support to ensure that individuals have participated and provided information during brain storming. It will also be of much help if the hospital can ensure that required improvements have been attained both in terms of intangible and tangible forms.
Nevertheless, recognizing as well as rewarding teams is another important step in the developing six sigma improvement tool. For another prioritized project, the hospital has to repeat the above steps, but try to improve on what they did in the past. Last but not least, the hospital has to take this project as “being corporate initiative as opposed to local project.” (Harry 1997)
This program is very useful in healthcare as it “seeks to improve the quality of process outputs by identifying and removing the causes of defects (errors) and minimizing variability in manufacturing and business processes.” (Ministry of Health 2003)
Audit as an Evaluation Tool in Healthcare
Audit has been defined as “an evaluation of a person, organization, system, process, enterprise, project or product.”(National Institute of Clinical Excellence, 2002) Though the term has been applied in accounting mostly, such concepts can also be applied in healthcare. However, in healthcare, the term means “quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change.” (Muir Gray, 1997) In healthcare, the term has been placed under clinical governance and is considered as being one of the system used when improving clinical practice standards, (Swage 2000). In developing audit programs in healthcare, problem identification is the first step. This step entails selecting topics or issues that need to be audited. In most cases, it involves assessment of healthcare process adherence, to ensure best results for patients. Healthcare audit might be initiated by factors like “what patients & public have recommended that be looked at.” (Powell 2000)
The second step involves defining criteria as well as standards. Criteria aim at defining the audit objectives. While standards aims at care aspect that ought to be measured, and it has to be based on any available evidence that is considered as being best. Data collection is another useful step in audit development. For precise and accurate data collection, some details like user groups and expectations have to be established. In addition, ethical issues have to be looked into while collecting data, as collected data has to be purposefully for audit; hence confidentiality and privacy of participants have to be observed. (Ghosh 2009)
Moreover, after data collection, next step is analysing data to establish similarities and differences between standards and criteria. This will lead to conclusion and recommendation on how well, or how poor the healthcare standards have been met. The last step is change implementation. This involves reaching at an agreement concerning recommendations made during analysis.
This program is very useful as it leads to “Improvements in practice: creating real benefits in patient care and service delivery; Develops openness to change; Provide assurance: meeting evidence-based best practice; Listening to patients, understanding their expectations; Development of local guidelines; Minimise harm to patients; Reduce incidents.” (Jenkinson, 1997)
Application of Quality Tools in the Healthcare Settings
Current Trends in Quality and Risk Management in New Zealand
There have been claims that undue influences in revising New Zealand’s standards for quality and risk management have been at a very high rate. I beg to reject this allegation that biasness and lack of integrity have been allowed in quality and risk management standards development. Let’s look for instance, compare the Christchurch earthquake which left no dead, and the Haiti earthquake which left more than 230, 000 people deal. The difference between the two scenarios explains the quality of quality and risk management standards in Haiti and New Zealand.
The process of developing standards in New Zealand are considered as being “very robust, indeed, as are often seen as being international Standards in themselves. We draw on scientific evidence, experience, judgement, risk assessment, and input from various stakeholders, including experts and the public.” (Gambrill & Shlonsky 2001)
According to Gambrill and Shlonsky (2001), there exists biasness in NZS6808:2010 standard. The article argues that during the development of wind farms, health effects as a result of noise were not taken into consideration at the time of development. It outlines that, the consensus concerning the same was not reached. As a result, very little efforts were made to reach at a consensus. This allegation is not true. This is based on the fact that, the standard was established under robust standard development conditions that are in line with international standard development procedures. Such standards are still being used in the development of many quality and risk management standards.
New Zealand’s standards have been developed by international experts, in consultation with the affected parties. Apart from that, the public has been always given opportunities to have their own say. It should be noted that, the changes that were made on some of quality and risk management standards like the NZS6808:2010, does not make them to be new, but just an improvement of already existing standards. It has been acknowledged by many experts that changes that have been made in quality and risk management standards are just part and parcel of standard updates. In such a manner, such changes are just improvements on the already existing standards. The revised standards have their basis on “international research and experience quality development over the last ten years. They are technical documents requiring a high level of technical input in addition to consideration of community interests on risk management and quality control”. (Gambrill & Shlonsky 2001)
It is always normal for experts constituting any committee to have differing views, and during standard development, such views are debated to come to an agreement. However, in case any issue can’t be resolved, New Zealand standard development legislations provide facilitations for discussions to ensure a consensus has been reached at. As a result, committees engaged in standard development in New Zealand had their major disagreements over standard wordings discussed and debated. In New Zealand, the voting rules concerning any standard calls for 80% support from committee members. This is a very stringent condition as compared to other international standard bodies. As a result, for any change in quality and risk management standard that has occurred in New Zealand, the committees have been achieving and exceeding this condition. (Powell 2000)
Complexities and tensions in quality and risk management in New Zealand fall in standard formation processes. There have been lots of politics surrounding the standard formation processes. Due to the fact that the policy formation committees are made up of experts only, there are policy makers who are not experts who want to be included in such committees. In case they are not included, they end up opposing policies that aims at implementation of such quality and risk management standards. This is for instance providing training personnel for the implementation of Six Sigma approach, and release of funds.
Another complexity lies on the number of stakeholders involved. Such parties include: the public, politicians and experts; as a result, there have been circumstance under which recommendations have been made based on theory, other than practicality.
Factors That Impact on Promoting Quality Improvement and Effectiveness in Healthcare
Though globally there have been clear improvements, innovations as well as integrations in healthcare, the problem is that, the provided solutions have “no empirical evidence of success and merely attempt to reformat roles and decision-making strategies without addressing the underlying authoritative structure and processes that restrict transformation.” (Cohen & De Back) This implies that, though there have been clinical auditing, various recommendations have been made, but such recommendations have no success evidence. In addition, the main question that has been asked by many is how to implement six sigma tools in projects that are ongoing. There have been no clear ways of introducing six sigma approaches in the current systems. (Davies, et al 2001) and (Worley & Lawler, 2006)
Though there have been higher demands for quality improvement in healthcare services, which have increased the need to audit healthcare service quality, financial challenges have been the main obstacle in achieving this objective. In many healthcare organizations, financial challenges have been ranked as being number one factor affecting service delivery for many years.
Despite the fact that there has been a rise in result improvement from regulatory, government and accrediting organizations, there have been no changes in leadership structure as well as operations that have been developed in healthcare sector. Most healthcare organizations lack Green Belt, Black belt as well as experts for the implementation of six sigma approach. Different bodies have been calling for leadership from clinicians; however, no one has been considering the source of such leadership. As a result, six sigma and audit approaches have been much ineffective in improving service quality in health care. (Dawson, 2001), (Pearce & Conger 2003) and (Juran 1989)
Quality improvement has been for many years affected by the development of monitoring and reviewing processes. There has been no process of ensuring that specified action plans of management remain important and updated. The ever changing environments that healthcare organizations are operating in globally are undergoing changes every day. This is even real when looking at costs incurred during quality and risk management cycle. This calls for frequent reviewing and monitoring of such environments. But such operations are not being carried out.
References
Cohen, E.L., & De Back, V. (1999) The Outcomes Mandate: Case management in Health Care Today. St Louis, Missouri: Mosby Inc.
Davies H. Tavakoli, M., & Malek, M. (Eds) (2001). Quality in health care: strategic issues in health care management. Aldershot: Ashgate.
Dawson, J. (Ed) (2001). Clinical Effectiveness in Nursing Practice. London: Whurr.
Gambrill, E. & Shlonsky, A. (2001). The need for comprehensive risk management Systems. Quality management in health care. 23 (1): 79-107.
Ghosh, R. (2009). Clinical Audit for Doctors. Nottingham: Developmedica.
Harry, M. (1997). The vision of Six Sigma. Phoenix: Tri Star.
Jenkinson, C. (Ed) (1997). Assessment and evaluation of health and medical care. Buckingham: Open University Press.
Juran, J. M. (1989). Juran on leadership for quality. New York: Free Press.
Ministry of Health. (2003), Improving quality (IQ): A systems approach for the New Zealand health and disability sector. Wellington: MoH.
Muir Gray, J. (1997). Evidence-based Healthcare: How to make Health Policy and Management Decisions. Oxford: Oxford Publishers.
National Institute of Clinical Excellence, (2002). Principles of best practice in clinical audit. UK: Radcliffe Medical Press.
Pearce, C. & Conger, J. (2003). Shared leadership: Reframing the how and whys of leadership. Journal of quality in clinical practice. 2, 130-140.
Powell, S.K. (2000). Advanced case management: outcomes and beyond. Philadelphia: Lippincott Williams & Wilkins.
Swage T. (2000). Clinical governance in health care practice. Oxford: Butterworth-Heinman.
Worley, C. & Lawler, E. (2006). Designing organizations that are built to change. MIT Sloan Manage Rev. 48(1): 19-23.