Improving quality is a challenge for healthcare organisations as most of them have failed to provide quality of services delivered to patients. The definitions of quality concepts are not sufficient to accomplish continuous improvement in healthcare organisations. Application of quality concepts in healthcare organisations consists of the degree to which healthcare service for individuals and population has met the following:
- Must increase the desired health outcomes (quality principles).
- Must be consistent with present professional knowledge (practitioner skill).
- Must meet the expectations of consumers (the marketplace).
- Principles essential to promote quality in healthcare
The healthcare services organisation must ensure to deliver quality services to patients. It is necessary to ensure the associated service provider for the patients to achieve the desired health outcomes and patient satisfaction. The main task of a healthcare organisation is to implement performance monitoring system which provides safeguards against:
- Under-utilisation of services.
- Unnecessary diagnostic and treatment procedures.
- Irrational use of drugs to patients.
- Use of fake or unregistered drugs.
- Bad response of clinical or non-clinical staff to patients’ needs.
Successful healthcare organisations, such as hospitals, physicians’ offices, pharmacies, nursing homes or ambulatory centers must understand, identify and implement the following essential principles into practice:
- Leadership and change
- Practitioner skills
Principles of Quality Concepts
Leadership and Change
Leadership is the ability to influence behaviour in quality concepts. The reason for changing behaviour is to reach specific goals within an organisation. Coping with change is an essential focus of an effective leader. Often, there is a challenge for a leader in bringing in competent people throughout the organisation to do challenging jobs.
Clinical and non-clinical staff in healthcare organisations must be resistant to change. The rapid rate of change in healthcare organisations leads to a constant update of skill for all healthcare administrators, medical staffs and non-clinical staffs. An important role of leadership is to set organisational goals through communication and to guide the organisation to accomplish the needed change in service.
Quality in healthcare services is measured in terms of outcome (a healthcare outcome is the change in health status of the patient that is a direct result of clinical care) or process (what providers do to and for patients). An outcome measurement is a powerful tool in cardiovascular surgery and hospital-acquired infections.
Measurement of process is a commonly used method than changes patient health status. Measurement of process is under great control of clinical care provider and needs a short time frame for results. It also directly modifies improvement and may not require statistical adjustment for severity of illness. For example, evidence based communication with a patient is performed appropriately in time. In a patient with typhoid, either the antibiotic was given on time or it was not. In a patient with fever, either a paracetamol was given or it was not. These processes are examples of the nationally reported core measures reported on a quarterly basis to certified statutory government agencies such as Joint Commission International (JCI) and the Centers for Medicare and Medicaid Services (CMS). The quality indicators are a significant part of hospital and physician assessment. For example, patients can decide the doctor and hospital with the available costs on the core measures of hospital and physician assessment.
Every identified problem in a healthcare organisation is the problem of a reliable process. In evaluating highly reliable service organisations, five principles are found to be universal. They are command and control, risk appreciation, a specific quality component of the industry, metrics driving management and reward.
Command and control – Healthcare services must be delivered according to the standards agreed in advance in an organisation. There must be a control over the quality of services delivered to patients to ensure the improvement and high quality services.
Risk appreciation – To have the knowledge about risk in delivery of service is important. It is also more important to take necessary steps to minimise the risks in healthcare organisations.
Quality – Policies and procedures for promoting high-quality services are essential to give reliable services to patients.
Metrics – A system of ongoing checks to monitor hazardous conditions is essential for accountability and also to keep a track on number of patients who receives the healthcare service.
Reward – The clinical and non-clinical staff must be given a warning or punishment for behaving badly with patients. For example, inappropriate care for patients in hospitals. In these situations, patients must be given expected social compensation and the staff must be given a warning to correct his/her behaviour. However, those who achieve patient satisfaction must be recognised and rewarded.
High quality services in healthcare can be achieved in a reliable way and doing the right things right. To do the right thing; physicians, nurses and all healthcare providers must make the right decision about appropriateness of services and care for each patient. To do it right requires skill, judgment and timeliness of performance.
Threats to quality are characterised into three broad areas that affect practitioners:
- Overuse (giving treatment of no value to patients)
- Under use (failure in giving needed treatment to patients)
- Misuse (making errors and defects in treatment)
The physicians and practitioners make treatment decisions in a way that appropriately utilises resources without overuse, under use or misuse. This is difficult to control because of variability in physician treatment methods. Evidence-based medicine has helped in decision making to reduce this variability. Relying on evidence based treatment, practitioners can decide on the appropriateness of services, care, and execution of the patient’s care appropriately.
Both overuse and under use limit the practitioners’ decision making ability. Both areas focus on the competence of the practitioners and their ability to utilise resources appropriately. A practitioner must ask the following questions and evaluate himself/herself to avoid the overuse or under use of service:
- Do they utilise resources appropriately?
- Are they ordering too many treatment methods and tests?
- Are they ordering too few treatment methods and tests?
- Is the treatment appropriate and consistent with patients’ risk benefit calculus?
The marketplace has a great effect in motivating healthcare quality services or quality concepts and it is essential to understand the role of quality of care in the current environment of healthcare services. Public transparency, the promise of improved payment and patient flow to the healthcare organisations, improves quality metrics. The value of quality and efficiency of service providers to deliver services excels in performance and results in more patient flow to the organisation. Thereby, improves the business of the organisation.
Healthcare involves the management of three main principles: cost, volume and revenue. A healthcare organisation must understand the role of quality in the market as it is fundamental to the environment in which it operates. Quality is an important component in the basic business model of the healthcare, the financial management of the healthcare, and the public opinion driving decisions for treatment plans and treatment locations.
If a patient has a bad experience and receives the wrong drug at a facility (a misuse) or determines a physician not ordering for a test with another physician (under use), the patient may be less likely to seek care at that facility or from that physician in the future. Additionally, patients will inform their friends about the bad experience they had. Although opportunities for service recovery exist, many patients are not returning to physicians and hospitals that provide poor quality of service.