Abstract
The purpose of this paper is to identify the theoretical and practical implications of the use of Total Quality Management in healthcare. An example of a situation that requires changes is provided, and the framework is employed to provide recommendations. TQM and the Donabedian model are described and applied to the topic, and suggestions are provided. They include patient satisfaction and safety, along with communication and general improvements. In particular, the benefits of critical practice guidelines and the choice of a treatment philosophy are discussed. Overall, the proposed changes should contribute to the performance of the Bright Road Health Care system significantly without incurring prohibitive costs in their implementation.
Introduction
The urgent care unit of Bright Road, Health Care System, is experiencing difficulties with regard to customer satisfaction. The situation was uncovered during the patient care survey result analysis, and the Chief Executive Officer of the organization wants to improve them. The responsibility lies with the System’s Director of Quality Improvement, who has hired me, a Change and Process Management Consultant. My role consisted of identifying the structure, process, and outcomes of the current urgent care system. Afterward, I would compile and analyze the results to identify issues and provide recommendations. Overall, the system appears to be experiencing problems with medical errors, inefficient information handling, and lack of space, as well as understaffing.
Total Quality Management
Total Quality Management (TQM) is an approach to improvement that first appeared in manufacturing companies but proved itself suitable for other applications. According to Wickramasinghe (2016), its central idea is the creation of an environment where continuous and efficient development happens. TQM assumes that people are motivated and want to perform at their full capacity. As such, the creation of a productive context would provide them with opportunities to make improvements, which they would take. The paradigm can be applied to most areas of medical treatment, helping advance care, optimize organization, and conduct research. Practitioners can identify issues in their practice, and TQM assists them in the elimination of such concerns.
Management Role
As with most large-scale initiatives, a source of leadership and orientation is required for the successful implementation of TQM. Wickramasinghe (2016) describes the commitment of senior management as one of the foremost predictors of success for the approach. Leaders define the framework of the process and oversee its implementation from an elevated position. This advantage gives them the ability to identify internal customer needs and address them, improving cooperation and promoting efficiency. The trait is particularly relevant in healthcare due to the number of various departments that address particular conditions. As patients can have many kinds of illnesses at once, and since medical history can be essential to treatment, information and assistance sharing are critical in healthcare.
Data Collection in TQM
TQM generally relies on real, quantifiable performance information to draw conclusions and make recommendations for improvement. It employs extensive documentation for every process that takes place in the organization and collects data from customers to identify areas that are dissatisfactory and address any issues. The three items that were identified by the patient survey are the long wait times, poor staff treatment, and a low rate of meeting the health needs. The first and second may be resolved by the addition of more rooms and the expansion of the nursing staff. The increase in nurse responsibility and accountability that was suggested by the Nurse Administrator may contribute to the resolution of the third issue.
Donabedian Model
The Donabedian model is named after its creator, who proposed a quality assurance framework over 50 years ago. According to Kelly, Vottero, and Christie-McAuliffe (2018), it consists of three categories: structure, or medical environment, process, or the activities that constitute treatment, and outcomes, or the results of the application of care. The four C’s that are identified in the scenario are Cost, Communication, Correctness, and Care Outcomes.
Among them, correctness is associated with employing the right medicine and procedures and avoiding errors. Care Outcomes refer to the ultimate result of the visit for the patient, the resolution of issues, and the lack of new ones. Improvements to outcomes as per the Donabedian model should ensure that patients feel well-treated and are satisfied with their visits.
Patient Satisfaction
In the survey, the patients mostly expressed dissatisfaction with three primary areas: wait time, staff treatment, and visit outcome. James Melbourne, the Urgent Care Director, organized the responses into four categories: Cost, Communication, Correctness, and Care Outcomes. Correctness is the observation of proper medical practices in the distribution of drugs, conducting exams, and performing procedures.
As such, an exemplary process with regards to this statistic would result in few medical errors. Notably, James identifies cost as an issue despite its absence from the survey results, at least in a clearly defined form. However, the rising costs of healthcare make medical facility visits less attractive to people, and when they do not feel they got their money’s worth, they tend to be dissatisfied with the outcome.
Patient Safety
The goal of healthcare is to maximize the patient’s well-being in both the short and the long term. To that end, safety is essential, and mistakes, especially ones that endanger the health of the person, should be avoided. Improved diagnosis tools and methods and safer, less intrusive interventions are required, and delivering them is one of the goals of quality improvement. TQM incorporates an approach known as root cause analysis, which is known to dramatically reduce error and accident rate (Kelsey, 2016). It should be noted that the method is not perfect and requires considerable expertise in some complex cases. Nevertheless, by using it along with other quality improvement measures, such as report standardization, TQM strives to ensure patient safety.
Patient Satisfaction Recommendations
The rising costs of health care are a concern for many patients in the lower and middle socioeconomic classes. As such, it is essential to research ways to help address pricing and financing for medical aid for patients as well as the facility. With regards to the former, it is vital to establish better communication and search for nearby organizations that are dedicated to assisting disadvantaged people with healthcare costs. The System, in turn, should become more transparent and offer a variety of financing options by partnering with low-interest lenders. The three areas that are mentioned in the survey can be addressed through the implementation of the ideas suggested by the Quality Improvement Director and Nurse Administrator.
Regulatory Bodies
Recent policy, such as the Patient Protection and Affordable Care Act, has been aimed at improving access to healthcare for disadvantaged population sections. The law attempted to make care more accessible by making more Americans eligible for Medicare. However, with the rising out-of-pocket costs, social forces such as poverty and poor infrastructure restrict many people’s access to care. With regards to the Iron Triangle, as described by Niles (2017), the System appears to be lacking in all three aspects. There are long wait times, the quality is inadequate, and the costs are still high. The last element is likely to affect patient sentiments strongly, and changes such as alternative financing options and improved transparency would help improve the situation.
Communication in Health Care
Communication is essential to patient satisfaction, as people dislike being uninformed about crucial matters such as health or costs. As James Melbourne mentions, the facility does not provide adequate explanations during and after treatment, and patients feel rushed into plans they do not understand as a result. This trend leads to a lower evaluation of the care outcomes, or the overall results of the visit, especially if the treatment is inadequate. As such, improvements to the structure of care and the attitudes of the staff towards the patients can help resolve existing concerns. The patient wait time can be reduced through the addition of new rooms and an expansion of the nursing staff. TQM contributes to patient safety by ensuring that the root causes behind mistakes are identified and eliminated.
Recommendations for Communication Improvement
Overall, three areas of communications require improvements: financial matters, condition and treatment plan explanations, and post-treatment discussions. The first can be improved through increased transparency, and the other two should be addressed by allowing doctors and nurses more time with each patient. Increased nursing staff and the addition of more rooms would help in this regard while also addressing the concerns uncovered in the patient survey.
Critical Practice Guidelines
Critical practice guidelines can improve care by providing a compilation of approaches that are currently considered the best. The methods are supported by evidence-based practice, and the documents remove the burden of researching each new proposition to determine whether it is appropriate. The new techniques can lead to improved outcomes and higher efficiency through the application of new technologies and practices. Critical practice guidelines may be found on various websites, including those of specific associations and various governmental portals. The National Guideline Clearinghouse, in particular, compiles many scholarly articles about medicine in an open-access format, and guidelines may be found in its database.
Patient-Focused vs. Technology-Focused
Technology-focused philosophies focus on the accumulation of advanced technology to improve efficiency. However, as noted in the scenario, many of the machines remain mostly unused, and patients are dissatisfied with the staff’s attitudes. By contrast, a patient-focused treatment philosophy focuses on providing the highest standard of physical and emotional care to the patient. “About BIDMC” (n.d.) states that Beth Israel Deaconess Medical Center workers “are passionate about caring for our patients like they are family” (para. 3) and lists facts such as numbers of births. “Our Mission, Vision and Values” (n.d.) claims that Cedars-Sinai intends to deliver compassionate care and conduct extensive research. As such, a patient-focused philosophy does not preclude technological excellence and may be considered an expansion of the other one.
Conclusion
The purpose of this module is to learn about quality management, particularly with regard to improvement strategies. The scenario that was provided is an example of a situation that requires significant changes before it becomes acceptable. A variety of recommendations can be made to address the various issues that were discovered in the analysis. Costs management was particularly important due to the rising prices of healthcare in the United States. Patient satisfaction and communication were also noteworthy, with each area permitting considerable changes. Lastly, the workers, as well as the institution, can create significant change by adopting the latest critical practice guidelines and deciding on a treatment philosophy.
References
About BIDMC. (n.d.). Web.
Kelly, P., Vottero, B. A., & Christie-McAuliffe, C. A. (Eds.). (2018). Introduction to quality and safety education for nurses: Core competencies for nursing leadership and management (2nd ed.). New York, NY: Springer.
Kelsey, R. (2016). Patient safety: Investigating and reporting serious clinical incidents. Boca Raton, FL: CRC Press.
Niles, N. J. (2017). Navigating the U.S. health care system. Burlington, MA: Jones & Bartlett Nursing.
Our mission, vision and values. (n.d.). Web.
Wickramasinghe, N. (Ed.). (2016). Handbook of research on healthcare administration and management. Hershey, PA: IGI Global.