The present report concerns the creation and implementation of a QI plan in the sphere of health care. Taking into consideration the diverse medical institutions existing nowadays, hospitals have been chosen as an object of research. Hospitals are general medical institutions conducting a wide range of medical procedures, which can be regarded both as an advantage and disadvantage for a QI plan. In fact, every hospital represents a multi-level organization with many departments and, consequently, many people in charge of their daily operation. Thus, it is necessary to consider all people and all departments responsible for the implementation of the plan as well as processes at which it should be targeted, objectives it has to accomplish and the structure that has to be adopted in its process.
There are a large number of methodologies tailored specifically to suit the individual profile of a hospital. Competitive analysis may also be sufficient in the process of quality improvement, so the most significant benchmarks and milestones for it are outlined in the present paper as well. Separate attention is paid to the completion of procedures aimed at the particular set of aspects of the hospital’s activity, so they should be given the central place in the framework of a QI plan.
Education and distribution of responsibilities in the QI plan is also one of the significant aspects of its implementation, hence the clear understanding of necessary training to be provided on a preliminary basis and the peculiarities of tasks distribution are also taken into account. They are considered at each level of administration and management to give a clearer idea of all peculiarities of the QI plan introduction in a hospital.
Introduction
Quality improvement in medical services has always been one of the major issues of concern for all medical institutions without any exception. The reason for this lies within the framework of importance of healthcare on the whole and the heavy impact on the overall level of well-being of the nation it has. Significance of continuous healthcare improvement has been recognized and legally stipulated nearly 25 years ago by the Health Continuous Quality Improvement Act. The adoption of the discussed legislative act was a natural response to the declining quality of medical services that became the subject of concern not only for patients but for the government as well.
In the process of continuous quality improvement all kinds of medical institutions have initiated quality improvement programs which do help them meet the changing needs of customers and growing demands of controlling institutions (US Institute of Medicine, JCAHO, NCQA etc.) (McLaughlin and Kaluzny, 2005). The process of improvement is the key point at which both clinicians and patients become the active participants being able to help on the way of accomplishing the goal.
Taking into consideration the exceptional importance paid to the improvement issues, it is important that every medical institution adopted the comprehensive, multi-faceted and multi-level QI plan that would include all aspects of its functioning, all levels of activities as well as all implications of performance standards both for internal and external review.
Goals/Objectives
Since the chosen medical institution for review is a hospital, before the creation of an efficient QI plan it is necessary to define the goals and objectives it has to meet in order to direct the QI process at their strengthening and fulfillment. Hospitals, according to their optimal structure, are the type of medical institutions providing the widest range of medical services: they provide the whole medical care cycle from diagnosis to end treatment and recovery. Thus, it is highly necessary to unify and organize the activities of the hospital in such a way that would let separate people be responsible for particular aspects of its functioning.
Though every hospital has to formulate operating and improvement principles individually, there are still a set of rules and aspects of attention that should be taken into consideration by every hospital. First of all, the issue of effectiveness is a significant objective; this fact arises from the observation that hospitals are either too broadly or too narrowly focused on the range of provided services. Thus to achieve higher performance measures and to ensure quality improvement it is important to first of all optimize the range of services available at any particular hospital in order to be able to sustain them efficiently and to lead to higher customer satisfaction.
The observation of Porter and Teisberg (2005) that the medical care provided in hospitals is still supply-driven and not customer-driven is also relevant in this discussion. The issue should become the dominant principle of quality improvement and hospitals should evolve and become more customer-oriented, becoming suitable to the contemporary customer needs.
Scope/Description/QI Activities
In order for the QI plan to be efficient it needs to be directed at certain spheres requiring close attention. The first process that has been chosen in the present QI plan to raise performance standards is the physician and provider profiling. It will afford making a grounded conclusion on their competencies, pitfalls, qualifications, current productivity etc. thus helping to make a relevant staff decision (Ransom et al., 2008). It often acquires key importance in questions of prolonging cooperation with staff members because of the history of their activities, behavior and other implications important for consideration.
Another sphere potentially favorable in the context of improving performance standards and indicators is adequate assessment of reflections from the customers about the whole scope of services that they received in the hospital. This information, in contrast to physician and provider profiling, is subjective. However, information of a subjective type is also efficient taking into consideration the direction at hospitals becoming customer-oriented.
Data Collection Tools
While analyzing the QI plan in a hospital one should constantly remember that the discussed aspects of improvement should not be the only focus of the plan – they are used only to illustrate the procedure and framework of improvement not covering it on the whole. Thus, the present paper considers the evolution of approach to record cards, CareMaps and primary data collection. These data collection tools provide an enormous amount of information important for the improvement process (Dlugacz, 2006).
For example, record cards should be improved and advanced in order to provide comprehensive data about patients and unification of diagnosis, symptoms database to simplify and unify the medical database of the country and allow making diagnosis, prescribing treatment and observing the flow of the disease more efficient and quick. It has been found out that in case hospitals increase attention to registering credit cards it will be possible to find out commonalties in diagnosis and symptoms that will help both clinicians and patients to collaborate more quickly and reduce costs for excessive tests and examinations, which will assist any hospital enormously.
CareMaps concern the patients’ stay in the hospital and allow to make overall statistical inferences about patients and guide ever patient individually on the way of their treatment and recovery. Speaking about primary data collection tools, it is essential to remember about them due to its specific data provision and its further importance in modeling the statistics, suppositions and predictions of disease and mortality rates.
In general, one should pay particular attention to the chosen data collection tools due to their central place in the QI plan – they provide all necessary information that may further be utilized to form the framework of improvement. This data serves as the basis for the QI plan – without it the plan would lack consistency and would be directed blindly.
Processes and Methodology
There is a huge set of methodologies applied to measuring and planning the quality improvement process in a hospital. The choice of the method to be applied to the QI plan designed for hospital depends on the measures intended to be taken, on the profile of the hospital as well as the objectives planned to be achieved. Thus, in the scope of the present study three methodologies have been chosen for analysis: they are the Six Sigma approach, PDCA and EFQM.
In the opinion of Dlugacz, the six sigma approach is highly suitable for the QI implementation in a hospital because it deals with managing a huge number of components making up the entire production process of the company, no matter whether it provides services or products. A hospital is a good example of an organization that is directed at providing a wide range of services comprising the complete health care cycle that has to be managed on every particular level. It is a productive approach that may lead to effective management and monitoring of all procedures taking place at each level of the hospital’s activities that are really multiple and diverse.
The PDCA approach, known in other words as the Deming Cycle, may also be efficient and highly suitable for the QI plan introduction in a hospital because its main focus is directed at the provision of continuous improvement. It does not provide a single act that will be completed and set aside – it presupposes a long-term process that will continuously monitor and implement change and improvement. The stages of the Deming Cycle, Plan, Do, Check and Act, ensure the high level of constructiveness of approach and help the people responsible for the improvement at first check the viability of the planned action and then implement it on the full scale, which often helps avoid excessive expenditures and waste of time in the process of the QI plan implementation.
The last but not the least in importance methodological model to be considered in the present research is the EFQM – the European Foundation Quality Model. Due to its sound standardization base the model helps unify all performance indicators on a single scale that will help assess data in more useful way. Its main emphasis made on standards helps stipulate the main measures for assessment, which finally adds to the efficiency of the plan considerably.
Comparative Databases, Benchmarks and Professional Practice Standards
Benchmarking and comparison according to a chosen set of standards has to become an indispensible element of every hospital’s improvement process because of the growing competition in the sphere and the recognized efficiency of comparative analysis. Knowledge about advantages and disadvantages as compared to the most significant competitors in the given market segment is likely to give valuable knowledge on the subject of improvement measures that should be additionally introduced. Milestones of quality improvement are vital for the success as well as they provide the theoretical basis for the choice of improvement measures as well as the scheme of their implementation.
Authority/Structure/Organization
Obviously, the organization of a hospital is diverse, and the number of people responsible for the QI plan introduction should also be multiple. The main executives in this respect should certainly be appointed in the medical staff because there employees are directly correlating with customers and providing certain quality of medical services. In addition, it is important to appoint a quality improvement committee that will guide the QI process and will detect any mistakes in the process of its implementation.
Board of Directors plays only the initial role in the process because they should be the initiators of the process, they should explain the purpose of the QI plan to stakeholders and justify the expenses allocated for it. Surely, it is possible to include such participants as the middle management and executive leaders who will also have a part of responsibilities and will report to their immediate bosses about the progress of the plan.
Communication
The key players in every medical institution are stakeholders and the Board of Directors, so results of the plan implementation should be communicated directly to them. However, the quality assurance committee that acts internally as well as external regulating bodies mentioned at the beginning of the paper, such as the JCAHO or NCQA, should also receive timely and precise data on the QI plan progress as they will finally have to evaluate the extent to which it succeeded as well as the measure of the hospital’s compliance with the generally accepted national and international standards of healthcare provision quality.
Education
It goes without saying that in case a QI plan is introduced in a hospital, some new knowledge and new skills have to be introduced as well. In this case, to ensure the efficient completion of the QI plan introduction it is important to give adequate training and educational resources in order to get the participants familiar with it. Ransom et al. (2008) accept the necessity of knowledge transfer which presupposes taking previously acquired knowledge from other spheres to introduce it in the newly improved sphere. The theory of knowledge transfer they mention in their book should give the employees clear understanding of the principles guiding the QI process and with eliminate potential misunderstanding, delays and questions.
Annual Evaluation
The QI document created in the process of introducing the QI plan includes annual evaluation of QI/PI, which means that surely the hospital has to evaluate the indicators which were initially chosen for improvement. This can be done in order to assess the achievement in the sphere and to understand whether the primary goals were achieved. This opinion is supported by Miller and Miller-Kovach (1994) stating that
“the first step in an annual evaluation of the quality management program is to review stated purposes, goals, and objectives to be sure that they reflect high standards and movement toward improved outcomes”.
Looking at the quotation, it becomes possible to make an inference that annual evaluation has to include record cards, CareMaps, profiles of clinicians and providers, customer reflections and other indicators mentioned in the present paper.
References
Dlugacz, Y. D. (2006). Measuring Health Care. John Wiley & Sons.
McLaughlin, C.P., & Kaluzny, A.D. (2005). Continuous quality improvement in health care. Jones & Bartlett Publishers.
Miller, M.A., & Miller-Kovach, K. (1994). Total quality management for hospital nutrition services. Jones & Bartlett Publishers.
Ransom, E.R., Joshi, M.S., Nash, D.B., & Ransom, S.B. (Eds.). (2008). The Healthcare Quality Book (2nd ed.). Health Administration Press, Chicago.
Rossi, P. (2003). Case Management in Health Care (2nd ed.). Elsevier Health Sciences.