Introduction
Improving quality of healthcare services is one of the key areas of management in many hospitals. According to Bergeron (2006, p. 37), whenever patients visit a healthcare facility, it is always the expectation of everyone that their problems will be addressed adequately to their satisfaction. In an effort to improve the quality of healthcare services, scholars have conducted researches on indicators that can be used to determine whether a given hospital or department within a hospital is performing as per the expected standards. These indicators help in identifying the gaps that might exist in a given department when offering services to the patients. It is appropriate to focus on specific departments when analyzing the indicators. In this study, the researcher will focus on the surgery department at Sheikh Khalifa Medical City. This department was chosen because of its strategic importance and sensitivity. They handle patients in acute conditions and they require highly specialized equipment in order to deliver quality services. The researcher will look at ten indicators falling under the categories of structure, process, and outcome.
Structure Indicators
Quality manpower
The first indicator in this category is the quality manpower that is needed to address various surgical processes. The rationale for selecting this indicator is to ensure that the surgical department at Sheikh Khalifa Medical City has the right team of experts that can deliver quality care to patients. This indicator has a rich source of literature given its relevance in healthcare institutions. Data was collected from journals and books. According to Marr (2014, p. 73), the surgical department requires a team of highly qualified and experienced professionals with the capacity to handle delicate processes in this unit. Sheikh Khalifa Medical City has some of the best qualified surgical doctors and nurses in this region (Challis & Clarkson, 2006). This indicator is classified as a structure because it defines the capacity and preparedness of this department to address various surgical procedures. This indicator included patients who were unconscious at the time of the surgical process. Those who are conscious- especially because the surgical process is simple- were excluded from the study. Data collection was done after every three months by auditing the manpower within the department. The target goal for this indicator is to have the right manpower within the surgical department with the capacity to meet the needs of patients.
Equipment and supplies
The second indicator in this category is the equipment and supplies within the surgical department at Sheikh Khalifa Medical City. The rationale for this indicator is to have the right equipment that is needed by the medical team within this department to address the needs of the patients. It was necessary to review the existing literatures on this indicator. Bergeron (2006, p. 43) says that equipment and supplies are just as important as having the right doctors within the surgical unit. These doctors cannot work when they lack the equipment and supplies. This indicator also falls in the category of structure because it involves having the right tools needed for the normal operations within this department. Included in this indicator are all the equipment and supplies needed for the surgical processes. This excludes the equipment and supplies that are used in other departments. Data was collected from this department by conducting a regular audit of these equipment and supplies on a monthly basis. The target of for this indicator is to ensure that the surgical department at this hospital is properly equipped.
Process Indicators
Technical activities
The process indicators are very important because they define the actual activities within the hospital that involve addressing the needs of the patients. The first indicator in this category that was analyzed is the technical activities. The rationale for this indicator is to have all the technical activities involved in the surgical department done in an appropriate manner. According to Challis and Clarkson (2006, p. 45), technical activities within the surgical department such as a surgical operation on a patient require precision and expertise of the highest order. When the technical malfunction occurs, it may lead to serious consequences in the medication process (Luce, & Dale 2008, p. 9). It may leave the patient with serious medical problems or even death. For this reason, it is important to ensure that the process is done using the right equipment and with professionals who have enough experience.
The number of experts involved in this process also matter in terms of the quality that is delivered (Marr 2014, p. 41). It also demands an environment that is free from any contaminations in order to eliminate cases of infection. This is a process indicator because it involves the activities conducted when addressing the needs of a patient. All major surgical processes done when a patient is unconscious were included in this study. In order to have the right information, the researcher collected data through observational (cohort) study on every Friday of the week for a period of three months. This was done with the help of the relevant authorities at this hospital. The goal for this indicator is to ensure that all the technical activities within the surgical department at Sheikh Khalifa Medical City are done efficiently.
Use of antibiotics before surgery
The second indicator in this category is the use of antibiotics before surgery. The rational for this indicator was to ensure that doctors in the surgical department use the right antibiotics before surgery to avoid cases of infections. According to Challis and Clarkson (2006, p. 70), although the surgical rooms are thoroughly disinfected after a surgical process is complete and just before another process can begin, it is always necessary to take extra precautions to protect the patient from any bacterial infection. According to Wattis (2007, p. 138), antibiotics are always very important in fighting infections in the wounds and internal organs when used before surgery. This indicator is classified as a process indicator. It involves a process which helps to ensure that patients are protected from any harm posed by bacteria when they are undergoing a surgical operation. It included all the major surgical operations meant to address the problems with the internal organs such as heart, kidney, liver, uterus, lungs among others.
The indicator excluded the operations meant to address problems such as minor cuts. Given the sensitivity of this process, data was collected through cohort study that was done twice per week at Sheikh Khalifa Medical City. The study also relied on the reports from the surgeons about the relevant medications that were used before the surgical processes. The target for this indicator was to create a culture within the surgical department at Sheikh Khalifa Medical City where surgeons and other surgical staff at Sheikh Khalifa Medical City maintain the use of antibiotics before a surgical process as an additional prevention from bacterial infection. This helps to improve the performance of this department.
Beta blockers for AMI
The use of beta blockers for patients after acute myocardial infarction as a form of therapy is another indicator that was studied in this research. The rational for this indicator was to determine the relevance of the use of beta blockers after acute myocardial infarction as a routine therapy. The use of beta blockers post acute myocardial infarction has been the subject to massive research. According to Marr (2014, p. 39), patients who suffer from heart attacks may need a prolonged therapy to revive the heart muscles, especially when it is established that some parts of the muscles are damaged or dead. The only way of protecting the patient from experiencing another heart attack in future is to revive the damaged cardiac muscles to ensure that the heart operates normally.
Beta blockers have largely been considered as one of the best forms of therapy for post AMI patients. However, Bergeron (2006, p. 58) says that its application has been under scrutiny in the recent past to determine when it is appropriate and how to use it among the patients with various myocardial problems. This is also a process performance indicator. It defines a process of using a given form of therapy to address a given problem within the surgical department. Included under this indicator are all forms of myocardial infarctions that require beta blockers as a therapy. However, this excludes low risk patients, especially those who do not experience angina. Data on this indicator was majorly collected from the secondary sources such as books, scholarly articles, and reliable online sources. Additional data was gathered from doctors at Sheikh Khalifa Medical City. A target for this indicator was to ensure that the use of beta blockers at this hospital is based on the recent research findings on its relevance and applications among AMI patients.
Thromboprophylaxis
The fourth indicator in this category is the use of thromboprophylaxis in various surgical settings. The rational of using this indicator is to determine how surgeons at Sheikh Khalifa Medical City can reduce mortality in surgical patients. The research by Marr (2014, p. 56) shows that the use of thromboprophylaxis is one of the best ways of reducing mortality rates among the surgical patients. It involves the use of mechanical methods and antithrombotic drugs to enhance venous flow from the legs (Challis & Clarkson 2006, p. 75). Despite the existence of massive evidence which support the use of thromboprophylaxis among the surgical patients, it remains one of the least used interventions in many hospitals.
An interview with three doctors at Sheikh Khalifa Medical City also confirmed that this is one of the intervention methods that is least used at this healthcare institution. This indicator is classified under the process category. It includes all the surgical processes among patients who are at risk of venous thromboembolism. Surgical processes with low risk of thromboembolism are excluded from this indicator. The researcher relied on both the primary and secondary data collection methods. Primary data were collected every Thursday of the week from the surgeons at Sheikh Khalifa Medical City immediately after the surgical process for a period of two months. Secondary data were obtained from medical journals and books in the online libraries. The goal of this indicator was to determine how effective thromboprophylaxis is in preventing mortality among surgical patients. It is also necessary to explain why this mechanism is not commonly used by the surgeons despite its effectiveness.
Outcome Indicator
Satisfaction
In this study, the researcher focused on four outcome performance indicators in the surgical department at Sheikh Khalifa Medical City. The first indicator that was looked in this category is satisfaction. The aim of every healthcare facility is to offer maximum satisfaction to all its clients. The rational for this indicator is to determine how well the services offered at the surgical department meet the expectations of the patients. According to Marr (2014, p. 116), the surgical department is one of the most important departments that define the overall ratings of a given healthcare facility, especially in handling complex diseases. The ability of the surgical department to satisfy its clients will depend on the effectiveness of the equipment and supplies used, the qualification of the doctors, the working environment of the staff among other factors.
This indicator falls under the outcome category. It includes all the major surgical processes, but minor surgical operations are excluded. In order to collect the relevant data, the researcher used primary sources only. The focus was to determine how clients who went through the surgical process felt about the service delivery at this hospital. On every Monday, the researcher interviewed patients who had been released from the hospital after a surgical operation to determine their views about the services they received. Friends and relatives of these patients were also allowed to participate in the study, especially those that had lost their loved ones while in the theatre rooms. The goal was to determine the level of satisfaction among the clients who went through the surgical processes at this hospital so that the management can be informed of the right strategy to use in order to address any shortcomings.
Physical disability
The second performance indicator that was analyzed was the physical disability. There are cases where a surgical process results into a physical disability. The rational for this indicator was to determine how the surgeons and other supportive health experts can prevent cases where a surgical process results into a physical disability. Bergeron (2006, p, 113) says that there are cases where it may not be possible to avoid a physical disability, especially when the surgical process involves the elimination of a physical component of the body. However, sometimes such eventualities are solely caused by mistakes made by the medical staff or problems arising from the use of poor medical equipment and supplies. When the disability is brought by mistakes of the staff and poor state of equipment, then a patient will have all the rights to blame the hospital, and this may have a negative effect on its performance. This indicator involves the end result of a process, and therefore, is classified in the outcome category. It includes all the surgical processes that may have impacts on the physical ability of a patient. Any surgical process impacts whatsoever on the physical ability of a patient is not included in the study. Data was collected from the records at the hospital, a direct interview with patients, their relatives, and the medical staff. Primary data collection was done with the help of a questionnaire. The goal was to determine the rates at which preventable cases of disability occur at the surgical department of Sheikh Khalifa Medical City and how the issue can be addressed.
Complications of care
Another performance indicator that was looked at was the complications of care. It is common to experience cases of complications during the surgical processes. The rational for this indicator was to determine what causes such complications and how they can be addressed in order to protect the life of a patient. It is clear from the research by Challis and Clarkson (2006, p. 42), that a number of complications do arise during the surgical process. They may be caused by the condition of the patient, wrong diagnosis, mistakes of the health staff involved in the process, or ineffective equipment and supplies being used. Bergeron (2006, p. 139) notes that when such complications occur, the life of the patient will depend on the ability of the staff to respond effectively to the complication. This indicator falls in the outcome category. All surgical procedures which involve addressing of the internal organ problems, including neurosurgery processes are part of this study. Surgeries that do not involve addressing of the internal organs were excluded. Data was collected from both the primary and secondary sources. Data from secondary sources obtained from books and journal articles helped to identify some of the common causes of the complications of care during surgical processes and how they can be addressed. The primary data collected from the surgical staff and patients helped in identifying the specific issues that caused complications of care at the surgical department of Sheikh Khalifa Medical City. Primary data was collected through interviews. The goal of this indicator is to identify the issues that bring complications of care at the surgical department, and how these issues can be addressed in order to have quality healthcare services at this institution.
Mortality rates
The fourth indicator that was looked at in this study was the mortality rates. The rational for this indicator was to determine the rates of mortality in the surgical department and how it can be regulated. According to Challis and Clarkson (2006, p. 43), death is one of the possible eventualities in the surgical department. Although very undesirable, it may not be possible to completely overrule this possibility. However, it is always the expectation of everyone that this eventuality will be prevented at all costs. As Majeed and Voss (2009, p. 210) observe, mortalities in the surgical processes may occur due to human error or equipment malfunction. This indicator is an outcome because it is the results that can be obtained during a surgical process. All surgical cases that ended in deaths at the surgical department of Sheikh Khalifa Medical City were part of the study. However, other cases where the patient made it alive were excluded. Data were collected from the records of the hospital and from the surgeons and other medical staff who participated in the study. The aim was to identify the possible causes of mortality during the surgical processes and how the authorities and staff at Sheikh Khalifa Medical City can work as a team to eliminate such eventualities.
Conclusion
Sheikh Khalifa Medical City is one of the leading healthcare institutions in the United Arab Emirates. The surgical department at this hospital is very important because it handles very sensitive cases. It is important to ensure that the services offered at this department are of high quality and meet the expected standards. In order to determine how effective this department is in addressing the needs of the patients, it is important to use a number of indicators to understand the performance. The three categories of indicators used included the structure, process and outcome indicators.
List of References
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Challis, D & Clarkson, P 2006, Performance indicators in social care for older people, Ashgate, Aldershot.
Luce, T & Dale, J 2008, Performance Indicators in Healthcare, Educational Researcher, vol. 7. no. 10, pp. 8-10.
Majeed, A, & Voss, S 2009, Performance Indicators for General Practice: Will Lead to League Tables of Performance, British Medical Journal, vol. 311. no. 699, pp. 209-210
Marr, B 2014, 25 need-to-know key performance indicators, Cengage, New York.
Wattis, J 2007, Do Performance Indicators Have A Role In Health Promotion, British Medical Journal, vol. 313. no. 7062,, p. 94-196.