Introduction
Researchers have developed various models and approaches to help sustain quality in healthcare services and facilities. The question, which model ensures quality care eludes most of care providers. This paper briefly examines the current models used in short- and long-term care facilities, and will settle on the most appropriate model for a nursing home. In addition, the paper will also consider the benefits and the limitations of adapting the new Quality Improvement model.
Quality models
- Quality Assurance: It refers to a systematic monitoring and evaluation of the different components of a facility, service, or project to guarantee that nursing homes attain standards of quality (Webster, 2003).
- Continuous Quality Improvement: Refers to an approach to quality management that improves on traditional quality assurance techniques. This process is done by highlighting the systems and the organization, including focusing on the process of delivery instead of the individuals; recognizing both inside and outside consumers; and supporting the importance of objective data to analyze and improve processes (Graham, 1995, p.69).
- Performance Improvement: The Joint Commission implemented this model in 1990’s. Performance Improvement is the continuous revision and implementation of processes and functions of a health care facility to raise the probability of achieving expectation and to better comply to the patient’s needs as well as of other consumers of the services; the third component of a performance measurement, evaluation, and improvement system.
- Total Quality Management (TQM): Hackman and Wageman (1995), defines TQM as the process of engaging all players of the organization in processes that results to the production of best quality good or services (p. 309).
- ISO 9000: According to Babwin (1998), theses are a range of quality management standards that International Organization for Standardization [ISO] initially published in 1987 (p.57). Presently, thousands of companies in more than 120 countries have implemented the ISO standards in their various organizations. These companies range from healthcare organizations to numerous other large and small-scale companies and organizations. ISO standards necessitate that an organization establishes a systematic direction to developing a quality management structure through sustaining a culture that has a quality focus.
- Six Sigma: This quality model is a management theory generated by Motorola that underscores setting extremely high goals, data collection, and analyzing outcomes to a fine degree as a means to diminish defects in goods and services (Ettiner, 2001, p.13). The letter sigma may denote deviation from a standard; however, the concept behind Six Sigma is that, when one measures the number of defects present in a process, s/he can identify a step-by-step action to eradicate errors and get as close to excellence as possible. A prerequisite for a company to attain six sigma means that it cannot generate more than 3.4 defects for every million opportunities.
Advocates of the Six Sigma model testify that its advantages include up to 50% process cost decline, enhanced customer satisfaction, cycle-time improvement, an improved understanding of customer expectation, minimal waste of resources, and more reliable goods and services. Currently, few companies have adopted Six Sigma model of quality management include; Allied Signal, General Electric, Scientific-Atlantic, and Texas Instrument. Healthcare organizations are evaluating Six Sigma companies for enhanced costs and quality, and many are considering adopting the Six Sigma concept in their quality Improvement programs.
Recommended quality management model
The organizers of nursing homes encounter various challenges in their effort to sustain quality care delivery. Elderly patients demand a lot of attention because of their vulnerability to health conditions that can jeopardize their quality of life. Therefore, an extremely appropriate quality improvement model must be adopted in such facilities to ensure that the processes, products, and services meet the needs of the client.
I think that the best model I would recommend for a nursing home is the Quality Improvement [QI] model. This conviction is supported by research from a non-nursing home setting which has shown that organizational culture; the principles, beliefs, and custom of an organization that determine its behaviors, is a crucial determinant of Quality Improvement [QI] implementation (Berlowitz, Young, Hickey, Saliba, Mittman, Czarnowski, Simon, Anderson, Ash, Rubenstein, & Moskowitz, 2003, p.65). The adoption of QI actions in hospitals is related with a group culture where innovation, teamwork, and risk-taking are highly regarded.
The rationale behind my recommendation lies in the understanding that, in nursing care facilities, QI signifies a substantial deviation from customary quality assurance methods. For a nursing home to adopt QI effectively, staffs must be enthusiastic to take risks and learn new techniques of carrying out their responsibilities. In addition, since QI in health care environment necessitates communication among staff from different medical disciplines, a culture that underscores teamwork also seems crucial.
A higher degree of QI implementation will be evident in such nursing homes with an intensive group culture. Theoretically, QI implementation enables employees to be enthusiastically engaged in all perspective of care. Indeed, it motivates the employees to develop creative practices that may enhance care. In hospital environment, QI implementation is associated with management perspective of improved human resource development. This approach concerns ability to hire and retain staff, doctor dedication to the hospital, and nursing employees’ satisfaction.
Benefits and limitations of IQ
Employees of nursing homes that have implemented more QI practices express more satisfaction with their work. In addition, QI implementation can improve satisfaction by facilitating employees to be more enthusiastic in routine care decisions. The findings by Shortell, O’Brien, Carman, Forster, Hughes, Boerstler, and Connor (1995) support the outcome that QI fosters employees’ enthusiasm by pointing that, there is a strong relationship between QI implementation and HR development consistent with a scale that involves factors including ability to hire and retain clinical employees, nursing employees’ satisfaction, as well as employee income (p.377).
Furthermore, employees at nursing homes with a higher degree of QI implementation expressed improved performance. Berlowitz et al. (2003) note that, management of nursing homes that had implemented QI observed a positive effect of Quality Improvement on care quality and patients satisfaction (p.70).
On the other hand, there are certain limitations to the implementation of QI. It is difficult to quantify the difference between outcomes with or without QI. Researchers cannot clarify whether this indicates absence of variation in practice or the problem in identifying key practices, including turning patients per two hours, in the clinical record.
Finally, there is limited literature of impact of QI on patients’ outcomes, and its uncertain effect on care. The Institute of Medicine (2001), asserts that there are a few clinical studies of QI adoption especially for nursing homes (p.16). In certain situations, improving the management of a certain health condition can yield improvements that may not be sustained. Thus, implementing a long-term care necessitates a holistic approach.
Long-term care facilities and sentinel event (communicable disease or disease outbreak event): Long-term care (LTC) facilities are liable for providing information about communicable disease and disease outbreaks. State statute 252 requires LTC facilities to report individual cases of notifiable disease to their respective health department (Haupt, 2010, p.1). This position is reasonable because the people visit their sick often in LTC and are exposed to this communicable disease.
Addressing nursing shortages in Long-term care facilities: I will address the nursing shortages from two perspectives including recruitment and retention. From the first approach, my organization can establish a nursing school that offers long-term care training program and employ graduates from the institution. We will provide many faculties to accommodate qualified applicants who do not have the opportunity to enter nursing programs because of lack of faculty. For nurse retention, our facility will provide incentives for current nurses, while we implement measures to attract back nurses who left the workforce. Such incentives include increased nurse wages and improved work conditions.
Quality in long-term care: Quality means high status goods, services, and conditions that are conducive for caring and healing process. Elderly people in need of long-term care demand high-quality care. Quality in Long-term care enhances patients’ satisfaction and employees’ productivity. Long-term care facilities spend a substantial amount of money in their effort to sustain quality. Certain factors are important for quality definition. These factors include patient satisfaction and care practice. The key factors associated with client include patient’s autonomy, homelike care environment, and individual focused care. Factors for care practice include competent employees, knowledge of the client, and sufficient resources.
Reference list
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Berlowitz, D. et al. (2003). Quality Improvement Implementation in the Nursing Home. Health Serv Res, 38(1), 65–83.
Ettiner, W. (2001). Six Sigma: Adapting GE’s lessons to health care. Trustee, 54(8), 10-15.
Graham, N. (1995). Management perspectives. Washington DC: Nursing spectrum.
Hackman, J., & Wageman, R. (1995). Total Quality Management: Empirical, Conceptual Practical Issues. Administrative Science Quarterly, 40(2), 309-335.
Haupt, T. (2010). Memorandum of communicable disease reporting Requirement, and Prevention and control of influenza in Long-term care facilities. State of Wisconsin: Department of Health Services
Institute of Medicine. (2001). Committee on Improving Quality in Long-Term Care Improving the Quality of Long-Term Care. Washington, DC: National Academy Press.
Shortell, S. et al. (1995). Assessing the Impact of Continuous Quality Improvement/Total Quality Management: Concept versus Implementation. Health Services Research, 30(2), 377–401.
Webster, D. (2003). International Society for Neonatal Screening (ISNS). Quality Assurance Committee. Auckland, New Zealand: National Testing Centre. Web.