Quality improvement in healthcare services institutions has acquired key importance recently, so every institution needs to adopt an improvement strategy that would fit its profile, goals, and peculiarities of functioning. As one knows, there are different types of healthcare institutions in the USA, e.g. hospitals, nursing homes, surgery centers, etc. All of them have a specific set of functions that have to be carefully kept in order to provide best-in-class performance. As one known, the QI process has to comply with the key processes and operations conducted within an organization to ensure constructiveness of approach. For this reason, it is vital to distinguish healthcare organizations and their peculiarities to design a QI plan most suitable for this particular kind of organization.
The medical care organization discussed in the present work is the hospital. Hospitals are the institutions providing the widest range of services in comparison with other medical institutions that specialize in some particular spheres of medical care. As stated by Porter and Teisberg (2005) hospitals actually suffer the acute problem of defining what particular range of services they offer and regard this as the main point in defining the improvement strategy – at the present moment they are usually either too narrow or too broad. In order to unify and organize activities in any hospital, there should be a single set of activities for which separate people will be responsible. Only under this way of arranging the hospital’s activities, one can speak about quality care.
On the whole, an ordinary hospital usually offers the complete care cycle beginning with the diagnosis operations and ending with directing the patient to the department he needs (radiology, urology, surgery, etc.). Every hospital surely has an internal medicine division that takes care of patients in the process of their treatment and guides their medical procedures. However, Porter and Teisberg (2005) voice an opinion that such arrangement of medical services provision leads to the situation in which doctors “tend to want to do a little of everything” which is unacceptable and reduces the quality of provision of medical care.
Another problem is faced by hospitals that have chosen to specialize in some particular field of medicine (oncology, surgery, anesthesiology, etc.). They surely offer a wonderful quality of care in their specific field; however, they fail to provide the patient with a comprehensive type of treatment and make the patient look for other organizations that will provide him or her with other accompanying services they need. This situation leads to extremely complicated and costly procedures in the process of receiving treatment by patients, which cannot help cause patient dissatisfaction, especially taking into consideration the fact that the US medicine is still supply-driven and not customer-driven (Porter and Teisberg, 2005).
For this reason, the QI plan that is planned for implementation in hospitals should, first of all, consider stipulation of services provided within a definite organization and structuring the services of a hospital in such a way so that they would represent an optimal combination. It should be not too narrow and not too broad, the one that would satisfy customers and would lead to a much higher quality of health care provision. As customers are still the key targets of QI processes, every hospital should think about the way to design services in a customer-driven way.
Proceeding to the issue of quality indicators according to which one may judge the quality of medical care provided in a certain medical institution and design the QI plan it is necessary to identify their role in the medical care process. As Huber (2006) states,
“indicators are valid and reliable quantitative measures of structure, process or outcome that are related to one or more dimensions of performance… Performance indicators may measure competence (ability) or productivity… Indicators may be focused on service, practice, or governance”
Quality indicators appear to be an important tool for assessment of the current situation in a medical institution as well as for the generation of an efficient improvement plan that would rest on the issues requiring the most intense attention. According to the opinion of McLaughlin and Kaluzny (2006), they “may reflect elements of technical quality, effectiveness, appropriateness, comprehensiveness, accessibility, efficiency, and equity/disparity”. For this reason, it is necessary to choose a set of external indicators that will aid in the process of composing the improvement plan to make the medical institution’s functioning more customer-oriented. With this purpose, one should choose the indicators directly of the customer’s being informed.
The indicators that have been outlined by Huber (2006) are safe, non-punitive work culture, quality measurement, and continuous feedback from employees and customers. McLaughlin and Kaluzny (2005) add another set of indicators to this list: public health practice guidelines, community health report cards, public health information networks, and pay-for-performance metrics. Many other indicators are equally important as the mentioned ones; however, these mentioned should be considered in more detail.
A safe, non-punitive work culture is the issue that represents active interest for customers of any hospital, i.e. its patients. Much in their perception of the hospital and services provided by it depends on the way the cultural value and organizational culture are organized within the establishment. High cultural values denote a high commitment to the working process, high morality, ethics, and culture with which the employees of the hospital comply. It goes without saying that these qualities appear essential in the sphere of medicine, since health issues may appear too discrete and delicate for many patients.
The arrangement of public information networks is also helpful in the process of communication of necessary information between the staff of the hospital and its patients. Communication channels are very important for the population to be continuously informed about all current changes and novelties in the hospital, which raises their trust towards its staff and popularity of the institution among broad layers of the population.
The third significant external indicator that certifies the customers’ being informed about peculiarities of the hospital’s functioning is the pay-for-performance metrics. Clients are personally interested in the way payment is produced – this is one of the key points shaping their relations with hospitals and influencing their choice of the medical institution they will attend. For this reason, it is substantially important to keep customers well-informed regarding this issue.
Finally, the quality improvement plan has to consider the role of stakeholders. First of all, it is necessary to remember that the plan may be successfully implemented only if all stakeholders express consensus on the terms proposed by it. For this reason, Huber (2006) emphasizes the fact that both customers and stakeholders have to be indispensable elements of each stage of the created improvement plan.
References
Huber, D. (2006). Leadership and nursing care management. Elsevier Health Sciences.
McLaughlin, C.P., & Kaluzny, A.D. (2005). Continuous quality improvement in health care. Jones & Bartlett Publishers.
Porter, M.E., & Teisberg, E.O. (2006). Redefining health care: creating value-based competition on results. Harvard Business Press.