Overview of St George Hospital
St George Hospital is found within Kogarah, a town in the Australian city of Sydney. The hospital, which began its operation in November 1894, provided basic care to members of the immediate community. Over the years, St George Hospital grew from its humble state to a major healthcare facility in entire Australia. By 1934, the hospital was among the most established district health facilities in the Sydney metropolitan (St George Hospital 2013). In 1964, the facility became a teaching hospital complete with various departments. A few years later, with the grant of $200 million, the hospital commenced its upgrade into an excellent healthcare center.
Since then, the institution has employed the services of nationally renowned physicians, as well as state-of-the-art technology. Presently, the hospital has 627 beds, making it one of the largest referral centers in Australia. It serves as the level 1′ Trauma Centre’ for the entire eastern Sydney, making it have a busy emergency department (St George Hospital 2013). In addition, the hospital provides a range of medical services, including surgery, special clinics such as care for diabetes and cancer patients, and women and pediatric care. Importantly, being a teaching hospital means that research is given a major priority at St George Hospital. This research is seen as part of promoting the hospital’s goal of affording quality care to all its patients.
Overview of the CQC Report of St George Hospital
A CQC report explains the state of affairs in a healthcare facility after a thorough inspection has been carried out. The aim of this inspection is to determine the quality of care that is present in a hospital. At St George Hospital, the South Eastern Sydney Local Health District (SESLHD) Clinical and Quality Council (CQC) conducts frequent inspections. This council focuses on introducing new interventional procedures that foster efficacy, efficiency, and safety within the healthcare environment. Resource utilization is examined in the committee inspection to determine whether the hospital is utilizing resources properly. This process is in line with concerns that the cost of healthcare continues to rise disproportionately with the quality of care being rendered (Squires 2012). The most recent inspection of the hospital was carried out in 2016. The CQC ruled that several areas at the institution needed improvement to match the Australian national standards. The outpatient and diagnostic imaging fields were among those rated as needing improvement.
Linking the Four Quality Process Techniques in the Organisation
This section presents the various quality processes that have been adopted at the hospital to manage the quality of care.
Benchmarking
Managers in whichever field are often under constant pressure to raise the performance of their organizations, as well as to adopt new approaches (Hamilton et al. 2014). This situation results in the need to carry out a benchmark to evaluate an institution’s processes relative to those of other similar or even dissimilar organizations. Benchmarking is the process of putting in place a standard of excellence, followed by comparing a business function with the said criterion. In other words, a standard is established, which then becomes the threshold for measuring the quality of an existing business function. This practice originated in the business world. However, it has since been incorporated into healthcare. As an aspect of Total Quality Management (TQM), benchmarking takes place as a continuous process whereby the organization measures its process from time to time (Maurici et al. 2014). This comparison is mainly made based on the performance status of other leading organizations. As such, St George Hospital is compared to the leading facilities in the Australian healthcare system. Importantly, benchmarking should be taken as only a part of the quality management process, rather than a replacement (Bernal-Delgado et al. 2015). Hence, the process should be carried out alongside other means of establishing quality in a healthcare institution.
Benchmarking has four main types, namely, integral, generic, functional, and competitive categories. The common types of benchmarking in health care assume the integral and competitive form. Functional benchmarking is whereby the processes in a healthcare institution are compared, whereas competitive benchmarking compares the processes of two different institutions that operate in the same field. At St George hospital, benchmarking is carried out as a team process because of the need to implement changes uniformly across the various departments. The teams include members with adequate knowledge of quality management in health care, communication, and computer skills. El-Saed, Balkhy, and Weber (2013) argue that benchmarking is only as effective as the people working to implement its outcomes are. The type of measurements utilized depends on the activity or process that is being benchmarked. The metrics for benchmarking are usually classified into the following four categories: productivity, time, quality, and cost-related. The healthcare standards that St George Hospital relies on are established by the New South Wales (NSW) Health Department to guide healthcare facilities in the state. The hospital compares its performance with the set standards in areas such as trauma (Sebaratnam & Murrel 2014), cancer care (Thompson et al. 2014), and pediatrics.
Key Performance Indicators (KPIs)
KPIs are quantifiable measures that are used in determining the success of an organization in line with its strategic objectives. Every organization has some key objectives that define its presence in the business world. The same situation holds for health care institutions in both the public and private sectors (Nurullah, Northcott & Harvey 2014). As competition continues to grow in the healthcare industry, St George Hospital has had to work extra harder to meet its goals with respect to delivering quality and ensuring patient satisfaction. Multiple values are employed as KPIs in the healthcare scenario to evaluate their success regarding set targets. At St George Hospital, KPIs have been employed to monitor and evaluate tasks against present values or benchmarks. They indicate trends in how improvements are being made over the course of time at the hospital (Northcott & Harvey 2012). In addition, just like benchmarking, KPIs can be used to compare the performance of St George Hospital with that of other institutions. This plan has helped St George Hospital to improve its services on many areas that were found not to be at par with the expectations of the institution and the NSW standards.
One of the KPIs that are commonly used at St George Hospital is the patient waiting time. As stated earlier, the hospital emergency department is the busiest in the NSW region, meaning that it receives numerous critically ill patients. As such, an evaluation is made on the number of patients waiting to be admitted to the emergency room (ER). If the number is large, it means that the average waiting time for every patient will be high. Based on the three levels of performance management, KPIs (and their scorecards/dashboards) can be categorized into tactical, operational, or strategic (Hungerford 2014). Each category represents some unique objectives, measurement methods, and outcomes. The Donabedian conceptual model proposes that healthcare processes should be evaluated based on the following three components: structures, outcomes, and processes (Hungerford & Fox, 2014). In this case, structure refers to St George Hospital’s physical structures such as buildings, the staff, equipment, and finance. On the other hand, processes refer to the interactions between caregivers and patients, while outcomes are the overall impacts of healthcare on the population of NSW. As a leading healthcare institution in the region, the statuses of patients in the NSW are greatly dependent upon how St George Hospital carries out its strategic goals.
Kaizen
Kaizen is the Japanese terminology that is interpreted in English to mean continuous improvement or incremental growth (Graban & Schwartz 2013). Just like Benchmarking, it also originated in the business world before finding its way into the healthcare sector. Kaizen follows a systematic way of implementing goals in an organization. It has been successfully employed in medical processes that take longer to complete since it allows systematic evaluation. Hence, the monitoring of progress is easy. St George Hospital is among the growing number of healthcare organizations that have embraced kaizen as a way to improve their quality of care, as well as patient safety (Thawesaengskulthai, Wongrukmit & Dahlgaard 2015).
Besides, kaizen is also seen as the solution to managing the ever-increasing cost of healthcare. The three key areas, which are targeted by kaizen, include patient benefits, employee empowerment, and the improvement of hospital processes/technologies. In line with these objectives, St George Hospital is working to empower its staff through creative ways with the aim of improving productivity. For this reason, practitioners at St George Hospital are exposed to regular training to empower them to work in the rapidly changing healthcare environment. Another element of kaizen is that it promotes the involvement of employees in the making of decisions. As such, the management at St George health facility takes involves as many employees as possible in major decisions. This plan boosts their personal pride and satisfaction. Hence, they are motivated to perform their duties.
Kaizen, as a philosophy, suggests that those who interact most with any given practice are the best placed to initiate change. For instance, doctors carry out surgical operations. As such, they know the tools/processes that require improvement. It is for this reason that St George Hospital wishes for incremental growth to emanate from the practitioners rather than the management. In other words, all ideas proposed must be addressed or responded to in one way or another. No idea is small enough to be dismissed before its feasibility is explored first (Hamilon et al. 2014). At the same time, the hospital is focused on minimizing waste by employing the values of kaizen. St George Hospital plans to gradually reduce the amount of healthcare waste it produces. One of the proposed approaches is by ensuring that procurement is only made for tools that are needed. This strategy will not only save money but also ensure that little waste is being released. The challenge of managing hospital waste is already being felt across the country. This situation calls for efficiency in managing waste.
The Balanced Scorecard
The balanced scorecard is a practice used by organizations to align their activities with their respective visions and strategies. Safety is a critical objective at St George Hospital. It evaluates whether the processes and equipment used at the hospital are safe for the patients to avoid injuries. Australia leads the world in terms of healthcare injuries, most of which are caused by a lack of skill in handling new equipment (Studdert et al. 2016). Healthcare technology is improving faster than the healthcare practitioners are prepared to cope, thus creating a gap in skills. At St George Hospital, it is a requisite to ensure that all practitioners are conversant with the equipment they use. This requirement helps to avoid accidents. As such, measures in ensuring safety examine how each equipment or process will affect a patient (Carayon et al. 2014). Is it likely to cause harm or a benefit? Sophisticated technologies call for highly skilled users to minimize medical errors. Thus, the outcome of the safety evaluation determines whether practitioners require extra skills to match the new technology. Another closely related objective is that of effectiveness, which focuses on the ability of the healthcare processes and equipment to bring forth the desired results and hence achieve the intended goals.
Effectiveness goes hand in hand with the timelines set for finalizing each important task at St George Hospital because time itself is an important resource that is used in determining the efficiency of any medical process or equipment. For instance, effective surgical equipment will help to reduce the mean time required to carry out a successful surgery. Not only can shorter timelines improve the chances of saving a patient’s life, but they also ensure shorter waiting times by the patients (Estape et al. 2014). To carry out a successful evaluation of timelines, it would be important to interview patients on whether they are satisfied with the duration it takes to treat them. After all, patient-centeredness in itself is a measure of quality in healthcare.
The Strengths and Weaknesses of Each Technique
Each of the techniques discussed above has its advantages and disadvantages. Thus, the hospital must decide whether the benefits outweigh the shortcomings before adopting any quality process. Importantly, the type of process being evaluated is key in determining the effectiveness, or lack thereof, of a process. The first process, benchmarking, has the advantage of helping an organization to rank itself subject to the performance of other similar institutions. This strategy is important for several reasons. Not only has competition increased in health care, but also patients are demanding quality now more than they did in the past. Thus, knowing its position helps a healthcare institution to adjust to meet and even surpass the set standards. In addition, internal benchmarking helps to identify key aspects of processes that need improvement. This way, the organization saves on costs that are otherwise wasted on inefficiency in processes.
One weakness of benchmarking as a quality process regards its effectiveness. Particularly where a comparison is being made externally, it is difficult to gather conclusive information about the other organization. In other words, while it is easy to observe the standards attained by a competitor company, it is almost impossible to establish the circumstances that it has undergone to attain the said level. In the event that the processes had flaws, the benchmarking institution risks importing them. Not only can these flaws result in underperformance, but they also cause organizations to fail to attain their goals. Another disadvantage is that of complacency, especially where the benchmarking institution is convinced it is doing better relative to the competitor. Organizations that realize they are ahead of their competitors based on the outcomes of a benchmark tend to relax (Aparicio et al. 2014). As a result, it becomes difficult to identify ways of improving their performance.
Regarding KPI, one of the advantages is that it is easy to identify all measurable metrics that can be used to determine success in an organization. The indicators help an organization to stay on course by focusing only on what is important. For instance, the number of customers that an organization has will not be as important as the revenue it generates (Muriana, Piazza & Vizzini 2016). On the other hand, setting performance goals becomes a major challenge if the organization fails to follow up on them. The process of carrying out such follow-ups can be involved because the input by all stakeholders must be assessed.
For the part of kaizen, the major advantage is that it allows improvement to be made gradually, enabling processes to be monitored effectively. As such, any errors are observed and rectified early in the implementation of a process. On the other hand, for kaizen to work effectively, an organization may need to undergo a total turnaround in the way it carries out its operations. This situation can be a disadvantage in the sense that previous progress records may be lost. The balanced scorecard has the strength of providing the full picture of the organization. As such, it is easy to decide whether the organization is performing well or badly. At the same time, the scorecard can ignore important areas of the organization, which can then fail to be improved.
Recommendations on how St George Hospital should proceed in developing the Quality Processes
One of the areas that require immediate improvement at St George Hospital is the safety of both patients and staff. St George Hospital has had its fair share of medical injuries in recent years. These errors have occurred because staff members lack the proper training to handle the new technologies that are being frequently integrated at the hospital. Wachter (2015) argues that medical errors are frequent because new technologies are introduced rapidly in hospitals. Hence, the facility hardly gets adequate time to train the staff on how to use the new often-sophisticated equipment. A solution to this problem would be to employ the philosophy of kaizen. Through continuous and gradual change, new technologies can be absorbed eventually. Not only does this plan allow adequate time to train the staff on their use, but also it allows any potential errors to be identified and rectified. Not every new technology is worth adopting, especially if it is yet to be tested to establish its safety.
Minimizing health costs should be implemented at St George Hospital to avoid unnecessary expenditures during these hard economic times. This process should be carried out together with the efforts to implement value-based care. The two aspects of healthcare management are related since quality care also involves the efficient management of healthcare costs. At the same time, wastage causes efficiency (and hence quality) to dwindle in the healthcare system. Therefore, St George Hospital must prioritize both quality and the utilization of resources as KPIs in the course of their duties. This approach will call for the revising of the existing procurement processes to ensure that orders are only placed for quality tools/materials and in the right amount. As a result, wastage will be minimized, hence reducing the resources channeled to unusual processes. Decreasing areas that do not result in value addition in an organization is also an important knowledge area of kaizen.
Conclusion
Based on the expositions made in the paper, it is apparent that quality processes are vital in the health care sector. As a leading healthcare institution in the NSW, St George Hospital has been dedicated to improving the quality of care it provides to patients. This goal is accomplished by employing various quality processes. The methods include benchmarking, KPIs, kaizen, and the balanced scorecard. Benchmarking enables the organization to compare its processes and patient satisfaction with those of key competitors. In turn, St George Hospital has been able to improve its processes to meet and surpass national standards. On the other hand, KPIs are based on the essential areas that determine the hospital’s position in the healthcare industry. The indicators include safety and quality care. Thirdly, kaizen allows the hospital to implement change gradually to ensure consistency while avoiding the dangers of a rushed change. Finally, the balanced scorecard offers a complete picture of the institution. Hence, management can determine areas that require improvement. These areas emphasize the safety and efficiency of processes.
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