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Risk and Quality Management Manual: Basic Concepts and Tools of Quality Improvement in HealthCare Industry
The Basic Concepts of Quality Improvement in Healthcare Industry
Quality improvement also known as QI consists of continuous and systematic actions that lead to quantifiable improvement in all health care services and also the health status of the patient groups considered. The Institute of Medicine (IOM) is the recognized head and advisor on the improvement of the Nation’s health care and has clearly shown that QI in health care is a direct correlation between the level of improvement of services and individuals’ or populations’ desired health outcomes. (HRSA, 2011) Furthermore, the concept of quality management builds upon traditional quality assurance strategies through emphasizing an organization and systems to concentrate more on the process rather than the people; also, QI helps to promote the necessity for objective data to assess and improve processes. (Graham, 1995) Finally, the United States Agency for Healthcare Research and Quality has defined quality health care as the process of “doing the right things, at the right time, based on the right way, for the right person – and obtaining the best possible outcomes. (Varkey et al, 1997)
In conventional organizations, QI is defines how things are done, meanwhile, quality in the health care performance is characterized by the efficiency of an organization and the result of care, and even the level of the satisfaction of the patients. Quality is a direct link to the service delivery approach of any organization or underlying systems of care. Achieving a different level of performance or result and improving the quality requires the need of the current system of an organization to make some changes. The major key principles of QI on which it operates include four key principles. (HRSA, 2011) They are:
- Quality Improvement work as systems and processes
- It requires focus on patients
- It requires focus on being part of the team
- It requires focus on the use of the data
When QI has to work as systems and processes, there’s a need for improvement in an organization. The organization needs to really understand its personal delivery system and major processes. This particular concept identifies that both resources (inputs) and other activities operated on (processes) are taken into consideration to make sure or improve quality of care (outcomes/outputs). This is necessary regardless of the size of the health service delivery, such as an immunization clinic, managed-care organization, or large and complex.
QI focus on patients based on the measurement of quality to which patients’ needs and expectations are met in due course and time. Some services in this category include:
- Patient safety
- Care provision that is evidence-based
- Systems that affect the patient access
- Support for the patient engagement
- The coordination of care with other parts of other larger health care system
When QI requires focus on being part of the Team, we say QI is a team process. Based on the required situations, a team harness the skills, knowledge, experience, and any related perspectives of various individuals within the team for lasting improvements. The approach of the team is effective when:
- Their process or system is complex
- There’s no one person in any organization that knows all the dimension of the issue
- The process employed involves more than one discipline or field
- The solution is dependent on creativity.
Finally, QI requires a focus on the use of the data. This is because data is the cornerstone of Quality Improvement. It is necessary for the description of how well the current systems are putting their operations to work; the circumstances that occur when the changes are applied, and any other related document successfully performed.
The Concepts Of Risk Management In The Health Care Industry
There are prevalence of risks to staff, patients, and organizations in healthcare. For this reason, it is required of any organization to have competent and qualified healthcare risk managers for the assessment, development, implementation, and monitoring of risk management plans in relation with the goal of minimizing exposure to these potential risks. (“University of Scanton, n.d) Therefore, risk management in healthcare is potentially an important aspect in any other industry. In many industries, an organization creates and implements risk management techniques to prevent and mitigate financial losses. This is the same for the healthcare industry, but this is based on the safety of the patient. Risk management in the health care industry can imply the difference between life and death, thus, making the stakes particularly higher. (“Investopedia, n.d”)
No matter the size of any healthcare organization, risk situation can arise, and appropriate measures of protection must be taken into consideration, especially against financial, clinical, and operational exposures. The core concept of risk management program revolves around the systematic effort required to reduce risk. (“nso, 2006”) This begins with a formal, well-written risk management plan that focuses on:
- Declared organization goals
- The description of the program scope
- The delegation of responsibility for implementation and enforcement
- The demonstration of commitment by the board
- And the delivery of guaranteed confidentiality and even immunity from retaliation or anyone who report any kind of sensitive information.
As part of the risk management process in the healthcare industry, the risk management must be formally clarified to all the staff members in order to ensure they understand the basic elements and goals. Other aspect may require addressing the organization’s specific confluence of liability issues, and thus, in the process of creating the program, quality research is necessary for specific exposure, and the use of general, industry resources.
No two healthcare organization operates alike, and this is majorly true of the structures of any healthcare organization with respect to the risk management or quality management structure. In most cases, the structure is usually driven by the organization size or its facilities. (“ASHRM, 2007) Additionally, identifying risk requires some skills and considerations and the healthcare organization has to establish some unambiguous, detailed policies to address any incident-reporting questions. Again, it is also required that the organization develops satisfaction surveys which point at locating problem areas before the problems are developed into full-fledged claims or incident. Finally, complaints should not be taken irrelevant, and when taking actions, the five basic initiatives to bear in mind include, prevention, correction, documentation, education, and departmental coordination. Then a strong risk management plan can be created to avert or reduce potential risks within the healthcare organization.
The information needed for decision-making processes in risk and quality management in the health care industry
As much as risk management offers the mechanism and tools to make excellent decisions with the task of risk reduction, which is the key input driver, risk management still provides a disciplined avenue in which proactive decision making is the major drive to: (“leidos, n.d”)
- Proactively identify potential risks and risks itself
- Priotizing the risks
- Implementing strategies to deal with risks
- Assuring and measuring the effectiveness of the implemented strategies
Healthcare managers cannot do without operating in an increasingly difficult system. Especially with the numerous legal, economic, organizational, ethical, and technical changes that take place. Managerial decision making has great impact on those working within the organization and also on the performance of the organization. The process of decision making inherent in every managerial function and is based on planning function. With no regards of any level, every manager makes one decision or the other, either in risk planning situation or in a quality management situation. (Guo, 2008)
In making decision in risk and quality management, the information required includes:
Defining the problem. This includes researching, observing, and identifying the potential problem at hand, what exactly the problem is, why should anything be done to fix the problem, and what exactly should or could be happening. This helps to really identify the necessary steps to take to avert potential risk, and build quality within the organization. (Guo, 2008)
Secondly, establishing the criteria is another required information. Defining what criteria are desirable in achieving risk and quality management will help decide what to achieve in the decision making processes as well as what is meant to be preserved, and most importantly, what should be avoided as the problems already identified. (Guo, 2008)
Thirdly, the need to consider all alternatives in any decision making process is relatively important. As there are two sides of every coin, there are always different and varying alternatives. The possible choices to meet the criteria should be adequately considered, as well as the factors that could affect the alternatives, either positively or negatively. (Guo, 2008)
Furthermore, identifying the best alternative at risk and quality management is an important aspect of making decisions. This is actually based on experience, skills, intuition, and experimentation. Most importantly, it is expected to use the maximization or the satisficing approach in this case. (Guo, 2008)
Moreover, developing an action plan for the implementation of the choice is necessary. This includes the processes of how the plan of action can be implementable and any necessary strategies needed to achieve the plan at hand. Additionally, the resources needed in the actual implementation process are an important aspect of those making decisions in risk and quality management. (Guo, 2008)
Finally, evaluating and monitoring the solution caps up the processes of decision making in risk and quality management. Troubleshooting the decisions is relatively necessary. This implies detecting any problem with the decision chosen, if there could be anything that should go wrong, and any back up plans to avert the problem. Feedback is necessary to keep track of the success. (Guo, 2008)
The Challenges in making risk- and Quality-Management Decisions in the Healthcare Industry
Healthcare providers are keen to making decisions in the process of the job they do. As a matter of fact, many of these decisions affect the health and safety of the patients in one way or the other. Any level of mistake made in the process of decision-making may have detrimental effect that may not be reparable forever. Basically, many lawsuits have shown reports concerning cases of medical negligence by doctors or some errors committed by other healthcare providers. To combat any level of risks, there is need to put together strategies to the risk and quality management of the organization. As much as health care providers strive to provide desired quality services, they still face some challenges. This may include doubt. In some cases, doubt arises in the event the healthcare provider cannot ascertain the possibility of a patient to give an informed decision. When a healthcare provider is faced with such a challenge, there is the possibility of a second opinion from a psychiatrist. (Kaplan et al, 2010)
In the same vein, another challenge can be seen when a patient tries to withdraw a consent which had been previously agreed upon. Any patient with the ability to make an informed decision, has the right to actually withdraw his or her consent untold, especially when the threat of death occurs. It is a serious challenge to determine the amount of information a patient should even know. Every healthcare provider is saddled with the responsibility of providing information to their patient, however, information provided should be weighed first, and also be enough to inform. There are stubborn patients who tend to refuse information and decides to make their own decisions based on their belief. This is also another challenge. Patients of this nature refuse the information given by the healthcare provider and thus, the healthcare provider has to act on the need to be informed. Moreover, dealing with adult patients that cannot make decisions on their own is another strong challenge. The healthcare provider should seek for alternative decisions at all time. Additionally, first aid must be offered regardless of the decisions given by the patient. Dealing with young people has shown that, many do not wish to involve their parents or guardian with their decisions. Emergency cases is another challenge, as healthcare provider must deliver imminent healthcare services regardless of any consent.
Conclusively, the manual has been able to highlight all aspects that deal with the provision of safe and excellent healthcare services. The provision of healthcare services must involve team work from different departments within the healthcare organization. Therefore, this manual offers the practical framework for the coordination of the healthcare, which is required to benefit the patient.
The Risk and Quality management Tools Used in the Health Care Industry
There are different approaches to risk and quality management in the healthcare industry. These tools were developed from the majority of medical errors that had occurred over time, and had been attached to the statement given by the Institute of Medicine, “to err is human.” The major tools employed in relation to risk and quality management are based on measurement. According to Ronda G. Hughes, measurement and benchmarks re very necessary to tackle he complexity of the health care systems and the delivery of services. And one of the major challenges in the use of measurement of the health care organization is based on the attribution variability related to high-level cognitive reasoning, problem-solving, discretionary decision-making, and experiential knowledge. The measure of quality and safety on the other hand, will help track the progress of the quality improvement programs based on the use of external benchmarks. Hughes defines benchmarking in the healthcare industry as the continua and collaborative discipline of the measurement and comparison of the results of the major work processes with the ones of the best performers in the evaluation of organizational performance. These tools include the Plan-Do-Study-Act (PDSA) model, six sigma, root cause analysis, failure modes and effects analysis as well as the health failure modes and effect analysis (HFMEA) tool for risk and quality assessment.
Risk and Quality Management Tool
Risk management tool performs the function of supporting the implementation and execution of any program risk management in the healthcare industry. The need for engaging health care providers (professionals) and staff in reporting errors for the purpose of reducing risk and then, improving the safety culture of the healthcare system is relatively important, but difficult in many organizations. In most cases, unless the members of the staff are engaged, free to talk, and are required to learn from the event of preventable medical errors, there will continue to be poor patient outcomes. Thus, the use of the risk management tools will help avert detrimental circumstances.
Quality Management Tools
Quality management tools can be referred to any chart, software, models, device, or technique that is required to support quality management efforts. The seven tools of quality include, the cause-and-effect diagram, check sheet, control charts, histogram, Pareto chart, scatter diagram, and stratification.
The Purpose of the Tool
- The cause-and-effect diagram identifies many probable causes for an effect or issues and then sorts ideas into reasonable categories.
- Check sheet is a structured, well prepared form for the collection and analysis of data; a generic tool that is adaptable or a large purpose.
- Control charts are graphs for the study of the changes of process over time.
- Histogram shows the frequency distributions, or how concurrent each value in a set of data occurrence is different
- Pareto chart is shown on a bar graph, and depicts he factors that are the most significant
- Scatter diagram is a graph pairs of numerical data, with one variable on individual axis, to check for a relationship
- Stratification is a strategy that divides data gathered from different sources for the patterns to be seen. Some lists are seen to replace stratification with run chart or flow chart.
- HFMEA is a model used to evaluate risks.
- The PDSA model is a method that is widely used for rapid cycle improvement
- Six Sigma involves the improvement, designing, and the monitoring of process for the purpose of eliminating or minimizing waste and optimizing satisfaction as well as increasing financial stability.
- The root cause analysis (RCA) is a formalized investigation and problem-solving approaches targeted at identifying and comprehending the causes of an event and potential events that intercepted.
Advantages of Root Cause Analysis
- RCA solves problems at their root, not just fixing the visible issues
- RCA digs into possible organizational changes, not just localized optimization
- It also uncovers the relationships between the causes, effects, and possible solutions
Disadvantages of RCA
- RCA requires frequently identifying more possible causal factors that anticipated
- It can include procedures that are not familiar with the particular health care organization
- It focuses on causes and does not give the interventions or operations that should best address the causal factors
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