Quality Management – Response

1. Cynthia

In healthcare, there are innumerable processes that are needed to provide patient care, perform business operations, and manage internal and external environmental factors. The manner in which these processes are carried out, can distinguish an organization from others in the marketplace both negatively and positively. Having processes means recognizing when there are opportunities and obligations for improving them.

At the heart of patient care and medicine is the level of quality at which it is provided. Langabeer and Helton (2021) define quality as the customer’s view of the amount of value provided by a business’s products and the degree to which the procedures and products measure up to the set requirements and standards (p. 89). Knowing what customers’ expectations are is beneficial, however, it may be unrealistic at times. For example, they may hear about the latest advancement in technology and expect their local health system to immediately purchase and make it available. They are unaware of the specific risks, benefits, financial commitments, or the demands placed on operations in order to incorporate it. If a system does not begin providing the latest technology, this can lead to patients feeling that the care provided is of less quality, which in reality, may not be accurate. Quality can be hard to interpret and gage since the meaning can be different for those who receive care versus those who provide it (Bergerum et al. 2020). Research has identified that systems where human life is dependent on its functionality within a multifaceted structure, that movements toward unsafe practices are more common since those involved like patients or healthcare providers work to make effectual changes that benefit their own subclass which leads to devastating outcomes for the entire system (Neumann & Purdy, 2023). This suggests that all groups must be part of any changes in order to prevent negative outcomes for those involved.

When quality or process outcomes fall short for either patients or healthcare workers, a standardize method for improvement should be implemented. There are several phases that make up process improvement methodology which include “plan and prioritize efforts, analyze and collect data, benchmark, de-bottleneck and deploy, then report and adjust as necessary” (Langabeer and Helton, 2021, p. 97).

With excellence in quality being a vital component of healthcare, there are key consumer or patient service level concerns that organizations focus on for value measurement and improvement efforts. These groups of concerns include what were the results of the care provided, how safe was the care provided, were any issues identified around finance, were there factors related to the staff and providers, and were there any administrative processes or building problems identified (Langabeer and Helton, 2021, p. 96).

Process improvement methodology when applied to patient safety can be particularly impactful in regard to service outcomes. When an issue has been identified that is affecting patient safety, like an increase in bed sores for example, following the process phases can lead to positive outcomes. The hospital can begin by prioritizing which departments have been most affected, what the costs and cost savings might be, and how quality and patient satisfaction will be affected. At this point, planning what factors to address could be identified along with who should be involved, a time limit for the review, and what the objectives are. These might include staff processes for turning patients or investigating if there are better mattress types available. Next, data could be utilized to show how many incidents have occurred, staffing levels, process steps, and what mattresses were in use. Benchmarking what other organizations have done to decrease bed sores is the next step followed by de-bottlenecking the processes currently used on the hospital floors and/or piloting the use of some newer mattress types. Finally, a report identifying the purpose and outcomes should be developed and any adjustments should be made if needed.

In the Bible it states, “The thoughts of the diligent tend only to plenteousness; but of every one that is hasty only to want” (King James Bible, 1769/2017, Proverbs 21: 5). We should not rush through the tasks we are delegated, but instead be diligent and seek the correct answers and solutions.

Bergerum, C., Engström, A. K., Thor, J., & Wolmesjö, M. (2020). Patient involvement in quality improvement – a ‘tug of war’ or a dialogue in a learning process to improve healthcare? BMC Health Services Research, 20(1), 1115-1115. https://doi.org/10.1186/s12913-020-05970-4Links to an external site.

King James Bible. (2017). King James Bible Online. https://www.kingjamesbibleonline.org/ (Original work published 1769)

Langabeer, II, J. R. and Helton, J. (2021). Health care operations management (3rd ed.). Burlington, MA: Jones & Bartlett Learning.

Neumann, W. P., & Purdy, N. (2023). The better work, better care framework: 7 strategies for sustainable healthcare system process improvement. Health Systems, ahead-of-print(ahead-of-print), 1-17. https://doi.org/10.1080/20476965.2023.2198580Links to an external site.

2. Whitaker

There are four primary phases in process improvement methodology (Langabeer & Helton, 2020). The first is Plan and Prioritize. This involves assessing organizational processes and prioritizing which to start with first based on returns on performance categories such as cost, satisfaction, or quality. Once the areas of improvement are prioritized, a plan can be formulated. Creating a plan requires gathering a team of specialists, establishing a quantifiable goal, and then allocating team members and resources to address each phase of the plan. The next primary phase is Collect and Analyze. This stage includes gathering all relevant data that will aid in successfully improving the process in question. Once key information is consolidated, performance is then monitored over a long duration. It is important to disperse data analysis over an extended period because it creates an understanding of how the overall process functions. Furthermore, it highlights deviations that would be otherwise missed if an isolated timeframe was used. The third phase is Benchmarking. After a process is thoroughly analyzed, benchmarking allows the organization to understand how its practices compare to industry competitors. This can be achieved by direct observation or second-hand, published data. The last phase of the process improvement methodology is De-Bottleneck and Deploy Pilot. As the name suggests, de-bottlenecking involves finding ways to reduce constraining variables and increase throughout. Finally, once all the previous process improvement phases and subphases are met, a pilot can be deployed. The use of a soft launch or pilot helps put all the work of process improvement to the test but in a low-threat environment. No matter if the pilot is a failure or a success, it provides the organization with a frame of reference for where to focus additional resources and is a critical aspect of process improvement. A supplemental process to the four primary phases is Report and Adjust. This should be ongoing throughout the process improvement methodology and 3-6 months after its implementation to provide documentation for future changes.

There is a slew of financial, logistical, and quality challenges that greatly affect how a customer or patient receives healthcare goods or services. In an ideal world, healthcare would be affordable, easily navigable, and high-quality. Unfortunately, “there is no one on earth who is righteous, no one who does what is right and never sins” (Holy Bible New International Version, 1973/2011, Ecclesiastes 7:20). In other words, as long as humans are operating a business, no matter the intent of it, there will be imperfections and areas for improvement. One of the most important factors in achieving operational excellence is the ability of an organization to have both robust and smooth logistical management. The patient triage process has been a continuous struggle across care settings and was majorly stress-tested by the COVID-19 Pandemic. Throughout the height of the pandemic, hospitals were often battling severe equipment shortages and an often unmanageable number of new patients (Wallace et al., 2020). Fortunately, this is not the normal operating condition for the average hospital. However, the pandemic did highlight some areas of opportunity for logistical improvement among hospitals. For example, many of the existing triage systems failed at efficiently handling large influxes of patients because the systems relied on laboratory data that may not always be immediately available. When handling a higher-than-expected patient volume, the system needs to be robust enough to adjust how quickly triaging is occurring.

To improve the triaging using process improvement methodology, planning and prioritizing should be focused primarily on reducing the intake time of new patients. An example of a goal to reduce intake times would be to reduce patient triage times by 30% from the first point of contact to care delivery. Once the goal was established, historical and present data on patient triage times would be collected. This would create a frame of reference for the past and current state of the hospital’s triage process. After the data is analyzed, it would then be compared to competitors to establish a benchmark. For example, if there is another hospital close by, attaining its triage times would help determine whether to follow its lead or make changes to the current plan. After these variables are considered, the process would then be de-bottlenecked. As previously discussed, bottlenecking is one of the main challenges facing the triage process. Using something such as a Smart Triage system, which has been shown to reduce time to treatment in certain populations would greatly help this phase succeed (Novakowski et al., 2022). Finally, the new process would be ready for piloting to determine the efficacy of the new triage process and smart system. After a successful pilot, full-scale deployment would follow with consistent reporting on progress and adjusting the new triage process as needed.

References

Holy Bible New International Version. (2011). Ecclesiastes 7:20 New International Version. https://www.biblegateway.com (Original work published 1973)

Langabeer, J.R., II., & Helton, J. (2020). Health Care Operations Management (3rd ed.). Jones & Bartlett Learning. https://bookshelf.vitalsource.com/books/9781284220575Links to an external site.

Novakowski, S. K., Kabajaasi, O., Kinshella, M. W., Pillay, Y., Johnson, T., Dunsmuir, D., Pallot, K., Rigg, J., Kenya-Mugisha, N., Opar, B. T., Ansermino, J. M., Tagoola, A., & Kissoon, N. (2022). Health worker perspectives of smart triage, a digital triaging platform for quality improvement at a referral hospital in uganda: A qualitative analysis. BMC Pediatrics, 22(1), 593-593. https://doi.org/10.1186/s12887-022-03627-1Links to an external site.

Wallace, D. W., Burleson, S. L., Heimann, M. A., Crosby, J. C., Swanson, J., Gibson, C. B., & Greene, C. (2020). An adapted emergency department triage algorithm for the COVID‐19 pandemic. Journal of the American College of Emergency Physicians Open, 1(6), 1374-1379. https://doi.org/10.1002/emp2.12210

Thread must include a biblical integration and 2 peer-reviewed source citations, in addition to the course textbook, in current APA format (3 sources and bible quote)

Course textbook :Langabeer, J. R., & Helton, J. (2021). Health Care Operations Management: A systems perspective. Jones & Bartlett Learning.