Quality Management The "Duke University Medical Center" (2005) website defines “quality improvement as a formal approach to the analysis of performance and systematic efforts for improvement”. Quality improvement programs are found in a variety of industries and are constructed differently. The medical field tends to use quality management to focus on patient and staff safety, reducing medical errors, and avoiding or decreasing morbidity and mortality rates.
Health care organizations have been attempting to improve the quality of care for as long as “the nineteenth-century when obstetrician, Ignaz Semmelweis introduced hand washing to medical care, and Florence Nightingale who determined that poor living conditions were a leading cause of death for many soldiers in army hospitals” (Chassin and Loeb, 2011 p. 559). When discussing the health care industry one of the top organizations that come to the minds of many are hospitals. Hospitals utilize quality management to achieve long and short term goals that improve the quality of care and patient safety.Quality improvement management programs are represented by different titles.
They have various concepts, influencing factors, and policies that are needed for the success of the organization. These components will be discussed throughout the paper. Key Concepts and Names of Quality Management Various terms represent quality management programs. Some examples are Continuous Quality Improvement (CQI), Total Quality Improvement (TQI), Quality Assurance (QA), and Quality Control (QC).The title of the program depends on the organization.
According to McLaughlin and Kaluzny (2006); “TQM more often refers to industry-based programs and CQI typically refers to programs designed for clinical settings” (p. 3). Hospitals are clinical settings, so they would title their programs Continuous Quality Improvement or just Quality Improvement. “Quality Assessments are planned systems of review and Quality Control programs are routine systems used to measure and control quality” (Ipcc, 1996).Performance Management programs can be considered quality improvement programs depending on the facility, but are often part of an overall strategic performance plan that is connected with quality management. Key concepts of quality management include improving quality and patient safety; linking quality improvement to strategic plans; preventing and controlling infections; managing private information; analyzing current processes and implementing new processes for improvement; and providing training and education for staff.
According to McLaughlin and Kaluzny (2006); “organizations embark on CQI for a variety of reasons, including accreditation requirements, cost control, competition for customers, and pressure from employers and payers” (p. 6). The primary goal for quality management in hospitals is to improve quality of care and patient safety and the representation of providing quality care is achieving and maintaining accreditation standards. Long-term and short-term quality improvement goals Part of the quality improvement process is to set, work toward, and reach short-term and long-term goals associated with quality improvement.One long-term goal of health care is to have a “high reliability” organization. According to Chassin and Loeb (2011); “high reliability organizations are those that maintain a consistent performance at high levels of safety over a long period of time” (p.
563). This goal begins with assessing the organizations current state and the assessments can be considered a short-term goal for health care organizations. Another long-term goal of health care organizations is to develop a culture of safety.This can be achieved by setting short-term goals such as education and training for staff.
“Organizations rely on a particular culture to ensure the performance of improved safety processes over long periods of time and to remain constantly aware of the possibility of failure” (Chassin and Loeb, 2011). If organizations are constantly aware of the possibility of failure, they can prevent failures before they become an issue. The third long-term goal of a health care organization like a hospital is remain compliant and achieve and maintain accreditation.This can be achieved through other long and short-term goals.
If the short-term goals of self-assessments, education, and implementation of quality improvement processes are put into place, the organization can be successful with their quality management program. Upper-level management will need to address this success and work to ensure that the policies and procedures put into place are maintained. Internal and External Factors that Influence Quality Outcomes Various internal and external factors influence quality management and outcomes in hospital organizations.One internal factor that affects quality management and outcomes is leadership within the organization. Leadership is important to have successful quality management outcomes because if the leadership does not support it, no change within the organization will be successful. “This commitment must be shared by the board of trustees and all senior clinical and administrative managers and understood that it is a long-term process” (Chassen and Leob, 2011).
Leadership is one of the most influential internal parts of the quality management program.Leadership can either help the organization succeed with their support or help the organization fail if they do not support and follow through with the process. Another internal factor that influences quality management is utilization review committees. According to Chassin and Loeb (2011); “utilization review committees were established to identify whether hospital medical staffs were providing appropriate clinical services and to prevent fraud” (p.
560). These utilization committees were put in place as a Medicare requirement.This internal factor did not positively affect the quality of care because there were no formal guidelines. An external factor that influences the quality of care for organizations is the Office of Clinical Standards and Quality at the Centers for Medicare and Medicaid Services. According to “Centers for Medicare and Medicaid" (2011), “They identify and develop best practice techniques in quality improvement and they develop requirements of participation for providers and plans in the Medicare and Medicaid programs. (Office of Clinical Standards and Quality).
The CMS Office of Clinical Standards and Quality can either have a positive or negative affect on health care organizations success with quality improvement management. If the organizations work well with the department, they could actually be a resource to the organization, but if the organization does not work with them and is not compliant, it could harm the organization. Another external factor that influences quality outcomes is the Institute for Healthcare Improvement (IHI).The Institute for Healthcare Improvement is “and independent not-for-profit organization that focuses on motivating and building the will for change; identifying and testing new models of care; and ensuring the broadest possible adoption of best practices” (Institute for Healthcare Improvement, 2011, para.
1). The Institute for Healthcare Improvement has programs designed with ideas and techniques to enable individuals to work together, share knowledge, and improve quality health care. This organization is committed to improving quality outcomes and is involved with a multitude of health care settings including hospitals.Accrediting agencies such as Joint Commission can be stressful for hospitals and other healthcare organizations, but they are beneficial to the quality outcomes for patients. The joint Commission was established in the 1990’s.
“The Joint Commission performs external peer assessments of processes, policies, and procedures of health care organizations” (Agarwal, 2010, para. 4). Obtaining accreditation is a great accomplishment for organizations because the accreditation symbolizes higher quality of care for patients. Accreditation has many benefits for health care organizations such as providing them with a competitive edge, strengthens community confidence, improve quality and risk management, and strengthens the organizations culture of safety for patients and staff” (Argwal, 2010, para.
4). Fundamentals of Quality Management Policies Quality Management Policies are essential to the success of the quality management program for the organization. Details involved with the construction of the quality management policy should be covered in depth throughout the policy and should ensure a clear definition of expectations and goals.According to the “Epa.
gov” (2001) website; “certain information requirements are to be included in the content of the quality management policy” (p. 9). Quality management policies should include “a definition of the organizations mission; description of specific roles, authorities, and responsibilities of management; clear description of the appropriate means of communication; outline of processes used to plan, implement, and assess the work involved with quality management with a description of how information will be measured; and a plan for continuing education” (Epa. ov, 2001, p. 9).
These requirements are needed so that management and staff have an understanding of what is expected of them and the organization to have positive quality outcomes and to minimize risks. If staff are focused on providing quality care and reducing risk, health outcomes will primarily be positive. The Relationship between Risk Management and Quality Management “As the risk management and quality improvement functions in hospitals focus on patient safety initiatives, professionals from both fields indicate that their activities overlap” (ECRI Institute, 2009, p. ). Since the goals of both risk management and quality assurance programs have shifted toward the improvement of patient safety through system analysis; risk management and quality improvement programs in the hospital setting overlap resulting in the risk manager and quality manager having to work synergistically to identify and eliminate any quality issues that may harm patients.
Providing safe, quality care to patients decreases the risk of litigation to our hospital.These two disciplines work together to improve performance management by educating and training staff on quality and risk management. They educate staff on how to identify, correct, and prevent quality issues that ultimately protect the patient. Conclusion Quality management programs are essential to health care industries because the focus on establishing and maintaining a culture of safety for patients and staff is paramount to the success of the organization.Quality management programs are complex because they are constructed with various concepts, influencing factors, and policies.
Regardless of the organization type a quality management program is established in, the complexity is very much the same and the benefits of a successful quality management program are imperative to patient and consumer care.
References
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