6231 quality imptovement
docx
keyboard_arrow_up
School
Walden University *
*We aren’t endorsed by this school
Course
6231
Subject
Health Science
Date
Feb 20, 2024
Type
docx
Pages
5
Uploaded by Clarina1
Quality Improvement in Healthcare
Quality improvement is a continuous cycle of attempts to improve care and achieve optimal outcomes. Johnson and Sollecito (2020) describe quality improvement as a continuous process of collaboration from a multidisciplinary team in planning, executing, and revising to improve the quality of healthcare. There are various models of quality improvement. The Agency for Healthcare Research and Quality (AHRQ) (2018) describes six domains of quality within the healthcare system proposed by the Institute of Medicine (IOM); (1) safe, (2) effective, (3) patient-centered, (4) timely, (5) efficient, and (6) equitable. The purpose of this discussion is to describe a healthcare experience and evaluate it for quality markers.
Professional Experience
The organization I work for is a smaller 111 bed hospital. In the 18 years I have been there, the organization has made vast improvements, and has received many recognitions for the efforts. More recently, the organization was one of only ten hospitals in California to be named by the Leapfrog Group for patient safety and quality care; ranking among the top 148 hospitals in the country. We are one of nine hospitals in the state to make all of the Cal Hospital Compare Honor Rolls; Maternity, Opioid Care, and Patient Safety. We also received an “A” grade from the Loan Institute in value, avoiding overuse and for cost efficiency; outcomes, clinical care, patient safety and satisfaction; and in social responsibility for health equity, value, and outcomes (MMC, 2022). However, we must be aware that this does not imply that every healthcare experience will be high quality.
I experienced a tragic situation in which a patient received low quality care. The patient was admitted for abdominal pain due to liver metastasis, and given a poor prognosis with not much time left. He was in his 40s with young children at home. He had recently been admitted
to the hospital a couple months prior, at which time the initial findings were discovered. He was to seek follow up care after discharge, but did not. This condition could have been easily treated
and resulted in a great prognosis.
There were many missed opportunities in which this situation could have had a better outcome. The findings and options were not made clear during the first admission. His understanding of the situation and urgency was not assessed. Not to mention the fact that he spoke little to no English. He was also discharged on the weekend so no follow up appointments
were made on his behalf; it was left to the patient to schedule. He was out of network so little was done to check in with the patient after discharge to clarify questions or address concerns. Anything that could have gone wrong with this event probably did.
Quality Domains
To an extent, all the domains of healthcare quality were absent in this situation. The care
that was provided was not necessarily unsafe, but what was not safe was the care that was not provided. There was no follow up care, which alone caused irreversible harm to the patient. The
patient did not receive effective care. The discharge instructions were not made clear to the patient. However, had they been, and if follow-up was confirmed, it is likely that the care would have been effective. Patient-centered care was absent. It is likely that the patient’s preferences were not followed because appropriate translation methods were not used to ensure understanding. Timely and efficient care was not carried out. I do not think lack of equitable care was much of an issue. Unfortunately, the events leading to this outcome could easily had happened to any other patient; despite the language barrier. References
Agency for Healthcare Research and Quality. (2018). Six domains of health care quality. https://www.ahrq.gov/talkingquality/measures/sixdomains.html
Johnson, J. K., & Sollecito, W. A. (2020). McLaughlin & Kaluzny’s continuous quality improvement in health care (5th ed.). Burlington, MA: Jones and Bartlett. K
MMC. Quality and patient safety: El Dorado County Hospital
. Marshall Medical Center. (2022). https://www.marshallmedical.org/about-us/quality-and-patient-safety/ Leslie,
Thank you for sharing; I appreciate you putting forth the effort to improve the quality of
care in your environment. I think the importance of behavior health can not be stressed enough.
I am not that experienced in the admission process for behavioral health however, I agree that
18 hours is not efficient, nor does it meet the timely domain of quality care. I understand that
there are things out of our control that can complicate the admission process, however the care
given in the first hours, or days has a tremendous effect on patient progress. Clark and Glick
(2020) explain that behavioral health is in a unique position to meet many key needs but often
miss out on opportunities due to the current care management model. They offer innovative
suggestion that can improve long-term outcomes.
I agree that frontline staff play a key role in quality improvement. Johnson and Sollecito
(2020) report that it is necessary to realize that frontline staff have a better grasp on their work
process than management. It is in everyone’s best interest that their knowledge is utilized in
quality improvement. This includes empowering staff to make desired changes, and ensuring
they have the tools to do so.
References
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
Alex Clarke and Ira D. Glick. (2020). The Crisis in Psychiatric Hospital Care: Changing the
Model to Continuous, Integrative Behavioral Health Care. Psychiatric Services 71
:2,
165-169
Johnson, J. K., & Sollecito, W. A. (2020). McLaughlin & Kaluzny’s continuous quality
improvement in health care (5th ed.). Burlington, MA: Jones and Bartlett. K
Paula,
Thank you for sharing. I can relate to the struggles of shifting from paper charting to electronic. My organization adopted EHR about five years ago. It was a trying process and we transitioned slowly, and department specific. Front line staff often create workarounds in regards
to electronic documentation by using alternative charting methods in order to provide safe, quality care. (Stevenson et al., 2018).
I understand the importance of real time charting and difficulties that can be associated with using a mobile work station while tending to patients. This can seem very cumbersome, especially during times when frequent charting entries are necessary. However, it has been shown that EHR improves quality in many domains such as efficiency, and availability (Ayaad et
al., 2022).
It is more than likely that you will be expected to eventually make the transition to electronic charting. I want to ensure you that if you have an efficient process that is user friendly
for the frontline staff that you will see the benefit without compromising the care you provide to your patients.
There is also technology available that can automatically upload monitoring information,
such as vital signs, directly to the EHR. The initial costs may seem to be high, but there are ways to show that the technology will pay for itself. If, or when, you do eventually fully transition to electronic documentation I suggest ensuring usability and that there is an efficient process in place for a smooth transition. It may be a stressful process, but you will appreciate it.
References
Ayaad, O., Alloubani, A., ALhajaa, E. A., Farhan, M., Abuseif, S., Al Hroub, A., & Akhu-Zaheya, L. (2019). The role of electronic medical records in improving the quality of health care services: comparative study.
International journal of medical informatics
,
127
, 63-67.
Stevenson JE, Israelsson J, Nilsson G, Petersson G, Bath PA. (June 2018). Vital sign documentation in electronic records: The development of workarounds. Health Informatics Journal. 2
06-215. doi:10.1177/1460458216663024