Improvement In Health Service Number Essay
Theimprovement of a country’s is an essential tool towards theprovision of quality and adequate health services. In the UnitedKingdom, the functioning of National Health Service and thecontribution by NICE has been detrimental in the realization of thehealth services quality and outcomes framework.
- Key issues for quality improvement in the NHS quality-improvement program as it goes forward
Thekey issues for quality improvement in the NHS-quality improvementprogram that needs to be changed include the issue of racial andethnic variations. Improvement In Health Service Number Essay. This is one of the aspects that needs to beaddressed in order to make sure that the National Health Systemremain on course to become one of the best in the country. Inaddition, another aspect that needs changing is adoption of theelectronic way of record keeping. Moreover, other key issues forquality improvement in its moving forward plan entails clients’safety, effectiveness, equitability/accountability, as well asbecoming patient centered and timeliness (McLaughlin, Williams &Johnson, 2012).
- Strengths and weaknesses of the effort to improve the development of QOF indicators
Despitethe implementation of programs to achieve the desired improvements,the efforts enacted have both strengths and weaknesses. One of thestrengths is that, the program has actually improved the quality ofhealth care available and accessible to the public. In addition,patients are receiving improved attention, as a result of improvedservices through effective monitoring. Additionally, the program hasbeen effective is making health services available to the majority inthe country, and collaboration between the NHS, and NICE has beenproductive. However, despite the achievements or the strengths, theprogram has had its shortcomings. One of the key weaknesses of theprogram is the efforts to use financial incentives haven’t not beeneffective to the maximum in the improvement of healthcare outcomes(McLaughlin, Williams & Johnson, 2012).
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References
McLaughlin,C., Williams, S., & Johnson, J. (2012). Implementing continuousquality improvement in health care: A global Casebook. Sudbury, MA:Jones & Bartlett Learning.
This paper will cover the quality improvement process in healthcare. It will also focus on the similarities and differences between the quality improvement plan processes that the Department of Veteran Affairs (VA) followed, against the quality improvement plan process listed in the book.Improvement In Health Service Number Essay. The VA Hospital wanted to establish a quality improvement plan that would allow them to expand services and improve the quality of care being provided. The quality improvement plan must work in conjunction with the strategic plan in achieving the same goals for the organization. Managers can develop a quality improvement program to measure levels of performance.
The relationship between the concepts in the book and the plan that was obtained on the VA’s improvement plan in quality of care has provided insight on how the VA uses the same concepts that have been around for years. They have structured these concepts to fit their patient population. Their patient population consists of veterans who have suffered from traumatic and psychological injuries from serving their country. The Veterans Health Administration, the second largest government-operated health-care system in the United States, has been actively engaged in quality improvement activities since 1990 (Rand, 2005). These activities have been implemented on both a system-wide and facility-specific basis. Some quality improvement efforts have been targeted to specific clinical services; others relate to the overall process of providing patient care (Rand, 2005). The VA uses the same quality management concepts that W. Edwards Deming had instilled.
Below there is a list which shows the process that the VA uses in managing quality improvement.
The VA finds a process to improve.
The VA organizes teams that know the process.
The VA clarifies current knowledge of the process.
The VA understands causes of process variation.
The VA selects the process improvement.
Below there is a graphical representation of the process that the VA follows.
Are there similarities?
There are similarities in the process that the VA uses and the one displayed in the book.
Are there differences?
There are no difference between the plan that the VA uses and the plan that is explained in the book.
The following paragraphs describe the features in the plan with the concepts in the book.
The Quality Improvement (QI) Program is designed to provide a formal ongoing process by which the health plan, participating providers and practitioners utilize objective measures to monitor and evaluate the quality of clinical and administrative services, provided to patients.Improvement In Health Service Number Essay. A quality improvement plan addresses both general medical and behavioral health care and services, defines and facilitates a systematic approach to identify and pursue opportunities to improve services and resolve identified problems. Healthcare providers must establish outcome measures to determine how they are going to monitor treatment effectiveness (McLaughlin & Kaluzny, 2006). There are three areas of care that managers can measure. The areas are structure, process and outcomes.
The first level of care that is stated in the book is structure. Structure is the resources available to provide adequate health care. VA hospital’s have an organizational structure that many other hospitals can replicate. The first phase of the Department of Veteran Affairs quality improvement plan was the introduction/purpose. The introduction/purpose explained why the VA wanted to improve the quality of care an services they were providing. Managers at this facility wanted to design a plan that provided a framework to systematically assess, evaluate and improve structure, process and outcome related to activities both in care and services. In order to accomplish this task managers will have to ensure there is a collaborative and interdisciplinary effort among VA healthcare providers. It is critical that managers allow staff to have input on the quality improvement plan as their recommendations can benefit the organization as well.
The second level of care that is stated in the book is process. Process is the extent to which professionals perform according to accepted standards. The Department of veteran Affairs hold their employees to the highest ethical and professional standards. VA medical employees follow a chain of command to ensure there is communication at each level. In order to implement the highest standards of care the VA has teamed up with Joint Commission. An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 17,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards (Jointcommission, 2010). VA medical centers work in conjunction with Joint Commission to ensure they are providing quality service to veterans. Improvement In Health Service Number Essay.
Joint Commission employs surveyors who are experts in their related healthcare field. These surveyors are responsible for conducting surveys of the various VA medical centers. There are various surveys conducted to measure the level of care the VA is providing. Joint Commission lets the VA know areas that are weak and may need reorganization to ensure quality care is being provided. The documentation of these processes will allow organizations to gather data that will be relevant in determining whether they are providing quality care. Processes are generally documented in patient records. Since the VA has a computerized record system they are able to track different types of data.
The third level of care that is stated in the book is outcomes. Outcomes are changes in the patient condition following treatment. The VA prosthetic department has been looking for ways in which the can measure the outcome of veterans receiving artificial limbs. VA staffs are required to follow up with patients that receive limbs to ensure they are effectively using the limb. The VA has done a remarkable job in documenting outcome measure in the veteran’s record. VA hospital mail surveys to patients so that they can provide veterans with questions that will help the surveyors determine the outcome measure for the level of care the veteran received. The overall goal of outcome measures is to provide data on quality of care.
Healthcare organizations currently demand information on cost, quality and outcomes as they negotiate contracts. In order to provide quality care organizations must negotiate contracts that will provide them with the quality products and service they need to provide patients with quality services. As new benefits were added, it was necessary to analyze whether they were worth what they cost. In some cases, it was necessary to evaluate the performance of providers in order to decide whether to offer certain types of care at medical facilities. Quality improvement in the health care industry can best be defined by examining the driving forces that are affecting the industry.Improvement In Health Service Number Essay. The evolution of health care in this country is driven by a single purpose. How can health care organizations lower cost, raise quality, and still remain competitive? The implementation of patient-focused quality improvement programs are at or near the top of the list for the Department of Veteran Affairs in their efforts to lower cost (Rogers & Joyner, 2010).
Health care managers must have a way to measure patient satisfaction. There are various ways in which patient satisfaction can be measured. It is critical that managers get feedback from patients on the service or products they have received. One question we must ask is how should we measure patient satisfaction? First managers will need to understand the purpose of measuring patient satisfaction. Measuring patient satisfaction helps us to identify patients’ expectations. Expectations are important because patients’ judge the quality of the care they receive based on their internal standards of what defines quality. These internal standards are based in expectations. In addition, it allows us to learn about patients’ perceptions of our service. By understanding their expectations and perceptions, we can begin to bridge the gap between how health care providers and patients define quality service (Tarantino, 2004).
In conclusion healthcare managers that use the quality improvement process should focus on satisfying their internal and external customers. The satisfying of their internal and external customers can not be accomplished without the guidance and leadership of management. Management must communicate their expectations to junior level managers. Mangers must understand that the main goal of the organization is to provide quality services to patients and employees. Improvement In Health Service Number Essay. When managers take care of their employees, employees will be motivated in taking care of patients. Quality improvement activities emerge from a systematic and organized framework for improvement. This framework, adopted by the hospital leadership, is understood, accepted and utilized throughout the organization, as a result of continuous education and involvement of staff at all levels in performance improvement (Businessballs, 2009).
Quality management in general sense is a major area in all customer oriented businesses and any degrade in the quality would tamper the image of the organizations and definitely there would be a reduction in the customers. It is actually defined s the ability of an organization to satisfy the actual needs of the individuals and stakeholders at minimum cost of resources.
This is an assignment mainly focused on the area of quality improvement in health and social care sector. In the perspective of health and social care sector, Quality is defined as the level of services in the health and social care enhances the outcomes of health. The regular changes and strategies that are introduced to improve the quality of health services is termed as the quality improvement and the various government legislations, guidelines and health programmes that are put into action are the agenda of quality improvement. The strategies have the main motto of improving the service quality in the health care for the patients and their respective families
Quality improvement agenda is the main subject discussed in the first section of the assignment which covers the details of almost all white paper publications, reports, bills and act. In the second part of the assignment, the author analyzes a nursing care organization in regard to the various improvements made according the quality agendas discussed in the previous section. In the final section, suitable theory and model are analyzed to overcome the quality defects in the organization and implement suitable efforts to improve the quality. Improvement In Health Service Number Essay.
TABLE OF CONTENTS
Introduction
Consistent improvement in the quality of service is the most required component for businesses that are completely customer oriented particularly in health and social care. The customers or patients of all categories should be treated with utmost care and ensure that their needs are satisfied completely at right time (Protzman, Mayzell, & Kerpchar, 2011).
The recent economic downturn forces most of the businesses to respond with certain indiscriminate cuts. But the cost cutting technique is not suitable for the health care sector. Instead the health and social care organizations would adapt quality service and improvement to make the healthcare organization more efficient, safe, effective, timely service to the customers and patient centred. Therefore to meet the current trends the health departments of UK have developed new quality standards for NHS which necessitates certain changes in service and staff to promote continuous and dynamic quality improvement.
There is a crucial need for improving the quality service of health care sectors in the current environment. An assignment is planned to analyze the subject thoroughly using different models and theories and suggest suitable strategies to enhance the quality in the health and social care organizations. The assignment would be divided into three different parts.
The first section is an evaluation of quality and service improvement agenda in NHS, UK
The second section deals with the impact of quality and service improvement in one of the nursing and care organization
Analyze the relevant theories and models to produce necessary recommendations and suggestions in appropriate areas to improve the quality
But before analyzing the assignment, the author would like to bring clear definition for quality, quality improvement and quality improvement agenda.
Quality, Quality Improvement and Quality Improvement Agenda
Quality in the perspective of health and social care sector is defined as the extent to which the health services offered increases the probability of required health outcomes (Chisholm-Burns, Vaillancourt, & Shepherd, 2008) and maintains the consistency to the latest professional knowledge. Improvement In Health Service Number Essay.Quality comprises six dimensions which are
Dimensions of Quality in HealthCare
Figure 1: Source: Made by Author (2013)
Safe: No harm is caused to the patients from the treatment offered to them
Effective: To offer services based on scientific knowledge that gives exact benefits
Person-centred: To offer necessary care appropriate to the needs and values of the individuals
Timely: To eliminate waits and delays (Caldwell, Butler, & Posten, 2009)
Efficient: To eliminate wastes
Equitable: To offer services equally to all regardless of income and wealth
Quality Improvement is defined as the systematic changes, methods and strategies implemented in the above mentioned dimensions to enhance the quality and ensure better patient experience and health outcomes.
Quality and Service Improvement Agenda according to this assignment is referred to the different policies, guidelines, health programmes, Government legislations and other improvement strategies implemented to improve the quality of service offered to the patients, their families and other related individuals in Health and social care sector (Turnock, 2008). Improvement In Health Service Number Essay.
Development of the quality & service improvement agenda in health & social care – A critical analysis
The first task would be in a form of a literature review which thoroughly evaluates the working of National Health Service, the world’s leading publicly funded health service popularly referred as NHS and its agenda of quality and service improvement
Introduction to NHS
Established in 1948, National Health Service, NHS is the world’s largest publicly funded health service and has the main objective of providing good healthcare to all, irrespective of income and wealth.
National Health Service (NHS) is the name shared by four publicly healthcare systems such as National Health Service, England, Health and Social Care in Northern Ireland, NHS Scotland, and NHS Wales. Though all four systems are funded centrally from the general taxation they are managed individually (NHS, 2010).
Except for certain unique prescriptions, optical and dental, NHS services are totally free for UK residents. Improvement In Health Service Number Essay. Any type of treatment from an ordinary coughs and cold up to a complicated heart surgeries and emergencies, NHS offers almost all advanced medical services. More than 62 million of patients have been treated so far.
1.2 Structure of NHS
The Secretary of State for Health is in the top hierarchy of the structure of NHS. This person is the Government minister of Health department and takes utmost responsibility for NHS and reports to Parliament. Next level is the executives of department of health and NHS responsible for strategic planning for NHS under which there are 28 Strategic Health Authorities responsible for planning the necessary healthcare for their appropriate regions. Health services are divided into Primary Care and Secondary Care. GPs, pharmacists, dentists, opticians and other regular services which are demanded often are categorized as Primary Care. On the other hand, certain specialized services that are used occasionally are termed as Secondary Care.
These services are offered by large number of NHS organizations called Trusts.Improvement In Health Service Number Essay. The trusts providing secondary care such as hospitals, ambulance etc is known as NHS Trusts and those offering Primary Care are Primary Care Trusts (White, 2010).
Organizational Structure of NHS
Figure 2: Source: Made by Author (2013)
1.3 Past Developments in quality and service improvement agenda in NHS
The various studies that were made on NHS two to three decades back pointed out that there was lack of responsibility in the management in regard to the quality improvement and maintenance. The organization managers focused only on financial matters and performance targets. There were only very few attempts made to improve the quality during 1990s and it included
Doctors were ordered to participate in medical audit in 1989 which was not in practice earlier
The 1991 patients charter, the Government document which declared various rights for the patients of NHS in areas such as general practice, hospital and community treatment, ambulance services, optical, dental, pharmacy and maternity (Silver, 1997).
The various white paper publications and community care reports have analyzed the problems of NHS and had made relevant changes in the structural pattern and policies to enhance the quality in NHS in a very short time. Improvement In Health Service Number Essay. The study of these publications and reports would assist to understand the developments made in NHS in regard to quality improvement. Some of the popular white paper publications and other government documents are discussed in the further sections.
1.3.1 The Griffiths Report: ‘Community Care: Agenda for Action’: 1988
This is a report prepared by Sir Roy Griffiths during the period when NHS faced various problems. Griffiths after an in-depth analysis came out with comments stating that NHS was lacking effective leadership management which was very essential for quality. Further to this the whole system of community care was analyzed by Griffiths and in 1988 a report was developed by him called “Community Care: Agenda for Action”. Griffiths proposed to sort out the area which included dependent groups such as older people, disabled and mentally ill (Tanner & Harris, 2008). The report had six recommendations to be put into action immediately:
Requirement of appropriate ministerial authority to implement the policy
Local authorities such as social work, service departments should have he responsibility to maintain long term and continuing care. On the other hand, the health boards should take responsibility of primary and acute care
Necessary grant from Central Government
The activities that have to be implemented by social service departments have to be specified after assessing the care needs of various localities. Improvement In Health Service Number Essay.
Flexible packages have to be designed based on the care needs for the senior residents
Collaboration between social departments and voluntary/private sector of welfare
Social services should take the responsibility of registering the residential homes
1.3.2 Working for Patients: 1989
The proposal of clinical audit was introduced in the white paper “Woking for Patients: 1989”. The main aim of the proposal is to create appropriate conditions that would make the clinical audit a regular practice for professionals thereby leading to improvement in the quality (Parliament.uk, 2010). Nearly £218 million was spent during the period 1989-90 and 1993-94 for the purpose of introduction and development of clinical audit in NHS. An additional £61 million was funded again in the period 1994-95
1.3.3 White paper ‘Caring for People’ 1989
This white paper published in the year 1989 is a response for the report of Griffiths Caring for People and also a supplement for the Working for Patients as both had the same views which are:
State provision was inefficient
The purchaser and provider roles was separated
Decentralization of budgetary control
The white paper supported and followed the recommendations laid down by Griffiths report but recognized six different objectives
New funding structure
The responsibilities of agencies have to be clearly defined
The management of care and needs assessment should be developed (Renwick, 1996) Improvement In Health Service Number Essay.
Domiciliary, day and respite care should be encouraged
1.3.4 The NHS and Community Care Act 1990
After the publication of the above mentioned white papers and reports, the UK government set out legislation to administer the health care and social of National Health Service. The legislation was laid down to assess the needs, conditions and requirements of the patients and provide appropriate care services. Additional to this, the act also established an internal market to supply the healthcare and make the state an enabler (Trauer, 2010). It was also pointed out that the local authorities should take the prime duty of assessing the people in regard to social care and support which would guarantee required services for those who require the community care or other service support. The results of the assessment of the needs and conditions assist the local authorities to identify whether the individual require care service or social service.
The main objectives of the act are as follows:
To restructure the NHS
To improve the quality in health care and services
To improve the health through health promotion and diseases prevention programs (White, 2010)
Provision of more information to users
Signing of contracts with GPs, opticians and dentists
To bring up individual care plan for patients and other users
The act and NHS together modified the structure and divided the role of local and health authorities. This was done to evaluate the needs of the local population and then make intend to purchase the services from providers.Improvement In Health Service Number Essay. The health organizations to develop as providers should become NHS trusts. The community care act has given along term care for the people either in their own place or residential homes
1.3.5 The new NHS: Modern and dependable – White paper
In 1997, the new Labor Government brought new changes and amendments of NHS and announced through a white paper, The New NHS: Modern and dependable which specified a modernized strategy to bring improved quality of patient care in NHS for a period of ten years (Gralton, 2000). The paper also elucidated that each and every staff of NHS should take utmost responsibility in improving the quality. This white paper also introduced a new concept called Clinical Governance.
Clinical Governance is a key component in the health and social care organizations which ensures that quality is at the first step of organizations’ objective. It is referred as a systematic approach to enhance and maintain the quality of care within the health system. Formerly the approach was developed by National Health Service, UK defining it as a structure through which the different organizations of NHS are responsible to ensure continuous improvement in the service quality and maintain high level of standards and create excellent clinical care environment.
Attributes of Clinical Governance
Figure 3: Source: Made by Author (2013)
Adding to the above, the white paper included six major aims declared by the department of Health. They are
The NHS should be renewed as genuine national service where the patients would get the consistent and best treatment of highest quality at right time
Doctors and nurses should deliver the services according to the latest standards (Blaber, 2012) Improvement In Health Service Number Essay.
NHS should work in partnership by developing links with local authorities to eradicate the barriers that hinders the quality improvement
NHS should adapt rigorous approach to drive efficiency
NHS should re-establish the public confidence
1.3.6 A first class service: Quality in NHS
The following year after the publication of White paper The new NHS: Modern and dependable, another consultation document “A first class service: Quality in NHS” was defined and pointed out that there would be consistency in the quality set by the standards through National Service Frameworks and National Institute for Clinical Excellence (NICE)
1.3.7 The NHS Plan: A plan for investment, A plan for Reform
This is a document published in July 2000. A team headed by Tony Blair developed a work of Modernizing and reforming the NHS and this was included in the document. The document included certain major policies and they are:
To ascertain that the number of doctors, nurses and medical students are increased
The consultant should put seven years of their service with NHS
To take a commitment of expanding the health care services by opening 100 new hospitals and adding 8000 bed spaces by another 10 years
Patients should be able to access GP’s within 48 hours
Waiting Lists proposals should be replaced as Booking Systems
To create a new level of primary care trusts to bring about effective relationship between NHS and Social services (Department of Health, 2010) Improvement In Health Service Number Essay.
The policies laid down by the document modernized the NHS by increased strength of staff.
1.3.8 Care Standards Act 2000
Passed in July 2000, this is an act of parliament that brought certain modifications in Registered Home Act, 1984. The major aim of the act is to examine thoroughly whether the services are delivered with utmost care. Another objective of the act is the registration of children’s homes, independent clinics, care homes, and other bodies offering health and social care services (Dening & Milne, 2011). The act to accomplish the above objectives incorporated certain changes.
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Local authorities should operate the functions with the same level of private healthcare service providers.
Setting up of National Care Standards commission to monitor the functioning of nursing and care homes. Improvement In Health Service Number Essay.
Launch new standards for National Minimum care
Effective coordination between the Institution of Social Care Council and individuals of social care
The setting up of standards, extension of regulatory functions and registration of care homes implemented in the act brought tremendous quality improvement.
1.3.9 Delivering the NHS Plan – Next Steps on Investment, Next Steps on Reform
This is a policy document supplementary to the 2000 White Paper The NHS Plan and summarizes the necessary steps to be taken to deliver the various reforms planned in the white paper. The document addressed various issues and suggested appropriate reforms to eradicate the issues.
Reduce the waiting time for surgeries
Decrease in deaths due to cancer and cardiac problems
Employ additional staffing
Stress the importance of training for staff
Motivate the trusts by offering incentives
Setting up of NHS Foundation trust for better flexibility in the management (Crisp, 2011) Improvement In Health Service Number Essay.
Improve the relationship between health and social services especially the care homes of senior citizens
Setting up of one independent inspectorate to manage and control NHS and private organizations
1.3.10 Health and Social Care (Community Health and Standards) Act 2003
The act put an end to National Care Standards Commission and Commission for Social Care Inspection (CSCI) was replaced. The act made changes and improvements to Care Standards Act 2003. The act described appropriate functions and powers for CSCI. Additional to these, the act also dealt with various functions of boarding schools, colleges and training centres. The different grievances on social care were dealt and provided relevant regulations to handle the complaints.
The major amendments made by the act are:
NHS Foundation Trusts were created
Independent health care regulator for set up
Establishment of Commission for Health Care Audit and Inspection (CHAI) and Commission for Social Care Inspection (CSCI) (Health and Social Care , 2003)
Legislation for compensation payment
Proviso for altering Welfare Food Scheme
The proposal accelerated the standardization of practice and service in Health and Social Care. The concept of self-government in Foundation Trusts was initiated and privatisation, marketing and variability of service were encouraged. Improvement In Health Service Number Essay.