Quality improvement in healthcare

Answer the following 3 questions :

• (1)-Some physicians perceive CQI and/or healthcare management process improvements as a challenge to their personal and professional autonomy. If you are working with physicians who perceive these as challenges, how might the management/ leadership team be successful at creating sustainable changes? Would physicians resist these changes?

———————————————————-

• (2)- What impact might that have on quality using a clinical or operational example, map 5 of Donabedian’s 7 attributes to the process and/ or outcome of the process? Give a direct example of how a clinician or the process demonstrated each of the 5 attributes.

——————————————————————–

• (3)-Deming is known for the “14 points”. Discuss how any 3 of Deming’s 14 points relate to the following frameworks for defining quality. Note you can use the same 3 points for each of the following or use the different ones, it is up to you.

 (3) A-   Porter’s definition of value,

(3) B-    The IOM’s six aim

(3) C-   Give concrete examples to support your discussion

Achieving the triple aim in Abu Dhabi (or your area) would include: increasing patient experience, improving health, and decreasing costs. Examples of how this might be achieved could include reducing wait time for appointments, reducing non-urgent ER visits, increasing self management of asthma, increasing preventative screenings, increasing the number of insured, reducing duplicative or unnecessary procedures, etc.

•  How would you measure the current state of Abu Dhabi (or your area), or your community, with respect to achieving the Triple Aim? Specifically, select at least one measure for experience, one for access and one for cost. Note, your data measures need to be reactive to changes so that we can determine (relatively quickly) if there are trends due to changes in processes.

Solution

Quality Improvement in Healthcare

Leadership/Management Success at Creating Sustainable Changes

            Continuous quality improvement changes are necessary to any healthcare institution to ensure to reduce or eliminate challenges that exist in the field. However, implementing the CQI strategies is usually a problem that demands careful approach for any success to be realized. One of the most common challenges encountered in the implementation process is the unwillingness of some or all of the physicians to participate in the process. Physicians are an integral part of CQI strategies, and their failure to cooperate can sabotage the whole program (Djuricich, 2007).

            Physician perceiving CQI programs as a threat to their professional and personal judgment will always resist CQI approaches and in some instances will not spare efforts to thwart them (CQI projects). The physicians are expected to oppose the program, and hence proper strategies need to be used to ensure they participate in the programs as expected for success to be realised (Djuricich, 2007).

            Implementing the CQI methods in an environment where the physicians perceive them as a threat to their personal and professional judgment requires different strategies. One of the approaches that are very vital is explaining the importance of the CQI programs to the physicians highlighting how they are going to benefit. The leadership/management team will have to explain to the doctors the uniqueness of the program from others that have were implemented before if any to ensure that they change their perception (Djuricich, 2007).

 Including the physicians or people who understand their challenges in the program management teams is imperative because they can identify points, which might cause problems in the implementation regarding the doctors. When the points of conflicts are identified then, solutions can be formulated to modify the program to conform to the physicians’ requirements if possible. The physicians are also critical in the identification of the quality improvements opportunities and formulating solutions so that they can own the program (Djuricich, 2007).

 Identifying champions is another technique that the management team will utilize in the implementation of the CQI strategies is the identification and nurturing of leaders and champions. CQIs require dedicated leaders and heroes for it to function properly without much resistance. Medical directors, CEOs and people involved in the physicians’ leadership need to be involved so that they can motivate their juniors to come aboard and ensure that the environment is conducive for the project.

            Setting of short-term goals and celebrating the successful achievements is another strategy that will help to convince the physicians to support the program. The physicians should be able to see the immediate effects of their efforts. Newsletters, posters, prizes, and parties are some of the methods that are applicable in illustrating and acknowledging individuals achieving improvements. Competitive physicians are specifically motivated by comparisons with their colleagues. Accurate tools will be required to measure the attainment of short-term goals (Djuricich, 2007).

            Implementing appropriate and working communication channels is also a technique that the management team will consider in the CQI program. Physicians should be able to make complaints and suggestions so that they can be able to feel a component of the process.

                Use of the techniques discussed above will be able to convince the physicians to participate in the program. The CQIs will obviously be a success with the doctors’ cooperation and other necessary factors working properly (Arch Pathol Lab Med., 1990).

Sustainable Changes Impact on Quality

            The continuous quality improvement programs will create lasting changes in the health care. When the doctors understand the uniqueness and the benefits of a CQI, the chances are that they will embrace the program leading to its success. The success of the programs will improve the quality of overall care. This impact is similar to the Donabedian efficacy attribute that advocates for the overall quality improvement of healthcare (Arch Pathol Lab Med., 1990).

 Setting of short-term goals and working towards achieving them successfully will improve the quality of healthcare immediately and in the future. Achievements of the short-term goals will leave the quality of care at a better position than before. Improvements can be regarding the quality of service or the number of people a service reaches. The impact directly relates to Donabedian effective attribute that emphasizes on increasing the number of people reached by an individual service (Djuricich, 2007).

            The motivation of the doctors by the short-term goals will invoke a competition between the physicians. The competition will ensure that the doctors are working at their best and hence achieving the best possible results. The physicians will hence attend to more patients with improved quality of services. The impact of this technique is directly related to the Donabedian optimality attribute that focuses on the ability of duty to provide the best possible results (Djuricich, 2007).

            The achievement of the short-term goals will motivate the doctors to participate in the program hence leading to long-term goals achievements. The long-term goals include improving the experience of patients and increasing the number of people a specific service reaches. This impact relates to the Donabedian effective attribute that focuses on increasing the number of patients benefiting from healthcare. The effect also refers to the efficacy attribute of Donabede that emphasizes on overall improvement of healthcare.

 Identifying and nurturing of champions will improve the implementation of the CQI strategies. The techniques target medical directors, CEOs and other people involved in policy formulation and implementation. Involving these people will ensure that the CQI strategies focusing on the caregivers’ availability are designed and implemented in a manner that reduces costs. The technique will lead to the availability of caregivers and a reduction in services costs. The Donabedian attribute that focuses on such results is the acceptability attribute (Djuricich, 2007). 

 Implementing appropriate communications channels will ensure that the physicians can make suggestions and complaints. The technique will make the doctors feel a part of the CQI hence contribute desire to see it succeed. Using the channels, doctors will make suggestions that will improve the quality of services and reduce costs because they own the program. This technique will lead hence to services that use lesser costs but reaches a larger number of people. The achievements of the art are directly related to the Donabedian efficiency attribute (Djuricich, 2007).  

Deming’s 14 Points Relationship with Porter’s Value Definition

            The porter’s value chains advocate for improving the quality of products and services and working on the outbound logistics to improve the value of a product. Similarly, the Deming’s I4 points emphasize on management practices that increase quality and productivity. One of the Deming’s points emphasizes on continuously improving the quality of products and services. The point relates to the porter’s definition of value by improving the quality of goods and services.

            The points relate to the porter’s inbound logistics of improving the value of products (Arch Pathol Lab Med., 1990). The Deming’s point that advocates for improvements in planning and production and services processes also relates to Porter’s inbound logistics of improving value. The operations of the segment of porter’s understanding of value conform to the Deming’s point of adopting new philosophies to improve the quality of the product. The views improvement areas include new packaging, new assembly, and maintenance among others (Arch Pathol Lab Med., 1990).

Deming’s 14 Points Relationship with The IOM’s six aim

            The Deming’s point that advocates on the reduction of total cost to improve value relates to the IOM efficiency objective. The IOM efficiency goal focuses on wastage reduction to reduce the total cost hence achieving the intention of the Deming’s point noted above. The Deming’s point advocating for self-improvement and education program leads to a workforce with a lot of knowledge to improve the quality of the product (Arch Pathol Lab Med., 1990).

            The point relates to the IOM effective objective that encourages the use of scientific knowledge to apply a service to the largest number of appropriate people possible. The point can assist in acquiring the knowledge while the objective insists on the use of knowledge. The creation of patient-centred services IOM goal improves the value of the care. The objective relates to the entire Deming’s 14 points that target improving the quality of the product by use of new approaches process and employing handling (Arch Pathol Lab Med., 1990).

Current State of Abu Dhabi Measure on Triple Aim

            One of the techniques that can be used to evaluate the customer experience is the increase in the number of patients attended in particular duration. Increased patients indicate that the experience of patients has improved hence attracting more patients. The increase also shows a reduction in the patient’s wait time hence improving the experience. The greater number of patients attended by a single physician in a particular duration is also a measure of costs reduction. Increase in the number of patients attended to by a doctor implies fewer doctors and hence less funds will be needed to care for a larger population (Arch Pathol Lab Med., 1990).

            The reduced number of illness cases such asthma among the targeted people in the Abu Dhabi will be an indication of many people accessing the services. Access to the services will ensure that illnesses are discovered early hence will be easily cured without proceeding to the advanced levels. The access naturally will lead to the diseases falling among the population (Arch Pathol Lab Med., 1990). 

References

Arch Pathol Lab Med. (1990, November). The seven pillars of quality. – Pubmed – ncpb. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2241519

Djuricich, A. (2007). A Continuous Quality Improvement (CQI) Curriculum for Residents. MedEdPORTAL Publications. doi:10.15766/mep_2374-8265.468