Posted: July 14th, 2019

Healthcare Quality Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment – Assignment 4 Research report

Healthcare Quality Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment
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Both the Grand River Hospital (GRH) and the St. Mary’s General Hospital (SMGH) have been offering healthcare for decades. The two hospital have been the leading care providers in Canada as a whole with the Grand River Hospital as one of the largest community hospitals of Ontario with over 3,500 employees who work towards achieving the hospitals vision of being the leader in the provision of 24/7 health care to patients through the use of innovation and collaboration using the available resources. The hospital has reported over 23,000 admissions, over 12,000 day-surgery visits, 58,596 emergency visits and over 210,000 ambulatory care every year. On the other hand, the St. Mary’s General Hospital has been known to be a key healthcare provider in the Kitchener Community since 1924 and the hospital has over 2,000 employees and volunteers who support the admissions of over 7,000 patients, over 100,000 outpatients’ visits, 20,000 surgical procedures as well as 47,000 emergency visits every year. The hospital has had a vision of becoming one of the safest and most effective hospitals in Canada through the use of innovation, compassion and respect for their patients. The close proximity between this two Canadian Hospitals has helped them collaborate in various aspects of health care and this has made them be in a good position to specialize in certain procedures of care as they all focus towards achieving their visions of being the leaders in the healthcare sector.
However, the two Canadian hospitals cannot achieve their vision of being the leaders in the healthcare sectors through the use of innovation, collaboration, compassion and respect without taking into consideration the existing regulations and standards set by the government to regulate the healthcare sector. It is due to such regulations that the two hospitals have endeavoured to make sure that their operations meet the set national set standards of operations. For instance, the Grand River Hospital has developed a quality framework that encompasses the quality and patient safety committee, the quality councils as well as the senior quality team and clinical programs all aimed at making sure that the hospital is held accountable for the quality and safety in their operations. On the other hand, the St. Mary’s General Hospital has also been leading in the implementation of 1,000 measurable improvements which reported multiple successes to the recognition and celebration of employee’s efforts in healthcare delivery.
All these initiatives in the improvement of quality care by the GRH and the SMGH are in line with the national regulations on healthcare as well as the 2003 agenda of the Canadian Patient Safety Institute of inspiring extraordinary improvements in patient safety and quality. This agenda has been as a result of the institute’s implementation of programs and projects so as to collaborate with all healthcare stakeholders such as healthcare providers, governments as well as educators such as the University of Waterloo management science researchers that have partnered with the St. Mary’s General Hospital to carry out deep analysis of the outcomes and actions from the hospital for the purpose of healthcare improvement. Despite the efforts of the Institute, there was an increase in the levels of inadequate patient safety that made the Canadian government enact legislation that was aimed at improving the quality of healthcare in Canada. It is true to state that the healthcare quality frameworks and initiatives reported at the St. Mary’s General Hospital as well as the Grand River Hospital are as a result of the regulations passed by the government such as the Bill 46 of Excellent Healthcare for All of June 3rd 2010 to make health care providers and executive become accountable for improving the levels of patient care and enhance the patient experience (Aghaei Hashjin et al., 2014). The Bill required that hospitals establish a quality committee that was tasked of reporting to the board of directors directly, create and publicize their annual quality improvement plans as well as mandated hospitals to survey their patients yearly and their employees every second year with the aim of collecting their views of the quality of healthcare they received or offered.
Additionally, the Excellent Healthcare Bill for All of 2010 required that hospital executives get compensated accordingly regardless of whether or not the Quality Improvement Plans are met. The regulations brought about by the Bill therefore were responsible for the quality framework developed by the Grand River Hospital that included initiatives to make hospitals accountable for healthcare quality and safety as well as evaluating itself using the four dimensions of appropriateness to care, access to care, patient experience as well as safety of care to assess its performance and progress as speculated in the law. Also, the hospital makes the analysis available to the public as stated in the Bill to ensure that there are transparency and openness in healthcare.
The St. Mary’s General Hospital has not been left behind in adhering to the national standard of regulations as it has incorporated healthcare stakeholders in its research such as the researchers from the Waterloo University to make sure that the quality of healthcare is continuously improved. The hospital has also implemented the standard regulation by establishing a guiding quality committee framework as well as an algorithm of actions following the critical incidents that occur at the hospital thus making the organization be in compliance with the regulation 156 of the Ontario Public Hospitals Act that requires that critical incidents be reported to the medical advisory committees as well as the administrators at the hospitals.
Other regulations that have been actualized at the two hospital to improve the quality of patient care is the announcement by the Ontario Ministry of Health and Long-Term Care on March 2012 that needed the phasing of a patient-centered funding model in over three years so as to have the hospitals achieve the quality and evidence-based care, improve d wait times and access as well as putting emphasis on the need for the hospitals to contain the cost of healthcare (Lawton et al., 2012). This regulation has contributed to 70 per cent improvement in healthcare quality through the creation of the long-term care homes as well as funding for the hospitals to be in a position to carry out their activities effectively. However, this is not enough as far as the improvement of the quality of healthcare is concerned as significant improvements for patient safety still have room in both hospitals as the hospitals have not yet adopted a true safety culture from administrative to frontline levels that is inhibiting improvements in the quality of care offered.
However, prior to the introduction of the many regulations governing the health sector such as the Bill 46, the law mandated the disclosure of critical incidents to patients where most hospitals such as the GRH and the SMGH had systems that made the collection of reports on such events possible. However, there existed the fear of professional consequences and criticism and this is the reason why the Quality of Care Information Protection Act of 2004, to offer protection of collected information that had been collected for the purposes of assessment and quality improvements and thus protected health practitioners from such consequences (“Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario – Google Search,” n.d.).
As stated above, the improvements that the two hospitals have achieved in the provision of quality health care are not yet done. This is because despite the regulations by the governments there still exists elements of quality healthcare that have not been achieved by both the GRH and that SMGH hospitals through the implementation of various Quality Improvement Plans. The main aim of a quality improvement plan is to aid health care providers like the Grand River Hospital and the St. Mary’s General Hospital self-assess their levels of performance in the delivery of quality education and care as well as plan for the future improvements in the institutions (“Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario – Google Search,” n.d.). One of the areas that need improvements in the course of improving the quality of health care in these two hospitals is the adoption of a true safety culture that moves all the way from the administrative to frontline levels that has been inhibiting the quality of care. For the realization of the benefits of CPSI, regulatory advances and incident reporting, there is the need for the hospitals to develop a safety culture.
A safety culture refers to the environment whereby the desire more safety is apparent in intangible beliefs, values and attitudes in addition to concrete practices and policies. In such an environment, administrators and clinicians do not have the expectations that each of the individuals within the environment will be flawless but they understand that people are not perfect that thus failures are hard to be evaded. With such an understanding, the hospitals can then be in a position to develop a high diligence to detect errors within their operations and in turn develop a defence mechanism that will aid in the prevention of adverse outcomes of the errors. Since these attitudes and behaviours exist throughout the hospitals from the administrators to the clinicians to the top management, then reporting will become more frequent, complete and generally efficient and near misses are shared willingly for greater quality improvement if the safety culture in the hospitals is achieved. In addition, for such results to be achievable, then there must exist a significant level of trust among the healthcare providers so that adverse events can be openly discussed and solutions established through collaboration.
Another area that needs health quality improvements is the establishment of the physician buy-into many quality improvement efforts that has been demonstrated by the existence of poor attendance and underreporting at the QCIPA reviews (“Beliefs and experiences can influence patient participation in handover between primary and secondary care’ a qualitative study of patient perspectives,” 2012). The intangible elements that define safety cultures such as values of clinicians and beliefs need to be influenced as the act of increasing the legislative requirements, administrative encouragement and QCIPA legal protection have not been enough to change the attitudes and behaviours of the physicians in a great way. Influencing these intangible elements that define safety culture can be achieved by making the clinicians, as well as all other employees within the two hospitals, have an understanding of the importance of quality improvement in healthcare instead of having to enforce through legislation that seems not to perform as anticipated. When clinicians and other healthcare practitioners understand the importance of giving the best care for a patient as well as following the laid down quality improvement plans, then it will easier for the hospitals to record an improvement in the quality of care acquired from the two hospitals.
Another area that health quality improvements are needed in these two hospitals is by making adjustments to the organization structure of organization within the hospitals so that the leadership positions can be formalized and help in increasing accountability on the health quality metrics. This can be through including the patient safety accountability in the job description of chiefs of a department to make them responsible for health care quality (“Beliefs and experiences can influence patient participation in handover between primary and secondary care’ a qualitative study of patient perspectives,” 2012). This is because when the managers become aware of the expectation of them to spearhead quality improvement in their department upon recruitment, then it will be easier for them to perform the tasks as the responsibility will not be bestowed on them after recruitment. When an employee is applying for a job and the role of making sure that the quality of healthcare is improved, then he will be up to the task immediately he or she steps into the work setting. Additionally, the hospitals can address the issue of the informal organizational structure where employees are not aware of their role of making sure that quality is improved by organizing quality competitions to recognize and appreciate staff contributions to patient safety improvements. Through this employees offer quality health care as they are aware of a reward during the competitions and thus help the hospitals achieve the anticipated health care quality improvement plans.
Additionally, the two hospitals need to look into the importance of communication and teamwork so that patients can have the highest levels of satisfaction as without the satisfaction among them, then it can be hard for the hospitals to realize the desired levels of health care quality. This is because failure to develop teamwork and communication can lead to major adverse events that undermine the efforts of realizing quality health care as established by the Johns Hopkins School of Medicine. To ensure that teamwork and communication are enhanced in the hospitals, there is the need for the medical education providers to include patient safety into their curriculums so that healthcare practitioners can have an understanding of why they need to communicate with patients well so that they can be guaranteed of their safety. Also, the hospitals can organize workshops for the staff, so that they can be educated on the clinician’s skills that are needed for patient safety. Conducting an extensive analysis and process redesign in this hospitals can also be a leader in making sure that the areas identified for health quality improvement are addressed (Karazivan et al., 2015). This could through the adoption of healthcare systems that measure variations in healthcare for various services and analyzed the financial, efficiency and quality outcomes to know the best practices for improving healthcare.
However, some of this approaches towards improving the quality of healthcare may render some of the physical to the feeling that their professional autonomies are not respected. This because despite the fact that the chief staff in a health organization having the authoritative power to decide what the staff under him are needed to do, individual physicians in the clinical setup are largely independent. Therefore, instances of the physicians receiving instructions from the heads of departments on the way that they may perform their daily healthcare duties might make them feel that their independence is tampered with.
Additionally, such supervision and close follow-ups of the physicians with the aim of them adhering to the quality improvement plans may interfere with the organizational cultures within the individual hospitals. This is due to the fact that, prior to the establishment of the quality improvement plans, clinicians enjoyed the undisputed freedom to practice their health care practices without supervision and also never worked in fear of their superiors. Supervision aimed at ensuring that quality improvement plans are actualized will make the inexperienced workers experience a difference in their self-efficacy based on how the supervision will be done (“Effective supervision in a variety of settings – The context for effective supervision: Culture,” 2017). All these changes that affect the culture of the organizations will be as a result of the changes in the behaviours and values that previously existed in the organization.
However the supervision and the act of introducing quality competition will lead to a positive impact in the organization culture of the two hospitals as the competitions will encourage the staff to perform in a better way thus promoting the implementation of the quality improvement plans as well as the organizations culture (“Organizational culture and quality of health care,” 2000). Also, introducing collaboration among employees to implement the quality improvements plans towards quality health care will impact a culture of teamwork among employees and therefore yield well than in previous times when the quality improvement plans had not been implemented.
In addition, the implementation of the Quality of Care Information Protection Act as part of implementing the quality improvements plans will lead to underreporting as most clinicians will avoid attending to the QCIPA reviews despite the attendance being mandatory in fear of the legal consequences that accompany them and also the recognition that the attendance cannot be enforced by the supervisors. Another anticipated outcome from the implementation of the initiatives towards the realization of quality healthcare is the inadequacy and the variability of the reports collected by critical incident reporting. This is due to the fact that reporters happen to cite individual factors instead of the systematic factors as the root causes of the adverse events and thus making them be on the sharp end of the problems and thus not considering the latent errors that might have occurred in the overall system.
Upon the implementation of the initiatives towards the achievement of quality health care at the two hospitals, it will be important for the management to re-evaluate the outcomes from the implementation so as to keep the systems up to date. This is due to the fact that the healthcare field is dynamic and different cases keep on arising depending on various factors out of control of the parent organizations. After the management has noted the various outcomes from the implementation of the quality improvement plans, then it is the appropriate time for the hospitals to check into the issues and come up with new analysis for them to be in a position to create a new plan of improving the quality of healthcare based on the changing environment (Murtagh Kurowski et al., 2015). Since, it can be hard for the exact outcomes of the various changes towards quality healthcare to be noted within an organizational setup, it is good for the hospitals to carry out a re-evaluation of the data on a yearly basis as this can help in the formulation of various reports that the law required the organizations to compile at the end of the year.
I think, the implementation of quality improvement plans at the Grand River Hospital and the St. Mary’s General Hospital is important as it will help the organizations be in line with the set out regulations of ensuring that patient safety is guaranteed as well as make sure that the quality of health care in the hospitals is enhanced. Additionally, the implementation of the plan will also help the management of this two organizations learn the changes in the healthcare field and align their various organizations towards the right ways to deal with critical incidents that arise in the day to day operations of the hospitals.

References
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Beliefs and experiences can influence patient participation in handover between primary and secondary care’a qualitative study of patient perspectives. (2012, December 1). Retrieved from https://qualitysafety.bmj.com/content/21/Suppl_1/i76
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Karazivan, P., Dumez, V., Flora, L., Pomey, M., Del Grande, C., Ghadiri, D. P., … Lebel, P. (2015). Patient partnership in quality improvement of healthcare services: Patients’ inputs and challenges faced. Patient Experience Journal, 90(4), 437-441. Retrieved from http://pxjournal.org/journal/vol2/iss1/6
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