Aspects of Clinical Quality
Clinical quality is defined as the measure to which the services, supplies, and healthcare systems achieve positive outcomes among the intended individuals or populations while remaining consistent with the current professional practices (Ballard, 2003, p. 13). Thus, clinical quality improvement entails the interdisciplinary processes aimed at raising the quality of preventive, rehabilitative, diagnostic, and therapeutic healthcare services available to individuals or populations.
As a result, the clinical quality is measurable in terms of the total outcomes, both perceived and real, that a patient realizes upon discharge. Here, it is important to note that most hospitalized patients may find it hard to understand all the indicators of clinical quality, but it is certain that they look forward to certain quality metrics availed by the hospital organization. Therefore, in most cases, the quality metrics do not necessarily need to reflect the actual experiences of the clients.
Consequently, a hospital organization needs to understand different aspects of clinical quality in order to achieve complete measurement or assessment. Here, it is obvious that to many hospitalized patients, quality metrics can be anything from personal aspects of care services (courtesy and compassion) to patient satisfaction. Overall, for an organization to qualify as a high-quality performer, clinical quality metrics and patient satisfaction must be held in equal accord.
Accordingly, clinical quality data is accumulated through surveys aimed at seeking the patient’s perspectives of the healthcare services offered by various hospitals. On the other hand, hospitals are required by law to submit quality data for assessment by regulatory authorities. Some of the parameters considered in this case include patients’ privacy, medication errors, emotional support, care accessibility, peer decision-making, use of evidence-based care services, and coordination of care among other things (Ballard, 2003, p. 16).
Therefore, the findings of these assessments determine whether hospitals will be accredited or recommended by patients and their family members. Certainly, it is very imperative for hospital organizations to maintain positive results in order to continue their operations by addressing quality issues upfront.
It is no secret that a healthcare organization is a complex environment for management because of the presence heterogeneous groups of people and many organizational areas within the same organization. Furthermore, the different groups of people are drawn from different cultures and religious denominations. Therefore, to counter these cultural and religious disparities, it is imperative for these organizations to adopt a culture that guides its people in their day-to-day activities. Additionally, the culture should incorporate different aspects of quality in that all patients are treated uniformly regardless of their race, religion, sex, and culture. Having achieved this, chances are high that such an organization will appeal to not only the regulatory authorities, but also to all patients and their families. This is the basis for ensuring that the quality of services meets the required standards in terms of achieving positive outcomes (Silow-Carroll et al., 2007).
Another important problem facing quality in our organization is the lack of the right people to advance quality at the grass-root level. According to Roussel (2010, p. 122), there is the need to have CNLs as the managers of the organizational micro-systems charged with the responsibility of systematically and purposefully identifying various projects and initiatives to guide quality and safety improvement. Given this opportunity, the CNL should conduct gap analysis and implement quality improvement tools in order to align various strategic initiatives with the organizational objectives/goals aimed at realizing overall quality. Furthermore, it important to note that most quality improvement initiatives require change management in terms of credentializing, re-credentializing, and selective training and hiring, and thus CNL is a very important managerial level for such changes (Roussel, 2010, p. 124).
On the other hand, maintaining in-house quality improvement processes particularly those processes used in the management of medical records, data analysis, quality assessment/accountability, and accreditation/evaluation has been shown to play a major role in guiding continuous quality improvement in different organizations. As a result, there is the paramount need to invest in such tools and processes to ensure that the process of quality improvement is guided by practical steps and real-life incidences (Carroll et al., 2007, p. 17).
As noted earlier, the people involved in quality improvement require different tools to achieve their goals. These tools include; updated medical records, data storage/cleaning/analysis tools, and strategic initiatives. Therefore, lack of such imperative tools not only limits the extent to which quality improvement occurs, but it also renders these people incapable of maintaining and improving quality in the organization.
Conversely, studies note that some organizations with excellent quality improvement records have had their CEOs advance to their current positions through promotions that reflect their level of training and organizational experience/knowledge. This eliminates any chances of outsiders getting such higher positions, a move that may deter quality improvement or even stop it completely. Therefore, there is the need to have people in the top management who have the necessary operational experience to manage and guide quality improvement in an organization (Silow-Carroll et al., 2007, p. 18).
Furthermore, highly-rated organizations seem to have adopted strategies of recognizing the efforts made in quality improvement by rewarding their nurses accordingly. These strategies include shared governance and pay-for-performance, which are aimed at rewarding the hospital personnel who attain, maintain, or exceed some pre-set standards or outcomes related to quality improvement. This being an old-age initiative in the healthcare sector, these organizations have shown the need to align such incentives for the sole aim of achieving solutions to certain pressing issues. Thus, this move is worth emulating in our organization.
Finally, our organization faces many challenges regarding data breaches with the introduction of the electronic medical records (EMRs). As noted earlier, the data recorded in EMRs can help an organization to gain public acceptance and accreditation when it is availed to the relevant authorities for assessment. However, the patient’s privacy is paramount to any organization no matter the cost. Therefore, in the process of seeking public recognition and patient recommendations, the interests of our patients should come before other less important aspects of quality improvement (American College of Medical Quality, 2005, p. 105).
Adopting the Quality Improvement Model
Silow-Carroll et al. (2007) note that this QI model or sequence is very effective in guiding the process of quality improvement in almost any organization regardless of its size or location. This is because the model is designed in such a way that the first step towards quality improvement should always begin with identifying the root-cause or a trigger that makes people to acknowledge the need for quality. This will then lead to re-organization of the structural processes in the organization in order to make resources and tools available for QI. Subsequently, the assembled teams should align the resources available towards identifying the inherent problems that cause the triggers, and finding solutions to the problems. As a result, the solutions should inform certain practical changes in the organization such as creation of evidence-based clinical protocols and guidelines. Overall, the foregoing steps should be able to generate positive results otherwise; the whole process should be repeated more keenly.
Solutions to clinical quality problems
The QI framework described in the preceding slides may seem simple and straight-forward, but in practice, it is not easily adoptable. This is because the framework entails many aspects, which require organizational changes, and thus, there is the risk that some people in the organization may resist the change. Therefore, it is important to implement the model by first concentrating on five critical areas of interest. First, there is the need to control or prevent cases of medical errors by implementing the Institute of Medicine (IOM)’s recommendations including adopting a culture of quality and patient safety, preventing adverse drug effects (ADRs), preventing infections in the hospital units, facilitating rapid response to patient needs, and encouraging teamwork and two-way communication systems (Silow-Carroll et al., 2007).
On the other hand, provision of QI incentives will go a long way in terms of encouraging the hospital nurses and physicians to continue improving the quality of services offered, which will in turn help them to develop a culture of quality. Furthermore, the availability of quality procedures and guidelines will make the work of nurses and physicians easy since they will be guided by pre-set outcomes or goals for any service offered to patients. Accordingly, equipping the QI department with the necessary tools, human resources, and finances will ensure that the readily required information arising from data analysis is made available to guide further steps in QI. Finally, the organization should be ready to evaluate the results of the first leg of changes made so far in order to reward the high-performers accordingly, and work out other strategic initiatives for future improvement (Ballard, 2003, pp. 13-16).
American College of Quality. (2005). Core curriculum for medical quality management. Sudbury, MA: Jones and Bartlett Publishers International.
Ballard, D. (2003). Indicators to improve clinical quality across an integrated health care system. International Journal for Quality in Health Care, 15(Suppl. 1), 13-23.
Roussel, L. (2010). Initiating and sustaining the clinical nurse leader role: A practical guide. Sudbury, MA: Jones and Bartlett Publishers.
Silow-Carroll, S., Alteras, T., & Meyer, J. (2007). Hospital quality improvement: Strategies and lessons from U.S. hospitals. The Commonwealth Fund Publication No. 1009. Web.