The importance of transforming healthcare has been extensively explored from the Institute of Medicine (IOM) first report, To Err is Human (2000) which examined how the surrounding forces of legislation, regulation and market activity influence the quality of care provided and then looks at the handling of medical mistakes. The second influential report, Crossing the Quality Chasm (2002), examined healthcare redesign and clinical Microsystems. The third report, Keeping Patients Safe (2003), examined the work environment including the structures and processes healthcare workers use in the delivery of care and emphasises the need to design nurses’ environments to promote the practice of safe nursing care. Much of the evidence that is available tends to indicate that public sector services are under pressure to improve in quality to benefit the user but also not to increase the burden on the taxpayers (Williams, 1994). To meet these parameters, the only solution is to increase the efficiency of the conversion of taxpayers’ money into public services.
Continuous quality improvement programmes stress the engagement of employees; the opportunities for improvement presented when errors or defects are found; and the idea that many small improvements lead to significant and continued improvement. From a nurse’s perspective, Quality Improvement (QI) initiatives are founded on respecting employees and allowing them to find solutions to problems that improve the environment and patient outcomes, and therefore, increase employee motivation and job satisfaction. Nurse’s involvement or participative management refers to the degree to which nurses can influence how their work environment is organised and how they carry out their duties.
From a patient perspective, QI is linked to key performance indicators and evidence- based practice to improve their experience and outcomes of their care. QI initiatives also have a responsibility to show efficiency and value for money.
There are four underlying commonalities of the now popular healthcare QI programmes. Firstly, many of these programmes use the idea of cycles of improvement, which involve data collection, problem description and diagnosis, the generation and selection of potential changes and then the implementation and evaluation of these changes that bring about improvement (Greenhalgh et al, 2004). We now know these cycles as Plan, Do, Study, Act cycles, used to identify elements of a new change package. Secondly, most use common tools such as cause/effect or fishbone diagrams, process mapping or flowcharting, brainstorming, quantitative indicator construction and comparative data analysis (Bamford & Greatbanks, 2005). Thirdly, most recognise the need for supportive leadership from senior management and a clear organisational commitment to the aims of the QI programme (Weiner, Shortell & Alexander, 1997). Fourthly, most recognise the importance of the engagement and involvement of front line employees, such as nurses (Audet et al, 2005) and the development and exploitation of organisational citizenship.
QI methodologies have gained increasing acceptance in healthcare over the past couple of decades with many programmes becoming the latest popular initiative used to improve both employees and patients’ experience, reduce waste and cost.
Visit www.koawatea.co.nz to see some exciting QI initiatives in healthcare settings.
The APAC Forum on Quality Improvement in Health Care is focusing on the theme, ‘Innovate today, Design Tomorrow” and has a programme full of international renowned speakers who can give you practical tools to help you become a QI expert, to improve your working environment and really make a difference to your patient’s outcomes.
Take a look at the website at www.apac-forum.com and register today.
Audet AM, Doty M, Shamasdin J, Schoenbaum S. Measure, learn and improve: physicians’ involvement in quality improvement. Health Affiliated, 2005; 24: 843-53.
Bamford DC, Greatbanks RW. The use of quality management tools and techniques: a study of application in every day situations. International Journal of Reliable Management. 2005; 22: 376-92.
Greenhalgh T, Robert G, Macfarlane F et al. Diffusion of innovations in service organisations: systematic review and recommendations. Milbank Q 2004; 581-629.
Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academic Press; 2000.
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academic Press; 2001.
Institute of Medicine. Keeping Patients Safe; Transforming the work environment of Nurses. Washington, DC: National Academic Press; 2003.
Weiner BJ, Shortell SM, Alexander J. Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership. Health Service Redesign, 1997: 32: 491-510.
Williams, I. (1994) Competing for Quality: competition in the supply of central government services, in: R. Lovell (ed.) Managing Change in the Public Sector, pp. 216 – 227 (Essex: Longman).