Leadership for Quality and Safety in Healthcare

Introduction

Quality system or framework in hospital refers to the characteristics that make a hospital achieve excellence in the provision of services (Chaboyer, 2009). Health care organisations emphasize the need of standardizing the quality of measurement so as determine the effectiveness of a health care system. National policies are responsible for determining how quality systems in health care organisations work. This is because researchers and policy makers base their decision on the legal framework provided by the national governments (Speedy & Jackson, 2004). Quality systems ensure that health care services are provided at high level of standard and using cost effective methods. As a result of this, hospitals are always questioned on issues relating to transparency and accountability during service delivery. Evaluation models such as Quality Management Systems (QMS) are applied in determining the level of transparency and accountability. This paper will discuss the quality framework used by the Victoria Health Services. The paper will consider the key aspects, barriers and facilitators and finally focus on the effectiveness of such a framework in ensuring continuous improvement of health acre services.

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Brief summary

The quality framework for the Victoria health services was a product of the Victoria Quality Council. The framework was referred to as safety and quality improvement framework. The major concern for the initiative was to work towards improving the nature of patient care and also the safety of the patients in Victoria. For the initiative to realize its goals, five basics objectives were considered important. These are:

  • Establishment of a safety and a quality framework
  • Provision of better access to data
  • Consumers’ involvement in the improvement of quality and safety
  • Consumers’ education on quality and safety
  • Prompt responses to potential problems and risks

The initiative of quality framework by the Victoria Quality Council is a set on strategic principles that work jointly with the aim to improving the level of management of the organisation so as to ensure that health care is provided effectively. The framework is developed in the principles of clinical governance whereby, the management board is tasked with the responsibility of ensuring that health care services are provided within the acceptable standards. A major focus during the provision of health services is the financial implication and thus accountability is always addressed during service delivery. The major consideration of the framework is to ensure that each an every department is in a better position to improve the safety and quality of the patients. Organisations can therefore use this framework as a benchmark for quality improvement or as a plan for reviewing the progress of the improvement process. The structures and processes used in the framework should be taken into consideration in any of the organizations.

As mentioned earlier, the objectives of the framework are: to achieve safety, effectiveness, appropriateness, acceptability, access and efficiency. The framework can realize these objectives if all the stakeholders involved in the accomplishment of a quality system take their respective tasks effectively. Such stakeholders include: the government, hospital board, quality assurance committee, organizational leaders, clinicians and the community itself. The framework also considers organizational elements that can ensure the objectives of the framework are realized. Such elements are: governance and leadership, consumer involvement, competence and education and lastly, information management. The framework considers the six objectives to be the dimensions of quality. These dimensions are interlinked with the four organizational processes. For the purpose of quality improvement in the organisation, the various stakeholders are expected to take their roles and responsibilities at all levels of management. The intersection between the various aspects is illustrated in the figure below.

Brief summary

Aspects of the framework and the way they relate to the goals and objectives

Traditionally, most health care organizations focused majorly on access and efficiency (Harvey & Wensing, 2003). These are important health care components. On the contrary, this framework considers other four components whose significance cannot be ignored in the measurement of health care improvement. From the literature perspective, safety and quality components have proven to be important factors not only to an organisation but also in reducing deaths, health complications, costs and better clinical outcomes. A quality health care program is realized when the board and the senior management come forward to promulgate a culture of quality management. This quality management can be achieved through teamwork and mutual respect among the members. According to Braithwaite & Travaglia (2008) “this should provide the foundation for a planned approach to quality and safety that encompasses staff and patients’ values, identifies clear priorities, allocates resources, provides education and addresses risks”.

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Since the process of developing a comprehensive framework for quality safety may be complicated and therefore take a longer time, such a process can be developed in stages. Additionally, the framework for quality and safety may keep on changing and therefore it calls for continued monitoring. Through monitoring, the management can identify the changing internal and external factors that require to be addressed so that the expectations of the consumers can be met every time (Newton et al, 2007). In addition to the changing factors, there are other health services components such as accreditation standards, policy reviews and national initiative bodies like the Australian Council on Safety and Quality in Healthcare that influence the nature of quality systems (Chaboyer, 2009). Such external components should always be considered when designing a quality framework since they influence the modes of operation (Buetow & Rowland, 1999). The consistency of this framework in external requirements which are necessary for safety and the improvement of healthcare programs can be easily noted. This is because the framework has drawn ideas from researches conducted on safety and has also integrated best practices in the implementation of safety and quality health care program (Shortell et al, 2005).

Barriers and facilitators

The framework for the improvement initiative is facilitated by the factors that are considered during the designing of the framework. According to Chaboyer (2009) “whatever approach is taken, however, a clinical governance based model on safety and quality improvement will demonstrate some standard features across organizations”. In addition, there are basic minimum requirements that should be integrated in the safety and quality management system. For instance, boards are expected to ensure that safety and quality management process is able to benefit from the processes of financial management and business planning (Shortell et al, 2005). For a quality program to be regarded as being effective, it requires an approach that is well planned and that will ensure that the board is able to provide such evidence like:

  • The existing organizational structures are appropriate. In addition to these structures, there should be processes and resources for monitoring, managing and improving safety care in the process of service delivery.
  • the quality program should have objectives that are clearly stated and all the members of the staff know very well their respective roles and responsibility in the program
  • there is easy access to information and quality support by all the members of the staff so as to ensure that the fully participate in improving service delivery to the consumers
  • consumers fully participate in safety and quality improvement, this is possible through raising complaints and providing feedback on matters of service delivery
  • possible areas that are prone to risks can be easily identified, given priority, fully managed and reported on a regular basis
  • the process of reviewing deaths and responding to adverse events is demonstrated in a clear and transparent manner
  • the best available opportunity is used in the provision of care to the patients and that such care is provided by a credentialed and well trained staff
  • the use of external reviews like accreditation is considered as a positive opportunity for reviewing the level of compliance with the standards
  • the is the existence of organizational culture that is characterized with continuous development and that participation and leadership in quality and safety improvement is fully supported and well recognized

Effectiveness of the framework in underpinning continuous improvement

The framework for improving quality and safety can be effective by the use of an improvement plan. A plan for ensuring the effectiveness of a quality improvement plan can be structured in multiple ways. As identified by Wagner (2001) “safety and quality improvement activities may be planned on the basis of the dimensions of quality, health services strategic priorities, organizational structures, accreditation frameworks or a combination of these”. It is the responsibility of each organisation to develop a process that is best suited for their structures. The role of the quality improvement plan is to facilitate the process of determining errors that may occur in the course of service delivery. Such a plan will help to report and analyze errors and any problems without regrets on the possibilities of negative consequences occurring. The plan would also help to investigate, manage and reduce the occurrence of such errors (Van Bokhoven, Kok & Van der Weijden, 2003). The improvement plan help to demonstrate that the risky areas are attended with priority; continued monitoring of such areas is also taken into account in order to minimize the chances of errors. According to Chaboyer (2009) “professional, statutory and external standards are met and key areas of care and service delivery are routinely monitored and improved by using the quality improvement plan”. The improvement plan helps to ensure that core values like, responsibility, transparency and accountability are ensured at every level of management within an organisation. It is also necessary to provide an explanation on any data that is used. Since the board is supposed to provide documentary evidence on matters related to outcomes and evaluators, transparency and accountability in an organisation can be realized at each level of management (Shortell et al, 2005).

Quality improvement methodology

A quality improvement methodology is an effective way in which a safety and quality process can be built upon irrespective of whether the processes of the operation are linked or separate (Victorian Quality and Safety Council, 2005). This process is usually continuous thus providing a feedback loop where any data or information that has been collected is analyzed and the responsive measure taken. It provides an opportunity for reviewing the results so as to determine the level of the effectiveness of the improvement plan (Moss, Garside, & Dawson, 2008). There are several methodologies that are used for quality improvement; for instance, assessment, action, review and breakthrough collaborative among others. However, any of the methodology that is chosen adopts specific improvement tools and techniques. Such techniques are:

  • Application of monitoring and diagnostic systems that provides an opportunity to set priority on activities such as, identification and management of risks through clinical risk management system.
  • Use of qualitative and quantitative data collection methods, use of checksheets and pareto charts to present and analyze data
  • Application of skills that help to enhance the effectiveness of processes like communication, decision making and discussion forums. The processes are effective in that they provide a better environment for communication thereby making the process of problem solving easy.

Conclusion

This paper has described a quality framework that is used by Victoria health services. It has been found that the framework is effective in that it brings together the various quality effectiveness components so as they can address the problems that might affect the process of service delivery to the sick persons. It has been found out that quality improvement could be realized if the various stakeholders would take their roles in addressing the various dimensions of quality.

References

Braithwaite, J. & Travaglia, J. (2008). An overview of clinical governance policies, practices and initiatives. Australian Health Review, 32 (1): 10-22.

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Buetow, S. & Rowland, M. (1999). Clinical Governance: bridging the gap between managerial and clinical approaches to quality. Quality and Safety in Health Care, 8, (3): 184-190.

Chaboyer, W. (2009). Bedside Handover: Quality Improvement Strategy to “Transform Care at the Bedside”. Journal of Nursing Quality, 24, (2): 136-142.

Harvey, G. & Wensing, M. (2003). Methods for evaluation of small scale quality improvement projects. Quality and Safety in Health Care, 12, (3), 210-214.

Moss, F., Garside, P., & Dawson, S. (2008). Organisational change: the key to quality improvement. Quality Health Care, 7, (5): 112-18.

Newton, P et al. (2007). Barriers and facilitators to the implementation of the collaborative method: reflections from a single site. Quality and Safety in Health Care, 16, (6): 409-414.

Shortell, S. et al. (2005). Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. International Journal for Quality in Health Care, 7 (30): 377–401.

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Speedy, S. & Jackson, D. (2004). Nursing Leadership. Sydney: Churchill Livingstone.

Van Bokhoven, M., Kok, G. & van der Weijden, T. (2003). Designing a quality improvement intervention: a systematic approach. Quality and Safety in Health Care, 12, (3): 215-220.

Victorian Quality and Safety Council. (2005). Better Quality Better Health Care. A Quality and Safety Improvement Framework for Victorian Health Services.

Wagner, C. (2001). Environmental and organizational determinants of quality management. Quality Management in Health Care, 11, (4): 63–76.

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