Quality improvement (QI) is necessary for successful healthcare organizations as it plays a pivotal role in providing best healthcare services to the patients. Moreover, work improvement is considered important for success in healthcare sector, thus the prime reason for such initiatives is to become more effective and competitive while providing quality healthcare services.
Such aspect is extremely significant because healthcare organizations continue to find means for cost reduction while maintaining the quality of healthcare. Healthcare organizations are compelled to introduce changes and improvements because of innovations in medical treatment and technology, financial constraints, increased expectations of patients and demographic pressure. Under such circumstances, the management of healthcare organizations realizes that increasing more resources will not solve the problems. As a result, other alternatives have to be considered, and quality initiative is viewed as one of the key strategies for meeting challenges and improvement. Current paper examines some critical problems faced by healthcare sector and highlights various improvement initiatives taken by this sector which help reduce cost without affecting quality of care. In addition, the paper documents the necessity of central strategies that improve outcomes as well as participation of stakeholders and management.
Quality Initiatives in Healthcare Organizations
During the last two decades, quality initiatives have gained significant importance in healthcare context. Problems, such as alarming increase in cancer and HIV cases, aging population, financial limitations, and safety of patients, have arisen. Therefore, quality initiative strategies have offered solutions to some of the above mentioned issues.
The healthcare sector has realized the significance of initiatives and devised some models and methods for patients’ safety aiming to improve functioning of the hospital system.
Some of these quality initiatives are the following:
- Initiative for quality management practices;
- Quality initiative in service and focus on customer;
- Quality in value of care.
Initiative for Quality Management Practices
Continuous improvement in quality is instilled in the culture of healthcare organizations. Implementation of best management practices ensures that all workers understand the standards set for quality work, share the same vision, and extend cooperation while working. Moreover, the continuous achievements of high-quality outcomes depend on the processes practiced by management. The management team designs and manages those processes. Undoubtedly, good management is a crucial factor, which determines the success of healthcare in continuous quality improvement. The management practicing quality initiatives can make effective decisions regarding strategic quality and systems.
Quality Initiative in Science and Technology
The science and technology in healthcare sector continue to develop rapidly. There is no doubt that advanced technology, development in pharmaceutical industry, and latest therapeutic approaches lead to positive outcomes and superior medical care. Federal regulations demand efficiency from new medical technology so that an average American citizen could benefit from the latest medical assistance. Organizations that fail to implement latest medical techniques lose clientele because patients demand quality care. As a result, they cannot compete with successful organizations. New techniques in medical science improve the final outcome for medical content.
Quality Initiative in Value of Care (Content Quality)
While patients expect the delivery of quality healthcare services, the offered medical content of healthcare still remains in the territory of organizations. Therefore, such aspect concerns the content quality of medical assistance, as determined by medical professionals. Value of care combines the quality of care content delivered and the resources (price) consumed. A healthcare organization must possess professional expertise as well as necessary equipment and facilities to deliver high-quality medical care at an affordable price. For enhancing value of care, healthcare organizations must cooperate with the medical professionals who create processes that ensure high quality, such as medical education, and training standards. Such efforts increase the quality of content and are considered to be successful (Batalden & Davidoff, 2007).
Cost Reduction without Reducing Quality of Healthcare
The healthcare sector has shown substantial technological development with the introduction of new surgical procedures, high-tech diagnostic devices and new pharmaceutical therapies. The development of these systems has enabled reduction in cost without reducing quality of care for the patients. Currently, patients receive more effective treatment.
Current section describes some of the following significant factors that contribute to quality healthcare without impacting its cost.
- Biomedical innovation that refers to latest knowledge of drugs, devices, and processes based on that knowledge, can reduce cost in a number of ways. Such innovations improve efficiency as well as save cost over time. In general, these are repetitive innovations that improve methods of treatment while utilizing fewer resources. For instance, incremental improvements in the designing of medical devices lower per unit cost of treatment. Repetitive innovations involve improvement in efficiency introduced through low-cost devices and provide quality service.
- Payment reforms have received significant attention as a central strategy to deliver high-quality care through effective control over finance management, and avoidance of overpayments to insurance providers and suppliers. Payment frauds and duplicity in payments also increase system waste; therefore, adding burden on providers and patients.
- Lack of coordination also promotes overtreatment and duplicates care, a source of waste in the payment systems, which compensates doctors on the basis of the number of services provided. Furthermore, the overuse of advanced medical technologies, such as bypass surgery, angiography and cataract surgery, is questionable, and some researchers state that only one out of ten patients needs such treatment. As a result, such treatments, if not necessary, can save costs without rendering impact on healthcare quality.
- Electronic Health Data and Health Information Records with e-Prescription minimize costs while increasing additional benefits of healthcare in monitoring and providing the quality of care. EHD is electronic health data that store patient’s medical history, medical procedures, lab results, diagnoses, and treatment undertaken.
- Therapeutic consultation programs, which include review of drug usage and disease management processes, reduce costs by improving care of patients suffering from chronic diseases. Such programs ensure that patients use only prescribed medications. As a result, this oversight will reduce payment to doctors and expenses of hospital caused by adverse drug interactions (Andersson & Olheden, 2012).
Healthcare in a Free Market System and Single-Payer Government System
In a single-payer healthcare system, national government directly pays all healthcare spending, and sometimes contracts with private agencies for providing healthcare services. In the US, federal government pays nearly half of the nation’s health insurance services through public funded programs like Medicaid and Medicare. Such approach offers a single-tiered system covering all people without discretion of income, diagnosis and age. Moreover, it provides health insurance coverage to every person enabling a patient to seek treatment from hospitals and doctors. The system fosters high quality healthcare services because of standards and rules established by the government for the benefit of its citizens. The US, the UK and Australia are countries that follow single-payer system.
Free market conditions offer a large variety of health products and healthcare services at the competitive and lowest prices. Mexico, India, and Canada established a free market healthcare system. In addition, government healthcare subsidizes available healthcare services for the entire population, a free market also exists for people who require treatment of their choice. Under free market conditions, prices for healthcare products are considerably low in comparison to prices in a single-payer system.
It is assumed that a free market provides better and affordable health coverage to almost entire population, but does not offer health coverage to every person. Many people need subsidized healthcare services, either because they cannot purchase health insurance in time, or they cannot afford it. Free market healthcare system can make medical facilities affordable for the disadvantaged people. A free market condition helps people with low and middle income to reach the medical aid by increasing innovation and healthy competition (Enthoven, 2004).
Common Regulations in Quality Initiatives
1. Focus on Customer
A new federal healthcare law, the Patient Protection Act will improve the lives of the US citizens. The new law focuses on patient’s urgent needs of healthcare that include long-term care, insurance coverage, financing and delivery of health services. Such quality initiative based on law emphasizes on providing superior healthcare services and proposes punishment by law in case of negligence in treating patients, which causes physical damages. In addition, the law demands to educate customers in order to serve them better. Adoption of such approach protects the interests of doctors, nurses, patients, suppliers, insurance providers and financers. Customer satisfaction has achieved significance in context of quality initiative. In order to measure customer satisfaction, healthcare organizations often conduct surveys, focus groups and interviews, which enable them to draw appropriate strategies for increasing positive outcomes and efficiency.
2. Consumer Protection Act as a Quality Initiative
The consumer protection act protects patients’ interests while receiving medical help and care. In order to avoid corruption in administration of an organization, healthcare management follows guidelines of CPA. It in turn protects the interests of the patient as well as the organization. Patients are not overcharged for duplicative services. Physicians cannot increase the number of services and visits in order to inflate the bill and thus financial capacity of patients is protected. Recent research shows that many dissatisfied patients do not return to hospitals and approach consumer court for the damages received. Hence, all healthcare organizations should implement this law as a quality initiative that will protect the hospital from loss and damages.
3. Unnecessary Readmissions
The Affordable Care Act of the United States requires from healthcare sector to reduce patients’ readmissions. The program helps organizations in smooth transitions of patients, and thus they do not have to return for the same treatment, as well as reward those hospitals that can reduce avoidable readmissions (Lombarts et al., 2009).
Importance of Healthcare Quality
A healthcare delivery system involves a series of interlinked procedures that produce one or more final outcome. Quality in healthcare represents patient’s subjective assessment of an outcome and the interactions that occur when the treatment is delivered to the patient. Satisfied patients will return to hospitals as well as encourage their relatives and friends to obtain treatment there. Healthcare profession requires qualified, experienced and dedicated physicians and nurses. Patients who spend extra money for their treatment have high expectations regarding quality care, which depends on the needs and experiences. Therefore, quality assessment evolves from patient’s value system.
Quality expectation is a measurable value system that changes over time through awareness and experience. Quality healthcare consists of two prime components, such as delivery and content. Content quality relates to the medical outcome that is achievable. Although providers and patients have become active in assessing medical content quality, it remains in the territory of doctors and healthcare specialists. Delivering quality healthcare services indicates how patient interacts with the available health care facilities. A patient evaluates, if the healthcare system is efficient; if the nursing staff is caring and cooperative; if services are rendered rapidly with accurate diagnosis and needs.
The delivery of services and content plays a significant role in providing accurate medical services. A significant proportion of American population receives unnecessary medical aid that enhances costs, and even endangers their lives. For example, an analysis of hysterectomies conducted on women observed that one out of five operations was unnecessary. Secondly, a study on the usage of antibiotics for treatment of ear infections in children proved that expensive antibiotics were prescribed whereas less expensive could cure the same infection. Thirdly, many Americans receive adverse reaction to medicines during their treatment, and some cases it may lead to fatal outcome. A study of injuries treatment in New York hospitals showed that 4.2 percent experienced adverse reactions to drugs; 13.2 percent died, and 2.3 percent received permanent disability (Mainz & Bartels, 2006).
Plan to Protect Patient Information with Legal Requirements
The following plan includes all legal requirements and is necessary for protecting patient’s medical history:
- Patient demographics: First name, surname, sex, race and age.
- Disease history: Is this the patient’s first visit? What were the patient’s past and current symptoms? Do comorbidities exist and, if yes, how serious they are at present?
- Lab and pathological tests: Was all lab tests done prior to patient’s admission, and results available at the time of admission? What tests were performed?
- Admittance: Were all formalities related to admission and insurance details provided?
- Patient’s awareness: Is the patient aware of the treatment procedures and processes that will be conducted during the stay at hospital? Was consent obtained from patient and his/her family members?
- Date/time of admission for surgery and consent of patient to perform surgery.
- Surgical process: At what time the patient entered the surgical ward, when did the operation begin and when did the operation finish, and the time of removal of patient from the surgical ward?
- Laboratory: What laboratory tests were suggested?
- Pathology: Are results positive or negative in pathological report?
- To what extent the patient is satisfied with hospital services, and treatment provided?
The paper argued that healthcare quality can be continually improved through eliminating errors and inefficiency, which in turn would minimize costs connected with poor quality, as well as introduce critical processes for efficient working. Improvement usually refers to the act of “better performance” by introducing changes and modifications. However, quality improvement in healthcare sector consists of diverse models. In other words, quality improvement reduces the difference between initiatives and their implementation