Quality improvement is a long process to undertake as it requires complex attention to many aspects of functioning of the hospital that affect the results of the improvement process in a complex way. For this reason it is highly important for the person generating a QI plan to choose the constructive, well-planned methodology for quality improvement. One of the necessary elements to be considered in the course of choosing the most compliable methodology is to clearly realize what aims it should serve and what stages of QI the hospital will undergo.
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Dlugacz (2006) offers a set of methodologies that function well and include the widest set of criteria according to which the improvement process may be undertaken efficiently. First of all, the author mentions the Six Sigma approach that proved to be efficient in many spheres of economic activity, especially in manufacturing industries. The six sigma approach to managing quality care is to make sure that the process involving many constituent parts to be united into a single whole (which is really true about health care management involving an enormous set of activities and treatment facilities to be provided to the patient in order to achieve the final result) is conducted properly (Dlugacz, 2006).
The ultimate goal of six sigma management is to provide compliance with the highest quality of performance at each stage of providing heath care, not only at the final stage as it is usually considered. For this reason the methodology provides much better performance standards to comply with and results in much higher customer satisfaction as a result of receiving healthcare according to the Six Sigma approach to quality management.
The second methodology described by Dlugacz (2006) is the PDCA approach to quality management and improvement. This approach underlies the complex action taken by the hospital management to introduce a certain improvement and comprises a set of steps to be undertaken in the course of action. The full name of the methodology is Plan Do Control Act approach, so each stage is a meaningful action interconnected with all other stages with the purpose of producing an effective result. Another name of this approach is Deming Cycle, which is also widely used in many spheres besides health care.
At the first stage of implementing the PDCA approach the improvement framework should be stipulated. This stage comprises prioritization in health care – the main branches of improvement are made the dominant spheres of focus and actions necessary to be taken to improve these spheres are worked out (Dlugacz, 2006). As a result, the scope of action is formulated and the practical stage begins to be implemented.
The second stage, Do, includes testing of the planned action in some small part of the whole planned area of improvement. The action is taken to check the validity of the chosen improvement process; results are accurately recorded and assessed. Here comes the third stage – Check. After the action takes place its results are evaluated according to the awaited criteria. It is important to understand whether the chosen activities are really helpful in the achievement of the target stipulated at the first stage of the improvement schedule.
If the results prove to be efficient, then comes the third stage. Action involves full-scale implementation of improvement planned in the scope of the PDCA framework. Success of such an undertaking is indisputable due to the middle stage of checking the results allowing to predict the final results more or less accurately. Thus, the final stage, Act, becomes the practical part of the process, the improvement itself that helps the hospital achieve all goals stipulated and prioritized at the beginning.
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It is also necessary to remember that the PDCA approach to improvement is called the Deming cycle not in vane. It is initially aimed at continuous improvement and does not presuppose a single action that is taken once in a certain period of time. The main secret of success of this model is that it involves continuous, uninterrupted action, checking and improvement and benefits the hospital in a number of ways. The continuous improvement model is the target of each institution striving for the creation of an efficient QI plan, so the PDCA model appears to be one of the most successful choices ever made.
The third model necessary to be recollected is the EFQM – the European Foundation Quality Model. This model is also efficient in case the objective, standardized assessment for the health care improvement process is needed. It is widely accepted in many medical institutions around the world, hospitals in particular. Its advantage lies within the strong emphasis made on standardization and benchmarking of a set of criteria according to which the quality improvement success in a hospital is assessed. In addition, it provides an efficient assessment framework that allows a more unified analysis and assessment to be made (Dlugacz, 2006).
IT Applications as Components of QI Management
Coming to the question of IT applications and their role in healthcare it is necessary to take a brief look into what caused the necessity of their implementation. The role of IT technologies in healthcare has been recognized only recently due to the fact that complexity of provided services grows, major problems such as excessive expenditures and inability to show improved performance results arise and hospitals are continuously unable to provide customer satisfaction for the US citizens unwilling to pay for declining services. Declining loyalty to doctors and absence of willingness to be under managed care also add to the problem. As a result, medical care has turned to experience of other industries and chose IT applications as one of the efficient means to increase performance measures and to improve healthcare provided.
The first and the most widely used IT application is the Internet service that is acquiring intense popularity and is widely used by the medical institutions as well nowadays. The Internet is the most easily accessed popular network that allows all customers and patients of hospitals to get all necessary data about the issues interesting for them and be well-informed about their health record, appointments with doctors, prescriptions etc. at every moment of their life and in every geographical location.
In particular, one should consider the fact that the Internet is now accessed from mobile phones or other portable appliances, which allows people to be in touch with their hospitals and get the freshest information promptly and fully. This innovation is a real breakthrough for hospitals that have a large number of clients and simply cannot keep all of them informed in a timely manner. Making information widely accessible in the Internet and communicating the range of possibilities patients will further have may substantially reduce costs for communication with clients and will eliminate the time expenditures for performing the same functions.
The next IT application that is continuously acquiring popularity and becoming widely used is a number of Business Process Applications that make functioning of the hospital’s information channels much easier and more efficient. Besides, the overall information network of a hospital that needs continuous alignment and unification is becoming managed in a much easier and constructive way:
“Sophisticated, flexible business process applications have benefited from recent improvements in the underlying technologies of database management, application integration, and workflow automation” (Ransom et al., 2008).
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It goes without saying that the main element of any business process application is the workflow engine that makes daily activities of a hospital more organized and structured, allowing at the same time to adopt a more individualized approach to all patients of a particular hospital (Ransom et al., 2008).
The last but not the least application to be discussed in the present work is connectivity and messaging. It also plays a significant role in the quality improvement process of any hospital due to its specific contribution to the work arrangement in an institution of such kind:
“Connectivity and messaging standards have matured in recent years, including the common object-request broker architecture (CORBA), extensible markup language (XML), and, more recently, “web services” standards” (Ransom et al., 2008).
The main function of connectivity and messaging is to reduce costs; that is wonderfully done with the help of standards introduced in this application (Ransom et al., 2008). It is a relatively new application in the healthcare industry and it has not been widely used yet, but the QI process requires a wider range of IT applications to be implemented, so it is possible to say that this one will acquire popularity in the nearest future.
Potential QI Benchmarks and Milestones
Benchmarks and milestones play an important role in the QI implementation due to the attention paid to other institutions, gaining competitive advantage and ensuring comprehensive assessment and improvement. Benchmarking in its essence comprises comparison of performance indicators of one institution with another one to understand what pitfalls it has and what areas it should improve. Rossi (2003) argues that a hospital planning to undertake the BM research should pay attention to the following areas, among others: what areas are causing the most trouble, what operation problems have been identified and what products are aimed at providing the patient/customer satisfaction.
These are only a couple of indicators mentioned in his work; however, they provide the general understanding of procedures involved in benchmarking. What every hospital’s administration should remember is that every hospital should have a competitive advantage, so repetitive BM research is essential in every industry, and health care is not an exception.
Milestones are vital in the process of generating the set of measures according to which the hospital’s quality will be measured. The efficiency of choosing the parameters may seriously affect the accuracy of assessment, so Ransom et al. (2008) offer a set of milestones that can be applied in this process: developing a measurement philosophy, identifying the concepts to be measured, selecting specific measures, developing operation definition for each measure etc. (p. 89). It goes without saying that these milestones are an indispensible element of designing a QI plan and implementing it in any hospital.
Dlugacz, Y. D. (2006). Measuring Health Care. John Wiley & Sons.
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Ransom, E.R., Joshi, M.S., Nash, D.B., & Ransom, S.B. (Eds.). (2008). The Healthcare Quality Book (2nd ed.). Health Administration Press, Chicago.
Rossi, P. (2003). Case Management in Health Care (2nd ed.). Elsevier Health Sciences.