Healthcare is one of the most vital sectors in the country. Therefore, the necessity for quality and safety improvement initiatives permeates health care. Afroz (2019), defines quality healthcare as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Therefore, quality healthcare takes into consideration the Safe of the patients and the Timely delivery of care to the patients. Quality care also takes into account the Effective of care process and structure, the equitability of care to all people, and its efficiency to the target population. Lastly, quality care is also patient-centered. As hospitals are striving to match the standard of quality care, they are finding it useful to have in place performance improvement tools. With the different performance improvement tools in the healthcare settings, they can track and show them the effectiveness of the process of healthcare they have in places. Fortunately, for most healthcare institutions, there is a wide range of healthcare improvements tools that they can use to measure the quality of care they provide to the patients. In this discussion, the focus is to focus on some of the performance improvement tools that hospitals can use to measure the quality of their performances in the healthcare setting.
Performance Improvements Tools In Healthcare
According to Potash, Hughes & Pogers, (2019), performance improvements are the processes or ways that the hospital institutions use to ensure that the nature of the services they provide to the patients is of quality. Quality improvements in the hospital consider the structure of the healthcare system where the healthcare staffs operate. Quality in a healthcare setting also encompasses the processes that are within the hospital and are the core of delivering care to the patients and the community ( Chia et al., 2019). Lastly, quality improvement in health care institutions also considers the outcome of the services that the hospital gets after providing their services to the patients and the community. Therefore, performance measurements can focus on the quality of the structure, the process, and the outcome of the healthcare services.
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The healthcare institutions, therefore, need to have in place tools to measure such performance improvements and ascertain whether they meet the desired quality performance. According to Guo et al., (2019) , performance improvement tools are standalone strategies or processes that the healthcare hospital can use to help the management better understand the quality of the services they provide to their patients. The performance improvement tools, thus, improve the hospital management analyze and communicate the effort they make regarding the quality performance and improvements within their facilities. The tools highlight areas where the hospital is failing to achieve the quality that is also affecting the overall quality performance of the services ( Mishra, Ghosh &Aravindan, 2019). The examples of the performance improvement tools that hospitals can use to measure quality include Improvement Model/PDSA, Cause, and Effect Diagram, Six Sigma, Root Cause Analysis, and Healthcare Failure Mode and Effects Analysis (HFMEA) . Alt hough these tools are numerous, the list provides some of the most proven and most used in different healthcare settings.
Improvement Model/PDSA
The Plan-Do-Study-Act (PDSA) is a model that has years of research behind it and is proven to be one of the most effective means assessing the performance improvements and measuring the quality of the performance in the hospital. The purpose of the PDSA, quality improvement tool, is to establish a functional or causal relationship between changes in processes and outcomes. Before using this tool to analyze the performance and define the quality in the setting, the hospital needs to understand the goal or the quality improvement target, how to measure the quality achieved, and the ways to reach the target.
The PDSA cycle allows the hospital to improve on different processes they intend to do and also measure their success regarding the quality standard desirable. Under planning, the hospital can assess the processes, the structure, and the outcome at its current state and come up with objectives for improvements. At the planning stage also, the healthcare organization assesses the quality of the current healthcare services and defines the goal or sets the target for the quality improvements of the same services ( Al Khamisi, Khan &Munive-Hernandez, 2019). At the second stage of the PDSA cycle, the hospital comes up with the quality improvement strategy and implement it within the setting. It then does a small pilot study to assess whether the process can achieve the desired improvement and meet the quality before they carry pout the process. Therefore, the tool is critical in determining the process before the hospital takes the initiative. It thus determines the quality of the process and makes a recommendation on the best ways to achieve the desired quality.
PDSA is a tool for measuring quality in healthcare improvement focuses on the changes that the hospital can make to improve quality. For instance, the hospital can use this approach when assessing the quality of the information system and flow within the hospital. The management can have, for example, goals in which they predict the nature of quality improvement they want to achieve within the hospital ( Afroz, 2019). The hospital can then carry out a small pilot study to indicate and measure the standard of the quality results they will have in case they carry out the project. With such results, they can determine whether the process will meet the standard or durable quality. The PDSA will also allow them time to improve on the process or areas where they are shortcoming.
Root Cause Analysis
RCA is a technique used to identify trends and assess the risk that can be critical whenever a human error is suspected. The root cause analysis is essential in determining the root cause of the problem and ways to respond to them. The foundation of the root cause analysis is the fact that all issues have root causes. The model postulates that such root causes must be understood to solve them ( Niñerola, Sánchez-Rebull& Hernández-Lara, 2020). For a hospital to use this approach, they have to understand that the problem is not people who work for them, but the system under which they work. While using the RCA tool, the hospital defines the area of the improvement in a retrospective manner to determine where the problem is and how best they can improve. While assessing the quality of service suing the RCA, the hospital also can use this approach to identify the causes of an event and evaluate the quality of services at the point where the incident occurred and what they can do to improve the situation.
Take, for instance, where the hospital would like to understand and also improve the quality of services by reducing the waiting time. The hospital can use the RCA tool to assess the quality of services and also factors that lead to an increase in waiting time ( Yu et al., 2020). The hospital can evaluate in a retrospective manner what could be causing the increase in waiting time. They can begin by assessing the staff and determine whether they have certification or may need the training to handle the number of patients that come in the hospital ( Niñerola, Sánchez-Rebull& Hernández-Lara, 2020). They can also evaluate the facility materials and equipment that are available. They would then compare it regarding the number of patients they serve. They could further analyze the patient staff-ratio and determine whether the ratio is the problem that is leading to more waiting time for the patients. The assessments or analysis's result can give the hospital an overview of its staff's quality, materials, and services they provide. The data can further be critical in improving the areas that lack progress and maybe causing an increase in waiting time.
Healthcare Failure Mode and Effects Analysis (HFMEA)
HFMEA is another performance improvement tool that a hospital can use to assess whether the services it provides to the customers are of quality. The goal of the HFMEA is to prevent errors within the system ( Al Khamisi, Khan &Munive-Hernandez, 2019). The HFMEA also attempts to approximate a probability that within the system, mistakes can occur that can lead to its failure in the future. The tool can also be critical in analyzing the consequences of the potential errors that could lead to system failure and ways the organization can combat them before they occur.
HFMEA can prove vital to the hospital when it needs to assess and improve its quality of services. Notably, the HFMEA’s goal is to detect areas where there are problems and could lead to low-quality service delivery. In this way, it can be critical in assessing the quality of services in different departments within the healthcare setting. The results of the HFMEA analysis can highlight to the hospital management the areas where they are falling short of quality they need.
Take a situation where the hospital needs to understand the quality and the effectiveness of its Electronic health record system to both the staff and regarding the quality of patients' data protection. Using the HFMEA as a performance improvement tool, they can assess the electronic health record system regarding how well the staff uses the system. They can also determine how effective the system is in delivering quality services to the medical workers and the patients ( Niñerola, Sánchez-Rebull& Hernández-Lara, 2020). They can then brainstorm on the results of the assessment regarding the quality of such services and list the potential threat to failures. The results will be vital in assessing whether the Electronic health record is offering quality services to the staff and whether the medical workers are using it in the recommendable ways. They can come up with scales and rank the results based on specific quality scales such as the Likert scale of one to five. Based on the quality assessment scale they chose, the hospital can be able to identify the potential failures and also assess the quality of the services they offer to the customers ( Al Khamisi, Khan &Munive-Hernandez, 2019). They can identify areas to improve and how they can come up with changes to meet the standards they require. In this manner, they shall have used HFMEA to assess the quality of their electronic health system services and make adjustments to meet the quality standards.
Six Sigma
Lean six sigma is another critical tool that the hospital can rely on to detect and also improve its quality services to the patients. Six Sigma allows a healthcare organization to break through the status quo and achieve real process improvement. The goal of the six sigma tool is to eliminate the defect that can occur during a process. L ean Six Sigma uses Define-Measure-Analyze-Improve-Control (DMAIC). The lean sigma is, therefore, a five-step approach to process improvement. Focus on improving the patient experience by making sure your processes consistently deliver the desired results.
While applying the lean six sigma, the organization first defines their area of the problem or an area where they need to understand the quality of the services they deliver to the customers. The next step is to measure the process in its current basis as they strive to understand the quality of the services at that point. The next step is to analyze the situation based on the results of the measure before coming with an improvement strategy. The organization must also have a plan to monitor the new strategy. Six sigma is critical and has a success record. Therefore it can be vital to the hospital.
Take, for instance, a situation where the hospital needs to understand the quality of services at the pharmacy department. Note that such may include assessing the medication errors within the department. The hospital may use the lean six sigma to determine the quality of the services at this point. They can first define what they want to evaluate, which in this case, is the medication errors at the department. The next step is to analyze the situation at the pharmacy department regarding how the staff handles the drug prescriptions. These could include the analysis of any factor that could lead to errors during the entire process. The documentation of the results should focus on issues that could lead to the mistake within the department. The next stage is to improve the situation. Improving the condition depend on the data that the team finds within the pharmacy that worth developing.
The last step is to come up with ways of monitoring the situation of the department. What is critical, therefore, is that by using the lean six sigma, the hospital shall have identified the need to make some changes towards improving the situation within the department. Based on the results they have after assessing the case, they shall have found out whether their operations match the quality they need, or there must be some improvement to achieve the goal ( Niñerola, Sánchez-Rebull& Hernández-Lara, 2020). Therefore, the six sigma is critical for the hospital in improving the quality of their operations. The tool can help the hospital identify not only the areas they need to improve on but also the strategies they may need to achieve the goal.
The Cause-Effect Tool
The cause-effect is another performance evaluation tool that the healthcare system can use to determine the extent of the quality services they offer to the customers and also improve them. The cause-effect or the fishbone diagram has years of research to define its success rate. In most cases, the results are favorable for the organization that resorts to this model as a performance improvement model. The goal of the tool is to examine the reason that could have led to something happening within the organization's operations. Take, for instance, a situation where the hospital is experiencing a high rate of readmission. The fishbone diagram could be significant in understanding some of the causes of this situation. In this sense, it can be critical to understanding the quality of the operations within the hospital. By highlighting areas that fall short of the quality services, the tool can help giving blueprints of processes that the hospital must improve to achieve the desired quality.
The following steps can be critical if the hospital has to use this approach to assess the quality of their services. The first is to define the area where the hospital needs to determine its quality of services. For instance, the area for assessment can be the use of evidence-based practice by health workers. In this sense, the hospital could have an interest in understanding whether the workers are emphasizing the use of evidence-based practices. The next step will be to assess all the factors that could either lead to an ease of applying the use of the evidence-based practice in the hospital or hinder the application of evidence-based practices ( Mishra, Ghosh &Aravindan, 2019). These factors could be staff, the hospital structure, and the availability of the resources, hospital management philosophy, and the use of technology within the hospital. Such assessment highlight the areas that must be of quality to produce a ripple effect on the use of the evidence-based practice in the hospital. The next step is to define the components of these factors that could be hindering or promoting the use of evidence-based practices in the hospital. Through such an assessment, the hospital management will be able to understand areas that they have achieved and areas where they are failing to produce quality. For instance, they can determine whether the staffs have quality training on the use of evidence-based practices or the training is in need to enhance its application in the hospital.
There are numerous performance improvement tools that a hospital can use to assess the quality of the performance. Some of these tools are not among the ones discussed but are some of the most used. From the discussion, the performance management tools are essential because they help the hospital analyze their operations. Through such analysis, they can find areas where they fail to meet the quality that the hospital need to provide the best and competitive services to the clients ( Rodgers et al., 2019). With such performance improvement tools, the organization can highlight some of the reasons that make them hit below the target regarding quality and come up with a solution to mend them. It is, therefore, critical that the hospital management team understand these tools and use them to assess and also improve their operation to meet the quality standard they set and those set by the regulatory bodies in the healthcare sector.
References
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