The increase in awareness of inadequate patient safety in Canada has led to the changes in the legislative system as a way of improving the healthcare quality. For instance, in 2010, the Excellent Care for All Act was passed in 2010 to increase the levels of accountability of the healthcare providers and executives as a model of enhancing the patient experience (Bolster & Rourke, 2015). On the other hand, the Ontario Public Hospitals Act was meant to improve the system of reporting of the critical incidences. Despite the efforts put in place by the government to ensure that there are high levels of improvement of the quality of care in the country, most of the healthcare facilities have not reached the met the patient needs as marked by the increase in preventable deaths at healthcare facilities (Gharaibeh et al., 2016). An analysis of the case of Grand River Hospital and St. Mary’s General Hospital can help in the revelation of the data related to benchmarks and the national standards, while the results can help in suggesting the initiatives that can address the deficiencies and opportunities in quality of care.
Data Analysis against Benchmarks and National Standards
The Grand River Hospital (GHR) is one of the largest community hospitals with a staff of over 3500 members who strive towards the achievement of the vision of leading in the provision of patient care programs through innovation and collaboration within the available resources. The data analysis shows that 23,391 patients were admitted in 2010/2011, while the hospital recorded 12,671-day surgery visits (Landry et al., 2015). The hospital also recorded 58,596 emergency visits with 210,557 ambulatory care visits. The hospital met the national standards by living up to the requirements of the regulatory environment (Bolster & Rourke, 2015). The government of Ontario requires that healthcare providers and executives should be accountable for improving the patient care and enhancement of the patient experience. Under the Excellent Care for All Act, all hospitals are required to establish a committee that is supposed to report directly to the board of directors, while they should also develop and publicize annual quality improvement plans (Gharaibeh et al., 2016). In addition, the regulation requires that the healthcare facilities should survey patients annually and employees every second year in a bid to collect their perceptions on the quality of provision of care. Moreover, the boards of directors must ensure that the hospital executives are compensated according to whether or not the QOPs are met.
Delegate your assignment to our experts and they will do the rest.
In line with meeting with the requirements of the national laws, the Grand River Hospital developed a quality framework meant to improve the patient safety and the quality of service provision (Gharaibeh et al., 2016). The hospital appointed a patient safety committee comprising of the senior quality team and clinical programs and services quality councils that are liable for ensuring that the hospital is accountable for quality and safety (Bolster & Rourke, 2015). The healthcare facility has continually evaluated itself in the required dimensions, which include the access to care, appropriateness of the care, safety of care, and the patient experiences with the care. This implies that the hospital uses benchmark indicators to assess its performance and to track progress by measuring the performance measures against those set at the national standards (Landry et al., 2015). On its part, the St. Mary’s General Hospital has established benchmarking procedures, where it measures its performance against that of the Grand River Hospital, bearing in mind that there is proximity between these healthcare facilities (Maier, 2015). The benchmarking activities include the use of selected measures such as the wait times for surgery and medical imaging, the wait time for adult medical imaging, and the safety of care of patients.
The data analysis shows that the hospitals have put in place measures of ensuring that they meet the operational goals according to the set targets. For instance, the hospital has set the operational goal of safety and quality, where it aims at eliminating preventable harm (Gharaibeh et al., 2016). In line with this goal, the healthcare facility has set the operational target of reducing the patient falls by at least 25%. In line with the goal of improving the patient experience, the hospital has ensured that the emergency department length of stay for at least 90% of the patient admitted is reduced by 25%, reaching its overall target of fewer than 8 Hours (Bolster & Rourke, 2015). This operational goal measures the time taken from the time when the patient enters the emergency department and is first triaged until the time when the patient moves out of the emergency department.
Areas where Quality Improvements are needed
Their healthcare facility has shown that there are measures put in place towards reaching out for the goal of improvement of the safety of the patients and the overall quality of care (Maier, 2015). However, the analysis of the benchmarking activities compared with the national standards shows that the management should address critical areas of improvement for the successful attainment of higher standards of quality of care (Landry et al., 2015). The healthcare facility needs to come up with a quality improvement plan that is aimed at addressing the broader integrated quality and patient safety in the course of the provision of care (Bolster & Rourke, 2015). The plan should describe the hospital’s areas of priority and the commitment to a series of quality issues, goals, measures and the plans for change in terms of making management decisions (Maier, 2015). The major areas of improvement include reducing the length of stay for the emergency department patients including those who are admitted and those waiting for an inpatient bed (Gharaibeh et al., 2016). The plan should also include the reduction in the number of patient falls and the possible number of staff injuries at work.
The organization should also recognize that teamwork and communication skills can help in providing the highest levels of patient satisfaction. This is the reason why the healthcare facility should embrace the human resource attribute of training employees on collaboration and effective acquisition of communication skills that can reduce medical errors in the course of the provision of duty. Teamwork is also essential in ensuring that there are reduced levels of burden of work among the nurses (Gharaibeh et al., 2016). On the other hand, effective communication skills can help in ensuring that there are lower levels of errors emanating from the convenience of patient data. Teamwork and collaboration should be the guiding light in the course delivery of duties, where the process of decision making at the healthcare facility should be based on the input of all stakeholders (Landry et al., 2015). The management should also realize the need for the motivation of all staff members as a way of increasing their performance levels.
The healthcare facility should also come up with a plan that ensures that all the units are in a balanced financial position. This will help in addressing the possible constraints brought about by the lack of adequate resources especially during the preoperative services (Maier, 2015). The management should then ensure that there is continued check in the hospital-acquired infections, where it should address issues such as hygiene and sound catheter placement methods (Bolster & Rourke, 2015). The hospital should speed up its process of implementing the patient and family advisory council, which will ensure that the voices of patients and that of their families is at the core of the process of decision making. The healthcare organization must then realize that falls in healthcare facilities are the most significant preventable causes of harm to patients (Gharaibeh et al., 2016). All forms of falls and injuries can cause pain and discomfort to patients, which may, in turn, affect the process of healing with the consequent longer stay, while patients are put at the risk of developing further complications.
The healthcare organization must develop ways of preventing falls, which should include an in-depth review of every single fall as a way of determination of the patterns, root causes and the potential ways of prevention of future injuries. The management should then come up with a way of making rounds to check on patients and ask the patients specific questions regarding their anticipation of potential falls (Gharaibeh et al., 2016). Reducing the length of stay for patients admitted to the healthcare facility should be one of the main goals that the healthcare organization should put in place to ensure that it meets the national standards. The management should understand that a smooth transition to an inpatient unit is not only better for the patients, but a model that will reduce the number of possible deaths at the healthcare facility.
The healthcare facility has also been faced with the problem of formalizing the leadership positions and increasing the levels of accountability on the quality metrics (Landry et al., 2015). This implies that the healthcare facility must consider making vital adjustments to the organizational structure so that the leadership positions are formalized as a way of increasing the levels of accountability on the quality metrics (Bolster & Rourke, 2015). The organizational structure should include the patient safety accountability in the job descriptions of the department chiefs as a way of assigning the responsibility of quality of care. The company should also develop quality competitions as a way of recognizing the staff contributions to the safety improvements of the patients. This implies that the organization should enhance a framework for leadership that is willing to integrate the spirit of accountability in the system of leadership.
The healthcare facility should also undergo a system of extensive analysis and redesign, where it should measure variation in care for particular services and analyze the quality of care, efficiency, and financial outcomes to determine the best practices. For instance, the organization should ensure that it implements the full integration of technological platforms for tracking devices and in the process of protection of patient information (Bolster & Rourke, 2015). It is evident that tracking of devices electronically can help in the assessment of the levels of fault and in ensuring that the devices are available for emergency operations to reduce the wait time during preoperative services (Gharaibeh et al., 2016). The administrative structure should be created in the course of implementation of the guidelines basing on the automated standards. For instance, the organization must understand that a comprehensive system of electronic records can help in reducing medical errors while ensuring that there are high levels of confidentiality of patient information. The administration should also develop a conceptual framework for analysis and categorization of medical errors depending on the adverse effects of these effects. The management should, therefore, question the existence of the preventable adverse effects to reduce the number of deaths at the healthcare facility.
Goals for Initiatives
The first deficiency identified was the organizational structure, where the major goal is to formalize the leadership positions and to increase the levels of accountability on the quality metrics. These metrics include access to care, appropriateness of care, the safety of care and the patient experiences with the system of care (Gharaibeh et al., 2016). This implies that restructuring the organizational structure will help the organization to improve in the levels of patient safety accountability in the job descriptions of departments in assigning the responsibility of quality of care (Bolster & Rourke, 2015). The other goal that will be achieved through formalizing the leadership will be the development of the quality competitions that will recognize the staff contributions to the patient safety improvements. The formalized leadership will help in increasing the levels of monitoring of the services and the operations within the healthcare organization, which will not only lead to the improvement in the quality of service provision but also the levels of safety of patients. In the long run, the healthcare facility will reach out to its goal of reducing the number of deaths reported at the healthcare facility.
The other deficiency that has been identified is the lack of awareness in the importance of teamwork and communication skills required to provide the highest levels of patient satisfaction. The healthcare facility must recognize that lack of training in teamwork and communication is one of the causes of adverse and risky outcomes in the course of delivery of care (Maier, 2015). Training the staff in the acquisition of skills in teamwork and communication will help in reaching out to the goal of reduction of errors especially in the emergency care units (Bolster & Rourke, 2015). Effective communication and teamwork is also an essential tool that can help in the identification of the right medication and the historical medications of the patient, which can help in the prescription of the right medical procedure (Landry et al., 2015). It is evident that teamwork is also an essential tool that will help the organization to reach out to its goal of reducing the burden of work for all healthcare practitioners, which can also aid in increased motivation levels (Gharaibeh et al., 2016). Moreover, teamwork and effective communication skills will help the novice nurses to learn from the experts, which will improve on the professional levels of the staff in responding to the safety issues of patients within the healthcare organization.
The other goal is reaching out for cost-effective best practices at the healthcare facility. The administration should carry out an extensive analysis and process redesign (Gharaibeh et al., 2016). This approach involves measuring the variations in the care for particular services, which should be analyzed against the quality, efficiency, and the financial outcomes in the course of determination of the best practices. An administrative structure should be created to implement the guidelines basing on the set standards (Bolster & Rourke, 2015). The practices should be measured on the basis of the cost-benefit analysis, where the most recommended practices will be selected if their benefits outweigh the possible costs. The goal is to reduce the throughput times and service times through the exploitation of the process redesign techniques. The rule of thumb here is to optimize the business process through improvement of the tasks, the routing structure and the resource organization (Landry et al., 2015). The healthcare organization should reach out to the goal of striving towards the wider application of structured methods on the selection or combination of the effective set of best practices for a specific medical context.
Outcomes Anticipated
The first outcome will be the incorporation of a safety culture in the healthcare organization, which is an environment the healthcare organization, will increase the desire of achieving greater safety that will be apparent in the intangible beliefs, attitudes and values, while embracing concrete structures, practices and policies (Landry et al., 2015). In this case, the adoption of the safety culture will mean that the clinicians and administrators will not expect that each individual will be flawless, but rather that they understand that people are not essentially perfect while failures are inevitable (Bolster & Rourke, 2015). The adoption of a safety culture will mean that there will be heightened levels of diligence in error detection and in the implementation of the possible defenses meant to prevent adverse outcomes. The attitudes and behaviors of embracing a culture of safety will exist throughout the organization from the administration to the frontline clinicians, where it will persist through changes in the senior management. A safety culture will also mean that reporting will become more frequent and complete, while near misses will be willingly shared for greater quality improvement (Gharaibeh et al., 2016). This will also mean that there would be an increase in the amount of trust among the stakeholders in the healthcare organization.
The other outcome that is anticipated in the accomplishment of the initiatives is the transformation in the system of reporting. It is evident that critical incident reporting system provides information that is often inadequate and variable (Gharaibeh et al., 2016). Restructuring of the reporting system will ensure that the reporters cite the systemic factors as the root causes of the adverse events, where the clinicians will consider the latent errors that occur in the overall system at the distal end of the problem. The other outcome will increase in the levels of awareness of the staff through the education programs on effective reporting (Bolster & Rourke, 2015). This will mean that the environment will be made to be comfortable in such a way that the clinicians will freely report incidences including detailed accounts and the possible near misses. The reporting system will also embrace the questionnaires as they are open-ended, which will allow the reporters to develop a story of the event.
Appropriate Timeframes
After the implementation of the initiatives, it will be vital to evaluate the programs in a bid to assess their effectiveness and recommendation of the improvements. Performance evaluation will be helpful in assessing whether the initiatives meet the stated objectives and the goals set by the healthcare organization (Gharaibeh et al., 2016). The quality improvement programs will span for a period of one year, while there will be appropriate timeframes that will be set to re-evaluate data and the provision of a new system of analysis. The data that will be re-evaluated basing on the key performance measures including the access to care, appropriateness of care, the safety of the care and the experiences of patients with the care.
On the other hand, the evaluation process will be an ongoing process in as much as the scarcity of resources may be an impediment in the accomplishment of the set goals (Landry et al., 2015). Regarding the case of GHR and SMGH, the management should ensure that there are consistent evaluations that are carried out after a three-month period, which will determine the effectiveness of the set initiatives (Bolster & Rourke, 2015). This time is ideal as it will allow the staff members to adjust to the proposed changes while ensuring that they meet the full demands of the initiative.
Conclusion
Patient Safety has been identified as the avoidance, prevention, and amelioration of adverse outcomes or injuries that emanate from the process of care. Ensuring that there are high levels of patient safety is essential at all levels of operations as it helps in addressing the constraints of the increase in healthcare related deaths which would have been preventable. Healthcare organizations are required to adopt a culture of safety as a way of ensuring that the patient safety is a sound clinical practice and not as impacted by the broader system of patient care. The case of the GRH and SMGH has depicted that the management teams should take up initiatives that will improve the levels of patient safety. For instance, adjustments should be made to the organizational structure to formalize the leadership positions and to increase the levels of accountability on the quality metrics. Moreover, the management should recognize the need for acquisition of teamwork and communication skills as a way of improving the levels of collaboration towards responding to adverse events. The healthcare organizations should then put in place systems for evaluation of the quality improvement initiatives to ensure that all stakeholders are in compliance with the set regulations.
References
Bolster, L., & Rourke, L. (2015). The effect of restricting residents' duty hours on patient safety, resident well-being, and resident education: an updated systematic review. Journal of graduate medical education , 7 (3), 349-363.
Gharaibeh, B., Anderson, J. E., & Deasy, B. M. (2016). Combating the threat of stem cell tourism through patient education and government regulation. Innovation and Entrepreneurship in Health , 3 , 15-24.
Landry, J. T., Foreman, T., & Kekewich, M. (2015). Ethical considerations in the regulation of euthanasia and physician-assisted death in Canada. Health policy , 119 (11), 1490-1498.
Maier, C. B. (2015). The role of governance in implementing task-shifting from physicians to nurses in advanced roles in Europe, US, Canada, New Zealand and Australia. Health Policy , 119 (12), 1627-1635.
