The Visit
The site visit was made at a local children’s hospital that is developing a special amenities wing. The special amenities wing is for catering for children who have been born with HIV and AIDS or been diagnosed with the virus in their infancy. The main purpose for the wing is to ensure that these children live a full and productive life physically, socially, and emotionally. The site visit was mainly kindred to nursing work from the perspective of care. There was also an administrative perspective associated to the project involving the new wing. Among the key issues to be addressed in the site visit was a quality assurance from the perspective of both nursing and Continuous Quality Improvement Process (CQI).
Meeting with the Quality Assurance Officer
Modern quality assurance is not what it used to be as indicated by the nursing and care quality assurance officer who was interviewed during the site visit. Traditionally, issues of quality would only be limited to the professional elements such clinical intervention and adhering to codes of service, rules, and regulations. In modern nursing and care, the issue of outcomes has been included. This means that it is not just about what the nursing officer does but how the same is received by the patient and the patient’s loved ones. Quality assurance must, therefore, involve both the concept of process and systems as well as eventual outcomes of those processes and systems. Finally, the officer also indicated that outcomes also relied on issues that were beyond the recognized dimensions of professionalism. Children will react differently to secondary factors such as feeling cared for and tenderness. These are issues that are kindred to personality yet are fundamental to quality of service in nursing. The quality officer indicated that evaluation and oversight under such a wide range of subjects cannot be based on rigid rules alone. The entire process and system must be carefully monitored and evaluated to ensure that it is constantly improved. These sentiments were found to be in line with the dictates of CQI (Hunter et al, 2014: McFadden et al, 2015).
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Critique of an Attendance of a Committee Meeting
Several committee meetings were attended and one stood out as specifically suited for the instant assignment. This was the medical and electronic supplies team committee for the new amenities wing project. The meeting had been called to assess the progress of the project from the perspective of purchase and assembly of medical and electronic equipment. The meeting was also meant to handle matters arising that relate to the aforementioned subject. It was, however, when the issue of matters arising was raised that CQI issues came up. One of the suppliers of specialized equipment had indicated to the procurement team that among the orders made was an item that would be considered archaic before the period set for its use had elapsed. This was based on a technological breakthrough that had taken place after consultations between the project team and supplier had come to a close.
Two important processes can be used to evaluate this issue; the Root cause analysis (RCA) and the Failure mode and effects analysis (FMEA). RCA seeks to understand where the actual problem being handled by this instance may have emanated from. The philosophy behind RCA is to ensure that the issue is not resolved based on the symptoms but rather on its very advent (Shaqdan et al, 2014). When the source of the problem is identified and resolved, then the problem will not recur. FMEA, on the other hand, has three distinct types; the functional, the design, and the process FMEA. Functional FMEA mainly focuses on outcomes and seeks to evaluate the outcome to understand where and how the failure took place. Design FMEA is akin to RCA and looks backward to seek the source of the problem. Finally, process FMEA is more related to CQI as it looks at the point in time where the project has reached to understand where the problem is and how it can be solved going forward (Shaqdan et al, 2014). A careful evaluation of the issue that had been raised at the meeting will reflect that process FMEA would be an ideal solution. With the process already underway, the best way forward was to evaluate the available systems and processes and seek ways of fine-tuning them.
Critique from Observation and Other Investigative Activities
An issue of interest that was also relevant to the instant assignment was that of the care and protection of employees. With this being a hospital that relies heavily on charity and government funding, a lot of advocacy was taking place. A careful evaluation of the processes revealed that a lot of CQI was being undertaken in the different areas of service so that a better report can be available as and when the donors would come calling (McFadden et al, 2015). One would have to wonder if anyone was caring for the nursing officers. With this being an institution that was in the processes of seeking to focus on HIV and AID patients, the definition of serious safety event (SSE) was going to change. A small unnoticed incident with a needle that had been used on an HIV patient can make a live difference for a nursing officer in almost the same a major accident can do for other workers (Sethi et al, 2016). An interview with management on the subject revealed that a careful local study on all available literature was being used to develop best practices kindred to the subject. Nurses who will be handling patients in this new wing will then receive extensive training based on the research. As and when the new wing becomes functional, the systems and processes already put in place to protect the nurses will continually be advanced and fine-tuned. A careful evaluation of the results of this interview clearly reflected that albeit the term Continuous Quality Improvement Process was not being continually mentioned, it was well embedded in the philosophy of the hospital.
Personal Evaluation of Work Settings Quality Improvement Processes
The concept of CQI brings to mind the statement about bettering the best on the one hand and not fixing something if it works on the other. Quality improvement is not the same as quality assurance in my estimation but the two are related. Quality assurance, which is the focus of most projects entails an attempt to ensure that an envisaged quality is achieved (Hunter et al, 2014). Quality improvement, on the other hand, entails ensuring that the best possible quality is achieved under the circumstances. It means that the project managers should achieve such as high level of quality within the project that they would also be surprised by the results. This takes a process of continuously seeking to better the very best in processes and systems. Further, even when these processes and systems are considered to be working at optimum, the project managers should seek to fine-tune them further and redefine optimum (Hunter et al, 2014). CQI is the means to bring out the very best in every project. It is never good enough under CQI.
References
Hunter, S. B., Ober, A. J., Paddock, S. M., Hunt, P. E., & Levan, D. (2014). Continuous quality improvement (CQI) in addiction treatment settings: design and intervention protocol of a group randomized pilot study. Addiction Science & Clinical Practice , 9 (4), 1-11.
McFadden, K. L., Stock, G. N., & Gowen III, C. R. (2015). Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety. Health Care Management Review , 40 (1), 24-34
Sethi, S., Kiran, D. N., Popli, G., Malhotra, A., Bansal, A., & Mohan, S. (2016). Risk of exposure and preventive strategies of HIV infection in dental office-A review. International Journal of Health Sciences and Research (IJHSR) , 6 (5), 317-323
Shaqdan, K., Aran, S., Besheli, L. D., & Abujudeh, H. (2014). Root-cause analysis and health failure mode and effect analysis: two leading techniques in health care quality assessment. Journal of the American College of Radiology , 11 (6), 572-579
