Health Care Quality Improvement

Quality Improvement
Health Care Quality Improvement

A report spawned by the Institute of Medicine’s IOM in the year 1999 revealed
that medical inaccuracy leads to death of more than 7000 Americans annually (Institute
Of Medicine, 1999). As such, the requisite for quality and safety improvement scheme
pervades health care sector in America. In order for the quality of service delivery to be
enhanced work structures, procedures and the outcomes must be methodically
restructured. Structural measures look at fairly fixed elements embed in the process of
health care delivery such as physical plant and human resources. The procedural
measures deal with the prime proportion of quality upgrading efforts, since they examine
the explicit transactions in clinical-patient processes such as use of suitable surgical
antibiotic prophylaxis, helping to enhance the quality of the anticipated outcomes (Freitag
& Carroll, 2011). On the other hand, outcome measures encompass superiority of life
endpoints factoring in morbidity and mortality (Armstrong, Spencer & Lenburg, 2009).
This study elucidates into the criterion for mitigating errors and faults associated with
health care delivery for the purposes of improving on the quality of the health care
services. [Thesis]
In a report dubbed, To Err Is Human, IOM established that the majority of
medical errors are resultant of defective systems and work procedures (1999). In the
modern-day, health care sector functions at a lower level, after establishing this fact IOM
established six parameters to assert the goals and objectives of health care and this
include effective, safe, patient-centered, timely, efficient, and equitable (Marshall et al,
2003). The underlying precepts behind health care effectiveness and safety are targeted

via process-of-care events. These procedures examine whether health care providers
carry out their processes accurately for the purposes of achieving the established
objectives at the same time avoiding all the processes subject to harm (Jarzemsky & Ellis,
2010). Health care appraisal helps to find out the degree to which health care adheres to
the right processes etched on scientific evidence or founded on professional consensus.
In order for health care providers to hone their credibility and improve on service
delivery systematic change should be implemented. There are varied reasons why
planned change is necessary in the provision of quality health care (Struth, 2009).
However, the change implementation phase may be tiring and challenging for the
management. In order to implement change in health care successfully, managers must be
acquainted with change frameworks so as increment the likelihood of success (MacPhee
et al, 2009). A purposeful and well-calculated change entails collaborative efforts
between the management team and the support staff leading to improvement with the
assistance of change agent (Sullivan, 2010). Kurt Lewis identified three main stages
through which change agents must ensue before assimilating changes in the existing

 Unfreezing- when change is needed.
 Moving-During this stage, change is initiated.
 Refreezing-when equilibrium is established ( Freitag & Carroll, 2011).
Ronald Lippit came up with seven stages that must be pursued in order for the course of
change implementation to be successful. Lippit’s theory is popular and successful
because it incorporates a more detailed model of how to generate change. This model is
also underpinned by the four core elements of nursing process assessment namely,

assessment planning, implementation and evaluation (Hall et al, 2009). Lippit’s theory
captures the essence of staff involvement, empowerment and commitment during the
change implementation process, which generates improvement initiatives.
The seven stages in Lippit’s model comprise of:-

  1. Diagonize the problem: During this stage, the management must work collaboratively
    with the staff to establish the area of deficiency to avoid making erroneous decisions. The
    team leaders during change implementation should also be team players having goals
    similar to the rest of the team.
  2. Assess capacity for change: in this stage, management works with the subordinate staff
    to establish the ability of the health care facility to handle change. During this phase, the
    staff must be empowered and motivated to voice out their opinions so that all the
    necessary requisites are taken into consideration.
  3. Assess change agent’s motivation and resources: On the third phase of Lippit’s theory,
    the management team and junior staff should establish the intended outcome spurred out
    of the proposed change.
  4. Select change objective: staff engagement during the change implementation phase
    enables the management to provide inspiration, support and vision (Rosenthal
    ,2006).During this phase, the management should come up with a strategic approach on
    how the change will be implemented, determining in advance the intended positive
    impact of the change.
  5. Establish the role of change agent: There should be parameters on specific stipulations
    on the roles to be played by the agent of change.


  1. Mantaining change: The staff should be well trained and improved in relation to the
    instituted change to make sure that the implemented change is assimilated and well
  2. Terminate the helping relationship: Once change has been implemented successfully,
    the helping relationship between change agents and should be ended.
    In order for change to be implemented successfully some upgrading tools such as
    Root cause analysis (RCA) are utilized to initiate a formalized inquiry and problem-
    solving approach. This technique helps to identify and understand the fundamental causes
    of an event, for example when errors occur at some stage while a patient is being
    operated on (Gaba, 2004). The Joint Commission has stipulated a regulation for RCA to
    be performed in response to all sentinel events and expects the organization to develop
    and implement an action plan to mitigate future risks. At the same time, RCA technique
    can be used in identification of risks that can be used whenever human error is suspected.
    There are various models for quality improvement projects such as Plan-Do-
    Study-Act (PDSA). These projects comprise of quality improvement projects that are
    aimed and enhancing positive changes in the provision of health care services.PDSA
    enhances implementation of favorable outcomes. This model is unique owing to the fact
    that its cyclical in nature an aspect which makes change assessment more effective
    through small and frequent PDSAs. The objective of PDSA quality improvement efforts
    is to establish a functional relationship between changes and outcomes (Dobson,
    Stevenson & Scott, 2009).
    There are three tenets that must be critically considered before the implementation of
    PDSA cycles:

 The project goals
 The expected outcomes of the goal
 Steps necessary for achieving the established goal.
After establishing the scope and nature of the problem, PSDA determines the necessary
changes to be implemented and then afterwards a plan for specific change is instituted
(Walsh, Jairath, Paterson & Grandjean, 2010).
In order to evaluate the effectiveness of improved quality measures, scientific
evidence can be used to establish whether the change implemented enhances the degree
of safety amongst the patients. One qualitative method that can be effective in
establishing the quality measures would be conducting Interviews with end users.
Through this approach, health care providers will get first-hand information concerning
the services being offered they will get varied views which can be tabulated and
presented in a pie chart concerning what the clients feel about the services being offered.
Interviews are effective as they augment the credibility of the information being given
since the researcher obtains varied views. Moreover, the researcher can use open-ended
questions in order to get finer details of the responses being given by the end users.
Another source of information is the administrative databases which archive all
the information relating to quality-of-care information. The databases have huge volumes
of clinically relevant data and this information can be used to establish any variations
related to the implemented change. As such, the researcher will be able to make use of
bar graphs to depict any changes in trends in relation to the quality of services delivered.

There is a positive connection between the quality of health care provided and the
outcomes. The movement to implement changes in order to offer quality health care faces

considerable clinical, financial, and political challenges (Sullivan, 2010).
Notwithstanding, the movement is gaining momentum as quality leadership is instituted
to watch over the change implementation process. In the future, as the care givers take on
the right frameworks for examining problems and devising solutions, delivery of quality
health care will be practicable. It is vital, therefore, that health care providers assume
increasing leadership roles in efforts to identify, quantify, report, and improve on service



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