Analysis of Hospital Quality Management Team

Analysis of Hospital Quality Management Team Contents INTRODUCTION BACKGROUND History Vision Mission Core values MAIN SERVICES AVAILABLE, HOW SERVICES ARE DELIVERED AND TARGET POPULATION ISSUES IDENTIFIED ANALYSIS OF QUALITY MANAGEMENT PROGRAM REFERENCES INTRODUCTION This is an in-depth analysis of quality management program conducted in Villingili hospital. Improving the quality of care management practice is a concern in many countries regardless of differences in definition, organization, and funding of services. Quality assurance involves a commitment to guaranteeing the quality of services, not as an additional element attached to the service, but as part of an ongoing system in which performance is monitored and achievement measured against set standards or benchmarks (Camp, 1989; Crosby, 1979; Oakland, 1993 cited in Clarkson Challis, 2003). First a brief introduction of the hospital will be presented followed by the discussion of various quality related issues that can be identified within the hospital. Followed by this, one quality management effort, which is the indoor environment of the hospital, will be analyzed. Subsequently, recommendations for any other strategies that could be implemented to improve the present situation and to overcome quality issues that are not part of any quality program at present will be elaborated. BACKGROUND History Villingili hospital was first opened as a health center in 21st April 1994. The health center was initially opened as a branch of Male’ Health center. The health center was set up in a four room building provided by Male’ municipality. On 15th April 2002, the government changed the health center to a three story building. On 14th August 2014, the health center was changed to a third grade hospital; same level as an atoll hospital. Vision: strive to provide healthcare services to people of Villingili and to make the community aware regarding health life styles and to provide ideal, quality and acceptable health care service to residents of Villingili. Mission: To provide an uninterrupted health care to residents of Villingili. To diagnose and treat different types of diseases and work towards the prevention of these diseases. To further develop the laboratory services. Core values: no core values are identified by the organization. Even though the Villingili Hospital have a rich history, it was depressing to find that the staff of the hospital was unaware of the vision, mission and core values of the organization. MAIN SERVICES AVAILABLE, HOW SERVICES ARE DELIVERED AND TARGET POPULATION The main services available in this hospital are, consultation services from general practitioners, consultation from specialized practitioners, laboratory services, community health care, vaccination and nursing care services. The target population is the residents of Villingili, whose population is around 17,000 people according to Villingili hospital. Specialized doctors’ consultations are on specific days. Gynecological consultations are done on Sundays and Wednesdays from 08:00am to 04:00pm. Orthopedics consultations are done on Sundays and Mondays at 08:00am to 04:00pm by Orthopeadician Dr. Hussain Faisal. Pediatrician consultations are done on Mondays and Tuesdays at 08:00am to 04:00 pm. All consultants are arranged sent from IGMH. Vaccination and child growth monitoring is done on all working days from 09:00 am to 01:00 pm. All available services are provided within the hospital. Even though they have a community health service unit, home visiting are not done. Services are provided 24 hours throughout the day, and shift duties are done by all consultants, nurses, receptionists, interpreters, ambulance drivers and attendants. Even though specialized consultations are done, it is evident that both the consultants and clients face enormous difficulty to diagnose and treat diseases and conditions as essential and compulsory diagnostic services such as ultra sound scanning and x-ray services are not available in the hospital. ISSUES IDENTIFIED After conducting surveys in the Villingili hospital and interpreting the results, I have identified some issues related to quality of service provided by the facility. Here are the results of the survey conducted in the facility. In the survey questionnaire, a question was used targeting to identify the staff response to patients need and their courteousness. The evaluation will be accurate if we analyze the situation in both directions. According to the hospital officials, clients can consult general practitioners through a walk in OPD. But the consultation for specialized practitioners such as the orthopeadician and gyneacologist, clients have to make appointment prior to consultation. Appointments are issued until the planned slots are filled. From the interviews conducted, we understood that the time delay dissatisfaction usually arose during busy situations where the doctor who is consulting in the OPD have to attend in patients or emergency cases. Some clients also noted that the doctors sometimes goes for break while more than 10 clients are waiting outside. A service provider have to consider suitable timings in order to provide a quality service to the clients. In order to evaluate this, we questioned whether they are satisfied with service timing of the facility, both general and specialized consultations. Among 10 clients, 2 clients (20%) informed that they are not satisfied with the time for specialized consultation while 3 clients (30%) told that they are moderately satisfied and 5 patients (50%) are fully satisfied with the service timing. Figure 1 Even though they get the appointment for specialized consultation and can consult the general practitioner through a walk in OPD, the time taken to consult the doctors vary. To verify the time taken to consult the doctor, we gave time ranges from 0-10 minutes, 20-30 minutes and more than 30 minutes. According to the clients who gave the interviews 5 clients (50%) informed that they had to wait between 0-10 minutes, 3 clients (30%) told that they waited between 20-30 minutes for the consultation and 2 clients (20%) stated that they waited for more than 30 minutes to consult the doctor. These findings are presented below in figure 2. Figure 2 Identification of the client satisfaction and dissatisfaction is crucial in order to upgrade and provide an ideal and acceptable quality service to the clients. In order to identify the overall satisfaction of the clients regarding the time they spent during consultation, we included questions targeting this issue. According to 7 clients, (70%) they are fully satisfied with the time they spent and 3 clients (30%) are not satisfied. These results are shown below in figure 3. According to the information we collected, we found that most clients highlighted that the biggest issue they face is the way the staff communicate with them. Some clients have informed that they were left feeling like a fool during consultations and some staff spoke rudely to them. Few noted they feel that the staff are overburdened with responsibilities and they seem very unenthusiastic. In addition to this, some clients informed that the staff seems to be involved in their personal things while attending the clients who goes to the counter for different things. Communication effectively with patient and family is a cornerstone of providing quality health care (Patient care improvement guide, 2008). The manner in which health care provider communicate information to a patient can be equally important as information being conveyed (Patient care improvement guide, 2008). Patient surveys have demonstrated when communication is lacking, it is palpably felt and can lead to patients feeling increased anxiety, vulnerability and powerlessness (Patient care improvement guide, 2008). Among 10 clients, 5 clients (50%) informed that the staff was poor in areas being respectful, friendly helpful and courteous. Another 3 clients (30%) noted that the staff was fair in this area while the remaining 2 clients (20%) informed that the staff was good in this area. It is depressing to note that not even one client told that the staff was great in this area. The information is shown in a pie chart below in figure 1. Figure 1 The next question was whether the staff explained the procedure and how they answer questions asked by clients. Among 10 clients, 6 clients (60%) informed that the staff was poor in explaining the procedure and answer questions asked by them. Another 3 clients (30%) noted that the staff was fair in this area. The remaining 1 clients (10%) informed that the staff was good in this area. The information is illustrated in figure 2. Figure 2. According to the information collected through survey, it is clear that most clients highlighted that the biggest issue they face is the way the staff communicate with them. Some clients have informed that they were left feeling like a fool during consultations and some staff spoke rudely to them. Few noted they feel that the staff are overburdened with responsibilities and they seem very unenthusiastic. In addition to this, some clients informed that the staff seems to be involved in their personal things while attending the clients who goes to the counter for different things. The issues identified through survey with clients of this facility that, may hinder the quality of service provided are, ineffective communication and unenthusiastic staff. Additionally, by conducting interview with the senior administrative officer of Villingili health center, it is evident that some staff lack knowledge in some areas such as care during emergency situations. Lack of knowledge is due to lack of practice as the institute have less inpatients who needs constant care. Communication effectively with patient and family is a cornerstone of providing quality health care (Patient care improvement guide, 2008). The manner in which health care provider communicate information to a patient can be equally important as information being conveyed (Patient care improvement guide, 2008). Patient surveys have demonstrated when communication is lacking, it is palpably felt and can lead to patients feeling increased anxiety, vulnerability and powerlessness (Patient care improvement guide, 2008). ANALYSIS OF QUALITY MANAGEMENT EFFORT As the Villingili Hospital is being rebuild to accommodate required facilities to function as a hospital, patients’ and staff are facing various difficulties. The major difficulty that most people face is that consultant rooms are situated in the first floor of the building. A person does not have to be elderly to have a difficulty to climb stairs, and because of this arrangement some patients have faced difficulty. It is evident that the changes to the present building is being brought on to provide a quality service to the customers. However, the effect of physical environment on healing process is evident through research. The arrangement of wards, labor rooms, consultant rooms and waiting areas and its physical environment such as ventilation, lighting, and temperature is important aspects to consider to provide a quality hospital environment. From my personal experience, it is clear that the physical environment of hospital is set to ease the staff only and patient prefer ence or perspective is rarely considered. As I have experienced, I have faced immense difficulty when I went for a consultation with high grade fever and wheezing. The consultant’s room air conditioner was set a temperature where it was difficult for me to utter a single word without clattering my teeth. Additionally, I have found that the present physical environment of the Villingili hospital can be considered dangerous for patient especially the elderly and young. The present construction activities and especially the smooth tiles put on the floor of the hospital is a hazard for falls. For this analysis, I will be looking into the extraneous factors of the hospital in order to deliver a quality service. Extraneous factor of hospital The physical work environment often influences (positively or negatively) the mindset of the service providers and their efficiency and capability to innovate in delivering expanded services (). Sometimes the aspects of the consultation rooms can have a negative impact. Such as the consultation room being too cold, hot, dark, noisy or unwelcoming (Moulton, 2007). Distractions in the room include visual distractions (eye catching photographs or art), auditory distractions (sounds from the waiting room or next consultation room) and olfactory distractions (bad odors or body odor of previous patients) (Moulton, 2007). Suboptimal seating arrangement also can be a negative extraneous factor of hospital, such as seats being hard and uncomfortable (Moulton, 2007). In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families as well as for healthcare staff (Huisman, Morales, Hool Korts, 2012) Studies have shown that excessive noise, glare and poor air quality can create stress as is evidenced by increased heart and blood pressure and reduced oxygen level in the blood in both adults and babies who are exposed to these environment (Blomkvist, Ericksen, Theorell, Ulrich, Rasmanis, 2005; Hagerman, Rasmanis, Blomkvist, Ulrich, Eriksen, Theorell, 2005;Zahr Traversay 1995 cited in Zborowsky Kreitzer, 2008). A healing environment with appropriate physical aspects contribute to patients’ outcome such as shorter length of stay, reduced stress, increased patients satisfaction and others (Ulrich et al., 2004 cited in Hussain Babalghith, 2014). REFERENCES Clarkson, P., Challis, D. (2003). Quality Assurance Practices in Care Management: A Perspective from the United Kingdom. Care Management Journals, 4, (3), 142-151. Huisman, E. R. C. M., Morales, E., Hool, J. V. Korts, H. S. M. (2012). Healing environment: A review of the impact of physical environmental factors on users. Building and Environment (58), 70–80. Moultan, L. (2007). The Naked Consultation: A Practical Guide to Primary Care Consultation Skill (1st ed). United Kingdom, UK: Radcliffe Publishing. WHO. (2004). Quality Improvement in Primary Health Care; A Practical Guide. WHO regional publication, Eastern Mediterranean Series 26. Zborowsky, T., Kreitzer, M. J. (2008). Creating Optimal Healing Environment in Health Care Setting. Clinical and Health Affairs, 91(3), 35-38. Saushan Rasheed Quality Assurance in Health Care Assignment 2