This writer’s definition of quality is a measurement of the strength, durability, and accuracy of a person, thing, or action. Phillip B. Crosby coined “doing it right the first time” as one of his main objectives when teaching and promoting quality (Guru Guide, 2010). Crosby’s ideas of quality improvement and steps deeply resonate with this writer. Crosby’s method of promoting quality addresses problems before it starts and prevents costly and timely interventions for identifying and fixing mistakes (Guru Guide, 2010). Crosby’s prevention method calls for zero defects (Guru Guide, 2010). While many argue that zero defects are not humanly possible, this writer believes that striving for less than perfect equates to striving for mistakes (Guru Guide, 2010). This writer described the idea of quality as a measurement of durability, strength, and accuracy. Crosby’s theory related to quality calls for 100% accuracy and emphasizes that quality is both tangible and measurable (Ramirez, 2019).
There are very few processes and practices that have no room for improvement. Healthcare is ever-changing; innovative studies and evidence change modern medicine’s face every day (Milella et al., 2021). In this writer’s experience, one of the most time-consuming procedures is logging into a computer and scanning medication before medication administration. Scanning medications and the patient’s wristband before administering the medication is an important safety net that reduces medication errors (Tolley et al., 2022). Taking the time to log onto the computer and get into the patient’s chart to scan wristbands and medications is time-consuming. In an emergency, every second counts, and wasted time could negatively impact the patient’s outcome. Recent technology used to log providers into their computers, such as tap and go, Imprivata, and similar programs, help eliminate time wasted manually logging into computer systems while still accomplishing elevated levels of accuracy. The promotion of elevated medication administration accuracy levels prevents the need to identify a potential medication error and then take the time to fix the error.
GURU GUIDE. (2010, 11). Quality Progress, 43, 14-21. Retrieved from https://www.proquest.com/magazines/guru-guide/docview/816914442/se-2Links to an external site.
Milella, F., Minelli, E. A., Strozzi, F., & Croce, D. (2021). Change and Innovation in Healthcare: Findings from Literature. ClinicoEconomics and outcomes research : CEOR, 13, 395–408. https://doi.org/10.2147/CEOR.S301169Links to an external site.
Ramirez, R. (2019, March 10). Philip Crosby. Academia.edu. Retrieved January 10, 2023, from https://www.academia.edu/38523531/PHILIP_CROSBYLinks to an external site.
Tolley, C. L., Watson, N. W., Heed, A., Einbeck, J., Medows, S., Wood, L., Campbell, L., & Slight, S. P. (2022). The impact of a novel medication scanner on administration errors in the hospital setting: a before and after a feasibility study. BMC medical informatics and decision making, 22(1), 86. https://doi.org/10.1186/s12911-022-01828-3Links to an external site.
The concept of quality was designed to improve the overall healthcare status of individuals and the community population. Quality in healthcare is defined by the Institute of Medicine as, “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Agency for Healthcare Research and Quality, 2022). There are six components that help define quality in healthcare. Each helps identify and describe what is needed to provide quality care to patients. These domains are effectiveness, efficiency, equity, patient centeredness, safety and timeliness (Agency for Healthcare Research and Quality, 2022).
Identify Practice Problem:
The customer experience that was identified in the main emergency department was overcrowding. Crowding in the ED has become a worldwide problem for hospitals and urgent care facilities. Crowding leads to a variety of problems that include satisfaction, health and financial negative outcomes. Customer satisfaction is not a domain described in the Institute of Medicine definition of quality in healthcare. This led me to choose another theory to include in determining patient satisfaction from the IHI Triple Aim. A wasteful practice that was observed in the ED was patients left without being seen. The triage flow needed to be revised during these high volume times to reduce the number of patients leaving without being seen by a provider. Patients that had a high triage score could be seen quicker and discharged faster leaving more time for higher acuity patients. Evidence states that there was a twenty-nine percent increase in satisfaction when a patient is seen by a provider within 30 minutes of the triage process” (Health Catalyst Editors, 2018).
The healthcare system is constantly changing and the need to recognize that improvements need to be developed is necessary for the overall health of the community it serves. The Triple Aim framework of quality incorporates improving the patient experience of care by including satisfaction. There are five components of the system that includes individuals and families, primary care structures, population health, cost control, and system integration (Institute for Healthcare Improvement, 2023). Understanding patient satisfaction at a basic level can improve and change at a system level using this framework.
Agency for Healthcare Research and Quality. (2022). Understanding quality measurement. https://www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/understand/index.html#:~:text=What%20Is%20Quality%3FLinks to an external site.
Health Catalyst Editors. (2018). Emergency department. Leveraging Lean in Healthcare, 319-334. https://doi.org/10.1201/b10406-27Links to an external site.
Institute for Healthcare Improvement. (2023). The IHI Triple Aim | IHI – Institute for healthcare improvement. Improving Health and Health Care Worldwide | IHI – Institute for Healthcare Improvement. https://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspxLinks to an external site.
SCHUSTER, M. A., McGLYNN, E. A., & BROOK, R. H. (2005). How good is the quality of health care in the United States? Milbank Quarterly, 83(4), 843-895. https://doi.org/10.1111/j.1468-0009.2005.00403.x
Define quality. Quality is a characteristic of the product or service, according to Spath (2018). There is always room for improvement; things constantly evolve to meet or surpass client expectations (Spath, 2018). Several factors determine health care quality. It encompasses more than just patient care and a procedure’s result. Per Juran’s idea of “fitness for intended use” is the foundation of today’s definition of quality (Guru Guide, 2010). This definition defines quality as “meeting or exceeding consumer expectations.” According to Deming, the only purpose of quality that matters is the one the customer gives. So, who exactly is the client/ customer (Guru Guide, 2010)? Ishikawa made the case that customers are the only reason a firm exists, even if focusing on the client is still a key component of quality and has grown to be accepted as the norm (Konuo, 1994). He also said all work must include corrective and preventive action to uncover and resolve problems downstream from the customer engagement point, making it the most cost-effective way to operate (Konuo, 1994).
Donabedian identifies efficacy, effectiveness, efficiency, optimality, acceptability, legitimacy, and equity as the seven qualities of high-quality healthcare (Upadhyay et al., 2020). An identified practice problem that is experienced by many is wait times. Wait times plague our everyday lives, whether waiting for service in a restaurant or waiting to see a medical provider. Only by continuously streamlining procedures, eliminating wasteful processes and activities, and boosting productivity can healthcare quality be improved (Upadhyay et al., 2020). The bar is being raised for health systems to achieve better health outcomes and higher social value due to shifting health needs, heightened public standards, and incredibly ambitious health goals (Kruk et al., 2018). Emergency rooms are overwhelmed with patients, some with life-threatening emergencies and others that are there for non-emergencies, thus creating longer wait times. The wasteful practice of going to the emergency room for non-emergent needs is more than likely the root of long wait times to receive needed care.
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