Assessment 4

Issue 1: Effect of Poor services

On Reputation of Kindly Residential Care Rest Home

Generally, the reputation of an institution, particularly elderly care facilities, is very essential in order to make known to concerned clients and their families how firm the institution is in offering quality health care services. In order for an institution live up to their reputation or even exceed the expectation of the clients and be more competent than other neighboring competitors, series of quality improvement measures are then conducted all year round. The first step or approach in quality improvement is to be able to identify certain factors that have a potential or a likelihood of contributing to the rise and fall of an institution’s reputation.

1. 
   
   Patient safety
   
   

Safety for the client is always considered the highest priority and is the topmost factor to consider. Issues such as shortfalls, injury, elderly abuse and the like are indicators that help measure the quality of service rendered by the institution. If and when complaints in relation to these issues start skyrocketing, that is when measures for legislative amendments are called for. When the safety of a resident is at risk in an institution that is reputed to have substandard services and management, the said institution will be subjected to disciplinary action set by the Ministry of Health.

2. 
   
   Management
   
   

The essential component of a healthy institution is quality satisfaction derived from both the staff and, most importantly, the customer or client. And the driving force of an institution is the operational team or the management. Any quality of service rendered by the staff and level of client satisfaction would greatly reflect on the management’s performance. Poor management over staff, facility and its services would lose the trust of its staff as well as its clients.

3. 
   
   Quality assurance
   
   

The quest for an institution’s outstanding reputation doesn’t happen only once. Over periods of time, a series of audits, surveys, investigations, studies and statistics are continuously conducted to ensure that an institution lives up to its reputation. Quality assurance is there to make sure that the institution still served its purpose. At some point, certain issues within the institution have been overlooked and what has been known to be reported to responsible parties doesn’t seem to reflect the raw evidence that may arise from poor quality assurance. This would then lead people to think otherwise about entrusting themselves with the institution.

On Accountability of Private Sectors and Public Sectors

Private sectors are at an advantage when it comes to accountability. The public sector accounts more than the private sector, since most legislations and policies governing private institutions are stipulated by the public sector. When poor services are noted from the public sector, consumers or clients tend to rely more on the private sectors due to their extensive services and features. Because the government has minimal or little involvement over private sectors over quality improvement measures, the private sector may have the opportunity to expand the boundaries of their services in order to improve better client outcomes. There is no formal organizational structure compared to the public sector. Therefore, in the event that poor services may arise from Kindly Residential Care Rest Home, it may turn to be more of a challenge in order to gain competency in the health care industry.

Stakeholders

They are the persons who have a “stake ‘’ in any organization. They may be called:

Internal Stakeholders – in the Kindly Residential Care Rest Home, the Internal Stakeholders are the Owners or the Healthcare Providers, the carers, the nurses, and all who work for the well- being of the elderly especially those persons with dementia.

The External Stakeholders include the Government and Non- government organizations which contribute their time, treasure and talent to help the Residential Care Rest Homes deliver quality service.

“Quality of Care’’ is a difficult concept to measure particularly within the context of residential aged care, which involves lifestyle issues as much as health issues.

• One example is the Australian Accreditation Standards having been credited with contributing to improve care.

Though they represent only minimum standards of quality, they do not focus on clinical outcomes.

Individual facilities

might only be assessed against these standards every 3 years; and within these years, much scope for quality variations may go unnoticed.

Hence, collecting and analyzing comprehensive clinical data from aged care facility residents constitutes an essential step in the process of monitoring quality environment.

Ways to Improve

• The USA has introduced and continued to refine, a compulsory technioque of assessment within its nursing homes aimed at monitoring quality of care and clinical outcomes. There is a Minimum Data Set/ Resident Assessment Instrument which is a system of forms to be completed at certain intervals to meet a number of purposes such as care planning, case mix funding and quality monitoring. This uses Quality Indicators as a means of implementing quality assurance and improvement within residential aged care.
• Residential facilities had been subsidized by the Commonwealth Government since 1962, but funding was not regulated.
• Initiatives relevant to residential care have included a standardized system of assessment (Resident Classification Scales) to determine resident care needs and a formal system of Accreditation to ensure quality service delivery.
• Because quality of care is a multi – dimensional concept, no single area of assessment can provide an accurate indication of quality. Thus, an effective assessment should contain as many items considered relevant to quality care. Hughes et. al suggested that quality measures should be integrated into routine clinical practice.
• The Australian Society for Geriatric Medicine described the Residential Classifications Scales as the “antithesis of a funding system that generates incentives for quality health outcomes.’’
• Government –appointed bodies responsible for assessing residential care facilities compliance with standards improved quality of care within residential care facilities.
• Aged Care Standards and Accreditation Agency was introduced in 1998 that compels residential aged care facilities to seek accreditation for funding.
• Clark and Bowling (32) suggested that quality of life in residential care could be ascertained by looking at measurable indicators such as general health, functional status, mental health, comfort, emotional wellbeing, privacy, choice and autonomy.
• When considering quality assessment for residential aged care facilities, indicators of quality should encompass areas of clinical care directly related to residents’ physical health, as well as quality of life and lifestyle-related issues such as activities and family involvement.

Issue 2: Quality Management Theories

Pareto Analysis

This is a simple methodology by which prioritization of potential changes through determining the problems that can be addressed and resolved through making necessary changes. Through this technique, the organization can make prioritization according to the individual alteration that could improve the scenario.

This quality management tool utilizes the Pareto Principle or the 80:20 rules. This rule utilizes the concept of 20 percent cause that could produce to 80 percent outcome.

The Kindly Residential Care Rest Home will use the following approach while taking into consideration the principles of Pareto Analysis to achieve the best practice in healthcare services of the said organization.

1. 
   Problem Identification and List it
   

First, the problems and potential threats are listed down. In this step, possible inputs from clients and members of the Kindly Residential Care Rest Home (KRCRH), and conduct surveys to identify the existing problems in the organization.

2. 
   The root cause of problems are identified
   

In this stage, methods are utilized that warrants the team to identify the root causes of threats and problems.

3. 
   Score Problems
   

In the third step, the organization prioritizes the problems according to its severity or effect on the healthcare practices of KRCRH.

4. 
   Problems are grouped according to their root cause.
   

The identified problems are put in to a group according to their root causes.

5. 
   Add up Scores
   

In this step, scores are added up and identify which of the group has the highest and lowest score. Through this, prioritization is according to scores are done.

6. 
   Take Action
   

In the final step, KRCRH will take actions in addressing the highest priority according to the group or problem that got the highest score.

William Edwards Deming

Dr. William Edwards Deming proposed the plan-do-check-act, also known as PDCA. It is a four step methodology by which used by the organization to control and improve the services and product of an organization.

Kindly Residential Care Rest Home will also make use of this kind strategy to improve the healthcare services of the healthcare organization. The end result of this would be a high quality of services by the facility to the residents and staff of the organization.

The following are the Steps of PDCA that the facility will make use:

PLAN

Objectives and processes are established which are necessary to deliver the outcome in to the expected results. The KRCRH will have a clear view of their target and their goals in achieving their proposed target in this initial phase.

DO

The plans from the initial phase are implemented in the second step. Data collection is also vital in this phase because the data collected will be used in the later stage of the process.

CHECK

The KRCRH will do evaluation of the data gathered during the DO stage. These will be charted and analyzed by the facility to identify which needs to improved and which are well in the health care services of the KRCRH facility.

ACT

Corrective actions are done in phase. The differences between the actual and planned results are analyzed and the root causes are determined. The corrective actions are implemented to achieve the planned outcome of the KRCRH.

Issue 3: Quality Management Tools

Total


Quality Management

Behind success of Kindly Residential Care Rest Home are the people who are hand in hand managing an organization, determined to make change for rendering the best of its healthcare services. Through years that Kindly Residential Care Rest Home offers quality of care to its residents and proves its Excellency by garnering prestigious awards, positive feedback and unending trust from stakeholders, family and community its success does not end instead continuity of more complete, comprehensive and structural way of management by enhancement of strategies to improve the quality of services is their big secret towards success or the so called “total quality management”.

Kindly Residential Care Rest Home utilizes total quality management to ensure that giving the quality of care for their residents will not be compromised which can lead to poor health outcomes and downfall of the organization due to improper management. Using the total quality management Kindly Residential Care Rest Home first identify the problem and plan what to do. Second is to implement the solution then evaluate or check if it resolves the problem. And lastly integrate the solution if it works upon further evaluation. As a result Kindly Residential Care Rest

Home identified the following problems and able to resolve and improve its quality of service.

• 
  Falls Risk
  
  – most of the common problem that arises among the elderly due to physical restriction like inability to walk or unsteady gait, mental incapacity, side effect of a drug, and in relation to disease condition like poor vision, etc. To prevent this happen solutions are the following: use of sensor mat, call bell, mattress, assistive devices (walker and gutter) , side rails (as necessary and with GP`s order)

• 
  UTI outbreak
  
  – another problem that is commonly and easily acquired by elderly due to low intake of water and poor hygiene. To address this problem the following should be implemented like hand washing, proper hygiene, use of PPE, hand sanitizer to each room and even corridor, health education or information dissemination (mass production of pamphlets regarding UTI prevention), infection control, and proper waste disposal.

• 
  Patient satisfaction
  
  – one of the most important thing to be prioritize because patients are the ones who receives care and they should be satisfied or even exceed the expectation of the services being rendered to them. To be able to improve the quality of care makes the patient satisfied and happy the following are being implemented to have quarterly auditing of services rendered, quality assurance, suggestion box or feedback forms.

• 
  Incompetent staff
  
  – to give a quality of care means to have enough knowledge and skills to handle the patients and assist them according to their needs. Incompetent staff is another problem identified that contribute in poor healthcare delivery service and patient`s injury. For example clinical error, and negative feedback. To address this problem the following are being implemented like comprehensive recruitment and selection, trainings and seminars, disciplinary action, continuous evaluation and staff appraisal.

Lean Management

Lean Management is all about encouraging everyone in the facilities from the top management down to the staff to be involved in helping to participate in the improvement of quality care, and reducing errors. First, you have to identify the problem and acknowledge that the problem exists and why it is a problem, willingness to change and you can now find ways on how to solve that problem.

In Kindly Residential Rest home we value our residents, respect our residents and continue to provide quality of care. We have to understand the voice of our clients, where they coming from, and made sure to meet their needs and put into action. The most important thing in lean for healthcare organization is that the errors and mistakes are being corrected nor improve, the amount of time taken is being valued, productivity increases, and so it is easy for the staff to work easier by eliminating those waste that can provide good quality of care and productivity of the staff.

Here are some of the common Errors:

• 
  Clinical Communication
  
  – In electronic patient record, if there is any laboratory test results needed instead of waiting for a week wherein referral needed from the attending physician of the patient and then sending back the result from the physician, the system is being made to remove any unnecessary stages instead laboratory people sends electronic results so he can access right away and evaluate the result. So, it saves time and effort of the patient from travelling.

• 
  Waiting time/ Getting Appointment
  
  – Appointment System is an agreement to meet with the physician at a specific time and day and it is used also to control the demand and the problem is on the mismatch on the capacity of the patients and the physician. In order to avoid this problem the system must be monitored or may provide different type of consultation to accommodate everyone. In result, the patient is being examined on the day she wanted to be seen, less stressed for the staff.

• 
  Overproducing
  
  – spending so much time on something that is not important for the patient
• 
  Defects
  
  – wasted time and effort for the inspection of something that has been already done or inspected

In KRRH we value our residents the most, we have to eliminate those wastes and focus to what is important to our client and be able to maintain the quality of work and our commitment to our profession and to the residents as well.

Issue 4: Continuous Improvement System

It is important to maintain a continuous improvement system for delivery of service to geriatrics. Quality management is one way to improve the system and it is composed of costumer focused organization, leadership, involvement of people, process approach, system approach to management, continual improvement, decision making, and mutually beneficial supplier relationships. In order to perform quality improvement an organization must consists of team that has a deep understanding of an area that requires enhancement. Organization like the Kindly Residential Rest Home is determined to continue finding solutions for the present problems as well in the future that may arise. By continuous improvement of the system there will be a positive result that will lead to a better healthcare service it will ensure the high standard of care that is cost effective and accessible to all.

Organization must be sensitive to the needs of the patients and therefore must understand and ensure that there will be a plan of action to meet those needs. This is the result when an organization is costumer focused. Secondly is the Leadership, this is the action of leading a group of people and the leader should know how to unite people that will be involved in achieving the organization’s goals. Thirdly, is the involvement of the people in the organization at any level must do their part in their full capabilities in order to have a successful outcome that can be used for the benefit of the organization. Continuous improvement is necessary because there is no permanent in this world, even the facility in some point changes. Given an example is the technology; people depend on computers and this help in many ways like documentation, auditing and research. Many facilities depend on computer and internet because they make the job easier and efficient. Trainings and seminars are also another way of improving the system. Developing and enhancing the skills of employees will lead to better healthcare delivery.

A well knowledgeable and trained staffs has so much to offer that will benefit not only the clients but also the organization. They will be more confident as well as an important member of the facility. The residents will be satisfied with the care that they are getting from the healthcare providers and as the result they intend to stay longer. The facility will gain a good reputation and the business will be successful. This will attract more people to invest in the health care industry. By frequent assessment and analysis of the problem or changes there will be an ideal plan of action. Continuous improvement in an organization is part of duties and responsibilities of management. To achieve highest performance and success adapting to changes is essential. There is no such thing as constant especially when it comes in dealing with lives of people. Different approaches must be applied depending on the person’s character, behaviour or needs.