Discuss about the Quality Improvement Initiative to Reduce Serious.
The quality improvement (QI) plan is based on the issue of high percentage of absenteeism or non-attendance among the haemodialysis patients in the renal unit. In Australia, approximately 50,000 patients are on dialysis. The incidence rate of age-adjusted and crude end stage renal disease (ESRD) is significantly high among the Australian population. The major problem is the majority haemodialysis (HD) centres in Australia are funded by private firms and perform both maintenance haemodialysis (MHD) and transplant oriented dialysis. However, another problem is that the maintenance of MHD program is not feasible via public sectors or government run organisations because of its high cost of operations. The HD operated via the privately run healthcare organisations is too costly. Taking into consideration of the per-capita income of Australia, it can be said that at least 20 to 30% of the population resides below the poverty line (Kidney Health Australia 2018). Thus, the overall financial burden posed by the periodic haemodialysis for the poor and their family members is huge and thereby causing frequent dropouts and non-compliance of the treatment. This kind of tendency is higher in the rural areas of Australia because, they are mostly infiltrated by the aboriginals and who suffer not only from inadequate knowledge about healthy living and disease but also lack adequate financial backup to withstand the daily healthy living needs (Ghandi et al. 2013).
Importance of the quality improvement plan will help in the proper identification of the issues associated with the high rate of absenteeism among the haemodialysis patients in rural area. Highlighting the issues will further help in the framing of the effective strategies in order to increase the footfall of periodic haemodialysis unit in the target rural setup and thereby helping in the improvement of the health and well-being of the renal patients in the rural areas (Garrick, KligerandStefanchik2012). In spite of being time consuming, haemodialysis this long-term interventions in the healthcare services and related organisations is effective in dealing with the complications associated with chronic kidney disease. Periodic haemodialysis is highly important in the preservation of the residual renal function and thereby help to sustain life among the affected individuals. This residual renal function significantly contributes to the overall health and well-being of the dialyses patients. This work-process within this healthcare service helps in the solute clearance (uremic toxic) which in turn helps in the maintenance of the fluid and electrolyte balance of the body (Chazot et al. 2012). Absenteeism in period haemodialysis may contribute to decline in the residual renal function leading to the generation and anaemia, malnutrition and inflammation which ultimately leads to kidney failure, an important cause of mortality and morbidity among the renal patients (Chazot et al. 2012). This QI plan is extremely significant in the target workplace settings because according to the reports highlighted in the QI plan, each month there is an increase in the rate of absenteeism in the haemodialysis unit along with increase in the number of hospital admission due to acute renal failure or emergency admission in the nephrology unit. This signifies that the people who are failing to abide by the regular haemodialysis are more likely to get admitted in the hospital for renal failure or other renal complications. QI plan will help in accessing the overall scenario while increasing the number of attendants (service users) in the haemodialysis unit (10% from the baseline data).
The incidence of missing dialysis numbers in the unit will reduce to less than 10% of the baseline data is the major outcome of the project.
Data collection is a process of accumulating information on the variables of interest (Englander 2012). The data were collected from the clinic review letter from the nephrologists which provided the ongoing treatment plan and the follow up plan of the patient. Apart from that, the patient allocation folder that depicted the day to day appointment of the haemodialysis patients and the patient pickup list, which that depicted that changes in the current pickup address of the patients are also provided. At the same time, the individual patient haemodialysis folder in order to understand how the patient is meeting the treatment plan and the follow up, minutes of the meeting provided the staff feedback, solution to the barriers and ongoing project and customer satisfaction form to understand the customer satisfaction are also collected and presented. Therefore, from the above-mentioned data collection procedures it can be concluded that, if the patients are experiencing the dissatisfaction there are some barriers that are arising in the process of the receiving haemodialysis. At the same time, how the patients are meeting the current treatment plan and what are the review of the patient treatment along with the information on the adequate follow up, provides ample justification that the plan will achieve its outcomes.
In Data measurement, data are measured from the customer feedback form and the form itself provides the provision of measuring the feedback from the customers. The ‘Did Not Attend’ (DNA) spreadsheet provided a lot of structured data that acted as a fundamental source of patients that did not attend the haemodialysis. The DNA data were measured through the spreadsheet application and are calculated by using a computer. The data measurement clearly focuses on the patients that are did not attended and the haemodialysis.
In Data analysis, the Data were analysed from the data that were collected from the customer feedback forms. The analysis mostly depended on the overall analysis of the form, categorizing and sub-categorizing the feedback, using the positive and the negative feedback, looking at the root causes of not attending the haemodialysis, understanding the values of certain customers, identifying the trends that are prevalent in the customer feedback form. It also ensures that the context are not comparing the unrelated data, consolidating and results and determining a particular plan of action, altering the right teams to look into the issues of absenteeism (Singleton 2014). The yearly DNAs spreadsheet that contained the haemodialysis data will be analysed by using the spreadsheet application in the computer. This justifies that the reasons behind the not attending the haemodialysis are highlighted and the exact number is known.
Information presentation tools- used for this project are the monthly stats, yearly attendance of the DNAs spreadsheet. These two presentation tools provide ample scope for highlighting the number of patients that are not attending or have attended the haemodialysis session (Chou, Chang and Lu 2015). Both the yearly and the monthly data are presented via the spreadsheet and have the potential to show numbers and the percentage of the DNAs.
According to O’leary et al. (2012), QI in medical domain is a method that is implemented in order to find innovate and improved ways of procuring better care to the service uses. At the core of QI plan is the effective interplay of the team members. This is because, Muething et al. (2012) is of the opinion that under appropriate circumstances team harness the skills, knowledge and experience along with perspectives of different individuals in order to make lasting improvements.
The key stakeholders and team members involved in this QI plan include executive board members of the organisation, service users (patients) and their family members, unit staffs, professional nephrologists and a group of social workers. The main team will be headers by a quality manager and the main unit stags include trained nurses, patient care assistances, ward clerk, aboriginal liaison officers. In order to ensure effective performance of the team, monthly meetings will be head at the end of month among the team members along with weekly meetings with the patients and their family members. According to Shaw et al. (2012), team meetings help in gaining respective reflection of the team members and this dynamic link of reflection helps in further leaning and making modification in the overall process of change implementation. Moreover, monthly team meetings also help to highlight the staff discontentment. Surfacing the staff discontentment help in identification of the gaps in the QI plan and thus providing a new avenue to make certain changes in the QI plan and thereby improving staff experience and overall health outcome of the patient.
Taking weekly meetings with patients is also essential for the better functioning of the team in QI plan. Al-Abri and Al-Balushi (2014) stated that weekly meetings with the patients and their family members help to access the level of patient satisfaction. Proper assessment of the patient satisfaction will further help to bring change in the QI plan and thereby helping in extract better outcomes. Al-Abri and Al-Balushi (2014), further stated that increase in the level of patient satisfaction also influence increase in the level of dedication of the team members working in the QI plan. So focus over the level of patient satisfaction will in turn promote effective team work.
The main risk towards the comprehensive implementation of the QI plan is inability of the staffs to understand the importance of the QI plan. This mainly arises from the lack of proper education about the disease progress and the expected outcomes. So in order to mitigate the risk and to increase the spontaneous participation of the team members in the change management plan, change management strategy will be implemented. This change management strategy will mainly deal with the education of the staffs and thereby increasing disease awareness (Cameron and Green 2015).
Quality improvement is a fundamental aspect in medical practices, which aims to continuously discover better methods to provide safer and more effective care methods to be discovered (Kaplan et al. 2012). It has to be mentioned in the health care context, the different complex issues cannot be addressed by the skills of one individual. Rather, addressing the complex issues in the health care industry, that needs the aid of the quality improvement programs, can only be achieved with the expertise of a variety of different professionals belonging to varied professional domains within the health care industry. As mentioned by WHO, the health care industry has immense advantage form the teamwork (Who.int 2018). It not only enhances the safety of the care provided to the patients, but, the teamwork helps in reducing the complex and prevalence performance issues in health care such as global workforce shortage, increasing complexity of the co-morbidities, and safe working hour initiatives. In this project as well, the importance of teamwork had been exponential in the different steps that had been taken in the project and the implementation of the same.
The entire project utilized a team based approach to provide education to the members and the unit staff and the patients as well. The need for team work and team communication has been identified as fundamental training needs of the quality improvement project. The primary objective of the quality improvement project had been to reduce the DNA (did not attend) rates of haemodialysis of the patients by 10% in the renal unit. The group incorporated monthly stats and yearly DNA spread sheets to reflect upon an increased number of non-attendance for the haemodialysis of the patients. The team members identified in the team for the project had quality manager who led the team of NUM, all staff members including registered nurses, patient care assistances, ward clerk, social workers, aboriginal liaison officer,patient, family members. One of the greatest factors associated with successful teamwork in a group is to arrange a very effective arrangement of meetings involving all the stakeholders associated with the team (O’Leary et al. 2012). In this case as well, the team was able to arrange for monthly meetings within 1400 to 1500 hours of every month to ensure effective follow up of the actions to be taken. According to the QI plan, the team had made effective use of different experiences, perspectives, skills and knowledge of all of the members of the team. Hence, it can be concluded that the quality improvement project has utilized the teamwork effectively in successfully completing the project.
The workplace culture also has a huge importance in the successful completion or implementation of the quality improvement project (Sinkowitz-Cochran et al. 2012). Workplace culture has a fundamental impact on the health care delivery and patient safety. A sound and supportive organizational culture not only enhances the safety and efficacy of the performance and productivity of the facility but also is a significant positive influence in successful change implementation and quality improvement. According to Acar and Acar(2012), multidisciplinary teams are the very essence of health care, and even in quality improvement scenario, a supportive and fair workplace culture can motivate the employees towards better performance, higher employee engagement and lastly, improved loyalty towards the organization. Evaluating the concept of workplace culture with respect to quality improvement in the health care facility, with a workplace culture that is focused on quality improvement and consistent growth of performance and productivity,the implementation of the quality improvement in the health care facility (Renedo et al. 2015). In this case, the workplace culture had been supportive of the changes that had been implemented in the renal unit and the educational needs of the staff had been taken into consideration with supportive and encouraging. Along with that, it has to be mentioned that there had been a few identified risks in the project which had been managed with efficacy and ease. Hence, the supportive organizational culture had been effective in quick and easy risk mitigation in the project as well.
Lastly, change management has to be considered as one of the most significant aspects associated with quality improvement. As mentioned by Hart et al. (2015), in the health care context, quality improvement is intricately associated with optimal and efficient change management. The authors have further illustrated that the in any quality improvement the team, with the guidance of a capable leader, enhances quality by fostering a culture of improvement, enhanced engagement of patients and families, educational interventions for them, and educational or performance related innovations for the staff. Hence, these are imperative elements of quality improvement programs and without proper implementation of these necessary change management concepts, successful implementation of quality improvement programs are not possible (Kash et al. 2014). With respect to the quality improvement plan, the objective that received the most resistance had been the implementation of the program had been stemmed from the lack of education and awareness about the disease progression and lack of cultural awareness and safety in practice. The staff had not been compliant initially with the educational programs either, as it had been a time-taking process; and this particular risk had been a fundamental resistance to the comprehensive implementation of the quality improvement plan. However, change management strategies such as motivational encouragement and incentive based reward system for participation in the educational intervention of the QI program had been taken to successfully mitigate this risk.
Hence, it has to be mentioned that the amalgamation of effective teamwork, change management strategies and supportive organizational culture had played key roles in the successful completion of the quality improvement program (Grol et al. 2013). Along with that, it has to be mentioned that each of these elements, are intricately linked to each other; without proper teamwork from each and every individual involved in the team the change management strategies will not be optimally successful. On the other hand, without an organizational culture based on impartial support and encouragement for the employees along with organizational commitment dedication and ethics, optimal team work cannot be expected either. In this case, the blend of all three fundamental elements of a successful quality improvement project, teamwork, workplace culture and change management, the implementation had been successful and the team could effectively achieve the key outcomes of the project.
References:
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