According to Gottwald and Lansdown (2014), quality is an individual construct that depends on the beliefs and values one holds that means: quality is a connection to the perceptions of self. The author also adopts definitions of quality from past authors. The first one is quality as a clinically effective personal and safe while the second one is quality as a journey and not a destination. Quality is to be continuously made better by continually increasing participations, structures as well as procedures.
Quality is closely linked to clinical governance since the latter involves implementation of evidence based practice in the daily patient care to allow for healthcare professionals becoming aware why and how what they do works. Clinical governance involves continuous quality improvement (CQI) (Gottwald & Lansdown, 2014).
From the National Safety and Quality in Health Service Standards, different groups take different roles within the healthcare setting like; patients and carers, the clinical and non-clinical workforce, health service managers, and health service executives and owners (NSQH, 2012).
TQM is described as long-term management approach to success via consumer satisfaction that involves every member in an organization to chip in the improvement of processes, products, services and workplace culture (McLaughlin & Kaluzny, 2006). Principles of TQM are:
Customer focused; meaning the customer is the center of care and the ultimate determinant of the level of quality to be provided.
Full involvement of employee; that means all employees take part in working towards shared goals. Full commitment by employee is come when the workplace culture is not guided by fear. It involves empowerment and suitable environments by the management.
Integrated systems; this means that TQM is dedicated to horizontal specialties like micro processes.
Strategic and systematic approach; this principle as a crucial management of quality as it involves the goals, mission and vision of an organization and how to achieve that.
Process-centered; TQM is focused on process thinking a well-defined framework of the steps involved in the process including an evaluation of the performance indicators for measurement of unexpected variation.
Other principles include, incessant improvement, flexibility, making decision based on facts and effective communication.
CQI has been adopted in the healthcare sector. Is not focussed on creating a quality workplace culture but on the process of improving quality by the deployment teams (McLaughlin & Kaluzny, 2006). principles of QTI according to McLaughlin and Kaluzny 2006, are: A link to the significant elements of the facility’s premeditated plan, a valuable council entailing of the top management in an institution, education programs for the members, ways of choosing opportunities for improvement, forming process improvement teams, supportive staff in analysis and redesigning processes, and incentive policies for motivation and participation of support staff in the improvement of process.
TQM and CQI differ from the Six Sigma in terms of origin, concepts, theory, process view, methodologies, effects tools approach as well as criticism (Andersson, Eriksson & Torstensson, 2006). On concepts for example, TQM describes how organizations should work to access better performance and customer satisfaction both internally and externally with limited use of resources a concept while six sigma is focussed on achieving no defects. Again the six sigma focuses more on economic saving than customer contentment (Andersson, Eriksson & Torstensson, 2006).
Patient safety is processes of preventing harm to patients while placing emphasis on a care system that prevents errors, learns from the errors, and built on safety culture involving patients themselves, health care professionals and organizations (“Patient safety | NHS Improvement”, 2018; Mitchell, 2008). Practices of patient safety are built to reduce the risk of harmful effects that recount to the acquaintance with medical care in range of diagnoses or conditions. A particular example of a patient safety practice is using all-out sterile barriers while positioning central intravenous catheters in the prevention of conceivable infections (Mitchell, 2008)
Safety in healthcare is not necessarily patient specific care. It involves all activities in the healthcare and include the safety of the providers. Safety in healthcare involves eradication of all potential risks to illness like preventing healthcare acquired infections (Vincent & Amalberti, 2016). It involves transforming the work environment to be safe for all. Patient safety on the other hand is care giving to patient against any form of harm without considering the medical practitioners. However, safety in healthcare is still patient safety as it is a broad concept. Improvement of working conditions in healthcare setting directly improve patient safety. An unsafe working healthcare environment is a threat to patient safety. Safety in healthcare involve other practices like health services involved, nursing, communicative and structural research, studies of safety, conclusions from human influences examination and engineering (Institute of Medicine, Board on Health Care Services, Committee on the Work Environment for Nurses and Patient Safety, 2004).
Risk management is a process of identifying factors that inhibit providing safe and efficient care to patients (McGinley, 2018). Risks can be changes in service delivery among others. The goal of risk management is ensuring that the risks are identified early enough and assessed how best they can be managed or controlled to lower their effects. Risk management and patient safety are closely related in that they both work towards mitigating patient care and ensuring that the goal of improving patient outcomes is reached (McGinley, 2018).
The process of risk evaluation (analysis) depend on facts while analyzing the possibility of harmful effects of work-place culture that allow for injuries and exposure. Risk analysis looks into the harmonization of scientific knowledge with the different concerns of administrators and the public. An approach to risk analysis is systematic in that it involves a methodical approach to identifying and characterizing biological, chemical, or even physical hazards that predisposes individuals to illness or injury. These hazards post adverse consequences such as permanent health consequences, unfamiliar disease or undesirable situations which are actually avoidable should the risk management had been taken early enough. A risk analysis approach prioritizes on fighting the risk factors that may lead to worst health-related consequences (National Research Council, 2003).
According to (Sandars & Cook, 2009), clinical risk management process involves planning, organizing and directing programs that pinpoint, evaluate and control risks. The principle and the first step to risk analysis however, is establishing the financial, political and legal contexts (Sandars & Cook, 2009).
Safety culture is a perception that was founded from outside the healthcare background (U.S. Department of Health and Human Services, 2018). However, in the healthcare context, safety culture encompasses an organizational framework that operates consistently to reduce the adverse events even when doing intrinsically multifaceted and hazardous work. A culture of safety in healthcare serves several purposes such as recognizing the high risk nature of activities in an institution, accomplishing steadily safe operations, a blame-free setting where reporting of mistakes is without fear of punishment, collaboration (team work) in all disciplines in seeking solutions to problems of safety, and setting aside resources that serve safety concerns (U.S. Department of Health and Human Services, 2018).
An improved safety culture in health means efficient services free from errors and an improved overall health care quality.
Safety culture is measurable and definable. Measurement of culture of safety is by use of surveys on providers at all levels within the healthcare organization. AHRQ’s Patient Safety Culture Surveys, Hospital Survey on Patient Safety Culture (HSOPS), and the Safety Attitudes Questionnaire are examples of authenticated surveys (Gallego, Westbrook, Dunn & Braithwaite, 2012). They surveys work on a very basic principle of asking providers to rate the culture of safety in their precise units as well as the general facility. The measurement points are the purposes identified in the preceding section on “Safety Culture” such as “what rate can you give environment as blame free?” Hospitals as well as nursing homes and AHRQ use the surveys and AHRQ measures the safety culture annually from the rationalized benchmarking statistics from hospital study.
Poor safety culture is a direct attribute to errors in the healthcare facilities. The perception of the culture could be high in one unit and low in another. While positive patient safety culture shows a respective low adverse events in hospitals and other departments, the opposite is also true meaning that poor safety culture is a causal factor to adverse events in a healthcare institution (Najjar, Nafouri, Vanhaecht & Euwema, 2015). These harmful effects from the poor safety culture ultimately put the patient’ safety at risk or even the condition of the providers, especially with health related infections.
References:
Andersson, R., Eriksson, H., & Torstensson, H. (2006). Similarities and differences between TQM, six sigma and lean. The TQM magazine, 18(3), 282-296.
Australian Commission on Safety and Quality in Health Care (ACSQHC). (2012). The national safety and quality health service standards. Sydney: ACSQHC. Retrieved 31 August 2018 from https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf
Gallego, B., Westbrook, M., Dunn, A., & Braithwaite, J. (2012). Investigating patient safety culture across a health system: multilevel modelling of differences associated with service types and staff demographics. International Journal For Quality In Health Care, 24(4), 311-320. doi: 10.1093/intqhc/mzs028
Gottwald, M., & Lansdown, G. (2014). Clinical Governance (pp. 14-25). Maidenhead: McGraw-Hill Education.
Institute of Medicine, Board on Health Care Services, Committee on the Work Environment for Nurses and Patient Safety. (2004). Keeping patients safe (pp. 3-5). Washington, D.C.: National Academies Press.
McGinley, P. (2018). Risk Management & Patient Safety – Patient Safety & Quality Healthcare. Retrieved 31 August 2018 from https://www.psqh.com/analysis/risk-management-patient-safety/
McLaughlin, C., & Kaluzny, A. (2006). Continuous quality improvement in health care (pp. 3-4). Sudbury, Mass.: Jones and Bartlett.
Mitchell, P. H. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Retrieved 31 August 2018 from https://www.ncbi.nlm.nih.gov/books/NBK2681/
Najjar, S., Nafouri, N., Vanhaecht, K., & Euwema, M. (2015). The relationship between patient safety culture and adverse events: a study in palestinian hospitals. Safety In Health, 1(1). doi: 10.1186/s40886-015-0008-z
National Research Council. (2003). Occupational Health and Safety in the Care and Use of Nonhuman Primates. Risk Assessment: Evaluating Risks to Human Health and Safety.
Patient safety | NHS Improvement. (2018). Retrieved 31 August 2018 from https://improvement.nhs.uk/improvement-hub/patient-safety/
Sandars, J., & Cook, G. (2009). ABC of Patient Safety (p. 24). New York, NY: John Wiley & Sons.
U.S. Department of Health and Human Services. (2018). Culture of Safety | AHRQ Patient Safety Network. Retrieved 31 August 2018 from https://psnet.ahrq.gov/primers/primer/5/culture-of-safety
Vincent, C., & Amalberti, R. (2016). Safer Healthcare (p. 131). Cham: Springer International Publishing.
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