Relationship Between Risk Management And Quality Management In Improving Clinical Outcomes

Six Dimensions of Quality

Moss (1995) suggests that risk management focusses on reducing the possibility of errors thus minimising the damage, discomfort or the distress that an individual can suffer when with errors. This means that the practitioner develops the ability to detect errors early and mitigate them before they occur. The role of clinicians is to achieve quality of care by ensuring that patients receive the best results (Singh & Ghatala 2012, p. 419). Risk management is therefore, to reduce errors and ensure that patients achieve improved clinical outcomes. Since reducing risks leads to improved clinical outcomes, then it means that risk management focusses on clinical care which leads to improved clinical processes.

Youngberg (2013, p. 11) suggests that through risk management quality of care is achieved thus leading improved clinical outcomes. In management, quality management is the process of improving organizational outcomes through developing a culture of safety that focuses on improved outcomes. The dimensions of care can be used to ensure that medical facilities achieve improved outcomes. Since practitioners exist to make patients feel better, the  it means that quality of care is a process that focusses on creating conditions that lead to improved outcomes (Gonzalez, et al. 2016, p. 87). quality management theorists have proposed its role in reducing risks and leading to increased organizational outcomes. Quality management sets thresholds required in the organization to ensure that the outcomes meet the required standards required by the profession. The link between quality management and risk management is clinical care that the patient receives. Therefore, by applying risk management strategies, practitioners put quality care standards that in turn lead to better clinical outcomes. 

Assess quality of healthcare in outpatient clinics using Maxwell classification. “follow the example of intensive care unit shown in box 2”

Assessing quality in outpatient clinics

	Structure Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper	Process	Outcome
Effectiveness	Patient to practitioner ratio Access to outpatient facilities Total clinical process time	Number of patients attended to. Compliance with quality and risk management standards.	Patient satisfaction level. Performance level of the hospital as compared to other facilities in the same cadre.
Acceptability	Is the waiting environment organized in an easy way for patients Support services for outpatient services	Is the role of third parties in clinical process utilized.	The way customer satisfaction is measured. The way repeated outpatient cases are handled.
Efficiency	Patient waiting time	What is the patient to practitioner ratio?	The level of meeting organizational standards.
Access	Availability of common outpatient services	The number of patient who can access the facility based on its capacity and coverage. How often does the facility become incapacitated?	How patients assisted when the hospital fails to meet their outpatient needs. What is the referral process Is the hospital linked with a similar facility for support?
Equity	Equal treatment of patients	Is there evidence of unique patient complaints	Are the complaints repeated, similar or refers to a particular practitioner.
Relevance	Does the hospital standards meet its level and ISO certification	How the hospital meets outpatient needs of the community and patients.	What is the role of the hospital in the community Is the community better off after the facility was introduced.

1. How risk management programs can interact with the Donabedian’s, Maxwell’s classification of quality. Explain this using each category of these classifications

Risk management and quality management are interrelated concepts that almost work in the same way to achieve clinical outcomes. Maxwell presented six dimensions of quality: effectiveness, efficiency, appropriateness, acceptability, access and equity. On the other hand Donabedian classified quality into structure, process and outcome. The two authors’ ideas are interrelated in that they all lead to the need to reduce risk and improve quality of care (Pereira 2016, p. 192). By applying quality management strategies, the two authors focus on the process of quality itself, and the drivers of quality.

From Donabedian components of structure, it can be related to Maxwell’s dimensions of effectiveness and efficiency. The process of care relates to the activities procedures and actions that take place within a hospital setting. This is the total of all the activities that patients undergo and how these activities meet the intended outcomes of the patient. (Gepke et al.  (2017, p. 3) adds that when measuring each individual activity in the hospital setting, effectiveness defines the extent to which the intervention process achieves the desired outcome. This includes how specific patient-related issues are handled within the facility. For example, some patients are allergic to certain treatments thus the need to ensure that personal related factors are incorporated in the clinical process. On the other hand, Meeker-O’Connell, et al. (2016, p. 400) adds that efficiency depends on the comparison between the system delivery outputs and inputs that are used. Therefore, the structure component focusses on the way the system is organized to meet the required needs.

Three Components of Quality

The structure component relates to the dimensions of access and equity of the healthcare system. The structure is a combination of resources to deliver the required healthcare needs of the patients within the hospital environment.  This can include the resources that the facility has to deliver healthcare to patients. Through resources, the accessibility of patient increases and can be measured in terms of the waiting time that the patient takes to be examined by a physician or checked for treatment. These relates to the structure of the facility since it defines the processes that patients go through to access care (McFadden, et al. 2015, p. 26). In addition to that equity in structure means fairness in a dressing patient-related concerns. Some facilities have quality of care policies that guide the conduct of practitioners. By having a defined structure that controls the way practitioners and patients relate, it becomes easy to manage risks and improve quality care.

Lastly, the outcome component relates to appropriateness and acceptability dimensions of quality. The outcome of a clinical process is attributed to the changes in the health of the patient. These include restoration, symptoms relief and changed life expectancy. This is defined through analyzing the condition of the patient to know what works and what does not work. Through the measure of outcome, patients can indicate whether the intervention was appropriate and acceptable to them (Frandsen, et al. 2015, p. 360). The rise of participatory approaches in healthcare calls for the need to involve patients in determining the appropriate and acceptable care to them. By acceptability, the practitioner recognizes the individuality of the patient and tailors the care process to meet the specific needs of the patient (Nikpay, et al. 2017, p. 219). On the other hand, appropriateness is the use of healthcare strategies that are defined as efficient. The appropriateness of an intervention means its ability to achieve the intended quality of care.

 Assignment Task 3: Scenario Analysis

• What are the questions you should ask to the infectious Control Nurse in the first meeting to investigate the case?

1. The time that the outbreak began.
2. The total of people affected up to now.
3. Symptoms noted and the duration of illness.
4. Any key exposure to related illness

• What kind of inputs you could receive from the Chief of General Surgery, and the head of pathology department?

Mosadeghrad (2012) suggests that the pathologist plays a major role in investigation of the disease outbreak since they are concerned in the study of diseases and their causes. Since the field is wide, it can be helpful in understanding the pathogenesis of the infection thus making it easy to determine the ways through which the disease can be analyzed to understand the causes and possible mechanisms for mitigating the disease. Pathologists work on any infection and develop since they can study and test different samples in an infection.

Clinical Implications of Surgical Infections

On the other hand, the Chief of General Surgery can be helpful in determining the source of the infections. Since the cause has not been determined, then there is need to work with the surgery team in determining the quality standards of care being observed during surgery processes. Since there has been an increase in the number of gallbladder surgery infections, then the department has to be investigated thus the need to work with the Chief Surgeon in the investigation?

• What are the clinical, financial, and legal implications of these infections?

Clinical implications of surgical infections are attributed to the risk of readmission and developing of other health challenges to the patient. The infections can result from primary or secondary causes that are attributed to the clinical process (Kumar & Jha 2017, p. 3). Primary causes relate to the quality of the surgery thus questioning the level of professionalism and risk management strategies adopted by practitioners (Frank, et al. 2015, p. 35). These infections pause a risk to the hospital facility and the doctors who were in charge of the whole process. Such instances threaten the quality of life of the patient and inhibit healing and quick recovery.

Elizabeth, et al. (2017, p. 4) argues that the financial implications of surgical infections affect both the patient and the healthcare institution. Since some surgical processes are expensive, it means that infections can lead to the need for a new surgery or other serious infections that require clinical costs to mitigate (Jenks, et al. 2014, p. 26). If the infection is a process error, then the hospital has to bear the burden of meeting the costs of the surgery or any other related infections. On the other hand, if the infections are patient based, then the patient has to meet the related costs of restoring the condition.

On the other hand, Perencevich, et al. (2013, p. 199) suggests that legal implications of clinical infections threaten the operation of the hospital in case there is an investigation in the causes. The nature of the infection defines the implications that can be faced. When detected and treated properly, these infections pose no legal implication since they are not considered as a threat to patients (Park, et al. 2016, p. 1965). This calls for an investigation into the potential liability of practitioners and hospital facilities. The nature of the infection can determine whether it was malpractice or a result of neglect within by practitioners. If the patient sues the facility for neglect or malpractice, then practicing certificate of the facility and the doctors in charge can be at risk (Bagdasarian, et al. 2013, p. 161). The expectations of patients when they enter a hospital is to receive the best care, if this trust that they have is compromised then they have the right to seek redress from the court  which can lead to expensive law suits and compensation for the patient.

• Plan for promoting workplace safety and highlight on those preventing infections from occurring in the future for both Patients and Staff.

Objective one: To  develop safety policies for employees and patients
strategy	Activities	Time line	Person responsible	Evaluation indicator
Develop work place policies for surgical units	Reviewing of existing policies Identifying gaps in surgical units Asking recommendations from practitioners and patients Developing the policies	Three months	Functional department heads	Policies developed Number of employee recommendations
Aligning work place policies with industry requirements to reduce surgical errors	Assessing surgical unit safety policies Assessing industry requirements Aligning the policies	Six months	Functional department heads	Policies developed
Objective two: building safety awareness among employees
Capacity building of practitioners on surgical safety standards	Identification of practitioner needs for effectiveness Designing training programs Evaluation of effectiveness	Six months	Departmental leaders, HR	Number of trainings held Number of employees trained
Establishing standards of performance when handling surgical incidences in the hospital	Developing criteria for policy implementations. Designing action plans for non-compliance Developing work safety evaluation tools	During training	Facilitators, employees, management	Number of action plans developed
Assessing application of the work place policies by practitioners	Practitioner  appraisal Evaluation using designed tools Observation and follow up	On going	HR, Departmental heads	Appraisal forms Observation notes
Objective three: implementation of work place and safety policies
Restructuring the organization for work place safety requirements	Identifying system and surgical unit areas for improvement Mobilizing the necessary resources for implementation	Within 9 months	Management Departmental heads	The number of policy areas implemented
Implementation of work place safety	Rolling down of the policies Measuring the adoption of policies	Within 1-year	Management Departmental heads, employees	The number of policy areas implemented
Objective four: appraisal of work place safety achievements and establishing standards for improvement
Assessing effectives of the policies	Appraising how standards are being followed. Measuring the reduced risks	After every 3 months	Management Departmental heads	Number of risks avoided
Continuous improvement	Identifying gaps and improvement areas in the appraisal	After every 6 months	management	Number of gaps identified

Conclusion

Assignment Task 4: Scenario Analysis

Harm caused	who would be potentially harmed	the risk level,	precautions that are already in place	additional precautions needed prior to implementation
Wrong prescription of patient drug	Patient, reputation of institution	High	Coding of drugs and use of health informatics to improve delivery	Proper training of administration practitioners
Mixing of patient records	patient	high	Use of admission number for patients	Coordination of patient records from one point
Cyber risks	Patient, hospital, practitioners	low	Cyber security protocols	Upgrading of security protocols
Low accredited telemedicine practitioners	patients	low	Training of practitioners	More training of practitioners
Alarm fatigue	Patients	moderate	Assigning practitioners to the minimum working hours.	Rotating of nurses from one station to another. Balancing work between practitioners Proper staffing
Violence from patients	Patients practitioners	moderate	Assessing employees mental health	Isolating employees with aggressive tendencies. Analyzing employee background
Disruptive employee behavior	Patients practitioners	low	Appraisal of employees	Employee appraisal Training and development Motivation
Emergency preparedness	Patients practitioners	high	Preparation of emergency wings immediately after use	Assigning of a nurses in emergency situations. Upgrading the emergency unit to accommodate more patients
Slips and falls	Patients practitioners	low	Removal of hazards Cleaning of floors
Compliance effectiveness	Patients practitioners	Moderate	Training of employees. Implementation of compliance policies	Instituting mechanisms for policy implementation. Developing a proper organizational culture for compliance

Assignment five

Job title: Registered Nurse

Medical surgical nursing is considered the foundation of the nursing practice due to the unique service that these nurses offer to the organization (Kahya & Oral 2018, p. 115). This is regarded as an exception field that is the backbone of healthcare institutions.

Job description

Education

Surgical nurses are required to have a bachelor’s degree in nursing and must be registered for practice in the United Arab Emirates.

Duties

1. Meeting with patients and their families to explain to them and prepare the patient for surgery by elaborating on the surgical process and expected recovery time.
2. Sterilize and set up surgical tools.
3. Prepare the operating room ready for the patient and also cleaning the incision site that the doctor will operate.
4. After operation, they assist in stitching and bandaging up of patients then take them to the recovery room.
5. Continue providing care to patients until they are transferred to other units like the ICU or discharged from the facility.
6. Collaborate with other members of the healthcare team for safety of the patient and increased outcomes.
7. Integrate the best clinical practices into the healthcare environment.
8. Promote and maintain patient’s safety standards.
9. Perform any other medical procedures as directed by doctors within the surgical room.

Professional development/Continuing education

1. Training on capturing patient data and proper documentation.
2. Training on safety standards at the workplace and how to increase patient safety within the work environment.
3. Psychosocial trainings on reduction of stress and psychological disturbances during surgical procedures.
4. Patient management state for patients who display higher extreme characteristics.
5. Training on the use of modern technologies for a better work place

Medical Surgical nurse stated goals

1. To increase capacity and awareness on risk management for a safe workplace and reducing of risks.
2. To attain proper knowledge on modern clinical technologies used in the surgical unit.
3. To create a safer clean environment with increased patient outcomes.

Schedule for monitoring your employee’s progress

Performance improvements focus on use of appraisal strategies that work well for the organization and the individual employee (Mayer & Gavin 2005, p. 879). This is supposed to be a combination of self-assessment and supervisor assessment to combine the two and come up with the best assessment that reflects the performance of the employee. Bicudo de Castro (2017, p. 539) suggests that the best way to monitor emplpoyee performance is a combination of self-monitoring, review work in progress on a regular basis and supervising employees once in a while. However, slef-monitoring is regarded as the best way that allows employees to take control of their own work enviornment and repprt on the progress that they have made.

Employee self-monitoring tool

Name of employee______________________________Date of employment________________

Position: ______________________________________Department___________________

Immediate supervisor

1. Type of nursing care

Medical surgery ( ) recovery ( ) administrative ( )   psychiatry ( )

1. Shift hours (check all that apply)

( ) days ( ) nights ( ) full time part time (list hours)

1. Attendance(respond to the questions)

Number of days present in the last three months ( )

Number of days absent in the last three months ( )

1. Quality of work (rate your work based on the following indicators)

(   ) Excellent    (   ) Satisfactory    (   ) Needs Improvement    (   ) Unsatisfactory

Has the nurse received an evaluation or counselling in the last 3 months? Yes ( ) No ( )

Have there been any incident reports or complaints from patients and other practitioners about the nurse? Yes ( ) No ( ) provide a copy

1. Medical duties

Does the nurse administer medications in the surgical unit? Yes ( ) No ( )

If yes, are there restrictions or supervision during the process____________________________________

If no dopes the nurse have professional access to medications? Yes ( ) No ( )

How often is the administration process reviewed for accuracy regularly () occasionally ()

Interpersonal relationships

With patents (   ) Very Good   (   ) Satisfactory   (   ) Needs Improvement – explain

With other practitioners (   ) Very Good   (   ) Satisfactory   (   ) Needs Improvement- explain  

1. How does the nurse work in the surgical unit

 (   ) Very Good   (   ) Satisfactory   (   ) Needs Improvement – explain

1. Does the nurse comply with the required safety standards in the surgical unit?

Always ( ) sometimes ( ) Never ( ) – explain

1. Do you think the conduct of the nurse puts the life of the patient at risk?

Yes ( ) no ( ) sometimes ( )

1. Suggests areas of improvement that you think management needs to work on

References

Bagdasarian, N., Schmader, K. E. & Kaye, K. S., 2013. The Epidemiology and Clinical Impact of Surgical Site Infections in the Older Adult. Current Translational Geriatrics and Experimental Gerontology Reports, 2(2), p. 159–166.

Barbara J. Youngberg, 2013. principles of Risk Management and Pateint Safety. Ontario: Jones & Bartlett Learning.

Bicudo de Castro, V., 2017. Unpacking the notion of subjectivity: Performance evaluation and supervisor discretion. The British Accounting Review, 49(6), pp. 532-544.

Elizabeth, S., Alok, G. & H., C. C., 2017. Cost and Consequences of Surgical Site Infections: A Call to Arms. Surgical Infections, 18(4).

Frandsen, B., Joynt, K., Rebitzer, J. & Jha, A., 2015. Care fragmentation, quality, and costs among chronically ill patients. The American journal of managed care, 21(5), pp. 355-362.

Frank, T. et al., 2015. Quality risk management principles and industry case studies. Medical and Biological Sciences, 28(3), pp. 33-43.

Gepke L Veenstra1, K. A. et al., 2017. Rethinking clinical governance: healthcare professionals’ views: a Delphi study. BMJ Open, 7(1), pp. 1-7.

González, R. et al., 2016. A risk-based integrated management for patient safety and quality in healthcare services. s.l., s.n., pp. 86-89.

Jenks, P., Laurent, M., McQuarry, S. & Watkins, R., 2014. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. The Journal of Hospital Infections, 86(1), pp. 24-33.

Kahya, E. & Oral, N., 2018. Measurement of clinical nurse performance: Developing a tool including contextual items. Journal of Nursing Education and Practice, 8(6), pp. 112-123.

Kumar, N. & Jha, A., 2017. Quality risk management during pharmaceutical ‘good distribution practices’–A plausible solution. Bulletin of Faculty of Pharmacy, Cairo University, 3(2), pp. 1-8.

Mayer, C. M. & Gavin, M. B., 2005. Trust in management and performance: Who minds the shop while the employees watch the boss. Academy of Management Journal, 48(5), pp. 874-888.

McFadden, K., Stock, G. & Gowen, C., 2015. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety. Health Care Manage Review, Volume 40, pp. 24-34.

Meeker-O’Connell, A., Sam, L. M., Bergamo, N. & Little, J. A., 2016. TransCelerate’s Clinical Quality Management System: From a Vision to a Conceptual Framework. Therapeutic Innovation & egulatory Science, 50(4), pp. 397-413.

Mosadeghrad, A. M., 2012. A Conceptual Framework for Quality of Care. Journal of the Academy of Medical Sciences of Bosnia and Herzegovinia, 24(4), pp. 251-261.

Moss, F., 1995. Risk Management and Quality of Care. Quality in Health Care, Volume 4, pp. 102-107.

Nikpay, S., Freedman, S., Levy, H. & Buchmueller, T., 2017. Effect of the Affordable Care Act Medicaid Expansion on Emergency Department Visits: Evidence From State-Level Emergency Department Databases. Annals of Emergency Medicine, 70(2), p. 215–225.

Park, B. Y., Kwon, J. W., Kang, S. R. & Hong, S. E., 2016. Analysis of Malpractice Claims Associated with Surgical Site Infection in the Field of Plastic Surgery. Journal of Korean Medical Science, 31(12), pp. 1963-1968.

Pereira, M. G., 2016. Total Quality Management in the Hospital Area and Its Contribution to Patient Safety. Journal of Statistical Science and Application, 4(7), pp. 190-195.

Perencevich, E. N. et al., 2013. Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge. Emerging Infectious Diseases, 9(2), pp. 196-203.

Singh, B. & Ghatala, H., 2012. Risk Management in Hospitals. International Journal of Innovation, Management amd Technology, 3(4), pp. 417-421.