Quality Improvement in Health Care
Instructions:-
We discussed the evolution of quality and the impact of the quality guru’s on the evolution.Based on your knowledge of the quality guru’s, answer the two questions below.
(a)discuss the contributions of each quality guru. Using the table below summarize each of the quality guru’s and their contribution to the field of quality. See the table below.
| Year: | Guru: | Background: | Contribution: | Example of Guru’s Influence in Healthcare |
| 1920-1930 | Walter Shewhart | Bell Lab | Control Charts: common cause vs. special cause variation | Control charts are a key component of quality improvement initiatives and sustainability |
| Edward Deming | ||||
| Joseph Juran | ||||
| Donald Berwick |
(b) explain the teaching of Donabedian. Which quality gurus in the table above is MOST like Donabedian and why? Which quality guru is LEAST like Donabedian and why? (~1-2 pages)
(c) what role does the IHI play in improving quality? How might physician and healthcare leaders in the UAE use the IHI framework and open school to improve quality awareness and/ or quality of care? (~1-2 pages)
GRADING RUBRIC:
| Assignment | Exceeds expectations | Meets expectations | Below Expectations |
| Guru’s (1pt) | |||
| Donabedian (1.5pts) | |||
| IHI (1.5 pts) |
Solution.
Quality Improvement in Health Care
Introduction
Quality improvement in health care is a concept determined by satisfaction received by a patient or the society. To improve, quality starts with a review of health organizations with regards to the degree of their current duties, function, and if they meet the required needs. Recent surveys and trends in quality evaluation are along the lines of customer satisfaction with process, structure, and outcome orientation for aspects of health care delivery.
Contribution of the quality guru’s
Walter Shewhart- for more than fifty years, several clinical laboratories are embracing the guru’s ideas and incorporating the statistical process of control into proficiency testing and standardized operating procedures in clinical laboratories for quality control.
Edward Deming- Based on the principles in the healthcare process improvement, he emphasized on quality improvement as science of process management. All quality improvements must me data driven in the healthcare; anything that cannot be measured can neither be improved (Berwick, 2003). On managed care, it means being in control of the process of care and not merely the management of nurses and physicians.
Joseph Juran- The guru’s healthcare strategies had developed methods that enabled hospital systems to deal with long and short-term challenges that face the healthcare organization. The methods were meant to reduce cost, improve patient’s experience, and improve operational and financial performance.
Donald Berwick- He was part of the faculty of Harvard School of Public Health and Harvard Medical School. He also served as a staff in Boston’s Children’s Hospital Medical Center.
| Year | Guru | Background | Contribution | Guru’s influence |
| 1920-1930 | Walter Shewhart | Bell lab | Control charts: common cause vs. special cause variation | |
| 1946-1980 | Edaward Deming | Deming principles | Ensured clinicians had the right data, with a right format, at the right hands and time | Based on Deming’s principles, Mckinsey survey noted that majority of physicians of about 84% are willing to change |
| 1931-1980 | Joseph Juran | Juran’s healthcare, quality control, quality improvement and quality planning | Improving financial and operational performance, reducing cost, improving patients outcome and experience | Launching of quality improvement initiative in the world for more than twenty years. |
| 1970-2001 | Donald Berwick | Honorary knight commander of the British Empire | Serving in the US preventive task force | Served in President Clinton advisory commission on consumer protection and improvement in quality healthcare industry. |
Donabedian
After receiving his medical degree, he went to practice family medicine in Jerusalem (Berwick, 2003). He transformed the thinking that concerns health systems by explicating how the social response to the health challenges is never an unrelated event collection, but a process with complexity that is below general principles. He introduced the concept of process and structure, which is currently the paradigm that evaluates the quality of health care. Donabedian built bridges between action and scholarship by convicting that the ideas world is not separate from the action world. A testimony to his contribution is the existence of the Foundation for improvement of health care in Spain, Barcelona, and various awards engraved with his name.
Certainly, a guru most likely similar to Donabedian is Edward Deming. As Donabedian based much of his focus on the structures, processes, and outcome, Deming based much emphasis on profound knowledge (Berwick, 2003). The profound knowledge emphasized on appreciation of systems, psychology, theory of knowledge and understanding. Donabedian’s structure and process emphasized on outcomes with exploration in quality assessment and monitoring.
However, the guru less similar to Donabedian is Donald Berwick. Berwick believes on the priority of measuring quality on more delicate interplay among process, structure and outcome. Donabedian emphasized on making a difference, the loci in responsibility care, and decision making that produces healthy outcomes.
The role of the Institute for Healthcare Improvement (IHI) in improving quality is characterized by a personal connection with serious medical errors and harm that are made in health care institutions. It encourages the organization leaders to find out how such unprofessional acts occur and what drives can be enacted for improvement. It encourages the understanding of medical errors; since, approximately 70% of the medical errors are commonly system derived. A solution for improvement is through designing care delivery systems to minimize harm from reaching the patient. The IHI ensures minimization of poor cost quality by ensuring healthcare institutions have standard and quality equipment for the patients (Berwick, 2003). The IHI ensures it addresses strategic priorities, infrastructure, and culture by engaging key stakeholders through communicating and building awareness. Moreover, it ensures redesigning the systems and improving reliability through the alignment of system-wide incentives and activities.
Physicians and healthcare leaders will use the IHI model to improve quality awareness. The associates involved in the process improvement develop the improvement model. The model does not change the original model used, but focuses on making it better.
The IHI achieves the role of improving quality by forming a team that includes the right people. The team varies in composition and sizes by considering the systems that relate to the aims. The team includes members that are familiar with the various parts of the process like administrators, such as, pharmacists, physicians, front line workers and nurses. The IHI sets aims that are measurable and time specific with a definition of the specified population for the patients that are affected. Coming into agreement with aims is important as well as allocating resources and people necessities for achieving the aims (Berwick, 2003). The IHI establishes measures that will be part of testing and making implementing of the changes. The measures will be of help in telling the team if the changes made can lead to improvement. The IHI will test and implement changes by establishing membership and developing measures that determine a change that will lead to improvement, and then implement it. The method used will be scientific and action oriented for learning. The IHI will finally spread the changes by taking the successful implementation process, a pilot population or pilot unit that replicate the changes in other parts of the organization in the health care quality.
Conclusion
For quality improvement in the healthcare systems there is need to put the gurus’ concepts in practice. The public’s increasing concern has directed holding of healthcare organizations responsible and accountable for the services provided. The healthcare field is presently making recognition of merit and needs for voluntary commitment in delivering quality and emphasizing on the identification of pressing society needs with effective management.
References
Berwick, D. (2003). Improvement, trust, and the healthcare workforce. Quality and Safety in Health Care, 12(6), 448-452