Healthcare Quality Improvement Plan, Research Paper Example

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Words: 2299

Research Paper

Abstract

Quality improvement programs for many social institutions are inevitable. It is essential for accountability in promoting safety, effectiveness, patient centeredness; timeliness; efficiency and equitable distribution of services. In the following pages of this document the writer wishes to identify a healthcare institution for quality improvement; offer a market analysis of the business; discuss stakeholders’imput; submit insights on how the 5 Ps inform quality improvement and clinical microsystems; use the 5Ps to implement an improvement  plan and evaluate the process based on IOM healthcare.

Introduction

The 5 Ps inform significant changes that can be made to reform healthcare practice from an organizational as well as clinical level. Jackson health care system in United States of America has been a major agency for the delivery of diverse health care services. Its contribution to health care generally, has gained international attention. While the services have been exemplary, it does not mean that there is no room for improvement. Obviously, the purpose, patient reach; professional practice, process through which services are rendered and pattern of care can be reorganized for accountability in promoting safety, effectiveness, patient centeredness; timeliness; efficiency and equitable distribution of services.

Introduction to quality improvement plan

This improvement plan is aimed at reforming hospital services when patients arrive at the accident and emergency department of a typical Jackson memorial hospital within United States geographic location.

Present service delivery scenario

The purpose of an emergency department within Jackson Memorial Hospital Health care system is to provide world class twenty-first century emergency care to adults and children. It takes the form of offering the only level 1 trauma care within the country; a comprehensive stroke center among numerous medical surgical emergencies such as heart failure; poisoning and respiratory conditions (Jackson Healthcare system, 2012).

Professional services include doctors, nurses, specialists, and auxiliary staff inclusive of porters, cleaners, medical billing and medical assistants. However, Jackson health care system has always had staffing issues even in the presence of being considered an excellent delivery service agency. The Miami Herald recently reported that hundreds of Jackson memorial nurses were either going to be losing or changing positions (Miami Herald, 2012).

From a process pattern perspective it is imperative that when patients wait more than twenty four hours either to be seen by a doctor or admitted to the ward after a diagnosis there is obvious need for improvement. This occurs mainly among categories of patients not covered within the trauma stoke typology of emergency care. According to an ABC news report, of June 2007, ER wait time problems are widespread resulting in injuries and deaths, which could have been avoided had emergencies addressed promptly (Brownstein, 2007).

Possible reasons advanced by researchers are that clients use emergency units as primary care services either when they do not have a primary care physician or in an effort to avoid extensive wait time for an appointment in cases of emergency. Alternatively, many hospitals are ill equipped with beds utilizing the emergency room for boarding, rather than a transitionary phase of care (Brownstein, 2007).

The department of health’s policy regarding emergency care specifies that these units ought to treat acute conditions as patients appear without prior appointment. As such, professionals are expected to be equipped with skills to manage a wide range of medical surgical conditions. In the presence of this intense wait time at emergency units across the nation measures must be taken to reduce waiting time by establishing fast tract or minor care units as well as providing more efficient primary care services whereby clients can call on their primary care physician in cases of emergency rather than arriving at the emergency room of a Jackson memorial Hospital.

Market Analysis

Jackson memorial hospital market focuses on a wide range of medical surgical services inclusive of its exemplary emergency care portfolio. Over the years it has attracted both local and international clients because United States of America tends to lead the rest of the world in healthcare and political administrative styles.

Hence, in discussing the market analysis informing an extensive wait time at a typical Jackson memorial hospital emergency room, for patients not arriving, essentially, from trauma or stoke; inevitably an examination of the financial culture of the institution as it relates to the accessibility of available services must be undertaken.

Jackson memorial health care system financially caters for the insured as well as the uninsured. Obviously, there are services for which the insured will qualify that would bypass the uninsured. From statistics some 45 million Americans are uninsured accounting for nearly 60% of the entire population. Research has validated that the majority of clients visiting emergency rooms are those with minor complains with no insurance coverage neither a primary care doctor (Jackson healthcare system, 2012).

As such, the institution has devised payment plans distinct from Medicaid and Medicare for clients who cannot afford the cost of emergency services when they arrive in a crisis due to inadequate primary healthcare interventions. However, from recent reports while this venture worked to provide care for the uninsured it seemed that the institution has been encountering financial difficulties to the extent of cutting back on staffing creating more misery go round in the emergency units of hospitals.

Importantly, CBS Miami reports that in desperation to save $55 million in 2012 and $69 in 2013, some 1, 110 positions will be redesigned or terminated. Further reports have been that Jackson memorial healthcare is the poorest staffed among major hospitals in the country (CBC Miami, 2012).

Speculations are that in the presence of President Obama’s acute healthcare reform, accessibility to quality health care along with improvements in healthcare services should be achieved and Jackson memorial hospital emergency services enhanced. Alternatively, emergency rooms continue to be overloaded with cases that are not due to accidents or stoke, but people who still cannot afford huge health insurance costs or are affected by diseases that Medicare or Medicaid do not cover the extent of care needed.

Stakeholders

Most importantly, this scenario depicts a real dilemma in the American healthcare system and a disaster for Jackson Memorial hospital emergency units across the country. Hence, the major stakeholders would be people directly related to the decision making process specifically concerned with operating emergency rooms within the health care arena.

They must include senators responsible for counties where Jackson memorial hospitals operate; financial healthcare planners responsible for operations within Jackson memorial hospital administration; interest groups such as physicians and nurses who are affected by work overloads as well as patients/ relatives receiving care at these institutions to testify regarding inappropriate care due to extensive waiting time in emergency units of the hospital.

Discussion on how 5 Ps inform quality improvement and clinical microsystems

Microsystems emerged from the need for improvement in quality care to consumers as the healthcare business show signs of depletion. A study conducted by the RWJ Foundation revealed that microsystems are subsets of a larger organization within a macrosystem. Essentially, it is aimed at improving unit performance as in the emergency room operations at Jackson Memorial hospitals. Precisely, it can be defined as a small group of people working together to enhance service delivery through a patient centered approach of collaboration and sharing information

(Huber, 2006).

Microsystems function within 5Ps framework informing quality improvement. Purpose denotes aims, goals or objectives of the unit; patient is the reason why aims, goals and objectives are designed; professionals are dedicated individuals who go beyond the call of duty to deliver quality care in patient/client interventions; processes are interrelated actions taken by members of the health team that would produce improved quality of care and patterns are indicative of defining how interventions are enacted such as measurements, charting and delegation of duties by healthcare practitioners and auxiliary staff ( Huber,2006).

Utilizing the 5Ps to implement improvement plan

Emergency units Jackson Memorial Hospital-reducing waiting time-quality improvement plan

Intervention/improvement strategy Purpose Patient Professional Process Pattern
1. Develop a purpose assessment guide Determine through

assessment if purpose meets the needs of patients

 Examine professional profile to determine the adequacy of staffing on units Examine the retaining process for patients on units Examine the present system to establish criteria for efficient intervention in emergency units when patients with non critical conditions arrive
2. Design aims, objectives and goals consistent with patient

Centeredness- reducing waiting time approach to care in units.

Implement the nursing process for evaluating patients’ condition upon arrival at the emergency units  Insist that professionals assigned to emergency units are fully trained to interact with both trauma and stroke cases as well as the minor ones that arrive.  Develop an appropriate screening method that would reduce time wasting and waiting in the unit Document instances when patients wait longer than two hours to be either evaluated or seen by the physician
3. Redesign aims objectives and goals in alignment to demands for less waiting time in the emergency unit  Patient care must be focused on allowing every category of patient access to services appropriate to their need immediately upon arrival at the ER. Professionals must be trained in becoming sensitive to the excessive waiting time and be assertive in reducing the ordeal for relatives and patients alike. Jackson

memorial hospital must set up a task force to investigate the excessive waiting time process at their emergency rooms

Documentation that will help in resolving the issue must be made available to stakeholders for review.
4. Allow newly designed aims, objectives and goals to guide future action  Allow a patient centered approach towards reducing waiting time to pervade the emergency room in the health care industry Promote a caring culture among ER professionals that is sensitive at discerning the impact of excessive waiting time

on effective nursing outcomes

Develop a process that would allow trauma and stroke patients priority care, but do not neglect patients arriving with asthma, psychiatric disorders or obstetric conditions.  Develop  profiles for acute cases beyond stroke and trauma typology
5. Consistently re-evaluate goals, aims and objectives to determine their effectiveness  Construct surveys which will inform effectiveness of the new intervention on delivery of services from a patient/relative perspective Allow the professional stakeholders’

Perspectives into molding the expected outcomes

 Allow the process time to evolve into a new way of relating to patients’ needs when they arrive at the ER of Jackson Memorial hospital  Document new approaches to intervention that have successfully reduced waiting time in Emergency rooms of

Jackson memorial Hospital.

Evaluation process based on IOM domains of healthcare

OM Domain O 1 2 3 4 5
Safe Waiting time more than twenty four hours. Waiting time between twenty and

twenty four hours

Waiting time between 10-20 hours Waiting time between 5-10 hours Waiting time between 2-5 hours Waiting time between 30 minutes and 2 hours
Effective

 

 No booking after twenty four hours No booking between 20-24 hours No booking  10-20 hours Booking between 5-10 hours Booking between 2-5 hours Booking between 30 minutes and 2 hours.
   Patient centered  Patient is   ignored and complaints neglected Professionals are engaged by answering telephone and attending to files making documentation Process focuses on cutting costs rather than providing quality care Process allows for patient accessibility to care based on Insurance coverage criteria. Process allows for patient to be treated according to nursing diagnoses promptly Process allows for  patients to access care immediately upon arriving at ER
Timely Intervention does not meet the criteria for right nurse; right patient; right time Intervention is slow and inappropriate for nursing diagnosis  Intervention lacks proper timing and creates complications                     Intervention is prompt but outcomes are not achievable Intervention is prompt and outcomes achievable.  Intervention is prompt,appropite and achievable
Efficient Professionals are not alert to patients’ needs Staffing inadequate for patient work load.  Skills necessary for delivery of care for  specific conditions is absent Staffing and skills are adequate but allocation difficulties exixt. Staffing and skills are appropriate with a few variations in allocation to meet Staffing and skills are appropriate to meet demands of ER operations
Equitable  Patients are not seen if they cannot prove how payment is made for their care Patients are given care based on their insurance coverage Patients not affected by accidents or stroke are placed on hold and do not receive immediate attention Staff are allocated to patients arriving from accidents or trauma and other category of patients receive very little attention Staffing and skills are equally distributed with very little emphasis placed on specialist intervention based on patients’ Staffing and skills are equally distributed with specialist intervention when necessary.

Conclusion

The foregoing report outlines an improvement plan regarding waiting time in ER at Jackson memorial hospitals around the country United States of America. This improvement plan was designed utilizing the 5ps theory of microsystems operation. It involved collaboration of stakeholders, sharing of information with consistent evaluation of the process, patterns of care as goals, aims and objectives are assessed continuously.

References

Brownstien R (2007) ER wait time widespread. ABC News CBC (2012).Employees Picket Jackson memorial Hospital Decision to lay off Employees. CBC News.

Huber Thomas (2006). Microsystems in health care: Essential Building blocks for successful delivery of health care in the twenty-first century. Power Point Presentation.

Miami Herald(2012). Thousands of Jackson Nurses losing jobs. Miami Herald

Jackson Memorial Hospital (2012). Emergency Care. Jackson Health Care system.

Jackson Memorial Hospital (2012).Managing care off the uninsured. National Association Of Public Hospitals Washington DC

Appendix

Stakeholder contact schedule

Week Grassroots- Patients/ relatives Professionals Senators
2 Conduct a survey to ascertain perceptions from patients and relatives concerning waiting times at Jackson memorial hospitals Garner support from nurses, doctors technicians, specialists regarding work overloads resulting in extensive waiting time  Have interest groups approach senators to sensitize them to the issue affecting various categories of patients arriving at the emergency unit.
2 Follow up on initial impact Follow up on initial impact Follow up initial impact
2 Evaluate responses from survey Evaluate the support from professionals and compare concerns Assess responses from senators
2 File petitions regarding improved waiting time at Jackson memorial hospitals across the country.  Have professionals sign petition Submit petitions to senators for consideration

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