Quality Improvement Processes, Essay Example

There are numerous, important differences between performance measurement and quality improvement processes.  Performance measurement in health care primarily focuses on understanding what outcomes are important for care and how to operationalize (measure) them accurately, as well as helping to reach strategic goals through improving effectiveness and streamlining decision-making processes (Martinez, 2000).

For example, a hospital may a serious problem with hospital-acquired bacteria infections (also known as MRSA).  In order to form and implement a quality improvement program, the hospital must first understand the scope and nature of the program.  In order to understand the hospital’s current performance, administrators may collate statistics regarding the number of infections acquired in the hospital by patients; also stratifying the analysis by different departments in order to asses where patients are exposed to the most risk. This is a (benchmarking) exercise in performance measurement. Although not inherently passive in nature, the analytical focus is on assessment and measurement of metrics, not on improving the outcomes observed.

A quality improvement exercise, however, would differ in its aims. For example, after a hospital measured the current incidence rate of MRSA-acquired infections in the hospital, particularly among acute versus chronic patients, the hospital might implement a quality improvement plan. The United States Veterans hospital system implemented such a QI system in 2010 addressing the problem of bacteria infections in hospitals: The agency used a “bundle” of measures to help reduce the level of bacterial acquired infections in the hospital including screening all patients with nasal swabs and isolating those found with MRSA (New York Times, April 11, 2011).  In addition, health care workers were urged to take special precautions to prevent spreading germs from those patients and to wash their hands carefully.  As a result of this quality improvement, the number of MRSA infections fell 62 percent in intensive care units and 45 percent in other hospital units. This program did not only focus on measuring variables related to MRSA infections (an act of performance improvement), but also implemented measures to actually improve those outcomes. Quality improvement is thus focused on improving outcomes, although measurement is inevitably part of this process.

The Blue Canyon Pain Management Center is dedicated to managing pain for patients across the range of different clinical diagnoses. The Center helps individuals manage acute or chronic pain through the advice and care of multidisciplinary specialists from neighboring medical centers; the Center also focuses on pain management solutions related to cancer. In addition to robust pharmacological solutions, the Center provides start of the art therapies in the areas of procedural and psychological therapy, including therapies related to transcutaneous electrical nerve stimulation (TENS) and microelectrode nerve stimulation (MENS).

Reducing medication errors is one of the main quality improvement goals of the organization. This goal is important for a number of reasons.  One, many patients who come to the pain management center have co-morbidities (multiple diseases), particularly older patients; thus, prescribing the right medication with the right dosage is imperative in order to treat pain that might be a function of several complex medical conditions.

Second, there is an inherent problem related to prescribing pain medication and the possibility of a patient developing an addiction- an addiction that can last over the long term. Clinicians must thus be aware of the type of medications they are prescribing and also the dosage that might lead to an overreliance on the pain mediation.  Over medication of individuals can foster an addiction among patients that can lead to even more damage over the long-term.

The role of consumers in our organization’s QI process is of inestimable value. This isparticularly true for pain management centers, where although (parts) of the treatment

are administered in a clinical setting, the majority of the patient’s treatment takes place in settings outside of direct clinical observation.  This is where the input and observations of patients (and individuals related to the patient) are invaluable.  If a patient is having difficulty with a treatment (particularly adverse side effects), doctors need to know in order to integrate it into their treatment and analysis moving forward.

Although pain management offers more difficulty in QI improvements than other clinical services, there are a number of valuable QI metrics that are made public. First, and perhaps most importantly, is the level of medication errors in the Center. Medication errors convey important information for consumers in assessing the basic competency and quality of the organization in providing adequate care and attention to each patient. In addition, this indicator shows the ability of the center to administer complex pain management solutions without adversely affecting quality.

The second main QI metric is the management of adverse side effects related to medication.  While it is important to ensure that each patient gets the right medication, it is also important to aggressively manage side effects related to that medication.  The Center’s ability to deal with serious side effects in a quick and decisive manner is important to make sure patients can effectively manage pain.

The third main QI metric is the overall management of pain in patients. This is undoubtedly the hardest to measure due to the subjective nature of pain in individuals: Levels of pain are typically measured on “pain scales” that inevitably rely on the patient’s ability to recall and calibrate movements in pain (Horner, Hanson, Wood, Silver, & Reynolds, 2005).

Not only with the three QI metric listed above, but with all QI metric, input from stakeholders is important to help improve the QI process in a number of different ways.  First, the patient is the most important source of feedback.  The patient, as well as being the main end user of the product, also provides key understanding regarding how treatments may or may not be working.  Even if treatments are working, patients may also provide key insights of side effects or other issues related to the medication or therapy that helps doctors to improve therapeutic options.  Second, the employees of the clinic also provide key feedback regarding how the clinic is or isn’t doing an acceptable job in meeting clients’ needs.  Clinicians provide a first-hand account of what treatments may be working or alternatives to traditionally used solutions; managers may have a more macro perspective understanding how departments can work together to provide better care for patients; administrators and health insurers provide perspectives on comparative cost effectiveness, balancing out the results of therapy with the costs incurred along the way,

References

Editorial. (April 17, 2011).  Hospitals shouldn’t make you sicker.  New York Times.  Available at: http://www.nytimes.com/2011/04/18/opinion/18mon3.html.

Martinez, J. (2000). Assessing quality outcome and performance management.  Global Health Workforce Strategy.  Available at: www.who.int/entity/hrh/documents/en/Assessing_quality.pdf.

Horner, J.K., Hanson, L.C., Wood, D., Silver, A.G. & Reynolds, K.S. (2005). Using quality improvement to address pain management practices in nursing homes. Journal of Pain and Symptom Management.  30(3), 271-277.