How can conflict in the workplace affect the quality of care
Slide 1 Slide 2 Slide 3 Slide 4 As a member of the healthcare team, you play a part in the quality and cost of healthcare as well as improving system and process performance Quality management took us from a reactive planning process to a proactive one as organizations began to look at ways of preventing problems and ways to improve patient care. Total Quality Management (TQM) emphasizes a commitment to excellence within the organization, widely used to improve patient satisfaction. TQM aims to address the needs of both internal and external customers. Internal customers include employees and departments within the organization. External customers are our patients, visitors, and physicians…to name a few. TQM strives to meet all of their needs. The goal of TQM is to empower employee engagement and to work together with other departments to increase productivity, teamwork, and ultimately influence positive patient outcomes. So, how do we measure quality? There are many tools for data analysis to help identify areas for improvement. When identifying these areas, each department must work together to promote positive outcomes. Where TQM is the overall philosophy, Continuous Quality Improvement (CQI) is used to improve quality and performance. However, these terms are often used interchangeably. CQI involves many facets to improve patient care. A well thought out process is key to CQI success. The four major components of CQI are resource group, coordinator, team leader, and the team. The resource group is made up of senior management who develop overall policy, vision, and values. The coordinator is often appointed by the CEO to oversee day to day management. Your team leader must be familiar with what is being evaluated, and this person oversees the team. The team are the ones that evaluate and improve select processes. A team is made up of 5-10 people, representative of all the functions of which the process is being evaluated. A comprehensive quality management program includes multiple components. A comprehensive plan, standards, performance appraisals, and both intradisciplinary and interdisciplinary focus. A comprehensive plan is a systematic plan Slide 5 Slide 6 ultimately used to improve organization and performance. Standards are written statements to set conditions relating three dimensions of quality care. These three dimensions are structure, process, and outcome. Structure describes the physical environment, process standards are those related to the delivery of care, and outcome standards are the end result. We use indicators to measure these standards. Once identified, comparing performance of these indicators aids in quality improvement. Performance appraisals are utilized to hold employees professionally accountable. When focusing on improvement, organizations must focus on intradisciplinary and interdisciplinary areas. Data must be gathered and analyzed to guide the decision making process. Let’s look at some quality management programs. Six Sigma is a quality management program that uses data to monitor progress by using a measure, a goal, and a management system. Six Sigma has six themes. The first three: Customer focus, data driven, and process emphasis are common among quality management programs. These focus on the object of service and in our case that is the patient. The last three are unique to Six Sigma and they include proactive management, collaboration, and aim for perfection while tolerating but tolerating failure. These most actively involve management and work to break down the walls between departments. Lean Six Sigma focuses on improving process flow and eliminating waste. Waste is described as providing more resources than is required. Lean Six Sigma identifies processes that contribute to this waste. The DMAIC method, which stands for define, measure, analyze, improve, and control, is a Six Sigma process improvement method. This is accomplished by defining which measures indicate success, measuring baseline performance, analyzing results, improving performance, and controlling and sustaining performance. The ultimate goal of all three is to improve the quality of healthcare. When an organization is reviewing how to improve quality of care, many national initiatives are used for guidance. National Quality forum is a Slide 7 Slide 8 nonprofit organization that has the goal of improving quality of care by developing a consensus on performance goals and standards and then reporting them. Other organizations, such as The Institute of Healthcare Improvement, work with healthcare organizations to improve the quality of care provided. Hospitals accredited by The Joint Commission must adopt national patient safety goals. We should all be very familiar with these. However, here is an example…Identifying patients correctly, improving staff communication, using medications safely, decreasing infection, identifying patient safety risks, and prevention of mistakes in surgery. When reviewing additional ways that organizations can improve quality of care, they must look at many different areas. Let’s look at some of these. Quality measures can reduce cost. One of these is wasted resources. Nursing plays a huge role in reducing these wasted resources by managing their time, admitting and discharging patients in a timely manner, and making sure that we are using supplies appropriately. Research suggests that using Evidence Based Practice (EBP) to compare clinical treatment can improve quality of care. However, there are barriers to using EBP. What are some of these barriers? What access to EBP to you have in your organization? Electronic Medical Records (EMR) can also increase quality of care by improving accuracy and speed of communication between providers. Some organizations use dashboards, or scorecards, to improve quality. Many different data points can be communicated with dashboards such as hospital census and patient satisfaction. They can also help to guide staffing or provide financial data. Evidence suggests that increased staffing results in better patient outcomes. Of course this makes sense but healthcare organizations also have to take into account that this will increase costs. Reducing medication errors improves quality of care. What steps is your organization taking to reduce medication errors? In addition to other evaluation methods peer review can be used to identify areas of practice and clinical standards that need improvement. Peer review isn’t Slide 9 Slide 10 Slide 11 intended to be punitive but rather a review process to propose an action plan. Risk management is a component of quality management involving all departments. There must be a commitment from all departments and this has to include the CEO as well as the CNO. A risk management program identifies risk areas for accidents and injuries, reviews current monitoring systems, analyzes past incidents to plan an intervention, reviews safety of patient care, monitors the laws that govern patient care, they work to eliminate risks, reviews committee work (such as infection prevention, nursing audits), identifies areas of education for patients and families. The program evaluates these programs and then reports to administration the results. So, what is our role in risk management? We are critical to the success of any risk management program. We can affect areas such as medication errors, falls, and dissatisfaction with care to name a few. A reporting tool that is utilized to identify areas of risk is an incident report. Incident reports should be non punitive. They should hope to improve the system. But what makes a reportable incident? A reportable incident is any unexpected or unplanned occurrence that affects the patient, a family member, or the staff. However the report is only as effective as the form that the organization utilizes. Therefore, careful consideration should be given to the adequacy of the form and the information being reported. Root Cause Analysis is a method used to look back at an event to discover where the error occurred. It’s a systematic process but it can also be a complicated process that uses multiple resources. System errors may not be taken into account in an effort to determine a single cause. The Nurse Manager plays a critical role in the success of risk management programs. One area is in the handling of patient or family complaints. The nurse manager should take a personal approach. A quick visit or a call can often verify information and calm emotions. The nurse manager sets the tone with staff. Mistakes should be seen as learning experiences to improve the system rather than being punitive. Slide 12 Healthcare is often known as a blame culture, inhibiting reporting of incidents. Organizations should work toward establishing a blame free environment. A just culture encourages reporting without fear of retribution. This culture also allows employees to question policies and procedures. However, accountability for errors must be maintained. Managing improving quality is a dynamic process involving all departments within an organization. Nurses, and the nurse manager, play a critical role in identifying areas for improvement as well as areas of concern. Working together with the multiple departments within an organization ensures the progression of the goal of improving quality within the healthcare system.