Healthcare Policy and Quality Management

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Healthcare Policy and Quality Management

For a long time, the healthcare industry has faced great challenges in providing healthcare services to patients. There has been great need for developing management techniques that would facilitate quality improvement in the service provided by healthcare industry. Taiwan is a best example of countries that have been affected by low quality of healthcare services provided. The research carried out to determine the reason for the challenges faced by health care industry in service provision indicted that it was all due to the low quality of service given out (Hung, Wei, Chuang, Chen, and. Lin. 1998).

This paper would effectively and widely provide a discussion of how these challenges faced in health care industry can be solved under the use of a Plan-Do-Check-Act (PDCA) circle. In response to the challenges faced in the health care industry, both the practices of the quality control circle (QCC) and learning techniques in the organization have been chosen as the PDCA tool for resolving the challenges (Lam, Hsu, Chu, Chen, and Wang. 2005). This paper’s review would mainly focus on achieving a high quality service provision as a way of responding to the challenges faced in the health care industry based on management of the quality of the service offered in healthcare, organizational aspects of healthcare realized in the previous studies and organization learning.

This paper would cover the following subtopics in a systematic analysis; the organizational and group learning theory, quality control circle healthcare service under which the paper would look at the methods, results extracted from research, and the purpose of quality control circle in healthcare industry, the use of the 4Is approach in quality control circle activities, and lastly the paper would look complete discussion of the role of quality control circle in improving the services and operations in healthcare industry (Liao, &. Hsu. 1997).

The components of quality control circle tool:

The main focus of the quality control circle as a tool of plan-do-check-act, its main aim is to ensure improvement of the quality of all organizational activities (Bureau of National Health Insurance (NHI), Department of Health, Executive Yuan, (Taiwan).2008). The tool first aims at focusing its wits towards the different internal factors that affect the performance of organizational groups or departments. These factors include;

Training; this refers to the extent to the academic knowledge of the employees in the healthcare sector as far as the medical field is concerned. When the employees of a healthcare firm have less experience and knowledge, the likely outcome in the firm is low quality service output. This would in return lower the general healthcare service provision state of the firm (Hung, Wei, Chuang, Chen, & Lin. 1998).

Communication; this refers to the openness and freedom with which employees within a firm can share ideas relating to the operations of the firm. In a case where communication skills are not effectively utilized, there is a likelihood of challenges and problems affecting the firm staying unsolved for quite some time.

Teamwork; this refers to the ability of the employees in different departments of a healthcare firm to work together effectively. In most cases, firms where there is no teamwork at departmental or organizational level, the firm is likely to collapse or lose customers to its services.

Coordination; this refers to the state whereby the juniors employees are willing and able to effectively carry out the task, jobs or assignments given to them by their seniors. In organizations where junior employees do not respect their seniors and cannot vary out their tasks or duties at their assignment, then the organization has no future.

On the other hand, there are three main components of facilitating the effective implementation of the quality control circle tool. The implementation of the quality improvement tool which is the quality control circle should involve implementing of its tools step by step (Ishikawa, 2002). These components of quality improvement activities include;

Efficient provision of healthcare services

Cost reduction in healthcare operations

Facilitation of organizational learning

Improvement of organizational management system.

3. Critical analysis of the components of the Quality Control Circle as a PDCA tool:

The ease and effectiveness of which the quality of healthcare industry can be improved majorly relies on group work. Group work is very common in the healthcare firms since operations, medication services, management process and knowledge advancement of employees greatly relies on group work. All departments in the healthcare firms are made up of groups of medical professions. These professionals might be of different fields or similar but in order to produce high quality outcome for the whole departments, there is need to work together as a team. There are many quality improvement activities in health industry that are very important as based on Garvin (1993) who provided that engagement in these activities, helps effectively at acquiring new skills and knowledge and applying them at personal duties in their respective departments.

Training the employees in the healthcare industry facilitates learning of new and helpful knowledge which if applied in their occupational positions helps in strengthening their power of motive. This later leads to integration of individual skills and knowledge into their departments for organizational competencies and also creates advantageous power for competition in addition to shaping the individual’s contribution towards the group effectiveness.

According to Yang et al. (2002), activities that aim at quality improvement are helpful in growth of organizations, departments/groups and individuals. This is because, with the help of supervision and group participation by all members; quality control circle is likely to provide opportunities for learning to all employees of the healthcare firm. The research outcome based on quality improvement indicated that support by the management team of a healthcare firm, motivation towards employee learning and the willingness of an individual employee to learn are the most important aspects towards achieving quality control circle activities.

Quality control circles in healthcare industry:

The main origin of the quality control circles as a tool of quality improvement originated from Japan. It was initially purposely meant for enhancing education in industries and for training purposes. Taiwan is a best example of countries that have effectively utilized the tool of quality control circle with an aim of the level of quality of healthcare services (Chiu, Yang, Kuo, Chen, and Chen. 2001). It reached a time when it was realized in Taiwan the healthcare services were very low and undesirable. The government looked forward to improve the quality of healthcare services and therefore, implemented the quality control circle tool which was at that time in application in industries.

The main focus of the quality improvement technique was to improve the quality of healthcare based on its relation to the structures of healthcare firms, the process of treating patients and the outcomes of the healthcare services. The first hospital accreditation and evaluation by Taiwan Joint Commission on Hospital accreditation (TJCHA) based on hospital structure, healthcare service provision and outcome of healthcare in 1999 (Lin, Chen, & Wu. 2002)This made most of the Taiwan hospitals to implement the quality control circle as a quality improvement concept by the year 2005. Healthcare firms that had implemented this technique gained popularity based on high quality of their services and infrastructure. By the year 2008, all healthcare firms in Taiwan had applied the tool. More emphasis was placed on improvement of the quality healthcare services, teamwork, and improvement of the management cycle. The quality improvement activities focuses mainly on learning process and organizational learning which mainly emphasized on the different tools of quality control such as plan-do-check-act (PDCA) and statistical process control (SPC).

Methods of Quality Improvement Tool:

The quality improvement tool mainly pays more attention to the control of healthcare costs and improvement of the quality of the healthcare operation. This according to researchers who facilitated the quality improvement in the Taiwan healthcare should be done in regards to the healthcare insurance policy put in place by the national system. The center of focus of this paper in relation to quality improvement would focus on management of quality, quality control circle and the facilitation of organizational learning for all healthcare service provision firms. This paper’s discussion is based on the research done in the Taiwan medical field with an aim of finding the different results based on the application of the quality improvement tool. After the elimination of the studies that were not empirical on quality control circle, which had been deemed irrelevant, another research was carried out.

The conceptual framework that was used in this research analysis was called 4Is conceptual framework developed by Crossan et al. This conceptual framework was developed with an aim of linking quality control circle and group learning in healthcare firms. This is then going to provide a clear and wide analysis of QCC in respect to the following components; process management, clinical process problem and cost management. The results obtained after the field research carried out in Taiwan indicated that based on the quality improvement basis, different result were obtained from working groups and individuals in healthcare. Other results were obtained from organizations and their management teams of different organizations. Based on the results obtained, the collective and combined conclusions would lead to the fact the activities linked to the quality improvement have one goal that is unifying thus making learning in the healthcare organization a way of organizational life.

Purposes of quality control circle:

The three approaches towards the quality improvement in healthcare industry based on the research carried out in Taiwan that remained dominant are; process management, solutions for both medical and clinical problem and cost management. At the same time, most activities of quality control circle greatly focused on healthcare administration and process management which fully included; analysis of the process, improvement of the process, performance appraisal and time waiting for improvement to take place. Therefore the four main steps that were used in carrying out quality control circle are continuous and recurring. Below are short discussions for the four different and orderly processes of implementing quality control circle in healthcare;

Process analysis; this is the first step of quality control circle as a tool for quality improvement. This step requires that the process which needs improvement should be first analyzed in its specific department. Some of the processes that were identified in this case include; developmental processes, treatment process, and drug supply in the healthcare stores for easy accessibility.

Process improvement; this step involves identification of what misses in that particular department or what needs to be done in order to improve on the operational state, of that process.

Performance appraisal; this step involves performing a further and detailed research which in real sense aims at finding out what are the probable positive effects of the improvement made on that specific process. This appraisal might involve carrying out field research of the effects of that particular improvement to the process in other healthcare firms that already applied it.

Waiting time improvement; this step refers to the patience employed by the healthcare department after implementing improvement activities on certain process until the changes or improvements start to take place. This step might take quite some time as it all depends on the type of implementations made in order to improve the process (Chung, Lan, & Huang, 1997).

After the application of the four steps of quality control circle, it was realized that the hospitals in Taiwan underwent quality improvement in two main aspect based on employee-based thinking;

The first aspect indicated that through application of quality improvement with quality control circle technique, employees get exposed to newly operational ideas in the field.

The second and last aspect indicated that, employees get to think distinctly about the nature of the work they do since they get to learn more about healthcare industry apart from just being social workers and carrier people.

In addition to that, quality control circle as a tool towards improving the healthcare service quality, it also went as far as enabling employees to learn more about control of infectious diseases (Chiu, Yang, Kuo, Chen, and H.J. Chen. 2001). Therefore, they managed to control most of those infectious diseases thus reducing the rate of infections in the healthcare sector. This also went ahead improving the intuiting skills of employees thus putting them in a better position to apply the skills and knowledge they possessed and those skills of their fellow employees where possible. Crossan et al. (1999) provided that the largest part of institutionalizing was based on the creation and development of standards of the organization.

The resultant outcomes based on application of QCC tool indicated that QCC leads to the improvement of the performance and also facilitates organizational learning. The fact that came out of this process achieved goal in both individual and group learning. QCC also enhanced social relationship during the time of work thus improving the teamwork state thus facilitating greater team effects at work. According to Blair and Whitehead (1984), the use of QCC in the improvement of quality of services offered in healthcare did not only improve the behavior and attitude of employees but also facilitated easy implementation of changes in the healthcare organizations (Bureau of National Health Insurance (NHI), Department of Health, Executive Yuan, (Taiwan). 2008).

References:

Bureau of National Health Insurance (NHI), Department of Health, Executive Yuan, R.O.C. (Taiwan). (2008). NHI profile. http://www.nhi.gov.tw/english/webdata.asp?menu=11& menu_id=290&webdata_id=1884 (accessed January 18, 2011).

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Chiu, W.T., C.M. Yang, N.W. Kuo, I.C. Chen, and H.J. Chen. (2001). Contingency factors study and performance assessments of quality control circles. Journal of Hospital Management

Chung, K.P., C.F. Lan, and P. Huang. 1997. The research of status quo and prospective development of quality assurance and quality management activities in Taiwan, R.O.C. National Science Council: NSC86-2416-H-002–021.

Crossan, M.M., H.W. Lane, and R.E. White. 1999. An organizational learning framework: From intuition to institution. Academy of Management Review 24, no. 3: 522–37.

Hsu, M.Y. 2002. Sharing QCC activities-improve parturient attendance rate of group health education program. Journal of Midwives 45: 89–100.

Hung, C.F., C.M. Lo, C.H. Wei, Y.P. Chuang, H.C. Chen, and Y.C. Lin. (1998). Using team learning and quality technique to improve hospital management- empirical study of reduce IV cost in Yung-Lin hospital. Hospital: Journal of Hospital Association, Republic of China 31, no. 1: 37–52.

Institutes of Medicine (IOM). (1999). To Err is Human: Building a safer health system. Washington, DC: National Academies Press.

Lam, Y.L., H.M. Hsu, C.I. Chu, H.C. Chen, and S.C. Wang. (2005). An empirical research on the advancing of quality control circle in hospital. Journal of Tzu Chi College of Technology Lay, M.S., M.L. Chern, P.L. Yang, J.C. Perng, J.Y. Jih, W.L. Liou, Y.W. Jahg, and L.S.Tsay. 2005. Using quality control circle methods to lower the nosocominal infection rate in intensive care unit. Journal of Infection Control 15, no. 1: 16–26.

Lin, H.C., C.T. Chen, and C.S. Wu. (2002). Using QCC method to reduce repeat prescription example in teaching hospital middle district area. Hospital: Journal of Hospital Association, Republic of China 35.