PUN219 Leadership Of Quality And Safety In Health

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PUN219 Leadership Of Quality And Safety In Health

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PUN219 Leadership Of Quality And Safety In Health

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Course Code: PUN219
University: Queensland University Of Technology

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Country: Australia


Discuss about the Leadership for Quality and Safety in Healthcare.


Quality Healthcare, TQM and CQI
The quest to promote the quality of health-care services in all the levels of health-care delivery system has become a predominant goal of the health-care professionals, international, national as well as local policy developers. The Institute of Medicine has called all the healthcare organizations to revive and re-new their focuses on promoting the quality- as well as safety- of client care in all the healthcare systems. AHRQ  (2012) states that the quality in healthcare means the degree to which the healthcare services which are rendered to an individual, family or community, increases the chance of getting expected healthcare outcomes that is in accordance with existing professional knowledge. Australia stands high in providing a quality healthcare to majority of country’s population and puts constant effort in promoting the performance of its health care sectors (AIHW, 2017). Even, the Australian framework of National health-performance has kept quality healthcare as its main indicator to evaluate healthcare performance.
Total quality management (TQM) also termed as continuous quality- improvement (CQI) functions to promote healthcare by identifying problems, framing, implementing and evaluating corrective action as well as to determine its effectiveness (NCCHC, 2017). Most of the healthcare centers implements TQM to minimize costs promote efficiency and render high quality-care. TQM and CQI are composed of various elements as philosophical, structural and health- care specific elements. The philosophical aspects include strategic emphasis on vision/ objectives, consumer emphasis on client/ care-taker satisfactions with healthcare outcomes, healthcare system evaluation, evidence- related care analysis, implementer involvement, tracing problems and framing solution to promote healthcare system performance, optimizing healthcare delivery, greater emphasis on organizational- learning. The structural aspects include emphasis on developing health-teams, framing quality managerial  structure (quality council), statistical analysis, consumer satisfaction, bench marking and redesigning process (McLaughlin, 2012). The specific aspects comprise quality-related research studies, emphasis on evidence-related practice, clinical governance and quality data analysis. 
NSQHS standards
The Australian’s Commission on safety- and quality in healthcare (ACSQHC) has proposed the NSQHS standards in 2012 after consultation, jurisdiction collaboration, technical persons and stakeholder (healthcare professionals and clients). These standards are the crucial components of the Australian’s healthcare services safety- and quality- accreditation scheme. The main aim of these NSQHS standards is to protect the individuals from harm as well as to promote the quality- of- healthcare service provision. They also provides a quality- assurance mechanism to evaluate whether the appropriate health-care systems are in place and also to determine whether minimum standards of quality- and safety- are met with a quality- improvement framework that guides the health-care services to realize developmental goals.
NSQHS standards include: 1). Appropriate Governance to evaluate safety- and quality- in healthcare systems which comprises the quality-assurance framework for healthcare systems (NSQHS, 2012). 2). Adequate partnering with patients which includes the strategies to develop a person- centered healthcare system that comprises persons in framing the quality- healthcare. 3). Appropriate prevention with control of healthcare acquired infections that describes strategies to prevent infection in patients (in the healthcare system) and in managing infections appropriately to reduce its consequences (Duguid, 2011). 4). Drug safety which includes the strategies to analyze the appropriateness of physician’s prescription, administration or dispense of proper medicine to the patients. 5). Clear identification of patient and procedural matching which comprises of strategies to clearly identify the patient and match him/her with appropriate management. 6). Proper clinical handing-over which includes strategies to promote adequate communication between healthcare staffs during the patient’s transfer. 7). Blood- and blood- products that comprises strategies to promote safe, effective and appropriate administration of blood- and blood- products. 8). Prevent and treat pressure sore that includes measures to minimize the risk of developing pressure sores. 9). Recognize and respond to clinical emergencies in acute emergency healthcare centers (NSQHS, 2012). 10). Preventing patient falls as well as harm caused by falls by following strategies to minimize fall incidence.
Patient’s safety & Safety in healthcare
The patient forms the core element in a hospital/ community treatment. The entire health care organization strives to diagnose and treat the patients by varied levels of professions ranging from front-office, clinicians, nurses, radiologists, pharmacists to bottom- level workers. Patient’s safety directly reflects on the quality of an organization as patient’s safety is considered as basic patient’s need. Douglas (2012) states that health care which is rendered in a safe manner and within a safe environment is an essential need for a patient’s well-being. The term ‘Patient safety’ means ‘preventing any form of harm to the clients’. Preventing harm refers to keeping the clients free from any injuries as accidental or preventable injuries which occur due to any medical treatment (AHRQ, 2012). The harm may lead to temporary and/or permanent effect on the physical or emotional functions and bodily structure. Therefore, a quality health care system should minimize and/or prevent medical errors as patient falls, prescription errors, administrative errors, accidents, etc and learn from clinical-errors that has occurred and should develop a culture- of- safety in hospital by engaging all the health- team members, organizational managers along with patients. Most countries have started framing quality frameworks based on the report of IOM (2011) (AHRQ, 2017). The Australian Government has framed NSQHS standards to promote quality in its health care system. Thus, patient safety is the corner-stone of a higher quality health care.
The National health- performance committee of Australia has stated that the safety in health care system involves avoiding as well as reducing any acceptable limit of actual or potential risk/ harm from a health care organization or the hospital-internal environment, where the care is provided. The previous Australian’s council for safety- and quality- in healthcare has given that quality in healthcare is an extent to which the actual/ potential harm along with un- expected results are minimized and/or avoided (AIHW, 2017). Hence, patient’s safety and safety of any health care system is the basis for achieving quality in a healthcare system.
Clinical Leader’s role in Quality- Improvement
Quality improvement process is an organized process which involves periodic assessment and evaluation of the healthcare services provided to the patients to improve the healthcare practices (curative or preventive) as well as quality of patient’s care. As the primary responsibility of the clinical leaders are assessing and evaluating the patient care, the clinical leaders should be responsible for improvement of quality in healthcare. This is supported by Francis (2013) that establishing an appropriate clinical- leadership is most important to promote quality in a healthcare setting. Recent research studies states that inter-disciplinary team cooperation along with clinical- leadership is needed to enhance healthcare quality and client safety. A report suggests that ward- nurse manager positions should be re-evaluated and redesigned to promote them as efficient clinical leaders in the healthcare sector (Francis, 2013). This is also supported by a study which states that at-least 70% of the ward- nurse manager’s time should be utilized for clinical duties and remaining 30% should be spent for managerial and administrative functions.
One of the important elements of quality- improvement involves adequate monitoring of higher-risk, higher-volume and/or problem-related healthcare elements. The clinical leaders should understand these elements and methods to handle it (Desveaux, 2012). The main duty of clinical- leaders is to evaluate the healthcare service and involve all the healthcare team members in the reform process to promote quality improvement in healthcare setting (Daly, 2014, McNamara, 2011).
Parand (2014) states that the clinical- leaders should involve all the healthcare team members to enhance good integration and implementation of quality- based changes. Every clinical leader should pose personal qualities that reflect positive attitude towards healthcare profession; improves courage and solve quality healthcare issues (Jackson, 2013, Pepin, 2011). The clinical- leaders should have right combination of clinical-acumen with organizational awareness, build strong relationship with other healthcare team members, lead complex change, enhance inter-professional collaboration, inspire the team and support innovative ideas (Papa, 2013).
Clinical governance and Clinical leadership
Both clinical governance and clinical leadership are crucial for promoting quality in healthcare organizations. They should work under a common vision, mission, values and objectives to achieve quality goals. The clinical governance is nothing but the managing bodies of the organization as board directors, executive, clinicians, staff-nurses, etc who share their role responsibility in enhancing quality health care (Daly, 2014). They strive constantly to provide quality health care, reduce harms and enable environment of excellence to the patients. On the other hand, clinical leadership flows as hierarchy from clinicians, nurses to third level workers. Clinicians make primary decisions to evaluate the quality- of healthcare and also have technical knowledge to frame strategic plans for various healthcare delivery patterns (Daly, 2014).
Though both clinical governance and clinical leadership strives to achieve quality care and patient safety, clinical governance is a framework and process through which a healthcare organization drives continuous- quality improvement in all the aspects of healthcare. It engages clinical-leaders and team members in quality improvement programs whereas in clinical leadership, the clinical- leaders will direct and control the team members by their actions. The responsibility of the clinical governance bodies involves improving productivity, placing orders, maintaining stability and managing the organization based on the goals while the responsibility of the clinical- leaders involves framing innovative ideas, possessing role-model excellence with strong communication skills, ability to collaborate and provide best clinical-outcomes with health-team and clients (Fealy, 2011, Papa, 2013).
In clinical- governance, the managing bodies will coordinate the functions of all the employees from top-level to bottom level organization with a common goal of achieving quality excellence in the hospital whereas in clinical- leadership, the leaders will influence the team members to work under common quality goals. They will establish a common objective and will develop a hospital environment with professionals who can completely involve in attaining the organization’s mission. The leaders should assess, plan and evaluate the healthcare quality performance and working of quality team. In terms of quality, clinical-governance should develop and implement healthcare services which are designed to reduce clinical errors (Jeffs, 2012) whereas clinical-leaders should perform various functions that are associated with system performance, attaining health-reforming goals and  healthcare system efficiency (MacPhee, 2013).
AHRQ. (2012). Agency for Healthcare Research and Quality: U.S. Department of Health & Human Services. Retrieved from https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/understand/index.html
AHRQ. (2017). Leadership Role in Improving Safety: U.S. Department of Health & Human Services. Retrieved from https://psnet.ahrq.gov/primers/primer/32/organizational-leadership-and-its-role-in-improving-safetyAIHW. (2017). Safety and quality of health care: Australian Institute of Health and Welfare- Australian Government. Retrieved from https://www.aihw.gov.au/safety-and-quality-of-health-care/Daly, J et al. (2014). The importance of clinical leadership in the hospital setting: Journal of Healthcare Leadership. 6: 75-83. Retrieved from https://doi.org/10.2147/JHL.S46161
Desveaux, L et al. (2012). Exploring the concept of leadership from the perspective of physical therapists in Canada: Physiother Can. 64(4):367–375.
Douglas, C. (2012). Potter and Perry’s Fundamentals of Nursing- Australian version. Missouri: Elsevier
Duguid, M & Cruickshank, M. (2011). Antimicrobial Stewardship in Australian Hospitals. Sydney: ACSHQC
Fealy, G et al. (2011). Barriers to clinical leadership development: findings from a national survey: J Clin Nurs. 20:2023–2032.
Francis, R. (2013). Report of the Mid Staffordshire NHS Trust Public Inquiry-Executive Summary. London, UK: The Stationary Office. Retrieved from https://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdf
IOB-Institute of Medicine, (2011). Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing: The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
Jackson, D et al. (2013). Understanding avoidant leadership in health care: findings from a secondary analysis of two qualitative studies: J Nurs Manag. 21(3):572–580.
Jeffs, L. P., Lingard, L., Berta, W. & Baker, G. R. (2012). Catching and correcting near misses: the collective vigilance and individual accountability trade-off: Journal of Inter-professional Care. 26(2): 121-26.
MacPhee, M et al. (2013). Global health care leadership development: trends to consider: J Healthcare Leadership: 21–29.
McLaughlin, C.P. (2012). Implementing Continuous Quality Improvement in Health Care: A Global Casebook. Sudbury, MA: Jones and Bartlett learning
McNamara, M et al. (2011). Boundary matters: clinical leadership and the distinctive disciplinary contribution of nursing to multidisciplinary care: J Clin Nurs. 20(23–24):3502–3512.
NCCHC. (2017). Continuous quality improvement: National Commission on correctional Health care. https://www.ncchc.org/spotlight-on-the-standards-24-1
NSQHS. (2012). National Safety and Quality Health Service Standards: Australian’s Commission on Safety & Quality in health-care. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf
Papa, A. M. (2013). EMPSF: The Role of Nurse Leaders in Quality and Patient Safety: Patient safety and quality health care. Retrieved from https://www.psqh.com/analysis/the-role-of-nurse-leaders-in-quality-and-patient-safety/
Parand, A. (‎2014). The role of hospital managers in quality and patient safety. Retrieved from https://www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)
Pepin, J et al. (2013). A cognitive learning model of clinical nursing leadership: Nurse Educ Today. 31:268–273.

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