Organisational Management in Health Care

Abstract

This paper is about organizational management in health care. Health care organizations are just like other organizations and their management is not different from others as well. The only difference exists between strategies and aims. Health care organizations aim at patient satisfaction while other organizations aim at customer satisfaction based on the services provided or products sold. Below is a description of a management process that helps health care organizations achieve their goals as well as improve quality.

The first section of this paper is an introduction to health care organizations, good management, and good governance. This is then related to the importance of quality improvement as a management process. A brief description of quality improvement has been given which is then followed by Quality Improvement frameworks. Two models have been used in this area to describe the process of quality improvement which are; the Plan-Do-Study-Act Cycle Model and the Data Decision Cycle. The last section of the paper is an analysis of the process followed by a conclusion about the process, its role, and all the sections that it improves.

Introduction

As part of good governance, hospitals and other health care service agencies must be effective. This means that they have to provide the right services at the right time and at the right places considering the costs at which the services are provided. The costs must be affordable to the people being offered the services (Taylor, 2000). Good governance means meeting the strategies’ objectives.

Management processes have aims and these aims all lead to the provision of health care services and meeting goals of management strategies. These services can never remain the same with the changing world that is globalization/postmodernism, the changing patient needs, emergence of new diseases, development of new health care services and so many other experiences in the health care industry (Barrett, 1993).

The institutions have to ensure they stay in touch with the new technology which also helps solve new disease problems, stay in touch with patient requirements and new management practices. This calls for continuous improvement which leads to improved quality in the health care sector. Continuous quality improvement is a process that the management team has to develop based on the areas that require improvements in the hospital or the health care agencies.

Additionally, self-improvement is another principle of good governance. Taylor notes that for health care agencies to maintain total quality management, the agencies and institutions have to ensure continuous improvement in every section of the hospital management (2000). Improving means a lot to a health care agency or institution. There are so many departments, processes, types of equipment, and many others that need improvement which have to be done through some management process (Taylor, 2000). The quality improvement process has to have a model or framework which guides the organization’s management quality improvement team on how to achieve improvement in different sections.

The Concept of Quality improvement

Quality improvement is a method used by any organization’s management to improve the effectiveness, reliability, and efficiency of public health practices and processes. The method considers all the systems in the organization and makes use of data to ensure its objectives are met. This means that quality improvement is multidisciplinary (McLaughlin & Kaluzny, 2005). According to Bate, Mendel, and Robert, a quality improvement process incorporates both the technical and social systems of the organization ensuring improvement in all these sections that are important in the provision of health care services, efficiency, and effectiveness (101-104).

To achieve quality improvement, a model, design or strategy has to be defined by a health care organization. This is the reason why there are so many models and designs of quality improvement but all aim at the same goal as described above. This process continues to gain force due to competition for market share in the health care industry and continuous health care reforms, which challenge health care managers and providers to react quickly to the changing payers, regulations, and markets (Barrett, 1993).

With the continuous need to make improvements in the health care agencies, the Continuous Quality Improvement (CQI) process emerges. This involves a cross-disciplinary team such as managers and employees involved in the collection and analysis of process data. The teams decide on the data to be collected, analyze the data and decide on appropriate actions to bring about improvements. The scope of data in this process is very broad and includes administrative and clinical obtained from different sources both internally and externally (McLaughlin & Kaluzny, 2005).

Health care institutions have so many areas to improve for example the emergency room which also has so many divisions. A quality improvement process can be commissioned on chest patients in the emergency room only. This kind of process will evaluate the patients by collecting information from patients, suppliers of diagnostic and medical types of equipment, from current medical literature, from financial, scheduling, and demographic information data systems, patient data charts, direct observation and so many other sources (McLaughlin & Kaluzny, 2005).

Coleman also notes that QI has a strong focus on customers of an organization in which case health care customers would-be patients. It utilizes team knowledge and data to improve decision making, involves the entire organization, and continually improves all processes of an organization (Coleman, 1999).

Quality Improvement Frameworks

This process uses different models or frameworks such as the Plan-Do-Study-Act model (Coleman, 1999), the Data-to-Decision Cycle framework (McLaughlin & Kaluzny, 2005), the model that uses the socio-technical system of the organization (Bate et al, 2006) and so many others to achieve its aims. All these follow the principles previously mentioned to ensure improvement in targeted sections of the health care institution.

QI models require the identification of aims of improvement, changes to be made, and criteria for improvement evaluation (Coleman, 1999). After the identification of such factors, an appropriate model can then be used. In this paper, two models of QI will be described showing how improvements can be achieved through them than an explanation of their importance in the health care organization given.

The Plan-Do-Study-Act Cycle Model

This cycle begins with planning which requires identification of areas that need improvement, identification of requirements for improving, and making an improvement plan. Just like in most organizational plans, this plan requires risk management. Improvement means better performance than the previous, better efficiency than the previous, and a better reliable system. Achieving such means elimination of any risks that can be a threat to the implementation of projects that lead to improvement.

Improvements are achieved through so many ways after the identification of areas of improvement. If for example, a hospital needs to improve the services offered in the midwifery section, the improvement team will collect and analyze information and decide on the appropriate steps to make. A step can be a project that will result in a better section than before. Projects can not be implemented without risk analysis. Any improvement plan, therefore, requires risk analysis (Plan Do Study Act Approach, 2007).

After a plan is developed, the team can implement the actions decided on a small basis to determine if it will be effective or not. The next step is studying the effects of the change plan. This can be achieved through other systems especially performance measurement systems apart from just studying the effects. If the plan and action are effective in creating the change needed, the quality improvement team can then act by implementing the plan on a large scale. The performance of this plan on large scale is also assessed to find out its effectiveness of which another is recommended if the first does not work as required (How to Improve). The last step in quality improvement leads to the first step of quality improvement.

The Data Decision Cycle

This Cycle gives the quality improvement team the framework for understanding how organization performance can be improved through technology and information management (McLaughlin & Kaluzny, 2005). The framework describes how information is obtained from data and how the information is transformed into knowledge which is very important in decision making. Decision-making is very important in the improvement process.

According to the above principles of quality improvement, the process should involve the collection of data for decision making hence making improvements. Data is collected from so many sources. According to this framework, data collection is specified as ideal only when it is alongside routine health care delivery of services. The data to be collected is also dependent on the quality improvement decisions made.

The first step is to collect data concerning costs, satisfaction, and quality for key care processes. The data collected provides information about financial and clinical practices and processes which is analyzed to provide answers on how improvement can be made. It is from this information that opportunities are selected. This phase is that where the data have been made meaningful.

The next phase of the cycle is knowledge. The model illustrates that when information has been gained and can be used to predict the future performance of the organization or can be utilized to change the future performance of the organization, then the organization and the employees have got the knowledge to improve the performance of the organization. Information is transformed into knowledge through intervention techniques such as statistical analysis that help make decisions (McLaughlin & Kaluzny, 2005).

After obtaining knowledge, analyzing, and making decisions, the next step is action. Assessment is done after the implementation of the decisions to determine the effectiveness of the decision made. If no improvements are realized after this process, it begins afresh.

The Role of QI in Health Care Organisations

Quality Improvement helps in the achievement of health care organizational goals in so many ways. One main aim for almost all health care organizations is patient satisfaction. This is achieved through so many ways of organizational management but quality improvement also helps the organization achieve such an aim. In the current world, new technology has led to the use of new machines, new diagnostic techniques, new drugs, and new diagnostic types of equipment. These new developments have been produced out of research that has found them more efficient than the previous techniques, types of equipment, drugs, and so on. If an organization does not implement a system that can make it continuously improve and have such new developments, patient satisfaction cannot be achieved (Robbins and Barnwell, 2006). Patients have also become aware of the new developments and would like the best out of health care service delivery.

Additionally, patients would not be satisfied by congested ward rooms, long queues, and poor emergency service provision due to lack of improvements. Quality improvements eliminate inefficiency, ineffectiveness improves processes, promote reliability in hospital/healthcare management, and boost everyone’s satisfaction (Coleman, 1999). Coleman notes that quality improvement is a framework to achieving health care organizational effectiveness, efficiency, and competitive advantage maintenance (1999).

Through the above-described models and many others, the organization’s strategies can be managed. Efficiency and effectiveness are not only achieved in processes and types of equipment and techniques but it is also achieved in most management techniques (Hillyer, 2001). Management strategies are ways of achieving organizational aims. The strategies have to use the resources available in the organizations. Resources range from human resources to technical systems and other sub-strategies used to achieve the aim of the main organizational strategies. An example of a sub-strategy that can be used to achieve the main organizational aim is knowledge management.

For organizations to stay competitive in the market, they have to develop strategies to remain in the market. Healthcare organizations as indicated earlier are included. Organizations have to keep up with the changes in the health care industry. The quality improvement process helps in continuous organizational knowledge management as opportunities are continuously identified through the process and improvements are made (Rossi, 2003). Knowledge management is a very important strategy in maintaining a competitive advantage in the health care industry (Robbins & Barnwell, 2006). By maintaining a competitive advantage it means the organization has achieved one of its important goals. The above Data Decision Cycle has illustrated how knowledge management is improved.

Quality improvements also play a very important role in organizational performance. Performance can be measured considering the whole organization or considering specific programs, departments, or health care services. Quality improvement can be used to improve the overall performance of an organization or the performance of specific departments, services, programs, and many others.

Just as described above, the process of quality improvement identifies the areas that require improvement, identifies the resources necessary to make such improvements, plans on how the improvements can be achieved, implements and evaluates the performance of the process. Continuous identification of areas that need improvement in healthcare improves the performance of the organization (Robbins & Barnwell, 2006). Both models described above describe how improved performance can be achieved.

Quality improvement can also be used to improve the culture of an organization. Culture affects so many dimensions of an organization for example learning, job satisfaction, attention to the error, and the overall quality performance of the organization. With improved culture, so many dimensions of the organization are improved (Boan & Funderburk, 2003).

Conclusion

Quality improvement is the process of identifying areas that need to be improved in any organization and making such improvements to ensure quality. It, therefore, leads to quality management both at the departmental levels and the whole organization. It leads to quality service provision, quality organizational culture, and quality performance.

Different organizations have different ways of achieving quality improvement. This mainly depends on the available resources and the managers responsible for selecting the model to use for quality improvement. The models can also depend on what is to be improved and the scale of improvement required. This process however has one aim which is to achieve improvement in the organization and the basic model has the following principles;

  • Identification of the areas that need improvement in the organization
  • Identification of the resources needed to achieve the quality improvement
  • Development of the objectives to achieve quality
  • Planning on how to achieve the quality improvement
  • Implementation of the process
  • Evaluation of the process

Due to the changing processes of organizations, the emergence of new technologies, changing patient needs, and several other changes in health care organizational management, health care organizations need a way of operating in such changing environments to ensure continued efficiency, effectiveness, reliability, and quality. The quality improvement process provides the solution to such a challenge apart from other organizational management processes and change management. It is therefore a very important process in health care management.

Reference List

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Bate, P., Mendel, P. and Robert, G. (2006). Organizing for Quality: The Improvement Journeys of Leading Hospitals in Europe and United States. The Nuffield Trust for Research and Policy Studies in Health Services.

Boan, D. and Funderburk, F. (2003). Healthcare Quality Improvement and Organisational Culture. DELMARVA Foundation. Web.

Coleman, T. M. (1999). Quality Improvement: First Steps. American Academy of Family Physicians. Web.

Hillyer, C. D. (2001). Handbook of Transfusion Medicine. London, UK: Routledge.

Institute for Health Care. (2009). How to Improve: Improvement Methods.

McLaughlin, P. C & Kaluzny, A. D. (2005). Continuous Quality Improvement in Health Care. (3rd Ed.) California: Jones & Bartlett Publishers.

Plan Do Study Act Approach. (2007). NH Public Health Improvement Team Worksheet.

Adapted from Materials from the North Carolina Department of Environment and Natural Resources. Web.

Robbins, P. S. & Barnwell, N. (2006). Organisation Theory: Concepts and Cases. (5th Ed.). NSW, Australia: Pearson Education Australia.

Rossi, P. (2003). Case Management in Health Care. (2nd Ed.). New York: Elsevier Health Sciences.

Taylor, W. D. (2000). Facts, Myths and Monsters: Understanding the Principles of Good Governance. International Journal of Public Sector Management, 13, (2), 108-124.