Quality in Healthcare- Why We need it ?

22 November, 2016

What do patients really expect from health care? People don’t want more care—they want right care. People don’t expect perfection, but they demand transparency. 

Plan, do check and act on two simple words,”Quality and Safety”, you will be successful. Quality is defined as “meeting or exceeding the needs and expectations of the customer”, while the quality health care means “doing the right thing at the right time in the right way for the right person by right person first time doing better next time and having the best results possible”. Quality week is celebrated throughout world from 7thNovember- 16th November to create quality awareness and encourage care providers and healthcare organizations to showcase the benefits of focusing on continuous improvement in quality healthcare. Of course safe health care system still remains the pain in neck and people of developing world so far haven't seen the real good solution to this burning issue and fear of Hospitals phobia is a reality. Nosocomephobia is the extreme fear of hospitals. “If I go to a hospital, I’m fairly sure I won’t come out of it alive” is quite well known fairly common phobia; many people (including vips) are known to suffer from it.

Reasons why hospital anxiety and surgery fear are so common. The standard of care required as safe, timely, appropriate continued, integrated, and coordinated is not available to all patients visiting the hospital. Despite claims of high per capita national health expenditures or Percent of national health expenditures for hospital care by state, medical errors continue to mar good professional and altruistic work of care providers and medical malpractice litigation is not uncommon among lawsuits. Not a day passes when some disturbing and egregious news of medical malpractice arising from alleged medical errors hit the media headlines. A medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment. As a general acceptance, a medical error occurs when a health care provider chose an inappropriate method of care or he health provider chose the right solution of care but executed it incorrectly. 

Globally, it is estimated that 142,000 people died in 2013 from adverse effects of medical treatment, a 2016 study of the number of deaths that were a result of medical error in the U.S. placed the yearly death rate in the U.S. alone at 251,454 deaths. Unarguably, health care is risk prone services with situation and settings vulnerable to hazards, errors and system failures where provision of care is provided at different levels in a physical environment populated with diversified human behaviors complexed with equipment, supplies, devices, and technologies. 

Factually errors occurring in health care are mostly preventable. However, in our part of world system of quality and safety has not received adequate attention. This inadequate attention partly may be due to tragic happenings around us. Patient safety is a global challenge that requires appropriate knowledge, skills and incorporating system of mistake proofing in multiple areas specially human factors and facility management system(FMS) and above all leadership commitments to improve value in healthcare. 

 

Sadly, the common initial reaction from leadership to many adverse events in past has been to find and blame someone. Generally speaking staff working in health care are considered among the most educated and dedicated workforce in any organization. Myself,being a proponent of zero tolerance to negligence in health care simply blaming an individual does not change these factors and the same error is likely to recur unless root causes are addressed or culture of safety is incorporated seriously in our system. The remedy is in changing systems of work. The remedy is in design. Where possible, physical design of mistake-proofing the system/design of health care structure and processes should be used to prevent error from being translated into injury by intelligent and imaginative use of additional cues that announce that an error has occurred and make it possible for the error to be picked and corrected before actual harm has been inflicted (near misses). 

To promote specific improvements in patient safety and highlight problematic areas in health care WHO recommended mandatory compliance for all healthcare organization on International Patient Safety Goals (IPSG) 1. Identify Patients Correctly 2. Improve Effective Communication 3. Improve the Safety of High-Alert Medications 4. Ensure Correct-Site, Correct-Procedure, Correct Patient Surgery 5. Reduce the Risk of Health Care-Associated Infections 6. Reduce the Risk of Patient Harm Resulting from Falls.Hospitals that used checklists to prevent errors involving surgical patients dramatically reduced both complications and in-hospital deaths and standard written checklists of time out and surgical site marking can reduce errors to one third. Also to enhance safety quality experts have enlisted the ESR-Essential National Requirements for Patient Safety is a list of national standards for hospitals. They are deemed to be basic conditions that must be fully observed to ensure patient safety and protection against healthcare related errors. To reduce the most feared hospital acquired infection the practice of using infection control bundles for - Catheter-associated urinary tract infections (CAUTIs) , Central line-associated blood stream infections (CLABSIs) Surgical site infections (SSIs),Ventilator-associated pneumonias (VAPs) along with other quality improvement initiatives on early elective deliveries (EEDs) , Injuries from falls and immobility, hospital-acquired pressure ulcers (HAPUs),preventable readmissions, Venous thromboembolisms (VTEs) prophylaxis ,ventilator-associated events (VAEs)and each checklist identifies the top 10 evidence based best practice protocols / interventions that health care organizations can implement to reduce harm prevents process breakdowns due to human or electro -mechanical factors.

Organizational culture is key to ensuring that staff feel supported and enabled to fulfill their role to their maximum potential, and are able to raise concerns where necessary. Teams should be well-structured, with supportive line management at every level of the organization.

Ensuring staff are able to speak up voluntary reporting errors, non conventional structure and processes  is fundamental to error prevention.To buy for OVA (observation occurrence ,variance )system at this juncture shall be too demanding . Things that physicians cant ignore are positive attitude, calmness, detailed explanations, education and friendliness are attributes of how a doctor should be.” To conceive, develop and implement ideas for promoting continuous quality improvements the role of the Accreditation certification in a world of modern safe medicine has gained momentum .Prevention and planning are essential to create a safe and supportive patient care facility let us initiate quality improvement initiatives by (FOCUS -PDCA )tools and introduce Quality departments to monitor whether or not departments and units comply to the quality system components. 

Dr Fiaz Fazili is a Surgeon; Consultant expert on Quality and Safety Management; and works on National (NABH) and International Accreditation (JCI) hospital improvement programmes.