Current Reviews in Musculoskeletal Medicine †MyAssignmenthelp.com

Question: Discuss about the Current Reviews in Musculoskeletal Medicine. Answer: Introduction Healthcare quality management is a critical factor that determines the patients clinical outcomes. The quality management and control is coupled with a number of issues that has both direct and indirect effect on the quality of healthcare. There are many different approaches that have been advanced to explain the healthcare quality management systems. One of the key quality issues in healthcare is the adverse event that also requires careful reporting and good environment to promote accountability. Another critical focus of the quality management within the healthcare system is clinical governance that plays an important in quality control. The following report explores the healthcare quality management and safety within the healthcare system. Deming quality approach is based on leadership management of healthcare setting and is almost similar to Juran approach to quality since Juran also focus on organizational structure especially on the leadership of healthcare. Ishikawa feature uses fishbone diagram to describe the cause of the problem in healthcare and these components of are inter-joined to form the fish skeleton. Ishikawa features include aspects such as leadership, policies and patient, and is compared Deming and Juran since Deming features includes leadership while Juran has an organizational approach (Walshe Boaden, 2006). Despite various similarities in features of these quality improvement theories, there are also various differences between these approaches. Deming mainly focuses on leadership as leading aspect of transforming healthcare system and this is also viewed as a management approach. Juran on the other hand, focus on healthcare organization structure as the main aspect of quality management and improvement. Ishikawa quality improvement approach differs with other quality approaches incorporates other aspects such as patient, processes, and policies (Petr Walter, 2009). The three quality approaches differ with traditional quality management and quality control approach that mainly look into performance and staffs in general. These approaches utilize leadership and organization approach to quality and others approach to focus on patient partnership or patient-centeredness as a way of improving the healthcare system. For instance, some of these approaches use patient partnership as opposed to product quality assessment that is commonly used within the industry to evaluate or monitor quality. Transparency is another approach to these quality management strategies that also differ from those of other industries that only focuses on output quality assessment procedures (Wolff Taylor, 2009). Toyota total production system (TPS) is a system that consists of two main pillars and these are continuous improvement and respect for people. The continuous improvement pillar is further divided into three namely; challenge, improvement, and Genchi Genbutsu (go and see for yourself). The second pillar (respect for people) is further divided into two and these are respect and teamwork. These quality pillars and elements are connected to each other forming a production system or line that is complex but highly managed (Jeffery, 2009). Key pillars that are used to monitor quality within the Toyota quality management system highly based on the foundation of teamwork. Teamwork and respect for people start with respect of team members who are within the similar line as customers. The main quality aspects involve monitoring any errors with products and any slight mistake is not passed to the next team member. This is critical to ensure that end customers do not receive products with a defect. The Toyota quality system assists those team members to raise alarm in case of any defect and the production is halted until the defect is corrected. This, therefore, ensures there are high accuracy and precision in assembling of products at Toyota (Hackman Wageman, 1995). One of the notable reasons for failure with the Toyota quality system that resulted in the recall of a number of Toyota products as noted by President Akio Toyoda is the change of traditional focus on quality. Change of focus by the company from quality priority has made the products that are produced by the company to have many defects leading to recalls. Secondly, another possible reason for quality issues that are witnessed in Toyota over the past few years includes faster production that is coupled with errors. This implies that over the past years Toyota has shifted its focus on high volume of production as compared to quality hence quality has been reduced. For instance, in 1998, Toyota's management set as their target 15% of the global market leading to faster production at the expense of quality (Jeffery, 2009). Healthcare quality refers to the value of the healthcare resources or services provided to patients or clients as measured using health care quality indicators. Healthcare quality in this sense represents a collection of all factors that are used to measure the value healthcare services offers within the healthcare system. Healthcare quality can traditionally measure in terms of performance of staffs based on the healthcare organizational structure set by the health management. The healthcare quality can also be determined based on the patient involvement in care and the healthcare patient outcomes (Chassin Loeb, 2011). Various authors of many healthcare quality management articles consider healthcare quality improvement an important aspect since it determines the quality of service provides to patients. Improving the quality of healthcare help in increasing the safety of patient hence healthcare system gain integrity. The necessary conditions for quality improvement include teamwork and multidisciplinary approach to healthcare, patient-centeredness, open and transparency, accountability and evidence-based practice in healthcare. Firstly, these authors indicate that teamwork and multidisciplinary approach to quality improvement in one condition that assists in raising harmony within work environment a precursor for quality healthcare service. Secondly, patient-centeredness care where the patient is involved in care increases the safety of patient hence high quality of healthcare service. Thirdly, open and transparent approach to healthcare also improves the ability of practitioners to share information with team members which are important for quality of health and low medical errors. Lastly, accountability is another quality improvement condition that applies the value of being accountable for ones action or decision (Krause Hidley, 2009). Adverse events include those untoward medical occurrences that are observed in patients due to administered medication or pharmaceutical products that may not be related to the medication. This implies that adverse event includes any unintended or unfavorable outcome signs, symptoms or diseases that may be associated with investigated medicinal or product administered to the patient. An adverse event can be classified as serious, life-threatening medically important or congenital depending on its most likely effect on the patient (Zhang, Pate Johnson 2008). The commonest types of adverse events According to Marjoua and Bozic (2012), some of the most common adverse events include drug complications, wound infections, technical complications and surgical operations complications. Operational complications account for more than 48% of all adverse events and this is due to surgical wound infections. Secondly, drug complications that result from administered drugs to patients. Wound infections is another adverse event mostly attributed to negligence and technical complication on the practitioners side. Most of the wound infections are associated with the surgical operation and the technically connected to the practice (Stevens, 2013a). I think there are variations across the studies since factors that were used to judge the adverse event also vary. Determination of negligence, for example, requires the establishment of technical complications that are also associated with those practices. Moreover, most of the causes of adverse events arise from more than a single source of complications. Wound infection can sometimes arise from both negligence and is also associated with surgical operational complications (Krause Hidley, 2009). Some of the adverse events are preventable while some of these adverse events are not preventable. Some of the operational complications are deemed preventable due to the nature of these adverse events. For instance, general management, postoperative care, administration of drugs and care at the time of discharge is some surgical procedure that results in adverse events though are preventable. For example, in the study by Neale, Woloshynowych, and Charles (2001) nearly 27% of adverse events are resulting from diagnosis errors. However, there are some other adverse effects that are not preventable such as postoperative complications among elderly patients and organ dysfunction resulting from past poor health conditions. Themes in the Bristol, Bundaberg and one other report Bristol Themes Description 1. Team conflict There was disagreement between surgeons, anesthetists, cardiologists, and managers that resulted in multiple surgical errors that were fatal to patients 2. Poor quality management There were clear quality management and improvement structure that help monitor and assess the quality of service within the healthcare 3. Lack of clinical governance The healthcare lacked clinical governance that could give direction and foster teamwork especially during surgeries Bundaberg 1. Lack of patients safety The healthcare does not care for the patient safety and many admitted patients were at 16% risk of an adverse event 1. Poor clinical governance Poor clinical governance that leads to frustration of healthcare practitioners 2. Poor medical error reporting Adverse event reporting did internally result in that attracted attention of politicians Many of the causal factors that resulted in the adverse event were classified as system issue or individual issues since most of these issues were either resulting from an error committed by an individual health practitioner or by the organizational system. For instance, in the case of Bristol poor clinical governance or lack of quality monitoring structure were causal factors and are purely systems and not the individual. Secondly, the case of Bundaberg involves both individual practitioner and clinical governance that is a system factor. Most of these casual factors are either system or individual factors are associated with either individual or healthcare system (Glickman, Baggett, Krubert, Peterson Schulman, 2007). Most of these hospitals were accredited yet the errors were not identified before accreditation since some of the quality improvement was either not developed at the time or those issues were not there at the time of accreditation. For instance, in the case of Bristol, most quality improvement and monitoring structures were either not developed or the healthcare transformation left quality management structures lacking within the healthcare system. Secondly, in the case of Bundaberg, most of the quality issues were not there at the time of accreditation and later management of quality dropped. Public inquiries are effective in achieving long-term quality improvement within the healthcare system despite some few weaknesses. Firstly, these public inquiries identify the underlying problems within the healthcare of both hospital and healthcare system in general. However, some of the public inquiries are triggered by politicians that bring interference with the hospital management for political reasons. For instance, inquiries into the Bundaberg hospital highly attracted the attention of politicians (Gauld Horsburgh, 2015). Blame free culture is a medical error reporting environment that eliminates blames when reporting errors that are done within the healthcare system. For a long time errors reporting has been difficult owing to the fear of victimization, blames and even suffers as result of reporting an error (Neale Woloshynowych et al, 2001). Therefore many health practitioners have been using words carefully developed to eliminate any blame on health practitioners through the practice has been associated with patient safety issues. Patient within this culture view medical practitioners as untrustworthy and with minimal care for the patient and this ensures that an accountability reporting of medical errors is encouraged among healthcare practitioners (Ker Ker, Edwards, Felix, Blackhall Roberts, 2010). Blame free culture focuses on preventing victimization of the employee while reducing the patient's safety as compared to just culture that balance between accountability and employee fair treatment. Just culture is medical error reporting practice where operators are unpunished for medical errors or decision that are commensurate with the medical experience and training, though where gross negligence is evidence, willful violations and destructive acts are not tolerated. Blame free culture, on the other hand, protect the practitioner from any blame associated with their error action or decisions (Al-Abri Al-Balushi, 2016). It is important to distinguish the two medical error reporting culture since they form part of patient's safety and accountability solution. Firstly, the distinction between blame-free culture and just culture is important since it touches on the healthcare quality and without proper understanding; the two medical environments remain unsafe for most patients. Secondly, an effort to establish accountability culture within the healthcare system, distinguishing the two sets an error reporting environment that has an effect on both healthcare practitioners and their clients. Thirdly, make a distinction between the two medical reporting cultures enable isolation of medical errors done with negligence from those errors done from errors that fallible humans make (Henneman, 2007). Berwick believes that traditional quality controls emphasize on rigid structural quality control measures as compared to the quality real issues of patient safety. Berwick indicates that nursing practitioners, for instance, focus on their own performance and communication as laid out within the traditional organizational structures (Varkey, Reller Resar, 2007). In addition, the traditional quality assurance discourages teamwork leading to blame culture when reporting medical errors or adverse events. Furthermore, traditional health quality management system does not address the preconditions for health quality such as patient safety rather than addressing organizational requirement and practitioners performance (Makary Daniel, 2016). Doctors are to be blamed under traditional quality management system for a number of reasons. Firstly, doctors do not freely share information about errors, hazards and adverse events. This is based on the cause of errors rather than blaming others on who caused the errors as traditional quality management systems work. Secondly, doctors are not open to patients reducing patient safety, especially where there are medical errors. This has adviser effect on the elimination of medical errors that are witnessed in many healthcare systems (Carroll Quijada, 2004). There are many different qualities activities that require open and just culture. Firstly, transparency with the healthcare that allows openly sharing of information is an important aspect of care is it allows practitioners to be accountable through just culture or open. Secondly, multidisciplinary teamwork approach is another healthcare quality improvement or quality management approach that also ensures there is open sharing of information, especially through error reporting. When reporting errors openly medical error are reported and shared without fear of victimization. Thirdly, patient-centered care where patients are partners in care and their decision is used to plan for their care. Involvement of patients in healthcare decisions ensures that there is no blame in case of medical errors (Chassin Loeb, 2011). Evidence-based healthcare is an important approach that works to effectiveness and efficiency in the healthcare services (Sandars Cook, 2007). Firstly, evidence-based practice presents research findings that are used in the treatment of patient thereby improving the quality of clinical patient outcome. This brings better patient experience and patient satisfaction with the services. Secondly, evidence-based practices enable clinical practitioners to apply evidence presented through studies and research finding thus improving healthcare clinical outcomes. Thirdly, evidence-based practice reduces the per capita cost of healthcare since evidence-based practice reduces treatment time and patient clinical time. Evidence-based practice increases client's satisfaction hence clients get value for their cost incurred during treatment (Provonost, Berenholtz, Goeschel, Needham Bryan et al. 2006). Evidence-based practice has some limitation and criticism that brings challenges on the implementation of the practice. Firstly, evidence-based practice suffers from lack of cultural and environmental support that enables implementation of the practice in some healthcare facilities. Secondly, studies show that many healthcare practitioners lack the necessary knowledge on the EBP that help in adoption of the practice in all healthcares (Stevens, 2013). Thirdly, there are many misconceptions about the implementation of EBP due to the time it takes to implement the practice. Fourthly, evidence-based practice is limited in some healthcare due to lack of resources to assist in the implementation of EBP. These resources include lack of budgetary allocation that advances the adoption and implementation of EBP in healthcare settings (Kane Mosser, 2006). Evidence-based practice though is one of the most important health practices that have the capacity to improve quality or effectiveness of clinical healthcare, EBP has some criticisms. Firstly, some of the critics are based on the popularity of EBP in the healthcare system of Australia as some argue that EBP is unpopular within the health system. Secondly, there is some argument that EBP lack advances educational backup that forms the basis of research in EBP making the practice lack credibility among healthcare practitioners. Thirdly, EBP is sometimes believed to use lower-level evidence that does not correspond to current research finding hence prone to errors when used in patients healthcare (Petr Walter, 2009). Domains of Quality Patient Centredness Patient-centered care is currently one of the quality improvement care practice that is coupled with numerous advantages (Cantiello, Panagiota, Shirley Sabiheen, 2016). Firstly, person-centered care approach applies comprehensive care that has the overall benefit of improving the client's clinical outcomes. Secondly, the involvement of patient into self-care has the direct benefit of assisting the patient to better manage their own health and this has an impact on patient wellness. Thirdly, empowering patient through their participation in self-care relieve patient off stress leading to improved health conditions. Fourthly, person-centered care approach appreciates the use of the available clinical resource in patient care (Beach, Saha Cooper, 2006). Some of the benefits of person-centered care for healthcare system or organizational level include improve communication between clinical health practitioners and patient, increase medical adherence, and recognize what is meaningful to the client (Chassin Loeb, 2013). Firstly, person-centered care improves patient-practitioner communication and coordination since the patient is involved in self-care and this has an impact on improves quality of health care. Secondly, person-centered care increase patients adherence to medication a strategy that streamlines patient-healthcare relation resulting in good healthcare outcomes. Adherence to medication is also part of health system requirement and person-centered care allows the use of client's wish to be incorporated into medication procedure. Thirdly, person-centered care allows incorporation of what is meaningful to the client into the decision-making process of the healthcare system (Cochrane, Panagiota, Shirley Sabiheen, 2017). Barriers to person-centered care approach Despite advantages of person-centered care approach to both patient and the healthcare organization, there are some berries to this healthcare practice. Firstly, lack of understanding of multidisciplinary or teamwork among healthcare practitioners and patients hinder applications of person-centered care within the healthcare system. Secondly, strict organizational structures and procedures or protocols restrict implementation of person-centered care approach in healthcare (Glickman et al., 2007). Thirdly, an individuals beliefs and cultural background can act as a barrier to adoption and implementation of person-centered care approach in healthcare. Fourthly, traditional clinical practices that attracted heavy structural development are also a barrier to implementation of person-centered care that requires doing away with these traditional clinical practices. Finally, development of structures and policies that encourage implementation of person-centered care within a healthcare orga nization has been a challenge preventing the adoption of this practice (Donaldson Fletcher, 2006). Clinical governance refers to incorporation both cooperate governance with hospital management to achieve better operations and management of healthcare organizations. This implies that clinical governance applies both professional approaches to quality management and clinical aspect of quality management in healthcare settings (Braithwaite Travaglia, 2008). I think clinical governance is context dependent on the aspect of clinical governance depends on the environment of the healthcare an strategic context. This context nature of the clinical governance allows the establishment of the risk associated and the level of acceptance of risk, management and control measures (Gauld Horsburgh, 2015). There are many barriers to change in clinical governance the organization needs to address. Some of these include lack of commitment, particularly in relation to the number of different organizations and bodies now involved in governance activities, the political environment, inadequate information and reporting systems; ineffective communication; and procedural issues such as timeliness of reporting, ambiguity of roles, and integration of the range of organizational systems (Amalberti, Auroy, Berwick Barach, 2005). I think some of the challenges in achieving changes in clinical governance include stiff organizational structures that need to be dealt with before changing the overall clinical governance. Secondly, many organizations are focusing on a traditional approach to governance at the expense of quality issues that are witnessed with the healthcare systems. Thirdly, external interference, especially from politicians, affects most clinical organizations and this acts as barriers to changing the clinical governance. In addition, lack of commitment to change this clinical governance is another factor that highly influences the changes in most clinical organizational management lack the goodwill to change the governance (Braithwaite Travaglia, 2008). Conclusion In conclusion, healthcare quality is an issue that not only affects the healthcare system but also affects the patients clinical outcomes. Healthcare quality lies on the foundation of the organizational structure, professional management, and ethical standards. In addition, healthcare quality management requires strong clinical governance that is coupled with good quality management strategies. Quality management strategies need to consider patients safety, transparency and open sharing of information, especially during adverse event reporting. Therefore, there is need to develop quality management systems that will ensure that all quality management conditions are put in place for the better healthcare quality and outcomes. Reference Al-Abri, R. Al-Balushi, A. (2016). Patient Satisfaction Survey as a Tool Towards Quality Improvement. Oman Medical Journal, 29 (1): 37. Amalberti, R., Auroy, Y., Berwick, D. Barach, P. (2005). Five System Barriers To Achieving Ultrasafe Health Care, Annals of Internal Medicine, 142, pp. 756 764. https://annals.org/aim/article/718374/five-system-barriers-achieving-ultrasafe-health-care Beach, M. C., Saha, S. Cooper, L. A. (2006). The Role And Relationship Of Cultural Competence And Patient-Centeredness In Health Care Quality, The Commonwealth Fund, No. 960 Executive Summary, pp. vi x https://www.commonwealthfund.org/usr_doc/Beach_rolerelationshipcultcomppatient-cent_960.pdf Braithwaite, J. Travaglia, J. F. (2008). An overview of clinical governance policies, practices, and initiatives', Australian Health Review, 32(1): 10-22. https://www.publish.csiro.au/?act=view_filefile_id=AH080010.pdf Chassin, M Loeb, J. (2013). High-Reliability Health Care: Getting There from Here, Milbank Quarterly, Sep, 91(3): 459490. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790522/ Cochrane, B. S. Mitch, H., Gino P., John A. K., Marshall, D. A., Brian N. Craig D. (2017). High reliability in healthcare: creating the culture and mindset for patient safety, Healthcare Management Forum, 30(2): 61-68. Carroll, J. S. Quijada, M. A. (2004). Redirecting traditional professional values to support safety: changing organizational culture in health care, Quality, and Safety in Health Care, 13, ii16 ii21. https://qshc.bmj.com/content/13/suppl_2/ii16.full.pdf Chassin, M.R. Loeb, J.M. (2011). The Ongoing Quality Improvement Journey: Next Stop, High Reliability. Health Affairs, 30 (4): 559568. Available at: https://content.healthaffairs.org/content/30/4/559 Cantiello, J., Panagiota, K., Shirley, M., Sabiheen A. (2016). The evolution of quality improvement in healthcare: patient-centered care and health information technology applications. Journal of Hospital Administration, 5 (2). doi:10.5430/jha.v5n2p62 Donaldson, L. J. Fletcher, M. G. (2006). The WHO World Alliance for Patient Safety: towards years of living less dangerously, Medical Journal of Australia, 184(10): S69 S72. Gauld, R. Horsburgh, S. (2015) Healthcare professionals perceptions of clinical governance implementation: a qualitative New Zealand study of 3205 open-ended survey comments, BMJ Open, https://bmjopen.bmj.com/content/bmjopen/5/1/e006157.full.pdf Glickman, S. W., Baggett, K. A., Krubert, C. G., Peterson, E. D. Schulman, K. A. (2007). Promoting quality: the health-care organization from a management perspective, International Journal for Quality in Health Care, 19(6): 341 348. Henneman, E. A. (1 October 2007). Unreported Errors in the Intensive Care Unit, A Case Study of the Way We Work. Critical Care Nurse, 27 (5): 2734. Available at: https://ccn.aacnjournals.org/cgi/content/full/27/5/27 Hackman, J. R. Wageman, R. (1995) Total Quality Management: Empirical, Conceptual, and Practical Issues, Administrative Science Quarterly, 40, pp. 309-342 https://www.jstor.org/stable/2393640 Jeffery, L. (2009). The Toyota Way, which describes the 14 principles of the Toyota management philosophy. You can read about these at https://strategy-insight.blogspot.com/2009/07/toyotas-14-principles-key-success.html (14 principles) and https://strategy-insight.blogspot.com/2009/08/toyota-way-2001.html Kane, R. L. Mosser, G. (2006). The challenge of explaining why quality improvement has not done better, International Journal of Quality in Health Care, 19(1): 8 10. Ker, K. Edwards, P.J., Felix, L.M., Blackhall, K. Roberts (2010). Caffeine for the prevention of injuries and errors in shift workers. The Cochrane Database of Systematic Reviews (5): CD008508. doi:10.1002/14651858.CD008508 Krause, T. R. Hidley, J. H. (2009). Taking the Lead in Patient safety, How Health Care Leaders Influence Behaviour and Create Culture, Hoboken, New Jersey: John Wiley Sons. Makary, D. Daniel, M. (2016). Medical errorthe third leading cause of death in the US. BMJ. Available at: https://www.bmj.com/content/353/bmj.i2139 Marjoua, Y. Bozic, K.J. (2012). A brief history of the quality movement in US healthcare. Current Reviews in Musculoskeletal Medicine, 5 (4): 265273. doi:10.1007/s12178-012-9137-8 Neale, G.; Woloshynowych, M. Vincent, C. (July 2001). Exploring the causes of adverse events in NHS hospital practice. Journal of the Royal Society of Medicine, 94 (7): 32230. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1281594 Petr, C. J. Walter, U. M. (2009). Evidence-based practice: a critical reflection, European Journal of Social Work, 12(2): 221-232. Provonost, P. J., Berenholtz C.A. Goeschel D.M. Needham, J. Bryan S.D.A., Thompson L.H. Lubomski J.A. Marsteller M.A. Hunt E. (2006). Creating High Reliability in Health Care Organizations, Health Services Research, 41 (4): 1599 1617. Sandars, J. Cook, G. (Eds) (2007). ABC of Patient Safety, Oxford: Blackwell Publishing. Stevens, K (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas, The Online Journal of Issues in Nursing, Vol. 18, No. 2. https://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice Stevens, K. (2013a). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas, The Online Journal of Issues in Nursing, 18(2). https://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice Varkey, P., Reller, M. K. Resar, R. K. ( 2007). Basic Quality Improvement in Health Care, Mayo Clinic Proceedings, 82(6): 735 739. Walshe, K. Boaden, R. (Eds) (2006). Patient Safety, Research into Practice, Maidenhead, Berkshire: Open University Press. Wolff, A. Taylor, S. (2009). Enhancing Patient Care, A Practical Guide to Improving Quality and Safety in Hospitals, Sydney: MJA Books. Zhang, J.; Pate, V.L. Johnson T.R. (2008). Medical error: Is the solution medical or cognitive? Journal of the American Medical Informatics Association, 6 (Supp1): 7577. doi:10.1197/jamia.M1232