Question

Please give feedback on the following:

The current state of healthcare quality has improved drastically since a focus on healthcare quality was put in place in the late 80’s through the 90’s. It’s a little hard to believe that there was a large focus on manufacturing quality and improvement but healthcare quality, for the most part, was not monitored in any way. When the American College of Surgeons was founded in 1913, their major focus was on the quality of medical education and then the quality of facilities. They didn’t focus on the quality of actual care being provided. The implementation of the Malcolm Baldridge National Quality Improvement Act, which created the Baldridge National Quality Award which eventually included healthcare as a category was a good starting point for healthcare organizations and accrediting bodies to use for standards.

The handoff from the ACS to the Joint Commission in the created better oversight of healthcare quality by creating accreditation standards. These standards were also used as an example by the Medicare health program.   In the 1980’s the Joint Commission started requiring organizations to implement quality assurance. There are now many accrediting bodies which require quality improvement. Overall there are many accrediting bodies which could seem fragmented, but it makes sense to have accrediting bodies that specialize in certain healthcare categories/specialties. All of these requirements will help force better quality care for patients. I imagine since our text was written in 2013, healthcare quality and improvement has continued getting better with more oversight, ideas and methods. Quality improvement is happening constantly where I work. It is a huge focus of the institution and a big focus for our resident and fellow trainees. The Accreditation Counsil for Graduate Medical Education (ACGME) requires that trainees must receive training and experience in quality improvement. (ACGME, 2020)

I don’t work in a position where the patient is my direct stakeholder. My stakeholders are the residents and fellows who are doctors training for specialties and subspecialties. I look at quality from a behind the scenes view. Am I providing them, within my capacity, with what they need to provide quality care to the patients? We recently just had two weeks of orientations. One in June for new residents and one in July for new fellows. There is a TON of information about the institution, about Graduate Medical Education at our institution, about rules, about resources as well as Personal Protective Equipment training and life support training for their certifications. The weeks were a blur to me, so I imagine it’s the same for them. These two chapters have me thinking about orientation, which was flipped upside down this year due to COVID and needed to be mostly virtual, and how we could make improvements to make sure they were able to get what they need, have time to soak in what they needed, and ensure they have the resources available going forward so they can hit the ground running. We know the information we throw at them isn’t what they came here to do. They want to help patients but it’s our job to ensure they know/get everything they need. After each orientation we have a survey, to see how orientation went and where we can make improvements. We have a core team of GME staff who plan and run orientation along with a couple Program Coordinators from the residencies and fellowships, however, a piece from chapter 2 caught my attention and it seems like a no brainer. It was talking about Kaoru Ishikawa and said that he was one of the first to stress a bottom-up method by including all members of the organization instead of just leadership. I think the evaluations we receive after orientation will be helpful but it would also be a great idea to bring in some residents and fellows to get their opinions after we determine that orientation might look like next year since we are planning on potentially having to keep a virtual format or at least a mix of virtual and in person.

I believe it is very important to include all types of stakeholders when making decisions on process improvements. In healthcare there are many patient advisory boards who take part in various decision making processes. Healthcare employees of various levels should also be included if it seems appropriate for the quality improvement task.

Answer 1

The above article is fine, except there can be certain improvements done to increase the impact of it. The focus of the article is the healthcare industry, how it has improved and how it progresses to improve. When quality and improvements are seen improvement tools and techniques used such as Six Sigma and Lean Management need to be explained as well. These have contributed well towards improving quality of service in the healthcare industry.

Also, you could describe the role healthcare experts have played in today's pandemic COVID-19, as compared to the earlier pandemic Spanish Flu, 1918-20. The difference between then and now healthcare systems and it's effectiveness in combating the pandemic. Further, you may also focus on how IT is being used by healthcare professionals to bridge the gaps created due to the social distancing norms and how trainings are being imparted through online medium.