Quality management: trinity mother frances hospital case study example

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Company Overview
Trinity Mothers Frances Hospitals and clinics include Mother Frances hospital-Jacksonville, Mother Frances hospital – Winnsboro, the Louis and Peaches Owen Hospital. They are affiliated with the health south, Tyler Care Hospital a facility that is a long-term acute care facility and trinity Clinic. It is preferred by multispecialty media groups as it has over 350 physicians and mid-level provider that represent 40 specialists in 36 locations that serve east Texas since March 1937. It is a 404-bed acute care facility that is located in Tyler, Texas. It offers a wide range of services; emergencies and trauma care, surgical and medical care. Tyler’s level II IA offers neonatal intensive care unit, maternal, childcare, and advanced neurosurgical, cardiac and orthopedics care. The Peaches Owen and Louis heart hospital opened in December 2012 in the heart region of East Texas. It builds along nearly 25 years of pioneering heart care for the East Texas region a new era that has improved cardiac care and patient safety. The hospital also offers a comprehensive program thus offering from diagnosis to recovery. Mother Frances Hospital Winnsboro is a critical center offering access to a range of medical services offered by primary care physicians and specialists and 24-hour emergency care center. Mother Frances hospital-Jacksonville is a critical center of access hospital including a state of the art Health center. It is the heart center and holds the cardiac and pulmonary rehab program. In Jacksonville, the women center is dedicated to caring properly for female patients. The women center offers digital mammography, bone, as well as, other surgical and diagnostic services. In this facility, patients have access to pain management and physical therapy facilities together with laboratory services and diagnostic imaging.

The Problem Statement

Total quality management entails the strategic activities aimed at implementing the awareness of quality by the management. Quality is a dynamic state that is linked with people, products, processes, services, and environment that meet or exceed their expectations. Hence, they help produce superior value and end product (Goetsch & Davis, 2010). Mother Frances Trinity is a chain of hospitals that faces some quality-related challenges that limit how the healthcare facilities can be highly reliable to its patients. Saxton, Hines, and Enriquez (2009) give depictions of how high functioning organizations stay safe. They display a collective mindfulness environment which all physicians look for while reporting small problems. That is precautionary before they face a substantial risk to the organization through handling of small and easy to fix issues. Such organizations have insignificant accidents happening within the organization. The most common cause of a safety problem facing the hospital relates to their failure of sensitivity to operations. Healthcare workers work under unsafe conditions, behaviors and practices. Unfortunately, more often fail in forwarding those problems to the attention of their management so that they can receive the problems and deal with them quickly. However, several factors contribute to this gap. Poor communication between the employees and management is a common condition in this healthcare facility. In addition, transitions from one care setting to another are common. The change carries a risk because of inaccurate and improper communication of crucial information of patients. The lack of recognition of unsafe conditions and practices gives enough reasons as to why such cases are not owned up and neither do they get reported. Furthermore, health workers are most commonly exposed to lots of intimidating behavior that suppresses them. The effect of this suppression manifests in their failure in reporting these problems of safety that they encounter. Nurses are commonly seen as the targets of intimidating and disrespectful behavior, unlike physicians.
Another challenge facing Mother Frances trinity facilities that is important to observe is its low reliability. The issue openly shows that hospitals cannot solve all those problems by redirecting higher practices at once. In this way, higher costs are incurred by the healthcare facility as the unreported behaviors calls for repeating or starting up the initial treatment process. Hence, a waste of resources and time that were scheduled for other duties within the healthcare facilities. It is most important to dissect the issue further to root out all the culprits that add to the quality management problem. As a matter of fact, it should be noted that inappropriate and unskilled personnel in the healthcare facilities also bring some of these extra costs about. As a result, these unreported cases may lead to more complications in patients and even deaths. Aside from the patient casualties, the hospital suffers in terms of revenue and overall company image.

Literature Review

Improved quality may lead to gaining more patients due to increased confidence, trust and customer relations. In so doing, there arises the need for higher and more effective methods of improving quality of products, personnel and services that will cater to the patients in the hospital. For instance, the drugs prescribed should be an area where the facilities can improve the quality of their components. Electro-system should be used for clarification before prescription or administration of any drugs. An extra advantage of electro- system is that they are more efficient in record keeping in case of future follow up and referencing.
Change is a strategic issue that every management must address. Change helps in dealing with quality. It thus shows how to improve the quality, regain control and how to ensure on time delivery of services. In this way, the whole system will improve its service delivery mechanisms and devices and a notable increase in productivity will get realized, as well as improvement in the return on assets and return on investments.
Quality management will ensure that the hospital will make keen follow ups on their clients and their progress until full recovery. In addition, in working with quality services it becomes easy to recognize and identify waste. That translates into high-unbudgeted costs that produce no corresponding benefit; the facilities will continue to hemorrhage funds and other resources. When these high-unbudgeted costs continue, they increase threat to the jobs of employees and the lives of patients.
The health care services are a continuous process in sustenance of human life. Therefore, there should be a keen eye to ensure things run as planned and all messes get undone and rectified to ensure the clients are well served and properly treated.
Firstly, the hospital should improve its quality. The quality of staff, services and products should be improved. In employing of staff, the hospital management should be strict and be able to get high-qualified personnel that can deliver quality and desired services (Leape, et al., 2012). In working with high and well-qualified personnel, the drugs administered and prescribed will face no doubt and will be of no harm to the patients.
Secondly, the hospital should work on eliminating the existing wastage. The staff should work within given schedules, and the working hours stipulated by the management. The excess products which turn to waste increase input costs as there are working financial budgets sales that are set within certain periods within the organization’s calendar. The management should stipulate penalties to these losses and wastages. The costs can be minimized upon close working gap. The principle should continually seek out and eliminate unsafe operating conditions and all practices in every aspect and process within the operations and in enhancing health and safety concerns, as well as, issues involving the environment.
Thirdly, the total costs should be reduced on the budgeting. That will help to give room for more upcoming costs that were not planned. In this way, the staff is limited to work within work frames and fixed schedules with no abrupt haste that may bring unnecessary additional costs. The staff, with time, will learn to perform any activity, or operation performed that helps them transform a product or the services offered from their raw state into their finished form as desired. All tasks will be completed right on time, and the products and services are delivered in conformance to specification. Consequently, the institute of medicine launched a concert in an effort to improve the quality of medical care. It defined it as the degree that health services for individuals and other populations increase due to the likelihood of positive health results and become consistent with professional knowledge. However, recent studies have proved widespread lack of quality healthcare, therefore putting the society into a great task of effectively implementing quality-improvement programs. Although the need for quality improvement is universal, achieving effective improvement in overall medical care is difficult as it is not well understood. In starting such a discussion, an appropriate framework is needed for undertaking this effort. Donabedian (2005) a pioneer in the field of healthcare quality, developed a basic framework about quality improvement efforts. Donabedian healthcare structural triad consist of a structure, process, and result. Although there is evidence based in quality improvement literature on process and outcomes, the reviewing of the structure attracts less attention (Donabedian, 2005). However, Donabedian strongly believed in the importance of healthcare structure as he views it as a driving force for care processes and health outcomes. His structure focused on physical structure and provider qualification and a modern accreditation. Due to the growth of organizational characteristics and behavior, the understanding of organizational characteristics and management capabilities driving quality improvement in healthcare areas remains undeveloped. From a management perspective, organizational attributes provide a definition of original classification. It will be an advantage that the healthcare facility would benefit from expanding the current structure interpretation to include broader perspectives attributes of the organization as determinants of the change process and quality improvement.
For several decades, there have been debates for hospital boards to be involved in the accountability of care delivered at their institutions. From the report by Kohn, Corrigan, and Donaldson (2000) the institute of medicine described patients’ safety as a major goal. Delivering high-quality care is being increasingly recognized as a responsibility of the hospitals. However, numerous barriers including poor communications, lack of knowledge among trustees, exchange of fragmented information, inadequate and disjointed structural committees have made efforts in improving quality difficult.
In relation to corporations, hospital boards are largely responsible for overseeing the financial budget. Quality improvement programs are costly; especially those using technologically sophisticated information management tools. Several studies in Texas providing an economic justification for quality management showed that they had higher productivity than their peers. There is no apparent evidence from the health sector demonstrating positive returns on investments of capital for quality- improvement efforts. Mismanagement of financial incentives creates a formidable barrier to the adoption of quality inventions. As a result, many hospital boards remain skeptical of the future for financial return from spending on quality improvement. Modifying the existing payment structures and policies may make a financial debate and disagreement of quality improvement more palatable.
However, due to the crises in the clinical quality, hospital boards should be more accountable for the quality at their institutions. Agendas should be prioritized, and sufficient resources committed for the implementation of quality improvement programs. Researchers have studied the impact of the culture of the organization on the quality in health care settings. However, there is little empirical evidence proving that there a link exists between organizational culture and performance.

Analysis

Quality has gained prominence as organizations and institutions have begun understanding the high-cost incurred due to poor quality. Quality affects all areas in an organization or institution and has high-cost implications. The most obvious consequence occurs in occurrence of poor quality services creating dissatisfaction in patients and later causes mistrust. Quality has other costs known as qualities control costs and quality failure costs. Prevention costs are all cost of preventing poor quality from occurring in health centers. The product and process are costs inclusive in the collection of information from patients in order to design processes that help in achieving conformance to specifications in the hospital. Training of medical staff in quality measurement is included as part of this cost. In addition to that, there is also the cost of records maintenance containing information and data that is related to quality.
Appraisal costs occur when defects get uncovered. These costs include product testing and performance to ensure quality standards are met. These costs include the worker time spent measuring quality and equipments costs that are used for quality appraisal. In addition, internal failures are associated with poor product quality that gets delivered to the patients. For instance, one example is rework. Working on patients and the services becomes unproductive. Hence, rework is needed to correct an earlier mistake; that is known as internal failure cost. External failure costs are majorly associated with quality problems happening to the customer/patient. These losses or costs can be of a negative impact because it may be hard to convince the patient hence difficult to regain their faith and loyalty.
On matters of sensitivity to operations, the healthcare facilities fail to train the staff on some of the protocols required from them as they carry out their duties. Each personnel has a role to play; from the lowest subordinate to the highest department head. They should function as one organism; such that work filters from one section to another seamlessly without any issues arising. The cause of this lag is the absence of synergy among the workers. They lack the cohesive training necessary to ensure they function as required.
Poor communication among the staff is a dangerous folly. The breakdown can result in a patient facing a life or death situation. Also, communication among the staff especially the low-level staff and the managerial staff ensures that the facilities operate efficiently. An open-door policy will encourage the staff to share their opinions and suggestions or complaints. Staff do not open up because they lack the training in how to approach and express themselves. The lack of effective communication allows problems to fester and issues to continue affecting performance of all personnel and safety of the patients.
Low-reliability is a systemic problem that requires keen assessment right from the onset of staff recruitment. Unskilled, unqualified or inappropriate staff injure the facilities and their service delivery. Staff should only occupy roles where they have the competency to match. The problem could be as a result of haste in recruitment or inadequate structures of recruitment that allow incompatible personnel to get positions.

Recommendations

In order to get zero patient harm, the hospital management must elevate quality and patient safety thus aiming to the highest strategic goal of the organization. Physicians are essential to the success of quality in health care. In order to move to high reliability, physicians must work on quality improvement within the hospitals. Both the formal and informal appointed leaders need to visualize and activate enthusiasm for quality. Thus, it includes physician leaders who are not employees of the hospital. The management of the hospital must choose a strategy to apply in order to attain the level of quality desired. The quality program and its measures put its focus on meeting the needs and addressing quality problems of the patients in the hospitals including the population of patients versus the assigned physicians. Other important accelerants that may serve to improve the quality include such as the use of financial rewards and staff advancements opportunities that are based on performance. It is the duty of leaders to employ the health information technology (IT) in service of improvement of quality.
In addition, giving lessons on management of resources and time in the health care services reduce extra-incurred costs that were not included in the financial budget. Boards of hospitals vary over a wide spectrum in their involvement in the quality of hospital programs that they oversee (Jha & Epstein, 2010). It is important that the management keep track of the staff working in the health care facility, as well as, their duties dedicated for each day as different sectors requires different knowledge and skills.

Reflections

In conclusion, achieving high-quality in health care requires hospitals to undergo substantial changes that take place in stages. When solving the laid out problems, there are steps that should be followed. Abrupt costs that have not been planned for may be hazardous in the successful running of the health care facility. The problem identified should be defined. The cause that brings about unexpected costing should also be defined. For instance, for the health care center handling high populations yet it has low personnel and physicians, may cause extra costs due to multitasking of the personnel as the duties assigned may be overloaded. However, work should be seen as part of logical framework (Chaudhry, et al., 2006). Further research and experience got from the practicability of this effectiveness, facilitates advancement of the hospital towards high reliability. To sum it up, policymakers and shareholders in different positions should evaluate how to support and withstand transformation.

TCO Linkage

Quality Mechanization
Performance Management
Empowerment
Process Control
Quality Strategies

References

Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W., Roth, E., Schekelle, P. G. (2006). Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annal of Internal Medicine, 144(10), 742-752.
Donabedian, A. (2005). Evaluating the quality of medical care. The Milbank Quarterly, 83(4), 691-729.
Goetsch, D. L., & Davis, S. B. (2010). Quality Management for Organizational Excellence: Introduction to Total Quality (7th ed.). Pearson.
Jha, A., & Epstein, A. (2010). Hospital Governance and the Quality of Care. Health Affairs, 29(1), 182–87.
Kohn L. T., Corrigan, J. M., & Donaldson, M. S. eds. (2000). To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press.
Leape, L. L., Shore, M. F., Dienstag, J. L., Mayer, R. J., Edgman-Levitan, S., Meyer, G. S, & Healy, G. B. (2012). Perspective: A Culture of Respect, Part I: The Nature and Causes of Disrespectful Behavior by Physicians. Academic Medicine, 87(7), 845–852.
Saxton, R., Hines, T., & Enriquez, M. (2009). The Negative Impact of Nurse-Physician Disruptive Behavior on Patient Safety: A Review of the Literature. Journal of Patient Safety, 5(3), 180–183.