Quality and Risk Management in Healthcare: Principles, Tools and Best Practices

In this document we will discuss about Quality and Risk Management in Healthcare and below are the summary points of this document:- The assignment aims to provide a better understanding of the quality project within the healthcare organization. The role of management is important in delivering quality services and products in healthcare. Quality improvement projects are becoming more systematic, with the involvement of patients and various organizations for development of healthcare quality.

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Overview
It is required by the clinicians and managers in the context of making decisions in the healthcare
industry to be aware about the ever-changing landscape of healthcare for the purpose of ensuring
quality care to patients. The main aim of this assignment is to bring a better understanding
regarding the quality project within the organization. Five answers will be given in this
assignment in order to elaborate the quality measure; the principles that are essential for
promoting quality of care, the discussion will be made on the risk management and detailed note
on quality improvement tools in health care.

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Answer 1
The quality is the concept that keeps significant value in the healthcare sector in comparison of
any other sectors. The philosophy, methodologies and practices are represented by the quality.
On the basis of the comment, it can be said that the role of management at individual and
company level is most important at the time of delivering the quality of services and products.
The scope of healthcare industry in last decades was not proper as there were number of people
who were not aware regarding the quality of healthcare. The industry of healthcare is most
effective sectors of the country. As per CDC statistics, 600,000 people in US affected from heart
disease and die every year. It has been analyzed that the cost of the healthcare in US was $3
trillion in 2014, which equivalent to 20% of the GDP. The demographics have been evolved and
chronic illnesses become out of controllable, these statistics are anticipated to top $4.3 trillion
(Harrison, 2018). This is the reason the highlight on healthcare and defensive medicine is
attaining popularity. It is necessary for people to look themselves in an effective manner as it
would be helpful to them to fewer falls ill, and they hence place fewer burdens on the healthcare
system. It is the major reason behind sponsorship by the governments to the health awareness
campaigns.
The role of the quality in the healthcare is not what it was ten years ago. Patients are now
become more advanced with the help of the technology. They can fetch information about any
healthcare and disease and take online support from doctors or specialists. The quality
improvement projects are starting to report to high authority in order to make systematic process.
Quality of care and developed health system process are the heart of these reports which have
become the major reason behind involvement of the patient in the quality of care (Nicolay, et. al.,

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2012). There are number of private as well as public hospitals that are working together in order
to improve quality of healthcare. Various organizations like the National Committee for Quality
Assurance (NCQA), the Institute for Health Care Improvement, TJC and many others help in the
development of quality of care and services in the healthcare industry. There are many medical
associations of medical specialists within the healthcare form quality development by focusing
on setting various standards and provide treatment recommendations in order to treat patients in
an effective manner. Along with that they provide benchmarking, and healthcare companies can
look data to understand the quality development efforts (Kaplan, et. al., 2010).
In present era, public has become aware about the quality in healthcare as they get knowledge by
using latest technologies. There are various sites available on internet that give proper and core
detail regarding specific diseases and their solution. From symptoms of disease to the resolution
of the disease, people have become aware and take initiative in starting to understand medical
term. Patient inclusion is the major aspect for all healthcare organizations- especially in forming
and suggesting healthcare solutions. There are some methods for quality improvement such as
ISO, Six Sigma, Lean manufacturing and Malcolm Baldrige National Quality Award that have
developed in the form of principle in the quality systems (Fan, E., Laupacis, Pronovost, Guyatt
and Needham, 2010). People have become aware about this method as well as it helps in
improving the quality of the healthcare system.

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Answer 2:
A quality measure is considered as the quantification of the extent to which required health care
process is attained or the level that a desirable structure to sustain health care delivery is in place
(Margalit, et. al., 2009). As per Institute of Medicine (IOM) report, the main reasons behind
faulty reports are faulty systems and processes, not a person. There are descriptions of principles
that are essential for promoting quality of care.
Principles essential for promoting quality of care
 Focus on improved quality of care
Improvement in patient care has become the precedence for all kind of providers of health care
with the entire aim of attaining a high level of patient satisfaction. There are so many factors that
contribute in bringing change within the healthcare such as increasing demand for better care,
increase in medical malpractice proceedings and apprehensions regarding poor results are
aspects that put in to this amendment. It is the major principle which represents the quality of
care to decide the quality of training, infrastructure and effectiveness of functioning systems.
There should be patient centric approach in the healthcare system to implement the function
(Cornwell and Goodrich, 2009).
 Support the physician-patient relationship
The first responsibility of the physician is to take care of his patients. It is the responsibility of
the physician is to offer sympathetic and competent careful care by taking consideration of the
acceptable medical standards and to make handling decisions that are in the favour of the patient
(North Carolina, 2016). The role of the mutual trust is significant in the physician-patient

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relationship and it can be maintained and handled by taking consideration of below mentioned
points:
 Timely report to the patient regarding all significant findings
 Confidentiality in the context of personal information of the patient
 Maintenance by physician in professional knowledge and competencies
 Respect for the autonomy of the patient
 Use evidence-based clinical guidelines
Clinical practice guidelines have been a well-known part of clinical practice for many years. The
clinical guidelines are majorly enhanced statements framed to facilitate practitioners and
administrators make resolution regarding appropriate health care in the context of main
circumstances (Qaseem, et. al., 2019). The role of the evidence based clinical guidelines is huge
in the clinics as it helps in giving the summary of the applicable medical literature and provide
help in making decisions which indicative tests to order, the right time to discharge patients from
the hospitals and many other necessary aspects of clinical practice.
 Use reliable, accurate, and scientifically valid data
The reasons behind faulty reports are improper system and processes which should be taken into
cosndieration by the health care system on prior basis. Use reliable and scientifically valid data is
the principle that refers to the consistence of a measure. There are three types of consistency
such as over time, across time and across different researcher. While providing the data of the

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patient to the top management and at the time of providing a report to the patient as well,
accuracy should be there.
 Provide positive physician incentives
Positive physician incentives plan in the healthcare motivates people to perform in a well
efficient manner without making any mistakes. Incentives helps people to remain to motivate the
most cost efficiency and clinically effective care and it is necessary to understand by providers to
a varying combination of controls and incentives, entailing capitates payment and use of
management. Physicians have been depicted to changing combinations of controls and
incentives, including profiling bonuses and quality assurance. There is a number of physicians
are dejected with the development of these arranged care innovations and how they can influence
status and income to follow their best-qualified judgment.
Focus on the use of data
The main process of organization is the medical decision-making approach. The decision of the
organization has been made that influence what shows to be an independent clinical judgment
developed by the trained professional. The collected data should be focused by the professionals
as both qualitative and quantitative data are vital to assess the growth of improvement in the
quality and give guidance for initiative modification. The process of recording the data and
developing files for the patient should be done by taking consideration of the proper process. A
well-appropriate quality development program includes a “systematic activities that are
developed and executed by the company to assess and monitor for the purpose of improving
healthcare. The main aim of the quality improvement program is to look forward to constant
development in the care provided to the patients (Goetsch and Davis, 2014).

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It has apparent from the above principles that the concept of the patient centered care is
considered as one of the evolving roles of the patient. The healthcare environment of today’s
world diverts the mind of the stakeholders that are looking beyond measuring the quality of the
patient experience and endorsing activities for making better care of improvement. Patient-
centered care can involve the engagement with the patient, commencement for self-care and
shared decision developing around the decisions of the suitable course of disease management.

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Answer 3
As per European Commission (2010), respondents were asked to analyze the entire quality of
healthcare in their country. While an average of 70% of people handles quality of healthcare
given in their country as better, noteworthy differences are taken into consideration among
respondents 86.5% of respondents from Saudi Arabia believe the quality of healthcare in their
country as good, pursuing by respondents in Austria i.e. 95% and Finland i.e. 91%. It has been
found that Italy is the country that is selected for the form of redress as this country is followed
by Sweden around Greece around 48% and Cyprus around 49%. It has been identified that the
last form of redress, an apology from the liable responsible individual or healthcare facility opts
most recently in Ireland (46%), Netherlands (44%) and Slovenia (50%). In the context of
unawareness of own country is 5% at the EU level, but, this range is obviously upper level in
several of the polled countries. There are various people in Bulgaria who has no knowledge
where to go for these matters with 13% of respondents in Romania and Estonia, 10% in Ireland
and 11% in Portugal being in the same position.

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Figure: forms of redress
Source: http://ec.europa.eu/commfrontoffice/publicopinion/archives/ebs/ebs_327_en.pdf
Redress available in another member state
The attitude of Italians is entirely different from each other as they go against this trend by
opting action taken against the liable healthcare facility most frequently. It shall be focused that
since there are many respondents who are not aware of what forms of redress are ready in
another Member state. It has been found that there are few people they would assume to be able
to seek to facilitate from a lawyer if they were hampered at the time of taking services of
healthcare in their own country (European Commission, 2010). Nearly 32% of respondents have
belief that the liability for patient safety in their country remains with their ministry of health or
concerned national authority department. Along with 27% has a belief that the liability remains
with the clinics, hospitals and doctors. On the other hand, the level of the respondents for another

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kind of authority is considerably low such as national government, insurance companies and
regional authorities. Although, depth detail on this matter is entirely missing as most of the
respondents are unaware of what kind of organizations are liable for patient safety in their
country.
There is a study conducted to evaluate the knowledge of patient safety and attitudes of medical
students those are under graduated in Saudi Arabia. A good response got from them in their
specific patient safety knowledge; however, poor knowledge was given by them in major issues
scores. Along with that this study showed improper percentages of the participants who self-
rated “good” for their certain and common knowledge on patient safety. In the current scenario,
there is a number of medical colleges in Saudi Arabia have embedded the criteria of patient
safety in their curriculum for the purpose of increasing their health professional education for
their students (Hodges, 2012). The role of the education in improving knowledge is huge as it
facilitates in improving the safety of the patient. It is essential to capture the point of view of
health care providers on their own knowledge and competence of the patient. However, less
knowledge regarding patient hampers the preparation of the professional for their role in the
context of developing the safety of the patients.

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Answer 5
Quality health care is elaborated as “the extent to which health services for individuals and
populations amplify the similar of required outcomes of the health and are reliable with present
professional knowledge. (Browne, Roseman, Shaller and Edgman-Levitan, 2010). As per the
Institute of Medicine report, To Err Is Human, it has been found that most of the medical errors
come from faulty systems and procedures. There are various factors in the healthcare systems
that increase the complexity of the business such as differences in provider education, health
insurance, mix case of the patients and inefficient processes. It has been asserted by IOM that the
functions of the health care industry at a lower range put forward the subsequent six aims of
health care: timely, patient centered, equitable, timely and effective (James and Savitz, 2011).
The role of the external benchmarks is huge in measuring quality and safety which can track the
development of quality improvement initiatives. The benchmarking is considered as the
collaborative and continual discipline that helps in measuring and evaluating the outcome of
major work procedures with those of the finest performers in measuring the performance of the
organization. It is one of the major tools of the health and care safety that can be taken into
consideration to measure the performance of patient safety and quality. Internal benchmarking is
taken into consideration in order to recognize the best practices within the company, to evaluate
best practices within the company and to evaluate present exercise over time. With the help of
this tool, it has become easy for the health and care safety organization to design the control
chart with statistically imitative lower and upper control limits (Chassin and Loeb, 2011). On the
other hand, with only internal benchmarking does not unavoidably symbolize the best training
somewhere else.

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There are several tools for quality improvement which are mentioned below:
1- Flowchart/process map: it is the tool for making a better understanding of the process. A
flowchart develops a map of the steps in the procedure and permits the outputs and inputs for
each step.
2- Check sheet: it is the device for simple data recording, custom intended by the user to permit
for easy data interpretation and accumulation (Oxman, Lewin, Lavis and Fretheim, 2009).
3- Cause-effect diagram: it is the tool for evaluating and measuring the process by
exemplifying the major reasons and sub-reasons leading to consequences. It is also named as an
“Ishikawa Diagram” after its inventor.
4. Pareto chart: it is the graphical tool for positioning reasons from most noteworthy to least
important. This is the tool which named for economist Vilfredo Pareto. According to him, most
of the effects come from considerably few reasons: that is, most of the effects come from a few
of the likely reasons.
5. Histogram: it is the tool that helps in healthcare to depict the variation in the set of data. A
histogram allows people to look for patterns that are hard to notice in a simple table of numbers.
6. Control chart: it is the tools that provide a chart with lower and upper control limits on
which various values for a series scheme. It is the chat that facilitates in entailing the central line
to find out a trend of schemed values toward either control limit.
7. Scatter diagrams—it is the graphics method for evaluating the association between two
inconsistent. There are two sets of data schemed as pointed on the graph (Straus, Tetroe and
Graham, 2011).

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Answer 7
Risk management is significant in healthcare as it is vital in comparison to any other industry.
The company executes and develops risk management strategies to protect and reduce financial
losses (Lundgren and McMakin, 2018). The same goes for healthcare but in the context of the
patient safety not financial safety. Risk management can mean the disparity between life and
death, which makes the stake noteworthy higher. The purpose of risk management in healthcare
keeps significant value in providing a proper guide to the patients in order to increase their care.
Inclusive risk management plans in patient care are helpful in reducing re-admissions and
provide patient safety initiatives. Robust risk management needs widespread preparation for the
aim of developing and executing. This is quite advantageous to entire patient satisfaction within
healthcare organizations (Tomey, 2009). Risk Management is considered as the process of
approximating a riskiness coefficient to be linked with each auditable unit in the company. Risk
management is majorly embarked on to concentrate scarce audit resources to the vital audit areas
and to facilitate with key audit prioritizing decisions like intensity and frequency (Dancer, 2016).
The discussion on do’s and don’ts are mentioned below in the context of risk management.
Do’s
Set inspiring objectives
It is necessary for the company to set the inspiring objectives which should cover all scenarios
and processes about what to attain and for what reasons the company is executing risk
management implementation. It is important for the company to consider all such aspects which
are liable to motivate people to embrace the amendment process.

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Assess your current status
There are a number of tools available which can be adapted by the company in different
situations. However, it is necessary for the company to stick on one kind of strategy to evaluate
things.
Consult the code
The company should maintain the codes elaborating the anticipated practices of healthcare. The
company must focus on maintaining the standards and facilitate to avoid replicating the mistake
of the past. The company should concentrate on different codes before designing the risk
management program and keep focus on following practices such as International and national
standards which include AUS-NZ 4360 and ISO 31000, professional associations and
governance bodies for economic sectors (American Society for Healthcare Risk Management,
2009).
Map out the path
It is the strategy as well as a comprehensive plan that helps in the risk management including
which steps need to be considered and who will be responsible to accomplish the task. The
communication plan is vital for covering the huge resistance. The risk management plan should
be reasonable including all priorities and constraints. The plan should be simple so that one can
go with it effectively without being so confused.
Cross train

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To productively execute risk management the company need to be managed in the technical
aspects of a highly skilled employee in organizational change management. It is necessary to
have good skills in risk management by developing a framework.
Don’ts
Don't expect a consultant to complete the task for the company
The risk management plan should cover all genuine information where all executive
management team of the company should lead the execution initiative. Leaders of health care
management should be active in terms of describing again risk and for which they do not
underestimate the decisions of others. This kind of attitude can lead the organization in
controversy (Dror, 2011).
Don't work in a vacuum
If the company has not previously implemented or designed a risk management program, you are
accounted into risky DIY territory. The company should enlarge the risk management network
through attending courses, conferences and networking events (Boland and Bremner, 2013).
Along with that the risk management knowledge should be there in managing risk and for which
without having proper knowledge, the management should not take actions against the whole
scenario.

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Conclusion
From the above discussion, it can be concluded that healthcare practices can be effective if they
are having specific principles. This assignment entails five answers of the question in which the
first answer is related to the evolution of awareness of quality in healthcare among the public for
which the discussion has been made by taking consideration of changing in the healthcare
industry. On the other hand, the second answer has depicted about the principles that are
essential for promoting Quality of care. It has been found from this answer that the involvement
of the principles in the health care can be helpful in rectifying the issues in an appropriate
manner through which one can send or store patient data in a systematic manner without making
any fault. The third answer is concerned about the perception of the respondents regarding the
forms of redress available to them in the event of harm by healthcare in their own country or
another member state. Fourth answer has defined the quality improvement tools in Health care
such as Flowchart/process map, Check sheet, Cause-effect diagram, Pareto chart, Histogram,
Scatter diagrams and Control chart. Last answer is related to the risk management plan in which
do’s and don’ts have been mentioned.

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References
American Society for Healthcare Risk Management, 2009. Risk management handbook for
health care organizations(Vol. 30). John Wiley & Sons.
Boland, B. and Bremner, S., 2013. Squaring the circle: developing clinical risk management
strategies in mental healthcare organisations. Advances in psychiatric treatment, 19(2), pp.153-
159.
Browne, K., Roseman, D., Shaller, D. and Edgman-Levitan, S., 2010. Analysis & commentary
measuring patient experience as a strategy for improving primary care. Health Affairs, 29(5),
pp.921-925.
Chassin, M.R. and Loeb, J.M., 2011. The ongoing quality improvement journey: next stop, high
reliability. Health Affairs, 30(4), pp.559-568.
Cornwell, J. and Goodrich, J., 2009. Exploring how to ensure compassionate care in hospital to
improve patient experience. Nursing Times, 105(15), pp.14-16.
Dancer, S.J., 2016. Dos and don’ts for hospital cleaning. Current opinion in infectious
diseases, 29(4), pp.415-423.
Dror, I., 2011. A novel approach to minimize error in the medical domain: cognitive
neuroscientific insights into training. Medical teacher, 33(1), pp.34-38.
European Commission, 2010. Patient safety and quality of healthcare. Available online:
http://ec.europa.eu/commfrontoffice/publicopinion/archives/ebs/ebs_327_en.pdf Accessed from:
13th Feb 2019.

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Fan, E., Laupacis, A., Pronovost, P.J., Guyatt, G.H. and Needham, D.M., 2010. How to use an
article about quality improvement. JAMA, 304(20), pp.2279-2287.
Goetsch, D.L. and Davis, S.B., 2014. Quality management for organizational excellence. Upper
Saddle River, NJ: pearson.
Harrison, J. 2018. Improving Healthcare Awareness. Available [online]
https://www.medpagetoday.com/nursing/nursing/72972 Accessed on 19th February 2019.
Hodges, C., 2012. Current discussions on consumer redress: collective redress and ADR. In ERA
Forum (Vol. 13, No. 1, pp. 11-33). Springer-Verlag.
James, B.C. and Savitz, L.A., 2011. How Intermountain trimmed health care costs through
robust quality improvement efforts. Health Affairs, 30(6), pp.1185-1191.
Kaplan, H.C., Brady, P.W., Dritz, M.C., Hooper, D.K., Linam, W.M., Froehle, C.M. and
Margolis, P., 2010. The influence of context on quality improvement success in health care: a
systematic review of the literature. The Milbank Quarterly, 88(4), pp.500-559.
Lundgren, R.E. and McMakin, A.H., 2018. Risk communication: A handbook for communicating
environmental, safety, and health risks. John Wiley & Sons.
Margalit, R., Thompson, S., Visovsky, C., Geske, J., Collier, D., Birk, T. and Paulman, P., 2009.
From professional silos to interprofessional education: campuswide focus on quality of
care. Quality Management in Healthcare, 18(3), pp.165-173.
Nicolay, C.R., Purkayastha, S., Greenhalgh, A., Benn, J., Chaturvedi, S., Phillips, N. and Darzi,
A., 2012. Systematic review of the application of quality improvement methodologies from the
manufacturing industry to surgical healthcare. British Journal of Surgery, 99(3), pp.324-335.

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North Carolina, 2016. The physician-patient relationship. Available [online]
https://www.ncmedboard.org/resources-information/professional-resources/laws-rules-position-
statements/position-statements/the_physician-patient_relationship Accessed on 13th Feb 2019.
Oxman, A.D., Lewin, S., Lavis, J.N. and Fretheim, A., 2009. SUPPORT Tools for evidence-
informed health Policymaking (STP) 15: Engaging the public in evidence-informed
policymaking. Health research policy and systems, 7(1), p.S15.
Qaseem, A., Forland, F., Macbeth, F., Ollenschläger, G., Phillips, S. and van der Wees, P., 2012.
Guidelines International Network: toward international standards for clinical practice
guidelines. Annals of internal medicine, 156(7), pp.525-531.
Shaw, C., Groene, O., Mora, N. and Sunol, R., 2010. Accreditation and ISO certification: do they
explain differences in quality management in European hospitals?. International Journal for
Quality in Health Care, 22(6), pp.445-451.
Straus, S.E., Tetroe, J.M. and Graham, I.D., 2011. Knowledge translation is the use of
knowledge in health care decision making. Journal of clinical epidemiology, 64(1), pp.6-10.
Taylor, M.J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D. and Reed, J.E., 2014. Systematic
review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ
Qual Saf, 23(4), pp.290-298.
Tomey, A.M., 2009. Nursing management and leadership. USA: Mosby Elsevier.

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