Leadership for Quality Effectiveness and Safety in Health Care

This article discusses quality, TQM, CQI, patient safety, safety in healthcare, risk management, safety culture, and measurement of the culture of safety in health care.

Running Head: SAFETY 1
Leadership for Quality Effectiveness and Safety in Health Care
Student’s Name
Institutional Affiliation

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Table of Contents
Question 1. Quality, TQM and CQI.............................................................................................3
Definition of Quality in Healthcare.............................................................................................3
Principles and Characteristics of Total Quality Management (TQM).........................................3
Principles and Characteristics of Continuous Quality Improvement..........................................4
How TQM and CQI Approaches Differ from Six Sigma Method..............................................5
Patient Safety, Safety in Health Care and Risk Management...................................................5
Patient Safety...............................................................................................................................5
Difference between Patient Safety and Safety in Health Care....................................................5
Risk Management in Patient Safety.............................................................................................6
Approaches and Tools to Risk-Analysis when Managing High-Risk Situations in Healthcare..6
Safety Culture and Measurement................................................................................................7
Safety Culture..............................................................................................................................7
Measurement of the Culture of Safety in Health.........................................................................8
The Significance of a Poor Safety Culture for Health Care Professionals and Patients..............8
References.......................................................................................................................................9

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Question 1. Quality, TQM and CQI
Definition of Quality in Healthcare
According to Gottwald and Lansdown (2014), quality is an individual construct that
depends on the beliefs and values one holds that means: quality is a connection to the perceptions
of self. The author also adopts definitions of quality from past authors. The first one is quality as
a clinically effective personal and safe while the second one is quality as a journey and not a
destination. Quality is to be continuously made better by continually increasing participations,
structures as well as procedures.
Quality is closely linked to clinical governance since the latter involves implementation
of evidence based practice in the daily patient care to allow for healthcare professionals
becoming aware why and how what they do works. Clinical governance involves continuous
quality improvement (CQI) (Gottwald & Lansdown, 2014).
From the National Safety and Quality in Health Service Standards, different groups take
different roles within the healthcare setting like; patients and carers, the clinical and non-clinical
workforce, health service managers, and health service executives and owners (NSQH, 2012).
Principles and Characteristics of Total Quality Management (TQM)
TQM is described as long-term management approach to success via consumer
satisfaction that involves every member in an organization to chip in the improvement of
processes, products, services and workplace culture (McLaughlin & Kaluzny, 2006). Principles
of TQM are:
Customer focused; meaning the customer is the center of care and the ultimate determinant of the
level of quality to be provided.

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Full involvement of employee; that means all employees take part in working towards
shared goals. Full commitment by employee is come when the workplace culture is not guided
by fear. It involves empowerment and suitable environments by the management.
Integrated systems; this means that TQM is dedicated to horizontal specialties like micro
processes.
Strategic and systematic approach; this principle as a crucial management of quality as it
involves the goals, mission and vision of an organization and how to achieve that.
Process-centered; TQM is focused on process thinking a well-defined framework of the steps
involved in the process including an evaluation of the performance indicators for measurement
of unexpected variation.
Other principles include, incessant improvement, flexibility, making decision based on
facts and effective communication.
Principles and Characteristics of Continuous Quality Improvement
CQI has been adopted in the healthcare sector. Is not focussed on creating a quality
workplace culture but on the process of improving quality by the deployment teams
(McLaughlin & Kaluzny, 2006). principles of QTI according to McLaughlin and Kaluzny 2006,
are: A link to the significant elements of the facility’s premeditated plan, a valuable council
entailing of the top management in an institution, education programs for the members, ways of
choosing opportunities for improvement, forming process improvement teams, supportive staff
in analysis and redesigning processes, and incentive policies for motivation and participation of
support staff in the improvement of process.

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How TQM and CQI Approaches Differ from Six Sigma Method
TQM and CQI differ from the Six Sigma in terms of origin, concepts, theory, process
view, methodologies, effects tools approach as well as criticism (Andersson, Eriksson &
Torstensson, 2006). On concepts for example, TQM describes how organizations should work to
access better performance and customer satisfaction both internally and externally with limited
use of resources a concept while six sigma is focussed on achieving no defects. Again the six
sigma focuses more on economic saving than customer contentment (Andersson, Eriksson &
Torstensson, 2006).
Question 2. Safety, Safety in Health Care and Risk Management
Patient Safety
Patient safety is processes of preventing harm to patients while placing emphasis on a
care system that prevents errors, learns from the errors, and built on safety culture involving
patients themselves, health care professionals and organizations ("Patient safety | NHS
Improvement", 2018; Mitchell, 2008). Practices of patient safety are built to reduce the risk of
harmful effects that recount to the acquaintance with medical care in range of diagnoses or
conditions. A particular example of a patient safety practice is using all-out sterile barriers while
positioning central intravenous catheters in the prevention of conceivable infections (Mitchell,
2008)
Difference between Patient Safety and Safety in Health Care
Safety in healthcare is not necessarily patient specific care. It involves all activities in the
healthcare and include the safety of the providers. Safety in healthcare involves eradication of all
potential risks to illness like preventing healthcare acquired infections (Vincent & Amalberti,
2016). It involves transforming the work environment to be safe for all. Patient safety on the

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other hand is care giving to patient against any form of harm without considering the medical
practitioners. However, safety in healthcare is still patient safety as it is a broad concept.
Improvement of working conditions in healthcare setting directly improve patient safety. An
unsafe working healthcare environment is a threat to patient safety. Safety in healthcare involve
other practices like health services involved, nursing, communicative and structural research,
studies of safety, conclusions from human influences examination and engineering (Institute of
Medicine, Board on Health Care Services, Committee on the Work Environment for Nurses and
Patient Safety, 2004).
Risk Management in Patient Safety
Risk management is a process of identifying factors that inhibit providing safe and
efficient care to patients (McGinley, 2018). Risks can be changes in service delivery among
others. The goal of risk management is ensuring that the risks are identified early enough and
assessed how best they can be managed or controlled to lower their effects. Risk management
and patient safety are closely related in that they both work towards mitigating patient care and
ensuring that the goal of improving patient outcomes is reached (McGinley, 2018).
Approaches and Tools to Risk-Analysis when Managing High-Risk Situations in
Healthcare
The process of risk evaluation (analysis) depend on facts while analyzing the possibility
of harmful effects of work-place culture that allow for injuries and exposure. Risk analysis looks
into the harmonization of scientific knowledge with the different concerns of administrators and
the public. An approach to risk analysis is systematic in that it involves a methodical approach to
identifying and characterizing biological, chemical, or even physical hazards that predisposes
individuals to illness or injury. These hazards post adverse consequences such as permanent

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health consequences, unfamiliar disease or undesirable situations which are actually avoidable
should the risk management had been taken early enough. A risk analysis approach prioritizes on
fighting the risk factors that may lead to worst health-related consequences (National Research
Council, 2003).
According to (Sandars & Cook, 2009), clinical risk management process involves
planning, organizing and directing programs that pinpoint, evaluate and control risks. The
principle and the first step to risk analysis however, is establishing the financial, political and
legal contexts (Sandars & Cook, 2009).
Question 3. Safety Culture and Measurement
Safety Culture
Safety culture is a perception that was founded from outside the healthcare background
(U.S. Department of Health and Human Services, 2018). However, in the healthcare context,
safety culture encompasses an organizational framework that operates consistently to reduce the
adverse events even when doing intrinsically multifaceted and hazardous work. A culture of
safety in healthcare serves several purposes such as recognizing the high risk nature of activities
in an institution, accomplishing steadily safe operations, a blame-free setting where reporting of
mistakes is without fear of punishment, collaboration (team work) in all disciplines in seeking
solutions to problems of safety, and setting aside resources that serve safety concerns (U.S.
Department of Health and Human Services, 2018).
An improved safety culture in health means efficient services free from errors and an
improved overall health care quality.

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Measurement of the Culture of Safety in Health
Safety culture is measurable and definable. Measurement of culture of safety is by use of
surveys on providers at all levels within the healthcare organization. AHRQ's Patient Safety
Culture Surveys, Hospital Survey on Patient Safety Culture (HSOPS), and the Safety Attitudes
Questionnaire are examples of authenticated surveys (Gallego, Westbrook, Dunn & Braithwaite,
2012). They surveys work on a very basic principle of asking providers to rate the culture of
safety in their precise units as well as the general facility. The measurement points are the
purposes identified in the preceding section on “Safety Culture” such as “what rate can you give
environment as blame free?” Hospitals as well as nursing homes and AHRQ use the surveys and
AHRQ measures the safety culture annually from the rationalized benchmarking statistics from
hospital study.
The Significance of a Poor Safety Culture for Health Care Professionals and Patients
Poor safety culture is a direct attribute to errors in the healthcare facilities. The perception
of the culture could be high in one unit and low in another. While positive patient safety culture
shows a respective low adverse events in hospitals and other departments, the opposite is also
true meaning that poor safety culture is a causal factor to adverse events in a healthcare
institution (Najjar, Nafouri, Vanhaecht & Euwema, 2015). These harmful effects from the poor
safety culture ultimately put the patient’ safety at risk or even the condition of the providers,
especially with health related infections.

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References
Andersson, R., Eriksson, H., & Torstensson, H. (2006). Similarities and differences between TQM, six
sigma and lean. The TQM magazine, 18(3), 282-296.
Australian Commission on Safety and Quality in Health Care (ACSQHC). (2012). The national safety
and quality health service standards. Sydney: ACSQHC. Retrieved 31 August 2018 from
https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-
2012.pdf
Gallego, B., Westbrook, M., Dunn, A., & Braithwaite, J. (2012). Investigating patient safety culture
across a health system: multilevel modelling of differences associated with service types and
staff demographics. International Journal For Quality In Health Care, 24(4), 311-320. doi:
10.1093/intqhc/mzs028
Gottwald, M., & Lansdown, G. (2014). Clinical Governance (pp. 14-25). Maidenhead: McGraw-Hill
Education.
Institute of Medicine, Board on Health Care Services, Committee on the Work Environment for
Nurses and Patient Safety. (2004). Keeping patients safe (pp. 3-5). Washington, D.C.: National
Academies Press.
McGinley, P. (2018). Risk Management & Patient Safety - Patient Safety & Quality Healthcare.
Retrieved 31 August 2018 from https://www.psqh.com/analysis/risk-management-patient-safety/
McLaughlin, C., & Kaluzny, A. (2006). Continuous quality improvement in health care (pp. 3-4).
Sudbury, Mass.: Jones and Bartlett.
Mitchell, P. H. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Retrieved 31 August 2018 from https://www.ncbi.nlm.nih.gov/books/NBK2681/
Najjar, S., Nafouri, N., Vanhaecht, K., & Euwema, M. (2015). The relationship between patient
safety culture and adverse events: a study in palestinian hospitals. Safety In Health, 1(1). doi:
10.1186/s40886-015-0008-z
National Research Council. (2003). Occupational Health and Safety in the Care and Use of
Nonhuman Primates. Risk Assessment: Evaluating Risks to Human Health and Safety.
Patient safety | NHS Improvement. (2018). Retrieved 31 August 2018 from
https://improvement.nhs.uk/improvement-hub/patient-safety/
Sandars, J., & Cook, G. (2009). ABC of Patient Safety (p. 24). New York, NY: John Wiley & Sons.

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U.S. Department of Health and Human Services. (2018). Culture of Safety | AHRQ Patient Safety
Network. Retrieved 31 August 2018 from https://psnet.ahrq.gov/primers/primer/5/culture-of-
safety
Vincent, C., & Amalberti, R. (2016). Safer Healthcare (p. 131). Cham: Springer International
Publishing.