Patient Safety, Quality Improvement, and Risk Management

This article discusses patient safety, quality improvement, and risk management in healthcare. It defines these aspects and provides suggestions on how to ensure them in healthcare organizations. The article also highlights the various processes of implementing these suggestions. Subject: Patient Safety, Quality Improvement, and Risk Management. Course Code: N/A. Course Name: N/A. College/University: N/A.

PATIENT SAFETY, QUALITY IMPROVEMENT AND RISK MANAGEMENT 1
PATIENT SAFETY, QUALITY IMPROVEMENT, AND RISK MANAGEMENT
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Table of Contents
Patient safety, quality improvement, and risk management.......................................................................3
1.0 Introduction...........................................................................................................................................3
2.0 Patient Safety........................................................................................................................................4
3.0 Building a patient safety culture............................................................................................................7
4.0 Quality improvement of the health care system...................................................................................7
5.0 Quality improvement process...............................................................................................................9
6.0 Risk Management................................................................................................................................11
7.0 Risk Management Process...................................................................................................................12
8.0 Conclusion...........................................................................................................................................14
References.................................................................................................................................................16
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Patient safety, quality improvement, and risk management
1.0 Introduction
The health care system in any country has the responsibility to ensure patient satisfaction by
embracing accountability in the provision of medical care. This can be realized through engaging
in risk management for patients by availing high-quality medical care aimed at ensuring patient
safety. Carroll, (2009) explains that in the recent years, the healthcare system has been using
patient safety, quality improvement and risk management as vehicles towards establishing safety
and reliability is the patient care system. The integration of these disciplines, risk management,
quality improvement and patient safety, into the patient care system, not only results into safe
and reliable patient services but also support in ensuring efficient use of the healthcare resources
towards achieving the desired outcomes.
This paper aims at discussing the healthcare issues relating to patient safety, quality
improvement, and risk management. It defines patient safety, quality improvement and risk
management considering the factors that constitute these aspects of modern health care system. It
further provides suggestions on how patient safety, quality improvement, and risk management
could be ensured in the healthcare organization. Finally, it highlights the various processes of
implementing these suggestions, before devising an appropriate conclusion regarding the major
issues discussed in the paper.
In the current society, health care system, aiming to achieve patient satisfaction through delivery
of high-quality healthcare services, could ensure proper healthcare risk management and patient
safety. Risk management, in the context of health care, entails those programs that are oriented
towards identifying and minimizing the liability exposure of the health organization, while
quality improvement refers to the process of ensuring that the services provided by the health
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care system are in line with the requirements of the Joint Commission that is responsible for
accrediting organizations. These programs are aimed at enhancing the health care’s process,
structures and outcomes. Risk management programs help in maximizing the quality of patient
care by complementing quality management programs in minimizing the liability exposure of the
healthcare organization (Barash, Cullen, Stoelting, Cahalan & Stock, 2009).
2.0 Patient Safety
It is a basic need of the health care professionals to provide all people with safe care. Healthcare
nurses are responsible for creating a safe environment for the patient through delivering
professionally high-quality nursing care pertaining to human hygiene enhancement, infection
control, and safety precautions. Medical errors were historically seen to result from incompetent
negligence behavior of the patient. However, current reports reveal that these most of these
medical errors result from fundamental mistakes in the health care delivery systems, not from the
carelessness of the patient (Delaune, 2013). These, therefore, create the need for patient safety
practices within the health care system.
Current healthcare organizations have the challenge to create a culture of patient safety and focus
on changing the risks to patients within and without the healthcare facility, rather than blaming
the patient for medical errors. The Australian government, through the National Health and
Medical Research Council (NHMRC), assists in ensuring a patient safety culture through
developing clinical practice guidelines to help physicians in taking care of people. Moreover, the
Australian Commission on Safety and Quality in Health Care (ACSQHC) has the responsibility
to promote patient safety. This body has, for instance, developed goals for personal safety within
the health care system (Delaune, 2013).
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Infection prevention is concerned with ensuring patient safety in the healthcare environment
through reducing microorganism transmission (Delaune, 2013). These practices aim at
prevention or elimination of infection sources within the health care facility or home. Such
practices as creating safety practices awareness, hand hygiene, disinfection, sterilization of
equipment and objects, proper disposal of infectious waste, cleaning baths with disinfectants and
use of medical gloves can be used to control infection within the healthcare organization.
Moreover, patient safety also requires the medical practitioners to ensure good record keeping
with regards to patient information. Proper labeling of the items and liquids used in the hospital
also helps in ensuring patient safety. Additionally, putting in place measures to avoid incidents
like falls due to the slippery floor or from hospital beds also improve patient safety (Delaune,
S.C., Ladner, P.K., McTier, L., Tollefson, J. & Lawrence, J. (2016)). Further, measures like
installing adequate lighting systems to assist in visualization of environmental hazards, good
patient supervision in hospital, orientation of persons to the hospital environment and call
system, provision of ambulatory aids, and placing the patient’s personal belongings to tables near
the patient’s bed to avoid falls, could be put in place to enhance patient safety as explained by
(Delaune, 2013).
Patient safety has been advocated for and encouraged by different agencies in the Australian
government and health care system regulatory authorities. By emphasizing different areas
considered as key to achieving patient safety, some of the major concerns of ACSQHC and the
National Action Plans for patient safety improvement (2001 and 2002), are highlighted as
follows (Joshi, 2012. Pg. 15):
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The Australian Commission on Safety and Quality Health Care, (ACSQHC), outlines the key
priority areas in ensuring patient safety as:
a. Supporting the health care personnel to practice safety
b. Data and information improvement for safer care
c. Consumers involvement towards improving the safety of the healthcare system
d. Health care systems redesigning in order to facilitate a safety culture
e. Creating awareness and understanding of the components of safety in healthcare
On the other hand, the National Action Plans (2001 and 2002) for patient safety improvement
considered the following as the critical areas towards achieving patient safety:
a. Making the consumers the center of healthcare by promoting approaches towards this
objective
b. Encouraging effective use of information to discover areas within the health system that
are doing wrong
c. Promoting cultural change focusing on improvement instead of blaming individuals
d. Introduction of improvement tools and measures that are practical towards helping to
make patient care safer
e. National standards for open disclosure development
f. Minimizing patient harms associated with medical care that can be prevented
g. Reducing healthcare-associated infections patient harms
h. Establishing a coordinated action plan aimed at learning from serious adverse events.
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3.0 Building a patient safety culture
According to Projectmanager.com, (2018), creating a patient safety culture requires the
organization to put in place the following practices and activities;
a. Simplification and standardization of workplace supplies, processes, and equipment
b. Developing the requirements that would encourage patient safety
c. Encourage communication between stakeholders in order to determine understanding of
patient associated problems
d. Training the medical professionals to equip them will the necessary skills to perform their
responsibilities
e. Planning on training for interdisciplinary teams
f. Establishing an organizational culture that encouraged fairness and accountability
g. Collection of data on patient safety, monitoring and evaluating the errors and
implementing the necessary steps to eliminate them.
4.0 Quality improvement of the health care system
All health provision activities should be built up from value-adding strategy. The planning,
hospital structure, data systems, and accountability, should be aimed at providing quality
health care to the patient (Sherwood & Barnsteiner, 2017).
An integrated healthcare cooperation approach is required within the health care system, not
only within the healthcare facility itself, but also involving active cooperation with the
patient as an individual responsible for his or her health. This enhances the quality and
effectiveness of the healthcare delivery (Rosiek-Kryszewska & Leksowski, 2018).
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In determining the quality of the health care services provided by the healthcare institutions,
patients’ opinion is a precious information source. Good quality health care services improve
patient trust, safety, health and the satisfaction of the patient with the care delivered. Rosiek-
Kryszewska & Leksowski, (2018) further elaborates that high quality of health care services
is attained through understanding and fulfilling the patient requirements, by paying attention
to the patient needs and considering the patients as the core business of the organization.
Therefore, all health care personnel should always work towards satisfying the quality
expected by the patient. The World Health Organization provides recommendations that
could be used to determine the quality of health care services, in consideration of the patient
needs. These recommendations or determinants are patient dignities, availability of services
and patient’s autonomy.
Patient dignity involves giving the patient the freedom to decide about treatment regimen and
type that they are offered. Patients should be protected from discrimination and any form of
abuse. Violation of patient dignity occurs when the patients feel that they are treated as
objects, rather than valuable persons worthy of equal respect (Schulman, 2008).
In providing high-quality health care services, the patients should further be allowed to make
decisions within the limits of their competence, and the doctors or the nurses should not try
in any way to coarse or influence the patient’s decisions unless in a direction that enhances
the patient’s proper treatment (Pearson, Vaughan & Fitzgerals, 2005).
They have the right to object to treatments and the right to be given the full information
about the treatment that is due to be given to them before the actual process is undertaken.
Finally, it is important to ensure that the healthcare systems medical care services are
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accessible depending on the needs of the patients. This entails having the required medical
practitioners within the facility. In the end, the healthcare should concentrate on satisfying
the patient’s interests in improving the quality of the services provided.
A quality assurance program is put in place by the health regulatory and supervisory
authorities to access the quality of health care services provided by the different healthcare
institutions. These bodies also work to ensure that there is the continuous provision of quality
services within the institutions. In Australia, the Australian Council on Healthcare Standards
(ACHS) is charged with the duty of evaluating the continuity of quality improvement in the
delivery of healthcare services. This quality assurance also helps in ensuring adherence to the
health care code of ethics and practices, and delivery of high standard services.
Proper assignment of duties and responsibilities within the healthcare organization, apart
from ensuring smooth flow of work process and enhancing safety within the facility, also
ensures that timely and appropriate services delivery is observed in the organization. These
are all aspects of high-quality health care.
5.0 Quality improvement process
A quality improvement process ensures that the customers constantly receive appropriate
health care services that are patient-centered and satisfies the patient’s needs. According to
(Riga, 2017), the process of ensuring that the health care services provided are of high
quality and that this quality is continually maintained or improved involves some steps that
can be summarized as below. These steps should be undertaken after establishing a quality
improvement team.
a. Identify quality breaches in the healthcare system
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The process of identifying whether the health care system observes the quality requirements
involves continuously assessing the health care system in relation to nurse’s practices and how
the doctors handle their patients. A patient survey should also be carried out when identifying the
quality breaches. Both the healthcare organization and the regulatory authorities apply this
process in attempts to enhance the services provided to the patients.
b. Planning the change
This entails developing a detailed action plan that identifies the achievable quality targets. This
plan details how solutions to quality breaches will be implemented to achieve the required
quality standards.
c. Deploying the plan
The quality improvement team then implements the developed intervention plan in an attempt to
solve the identify quality breaches problems.
d. Studying the Effects of Implementing the action plan
After implementing the plan, it is necessary to review the plan in order to determine the parity
between the achieved results versus the pre-determined performance indicators. This helps to
find out if an appropriate plan was implemented and whether there are needs for improvement.
e. Taking action on the results and standardizing the result
Based on the results from stage four above, appropriate corrective measures are taken to close
the gaps identified between the required and the actual performance. These changes should then
be communicated to all the concerned healthcare personnel.
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6.0 Risk Management
Risk management is the process of identifying risks, analyzing the risks identified to find the
possibility of their occurrence and to determine the possible solutions to eliminate or reduce the
chances of the risk occurring or hedging of the risks or the actions that could be taken to risks
reduce the risks or impact of the risks.
Every healthcare institution has a risk management plan. A healthcare organization should
employ qualified healthcare risk managers to help in assessing, developing, implementing and
monitoring the effectiveness of the risk management plan of the organization with an objective to
minimize the risk exposure to the institution. These managers handle various issues ranging from
clinical research, emergency preparedness, event and incident management, psychological and
human health care to claims, financial and insurance management. Further, they assist in the
development of the organizational risk assessment plan that covers: patient safety, compulsory
federal regulations to be observed, potential and medical error observation, current and future
policy formulation and legislation that impact on the healthcare field (elearning.scranton.edu.
(2018).
Healthcare risk management process helps in identifying and evaluating risks in order to reduce
injuries and accidents that may occur in patients, members of staff and visitors within the
healthcare environment.
Both quality improvement and risk management stress on achieving quality standards and
avoidance of patient care problems. According to Yoder-Wise, (2013), the healthcare department
of risk management is formed to carry out various functions such as: defining those situations
that may place the health care system or organization at some financial risk, for instance patient
falls and medical errors; determining how frequent these situations occur within the organization;
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investigation of the identified risk situations and risk identification or identification of
opportunities for healthcare improvement.
Therefore, considering the importance of risk management to ensuring quality provision of
health care services and in enhancing patient safety and satisfaction, and health care organization
should engage in developing an effective risk management plan and engage the right personnel
in the risk management plan and assessment development.
7.0 Risk Management Process
Developing a risk management plan requires undertaking some processes, as explained in
Elearning.scranton.edu, (2018) that are highlighted as below:
a. Risk identification
Analysis of all the risk exposure areas of the organization is important in order to identify all the
risks that the organization faces or may face. This is only possible through the risk management
team, with a substantive understanding of the health care system and processes, that is, an
effective risk management team and program.
An effective risk management program will enable the organization to identify and analyze the
risk exposure level of the organization. Early identification and analysis or risks are very
important to the process of risk management. Identification of health care risks entails analyzing
the services offered by the healthcare facility, initiatives, systems and processes that can
contribute to the loss, the location of the facility, and the environment and culture of the
concerned organization (Carroll, 2013).
b. Risk Analysis
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Risk analysis is important as it enables the organization to ensure that it has identified most of
the risks it may be exposed to, or it is already exposed to. The process of risk analysis requires
adequate expertise and knowledge of the healthcare system of delivering services, the nursing
procedures, and the medical practices. Through this process, the risk management it is possible
to create a dependable list of significant risk exposures to the healthcare organization or system
(Kraus, 2000).
c. Prioritizing/ Classification of Risks
A standard method of classifying the individual health risks is necessary for proper risk
management. This risk classification is done based on the presence or absence of risk factors.
According to the World Health Organization’s definition, a risk factors any individual’s
behavior, attribute or exposure, which increases the possibility of disease development or injury
(Panel on measuring medical care risk in conjunction with the new supplemental income poverty
measure) (O’Grady & Wunderlich, 2012). Health risks can be classified based on the exposure
levels, predicted loss levels, areas from where the risks are perceived to originate or any other
method depending on the risk management’s choice that is appropriate to the organization.
After risk classification, prioritization is done depending on the degree of exposure or the degree
of losses that the risk would bring about in case it occurs. This enables the risk management team
to identify appropriate risk handling method of the different risk classes and give the sue
priorities to those risks whose occurrence would result into huge losses or greater impacts to the
healthcare organization.
d. Risk assignment to an owner
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The owner here refers to expert identified to help in the risk management process. Under this
step, the risk managers assign the various risks identified, analyzed and classified by the right
people to oversee the particular risks. These people would be responsible for identifying the
specific risks when they should occur and spearheading the process of solving the risks. This
assignment of risks to owners is based on the experience one has in relation to the specific risks
to be assigned.
e. Responding to the risk
This entails developing a mitigation process for the identified risks. Strategy development or
plan to prevent or reduce the chances of the risk occurring or the losses incurred in the
occurrence of the risk. This process requires the risk management team to communicate with the
risk owners to decide on the appropriate plans or strategies developed to implement, in order to
mitigate the risks.
f. Monitoring the risk
The process of monitoring the risk requires the risk managers to keenly access the occurrence
patterns of the risk, the effectiveness of the risk mitigation plan or strategy in dealing with the
respective risks. Through monitoring and evaluation of the risks, areas in the risk management
process and the risk mitigation strategy that require improvement are identified, then appropriate
measures are taken to ensure effective and efficient use of the organization’s strategy to handle
the healthcare organization’s risks.
8.0 Conclusion
Various factors surround the issues of patient safety, quality improvement and risk management
in the context of health care. The main concern of the health care system should be to provide
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patient-specific and appropriately high-quality health care services within an environment and
through processes that are safe to the patient while minimizing the risk exposures to the
organization that may result from failure to consider patient safety. Therefore, every healthcare
organization needs to critically assess their systems to ensure that they satisfy their patients’
needs. They could conduct a survey on their patients to discover whether they provide high-
quality services or if they need to improve the quality of the services they provide. Moreover, it
would be appropriate to employ risk management processes to help mitigate the risk exposures to
the system. Risk management requires engaging qualified and expert risk managers to develop
an effective risk management plan or strategy.
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