Theoretical Approaches to Quality Improvement in Health and Social Care

This essay explores and critically analyzes the concept of quality and quality improvement within healthcare. It identifies and describes the key drivers, barriers, and facilitators of quality improvement in health care. Lean and six sigma quality improvement techniques are described and a comparison is made among them by referring to a case study on the lean six sigma approach. The essay also briefly discusses the policy and strategy of NHS in quality and quality improvement in health care in the United Kingdom.

Essay - Discuss and
critically analyse
theoretical approaches
to quality and quality
improvement in health
and social care

Contents
INTRODUCTION...............................................................................................................................3
Conclusion............................................................................................................................................7
REFERENCES....................................................................................................................................8

INTRODUCTION
One of the biggest and most important leadership challenges in healthcare is
improving quality. There is sometimes a failure to involve professionals on the front lines of
initial changes to clinical and patient-directed improvements in health care. Moreover, health
and social care organizations face many issues that threaten people's lives, increase health
care costs, and make patient care unpredictable.(Brandrud et al, 2017). Health-care quality
improvement generally aims to ensure low costs and increased satisfaction among patients,
and maintain a good sustainable change in the health-care services(The King's Fund, 2019).
The purpose of this essay is to explore and critically analyze the concept of quality and
quality improvement within healthcare. The essay will begin by defining quality and quality
improvement within healthcare. The organizations that strive to provide safe and cost-
effective care for their clients, highlighting their importance at local, national,
and international levels. And then
different approaches to quality improvement in health care will be
discussed and critically analysed in this essay. The next step is to identify and describe the
key drivers, barriers, and facilitators of quality improvement in health care.Then, lean and
sixsigma quality improvement techniques are described and a comparison is madeamong the
m by referring to a case study on the lean six sigma approachUsing a critical evaluation
of lean six sigma as a quality improvement tool. Finally, before writing the summary the
essay will briefly discuss the policy and strategy of NHS in quality and quality improvement
in health care in the United Kingdom.
QUALITY AND QUALITY IMPROVEMENT
In various industries, quality and quality improvement have become critical components of
service continuity. It is widely assumed that defining quality and quality improvement is
difficult due to their varying meanings in different contexts and among different people's
perspectives (Boaden, 2011; Mosadeghrad, 2013). The importance of quality improvement
approaches is typically to maintain a good, sustainable change in health-care services at a low
cost while increasing patient satisfaction (The King's Fund, 2017).Health care providers
define quality by referring to Lord Darzi's quality definition in "highquality care for all"
published in 2008. This definition identifies three aspects of health care quality: clinical
efficacy, patient safety, and patient experience. Clinical effectiveness, patient safety, and
patient experience are three dimensions of quality in health care (The King’s Fund, 2014). In

the field of health, the generally accepted definition of "Quality". However, the following
definition Frequently used US Institute of Medicine: which quality is the extent to which
medical services are available
individuals and groups increase their potential.
Agree with desirable healthy resultscurrent expertise.The institute has diagnosed six
dimensions of quality of health care. All of these must be safe, effective, equitable, timely,
efficient, and patient-centered (The Health Foundation, 2013). Today, many people in the
medical field are interested in defining the concept of 'quality'.improvement ''. We propose to
define it as cumulative and continuous.The efforts of all medical staff, patients, and
familiesResearchers, Payers, Facilitators and Educators -Improve patient outcomes (health),
improve system (care) performance, and Professional Development(Batalden& Davidoff,
2007). According to (The Health Foundation, 2021) All healthcare systems are built on
complex foundations.A network of processes and methods that provide support.The qualityof
the services provided by the system is how well the network is performing, and how well are
the people providing and managing the care?to work together. Several definitions define it as
a systematic approach to quality improvement that employs specific techniques. The quality
improvement defined as the concept of optimization finally arrived atas a result of the review,
the improvement was identified as followsAchieving the best patient experience and
resultsby changing the behaviour of the provider andOrganizing through the use of systemic
change methods and strategies.In order to achieve better results, the key elements in this
definition are the combination of a 'change' (improvement) and a method (an approach with
appropriate tools) while paying attention to the context(The Health Foundation, 2013). A
report published by HQIP (2015) detailed a list of quality improvement methods found in the
literature. These quality improvement methods include clinical auditing, lean six sigma,
process mapping, decision trees, and a model for improvement, among others. Quality
improvement methods such as clinical audit are used to determine whether clinical care meets
specified quality standards, whereas lean six sigma methods are used to eliminate waste
before redirecting resources to efficiency and improving quality (HQIP, 2015). According to
The King's Fund (2017), quality improvement approaches and tools are extremely beneficial
in terms of lowering costs and increasing the value of healthcare services.Therefore, as the
World Health Organization (2006) points out, between quality development strategies,
understanding the needs of healthcare providers to achieve the best results and the
involvement of service users in the methods of these services. Has an important relationship.

Delivered because they are the primary beneficiaries. However, quality improvements are
primarily related to ways to make health care organization more effective and decrease
harmful errors, and how to mitigate harm to health care providers and provide health care
effectively(World Health Organization, 2006).
The demand on changing in health care services is increased as well as the challenges.There
are a number of drivers for improving the quality provided in health care system. .Moreover,
providing a good quality with low cost is the major demand in the health care system. this
could be done by diminishing the overuse or the misuse of specific treatment or
equipment .for e.g. a program naming The Getting It Right First Time (GIRFT) has been used
to connect the staff and those who are responsible for delivering services with the national
data about the changes and the variations and it has been approved that applying of this
program was beneficial in the improving the value of quality. QI is fundamentally a
collaborative activity. Under the correct conditions, a team can use the information, skills,
experience, and views of its members to achieve long-term advances. A team approach is
most effective when:
• the process or system is complex
• no one individual in an organisation understands all aspects of an issue
• the process encompasses more than one field or work area
• solutions necessitate creativity; and
• staff commitment and buy-in are required.
To achieve this many strategies and roles needed to be applied for improving the quality
provided in health care system such as, making the improvement is the priority for all health
care staff in particular leadership changing for a better position in the service provided by
encouraging the health care worker, constant review of the service provided by using an
appropriate quality improving approaches, engaged patients and service received in the
equality improvement criteria, present and analyse the collected data very clearly to have a
good feedback and support any effort for progression.
However, providing a professional service quality in healthcare system is very complicated
and any issue or problem in this system required a high effort and coordination between the
organizations and the providers.Moreover,limited- resource is known as the major obstacle in

quality improvement for many of business organisation as well as the NHS. Given the
escalating global economic competitiveness and other external challenges, businesses have
been pushed to embrace long-term quality and quality management, which will boost their
competitive edge. Quality has evolved throughout time, and it now includes objective quality
bordering on the characteristics and quality of goods and services that fulfil implicit and
explicit client demands. It also contains subjective quality, which signifies the ability to
produce goods and services in the most effective, efficient, and effective way possible. In the
context of health-care delivery, quality has always been a goal since the time of Florence
Nightingale. Given that quality assurance is a requirement for economic survival as well as
an issue of ethics, law, and social rights, the health industry has been concerned about it for
more than a decade. Quality assurance is important because it affects customer satisfaction
and the minimization of risks associated with health care. Health care is currently a
developing profession with an approach to care quality based on the evaluation and
regulation of structure, process, and care result components. TQM is a system established by
an organization's management to ensure customer/patient satisfaction. In this age of
globalisation, the importance of TQM as a strategy for improving organisational performance
has expanded. Numerous studies have proven the impact of TQM in improving system
quality and improving employee and organisational performance. TQM stands for total
quality management, quality management, and continuous quality improvement. TQM is
regarded as an innovative method to organisational management. TQM integrates quality
orientation into all processes and procedures in health-care delivery in the medical industry. It
is currently widely used in many countries' medical sectors. To provide optimal health care
services, specific steps must be taken. When these stages are linked to relevant clinical
guidelines, optimal results are obtained. These key (or clinical) steps are referred to as the
critical (or clinical) pathway. The important pathway steps can be identified and plotted. An
organisation acquires a better grasp of what and how care is provided by mapping the current
critical pathway for a certain service. When a company compares their map to one that
depicts optimal care for a service that is consistent with evidence-based guidelines (i.e.,
idealised critical pathway), it discovers new ways to supply or improve delivered care.
Quality improvement efforts are an essential part of hospital operations. Because QI
operations are data-driven and involve human participants, it is not surprising that there may
be overlap with human subjects research approaches. Where QI and research approaches
intersect, federal restrictions protecting human study participants may apply. Whether the QI

activity involves human subjects research or not, it is critical that it be carried out in an
ethical manner that respects the rights and welfare of the human participants.Quality
improvement in healthcare refers to a systematic process used by a healthcare institution to
monitor, assess, and enhance quality healthcare standards. The organisational chain of
operations is cyclical, and it requires continuous improvement in order to achieve a greater
level of performance. Continuous improvement in healthcare activities can free healthcare
organisations from inefficient old conceptions and enable them to use technology/tools to
function more efficiently and hence produce higher-quality results.The approach to service
delivery, level of patient satisfaction, efficiency, and outcome are all intimately tied to quality
improvement. A successful programme constantly integrates quality improvement principles
in order to create an improved level of performance and a successful organisational
healthcare system. Here are four key principles that healthcare systems can use to improve
quality:
Work as Systems and Processes Rather than viewing an organisation as small and simple or
large and complex, it must comprehend its own delivery system and critical processes. The
key to any size organization's quality improvement approach should be to streamline "Input –
Process – Output" to match the needs of a given organization's health service delivery
system.The foundation of quality improvement is data. It outlines how present systems work,
tracks changes, and allows for comparison and monitoring for long-term improvements.
Better outcomes, less variance, fewer re-admissions, lower infection rates, and fewer medical
errors are all delivered by data-driven insights. To improve the quality of the healthcare
system, both qualitative and quantitative data collection approaches are used.The Advantages
of Quality Assurance in the Healthcare System
 Safe: A systematic and planned strategy aimed at optimising treatments for patients it
serves while avoiding damage. It promotes a positive safety culture, quality, and
openness.
 Effective: By enhancing the 'process,' a company decreases the risks of failure and
redundancy. The better healthcare system is based on data-driven research rather than
anecdote-driven experience.
 Patient-centered: Improved administrative and clinical process efficiency frees up
transition space for medical people to offer responsive, courteous, and real worth care
to patients.

Although quality enhancement algorithms have been extensively utilised in agribusiness and
majority of enterprises based on procedures, a few presume they cannot be implemented to
health care services due to its handcrafted nature. Clinical information is really not usually
thought of something which could be enhanced. Physicians gain the knowledge to provide
treatment for people, attempting to make independent choices for each particular instance.
Among the most significant roadblocks to wellness outcomes advancement is a lack of
knowledge that structures and procedures can exist side by side with personalised services.
With this knowledge, performance enhancement attempts could indeed focus on procedures
whilst also physicians continue to provide personalised performance of healthcare (Beam and
Kohane, 2018). There seem to be various central tenets that healthcare organisations must
take into account while using quality enhancement methodologies and techniques.
 Adaptation can be facilitated via hands-on infrastructure improvements. Merely
revealing health care professionals to quality enhancement concepts and addressing
research experiments does not encourage people to implement improvements. Hands-
on step towards improved quality enhancement hypothesis and research methods to
the real-world clinical setting—is a good way to gain knowledge quality enhancement
hypothesis and research methods. Adaptation would indeed be facilitated by
recognising a region which seems to be essential to healthcare professionals and
developing a framework for advancement.
 Describing Quality and Reach Consensus- Reaching consensus about what to quantify
as well as how to gather information on such metrics in any situational setting creates
what to quantify as well as the aspect of gathering and collecting information in
such metrics.
 Lean management prioritises customer benefit before concentrating on activities
which shape long term budget efficiency (Birdsall, 2018).
 Not for responsibility, but for enhancement- Quality advancement is aided by
information and quantification, but health support system is more difficult than other
industry sectors in this regard. While physicians initially listen regarding quality
productivity measurements, they automatically associate them with metrics, that also
appear to suggest responsibility. It is indeed critical to distinguish between
advancement and compliance requirements.
Approaches to continuous quality improvement (CQI) in primary health care have facilitated
adherence to best practise clinical recommendations and increased client attendance

frequency (1). CQI method implementation has also resulted in a CQI workforce, appropriate
health system supports, and collaboration with other organisations and community
participants (2). However, because the relative contribution of health care to health outcomes
is expected to be between 10% and 20% of gain (3–5), improving health-care performance
alone will not result in improved health outcomes. We believe that maximal benefit from CQI
for health care will be achieved through a systems approach in which comprehensive primary
health-care providers are better equipped to make evidence-based and locally responsive
decisions by integrating CQI vertically in links with other services. Internationally, numerous
effects of applying CQI in clinical health care have been reported. According to studies,
individuals with chronic diseases had fewer hospitalizations, and older patients have fewer
emergency department visits. Furthermore, studies show that the workforce's capabilities,
competencies, and enthusiasm for providing best-practice primary care have grown.
Improved organisational efficiency result from the availability of high-quality, timely local
data, such as the self-sustaining ability to notice, analyse, and improve quality concerns by
more efficiently controlling and allocating available resources. The CRE-IQI builds on and
expands on CQI methodologies that Indigenous primary health-care services have used since
2002 to improve best practise clinical health care. Over many years, CQI strategies have been
employed in various ways in Indigenous Australian primary health-care facilities. The
Healthy for Life, Audit for Best Practice in Chronic Disease, One21seventy, and Australian
Primary Care Collaborative programmes have been particularly significant in terms of their
broad scope and reach. A variety of initiatives have also been carried out at the local level.
The systems framework demonstrates the ability of primary health-care services to support
and extend CQI activities in two dimensions: vertically across the health system and
horizontally across sectors. Vertical integration refers to the use of CQI at all levels of health
care, from community participation and patient treatment through state, territory, and national
policy. Horizontal integration entails not just incorporating CQI into clinical guideline
adherence at the individual primary health-care service site, but also links and advocacy for
the social and cultural determinants of health. Connections to land and spirituality, family and
tradition, accommodation, education, employment, justice system, and other sectors that
impact health are examples of social and cultural determinants of health. Trained and
supportive employees, robust management structures, CQI systems and a culture, and funding
and cost-effectiveness are the conditions that promote an integrated systems approach to
health service improvement. Vertical and horizontal integration are not discrete processes
since "the influence of any given input depends on other circumstances in a system"—the two

must occur concurrently and reinforce one another. CQI action and engagement take place at
the health service, regional, and national levels of the health system, tackling systemic
impediments in local settings. Consistent and ongoing policy and infrastructure support for
CQI in the Northern Territory has resulted in a gradual uptake of evidence-based CQI
activities and a stronger increase in health-care performance than in other jurisdictions.
Performance improvement is mostly due to better decision-making, which is supported by the
active and timely participation of primary health-care teams in the collection, analysis,
participatory interpretation, and reporting of high-quality local health-care and health-
outcome data. CQI projects have traditionally relied on local service managers and
physicians, with quality improvement efforts impeded by a lack of localised and accurate
health-care performance data. However, significant development work has been done in
recent years, and a national CQI framework for Indigenous country primary health care is in
the final stages of consultation. Its impending release and implementation should draw
attention to how consistent policy and infrastructural support can be preserved to enable
widespread adoption of CQI activities.
Improving patient experience and happiness requires ensuring quality and safety in
healthcare. Healthcare process improvement refers to the deliberate quality increases made to
all related functions, with a strong emphasis on patient happiness. While drafting this, the
hospital administration must prioritise the staff and the healthcare facilities supplied, as well
as the practical demands and ambitions of the patients and their relatives. Because managers
and personnel in the healthcare sector will be in direct contact with patients, there must be a
strong emphasis on 'lean manufacturing.'
Cost reduction is critical in order to deliver cheap healthcare services to patients while also
profiting healthcare providers. Patients expect to receive quality care in hospitals, and when
this does not occur, patient satisfaction suffers. If hospital administration aims to boost
patient satisfaction, the cost-cutting procedure should be carried out methodically without
jeopardising healthcare quality and safety. The technique we generally advocate is a
systematic evaluation of the present organisational functioning style and the deployment of
strategic cost management. Quality management in healthcare is impractical unless the
throughput time is effectively and competently managed. In the healthcare industry,
throughput time refers to the total amount of time required to accomplish the relevant
therapeutic duties precisely and on time, so that patients feel at ease throughout their
outpatient appointment as well as their routine check-up. This encompasses all functions

related to the patients' points of interaction with the hospital. It is critical to manage
throughput time wisely in order to improve quality and safety in healthcare. This will restore
the hospital's credibility and friendliness. The productivity and performance of the workforce
are two critical areas on which management must focus in order to implement quality
management in healthcare. These two components are critical and will have an impact on the
outcome of the healthcare service. Productivity and performance are inextricably related. We
aid in developing and establishing the benchmarks against which the performance monitoring
committee will analyse, monitor, and verify the performance and productivity of the
personnel.
Conclusion
Thus it can be said there are a number of methods which can help the quality
improvement in health and social care systems and hence there must be utmost accuracy and
precision in maintaining and sustaining all those so that they can all add value to the society
in large and that too in the long run scenario.

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