Healthcare Quality Management: Patient Safety at GRH & SMGH Case Study

This case study examines patient safety and quality management at Grand River Hospital (GRH) and St. Mary's General Hospital (SMGH). The analysis evaluates the hospitals' performance against benchmarks and national standards, highlighting areas for improvement such as physician engagement, critical incident reporting, and patient-centered care. The study identifies deficiencies in the existing systems and proposes initiatives to address these issues, including technological advancements, improved communication, and enhanced human resource plans. The anticipated outcomes include increased employee engagement, improved patient care, and enhanced skills among staff. The case emphasizes the importance of evidence-based practices and inter-professional collaboration in achieving sustainable improvements in patient safety and healthcare quality. The study also addresses the need for long-term strategies to meet the demands of an aging population and increased hospital admissions, advocating for innovative approaches to healthcare delivery.

Running Head: Healthcare Quality Management
Assessment
Title: Healthcare Quality Management
(Case Study: Patient Safety at Grand River Hospital & St. Mary’s General Hospital)
Student Name:
Student ID:
University:

Healthcare Quality Management 2
Abstract
Patient Safety refers to a responsibility and discipline that focuses on prevention, reduction,
reporting and analysis of medical errors which often result into adverse events. The Grand River
Hospital and St. Mary General Hospital aims to address the concept of patient safety by
identifying the deficiencies and opportunities present in the Organization System and providing
effective measures of quality improvements in patient safety. The hospitals adopt the approach of
changing the attitudes in patient care and technical up-gradation. The report analyzes the case
study of both these hospitals against the benchmarks and national standards, explains the
observations about where the quality improvement is needed, lists the goals for initiatives that
address those deficiencies in quality, the anticipated outcomes and expected timeframes to re-
evaluate the data.
Keywords: Healthcare; Office; Quality; Management;

Healthcare Quality Management 3
Introduction
Patient Safety refers to a responsibility and discipline that focuses on prevention, reduction,
reporting and analysis of medical errors which often result into adverse events (World Health
Organisation, 2018). The patient safety includes how the Healthcare Organizations protect their
patients from the adverse incidents like accidents, hospital borne infections, medical errors and
injuries (Ghahramanian, Rezaei, Abdullahzadeh & Sheikhalipour, 2017). The government and
healthcare Organisations take effective measures to maintain the safety of patients. According to
CBC News, “Inadequate patient safety costs more than half million deaths in US hospitals, every
year mainly due to preventable medical errors”(CBC News, 2018). Effective measures to
maintain the patient safety involve reducing the infection rate, facilitating transparent
communication with the patients and putting quality checks to mitigate the medical errors.
However, few hospitals have no such mechanisms in place which results in experiences of fatal
complications, reduced rate of recovery and preventable death incidents. The Grand River
Hospital and St. Mary Hospitals have best effective patient safety standards.
Grand River Hospital (GRH) has its own quality framework with a quality and patient safety
committee, quality councils and teams to make the hospital responsible for the safety and quality.
According to Canadian Institute of Health Information, GRH uses five benchmark indicators to
assess its performance: Mortality after major surgery, Nursing-sensitive adverse events in
surgical patients, Nursing-sensitive adverse events in medical patients, Readmissions after
surgery and Readmissions after medical treatment (CBC News, 2018).

Healthcare Quality Management 4
St. Mary’s General Hospital (SMGH) uses lean management approach to bring consistent
improvement in delivery of quality healthcare. The hospital has an objective of bringing 1000
improvements in a year and has a quality committee framework with ‘algorithm of actions’ to
mitigate the adverse events. It is known as the safest hospital in Canada with a vision of
‘Respect, Innovation and compassion’ (GRH Strategic Plan, 2017). Even after all this, these
hospitals still lack in quality standards and need to eliminate their medical and surgical errors
more effectively.
Data analysis against benchmarks and national standards
There are several areas of improvement in both of these hospitals to make them actually safe for
the patients. The hospitals do not follow a true culture of safety at both the frontline and
administrative positions.
For both the hospitals the evidences of poor attendance and underreporting at QCIPA (Quality of
Care Information Protection Act) reviews show that there is a shortage of agreement of
physicians about the existing quality improvement measures (Grand River Hospital, 2019).
Though the attendance of Physicians in these reviews is mandatory, most of them do not attend
it. They assume that the attendance is not to be enforced. Moreover, they are afraid of the legal
outcomes of reporting the medical errors (St. Mary Hospital Improvement Plan, 2011).
Both the hospitals have poor Critical Incident Reporting Records (CIRR) (Grand River Hospital,
2019). The data collected through the reports is generally variable and inadequate. Even the
consistent pressure from IOM for more than a decade, legal protections of QCIPA for the

Healthcare Quality Management 5
physicians, legislative requirements and administrative encouragement could not change the
behavior and attitude of physicians.
According to Bill 46, Excellence of care for All Act, both the hospitals have quality committees
to directly report the critical incidents to the administrators (GRH Strategic Plan, 2017). Both the
hospitals have annual quality improvement plans. Yet there is improper and irregular reporting of
critical incidents. It is because the physicians fear the legal repercussions and professional
criticism. There are cases of underreporting and absence from attending reviews. The
organizational design of the Hospitals encourages operator error, budgetary and commercial
pressures, missing safeguards and barriers, high workloads and bad communication (GRH
Strategic Plan, 2017). However, every two years both the hospitals conduct a patient, employee
and physician engagement survey and the results of the survey are transmitted to the senior
administrators.
In both the hospitals the healthcare delivery services comply to the standards of Canadian
Standards Association (CSA) (Grand River Hospital, 2019). Still the opportunities exist for
making the environment better for the patients by reducing the interruptions and noise. The
medication errors can be reduced by taking the patient safety as a systemic property instead of
considering it as an individual physician’s responsibility (Accreditation Canada, 2015).
Observations about where quality improvements are needed
The quality improvements are needed to develop patient centered care by engaging the patients
and their families in discussions and targeting the improvements on the basis of their feedback.

Healthcare Quality Management 6
The hospitals need to seek out evidence based best practice programs to adopt Quality based
Procedures. In both the hospitals, the existing procedures necessitate violations to complete the
jobs. The improvements in medication safety are needed by implementing new innovative
technologies and analyzing the systemic failures like staff workload and equipment design
(Accreditation Canada, 2015).
Most of the staff members have to work for longer hours at these Hospitals. Also according to
Emergency Wait Times Performance Metrics, the patients at emergency departments have to
wait longer to obtain care (GRH Strategic Plan, 2017). The information transfer in these
hospitals is not timely. The hospitals need to implement additional technologies to facilitate
effective transfer of information from the hospital to the other primary care departments.
According to Physician Engagement Survey 2018, the physicians play no leading role in
bringing the change in patient safety and care (Feldman, 2018). The physicians should lead the
role to facilitate improvements in the operations and overall care at the hospitals. There are no
employee talent management systems to implement recruitment, education, performance review
and compensation. Both the hospitals need an effective Human Resources Plan to consistently
support the professional development and education opportunities for the staff.
The reporting of the critical incidents and medical errors should be timely, accurate and
consistent without any fear of legal consequences (Office of Efficiency and Renewable
Energy ,2019). The clinicians should be transparent about their near-misses and medical errors to
find the solution to systemic causes. The attendance of physicians at the review should also be
consistent and regular. The environment can be made better for the patients by reducing the
interruptions and noise, and by putting the silence zones around the pyxis dispensing machines

Healthcare Quality Management 7
(Ghahramanian et al., 2017). The fall prevention strategy at ambulatory services and diagnostic
imaging services also needs to be improved (Accreditation Canada, 2015). There is a need to
address the strategy of information management system (Accreditation Canada, 2015).
Goals for initiatives that address those deficiencies/opportunities in quality
1. Development of patient centered care and evidence based guidelines by engaging the
patients and their families in discussions and targeting the improvements on the basis of
their feedback.
2. Implementation of new innovative technologies and analysis of systemic failures.
3. Develop an integrated electronic medical record to assist the patient care, in partnership
with the other hospitals.
4. Reduce the staff workload and longer waiting lines of patients.
5. Effective Human Resources Plan to consistently support the professional development
and education opportunities for the staff.
6. Support the patients through transparent communication.
7. Strengthen Physician Engagement and implement professional collaboration
Outcomes that are anticipated in order to accomplish the initiatives
The hospital have already organized quality competitions to identify the contributions of staff
members in safety improvement programs (Grand River Hospital, 2019). This improved the
participation at the grass root level and also improved the physician leadership considerably.

Healthcare Quality Management 8
Such programs should be conducted regularly in future also to improve the employee
engagement. The programs to elevate the communication skills, teamwork and leadership should
be included in the curriculum in addition to patient safety. The hospitals followed the model of
Johns Hopkins School of Medicine to demonstrate patient safety training sessions which
developed student’s skills in safety and systems thinking. Similar workshops can be hosted for
improving the skills of practicing clinicians.
Adjustments were made in Hospitals’ organizational structures for formalizing the positions at
leadership and enhance the responsibility at individual level. Mr. Sharma also introduced
process redesign based on extensive analysis. This model was helpful in measuring the variations
in care and analyzing the efficiency, quality and financial outcomes. The administrative structure
also developed to implement the guidelines on the basis of Intermountain Healthcare Delivery
System.
The evaluation programs like Physician Engagement Survey, Progress on Human Resource Plan
and patient Experience Feedback are highly effective in supporting the process of transformation
(Office of Research and Innovation , 2019). Improving the access to care and transforming the
processes is not a one day task. It requires a consistent improvement progress that is compulsory
to follow up for many years. The joint research programs guided by the Hospitals are expected to
improve the care for the patients in future and will also improve the skills, knowledge, and
abilities of the staff. Through knowledge exchange and transparent communications, exceptional
improvements in patient safety can be achieved (Okuyama, Galvao, & Silva, 2018).

Healthcare Quality Management 9
The hospitals need to optimize the safety and quality of patient care by facilitating the evidence
based programs. They need to demonstrate best medication safety by following the best practices
and improvements in creating the infrastructure and adopting new technologies.
The community of Grand River Hospital and the St. Mary General Hospital is continuously
aging. Within the next 10-15 years the population will have double the old age people whose
care would require 4-8 times greater resources than those used to care for young people. By the
next 5 years, the hospital admissions will increase by24% and thus the need for inpatient beds
will also increase by 34% (Ontario Hospital Association, 2019). The Grand River Hospital and
the St Mary Hospital have 4th lowest rates of inpatient beds use. Thus, the approach of these
hospitals demands new innovations in future with enhanced integration, improved efficiencies,
and standardized care. These hospitals need to be attractive in recruiting and sustaining the
highly skilled clinicians to facilitate consistent care.
The hospitals need to bring evidence based policy to bring quality improvements. The
coordination and transition of care need to be improved (GRH Strategic Plan, 2017). The
achievers in staff need to be recognized and appreciated for their progressive work culture and
quality performance.
The GRH Planning Framework involves five main components of internal planning:
Communications, Information Technology, Patient safety and quality, Human Resources and
Enterprise Risk Management (Grand River Hospital, 2019). The strategic priorities of the
hospital are in congruence with these components.

Healthcare Quality Management 10
Better hygiene methods like hand wash and sanitation procedures have reduced the risk of
preventable adverse events. The factors which contribute to patient safety may range from
communication and safety culture at the individual level to the active failures at the organization
level such as mistakes in clinical procedures (Yang, Poly & Li, 2019). Knowledge and skills up-
gradation can help in mitigating these risks in the hospitals (Yang et al., 2019). The local
working conditions, situational factors and team based efforts also need to be considered in
priority to make the working environment error free.
Appropriate time frames to re-evaluate data and provide a new analysis; Justify your response
With evidence based guidelines and inter-professional collaboration, the revaluation and analysis
of data will take around 1 year time to develop Quality Improvement Plan for these hospitals
(Goodman, Khemani & Cacao et al. 2018). Plan-Do-Study-Act methodology can be adopted to
accomplish the specified goals in two cycles of 6 months each.
PDSA Cycle I (Jan 2019 to June 2019) can be used to provide education and training to the staff
about Evidence Based Approach, Patient inclusion in care, and how to reduce work overload and
patient waiting line through professional collaboration and extended support. The role of soft
skills like compassion, open communication, positive attitude and cooperation can be focused to
improve the safety of patients. This cycle will also involve the training sessions on physician
leadership and integrated Human Resources Development Plan for the Healthcare staff.
Staff and Physician engagement will be increased by upgrading the skills, knowledge and
clinical skills of the staff (St. Mary Hospital Improvement Plan, 2011). It will improve the

Healthcare Quality Management 11
discipline and punctuality in physicians to attend the reviews on timely manner. A
Comprehensive Employee Talent Management Program will be put in the hospitals.
PDSA Cycle II (July 2019 to December 2019) can be used for electronic documentation,
installation of innovative technology and electronic medical records. By bringing this change the
hospitals would be able to assess the compliance of nursing staff with Standard Healthcare
Guidelines. It will help to monitor and track the patients and the staff performance within the
Organizations. It will establish a common information systems solution. The initiative will
improve the process of physician engagement. It will also help in early identification and
assessment of high risk patients to implement effective interventions for safety and care.
Conclusion
Both the hospitals have adopted exceptional initiatives to improve the patient safety and quality
performance. They consistently follow re-evaluation practices and surveys to improve and
monitor the met and unmet goals. The hospitals have adopted several strategies to consistently
improve the patient safety and care from 2012 to 2019. During the years 2012 to 2015, these
hospitals have done major transformations in facility renewal, capacity building and leading the
edge technology. They have improved greater access to services, have modernized the tools for
information management, have reduced the waiting times for the patients, improved their sound
infrastructure and physical environment while supporting the education and learning for the staff

Healthcare Quality Management 12
and students. The hospitals have continuously focused on the improvements in patient care and
services. However still there remain few areas which need further improvements. For example:
Improving the communication and inter-professional relationship, improving the technical skills
of the employees, bringing technical advancements in information exchange and improving the
discipline and diligence in staff.
References
Accreditation Canada (2015). Accreditation Report. Retrieved from http://www.smgh.ca/wp-
content/uploads/2012/01/Accreditation_Report-SMGH-2015.pdf
CBC News (2018). Grand River Hospital. Retrieved from
https://www.cbc.ca/news2/health/features/ratemyhospital/profiles/grand-river-hospital/
Feldman, S.S.(2018). Health Information Technology in Healthcare Quality and Patient Safety:
Literature Review. JMIR Med Inform. 6(2):e10264. DOI: 10.2196/10264
Goodman, L., Khemani, E., Cacao, F., Yoon, J., Burkoski, V., Jarrett, S., … Hall, T. (2018). A
comparison of hospital-acquired pressure injuries in intensive care and non-intensive care
units: a multifaceted quality improvement initiative. BMJ open quality, 7(4), e000425.
doi:10.1136/bmjoq-2018-000425