Addressing Barriers to Quality Service: A Healthcare Case Study

This essay examines the barriers to quality service in a healthcare setting, focusing on patient dissatisfaction with nursing care. It investigates issues such as delayed nurse response due to staff shortages and a perceived lack of respect for patient dignity. The essay details a case study where a health...Read More

Running head: BARRIES TO QUALITY SERVICE 1
Barriers to Quality Service
Student’s Name
University Affiliation

BARRIERS TO QUALITY SERVICE 2
Introduction
This essay discusses threats to quality process in a healthcare unit. It provides an
understanding of the steps that led to the problem and the possible preventive and recovery
process. A scholarly article that presents a similar case is addressed and how the organization
responded to the problem as well as the similarities between the approaches that were taken. The
essay also focuses on the fishbone analysis to address the issue of patient dissatisfaction with the
quality of care by nurses. Fishbone is a vital diagnostic tool used for analysis and illustration of
problems within the root cause (RCA) analysis (Oleske, 2014).
To understand what led to the issue of patient dissatisfaction with the quality of care by
nurses, a group of healthcare officers in a healthcare centre involved all their personnel including
the representative patients in a meeting to ensure everyone took part in the exercise. They called
upon one of their team members to facilitate the session with the writing up. A fishbone tool was
Patient’s
dissatisfaction with
quality of care by
nurses
Delayed
nurse
Lack of respect to
patient’s dignity
and independence
Lack of involvement
by nurses in decision
making
Poor
communication
-Poor nurse response due to
shortage of staff
-Nurses failed to
uphold patient’s
dignity
-Lack of communication
between team members
-Nurses did not
involve
patients or
family
members in
decision
making

BARRIERS TO QUALITY SERVICE 3
used to document all the possible causes that could have led to the problem. After the problem
statement was agreed upon, the team started to find all the possible causes using the ‘five why’s
(what, when, who, where and when) approach’ which was a significant search of the connection
in the main causes. Also, this technique enabled the team thoughts and processes to develop as
well as look at the possible causes, in preference to closed questions that tend to give a one-word
answer. Once the team agreed on the ‘possible causes’ of patient dissatisfaction with the quality
of care by nurses, they rechecked for the causes to know how and why they impacted the issue.
For example, nurses did not involve patients in decision making regarding treatment which made
them upset and felt that their dignity was not held.
Through the ‘root cause analysis’ (RCA) technique, the team could find some of the
answers to the problem. This comprised of scoping the needs for the patient's notes tracking
system as well as opting for a person-centered care (Nicolay et al., 2012). Eventually, the
facilitator helped the group to draft the action plan for other phases that provided structure to
resolve the issue, and a small project was started for improvement delivery. In the aspect of
delayed nurse response because of staff shortage, a post intervention phase was implemented to
develop person-centered care. This made the nurses tolerant to everyone including the patient
and family members. They developed proper ways of engaging themselves with all the people in
the unit which helped them to maintain the dignity of all including the patients.
Scholarly Article Addressing a Similar Problem
Respect is an essential element to patients since they need nurses to treat them as
individuals as well as engage them personally (Appari and Johnson, 2000). This goes in contrary
to everything that nurses have been learned since they are taught to be unemotional as well as

BARRIERS TO QUALITY SERVICE 4
objective. For the patients, (Appari and Johnson, 2010) holds that these kinds of connection help
nurses be on personal levels with them hence leave no room for mistakes by the service
providers. Although patients are not medical professionals, they use measures like
communication between doctors to access the quality of care they are getting (Card, 2013). This
manifest itself when there is poor or lack of communication between a doctor and a nurse hence
make a patient have a perception that he is receiving substandard care since that is what would
prevail when a nurse and doctor are not communicating with each other.
Most importantly, patients want to see happy healthcare providers since they are
approachable. For example, if a physician walks into the patient’s room and appears to be in a
hurry, the patient will be hesitant in asking questions since they do not want to be part of what
the physicist is going though. Also, when a nurse enters the patient’s room and appears to be
angry, the patient will not engage the nurse in questions since it is perceived that the nurse is
furious because of the patient (Card, 2013).
Above all, if a healthcare provider wants to win the complete trust and satisfaction of the
patient, they need to put the interest of the patients on top of everything they do since they will
continue to gauge their quality of care on their proxy measures. However, to become completely
transformed as well as progress in the value based care environment, Appari and Johnson (2010)
holds that nurses should know their patient's needs and since not every little problem can be
fixed, it is nice to be considerate of every patient's needs.
Summary and Conclusion
A fishbone diagram is a tool used to identify the possible leads to a problem, by establishing its
root cause from different possible causes using a systematic point of view (Dinesh et al., 2013).

BARRIERS TO QUALITY SERVICE 5
Another approach of analyzing a problem is the root cause analysis that focuses on answering
questions such as what happened? How did the problem occur? Why did it occur and what
possible remedies need to be developed as Honroe et al., (2013) explains. When using either of
the tool (Fishbone or RCA) some of the steps that need to be considered include; considering all
the people who are involved in a problem, commence a discussion with mind mapping to evoke
issue or ideas related to the problem statement, each key section should be investigated to find
the main causes of the problem and lastly a facilitator needs to be there to acts as note taker and
keep the team on the right path (De la Lama et al., 2013).
Through this process, the root cause of a problem is found rather than the possible leads of an
issue. However, delving deeper into a problem usually shows the possible outcomes that could
not have been mentioned in the previous cases. Although the participants in the RCA might seem
daunting, the skills gained through this exercise can help a person through their roles in the
healthcare profession (Duckett and Nijsen-Jordan, 2012). For example, nursing students can be
involved in the RCA exercise to develop awareness of their duties and professional responsibility
to take part in making the environment much safer for the patients.
Since the fishbone analysis helps in categorizing the causes of a given problem by helping a team
concentrate on the main cause of the issue instead of history, it’s increasingly being used at the
hospitals to improve both safety and quality care (Kumar and Aldrich, 2010). One of the good
ways of using fish bone tool is to motivate the team of staff involved with service delivery to
work as a team in identifying the possible causes of the problems that emerge in the health
service sector. The causes can be classified into groups including the method, people,
environment and equipment. After completing the exercise, solutions can be identified and the
action plan for the next phase determined.

BARRIERS TO QUALITY SERVICE 6
REFERENCES
Appari, A., & Johnson, M. E. (2010). Information security and privacy in healthcare: current
state of research. International journal of Internet and enterprise management, 6(4), 279-
314.
Askarian, M., Heidarpoor, P., & Assadian, O. (2010). A total quality management approach to
healthcare waste management in Namazi Hospital, Iran. Waste management, 30(11),
2321-2326.
Card, A. J. (2013). A new tool for hazard analysis and force-field analysis: The Lovebug
diagram. Clinical Risk, 19(4-5), 87-92.
De la Lama, J., Fernandez, J., Punzano, J. A., Nicolas, M., Nin, S., Mengual, R., ... & Ramos, G.
(2013). Using Six Sigma tools to improve internal processes in a hospital center through
three pilot projects. International Journal of Healthcare Management, 6(3), 158-167.
Dinesh, T. A., SINGH, S., NAIR, P., & Remya, T. R. (2013). Reducing waiting time in
outpatient services of large university teaching hospital-A six sigma approach.
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Duckett, S., & Nijssen-Jordan, C. (2012). Using quality improvement methods at the system
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Healthcare, 21(1), 29-33.
Honoré, P. A., Wright, D., Berwick, D. M., Clancy, C. M., Lee, P., Nowinski, J., & Koh, H. K.
(2011). Creating a framework for getting quality into the public health system. Health
affairs, 30(4), 737-745.

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Kumar, S., & Aldrich, K. (2010). Overcoming barriers to electronic medical record (EMR)
implementation in the US healthcare system: A comparative study. Health informatics
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Nicolay, C. R., Purkayastha, S., Greenhalgh, A., Benn, J., Chaturvedi, S., Phillips, N., & Darzi,
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Oleske, D. M. (2014). Epidemiology and the delivery of health care services. Springer.
van Wijngaarden, J. D., Scholten, G. R., & van Wijk, K. P. (2012). Strategic analysis for health
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