Healthcare, …- Doing Right Things Right
Importance of Standards and its use
in Health Care":
(A Journey to Excellence)
“To improve Quality and Patient safety(QPS); Basic minimum( Standards) in Health care settings have to be inducted where care providers are encouraged to work towards these best practice objectives”. What Is It, Why Is It Important, and How Can It Be Improved ?.writes Dr Fiaz Fazili
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Do it Right…the First Time…Every Time. This definition of
Quality, as it relates to patient/health care , is conformance to the
established requirements or standard of
any organization. Unfortunately, value
of these indispensable ideals we appreciate
only when you or your loved one is
in the midst of a severe illness .
For
Quality ,All improvement is change. All change may not be improvement. Every day, thousands of Valleyites receive
health care that helps to maintain or restore their health. However, far too
many patients are concerned that the
care delivered is not, essentially, the
standardized one they should receive. Reflecting the need for urgent
action,under public and media outcry, ,on the high rate of Mortality and Morbidity in one of our hospitals, FMEA – Failure Mode and Effects Analysis,
exposed a system for fundamental change to close the gaps,
which describes a fragmented and
inefficient system of healthcare leadership, clinical governance
and accountability posing
many risks that are preventable. The sensitivity levels of expectations on improvement ,both
patients and ,society, clinicians and Health leadership probably never ran so
high .Crossing the quality chasm to bring improvement in safe practices for better health care, the
leadership was prompted to re-design and implement new care
processes under new managers, the results of
some of these steps are now visible and
getting appreciably brighter with time .Infrequently crucial reports on health care harms in print and/or our social media documenting the scale and gravity of
the problems eclipse these changes . Health care system under new innovative
leadership appears to be in mode of reforms on structure and organizational pressures, attempting to remove obstacles
that place, autonomy in healthcare
system’s human and material resources,
financial sustainability in competition with patient-centered care. Assuredly
, these
measures add value, and
possibility in improvement.
Building Tomorrow’s Healthcare- What
others do differently?
A Perspective on Governance, Leadership, and Direction ; Quality
in healthcare is never an accident …but
an integrated care arising out of disciplined team effort in an accountable
system well defined by its minimum
requirements ( standards manual )prepared by experts in this field ,for strict
compliance by its care givers with well defined policy procedures,job
descriptions and responsibilities under
the constant vigil of dedicated administrators. There’s an
old saying in emergency medicine: "Don’t just DO something, STAND
there." In other words, sometimes leaping into the fray without careful
thought can result in wasted effort, or even make matters worse. To improve an
operation's effectiveness, to get
everyone moving in a new direction
champions disperse across the
whole hierarchy of hospital positions
where many individuals and factors matter using the DMAIC Methodology. (the acronym for
Define, Measure, Analyze, Improve and Control).
Making System Accountable for monitoring
Hospital /employee, providing visibility and clarifying accountability
related to performance expectations. What to do ,if you find your
hospital is not meeting standards set
by the
concerned Authorities ? Inadequate regulations undermine
health care.The seriousness of the non-compliance needs strict enforcement. You can't manage what you don't measure. -an old management
adage that is accurate today. Unless you measure something you don't know if it
is getting better or worse.The
accountability process will help you know what to measure and how? The goal is to ensure optimal health care, patient, and staff
safety /satisfaction, avoid duplications and errors arising from the overuse, underuse or misuse of
hospital resources.”The private sector dominates health care in India, but
inadequate legislation and failure to enforce regulations are contributing to
poor quality medical services”, says a World Bank publication. “Eighty per cent
of spending on health in India is from personal funds, but existing laws do not
ensure that private medical services maintain even minimum standards”, says the
report.“Powerful medical lobbies have opposed government efforts to regulate
the private sector,” it says, adding that India's medical councils are not
enforcing laws relating to registration and licensing of medical
practitioners.( BMJ)
Do No More Harm; Perfection
versus excellence ;Health care-
a risk prone, specialized service with high expectations.. Knowing your sources of risk is
critical, picking up errors
before their actual occurrence(near misses)is excellence. Protect system from
inflicting harm or an abuse by encouraging
non punitive attitude
on voluntary error reporting ;
OVA -observation variation
accidents ,sentinel events , and eliminating causes of
recurrence by RCA –root cause analysis .Every State’s organization defines the basic minimum norms of,
Performance Standards and expectations, policy
procedures, protocol’s ,for strict compliance at every level and position. Health care leadership ensures an atmosphere to protect
patients, staff, others (Visitors-Attendants-Medical representatives ) and
themselves from danger, harm and abuse. Every duty-holder, supervisors, organization’s heads are
held accountable for failure to meet these standards. Besides enhancing
efficiency, standards focus your
understanding of what you can do to protect
yourself and others, and what
your responsibilities are in observing requirements for safety in medical devices, buildings, systems, and management of
professional practices without compromising patient care.
THE BIG QUESTION?; Will the Standards make a difference, When implemented? The ANSWER??
“More than anything, what distinguishes the great from the mediocre is not that
they fail less, it is that they rescue more”! AGawande.
Quality
in Healthcare is Everyone's Responsibility. We need a little help from the community too. Eliminating
disruptive behavior is essential to creating a culture of safety in Hospitals.
It's not uncommon for people to react to that stress in a very hostile,
aggressive fashion. Taking exceptions to negligence and/or greedy attitudes,
a big price to pay Medical Staff often work under difficult conditions.
Compromised standards, lack of clear protocols , substandard drugs or machinery
often mean the staff or building have to face the wrath of patients.
Dear lawmakers: This is what it’s like to be a care provider today. My true
wish is to illustrate the sacrifices doctors /other staff do make because I
feel we are not represented fully when laws are made.
We live in a world that loves to focus on success and loves to
compare. However, starting with basic minimums (standards), focus on the best
we can be and realize that our greatest competition is not someone else but
ourselves. A best practice Standards
establish consistency and
continuity, uniformity and integrated
care across multiple individuals and organizations ,where both receivers ‘or providers can expect to be respected, involved and told
what’s happening at every stage- You can expect care, treatment and support
that meets your needs. You can expect to be safe. You can expect to be cared
for by staff with the right skills to do their jobs properly—which helps future
accreditation process also. You can expect your hospital to routinely check the
effectiveness of its services. Nobody wants demoralized staff caring for them.
A punitive mindset often forgets to reward the people, share that improvement
with everyone who was responsible for the success, even if it's just a verbal
pat on the back.so let’s stick together ,shall we?"Coming together is a beginning. Keeping together
is progress. Working together is success."
**Feedback ;fiazmfazili @yahoo.com**Dr Fiaz
Fazili- Acute care Surgeon and Certified
Professional on Health care Quality, worked
for JCI accreditation with GE international for Hospital improvement standards)
