Table of Contents
Introduction
Errors and accidental deaths occur in hospitals during healthcare delivery. However, patients within a healthcare system have low tolerance for risky medical services. Frequent media reports about healthcare delivery challenges including medical errors, inaccessibility of medical services, and low quality of healthcare services raise fears and concerns among people globally (Spath, 2013). Over the years, international fears and concerns on medical errors and other healthcare delivery inefficiencies have necessitated researches to understand frameworks and systems for improving healthcare services delivery in hospitals. Consequent to the researchers, hospitals have been able to gradually improve the quality and safety of their healthcare services. Aspects of quality and safety in healthcare continue to evolve with time (Jiju & Preece, 2002). William Forster is famous for asserting, “Quality is never an accident; rather, it should always be a result of high intention, sincere effort, intelligent direction and skillful execution” (Davies, Powell & Ruhmer, 2009). Therefore, the development of improved health quality and safety frameworks is continuous and changes depending on the changing needs and expectations of patients and other stakeholders in the healthcare industry.
This paper covers on a business case analysis for a public healthcare organization within the United Arab Emirates. The case analyzes the health quality and patient safety aspects at the hospital, and provides a deep evaluation of the systems and frameworks for improving quality and safety processes at the organization. In the United Arab Emirates (UAE), the government is committed to creating and sustaining a world-class public healthcare infrastructure (Ali, Hunter, Whiddett & Tretiakov, 2017). World Health Organization reported that one-third of citizens in the UAE are overweight and one fifth of Emiratis live with diabetes. These high cases of obesity and diabetes means hospitals in the UAE will experience increased demand for healthcare services in the near future; hence, the government desires to expand healthcare services without compromising on quality and safety aspects. Also, the UAE government strives to make UAE a medical tourist destination globally. Therefore, improving UAE’s position as a global medical tourist destination requires keen focus on improving the quality and safety of healthcare services in UAE hospitals.
This paper comprise of two parts. Part A examines the quality and safety aspects within the public hospital in the United Arab Emirates. Quality and safety aspects are examined through the current safety and quality aspects at the organization followed by proposed options for improving the current level of health quality and safety at the hospital. The proposed options expand on business dimensions including necessary frameworks, risks of implementation, costs of implementation, and the elaborate investment plan for implementing improved quality and safety aspects at the hospital. Part B covers on a personal reflection of major lessons learned from completing Part A of the assignment. Also, Part B provides a personal perspective of healthcare quality and patient safety in the United Arab Emirates. The personal perspective of healthcare quality and safety issues in the United Arab Emirates is given from a point of view of a physician working at the public hospital featured in this paper.
PART A – Business Case Analysis
Organizational Context in regards to Quality and Safety Aspects
The public healthcare organization analyzed in this paper is a 450-bed referral hospital located in South-East Abu Dhabi. From this point onwards, the public hospital under analysis is referred to as Abu Dhabi H. Abu Dhabi H specializes in the provision of services including pediatrics, trauma care, surgery, and general medicine. Abu Dhabi H employs over 2000 staff members, with most of the employees being foreign nationals. In regards to healthcare quality and patient safety, the vision of Abu Dhabi H is to provide services with excellence and in a caring environment. Abu Dhabi H is part of the SEHA Health System in Abu Dhabi. Thus, Abu Dhabi H together with other hospitals under the SEHA Health System strives to improve its quality and safety aspects in line with the healthcare objectives of Abu Dhabi Vision 2030.
Quality and safety aspects in Abu Dhabi Vision 2030 touch on minimizing unnecessary accidents during treatment and improving patient outcomes. In line with the quality and safety aspects of Abu Dhabi Vision 2030, Abu Dhabi H seeks to attract and retain a competent workforce. Abu Dhabi H understands that medical errors occur whenever incompetent doctors are allowed to treat patients. Abu Dhabi H also understands the improvement of patients’ health conditions during and after treatment depends on the experience and skills of the doctors (Spath, 2013). Therefore, Abu Dhabi H desires to improve its quality and safety aspects by focusing on developing its personnel. In particular, Abu Dhabi H seeks to improve the quality and safety of its healthcare services by aligning the understanding of safety and quality among the hospital’s workers to the understanding of safety and quality aspects among the patients.
Abu Dhabi H understands health quality and patient safety as the provision of healthcare services that meet or exceed patients’ expectations. Patients expect hospitals to provide healthcare services characterized by no needless pain, no needless death, no unnecessary waiting, no inequality and discrimination in hospitals, and no wastage of recourses in regards to cost of procuring medical services (Ali et al., 2017). At the organizational level, the expectations of patients in health quality and safety translate to systems and frameworks for meeting the healthcare needs of the patients and their families. Therefore, Abu Dhabi H understands systems and frameworks for improving its health quality and patient safety practices as the templates for inputs and outputs of organizational culture, structures of healthcare delivery, and governance of the healthcare organization to meet the expectations of patients. The templates for quality and safety improvement at Abu Dhabi H are dynamic and adaptable to the changing perceptions of healthcare quality and safety among the patients.
Abu Dhabi H selects and implements frameworks (templates) that not only minimize pain and unnecessary deaths among patients but frameworks that also increase the speed of accessing healthcare services, especially for medical emergency cases including car accidents. Abu Dhabi H uses the healthcare frameworks to enhance patient-centeredness in the provision of its healthcare services (Koornneef, Robben, Seiari & Zaid, 2012). At Abu Dhabi H, patient centeredness results from a combination of five parameters including safety, timelines, equitability, efficiency, and effectiveness. Therefore, the structures, processes and outcomes of healthcare provision at Abu Dhabi H are aligned with the goal of increasing patient-centeredness by providing safe, efficient, timely, equitable and effective healthcare services.
Reasons for Resourcing and Implementing Health Quality and Safety
United Arab Emirates is struggling with high incidences of lifestyle diseases. The high-income economy of Abu Dhabi allows UAE citizens to spend most of their free times eating and sleeping. Are a result of inactive lifestyles and poor nutrition, 36.7% of deaths within the UAE in 2013 resulted from cardiovascular complications. Treating cardiovascular diseases is not only an expensive process but also require exceptional skills and experiences from the doctors (Davies, Powell & Ruhmer, 2009). Patients and family members dealing with cardiovascular diseases expect hospitals to prevent the deaths and minimize costs of treating cardiovascular diseases by providing timely, effective and efficient medial services.
Also, accidents, particularly occupational injuries and car accidents accounts for 19.6% of annual deaths in the UAE. Injuries from occupational and road accidents often cause quick deaths because of trauma and over bleeding; hence, accident victims require quick and effective medical interventions (Spath, 2013). The capacities for emergency medical services in most hospitals are often suboptimal. Emergency responses require hospitals to have enough resources including ambulances, emergency surgery units, and medical personnel with knowledge and experience in emergency medical interventions. Failure of hospitals to avail enough resources and personnel for emergency medical interventions lead to unnecessary deaths and needless pains among victims of accidents in the UAE (Corrigan & Parsley, 1999). Therefore, hospitals in the UAE, including Abu Dhabi H need to improve its timelines and effectiveness elements of quality and safety practices to meet the needs of accident victims.
Currently, Abu Dhabi H struggles with quality and health issues in responding to lifestyle diseases and emergency medical services. Most patients of cardiovascular diseases at Abu Dhabi H are Emirati citizens. However, most personnel at Abu Dhabi H are foreigners hired by the hospital to bridge the shortage of competent healthcare workers at the United Arab Emirates. In 2010, United Arab Emirates had 2.1doctors per 1000 Emiratis. In comparison, other nations with excellent healthcare reputations including Germany and France had 5.2 doctors per 1000 Germans and 4.7 doctors per 1000 French citizens respectively (Oxford Business Group, 2016). The shortage of qualified medical personnel in the UAE has necessitated Abu Dhabi H to hire foreign doctors. Unfortunately, foreign doctors have little understanding of health beliefs and behaviors of Emirati patients. Consequently, the efficiency of healthcare services in relation to patients-doctors cooperation is undermined by the cultural incompatibility between doctors and patients at Abu Dhabi H (Koornneef et al., 2012). Therefore, Abu Dhabi H seeks to improve its efficiency by recruiting and retaining more local healthcare workers.
Also, Abu Dhabi H realizes the need to modernize its structures and processes to prevent unnecessary deaths and meet patients’ expectations. Cancer accounts for 12.9% of annual deaths in the United Arab Emirates (Oxford Business Group, 2016). Globally, the treatment processes for cancers are indeterminate because the etiology and pathogenesis of cancers are still not fully understood. New and improved treatment procedures for cancer continue to emerge as a result of on-going research projects around the world (Davies, Powell & Ruhmer, 2009). Therefore, hospitals providing cancer treatment must keep up with the emergence of new evidence-based procedures for treating cancers. Abu Dhabi H seeks to improve the quality of its cancer treatment services by continually updating its structures and processes, particularly medical equipment, training of oncologists, and use of experimental treatment processes to meet the changing needs of cancer patients amidst latest treatment procedures for lifestyle diseases like cancer.
Frameworks and Options for Implementation
At Abu Dhabi H, frameworks for improving the quality and safety of healthcare practices should target the structures (personnel and medical infrastructure) and processes (the esprit de corps among medical personnel) (Langley et al., 2009). Quality frameworks allow hospitals to ‘do the right thing’ and to ‘do the thing right.’ Thus, frameworks for continuous improvement of health quality and patient safety at Abu Dhabi H involves adjusting the professional philosophy of the medical workforce to improve healthcare delivery processes and utilizing scientific methods to improve the structures (personnel knowledge and medical equipment) at the organization (Deming, 1982). Applicable frameworks include the PDSA cycle and LEAN management.
Deming Cycle (PDAS Framework)
Deming Cycle comprising of Plan-Do-Study-Act (PDSA) is an appropriate quality improvement framework for the case of Abu Dhabi H. Planning in the PDSA cycle involves recognizing opportunities for change in health quality improvement (Deming, 1982). Abu Dhabi H has recognized that most patients in the UEA are struggling with lifestyle diseases and road traffic accidents. Unfortunately, limited number of Emirati citizens in the medical workforce of Abu Dhabi H is undermining the efficiency of meeting the culture-specific needs and expectations of patients in the hospital (Oxford Business Group, 2016). Therefore, the planning phase requires Abu Dhabi H to partner with universities and medical schools across the UAE to recruit, hire and train more Emirati doctors.
The ‘Do’ stage of the PDSA cycle involves implementing a pilot study of the planned courses of action (Buccini, 1993). Abu Dhabi H will implement its plan to partner with UEA medical schools by absorbing a small sample of UAE medical graduates in internship capacities. The internship capacities will enable Abu Dhabi H determine whether or not the Emirati medical students are better placed to meet the culture-specific needs of Emirati patients compared to foreign doctors working at Abu Dhabi H. At the ‘Study’ stage, Abu Dhabi H gathers data on the incidences of medical inefficiencies and ineffectiveness, patient satisfaction rates, and changes in cost of care brought by the inclusion of the Emirati interns at the Abu Dhabi H’s workforce.
The last stage of ‘Act’ in the PDSA cycle involves relying on the findings from the ‘Study’ stage to make decisions and implement successful courses of actions. At Abu Dhabi H, inclusion of more UAE nationals in its team of physicians and nurses will either improve the aspect of patient-centeredness and yield better patient outcomes or lead to more cases of medical errors and patient dissatisfaction (Abduelkarem, Hassali & Khalid, 2015). The outcomes from the three earlier phases of Plan-Do-Study will inform the eventual decisions taken by the hospital (Deming, 1982). In the case of failure of the first three stages, Abu Dhabi H will have to restart the PDSA cycle by making alternative plans to improve the health quality and safety issues in its healthcare services delivery. Therefore, the Deming Cycle (PDSA cycle) is a self-contained framework for quality improvement.
LEAN Principles and Continuous Quality Improvement
Besides the PDSA Cycle, Abu Dhabi H can improve its processes by using the LEAN principles of quality and patient safety management. In healthcare, LEAN principles of management seeks to minimize wastages including wastage of resources, wastage of time, and wastage of personnel skills and professional goodwill (Spath, 2013). LEAN philosophy at Abu Dhabi H will help in minimizing cases of unnecessary deaths and patient dissatisfactions resulting from delays in the provision of medical services, deaths resulting from incompetence among the employees, and delays and dissatisfactions resulting from lack of adequate resources including medical equipment and staff members.
LEAN principles in quality improvement are used to improve processes of healthcare delivery by eliminating non-value-added parts of a process to create a process that offers a precise value for customers (Spath, 2013). At Abu Dhabi H, LEAN principles of management will be used to create interdisciplinary workplace teams to improve workplace cooperation (Booth & Snowdon, 2007). In healthcare, employees’ teamwork is a powerful driver towards increased efficiency of medical processes. Errors in the provision of medical services often result from lack of proper communication between medical personnel. Therefore, interdisciplinary teamwork and friendliness among the medical personnel will reduce inefficiency of processes at Abu Dhabi H.
LEAN Principles are also useful in inventory management to prevent either underuse or overuse of resources and processes. Two leading causes of death in the UAE include lifestyle diseases (cancer, diabetes and cardiovascular complications) at 36.7% and accidents (road traffic accidents and occupational injuries) at 19.6% (Oxford Business Group, 2016). Based on these statistics, more than half of resources and medical processes at Abu Dhabi H should be devoted to providing care for patients of lifestyle diseases and accident injuries. LEAN principles of management helps hospitals in determining whether certain departments are understaffed and under-resourced based on the prevalence of different healthcare conditions within the patient population (Davies, Powell & Ruhmer, 2009).
LEAN philosophies will allow Abu Dhabi H to increase specialists and equipment for priority areas including diabetes, cancer and emergency casualty for accident victims. For optimal results in health quality and patient safety improvement, LEAN principles are complemented with the Continuous Quality Improvement (CQI) framework. The CQI philosophical framework advocates for reliance on scientific knowledge to improve the design of work structures and processes (Spath, 2013). Healthcare organizations must rely on evidence-based best practices to improve the quality and safety parameters of its healthcare processes and structures (Abduelkarem, Hassali & Khalid, 2015). Abu Dhabi H will use the CQI framework to continuously identify, approve and evaluate the use of emerging evidence-based best practices in healthcare services delivery.
Specific, Measurable, Expected Benefits
From the patients’ perspective, high-quality and safe healthcare services are characterized by no needless death (safe), no needless pain (effective), no helplessness (patient-centered), no unwanted waiting (timely), no unnecessary costs (efficient), and no discrimination and inequality (equitable) (Buccini, 1993). Therefore, Safe-Timely-Effective-Efficient-Equitable-Patient-centered (STEEEP) model governs the specific benefits for continuous quality improvement at Abu Dhabi H.
Quality benefits based on the STEEEP model will be implemented and measured with the guidance of the SERVQUAL instrument. The SERVQUAL instrument measures five key aspects of healthcare services quality including reliability, responsiveness, assurance, empathy and tangibles (Berry, Parasuraman & Zelthami, 1988). SERVQUAL instrument measures the outcomes of services based on overall satisfaction of patients. Patient determine their satisfaction with a healthcare service based on word-of-mouth, expected service, perceived service, personal needs, and past experiences. On the other hand, hospitals design their healthcare structures and processes based on the perceived expectations of patients, external communication with patients, and service quality specifications in the larger healthcare industry.
The SERVQUAL model measures the objectives of quality and safety at three stages including the pre-service stage, at the point of service, and at the post-service stage. The measure of reliability targets safety and effectiveness of medical services in a hospital (Berry, Parasuraman & Zelthami, 1988). Safe and effective medical services minimize risks of needless deaths by improving the professional vigilance of doctors and nurses during services delivery. Responsiveness measures the timeliness and patient-centeredness of medical services. Timely healthcare services are prompt and immediate while patient-centeredness involves providing customized services based on each patient’s needs (Berwick, 2003). Responsiveness is measured through average time patients wait in lines before being attended by medical personnel.
Assurance is closely related to efficiency of medical services, and depends on the competence and expertise of medical personnel and the effectiveness and efficiency of medical infrastructure. Customers determine the assurance of medical services based on their past experiences and through word-of-mouth from other patients (Berry, Parasuraman & Zelthami, 1988). Thus, perceived efficiency of medical services is measured based on the overall reputation of Abu Dhabi H in the UAE’s healthcare industry. The measure of empathy relate to patient-centeredness and equity in services delivery. Empathy is measured from how patients perceive the willingness of medical personnel to provide prompt and customized assistance (Berry, Parasuraman & Zelthami, 1988). Lastly, tangibles relate to the physical appearance of a healthcare facility including its employees’ uniforms and the newness of its medical equipment. Tangible dimensions of service quality affect effectiveness, efficiency, and equitability of medical services including the provision of ramps for disabled patients in wheelchairs.
Risks Associated with Implementing Quality and Safety Options
One identifiable risk is resistance or lack of cooperation from the workforce while promoting a culture of ‘learning-from-mistakes.’ Improving quality and safety of healthcare services involves learning from past mistakes (Koornneef et al., 2012). While implementing the PDSA cycle, leaders at Abu Dhabi H will require medical personnel to fully disclose common mistakes and failures in their day-to-day duties to inform the training and development needs of the workforce. Unfortunately, employees may perceive the admission of past mistakes and failures as admitting to incompetence.
Workers may withhold crucial information or provide false accounts of past mistakes to avoid the perceived negative consequence of admitting to incompetence. Consequently, withholding information or providing false accounts will undermine the use of continuous quality improvement frameworks (Langley et al., 2009). The leadership at Abu Dhabi H can prevent workers’ resistance or lack of cooperation by using anonymous means for full disclosures to inform the overall inefficiencies within the workforce.
Another possible risk is the high authority gradient within the UAE healthcare industry. Workplaces in the UAE are characterized by top-down communication hierarchies where senior managers direct and controls subordinate staff members while subordinate workers exert little influence on the decision-making process (Oxford Business Group, 2016). Therefore, the steep authority gradient at Abu Dhabi H will prevent managers from delegating decision-making duties to the knowledgeable frontline staff members; hence, undermining interdisciplinary teamwork (Ashley, Harris & Lorraine, 2017). Risks resulting from the high authority gradient can be minimized through the training of senior managers on delegation of authority.
Cost of Quality and Safety to the Organization
Failure to improve quality and safety aspects at Abu Dhabi H will lead to negative financial and non-financial costs. Anticipated financial costs include increased compensation of patients harmed by medical errors at Abu Dhabi H following medical malpractice lawsuits and loss of revenues attributable to decreased patient population in need of the hospital’s services (Koornneef et al., 2012). Poor word-of-mouth and dissatisfactory past experiences with the safety and quality of medical services at Abu Dhabi H will push patients to other hospitals in Abu Dhabi. Eventually, decreased revenues will compromise the financial viability of Abu Dhabi H.
Non-financial costs of not improving quality and safety issues include the damaged reputation of Abu Dhabi H. Abu Dhabi H is part of the SEHA Health System tasked with improving the quality of public hospitals across Abu Dhabi (Abduelkarem, Hassali & Khalid, 2015). The government of the UAE wants to make Emirates a medical tourist destination. However, failure of the SEHA Healthcare System to improve quality and safety of healthcare services in all public hospitals will compromise the plan of the government to make UAE a medical tourist destination by the year 2030. Thus, failure to improve quality and safety at Abu Dhabi H will negatively affect national objectives of the UAE.
High Level Plan for Implementing Quality and Safety
This plan uses the SERVQUAL instrument to improve the safety, timeliness, effectiveness, equitability, efficiency and patient-centered aspects of healthcare services at Abu Dhabi H. The plan details specific and real-world actions targeted at improving reliability, responsiveness, assurance, empathy and tangibles of healthcare services at Abu Dhabi H.
| SERVQUAL Item | Specific actions | Timeframe |
| Reliability | 1. Contract more consultants and specialists 2. Train existing personnel using evidence-based best practices 3. Replace old medical equipment with new ones | Between 6 months and 12 months |
| Responsiveness | 1.Increase number of employees for priority departments in casualty and lifestyle diseases 2. Acquire more medical equipment to reduce delays and waiting times | Within 12 months |
| Assurance | 1.Display certifications and accreditation permits on waiting lounges to reassure patients | Within 2 months |
| Empathy | 1.Train personnel to smile and make eye contact with patients 2. Encourage employees to listen to patients during treatment | Within 12 months |
| Tangibles | 1. Distribute new uniforms to employees every 6 months to improve their appearance 2. Redesign the hospital’s built environment to allow to address the needs of disabled patients | Within 6 months |
Investment Appraisal for Implementing Quality and Safety
Improving quality and safety aspects should not only seek to address the needs of the patients but should also preserve the fiscal well-being of a hospital. Implementing quality and safety involves hard cash spending and results in both hard cash improvements and soft fiscal outcomes (Swensen et al., 2013). Hard cash improvements include increased revenues and reduced revenue losses while soft fiscal outcomes include improved reputation of the hospital and any other non-quantifiable benefits. The investment appraisal tabulated below determines whether each item of the SERVQUAL instrument leads to either hard cash improvements of soft fiscal outcomes.
| SERVQUAL Item | Costs of implementation | Expected financial returns |
| Reliability | Hard Cash Expenditure | Hard Cash Increases |
| Responsiveness | Hard Cash Expenditure | Hard Cash Increases |
| Assurance | Hard Cash Expenditure | Soft Fiscal Increases |
| Empathy | Hard Cash Expenditure | Soft Fiscal Increases |
| Tangibles | Hard Cash Expenditure | Hard and Soft Increases |
Conclusion
Overall, the current quality and safety aspects at Abu Dhabi H require improvement to meet the national objectives of UAE’s healthcare visions. Abu Dhabi H needs to improve its staff composition and the responsiveness of its emergency medical services as necessitated by the cultural-specific needs of UAE patients and the prevalence of emergency medical cases at UAE. Quality and safety can be improved continuously through the PDSA cycle, the CQI framework and the LEAN management principles. Improved quality and safety are measurable through the SERVQUAL instrument. Successful improvement of health quality and patient safety will reduce revenue losses and improve revenue generations.
Part B – Personal Reflection
Reflecting on definitions of quality and safety plus the frameworks for improving quality and safety will be applicable in improving my professional undertakings as a medical professional within the UEA healthcare industry. The value of personal reflection cannot be underestimated in applied settings of healthcare professionalism (Critical Thinking Community, 2011). Francois Arouet (1694-1778) once said, “Judge a man by his questions rather than by his answers.” Competent professionals in the healthcare industry enhance their skills by raising critical questions, gathering relevant data, and arriving at informed conclusions based on the evidence gathered (Berwick, 2003). Thus, addressing complex problems in the healthcare industry require open-mindedness and thinking ‘outside the box.’ Critical reflection of learning contents is a practical way thinking ‘outside the box’; thus, leading to self-improvement and flexibility in professional undertakings.
Module 1 on ‘Introduction to Quality and Safety’ covered on important aspects of continuously improving quality and safety of healthcare sectors. The module raised questions including: Why is quality and safety defined from the perspective of patients? The healthcare industry is a business sector operating with the basic business principles of demand and supply (Booth & Snowdon, 2007). Hospitals are established to meet the demand for healthcare services among a nation’s population. On the other hand, patients come to hospitals seeking healthcare services that meet their specific needs. Healthcare organizations including the Abu Dhabi H exists for the sole purpose of meeting the demands of the patients (customers). Without patients, hospitals will cease to exist. On that account, everything done by a healthcare organization must be centered on the needs of patients. Therefore, the definitions of quality and safety can only be understood from the perspective of patients.
Another question raised by Module 1 is: Why do the needs of patients in regards to quality and safety of healthcare services change with time? The primary purpose of seeking medical services is to improve the medical conditions of ailing patients. Injured victims of car accidents rush to hospitals to seek emergency treatments that stop their bleeding and subsequently save their lives. In certain circumstances, hospitals fail to save lives because of limited knowledge, skills and infrastructure of medical provision within the hospitals (Berwick, 2003). Therefore, patients know that the quality and safety of medical services vary from one hospital to another. Hospitals that use advanced medical equipment and employs knowledgeable and skilled personnel deliver better medical services than hospitals that use old medical equipment and employs incompetent doctors. In this context, patients change their understanding of high-quality and safe medical services depending on the changes of medical practices not only within the national healthcare sector but also within the global healthcare scene (Berwick, 2003). Therefore, needs of patients change with time because of advancing practices of healthcare provisions around the world.
Module 1 also raised a third question: Why do the quality and safety of healthcare services vary from one hospital to another? The provision of healthcare services to meet the patients’ needs is a commercially competitive endeavor. Like any other business endeavor, each healthcare organization seeks to improve its revenues by attracting more patients willing to consume their services at their predetermined prices (Davies, Powell & Ruhmer, 2009). Also, hospitals understand that patients are attracted by healthcare services with attributes including no unnecessary deaths, no unnecessary pains, short waiting periods, limited wastage and no discrimination of patients by the medical staff. Therefore, each hospital uses whatever frameworks suit them to meet the specific needs of the patients. Some hospitals utilize effective and evidence-based frameworks to meet patients’ needs while other hospitals use ineffective methods in a quest to meet the needs of their patients. Eventually, hospitals like Abu Dhabi H that choose to use tried-and-tested methods of improving structures and processes including the PDSA cycle and LEAN management principles are able to better meet the needs of the patients compared to hospitals that fail to use effective quality improvement frameworks.
We can do it today.
The answers to the three questions raised by Module 1 will help me in the day-to-day performance of my duties as a family physician at Abu Dhabi H. My daily duties as a physician include eliciting diagnostic information from patients, performing tests and diagnostic imaging to determine patients’ medical conditions, and administration of prescription medications to patients. After completing Module 1, I learned that patients demand for medical services characterized by no unnecessary waiting. Quickness of healthcare delivery processes depend on the speed of individual physicians in delivering care to each patient (Berry, Parasuraman & Zelthami, 1988). For example, I attend to approximately 30 patients every day. My ‘next patient’ often waits for averagely 45 minutes before entering my office for consultations. 45 minutes of waiting time is cumbersome and tiresome to most patients because patients have inherently low tolerance for long waiting periods.
Therefore, elements of responsiveness and timeliness in the definition of quality healthcare services taught me that I should improve on my speed while attending to each patient during consultations to lower the average waiting time from 45 minutes to perhaps 20 minutes. Reducing time wastages during my daily duties require the application of LEAN management principles. During consultations, I spend averagely 8 minutes between patients waiting for nurses to deliver records of medical histories for returning patients. Some medical records at Abu Dhabi H are still kept in hardcopy folders in cabinets. Retrieving the hard copies of medical records and delivering them to relevant points of care lead to unnecessary time wastages. LEAN management principles advocate for use of technology, particularly electronic management of patient records, to minimize time wastages (NHB Institute for Innovation and Improvement, 2007). Therefore, incorporation of appropriate technological solutions will quicken my services as a family physician.
Also, I need to rely on the PDSA cycle to improve my duties while administering prescription medications to patients. There are different medications for treating health conditions including cancer and diabetes. Different medications have different efficacy levels and different side effects. In applied settings, it is upon a physician to determine the best type of medication to prescribe a patient depending of a patient’s preferences and nature of a patient’s medical condition. The PDSA framework provides a practical template for continuous improvement in determining the efficacies of different medications. Therefore, I will use the PDSA cycle to continuously improve my decisions in future prescription of medications to patients.
Overall, Module 1 has enhanced my understanding of health quality and patient safety parameters in healthcare delivery. Consequently, lessons gained from Module 1 will help improve my daily professional responsibilities as a family physician.
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