This article discussesin details High-Reliability Quality Program.
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High-Reliability Quality Program
The Memorial hospital needs to develop and implement a high-reliability quality program to improve and maintain safety, quality, and the overall patient experience. By developing intuitive designs to help employees perform effectively, the leadership team can improve reliability and leverage human factors. A high-reliability quality program requires the hospital to be preoccupied with failure, focusing on errors, mistakes, and near misses and learning from these errors to avoid them in the future (Anderson center, n.d.). Everyone needs to be part of fixing problems, and the leadership should encourage and support their involvement. A high-reliability quality program would help the leadership and the employees constantly ask “why” questions and invite diverse experiences and perspectives.
The hospital needs to be sensitive to operation. This program would enable the quality improvement team to be prepared for the unexpected, identify, and close loopholes where there is probable harm to the patients. The program helps maintain situational awareness, create teams that can speak up, and pay attention to front-line nurses, patient care attendants, techs, and the support staff. Implementing the high-reliability quality program would help the hospital be committed to resilience (Veazie et al., 2019).
The quality outcomes have increasingly dropped over the last two years. The leadership teams need to realize that mistakes and troubles can happen unexpectedly, but they should be quick to identify issues and respond to them immediately and effectively to minimize the impact. The program requires deference to the experts to help the hospital identify and respond to issues appropriately.
The hospital should empower the experts, who are the closest to the front-line, to make decisions when critical problems arise. These decisions help in quicker mitigation of issues that affect quality care delivery. The leadership team is expected to perform frequent walk-arounds to strengthen safety behaviors and identify and fix safety issues. The organization should learn from its failures and look forward to improving to minimize risk or harm. To solve these issues, the hospital needs to operationalize a high-reliability quality program.
Elements of Patient Experience to be Targeted for Quality Improvement
The hospital receives multiple complaints from patients. Many patients are generally dissatisfied with the services at the Memorial Hospital. The leadership team needs to address the issues patients present to improve care quality and safety, and overall satisfaction. Several patients complain about a lack of consultation and involvement in making medical decisions. A woman complains about her legal right to be involved in her patient’s treatment. There is a lack of employee-patient interaction and engagement. The physicians are also ignorant and do not consult the patient’s family on critical treatment matters. The implementation team should target improving physician-nurse patient relationships and engagement of the family in making medical decisions.
The practitioners lack multicultural awareness. The hospital should consider training programs to train their personnel on cultural competencies to work in a multicultural environment. Some staff members have poor attitudes towards particular patients, especially those of a different culture. Some patients complain of lack of consultation on making medical decisions based on the patient’s accent and assumption of lack of understanding for English. There should be training for multilingual competencies and respect for various cultures.
In-patients want the best experience, and some of them have complained of unsanitary rooms and negligence from housekeepers. They also report a lack of respect from the staff. The implementation team should target work ethics and accountability among the housekeepers to improve patient safety by ensuring the rooms are clean. Some patients also complain of a lack of timely treatment response. The delays can be critical in situations of dire need, and the hospital needs to focus on improving efficiency and treatment response. Other complaints are related to rudeness, arrogance, and lack of respect from staff. The organization should focus on adopting competency training programs and patient-safety awareness programs to help improve the relationships between staff members and their patients. The overall patient satisfaction is low, complaints keep on increasing, and the hospital needs a quick and strategic response to these issues, which a high-reliability quality program would provide.
Potential Resources The Hospital Can Utilize For Improving And Maintaining The Quality Of Care
There are multiple resources the organizations can develop and implement to address patient care quality and safety and general patient satisfaction. These innovative tools help address quality of care and safety issues evident from the patient’s complaints delivered to the CEO. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) enables healthcare organizations to conduct surveys to evaluate patient’s experience of their care, such as communication with physicians and nurses, staff responsiveness, and other care quality and safety indicators (“AHRQ patient safety tools and resources,” n.d.). The surveys are based on the patient’s perspectives, and they are critical for health service research and quality improvement.
The Comprehensive Unit-Based Safety Program (CUSP) Toolkit has tools that help build capacity to tackle safety issues by bringing together clinical best practices, attentiveness to safety culture, and the science of safety (“AHRQ patient safety tools and resources,” n.d.). Clinicians use the toolkit, w includes training tools that help improve care safety by enhancing the cohesion between clinical team members. The toolkit has teaching tools and resources that support redress at unit levels and include notes that provide step-wise guidance through modules. The organization should respond accordingly when a patient is harmed.
The Communication and Optimal Resolution (CANDOR) Toolkit allows healthcare organizations to respond immediately in case of patient harm and offer a timely solution to the patients and the caregivers (Dossett et al., 2019). The toolkit will be fundamental in preventing medical errors, mitigating malpractices, and improving disclosure.
Surveys on Patient Safety Culture (SOPS) are staff-administered and can help the hospital assess their staff’s perspectives of various safety culture aspects (“AHRQ patient safety tools and resources,” n.d.). The hospital also requires a curriculum to train staff to reduce risks to patient safety. The Team Strategies and Tools to Enhance Performance and Patient Safety 2.0 (TeamSTEPPS) is suitable for training since it includes multi-guide training resources that enhance teamwork and communication skills (“AHRQ patient safety tools and resources,” n.d.). The hospital should focus on improving care delivery by adopting a curriculum and training program for front-line workers.
Lean and Six Sigma Tools and Techniques
The hospital needs to generate high-quality output consistently by minimizing errors and increasing efficiency. The hospital should conduct frequent monitoring and measurement of performance to fix any issues and reduce output variations. There are several lean and Six Sigma tools that help ensure continuous delivery of high-quality services. The hospital should introduce Standard Work, which is the documentation for best practices for every task or service provided at a given moment (Suman & Prajapati, 2018). Standard Work is the baseline for improvement to ensure consistent, high-quality service delivery. The hospital can also develop and implement Control Charts, which are graphs used to track process behavior over time (Suman & Prajapati, 2018). The charts identify and address problems by looking at average outcomes alone rather than result variation. They help leaders avoid panicking during every up and downsizing.
The 5S Workplace Organization helps eliminate result variations. The technique involves sorting, setting, shining, standardizing, and sustaining (Suman & Prajapati, 2018). It helps in quality assessment by checking whether processes fulfill the 5S. Another improvement technique the hospital can employ is the DMAIC, a cycle consisting of defining, measuring, analyzing, improving, and controlling (Ahmed, 2019). This technique ensures that every change involves careful analysis and valuable data. It is used with every improvement opportunity. These Lean and Six Sigma tools would be effective for use in the high-reliability quality program.
Culturally Sensitive Programs
Cultural sensitivity accounts for people’s attitudes, feelings, and circumstances from distinct national, cultural, linguistic, religious, and racial heritage. Integration of cultural sensitivity into health care improves the efficiency of reaching diverse people and offering non-bias care. Healthcare practitioners should interact with patients and their families by following and respecting their norms to make them feel respected. Cultural competency helps minimize health disparities like language barriers, variation in health care access, unconscious and conscious medical bias, and cultural norms and practices (Jongen et al., 2018).
The patient-Centered, Culturally Sensitive Health Care model can help improve health outcomes, quality care, and patient safety. Culturally sensitive programs enhance practitioners’ cultural competency by increasing cultural awareness, eliminating assumptions, building trust and rapport, overcoming the language barrier, enhancing patient-active listening, and educating patients about care practices. Culturally sensitive programs are fundamental to patient-centered care.
Culturally sensitive programs in healthcare build understanding and help care providers be more aware and sensitive of other people’s cultures. Some staff members in Memorial hospital display cultural incompetency and insensitivity while interacting with patients. A patient complained about a lack of medical decisions about him because the physicians thought he did not understand their language. The lack of cultural sensitivity at Memorial hospital affects patient outcomes, and they feel left out in medical decisions that affect them.
The physicians and nurses need to do better regarding patient engagement and respect of patient autonomy despite language and cultural disparities (Kaihlanen et al., 2019). The patient’s needs should be a priority; otherwise, they feel violated. Cultural competency will also help eradicate arrogance, rudeness, and lack of respect among some staff members at the hospital. It would also make consultation and patient involvement easier since practitioners are more aware and understand varying languages and cultures. Translators can also be used to minimize the language barrier in health care.
Patient-centered care involves care provision that is respectful and responsive to an individual’s values, preferences, and needs, and ensuring these values and preferences guide every medical decision. Patient-centered care requires a true partnership between health care providers and patients (Jongen et al., 2018). Cultural and ethnic backgrounds sometimes affect an individual’s values. To develop healthy partnerships, health care providers need to undergo training on various cultures and languages to enhance their understanding and awareness.
The practitioners can then address specific needs and values based on a patient’s cultural provisions, improving patient-centeredness. Cultural values in most countries dictate medical decisions. Some treatment and testing procedures like drawing blood from the elderly patient at the Memorial hospital have cultural confrontations. In this case, the Chinese patient feels he will never recover the blood drawn. With a better understanding of the patient’s cultural beliefs, the physician would seek alternative testing methods or create a rapport that helps the patient understand the necessity of drawing blood for testing. Given the increasing Chinese demographics in the US, ER doctors ought to be more informed about their cultural beliefs and values. The ER doctor did not consult nor involve the patient’s values in making the medical decision to perform blood work, showing a lack of patient-centeredness at the Memorial hospital.
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Data Collection
The staff in Memorial hospital need culturally sensitive training. The training program would focus on identity, diversity, and engagement. The practitioners should reflect on how their cultural identity affects their lives and their family to understand better why they should respect a patient’s cultural identity in making medical decisions (Handtke et al., 2019). The programs also help the physicians, nurses, and other care providers critically evaluate how people from diverse backgrounds interact with each other. They would also focus on identifying all the barriers preventing creating an environment and a workforce that embraces diversity and equity.
The participants would then develop initiatives that facilitate an inclusive environment. Participants would also learn and examine strategies and activities that help promote cultural sensitivity, diversity, equity, and support of self-and social awareness (Handtke et al., 2019). Cultural sensitive programs would enhance patient-centeredness since the participants raise their cultural awareness, change behaviors to connect with patients more effectively, make better patient-inclusive medical decisions, improve communication skills, and speak up about cultural bias and insensitivity the hospital.
How A High-Reliability Quality Program Can Meet The Needs Of Culturally Sensitive Programs
The increasing patients’ complaints create a catastrophic atmosphere at Memorial hospital. Most of these complaints originate from staff-patient interactions, and the hospital should be proactive to address these issues and avoid an escalation of events. The high-reliability quality program can help the hospital build diverse teams that use the individual and expert experience to address the specific needs of patients. Cultural-diverse teams would enhance patient-centeredness since many patients would have a representative that can address their particular needs (Kumra et al., 2020).
Deep level diversity in healthcare teams is pivotal in reducing culture-related health disparities. High-reliability quality programs also support effective leadership and cultural maturity at the workplace (Kumra et al., 2020). The leadership should create a culture of inclusivity and patient engagement, enhancing patient safety since staff would be mindful of other people’s cultures. The leaders should be more engaged in providing patient care to monitor activities and foster cross-organizational learning of cultural diversity.
Approving high-reliability quality program concepts and principles at Memorial hospital would help create a culture of transparency, communication, accountability, continuous learning, and constant improvement. This program support deference to experts that can be involved in culturally sensitive training programs. Cultural experts can educate staff about the importance of cultural awareness and how to create an environment mindful of other people’s cultures. Experts are critical in addressing the situation of cultural insensitivity at the Memorial hospital.
Leaders should use experts and engage staff to create a transparent, communicative, and responsive culture of high reliability to manage cultural conflicts (Williams et al., 2020). The high-reliability quality program can also help create improvement models that make the hospital reluctant to simplicity. The staff at the memorial hospital have low motivation, and they report decreasing job satisfaction. The staff might have undergone culturally sensitive training previously, but they care less about the patients and care quality and safety because their working environment is unsatisfactory. They are more reluctant to engage patients.
However, improvement models can help the hospital refine the working environment, raise job satisfaction, engage more with their employees, and adopt culturally sensitive programs staff will be more willing to participate with a heightened motivation level (Williams et al., 2020). Improvement models enable a realistic and systematic approach to addressing the issues and achieve results that matter to patients, their families, and the staff.
The high-reliability quality program also facilitates continuous learning, ensuring situational awareness among staff at all levels (Veazie et al., 2019). Potential issues are easily identifiable and resolved quickly in an environment that is proactive and real-time. Culturally sensitive programs should be part of continuous learning to help correct the cultural insensitivity in real-time. Continuous learning also raises accountability levels and commitment to resiliency.
Health care practitioners can be held accountable for their actions now that they know better about other people’s cultures. Leaders coordinate with staff to undertake a quick situational evaluation and hold people accountable for their actions. Cultural sensitivity training integrated into the high-reliability quality program would ensure that individuals embody organizational and professional values.
References
Ahmed, S. (2019). Integrating DMAIC approach of Lean Six Sigma and theory of constraints toward quality improvement in healthcare. Reviews on environmental health, 34(4), 427-434. https://doi.org/10.1515/reveh-2019-0003
AHRQ patient safety tools and resources. (n.d.). Agency for Health Research and Quality. https://www.ahrq.gov/patient-safety/resources/pstools/index.html
Becoming a high-reliability organization | Safety | Anderson center. (n.d.). Cincinnati Children’s Hospital Medical Center. https://www.cincinnatichildrens.org/research/divisions/j/anderson-center/safety/methodology/high-reliability
Dossett, L., Miller, J., Jagsi, R., Sales, A., Fetters, M. D., Boothman, R. C., & Dimick, J. B. (2019). A modified communication and optimal resolution program for intersystem medical error discovery: protocol for an implementation study. JMIR research protocols, 8(7), e13396. https://doi.org/10.2196/13396
Handtke, O., Schilgen, B., & Mösko, M. (2019). Culturally competent healthcare–A scoping review of strategies implemented in healthcare organizations and a culturally competent healthcare provision model. PloS one, 14(7), e0219971. https://doi.org/10.1371/journal.pone.0219971
Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: a systematic scoping review. BMC health services research, 18(1), 1-15. https://doi.org/10.1186/s12913-018-3001-5
Kaihlanen, A. M., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: a qualitative study of nurses’ perceptions about cultural competence training. BMC nursing, 18(1), 1-9. https://doi.org/10.1186/s12912-019-0363-x
Kumra, T., Hsu, Y. J., Cheng, T. L., Marsteller, J. A., McGuire, M., & Cooper, L. A. (2020). The association between cultural competence and teamwork climate in a network of primary care practices. Health care management review. https://doi.org/10.1097/HMR.0000000000000205
Suman, G., & Prajapati, D. (2018). Control chart applications in healthcare: a literature review. International Journal of Metrology and Quality Engineering, 9, 5. https://doi.org/10.1051/ijmqe/2018003
Veazie, S., Peterson, K., & Bourne, D. (2019). Evidence Brief: Implementation of High-Reliability Organization Principles. https://europepmc.org/article/nbk/nbk542883
Williams, G., Irving, G., Wright, A. L., & Middleton, S. A. (2020). Managing Diversity in High-Reliability Teams in the Emergency Department. In Academy of Management Proceedings (Vol. 2020, No. 1, p. 20366). Briarcliff Manor, NY 10510: Academy of Management.
Question
PART 1
The Module Pre-Assessment is your opportunity to practice applying module content before submitting the final Competency Assessment. In the Final Assessment, you will be asked to develop a white paper that proposes a high-reliability quality program to address issues identified in the scenario provided.
To prepare for your Final Assessment, read the scenario and consider a justification for why the hospital needs to create a high-reliability quality program. Next, reflect on the descriptions provided for the elements of the patient experience to be targeted for improvement related to quality, safety, and overall satisfaction in the hospital. Then, think about what recommendations you could make for potential resources that could be utilized for improving or maintaining safety, quality, and the overall patient experience and explanations of why these resources would be of value. Finally, think about what Lean Management and Six Sigma improvement tools you would recommend for use in the high-reliability quality program.
For this Module Pre-Assessment, create a draft of your white paper. Be sure to review the Final Assessment instructions for more details and include the references that support the content of your white paper.
PART 2
The Module Pre-Assessment is your opportunity to practice applying module content before submitting the final Competency Assessment. In the Final Assessment, you will be asked to explain in the white paper you created for the Module Two Pre-Assessment, why culturally sensitive programs are important to patient-centred care and two ways the high-reliability quality program can meet this need.
To prepare for your Final Assessment, consider your rationale for why a cultural sensitivity program is important for patient-centred care. Then, reflect on how the high-reliability program meets the need for culturally sensitive programs.
For this Module Pre-Assessment, continue drafting your white paper to address why culturally sensitive programs are important to patient-centred care and how the high-reliability programs meet the need for culturally sensitive programs. Be sure to review the Final Assessment Instructions for more details and include resources to support the content of your white paper.
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To complete the Assessment, you will synthesize your learning about patient experience and culturally responsive patient care by creating a white paper that proposes a high-reliability quality program targeted to the audience described in the Memorial Hospital Patient Experience Scenario.
To complete this Assessment:
- Download the Academic Writing Expectations Checklist to use as a guide when completing your Assessment. Responses that do not meet the expectations of scholarly writing will be returned without scoring. Properly formatted APA citations and references must be provided, where appropriate.
- Be sure to use scholarly academic resources as specified in the rubric. This means using Walden Library databases to obtain peer-reviewed articles. Additionally, .gov (government expert sources) are a quality resource option. Note: Internet and .com sources do not meet this requirement. Contact your coach or SME for guidance on using Library Databases.
- Carefully review the rubric for the Assessment as part of your preparation to complete your Assessment work.
This Assessment requires the submission of one (1) file. Save your file as OM003_firstinitial_lastname (for example, OM003_J_Smith).
When you are ready to upload your completed Assessment, use the Assessment tab on the top navigation menu.
Instructions
Before submitting your Assessment, carefully review the rubric. This is the same rubric the assessor will use to evaluate your submission and it provides detailed criteria describing how to achieve or master the Competency. Many students find that understanding the requirements of the Assessment and the rubric criteria help them direct their focus and use their time most productively.
Rubric
Access the following to complete this Assessment:
Read the “Memorial Hospital Patient Experience Scenario”. Then, complete the following:
- Patient Experience, Improvement Tools, and Culturally Sensitive, Patient-Centered Care
- Develop a white paper that proposes a high-reliability quality program that will address the issues identified in the scenario. (7–10 pages)
- Your white paper should include:
- A justification for why the hospital needs to create a high-reliability quality program.
- Description of five elements of the patient experience to be targeted for improvement related to quality, safety, and overall satisfaction in the hospital.
- Recommendations for five potential resources that could be utilized for improving or maintaining safety, quality, and the overall patient experience and explanations of why these resources would be of value.
- A recommendation for three improvement tools (i.e., Lean Management and Six Sigma) that will be used in the high-reliability quality program.
- An explanation for why a culturally sensitive program is important for patient-centred care and two ways the high-reliability quality program can meet this need.
Related FAQs
1. What is high reliability health care?
High reliability health care refers to patient care that is consistently excellent and safe over long periods across all services and settings.
2. What does it take to achieve high reliability?
Achieving high reliability requires:
1 Leadership committed to the goal of zero harm.
2 An organizational safety culture where all staff can speak up about things that would negatively impact the organization.
3 An empowered work force that employs Robust Process Improvement tools to address the improvement opportunities
3. What is reliability?
What is Reliability? Quality Glossary Definition: Reliability Reliability is defined as the probability that a product, system, or service will perform its intended function adequately for a specified period of time, or will operate in a defined environment without failure.