Quality improvements are the main driver of change in hospitals. They make it possible to create a safer and more comfortable environment for healthcare professionals, provide a high level of patient care and improve the quality of the entire healthcare system. Improving the quality and safety of healthcare services is becoming increasingly crucial for nursing and healthcare systems as a whole, as healthcare organizations aim for efficiency, lower healthcare costs, and offer high-quality patient outcomes. This is a complex and multi-level task that requires detailed analysis and a critical individual approach for each institution and has many current challenges for the quality and safety professionals in hospitals.
A systematic, data-driven strategy for improving the quality and safety of healthcare delivery is known as quality improvement. It is the responsibility of quality and safety professionals in hospitals who aim to create an environment that allows for providing safe, timely, efficient, efficient, fair, and patient-centered care. It aims to provide care that is safe, timely, effective, efficient, fair, and patient-centered. Current challenges that quality and safety professionals are facing in hospitals may include readmissions, infection rates, medication errors, falls of patients, medication-related adverse events, under-optimization of sepsis care, poor use of electronic medical records, and problems in coordination and care between departments (Graban & Toussaint, 2018). All these factors are a problem for different hospitals to a greater or lesser extent. However, all of them negatively affect the quality of patient care and, with the right approach and techniques, can be minimized by a quality and safety specialist. This will allow the hospital to improve its operations in everything from financial savings to, most importantly, saving patients’ lives.
Continuous Quality Improvement analyzes patient care in order to provide better and more efficient healthcare. It is a continuous healthcare improvement process that aims to improve healthcare by identifying problems, implementing changes to address those problems, monitoring whether the changes are helping, and making additional adjustments if the changes do not produce the desired results.
The successful creation of a continuous improvement environment for hospitals is the result of a careful and thoughtful structured approach to planning. The key factors are, first and foremost, identifying the most pressing problems facing the institution and setting clear and measurable targets to mitigate them. 5W1H (who, what, where, when, why, how) is a method of asking questions about a process or problem that needs to be improved. In the context of a problem such as readmissions, this model might include questions such as “Who is affected by this phenomenon?” “What specifically happened” “Where did the problem occur?” “When and at what stage did the cause of the problem arise” “Why did the problem arise?” After that, it is analyzed how it could have been avoided and how to avoid it in the future. An important factor is also the evaluation of current processes in order to determine what functions do not work in the current hospital and what needs to be changed. Once the goals and methods are defined, the next factors that create an environment for continuous quality improvement are to create a culture and infrastructure for continuous improvement and apply the methods in daily practice.
The readmission rate is one of the quality indicators of hospital care that may be used to evaluate the process of a treatment since it indicates the influence of hospital care on the patient’s status after discharge. Medication is responsible for around 16% of readmissions, with 40% of these possibly avoidable (Uitvlugt et al., 2021). Non-adherence (35%) and prescription mistakes (35%), followed by transition errors (30%), accounted for the bulk of medical errors linked with possibly preventable readmissions (Uitvlugt et al., 2021).
Readmissions are linked to poor patient outcomes as well as significant financial expenditures. Reasons for readmission are multifaceted and vary greatly between hospitals. Even preventing 10% of these readmissions might result in $1 billion in savings (Wadhera et al., 2019). As a result, lowering readmissions has become a top concern for hospitals and the country as a whole.
Readmissions are expensive for the hospital, often doubling the cost of treating one of those episodes, which is why this is a key performance indicator. From this problem, both patients experience negative consequences, since it carries additional health risks, emotional burden and stress, and staff, as the workload increases. In addition, although the hospital and its staff can only control some aspects of these conditions, the hospital is responsible, otherwise, it affects the performance. Since the readmission rate has been included in the ratings and published in the public domain, this also affects the image and reputation of the hospital, which in the long run can be one of the key advantages if quality and safety specialists can achieve a noticeable improvement. If this problem is not solved, the consequences can lead to a negative reputation for the hospital, an increased burden on staff, and significant financial losses.
Foreseeable challenges and barriers to doing a quality improvement project on this issue are related to the fact that the hospital cannot control all the causes of readmissions but nevertheless bears responsibility for them. Discharge too soon before the patient is stable enough or before drug-related causes can be handled and reduced. However, issues such as being discharged to a place that cannot support recoveries, such as a home, health visitor, nursing facility, or nursing home, can result in a readmission that the hospital cannot influence, as well as a relapse or exacerbation of the underlying disease due to patient noncompliance, inadequate follow-up or follow-up, or simply bad luck.
References
Farokhzadian, J., Dehghan Nayeri, N., & Borhani, F. (2018). The long way ahead to achieve an effective patient safety culture: challenges perceived by nurses. BMC health services research, 18(1), 1-13. Web.
Graban, M., & Toussaint, J. (2018). Lean hospitals: improving quality, patient safety, and employee engagement. Productivity Press.
Uitvlugt, E. B., Janssen, M. J., Siegert, C. E., Kneepkens, E. L., van den Bemt, B. J., van den Bemt, P. M., & Karapinar-Çarkit, F. (2021). Medication-related hospital readmissions within 30 days of discharge: prevalence, preventability, type of medication errors and risk factors. Frontiers in pharmacology, 12, 567424. Web.
Wadhera, R. K., Yeh, R. W., & Maddox, K. E. J. (2019). The hospital readmissions reduction program—time for a reboot. The New England journal of medicine, 380(24), 2289. Web.
