Nursing Management: Australian Quality Improvement

Introduction

A plenty of health care organisations from different parts of the world try to undertake as many quality improvement initiatives as possible (Strome, 2013). Still, despite their intentions to create a powerful health care system in the country, some organisations fail to introduce effective and sustainable results. Therefore, the concept of quality improvement remains to be open and crucial in the sphere of health care. As a rule, it is expected to see quality improvement initiatives in the forms of clear and continuous actions that can be taken in regards to the current needs of society and change the quality or even the structure of health care services. Each country has its rules and standards according to which healthcare services and jobs are offered to people. In this paper, the Australian healthcare system and the conditions under which quality improvement is possible will be discussed.

There are two main organisations that may take responsibility for quality improvement: the Australian Commission on Safety and Quality in Health Care (ACSQHC) and the Victorian Department of Health and Human Services (DHHS). Both of them are the governmental agencies that aim at providing a safe and effective health system, establishing health services for the Australian citizens, and developing policies and programs that help to promote the wellbeing of all Australians (in the case of the ACSQHC) and of all Victorians in particular (in the case of the DHHS). The role of these organisations remains to be integral in terms of quality, safety, and service improvements that occur in hospitals and various private and governmental institutions because they not only establish the standards and check how they are followed but also analyse the current situation in the country and develop the required improvements to achieve the necessary high level. In this part of the project, the evaluation of these agencies in terms of quality improvement will be given to clarify what kind of work has been already done and what is expected to be done in the nearest future.

Concept of Quality Improvement

Nowadays, the use of quality improvement (QI) methods in health care is widespread and studied by a number of researchers (Kaplan, Provost, Froehle, & Marholis, 2012). The nature and outcomes of quality improvement depend on many internal and external factors because QI initiatives are usually based on the needs of a particular group of people and the resources and opportunities of the country where these initiatives are offered. The peculiar feature of the Australian health care system is the fact that is based on a powerful mix of state and private care (Pallot, 2010). On the one hand, such decision is effective indeed because it helps to use a number of opportunities and provide people with various services and options. On the other hand, such variety of choices requires more attention, evaluations, and comparisons. Kaplan et al. (2012) say about scepticism concerning the effectiveness of some QI initiatives because their promoters cannot be confident of all their ideas cannot give clear explanations of why the system may be improved in one situation and the same some methods fail to show the required portion of the improvements in another situation. Despite all these misunderstandings and shortages, quality improvement remains to be an ongoing process with a number of systematic approaches and high-level performances.

There are many models that can be used by the promoters of quality improvements to establish effective clinical governance. The most famous are FADE, PDSA, CQI, TQM, LEAN, and Six Sigma. FADE and PDSA models may be united into a separate group due to their possibility to combine education and implementation at the same time. First, these models help to identify the needs and challenges. Then, they help to find out the solution. The only difference is the nature of stages and their goals. For example, FADE is all about the importance to Focus, Analyse, Develop, and Execute, and PDSA model has other four stages that are to Plan, Do, Study, and Act (Wickman, Drake, Heilmann, Rojas, & Jarvis, 2013). In these models, the identification of the needs and the importance of changes play a crucial role. Still, the FADE model is focused on the preparatory steps, and the PSDA model is focused on the action and the possibility to analyse the mistakes with time.

In many medical institutions and healthcare agencies, TQM (Total Quality Management) is one of the most frequently used models due to the possibility to transform a traditional quality improvement system into a customer-oriented system (Talib, Rahman, & Azam, 2011). The essence of TQM is to clarify what may prevent an organisation to achieve the best possible results and to offer the ideas that may cover all spheres of work and promote the modernisation on the necessary level including patient’s satisfaction, quality of service processes, equipment, etc.

CQI (Continuous Quality Improvement) is another model that can be used to improve the system due to the possibility to concentrate on the processes and the organisation of an institution (in this case a hospital may be taken as an example). The main peculiarity of this approach is to understand the needs of the system but not its individuals and suggest the ideas before some problems actually occur on the knowledge base and experiences that have been already observed.

LEAN model defines change values on the basis of patients’ needs and wants. This model helps to create the best possible conditions for patients and reduce waste and waits that can prevent customers’ satisfaction (Lawal et al., 2014). The peculiar feature of this model is its origins in the auto industry. For a certain period of time, LEAN model had nothing in common with health care. It was developed by the Toyota Company that wanted to understand what its customers expected to get. If there was no value of the idea, it had to be identified as waste and improved in a short period of time. Almost the same approaches were transformed to the healthcare system and helped to achieve certain changes in health system outcomes, patient outcomes, and professional outcomes (Lawal et al., 2014).

Finally, there is a Six Sigma strategy with the help of which healthcare workers understand what they can do to reduce waste and improve the quality of care their offer to their patients. This model also came from another industry and became usable in health care (Glasgow, 2011). It focuses on the defects the chosen system may have and the possible negative outcomes in regards to people, who are involved in the system, or who have to use the services developed within the system. In health care, this model is important due to the possibility to understand the expectations for quality and the opportunities healthcare organisations may use to meet the needs of their patients.

In fact, each model has its own peculiarities and importance to the healthcare system. Still, there is one thing that cannot be ignored. All of them have the same goals – to promote quality improvement in medical practice, reduce healthcare and systematic errors, and change the quality of services – and their different methods make the achievement of these goals possible for different organisations.

Importance of Quality Improvement in Health Care

Taking into consideration the essence of quality improvement and the existing variety of methods and models that can be used in the healthcare system, it is possible to talk about the importance of QI initiatives and the necessity to study their peculiarities in one particular system that offers clinical governance. In this report, the task is to comprehend how the Australian Commission on Safety and Quality in Health Care and the Department of Health and Human Services can complete their functions and promote quality improvement. Still, before, it is important to understand why such serious governmental agencies focus on quality improvement.

The importance of quality improvement depends on QI success (Kaplan et al., 2010). In many organisations, people fail to comprehend that the same management methods cannot be effective all the time. As soon as some innovations and new possibilities occur, people expect them to be used. Therefore, patients want to believe that their healthcare system can be improved in regards to the innovations they are aware of and have already used in other institutions and countries. The exchange of experience happens online every second. People become able to learn what different countries can offer to solve various problems and challenges. In health care, the changes may occur in treatment, management of services, and even the level of communication they can get from different medical workers. The Australian healthcare system has to be improved from time to time so that the Australian citizens could comprehend their worth to the country and use the best services their country could offer.

Roles of the Australian Commission on Safety and Quality in Health Care

The Australian Commission on Safety and Quality in Health Care, also known as the Commission, is a governmental agency that was established in 2006 to promote the improvements in terms of safety and quality in health care (Australian Commission on Safety and Quality in Health Care, n.d.-a). The Commission may work independently and in cooperation with patients, clinical managers, and healthcare organisations in order to meet its goals and their expectations, support health professionals and explain how to promote safe and high-quality services and care, and show the best approaches in health care. The main areas where the Commission tries to implement improvements are safety, quality cost, and value (Australian Commission on Safety and Quality in Health Care, n.d.-a). In 2010, the Framework was developed by the ACSQHC where a vision of safety and quality was offered. This source of information says about quality improvement as the result of the steps taken by the agency as well as by healthcare organisations. There are three main principles according to which 21 areas of actions can be described. According to these principles, health is of high quality in case it is consumer centred, information driven, and organised for safety. In regards to these principles, the main roles of the Commission could be formulated:

  • To introduce national standards and promote accreditation (high-quality care is possible in case all hospitals and services are accredited to the NSQHS Standards) (Australian Commission on Safety and Quality in Health Care, 2015);
  • To identify national priorities (the Commission has to coordinate the improvements in health care in terms of safety and quality and focus on such specific projects as antimicrobial resistance and utilisation, reduction of radiation exposure, promotion of healthcare rights, etc.) (Australian Commission on Safety and Quality in Health Care, n.d.-b);
  • To introduce various publications, reviews, and reports so that people could learn the latest achievements, understand what is planning, and comprehend how the agency is going to improve the quality of services and care in Australia, and
  • To support quality practice such as the promotion of clinical communication, verification of medical practitioners and their abilities to provide patients with appropriate and in-time services and support, the organisation of end-of-life care, preventive care, pain control, etc.

In fact, the last point has a number of sections and peculiarities. The Commission was able to evaluate and identify its powers and opportunities and prove that quality practice may be supported in a variety of ways. Therefore, the ability to support quality practice demonstrated by the ACSQHC presupposes the completion of such role as the identification of patients and matching of patients to the required treatments. Sometimes, patients complain that their treatment is not as successful as they expect it to be. Such situations happen if a kind of mismatching takes place and the components of care such as diagnosis, treatment, or support are misunderstood and introduced in a wrong order (Australian Commission on Safety and Quality in Health Care, n.d.-d).

In fact, the roles of the Australian Commission on Safety and Quality in Health Care are crucial indeed because this agency helps to understand that the Australian citizens are free to get high-quality medical and healthcare services and promote quality improvement by means of various methods and approaches.

Roles of the Department of Health and Human Services

The Department of Health and Human Services takes responsibility for the evaluation of the existing health services and policies that can be applied to all patients, who address the Victorian hospitals and other medical institutions. This department is one of the youngest organisations in the country. It was established in 2015 in order to develop appropriate policies and services that help to enhance the Victorians wellbeing (Victoria State Government, n.d.-a). According to the Department, support and enhancement of high-quality care for Victorian patients should be (Victoria State Government, n.d.-b):

  • Respectful (people deserve to understand their perspectives and communicate honestly);
  • Integral (services have to be professionals and trustworthy);
  • Collaborative (the Department tries to develop fair and trustful relations with colleagues, medical workers, and patients, involve people to improve the quality of services, and share knowledge and skills); and
  • Innovative (the Department offers flexible and creative ideas on how to improve the services and promote quality and consider the risks that could take place).

The role of Victorian health services is focused on the necessity to meet or even exceed high-quality standards and safety and to promote continuous service improvement by means of clearly identified systems and standards (Victoria State Government, n.d.-c).

One of the main functions the Department has to complete is to identify and scale innovations that could influence the healthcare system. The same way the Commission promotes accreditation for hospitals and medical institutions, the Victorian Department offers service improvement by means of accrediting hospitals in regards to the standards of quality and safety. One of the current examples of how the Department promotes quality improvement is the introduction of the Redesigning Hospital Care Program that spread the improvements in various healthcare operational processes and the methods of how patient care is delivered to patients (Victoria State Government, n.d.-d).

A peculiar feature of the Department steps to improve the quality of services is the attention to the outcomes of their work and the necessity to evaluate what kind of work has been already done and what kind of improvements can be offered on the basis of the currently made achievements. The Department introduces a powerful system of assessment tools within the frames of which the capabilities of the services are taken into considerations and informs organisations if their services can be improved. Healthcare studies are the types of publications that are used by the Department to demonstrate the current improvements and their impact on the overall system.

The roles of the chosen Department in quality, safety, and service improvements within hospitals and healthcare services cannot be neglected because their activities and ideas are developed on the latest innovations and suggestions. Medical and healthcare organisations benefit a lot from the Department’s activities. The Australian public is in need of various types of health care. For example, the aged population wants to know more about their opportunities and quality of services to rely on. The Department helps to make the information available and control the ways of how quality is offered to people. Therefore, the main aspects the Department covers in its work are the provision of information and the delivery of high-quality services.

Conclusion

In general, quality improvement is an important approach to the work of different organisations that focus on the evaluation, development, and perfection of performance. This practice is crucial in all spheres because of the appearance of new technologies, the identification of new needs, and the possibility to share knowledge and experience in a short period of time. In health care, quality improvement cannot be neglected because various activities and approaches help to analyse the current situation, learn the needs and expectations of patients, and introduce new ways of how the health care system and services can be improved. With time, people are able to identify new challenges and health needs. They want to be sure that the healthcare system of their country works effectively. In Australia, there are many agencies and governmental organisations that aim at working with quality services, establishing standards, and checking the ways of how hospitals and other healthcare providers meet the expectations and follow the requirements.

The peculiar feature of quality improvement in health care is a kind of responsibility healthcare providers have in regards to human lives. It is wrong and ethical incorrect to give some promises and not to follow them. Therefore, such organisations as the Australian Commission on Safety and Quality in Health Care and the Victorian Department of Health and Human Services are established in order to inform citizens about their opportunities and rights and the conditions under which they can ask for treatment. Besides, such organisations are important because they show the best ways of how quality and safety may be established and delivered to people.

Introduction

The Australian Commission on Safety and Quality in Health Care (ACSQHC) is a governmental organisation that takes responsibility for provision and control of high-quality healthcare services and the guidelines according to which clinical handover is discussed and evaluated. In this part of the paper, the key focus is on the ACSQHC and the OSSIE Guide that explains how the implementation of standardised processes and clinical handover should be organised to meet the local context and improve the quality of healthcare professionals’ work (Australian Commission on Safety and Quality in Health Care, n.d.-c). The improvement of handover communication in the Australian healthcare settings is an important kind of activity that has been in practice since 2007. The OSSIE Guide to clinical handover improvement and the identification of clinical communication factors and conditions help to comprehend that safety and quality in health care are complex issues that may be improved with the help of certain standards to be followed. As soon as the clinical handover of the agency is investigated and explained, it is expected to clarify the essence of organisational change and the ways of how change management theories can be used in clinical settings.

Change management theories vary by their nature, and the ACSQHC’s initiatives in the form of OSSIE is one of the possible frameworks for change management that has to be analysed in regards to the models developed by Lewin or Kotter. The Australian Commission is a powerful organisation with a number of responsibilities identified in its framework, and clinical handover improvement is one of the possible examples of how the change management process may be implemented in health care and may improve the results that have been already achieved using the same or additional sources, knowledge, and experience.

Clinical Communication

Khanna, Wachter, and Blum (2016) introduce communication as “the lifeblood of clinical medicine” (p. 21). Despite the fact that a number of health care providers and practitioners are not able to comprehend a true worth of a properly developed communication process, the researchers continue focusing their attention on the place of clinical communication in hospitals and the productivity shifts that have been recently observed. Still, it is not enough to admit that clinical collaboration and communication are important for an organisation. It is more important to promote a strategy in terms of which an organisation can identify its weak and strong aspects and clarify how communication can be used.

The main characteristics of effective clinical communication are the possibility to understand the problems of patients and listen to their stories and descriptions, the necessity of sharing information and knowledge about diagnostic details, treatment methods, and other procedures that may be expected, and the importance to support and explain the details patients want to be informed about. Besides, health care providers should understand their roles in the lives of patients and comprehend that their task is not only to diagnose and treat but also to encourage, listen, and stay compassionate with the majority of patients’ needs and expectations. Warnecke (2014) admits that good communication is a crucial process that can improve the outcomes for doctors, patients, and other health care workers; therefore, it is expected to not only develop required skills but also improve knowledge and clinical experience. In the Australian guidelines, effective communication is one of the obligatory standards for all doctors. Despite all current technological achievements and approaches to treating patients, such issues as compassion, care, and understanding are defined as effective therapeutic tools that cannot be neglected. It is expected to improve the quality of clinical communication and consider patients’ attitudes to the innovations offered (Ashoorian, Davidson, Rock, Dragovic, & Clifford, 2015).

The importance of clinical communication in health care can be explained in several ways. First, as soon as communicative skills are properly developed by doctors and medical staff, these people can interview their patients in a clear and informative way and get the required for treatment portion of information. Then, clinical communication helps to calm down patients, who cannot comprehend what is going to their health and what changes should take place. Clinical communication is a good way to clarify the situation and present information in the best possible way. Finally, handover communication may occur via different modalities regarding different aspects (Australian Commission on Safety and Quality in Health Care, 2010). Therefore, its improvement is an integral part of the working process.

The OSSIE Guide to Clinical Handover Improvement

The ACSQHA’s OSSIE Guide to clinical handover improvement is the collection of methods with the help of which the evaluation of an organisational, clinical handover practices is possible (Pascoe, Gill, Hughes, & McCall-White, 2014). The authors of OSSIE mention that the system of the delivery of health care is a complex notion, and it is very easy to identify the reasons for why some mistakes or failures take place (Australian Commission on Safety and Quality in Health Care, 2010). The explanation of why OSSIE is a priority for the ACSQHC is the possibilities of informative breakdowns and the inabilities to gain control over the situations that could be developed. The information offered in terms of the ACSQHC’s OSSIE introduce the actions that help to provide patients with high-quality care and explain how such simple still effective five steps as “Organisational leadership”, “Simple solution development”, “Stakeholder engagement”, “Implementation”, and “Evaluation and maintenance” can help Australian hospitals and governmental organisations improve the quality of health care services, predict and overcome risks, and choose the techniques that are appropriate in particular settings (Australian Commission on Safety and Quality in Health Care, 2010). The Commission was founded several distractions during handover that were connected with poor and ineffective communication and the inabilities to plan the activities properly regarding time available to people (Kowitlawakul et al., 2015). This guide proves one simple truth that a human factor can never be ignored. Being one of the most effective change management frameworks in the Australian Commission, OSSIE is the crucial clinical handover that is based on nursing interventions and communication, doctors’ cooperation with patients and nurses, the identification of principles. The authors believe that the majority of these principles could easily guide improvement of other handover situations in clinical settings, primary care, and other community handovers.

At the same time, it is necessary to comprehend that the OSSIE Guide is not a quick fix that can be used to achieve the required improvement. This source of information should be identified as a list of directions that could be used to achieve the required improvement. Still, to use the hints, it is important to analyse the environment, understand the resources available, and make the conclusions based on a particular situation. The importance of this guide in health care is not only the hints on how to improve health care services but also a kind of motivation and inspiration for doctors, nurses, and other stakeholders. The handover of patients and poorly developed communication are the prevailing accidents in many Australian medical settings (Hannaford et al., 2013). Therefore, the offered guide and hints on how people can improve health care services, understand what people may expect from health care, and identify their own abilities to promote care and safety are important in the health care system of Australia and should be considered as a good example of change management.

Organisational Change

Regarding the material of the previous sections, the importance of improvement and quality standards cannot be ignored. Organisations aim at evaluating their current achievements and understanding the needs of patients to demonstrate a high-level performance. Therefore, any kind of improvement is a change that has to cover a whole organisation, its system, services, and even people. In other words, any organisational change happens within organisational culture that is defined by Parmelli et al. (2011) as a “lens through which an organisation can be understood and interpreted” or the “shared cognitive and symbolic context within which a society can be understood” (p. 34). People are usually in need of certain powers and motivation with the help of which they can identify and deal with real changes in their work. It is important for medical workers and health care providers to stay sustained and focus on the problem. At the same time, organisational change should not be imposed on people but explained. People need to be prepared, and appropriate tools in healthcare change management should be chosen. Sometimes, change management is not taken into consideration as a part of the project that has to be completed. However, Queensland Government Chief Information Office (2011) suggests accepting changes as something that cannot be regarded separately from a working process.

Change Management Theory

Today, a constantly developing world and new requirements make people consider the roles of organisational changes, methods, and theories in order to stabilise and approve working conditions and the quality of services offered to people. In health care, change management theories play an important role as they help to increase the chances to improve services, choose appropriate methods, and support patients, doctors, nurses, etc. There are many strategies to implement change management, and, in this project, OSSIE will be analysed and criticised on the basis of two most popular and effective models, Lewin’s theory and Kotter’s theory (Hayes, 2014).

Lewin’s Theory

Lewin’s theory of change is identified as one of the most successful and commonly recognised models in nursing and health care (Stichler, 2011). According to the chosen theorist, there are three levels of change with their own functions and goals. An unfreeze stage is required to make all necessary preparations for the change. In OSSIE Guide, there are five main stages. The first three phases that include organisational leadership, simple solution development, and stakeholder engagement may be regarded as the constituents of the “unfreeze” stage during which it is necessary to make preparations, analyse the situation, and clarify the reasons for change. The next stage of the Lewin’s theory is a changing process itself when a real transition is observed. It requires certain time and clear directions to be offered. OSSIE Guide has the Implementation phase during which the development of a plan, the delivery of education, the establishment of the strategy, and the introduction of the activities occur. Finally, according to Lewin, there is a refreeze stage during which employees start working under new conditions, and the processes go back to their routines. OSSIE Guide introduces its final stage, evaluation and maintenance, with the help of which the analysis of the impact of the change on clinical handover in a form of clinical communication takes place. Medical workers should understand that clinical communication is an effective tool to succeed in clinical handover, and they have to study new approaches to communication, share their knowledge and experience, and analyse their achievements. In general, the developers of OSSIE Guide consider the stages described by Lewis to their full extent and make sure the change is properly identified and implemented in the environment.

Kotters’ Eight Steps Change Models

Kotter’s model consists of eight stages with no stage being skipped or neglected to reach the required results (Appelbaum, Habashy, Malo, & Shafiq, 2012). OSSIE Guide has a number of similarities with this model because its authors focus on the details process and make sure that each step has its goal and effects on organisations. To increase urgency of change, OSSIE developers succeed in describing organisational leadership as an opportunity to prioritise the importance of clinical handover and understand what practices and barriers could be expected. The establishment of the team is an integral process that takes place before any other activities taken to clarify what people could participate in the project and what contributions they could make. The correct vision of the project and communication are the parts of the organisational leadership phase during which organisations are free to demonstrate their attitudes to change, share their opinions, and clarify their goals. Such stages as the empowerment of broad-based actions and the generation of short-term goals can also be traced in the guide because the developers focus on the necessity to educate people about different aspects of change and consider their goals at each stage to succeed in its completion. Finally, the consolidation of gains and the identification of new approaches are the integral parts of the last phase of OSSIE Guide because it makes clinical organisations comprehend the worth of clinical handover and clinical communication and the direct dependence on what has been done to what could be done.

In fact, the successful integration of the steps developed by Kotter in 1996 is observed in the guide introduced by the Australian Commission on Safety and Quality in Health Care in 2010. Though the authors did not follow the same order of the steps, all of them were taken and explained. Each of five stages has a number of goals. Their impact and implementation are properly described. It is easy to understand what the organisations with problematic clinical handover should do to change the situation and create appropriate and safe conditions for their work. Clinical communication is a crucial factor of work in the clinical environment. It is necessary to comprehend that change management is something that could improve this kind of work and provide people with clear guidelines on how to improve quality, safety, and results of the work.

Conclusion

In general, organisational change is one of the most crucial concepts that are not always east to comprehend. Such difficulty is based on the necessity to evaluate huge amounts of the material, involve a number of people, and create the conditions under which all stakeholders can gain emotional, physical, or even financial benefits. People cannot even guess how many changes they accept in their work every day because change is not only a process that should occur. It is a state of affairs and the outcomes that could be observed. Organisational culture in health care plays an important role because medical workers, doctors, and nurses have to understand that their achievements and actions influence human lives. In their turn, patients should realise that their opinions, experiences, and communication define the level of services and treatment that they can get.

Change management theories show the ways on how medical organisations can improve quality of health care services. Due to the existing variety of guidelines and hints, people are at loss to understand what methods are appropriate for their environments. Therefore, it is necessary to analyse the offered guides and programs relying on the already established theories and models. In this paper, the attention is paid to Kotter’s and Lewin’s theories of change management. These models show that the OSSIE Guide developed by the Australian Commission on Safety and Quality in Health Care is a successful combination of the ideas about the worth of clinical communication in clinical handover processes and the necessity to develop it on a high-quality level educating and supporting all stakeholders. The Australian example proves the importance of quality improvement and the effectiveness of changes in health care.

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