Identify two organisations in an industry of your choice. These Organisations must have clearly different value chain designs and structures.
Healthcare is the second-largest growing industry sector for economy and nursing being the largest occupation within this healthcare industry. The improvements in healthcare improve the safety and quality of patient care and delivery of care by the nurses. There is an ardent necessity of quality and safety improvements that would permeate healthcare. Everyone who works in healthcare sector has the responsibility to create a safe and quality healthcare system that ensure patient safety and best practice in accordance with clinical standards (McFadden, Stock & Gowen III, 2015). To maintain a safe environment in healthcare reflects the vigilance and compassion level for patient safety and is an important aspect in healthcare. Besides safe workforce, it is also necessary that a stable environment prevent the adverse healthcare events that hamper patient safety and their health outcomes. The following essay involves the safe and quality nursing care in healthcare organizations focusing on the five moments of hand hygiene, process data and outcome data in order to improve the quality and safety of healthcare and nursing focusing on auditing process to improve patient outcomes and reduction of hospital infections.
Aim and core business of healthcare system
The aims of healthcare system are to deliver safe, effective and quality health interventions to patients with minimum wastage of resources to achieve best health outcomes. This can be achieved through a well functioning workforce who would be fair, responsive and efficient in providing the best quality of care to patients (Bodenheimer & Sinsky, 2014). It is also aimed at providing adequate care and treatment to patients through surgical, medical and nursing care where patients’ health and life are the central concern of the healthcare institutions. Apart from focusing on health care, the core business also involves the nursing sectorStress being a psychological assessment parameter in the form of occupational stress affects the patient care, responsibility, decision-making and organizational change. The work hours, human suffering, physical labour, staffing and interpersonal relationships has a great impact on the working state of nurses that has created a turbulence in their working condition (Ulrich & Kear, 2014). The lack of recognition as an employee, poor appraisal and working conditions like less nurse to patient ratio affect the nurses’ performance and the healthcare system as a whole.
In a similar manner, core business of health institutions is also affected. Interpersonal relationships between the healthcare provider and patient as well as burnout and poor working conditions affect the performance and productivity of the healthcare organization as a whole. The underperformance of hospital staffs and poor delivery of care services affect the performance of the healthcare organization leading to nurse burnout and staff shortages. These factors adversely affect the provision of quality healthcare services among the healthcare organizations (Aiken et al., 2013).
The collection, classification and aggregation of data concerning prevention, mitigation and recovery strategies are the process data that is crucial for patient safety and quality of care. Process data measures determine the healthcare provider ability to maintain health and improve the quality of care to the people receiving care (Moore et al., 2015). Process data reflects the general recommendations that are required to improve the healthcare quality and ensure patient safety. For the quality improvement, process data is a way to understand the actual scenario in the delivery of healthcare services, factors affecting delivery of services and how improvement can be achieved in quality and safety in healthcare. The processing of data can be done in many ways like staff or patient feedback, clinical audit or analysis of the near mistakes and misses (Ivers et al., 2014).
Auditing in healthcare is a process for the assessment, evaluation and improvement of patient safety and care in a systematic way (Black, 2013). Auditing measures the current practice against a standard or desired practice. This is a part of clinical governance that is aimed at safeguarding the highest quality of care and safety in healthcare services. For instance, auditing of hand hygiene is a way to prevent hospital-associated infections and improve the organizational practice in quality of healthcare services (Gould et al., 2017). Donabedian model explains that the measurement of process data evaluate the quality of care that contains the healthcare delivery acts (Mumford et al., 2014). This data can be obtained from interviewing patients and medical staffs, medical records or healthcare visits through direct observation (Victor et al., 2015). Therefore, this framework examines the healthcare services and evaluates quality of healthcare.
Outcome data measures in healthcare is defined as the change that is required for the patients, medical staffs or population that attributes to an intervention to bring about a desirable change (Nelson et al., 2015). It studies the results or outcomes of structure and process of healthcare system on the well-being and health of patients and medical staffs. It measures the hospital safety and quality performance in terms of outcome measuring mortality, patient experience and readmission, etc. The outcome data measures, reports, compare the health outcomes that are aimed at improving the patient health, experiences, and reduce the per capita healthcare costs (Boyce, Browne & Greenhalgh, 2014). It is dedicated to outcome improvement where it a measure to test and implement the changes required improving the quality of healthcare. For instance, outcome data measures the result of an intervention or test that is objectively developed to determine the implemented desired change over the current practice. For example, outcome data in hand hygiene are the direct results of care that patients receive. The gathering, measuring and analysis of the processing data through auditing support and measure the health outcomes in the healthcare institutions (Zingg et al., 2015). This would measure the performance of healthcare delivery in maintaining hand hygiene and in the reduction of hospital associated infections.
The outcome data would discretely measure the endpoints in quality, safety of healthcare like infection related morbidity, mortality, readmission, and length of hospital stays. Through auditing and patient feedback that is the processing data for hand hygiene, the outcome would measure the change in behaviour and patient health outcomes to reduce the rate of hospital related infections like nosocomial infections or readmissions. There should be improved patient outcomes that would measure improved health outcomes in patients ensuring safety and care. Outcome data would also measure the behaviour change in patients and medical staffs regarding hand hygiene, monitoring of the infection rates and transmission rates of the epidemiological pathogens monitoring.
Clinical care activity
The hand hygiene and the five moments is a clinical care activity for the processimg and outcome of the data can be measured. Hand hygiene is an approach that defines the performing of hand washing by the healthcare workers to reduce the hospital related infection rates. The five moments include the cleaning of hands by healthcare providers before and after touching a patient, use of clean or aseptic procedures, when exposed to body fluids and the patient surroundings (Bergsbaken et al., 2014).
According to World Health Organization (WHO) there are millions of patients being affected by healthcare and hospital related infection. It is a true global burden of disease as there is difficulty in gathering reliable data. However, this can be prevented through five moments of hand hygiene that is cleaning hands at the right time and way. Process data can be done for the hand hygiene through clinical auditing activity (White et al., 2015). In this, patients and healthcare providers are being interviewed to know about their hand hygiene practices like how often they clean their hands. Auditing is the process data and monitoring tool where it measures the hand hygiene compliance and extent to which they adhere to guidelines of hand hygiene (Ryan et al., 2015). This would also aid in reducing the rates of hospital related infection, readmissions and longer hospital stays. Process of data can be applied in a way whether the healthcare professionals can be interviewed to know about their hand washing practice.
The outcome data of hand hygiene and auditing would measure the practice of hand washing among the healthcare professionals. For example, it would also measure the lapses that would be seen in the infection prevention measures and control team in a clinical setting. Hand hygiene audit data would measure the hand hygiene compliance by the medical staffs and patient health outcomes. This also monitors the rate of infections before and after the implementation of infection prevention programs for better health outcomes among patients.
Clinical auditing is the process data that is used to measure the safety and quality of healthcare and nursing practice. Auditing by healthcare providers is a measure that can be used to look for the awareness among the healthcare providers regarding hospital related infections and hand hygiene compliance to prevent it (Higgins & Hannan, 2013). Clinical auditing has been chosen as it can benefit the patients, healthcare professionals and organization for improving the quality and safety of healthcare services. It improves the patient outcomes and prevention of hospital related infections, readmissions and longer hospital stays. The process data measures the degree of improvement made in healthcare and patient satisfaction. It can be executed in a way to measure quality of healthcare against relevant standards to prevent infection rates. It would involve a cycle of activities that provides evidence for specific measures to raise the quality standards and reduction of hospital related infection control. Surveys and focus groups interviews of the healthcare professionals are a way to obtain their views about the hand hygiene and quality of care they are delivering under the provision of care (Bowling, 2014). To prevent hospital related infection, survey questionnaire and interviews of healthcare providers would help to evaluate how often they practice hand hygiene and monitor the infection rates, readmissions and hospital stays.
Clinical auditing also measures the behaviour change that is required to inculcate the hand hygiene compliance and as a result, reduce the hospital related infection rates and ensure patient safety. Direct observation is also regarded as the gold standard for the auditing of hand hygiene. It provides information about hand hygiene products in use, thoroughness of cleaning, staffs compliance or failure to maintain hand hygiene and barriers to performance and ways to overcome it.
After the evaluation of the auditing data, results would show the recommendations required for change. The auditing data results have been chosen as it would measure the compliance of healthcare professionals towards hand hygiene practice and monitoring of the hospital related infections. The outcome data of a careful hand hygiene audits would help to motivate the staffs to enhance their compliance to hand hygiene and the audit results leading to decrease in infections rates and hospital stays (Arai et al., 2016).
The outcome data for the illness was selected as it would help to understand the impact of the hospital related infection on clients, hospital and the state as a whole. The prolonged illness due to infections would increase the hospital stays and readmission of the patients affecting their health and well-being. It would also have a great impact on the hospital or the healthcare institution. The increase in the duration of hospital stay would result in bed blocking and decrease in the productivity of the hospital. It also questions the hospital’s efficiency to provide best quality of care to the patients and in some rare cases, there might be court claim that hampers the reputation of the healthcare institution. The illness data like nosocomial infections would also have an impact on the state as a whole. If a person is hospitalized for a longer duration, it decreases the productivity of that individual as his or her inability to work. There is a great burden of disease in the state due to the hospital related infections and increased healthcare costs for the patients (Luangasanatip et al., 2015).
This outcome data from the healthcare professionals through clinical auditing also measures the compliance of the staffs towards five moments of hand hygiene to reduce the infections rates in hospital and decrease burden of disease due to hospital related infections. This also helps to understand the change required and its impact on the hospital as a whole. It also paves the way for implementing behaviour change that would help to increase hand hygiene compliance among staffs and awareness about hospital related infections and prolonged patient illness.
Clinical auditing is an important tool that improves the quality of care in healthcare institution. It consists of a clinical process or outcome that is well defined and against the standards that are set on principles of evidence-based practices that identifies change need to improve the safety and quality of healthcare services. In particularly, clinical auditing measures the hand hygiene compliance by the staffs and present the overall evidence that favours the clinical auditing process data (Lippi et al., 2015). Auditing, a part of clinical governance that provides opportunities for change required against current practice and implement desired change. After knowing this, it provides recommendations for behaviour change and compliance towards hand hygiene leading to reduction of hospital related infections. It is a part of continuous improvement process in quality and safety of healthcare institutions and nursing. These steps to change can improve the healthcare quality as it ensures patient safety and improve in quality of healthcare services, as there is reduction of hospital related infections. This result in decrease of hospital stays readmissions, bed blocking because of hospital related infections. However, direct observation is exhaustive and time taking, but use of hand washing products can help to measure the hand hygiene practice among the staffs.
The outcome data would measure the compliance of the staffs towards hand hygiene and interventions required to bring about change to reduce hospital related infections. The questionnaire and interviews from medical staffs would help to evaluate their awareness regarding the infection control and their compliance to hand hygiene. This would also help to determine the targeted group for change, its management, barriers and ways to overcome it. This measures the rate of infection control awareness among the staffs to ensure patient safety and quality of care (Chartier et al., 2017).
The above discussion demonstrates that everyone who works in healthcare sector has the responsibility to create a safe and quality healthcare system that ensure patient safety and best practice in accordance with clinical standards. Process data measures indicate the ability of a healthcare provider to maintain health and improve the quality of healthcare to the people receiving care. The outcome data measures, reports, compare the health outcomes that are aimed at improving the patient health, experiences, and reduce the per capita healthcare costs. The auditing data results helps in measuring the compliance of healthcare professionals towards hand hygiene practice and monitoring of the hospital related infections. Surveys and focus groups interviews of healthcare professionals are a way to obtain their views about the hand hygiene and quality of care they are delivering under the provision of care. Therefore, process and outcome data are useful in improving the quality and safety for patients.
Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Sermeus, W., & RN4CAST Consortium. (2013). Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe. International journal of nursing studies, 50(2), 143-153.
Arai, A., Tanabe, M., Yamazaki, D., Muraki, Y., Yasuda, K., Nakamura, A., & Kaneko, T. (2016). Impact of Measuring Physicians' Hand Hygiene Adherence in Outpatient Setting Using Automated Hand Hygiene Count Devices. American Journal of Infection Control, 44(6), S63.
Bergsbaken, J., Schulz, L. T., Trapskin, P. J., Marx, J., & Safdar, N. (2014). Pharmacist participation in infection prevention: an innovative approach to monitoring compliance with the Five Moments for Hand Hygiene in a large academic medical center. American journal of infection control, 42(3), 331-332.
Black, N. (2013). Patient reported outcome measures could help transform healthcare. BMJ: British Medical Journal (Online), 346.
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: care of the patient requires care of the provider. The Annals of Family Medicine, 12(6), 573-576.
Bowling, A. (2014). Research methods in health: investigating health and health services. McGraw-Hill Education (UK).
Boyce, M. B., Browne, J. P., & Greenhalgh, J. (2014). The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research. BMJ Qual Saf, bmjqs-2013.
Chartier, L. B., Cheng, A. H., Stang, A. S., & Vaillancourt, S. (2017). Quality improvement primer part 1: Preparing for a quality improvement project in the emergency department. Canadian Journal of Emergency Medicine, 1-8.
Gould, D. J., Creedon, S., Jeanes, A., Drey, N. S., Chudleigh, J., & Moralejo, D. (2017). Impact of observing hand hygiene in practice and research: a methodological reconsideration. Journal of Hospital Infection, 95(2), 169-174.
Higgins, A., & Hannan, M. M. (2013). Improved hand hygiene technique and compliance in healthcare workers using gaming technology. Journal of Hospital Infection, 84(1), 32-37.
Ivers, N. M., Grimshaw, J. M., Jamtvedt, G., Flottorp, S., O’Brien, M. A., French, S. D., ... & Odgaard-Jensen, J. (2014). Growing literature, stagnant science? Systematic review, meta-regression and cumulative analysis of audit and feedback interventions in health care. Journal of general internal medicine, 29(11), 1534-1541.
Lippi, G., Banfi, G., Church, S., Cornes, M., De Carli, G., Grankvist, K., ... & Nybo, M. (2015). Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE). Clinical Chemistry and Laboratory Medicine (CCLM), 53(3), 357-370.
Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A. S., Harbarth, S., ... & Cooper, B. S. (2015). Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. bmj, 351, h3728.
McFadden, K. L., Stock, G. N., & Gowen III, C. R. (2015). Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety. Health care management review, 40(1), 24-34.
Moore, G. F., Audrey, S., Barker, M., Bond, L., Bonell, C., Hardeman, W., ... & Baird, J. (2015). Process evaluation of complex interventions: Medical Research Council guidance. bmj, 350, h1258.
Mumford, V., Greenfield, D., Hogden, A., Debono, D., Gospodarevskaya, E., Forde, K., ... & Braithwaite, J. (2014). Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals. BMJ open, 4(9), e005284.
Nelson, E. C., Eftimovska, E., Lind, C., Hager, A., Wasson, J. H., & Lindblad, S. (2015). Patient reported outcome measures in practice. Bmj, 350, g7818.
Ryan, K., Havers, S., Olsen, K., Stewardson, A., Cruickshank, M., & Grayson, M. L. (2015). The keys to success: initial findings from the Hand Hygiene Australia (HHA) program review. Antimicrobial Resistance and Infection Control, 4(1), P144.
Ulrich, B., & Kear, T. (2014). Patient safety and patient safety culture: foundations of excellent health care delivery. Nephrology Nursing Journal, 41(5), 447.
Victor, E., Vasanth, E., Raghavan, S., Joshi, P., Lodha, R., & Kapil, A. (2015). A clinical audit to assess the impact of hand hygiene awareness program on health care professionals compliance with hand hygiene in a tertiary care hospital. Journal of Patient Safety & Infection Control, 3(2), 78.
White, K. M., Jimmieson, N. L., Obst, P. L., Graves, N., Barnett, A., Cockshaw, W., ... & Martin, E. (2015). Using a theory of planned behaviour framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses. BMC health services research, 15(1), 59.
Zingg, W., Holmes, A., Dettenkofer, M., Goetting, T., Secci, F., Clack, L., ... & Pittet, D. (2015). Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. The Lancet Infectious Diseases, 15(2), 212-224