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Quality Improvement In Health Care Introduced By WHO

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Question:

Discuss about the Quality Improvement In Health Care.
 
 

Answer:

Introduction:

With the emerging problems with the complex lifestyle in this generation the health standards are decra4sing as well. There are many a public health concerns that are rising every day. Infections have emerged as one of the most dreadful public health concern in this age. Hospital acquired infection are one of the prime reasons for causing further complications for the patients and increasing hospital stay time and the cost. Furthermore this particular complication if not attended properly can create fatal complications for critically ill patients as well (Wolf, Doane and Thompson, 2015). Hence, there have been infection control policies enforced by the world health organization as a global health care authority that has been overlooking the heath care standards over the years. The hand hygiene policy is considered to be the most important infection control policies that have been incorporated worldwide to minimize the rate of hospital acquired infections. However, many a developing countries are still not complying with the practice protocols set forth by WHO and the patients are paying the price for it (WHO, 2017). This assignment will focus on determining the causes behind the noncompliance to hand hygiene in nurses and attempts to formulate a quality improvement plan for the same taking an Indian small hospital as an example.

Intended improvement:

The major reason behind the massive noncompliance in the developing countries that has been determined by extensive research has been the absolute lack of knowledge regarding any aspects of the hand hygiene policies. In the developing countries the lack of enough infrastructure and extensive training program is a contributing factor that the healthcare staff is mostly unaware of the changes to the health care practice policies and protocols (Ward, 2017). This is the major reason why the nursing staff as well does not get access to the improvements to teh practice standards and continues with the back dated polices t health care setting. In order to ascertain the compliance to the hand hygiene policy in the nursing staff of lifeline hospital of India, training and educating the staff about the benefits of the hand hygiene policy will be required.

The model chosen for this training and quality improvement program, the model chosen is the PDSA model. PDSA stands for Plan Do Study and Act, which is the standard procedure for health care quality improvement program. Albeit being a extremely powerful tool, it is simple and easy adaptable to any improvement scenario, and hence is abundantly used. As mentioned above this model have four interlinked variable starting with planning, doing, studying, and acting (Stowell et al., 2014). The first variable is planning which is concerned with planning the activities prior to implementing them to ascertain a well organised improvement plan. In which settings you are you are required to plan the activities that will be implemented in the improvement programs. For example educational seminars, workshops, and training programs to explain to the nurses the benefits of hand hygiene policy and how that would help in protecting the nurse is from any Hospital acquired infections and also protecting the patients. The next item to this model is doing, in this article of variable the implemented plan in the previous section will be implemented on a small scale of population are subject population to test out the viability of the plan. In which part the quality improvement program leader will evaluate the viability and efficacy of the planning that will be able to implement the changes that are required to be achieved in this quality of improvement program (Smiddy, O'Connell & Creedon, 2015).

The next step to PDSA cycle is to study the results that the previous activity could formulate. This particular step is associated with data collection and data analysis to evaluate the efficacy of the entire plan. In last step which is acting will be concerned with incorporating revisions and improvisations to the plant on the basis of the small scale tryout. In order to ensure that the quality improvement program will be absolutely effective, it is vital to plan the activities accordingly (Siddiqui et al., 2017). The aim of this quality improvement program will be to incorporate better knowledge and better understanding in the nursing staff about hand hygiene policy and the benefits of it. The activities for this quality improvement program will include educational seminars, presentations using interactive graphics, interactive workshops and on hand demonstration policies to ensure that the nursing staff in the small Indian hospital has access to all the literature and understanding to incorporate compliance to the hand hygiene policy. However prior to that, it will be beneficial to assess the level of knowledge that the nursing staff of the Indian small Hospital already have on the subject of hand hygiene policy. Along with that it will always be beneficial to elicit information on why and how the non compliance to hand hygiene protocol has been initiated in the Lifeline Hospital. Gaining information on how the nursing staffs’ feels about the hand hygiene policy will be beneficial for incorporating changes that will be adapted to the situation of the Indian small Hospital.

After the entire planning question so it will be required to assess the level of compliant that the quality improvement plan could facilitate. In order to achieve this goal a measurement plan has to be incorporated into the quality improvement program. For this case scenario the quality improvement program will include measurement of the percentage of the compliance of the nursing staff to the hand hygiene policy.

 

Planning of the interventions:

In order to create an accurate and effective quality improvement plan it is title to standardise the research study setting. Standardizing the setting will allow the improvement program leader to design a well organised and curated plan of action that will serve the purpose of the research study effectively and will be the most effective and adaptive to the case scenario at hand. What is research study the purpose is to incorporate effective and absolute compliance to hand hygiene policy. As discussed about the hand hygiene policy has been introduced by the World Health Organisation as a Global Health authority and all the Healthcare facilities along with the clothes are required to comply with this infection Control Programme to ensure minimum Hospital acquired infections as possible. The research setting that has been opted for this assignment has been a small Hospital authority of a developing country India. On a more elaborative note this Hospital is a small scale Hospital with minimum infrastructure to start with. The patient accommodation for this Hospital is minimal, with just two storey Hospital setting. The speciality wards in the hospital are not many, just a critical care unit, a maternal care unit, respiratory and cardiac unit, and an emergency unit. The number of beds per unit is 20 to 25 maximum. The subject population or subject setting opted for this assignment will be the respiratory and cardiac care ward as the chances for infection are the maximum in case of these two complicated healthcare concerns (Roy, 2017).

Another important aspect of any improvement program is standardizing and determining the target group. The target group selected for this assignment is the registered nurses and enrolled nurse is that are working in the respiratory and Cardiac unit of the small scale hospital in India. The rationale behind choosing this group of nurses is the fact that the studies suggests most of the infections on a more precise note the most Hospital acquired infections are prevalent in the respiratory and cardiac unit due to the abundance of machinery and clinical tools that are used in those two wards. In the quality improvement design we have also incorporated the number of nurses working purchased to better understand the manner and method of implementing these interventions to initiate the best results. As a matter of fact the Lifeline hospital that has been selected for this assignment has 45 nurses working in the entire hospital and the respiratory and Cardiac Care Unit has been allotted 10 nurses. Our intervention program will target all the nurses at a working in the night shift in the each unit to ensure that the minimal damage is done to the daily patterns of working and caring of the patients (Rai et al., 2017).

The next step to the model is outlining the intervention program that will be implemented on the nurse population selected. As mentioned about the major reason behind the massive non compliance to hand hygiene policy in the nursing population is due to the lack of education, training and understanding about the benefits and advantages of such infection control policies. Text in order to enforce compliance to the hand hygiene policy in the nursing population selected it will be required educate them train them and explain to them the benefits of using hand hygiene as a daily protocol to the nursing schedule. The quality improvement program will incorporate all the education and training programs that could be provided to the nursing population of the selected hospital to ensure compliance to the hand hygiene policy and it will include hand hygiene workshops, seminars and presentations to make them understand the benefits of use using hand hygiene policy and also demonstrated programs and interactive test to ensure that they have understood how to incorporate hand hygiene in today daily schedule with clarity and transparency (Ng, Shaban & van de Mortel, 2017). The intervention program will begin with an intern introductory beginning scale presentations to explain to them the benefits of hand hygiene policy and how the hospital authority is that have incorporated hand hygiene policies have benefited from it. Experienced and comprehensive speakers from the field of Healthcare and infection control will be participating in this presentation with interactive learning module to ensure that the nursing population selected has the best chance understand all the aspects of hand hygiene policy clearly.

 


After all the academic training about hand hygiene policy, the introduction of it and the establishment of it, the nurses will be demonstrated the activities, the when the why and the how's of hand hygiene policy in a healthcare setting. It has to be understood that regardless of academically training the nurses of the small scale hospital setting will not be enough to integrate hand hygiene policy to the daily schedule. Education about hand hygiene policy, how it will benefit the patients and how it will protect the nurses themselves from different infections will generate the understanding of the need of hand hygiene policy in the health care setting but it will not explain to them how they can incorporate hand hygiene policy into the daily schedule. To achieve that goal the nurses will have to be demonstrated and allowed to experience in hand in a workshop setting. Here's the second part of the intervention program will be elaborative and interactive workshop setting where the experienced and renowned personnels of infection control Programme of World Health Organisation will demonstrate the name the easy and simple 5 moments of hand hygiene program. This program will demonstrate to the process in a practical setting when how and why incorporate hand hygiene in the daily health care setting of the work schedule. There after the necessity allowed to perform hand hygiene in all the variables of the 5 moments of hand hygiene program, that is before touching a patient, before our safety procedures, before and after body fluid exposure, after touching the patient, and after touching the patient surroundings. An interactive and comprehensive educational leaflet will be provided to the nurses post the workshop to ensure that they retain all they have learned in the seminar and workshop for years to come (Nair et al., 2014).

The last and most important step of this quality improvement program will be measuring the changes that the intervention program was able to bring in order to do so and interactive contest will be held in which the tennis objects will be supplied a set of questionnaires on hand hygiene policy that they have to fill up based on the knowledge they have gained in the seminar and workshop programs and later on they will be monitored periodically in their working setting. In this evaluative measurement program the data will be collected from the filled out questionnaires and the performance of the nurses in the daily activities. The data will be analysed to ensure the progress the quality of improvement program could bring to the daily work schedule of the subject nurses (Morelli, 2016). In order to articulate all the intervention programs that has been a part of this quality improvement the stakeholders associated with this setting that is the hostel management the clinical Champions and opinion leaders that have been invited to participate in the presentation and seminars will be informed and consented before the beginning of this quality improvement program. In order to ascertain the ethical justification of this quality improvement programme the nurse subjects and all the other stakeholders associated with this program will be briefed and their wilful consent will be elicited (McCalla et al., 2017).

 

Measuring best practice:

Quality improvement programme will be incomplete without an accurate and demonstrative data collection and data analysis procedure. In order to ascertain that the nursing population selected from the program have understood the benefits of hand hygiene policy and will diligently comply to it the data collection is necessary by all means. As mentioned above after the successful completion of the workshop setting a set of Questionnaires will be distributed to the subject nose population to and short the level of understanding about hand hygiene and afterwards their performance with the patient on the basis of compliance to hand hygiene policy will be measured periodically. The data will be collected every big to track the progress of the improvement program and evaluate the efficacy of the program in generating compliance. The data will be collected with the help of Earth hand hygiene compliance checklist that will be prepared by the improvement program team (Lapinski et al., 2013).

The data collection will be carried out by the nursing managers and also the improvement program leaders and clinical Champions that have been brought forward into the hospital setting to reduce hand hygiene in the life line hospital. The data collection procedure will be real time observing the performance of the nurses throughout the work schedule and then their performance will be audited. This change strategy will be implemented on a small setting first that is the night shift nurses and on the basis of the success of the strategy it will be implemented on the other group of nurses. As mentioned above to justify the justification of this improvement program the privacy will be maintained at any circumstances and the data collected will be dealt with extreme confidentiality (Lanning, 2014).

Quality improvement programme will be incomplete without an accurate and demonstrative data collection and data analysis procedure. In order to ascertain that the nursing population selected from the program have understood the benefits of hand hygiene policy and will diligently comply to it the data collection is necessary by all means. As mentioned above after the successful completion of the workshop setting a set of Questionnaires will be distributed to the subject nose population to and short the level of understanding about hand hygiene and afterwards their performance with the patient on the basis of compliance to hand hygiene policy will be measured periodically. The data will be collected every big to track the progress of the improvement program and evaluate the efficacy of the program in generating compliance. The data will be collected with the help of hand hygiene compliance checklist that will be prepared by the improvement program team (Langoya & Fuller, 2015).

The data collection will be carried out by the nursing managers and also the improvement program leaders and clinical Champions that have been brought forward into the hospital setting to reduce hand hygiene in the life line hospital. The data collection procedure will be real time observing the performance of the nurses throughout the work schedule and then their performance will be audited. This change strategy will be implemented on a small setting first that is the night shift nurses and on the basis of the success of the strategy it will be implemented on the other group of nurses. As mentioned above to justify the justification of this improvement program the privacy will be maintained at any circumstances and the data collected will be dealt with extreme confidentiality (Huis et al., 2013).

 

Data analysis:

The next step to the program will be the analysis of the collected data, in order to bring order to this program the data will be collected every week as the improvement program progresses. As the data collected are real time data the analysis procedure opted will be qualitative. The analysis of the data will be presented as bar graphs and charts on the bases if percentage of compliance and accuracy. The progress of the subjects will be displayed each week on the common notice board of the health care facility to ensure that the participants can assess their progress. At the end of each week progress analysis meeting will be held with the Healthcare management and definitions of the hospital with the quality improvement team to assess and evaluate the problems that the nurses are making. Thrilling the feedback about the performance of the nurses before and after the following improvement plan will not only facilities more sincere effort from the nurses and but also generate understanding about efficacy of the program so that other Health Care units can utilize these programs to improve their care standards (Hagel et al., 2015).

Conclusion:

On a concluding note it can be said that the healthcare organizations and authorities are taking adequate steps to ensure the best quality of Health Care provided to each and every individual of our society. It has to be understood that his day is not a commodity that can be purchased based on the socio economic status of the individuals. Rather Healthcare is a basic necessity that each and every sector of our society has a right to regardless of the social economic or racial aspects. Infection control policies were introduced on the foundation of this motto, to ensure that every patient has a safe comfortable and optimal experience in any Healthcare facilities that the witch to access in any part of the word. Healthcare practice guidelines like this that are enforced by the Global authorities have the purpose of enforcing the best care standards for the patients regardless of the fact that the demographic restrictions do not affect the quality of care.

However in many developing countries the healthcare facilities have no access or infrastructure to introduce these improved and effective guidelines to ensure best practice. This periodic quality improvement program and assessment can help small scale hospitals in developing areas to incorporate best practices in Healthcare so that the patients are not deprived of quality care.

 

References:

Allegranzi, B., Gayet-Ageron, A., Damani, N., Bengaly, L., McLaws, M. L., Moro, M. L., ... & Donaldson, L. (2013). Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study. The Lancet Infectious Diseases, 13(10), 843-851.

Brotfain, E., Livshiz-Riven, I., Gushansky, A., Erblat, A., Koyfman, L., Ziv, T., ... & Borer, A. (2017). Monitoring the hand hygiene compliance of health care workers in a general intensive care unit: Use of continuous closed circle television versus overt observation. American Journal of Infection Control.

Chatfield, S. L., DeBois, K., Nolan, R., Crawford, H., & Hallam, J. S. (2017). Hand hygiene among healthcare workers: A qualitative meta summary using the GRADE-CERQual process. Journal Of Infection Prevention, 18(3), 104-120. doi:10.1177/1757177416680443

Donnelly, P., & Kirk, P. (2015). Use the PDSA model for effective change management. Education for Primary Care, 26(4), 279-281.

Grayson, M. L., Russo, P., Ryan, K., Havers, S., Heard, K., & Australia, H. H. (2013). 5 Moments for Hand Hygiene. Hand Hyg Aust.

Hagel, S., Reischke, J., Kesselmeier, M., Winning, J., Gastmeier, P., Brunkhorst, F. M., ... & Pletz, M. W. (2015). Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring. infection control & hospital epidemiology, 36(08), 957-962.

Huis, A., Hulscher, M., Adang, E., Grol, R., van Achterberg, T., & Schoonhoven, L. (2013). Cost-effectiveness of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: a cluster randomised trial. International journal of nursing studies, 50(4), 518-526.

Huis, A., Schoonhoven, L., Grol, R., Donders, R., Hulscher, M., & van Achterberg, T. (2013). Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: a cluster randomised trial. International journal of nursing studies, 50(4), 464-474.

Kingston, L. M., O'Connell, N. H., & Dunne, C. P. (2017). Survey of attitudes and practices of Irish nursing students towards hand hygiene, including handrubbing with alcohol-based hand rub. Nurse Education Today, 5257-62. doi:10.1016/j.nedt.2017.02.015

Langoya, C. O., & Fuller, N. J. (2015). Assessment of knowledge of hand washing among health care providers in Juba Teaching Hospital, South Sudan. South Sudan Medical Journal, 8(3), 60-62.

Lanning, M. A. (2014). Improving the plan do study act model: Examining the characteristics of the five silent killers affect on veterans and improving their care using the PDSA model (Doctoral dissertation, Utica College).

Lapinski, M. K., Maloney, E. K., Braz, M., & Shulman, H. C. (2013). Testing the effects of social norms and behavioral privacy on hand washing: A field experiment. Human Communication Research, 39(1), 21-46.

McCalla, S., Reilly, M., Thomas, R., & McSpedon-Rai, D. (2017). An automated hand hygiene compliance system is associated with improved monitoring of hand hygiene. American Journal Of Infection Control, 45(5), 492-497. doi:10.1016/j.ajic.2016.12.015

Morelli, M. S. (2016). Using the Plan, Do, Study, Act Model to Implement a Quality Improvement Program in Your Practice. The American journal of gastroenterology.

Nair, S. S., Hanumantappa, R., Hiremath, S. G., Siraj, M. A., & Raghunath, P. (2014). Knowledge, attitude, and practice of hand hygiene among medical and nursing students at a tertiary health care centre in Raichur, India. ISRN preventive medicine, 2014.

Ng, W. K., Shaban, R. Z., & van de Mortel, T. (2017). Healthcare professionals’ hand hygiene knowledge and beliefs in the United Arab Emirates. Journal Of Infection Prevention, 18(3), 134-142. doi:10.1177/1757177416677851

Rai, H., Knighton, S., Zabarsky, T. F., & Donskey, C. J. (2017). A randomized trial to determine the impact of a 5 moments for patient hand hygiene educational intervention on patient hand hygiene. American journal of infection control, 45(5), 551-553.

Roy, L. (2017). Maintaining hand hygiene to prevent the transmission of infection. British Journal Of Healthcare Management, 23(5), 209-213. doi:10.12968/bjhc.2017.23.5.209

Siddiqui, N., Friedman, Z., McGeer, A., Yousefzadeh, A., Carvalho, J. C., & Davies, S. (2017). Optimal hand washing technique to minimize bacterial contamination before neuraxial anesthesia: a randomized control trial. International Journal of Obstetric Anesthesia, 29, 39-44.

Smiddy, M. P., O'Connell, R., & Creedon, S. A. (2015). Systematic qualitative literature review of health care workers' compliance with hand hygiene guidelines. American journal of infection control, 43(3), 269-274.

Stowell, J. D., Forlin-Passoni, D., Radford, K., Bate, S. L., Dollard, S. C., Bialek, S. R., ... & Schmid, D. S. (2014). Cytomegalovirus survival and transferability and the effectiveness of common hand-washing agents against cytomegalovirus on live human hands. Applied and environmental microbiology, 80(2), 455-461.

Ward, D. (2017). Implementing infection prevention requirements. British Journal Of Healthcare Management, 23(5), 200-204. doi:10.12968/bjhc.2017.23.5.200

WHO | About SAVE LIVES: Clean Your Hands. (2017). Who.int. Retrieved 19 May 2017, from https://www.who.int/gpsc/5may/background/5moments/en

Wolf, L., Doane, E. and Thompson, S., 2015. Use of the PDSA Model with the ERAS Checklist. Journal of PeriAnesthesia Nursing, 30(4), p.e26.

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