In this project, the innovation proposed is a continuous patient satisfaction improvement process and is planed to be promoted in the local Public hospital’s haemodialysis unit.
The particular unit offers haemodialysis treatment to almost 120 patients suffering from End Stage Renal Disease (ESRD). All the patients are undergoing haemodialysis treatment which is last four hours per session, three times a week. Treatment is governed by the adequacy and mode of dialysis. Haemodialysis requires an access to patient’s circulatory system that will sustain a blood flow of 300 to 500 millilitres per minute per treatment session. The blood must be able to pass through the dialyser for a prescribed amount of time in order to guarantee dialysis adequacy. This is usually expressed as a Kt/V value which is a standard measurement of urea clearance during a specified time.
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In order to manage all those patients the unit has 14 haemodialysis stations that are working 18 hours per day, every day including weekends. The dialysis program is spread in three shifts (morning, afternoon, and evening) with the majority of the patients coming in morning and afternoon shifts. The unit delivers approximately 300 haemodialysis sessions per week. In order to carry out all this workload the unit occupies 30 first grade nurses, two sisters in charge, and one nurse supervisor. Furthermore, along with the nursing staff there are 3 doctors specialized in nephrology contributing to the care of those patients.
With the growing changes due to the emergence of advance technology, globalization and other economic aspects, different organisations, particularly healthcare organisations are considering changes through the context of innovation (Shelton & Davila, 2005). Accordingly, innovation can be regarded as the creative and resourceful approaches as well as duties resulting to the effective and efficient function of a firm or organisation. It is essential for health care organisations to ensure high levels of their client satisfaction – in this case the patients- their personnel and the entire organisation. It can be noted that innovation focus on thorough management of the approaches involving the deliberation of the services or even products (Amsden, 2001).
Consequently, like any other firms and organisations, the healthcare industry should also adhere in having the knowledge of considering changes and innovation to ensure that the organisation always adapt to the newest trends and developments in providing quality healthcare, it may be in the facilities used or the knowledge of the personnel.
The context of innovation is very crucial in enabling the organisation to analyse its current situation and status so as to reduce costs, increase income, spot healthcare trends rapidly, and communicate efficiently with the target market. Nonetheless, to be able to complete such purpose, innovation approaches are required to be relevant, precise, thorough and timely. It is essential that the innovation team should be able to determine what part of the organisation needs change and how they are going to initiate such innovation activities. For instance, in healthcare institutions, it is important that the organisation should constantly adapt to the changes in providing quality health care.
The innovation opportunity
The importance of providing quality healthcare services has long been recognized by the health care providers. But, such has been influenced by the consideration of the quality assurance, improvement programs and also the participation of the patients (Darby, 1998). Quality assurance in the healthcare services has long been studied as one of the driving forces of innovation in these institutions. Quality is referred to as the creation as well as maintenance of a competent edge has been widely considered by different institutions. (Frangou et al., 1999). In line with the health care practice, recent decades have researched and noticed remarkable innovation even an evolution in the quality supervision in the health care organisation, (Millenson, 1997). Prior to these changes, the context of the quality assurance for patient care had been analysed thoroughly by professionals, frequently this is conducted a subjective approach for the patients and individuals (Iglehart, 1996). But the obligations for quality in this system are no longer considered as exclusive realm of the health care providers. Healthcare authorities, governmental institutions and also the accrediting sectors have to innovate for the improvement of health care system in quality assurance.
Nowadays in my country, an overhaul reconstruction of the entire health system is in progress therefore, major important changes are due to take place. Among these anticipated changes is public hospitals’ status. Until now these hospitals are totally dependent for financial support from the Government and particularly from the Ministry of Health. With the new plans, they will transform into autonomous organisations leading to independence from their current state. The implication of this transformation is that once independence is granted, each institution will have to seek for its own sources of funding and other facilities, as are necessary to maintain their services, just as is the case in the private sector. This means that, they will have to compete equally for their resources with other organisations existing in the private sector. However, to be successful competitors, public hospitals have to identify their present quality status and where necessary, to enhance their care provision in all areas. Therefore, all hospitals have to adopt quality assurance programs, even before they transform to autonomous organisations.
The new healthcare reformation which will come into effect in the near future, aims to give patients, wherever they lived in the country, better health care and greater choice of service. Therefore the concepts of the internal market will be introduced, according to which, the ‘providers’ of healthcare will be separated from the ‘purchasers’ of healthcare. The idea is that by giving the purchasers the freedom to choose where to buy the best care, including the private sector, the system would place competitive pressure on the providers to offer greater quality, efficiency and value for money. Therefore, measurements of patient satisfaction have to play an increasingly important role in the growing demand towards accountability among health care providers. Overshadowed by measures of clinical processes and outcomes in the quality of care equation, patient satisfaction measurement has traditionally been downgraded to service improvement efforts by hospitals.
However, in today’s hyper-competitive environment, how much satisfied the patients are can determine whether a healthcare provider become preferred provider and retain that status. Therefore, continuous monitoring of patients’ satisfaction level it is expected to have a positive outcome not only on how the patients perceive the care they receive but also on the quality of delivered care in general.
Finally, as quality matters are in a primitive stage in my country such a venture will be the first of its kind especially in haemodialysis settings and probably will open the doors for others to follow.
C. The innovation planned
The project’s aim.
The aim of the propose project is to establish a Continuous Patient Satisfaction Improvement (CPSI) process within the Local General Hospital’s haemodialysis unit by utilizing the PDCA circle (Plan Do Check Act) or as differently known by many as `the Deming Wheel’ along with having Patient Satisfaction Index (PSI).
The major objectives of the proposed project are:
To establish the current levels of patients’ satisfaction towards specific aspects of the care they receive.
Caring and communication.
Quality of haemodialysis unit care and procedures.
To recognize and report on the patient perceived strengths and weaknesses of the health care service provided.
To report the results to haemodialysis unit’s authorities to assist them to integrate patient understanding of good health care into the provided services.
Establish benchmarks to allow unit’s authorities to compare their results with those of other units either domestic or international.
Individuals that you might consult or ask to support the project in question.
To be able to have an efficient and proficient initiation of the proposed innovation it is essential to recognize the stakeholders who will have specific participation in the proposed innovation. The intention of such analysis is to recognize who among the stakeholders will have a high interest on the innovation, which will have the highest effect and effect on others for the initiation and establishment of continuous patient satisfaction improvement process. Further, this stakeholder analysis also aims on recognizing who will be subjects, players, spectators and actors concerned in the said innovation. The stakeholder analysis will be discussed through the consideration of the stakeholders’ grid.
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In this proposed innovation the potential stakeholders composes of the haemodialysis unit’s authorities (as they will have the main responsibility for the process, interpreting the results and promote and implement changes), the patients receiving haemodialysis treatment and medication (as they will provide the information and they will have a direct impact from the changes), the unit’s personnel (as they will be asked to apply the changes), the hospital’s authorities and of course the Ministry of Health as the hospital’s and consequently the unit’s funders. The different participants for this innovation have varying amounts and classification of power, and those with the greatest effect shape approach and methods from a number of precise decisions (Shafritz & Ott, 2001). Participants for innovation are provided with the utmost authority in any organisational setting, like in this situation the initiation of the innovation of the continuous patient satisfaction improvement process. Their power and significance is beginning to expand slighter advantage when compared to an institution’s management team. The innovation participants will give diverse effect to both kinds of institutions and authorities and they guide the people in the health care organisation that the innovation aims and purposes will be met.
The following is an outline of initiation plan for the innovation of Continuous Patient Satisfaction Improvement through the process of PDCA circle.
Carry out research to establish the current situation on patients’ satisfaction.
The first stage is to consider a research study to identify the current situation regarding patients’ satisfaction in this unit.
The innovation process will not be able to attain its purpose if the tasks rendered were not appointed to efficient individuals to implement CPSI. Task allocation is not merely a situation of handing out the various tasks on final lists to the individual healthcare personnel you have available; it is far more delicate as well as powerful than such context. Hence, the unit’s authorities should consider what each member of the team is capable to provide sufficient complexity of tasks to match that.
Identify the weaknesses or problems regarding patient satisfaction
The next thing to consider is the identification of the weaknesses and issues relating to patient satisfaction to know what specific approach needed to satisfy them in the future.
Plan the changes that will promote the patients’ satisfaction with the care they receive.
The management should elaborate and disseminate information regarding the modification needed to promote the satisfaction of the patients with the care that they receive. For this matter, the change will include the enhancements of communication process and healthcare provision in the unit.
Report writing. A results report will be produced at the end of the cycle describing the methodology and the results of the first cycle. The report will be disseminated to the haemodialysis unit’s authorities, to the hospital administrators as well as to ministry of health.
Finally in this project, the time limit estimated to be about 9 months, however the exact time that will be requested will be decided by the innovation team after discussions with the unit’s authorities.
In this paper the Continuous patient satisfaction process had been presented as an innovation opportunity. Implementing such a process within the haemodialysis unit of the Local General Hospital it is expected that the overall quality of the services provided there will be promoted and change in such a way that will meet its clients/patients expectations on the higher possible level. In the light of the forthcoming changes of the entire health system in the country where every healthcare institution will have to compete in equal terms with other institutions the concept of keeping the client/patient satisfy is imperative. Utilizing established and effective processes like PDCA and PSI to monitor the patients satisfaction levels the unit’s authorities will be in position to early identify any possible weaknesses and proceed to the necessary changes so that to keep its clients/patients as satisfy as possible which in return will become “loyal customers”.
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