Monitor and Report Specific Outcomes

To assess how the quality of the product or services is being improved, progress can be monitored through systems and technology. In a healthcare setting, planning and operations can be improved throughout a variety of areas. These quality approaches include monitoring whether client expectations are fulfilled and streamlining organisation processes.

Identifying Client Expectations

Healthcare organisations strive to deliver quality care to clients. Accordingly, identifying whether services have met customer expectations can allow workers to monitor performance. The following dimensions of client expectations that are in line with patient centred care can be considered when monitoring progress (Delaney, 2018):

• Respect for client values and preferences: Workers should evaluate whether they have been considering the client’s values and preferences when making decisions surrounding their healthcare. This ensures clients are fully involved in decision making processes, thus allowing clients to feel empowered to make decisions.
• Coordination of care: When clients are engaged in multiple services, workers should ensure a smooth transition of care between services. This involves comprehensive and efficient handovers to ensure continuous care between services that fully meet the client’s needs.
• Information and education: The clients should be receiving the appropriate amount of information about the type of healthcare services they are receiving. Workers should ensure that clients fully understand they treatment plans.
• Physical and emotional comfort: Throughout the client’s engagement in a healthcare service, workers should monitor the client’s physical and emotional wellbeing. While workers may offer reassurance when appropriate, workers should consider the appropriate referral options when a client is experiencing significant physical or emotional harm.
• Involvement of family and friends: Given the important role social support plays in a client’s recovery and wellbeing, workers may consider involving the client’s family or friends who may support the client’s recovery.

Customer relationship management systems can be used to assist workers with monitoring whether customer expectations have been met. These systems use technology to monitor customer interactions and feedback, thus allowing organisations to assess quality of services and make the necessary improvements.

Survey and feedback forms can also be used to gather client feedback and ratings of services. Furthermore, workers may use online survey platforms that have features that allow workers to compile and analyse data easily.

Documenting and Examining Processes

Documenting processes helps workers to better visualise how the process is carried out. This subsequently allows workers to identify any unnecessary steps in the process and areas for potential process breakdown.

The Failure Mode and Effects Analysis (FMEA) can be used as a framework to help workers evaluate processes. This FMEA was originally used in the context of computer design where it helped workers understand the consequences of both hardware and software failures, which helped them incorporate new designs to prevent failure. In a healthcare context, FMEA has been used to improve patient safety and reduce medical errors (Liu et al., 2020).

The following steps can be used to help workers evaluate processes.

1. Brainstorm different ways a process could fail.
2. List the consequences or effects of the failure.
3. Identify the root causes or contributing factors that would lead to the failure.
4. On a scale of 1 to 10, answer the following questions for each failure:
   1. What is the likelihood of the failure occurring?
   2. How severe could the failure be?
   3. What is the probability that the failure can be detected?
5. Using the criticality score, prioritise the failures.
6. Improve the process to eliminate the failures.
7. Implement the improvements and continue the Shewhart cycle.

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When workers are developing plans for continuous improvement, they may consider the following techniques and processes.

Lean

Lean is a continuous improvement technique that focuses on eliminating or reducing wasteful or redundant steps in a process (Graban, 2017). Organisational activities are divided into either a value added or a non-value added activity. Value added activities contribute to client satisfaction, while nonvalue activities take time and resources without meeting the needs of clients. In healthcare organisations, non-value activities are processes that involve costs that clients are not willing to pay for.

The following processes in healthcare organisations are described as waste non-value activities (Graban, 2017):

The Lean process starts with understanding what the client values. The team then observes the day-to-day processes to identify areas of waste. Workers document each step of the process, the time it takes for each step, as well as the total time it takes for the process to be completed. The team then visualises a “flow” state where all steps of the process occur one after another without interruptions. This allows workers to brainstorm new ideas of how each step of the process could be improved or streamlined. In this phase, workers should aim to eliminate or reduce any non-value steps. An improvement plan is then created and implemented. This implementation phase involves communicating the plan to the relevant workers. At this phase, revisions to the plan can be made to demonstrate an organisational commitment to continuous improvement.

5S Workplace

The 5S method (sort, store, shine, standardise, and sustain) can be used to assist workers to reduce waste and streamline processes through improved workplace organisation and visual management (Graban, 2017).

Sort: This involves identifying items that are involved in the process and disposing what is not needed. Workers should also identify items that need repairs and replacement. This can include dated forms, old computers, and stationery. Workers should consult the relevant staff member if unsure about whether an item should be disposed of.

Set in Order: This process involves storing items in a way that flows with processes. For example, workers may identify items that are used frequently and ensure that such items are stored in an accessible location for convenient access. Workers should also ensure that storage areas are clearly marked or labelled.

Shine: This involves ensuring that the work area is cleaned, and that all equipment are in a good condition and ready to use. Cleaning equipment also gives workers the opportunity to inspect and report faulty parts of the equipment.

Standardise: This involves each worker having a clear understanding of their roles and responsibilities to carry out the standard tasks needed to keep work areas orderly. Workers may use visual tools to easily communicate standardised processes. For example, workers may place markers on a laboratory bench to drop off specimens in the appropriate location.

Sustain: The 5S is not a one-off process and should be continued and processed. Hence, sustaining involves workers continuously looking for opportunities to make improvements. While the 5S places a focus on cleaning and organisation, it also allows workers to better understand their workplace. Workers are better able to engage with the people and processes that contribute to quality healthcare delivery.

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Using organisation systems and technology, workers can effectively monitor their work performance. Specifically, worker may monitor whether client expectations have been met and if organisational processes are efficient. Accordingly, workers can then implement the various continuous improvement techniques to ensure high quality service.

Delaney, L. J. (2018). Patient-centred care as an approach to improving health care in Australia. Collegian, 25(1), 119-123. https://doi.org/10.1016/j.colegn.2017.02.005

Equation Technologies. (n.d.). [Cartoon people dressed in professional work clothing sitting on boxes and process diagrams]. https://www.equationtech.us/sage-accpac-blog/6-simple-steps-for-documenting-procedures

Graban, M. (2017). Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Third Edition. Productivity Press.

Liu, H., Zhang, L., Ping, Y., & Wang, L. (2020). Failure mode and effects analysis for proactive healthcare risk evaluation: A systematic literature review. Journal of Evaluation of Clinical Practice, 26(4), 1320-1337. https://doi.org/10.1111/jep.13317