Continuous Improvement Process
Quality Improvement Process exists as one of major components
in health care system. It covers the same content of quality activities like
other industries plus additionally specialized characteristics which are only
observed in health care related sectors. In fact, health care system is structured
and dedicated to meet for human’s care needs by providing products and services
that help improve well-being condition, cure diseases, or reduce health-related
morbidity and mortality issues.
The operation circle keeps moving and changing over time in
accordance with social conditions and their respective requirements. The
successful movement will keep organizations sustained and developed while
failure will drive the units to closure or similar negative impacts. Modification is consistently made during the
circle to better adapt to new challenges and meet new requirements.
The critical steps which are highly recommended in system controlling
methodology include carefully planning ahead of time, executing, checking, and
acting to modify as needed. Throughout the development process, the role of
Quality Control and Quality Assurance as parts of Total Quality Management
demonstrates the high capabilities in verifying the quality of product delivery
and ensuring they all meet expected specifications and satisfy customers’
expectation. On top of that, commitment to regulatory requirements is strictly
respected and satisfies.
Any deviation is
expected to detect through investigation process for potential issues. This
process can be done any time at any step throughout entire process. Corrective
action is taking place as the last step to assure the problem being well taken
care of. Along with implementation of continuous improvement process, risk
management is another critical part to ensure the organization on the right
track of professional performance and financial stability.
Quality Circles
Part of quality process, the formation of quality
circle is considered as a good preparation step for controlling activities. Quality
circle is a small group of six to 12 employees who perform similar type of work
and voluntarily meet at regular period to review the specific subject of their
work performance. The purpose of this meeting is specifically made for process
improvement. The main focus is how to effectively improve current operational
system by determining ongoing issues, analyzing them with sufficient data
collected, and working toward resolutions.
This process is critical to health care when the
system by itself includes complex structures with both independent and
interrelated functional compositions. Depending on each type of function every
group or department to be in charge, they need to update their system
continuously and consistently. Each
group should have the same background on their type of work to maximize their
contribution and initiative on solving the problem. Encouraging employees to
participate in this activity is highly recommended and proven effective in
process improvement.
Specifically, in health care improvement practice, the
quality circles have been proved to be effective in term of cost reductions,
ordering tests, and prescription habits. The better outcomes in patient treatment
are the combination results of appropriate clinical practice guidelines and
adequately updated instructions from process control (Verstappen et al., 2004
& Wensing et al., 2009).
Quality Circle in Primary Care: Test Ordering: Implementation and Results
The study was
conducted by Verstappen and his colleagues to examine the effectiveness of
implementation quality circle in primary care practice. The core content of the
research mainly focused on the test ordering strategy from primary care
physicians. The main expected outcomes would be measured in concern of cost
reduction while maintaining sufficient number of test ordering for diagnostic,
treatment, and follow-up per 6 month period.
When the project
got started, in regular quality meeting, the groups of primary care physicians discussed
about how they practically order the tests in general cases or for specific
requirements. The test ordering behaviors must follow practice guidelines and
appropriate to initial diagnostic. The individual and/or group plans are
designed to change the current process to more effective practice. The results
were measured every period of 6 months and data was collected for the next
meeting.
On the basis of
findings, the mean cost reductions achieved by decreasing unnecessary tests are
significant compared to previous periods. The initially successful steps in
finding adequate ways to reduce the incurring costs at primary care level
encouraged the development of other studies which focus on further long-term
effect and cost-effects by implementing the new quality strategy. Even though the study results supported for
the conclusion of reducing cost related to a decrease in the volume of tests,
in accordance with the national guidelines, but there was no data available to
compare the clinical outcomes before and after the plan implementation.
Prescribing of
Primary Care Physicians
The study
conducted by Wensing and colleagues in 2004 to inspect the effectiveness of
quality circles related to prescribing patterns of primary care physicians in
Germany.
Quality circles
in this study included small group sessions of primary care physicians who
voluntarily participated in the programs. They shared experience on their own prescribing
practice patterns and discussed how to improve them in term of cost reduction
and effectiveness. According to Wensing, the main purpose of this study is to
determine the impact of quality circles on quality and costs of prescribing on
a large-scale program.
Primary care
doctors who participated in the study were randomly allocated to either quality
circles group or control group. The subjects were 100,000 patients who visited
program-participating doctors in both groups in the 3 month registration period
from 1996 to 1998 in Germany. Main outcomes measured the proportion of patients
who received a prescription, mean prescription costs per patient, and
proportion of generic prescriptions.
The study conclusion was bringing substantial
reasons for physicians to believe in the bright future of the new process. It
confirmed the large-scale application of quality circles had intended effects
on prescribing decisions in primary care in Germany. The proportion of patients
received a prescription is reduced along with decrease of mean prescription
costs per patient. The proportion of generic drugs was increased as compared to
other previous studies.
Conclusion
In conclusion, Health Care Reform
activities with open market for health care providers to compete and
well-position themselves in the long run with other competitors are good
opportunities to improve our current health related system. The high qualities
of service and cost effectiveness are the best indicators for consumers to
select their health care providers. In responding to high demand of customers’
requirements and ensuring quality of service delivery, each health care
provider is encouraged to update their system on the basis of professional
perspectives and quality-related issues. Feedback received for related
activities and efforts are main sources to assess the effectiveness of
implemented projects and foundation for next study subjects in the action plan.
Therefore, consistently planning to build the quality system with essential
components such as quality groups or quality circles with specific goals to
achieve in each period of time is highly recommended. The success of any plan
is always imprinted by careful preparation step in addition to full
understanding of entire process.
References
Verstappen, H.; Van, M.; Grimshaw, J.; Dubois, I.;
Grol, P.; & Van der Weijden T., (2004). Comparing cost effects of two quality strategies to improve test ordering
in primary care: a randomized trial. Int J Qual Health Care , 16(5), pp.391-398.
Wensing, M.; Broge, B.;
Kaufmann-Kolle, P.; Andres, E.; & Szecsenyi ,J. (2004). Quality circles
to improve prescribing patterns in primary medical care: What is their actual
impact? Journal of Evaluation in Clinical Practice, 10(3), pp. 457-466.
Wensing,
M.; Broge, B.; Riens, B.; Kaufmann-Kolle, P.; Akkermans, R.; Grol, R.; & Szecsenyi ,J. (2009). Quality circles to improve prescribing of
primary care physicians. Three comparative studies. Pharmacoepidemiol
Drug Saf , 18(9), pp. 763-769.
