“The Recent Experience of Policy Interventions in Healthcare Quality Is Largely One of Assurance Rather

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“The Recent Experience of Policy Interventions in Healthcare Quality Is Largely One of Assurance Rather Than Improvement”


Every clinical practice should be committed towards the delivery of quality care. For several decades, health professionals have witnessed a situation whereby policy makers have been affected by financial issues and activity targets in their board agendas. The government has since introduced white paper which governs NHS (public funded system) in England. The white paper outlines new guidelines that aim at addressing quality improvement that has been challenged by financial issues and activity targets. The new guidelines in the white paper state that health organizations should have statutory duty to seek quality improvement by engaging in clinical governance of public funded system. In the coming years, quality improvement will depend on health organizations with financial control, and service performance. In addition, quality improvement will depend on clinical quality provided by health professionals (Healy, 2011; Ovretveit, 1997).

The public funded healthcare system is an important aspect of national health in the United Kingdom that must be managed effectively. Several UK residents depend on this system for survival. Policy makers should therefore ensure that quality is a top priority for all institutions operating under NHS. In particular, regulations concerning correct health practice should be guaranteed by all health professionals. The government’s white paper regulating operations at the NHS in England echoes corporate governance. This refers to an initiative originality that seeks to address failed standards in healthcare (public funded system). The Cadbury report is one of the policy documents that are being used to address failed standards in the healthcare. Further, the Cadbury report has since been extended to public service institutions such as the NHS. The government introduced clinical governance so that quality of care at all levels in England could be improved. This is one of the ambitious quality initiatives that have been implemented by the NHS (Healy, 2011).

Clinical governance has been seen by health professionals as being positive and developmental. However, it can also be seen as a method of addressing issues that affect the quality of healthcare. Quality improvement changes in healthcare have been prompted by failures that have led to major injuries in public funded system. Policy makers have been able to document variations in standards of care that is given to patients. Previously, the government operated the NHS through their market driven system. In such a system, several health professionals felt that provision of quality care was dependent on price and quantity in terms of competition. In addition, there were major clinical failures in market driven system. For instance, in breast cancer and cervical cancer treatment, clinical failures have been used or publicized so that clinical quality can be made a public confidence issue. Clinical governance can thus be said to be the recent policy intervention aimed at improving quality in public funded system. Clinical governance can be described as a process whereby NHS institutions are made responsible for the quality of services they provide to patients as well as adhering to high standards of care. This can be achieved through creating of an environment where health professionals aim at excellence in clinical care (Healy, 2011).

Healthcare quality has always been affected by several approaches. In particular, world health organization (WHO) has been useful in helping governments and health professionals to explore the concept of clinical governance. WHO divides healthcare quality into four categories. They include: professional performance (technical quality), resource use (efficiency), risk management, and client’s satisfaction with the services provided (Klazinga, 2000).

These categories of quality are discussed further based von the guidelines identified in the current NHS white paper. They are regarded as the attributes of an institution providing high quality healthcare. The creation of clinical governance theory is aimed at consolidating, codifying and universalizing fragmented and unclear policies and approaches, to develop institutions whereby final accountability for clinical governance is exercised by the chief executive of the health institution. Chief executives are expected to produce regular reports so that they can be discussed by board meetings. In addition, they should develop daily responsibility tests with a senior clinician. Every institution is expected to work out accountability arrangements in detailed perspective and take action so that they are communicated in the institution (Klazinga, 2000).

Healthcare improvement philosophy

Institutions that form health service have shown their variation when providing quality care in public funded system. The variation can be explained according to the figure below. Quality improvement in health institutions is expected to address several performances. In particular, drawbacks in standards of care were determined through complaints, audit, and routine surveillance. These factors represent one end of the range in the figure below. Health institutions that are considered to be providing quality care (exemplars) are depicted on the other end. Currently, after determining good practice, the choice for general applicability and procedures to transfer it in the NHS system has not been developed fully (Ovretveit, 2005).

Variation in the quality of health institutions

Source: http://www.bmj.com/content/317/7150/61

Health organizations in NHS have never learnt a lesson from organizations that have excelled and those that have experienced problems. The NHS has also not tackled the learning lessons from the exemplar and problem services. Important, achievement of quality healthcare will only be achieved when health institutions that are found in the middle range are transformed. This means that the quality curve will have to be shifted. By doing this, NHS will ensure that several institutions adopt principles and methods that can improve quality. In particular, quality improvement will involve institutional wide approach by putting more emphasis on preventing negative outcomes. This can be done through simplification and improvement of the healthcare process. The commitment of organizational leaders, team work, focus on the patient, and good data are necessary in healthcare quality improvement (Klazinga, 2000).

In the NHS, an important aspect of assessing a new philosophy of quality improvement involves making a decision on how clinical audit fits into the public funded system. It should be noted that the idea of peer review has been developed in all sectors of healthcare in United Kingdom. However, the implementation of clinical audits has not been fully carried out by the NHS. Health professionals and policy makers have cited failures on the part of audit process to identify and control major clinical failures. Further, health professionals have been concerned about incomplete participation of all stakeholders, and lack of cooperation in the process of information flow to persons in charge of the management of services (Arah and Klazinga, 2004).

There are external institutions that have been formed to facilitate and reinforce the need for quality in NHS public funded system. The two institutions include the commission for health improvement and the national institute for clinical excellence. These external institutions are expected to inspect, investigate, provide counsel, provide experts, and accredit health institutions. The functions of these two institutions can involve all elements of these functions. Important, they should come up with overall philosophy that they will use when dealing with local health institutions or when facilitating quality improvement and inspiring institutions to engage in evaluation activities. Healthcare quality improvement can only be achieved when health institutions do not become defensive to the operations of the two important bodies instituted to oversee the activities of the NHS (Pollitt, 1996).

Leadership and culture theories

Success in health organizations toward provision of quality healthcare depends on their culture. Health institutions that create a working environment where every person can participate in the decision making proves, where professionals share ideas, where evidence-based practice is respected, and where blame game is not fostered is likely to provide quality healthcare. A major challenge in the NHS has been in the creation of such cultures in most hospitals as well as primary care groups. The definition of a good culture and leadership is lacking in the NHS. Health institutions should aim at improving quality of healthcare through the use of current research. This can be done by adhering to the principles of evidence-based practice. Evidence-based practice shows that any medical intervention in health institutions must be based on previous research that was successful in treating similar conditions. Failure to use evidence from medical trials ca.............

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