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Running head: RESEARCH PAPER
Research Paper
Research Paper
In countries as advanced as the United States, it is estimated that up to a quarter of all
deaths in hospitals are preventable. Hospitals, however, fail to prevent them due to issues such as
lack of follow-up of laboratory results, exposure to unnecessary risks among other factors. In a
country such as USA that is still in the process of improving its health services to match those
offered by countries such as the United States; these issues are all too common. They point to an
inherent lack of quality management and lack of emphasis on quality of services offered by the
health sector (Weiner, 2006).
Quality has been defined by many terms. At the end of the day, the goal is not absolute
perfectness, but movement in that direction, so that unnecessary deaths and extended hospital
stays are minimized. The quality of care does not stop at curing the patient though. It involves
planning for this and continually striving to improve the quality of care offered (Weiner, 2006).
Poor quality healthcare not only causes undue patient suffering, and but it also leads to
institutional waste, loss of funds, and damage in the reputation of the health profession as a
whole (Almutairi, 2014).
Though the individual competence is extremely important, there is a growing consensus
in the medical field that the individual delivering care is not the only one responsible for the
quality of such care. Rather, the institution he works in is as important in creating an enabling
atmosphere that is able to prevent errors, and ensure that the necessary information is readily
available so that individuals can make decisions based on sound and accurate information on
their patients (Weiner, 2006).
Research Paper
In order to achieve acceptable quality standards, various factors must be addressed. These
cover not just healthcare professional and the institutions they work under, but also the patients
who seek healthcare there. In the USA for example, the issue of patients’ health literacy is a
major one that creates challenges not just for adherence to physicians’ instructions, but also for
the success of any intervention. This disconnect can only be overcome by a concerted effort by
all partners to enlighten the masses. Whereas the kingdom has achieved phenomenal success in
improving the accessibility of healthcare to its residents, there still remain gaps that need to be
covered. Cultural issues and beliefs with respect to modern medicine should also be addressed
sufficiently to overcome them (Almutairi, 2014).
Institutions also need to address issues such as the motivation of their staff. Poorly
motivated medical personnel, who are not satisfied with their jobs, are likely to provide services
of inferior quality to their patients. Where they are sufficiently motivated, the lack of enough
personnel may mean that they take excessive amounts of work. Too much work makes for a
fertile ground for committing mistakes, which obviously undermine the quality of care provided,
in addition to creating avenues for litigation. An organization-wide and ministry wide effort are
therefore needed to ensure that quality management is successful (Almutairi, 2014).
Smaller health institutions under the ministry face a unique set of challenges. Where they
are not located in remote areas of the kingdom, they face financial and administrative issues.
They are also not under too much focus as far as quality improvement is concerned.
Additionally, they may be overlooked by accreditation programs such as those by the Joint
Commission (Alomari, 2015).
Research Paper
Problem Statement
Several initiatives have been tried out in the USA to implement quality management and
improvement. These initiatives have been led by the Ministry of Health. Some of the initiatives
have been carried in partnership with partners in the programme to have computer-based
information systems in the hospitals. Despite such programmes, however, serious challenges
exist, that threaten the success of the transformation. Issues such as leadership deficiency, poor
funding and management support are some of the barriers that have to be overcome. Others
include negative attitudes and perceptions by medical personnel, who may not take too kindly to
being told to change their established way of doing things. A standard framework on how the
government can implement quality management is required to help individual hospitals
implement it effortlessly.
According to Gotzamani & Tsiotras (2001), the ISO standards commencement is based
on the voluntary implementation of requirements and recommendations included into a special
set of international ISO 9000 standards. The latest version of the standards was given out at the
end of the 2000 year. These standards are generic which means they can be presented in each
organization irrespective of its size and products as well as services offered to customers. An
operative implementation of these standards has been already substantiated. These standards are
documented everywhere in the world, and their principal meaning can lead to an effective and
efficient management system on the foundation of common. A number of studies have been
attempted to examine the implementation of the effective quality management systems in health
care institutions, and it has some vibrant benefits within the general hospitals in the USA (Becher
& Chassin 2001). Quality management has the following strengths when implemented:
Research Paper
The patient and other stakeholders confidence will intensify;
The level of management and comprehension procedures and level of their
repeatability will grow;
The number of let-downs and errors in organizational components and number of
patient entitlements will reduce;
Altogether responsibilities and authorities are clearly defined for each cluster of
The overall healthcare institutions expenditure will cut as a result of reducing wasted
resources as a result of failures;
It forms prerequisites for avoidance of potential complications happening at offices;
It escalates quality and effectiveness of services accessible to the customers
specifically patients; Gotzamani & Tsiotras (2001)
Quality Measure and Memorial Hospital
In general, hospitals come under a service industry heading. Consequently, there are
dissimilar ways to measure the quality. With the help of procedures and treatments, quality is
measured by Memorial Hospital. These procedures and treatments do not return a rating for the
reason that analyzing it is hard. By the rates of post-surgical infection, quality can also be
measured by Memorial Hospital. As it is considered by the hospital, the infections are
preventable, decreasing the rates of infection is a good quality measurement. There is a high cost
to run the hospital, and for Memorial Hospital, prevention is a top of care. It is believed by the
Memorial Hospital that preventing the disease is the best way to curing it.
Potential Costs and Failures of Quality
Research Paper
The failure cost associated with the empathy, assurance, responsiveness, and reliability.
There can have a greater influence on cost and patient because of higher levels of stress and
shortages of staff by maintaining and hiring registered nurses. Sometimes, registered nurses
leave an establishment or give the patients poor care quality, which results in extra costs. It is
stated in the article that it can be costly as much as $10,000 in direct costs of recruitment every
time a position of register nurse is turned over. The register nurses costs come from hiring
nurses that are ready for traveling, new nurses’ recruitment, or overtime pay (AFSCME We
Make It happen, 2015). Quality holds the characteristics of being tangibles, empathy, and
assurance, reliable and responsive.
Such features are vital and belong naturally to the industry of services. Reliability
associates with the measurement of procedures and with attaining the similar outcomes upon
repeating. Memorial Hospital’s reliability may be the assurance that there would be a registered
nurse for administering medicines, establishing plans of treatment, performing a diagnostic test,
conferring with doctors, along with assisting in the operation room. Additionally, quality can be
measured by Memorial Hospital in their openness to needs of the patient. Openness indicates the
sympathetically and/or appropriate reaction to the circumstances. With the help of abovementioned instance, when a patient is suffering from a heart attack and seceded to visit Memorial
Hospital, aspirin is given to the patient when they arrive in the hospital (Northwestern Memorial
Hospital, 2015). Registered nurses mostly administered these services.
If at Memorial Hospital, there is a higher turnover of registered nurses, it might not be
capable of holding up to the standards of quality for the reason that newer registered nurses
might have the knowledge and confidence essential for assuring they are giving the correct and
best care to the patient. If these nurses have lack of confidence that is required for administering
Research Paper
the medicines, they will not be capable of building trust and delivering the individualized and
personal attention that is required by the patients.
Finally, there are tangibles that can be recognized or seen; this falls into the group of
staff and hospital appearance. For turning off a consumer or patient one fastest way is an
institution and its presence. If the personnel, equipment or facility are not sanitary clean, patients
will not visit the hospital again.
Six Dimensions of Healthcare Needing Improvement
Safety—healthcare provided to the consumers and not focused towards harming them
Effectiveness—this is the care provided to the patients based on the scientific knowledge
and delivered to patients who could get the assistance and should not be provided to the
patients who are not unlikely to benefit from it. In other words, underuse and misuse
should be prevented.
Patient-centeredness—health-care given out by the providers should be respectful of and
receptive to individual patient preferences, needs, and values, and patient values should
direct all clinical judgments.
Timeliness—care should be given on time when the patient needs it.
Efficiency—the medical waste, including equipment, supplies, ideas, and energy, should
be evaded.
Equity—healthcare should be universal, irrespective of age, sex, race, financial status, or
any other demographic variable Al-Borie & Sheikh (2013).
According to Kizer (1999), a lot of knowledge and experience in increasing the quality of
healthcare has amassed worldwide over many years. Even though there is increased knowledge
Research Paper
and experience in the quality of health care, the challenge frequently faced by the policy makers
within the national level among the high-end low-middle- income countries is the kind of quality
strategies- perfected by and can be integrated with the external strategic initiatives, would have
the best impact on the results carried out by their health care systems. As stated by Talbot &
Verrinder (2009) to achieve the quality of the healthcare system in the general hospitals in the
USA, a lot of emphases should be put on decision makers and the planners with an opportunity
to come up with proper informed strategies choices to improve the health care quality. There are
two main opinions for promoting a focus on quality in health systems management currently.
Even though there is health system in developed countries with the help of development and
resources available, there is still a clear evidence that quality remains a serious concern, with
probable outcomes not predictably achieved and with wide variations in standards of health-care
delivery within and between health-care systems. Where health systems mainly in developing
countries, need to enhance resource use and increase population coverage, the procedure of
enhancement and scaling up needs to be based on sound local strategies for quality so that the
best possible results are achieved from new investment.
Total Quality Management Technique
A procedure that turns around the external or internal customer is total quality
management. It is a distribution function according to which everybody is accountable for
quality. It comprises the top administration and comes down to the front line employees.
Everybody is a team’s part and engaged in the TQM and works as a team for assuring that every
process is accomplished and every service is performed. For expounding on the services, the
customer’s voices could be considered. With the intention of translating the customer’s voice
Research Paper
into process design and product characteristics that would be valuable for the hospital, quality
function deployment (QFD) can also be used (Vonderembse, M. A & G.P. White, 2013).
In the current age, businesses define quality as continually exceeding or meeting the
expectations and needs of customers. In general, hospitals come under a service industry
heading. Consequently, there are dissimilar ways to measure the quality. The failure cost
associated with the empathy, assurance, responsiveness, and reliability. If at Memorial Hospital,
there is a higher turnover of registered nurses, it might not be capable of holding up to the
standards of quality for the reason that newer registered nurses might have the knowledge and
confidence essential for assuring they are giving the correct and best care to the patient. A
procedure that turns around the external or internal customer is total quality management. There
is a committee is the Memorial Hospital that utilizes national comparisons for assessing its
healthcare’s quality.
Research Paper
Al-Borie, H. M., & Sheikh Damanhouri, A. M. (2013). Patients’ satisfaction of service quality in
Saudi hospitals: a SERVQUAL analysis. International journal of health care quality
assurance, 26(1), 20-30.
Almutairi, K. (2014). Systematic review of quality of care in Saudi Arabia. Saudi Medical
Journal , 37 (8), Published online.
Alomari, F. e. (2015). Knowledge, attitude, and practice of quality standards in small-sized
public hospitals, Saudi Arabia. Journal of Health Specialties , 22-27.
Becher, E. C., & Chassin, M. R. (2001). Improving the quality of health care: who will
lead?. Health Affairs, 20(5), 164-179.
Gotzamani, K. D., & Tsiotras, G. D. (2001). An empirical study of the ISO 9000 standards’
contribution towards total quality management. International Journal of Operations &
Production Management, 21(10), 1326-1342.
Kizer, K. W. (1999). The” new VA”: a national laboratory for health care quality
management. American Journal of Medical Quality, 14(1), 3-20.
Talbot, L., & Verrinder, G. (2009). Promoting health: the primary health care approach. Elsevier
Vonderembse, M. A & G.P. White. (2013). Operations Management. San Diego, CA:
Bridgepoint Education Inc.
Weiner, B. ,. (2006). Quality Improvement Implementation and Hospital Performance on Quality
Indicators. Health Services Journal , 41 (2), 307-332
Research Paper
AFSCME We make It happen. (2016, June 26). Retrieved from The Cost of Failure:
Northwestern Memorial Hospital. (2016, June 26). Retrieved from How We Measure Quality:
Northwestern Memorial Hospital. (2016, June 26). Retrieved from National Comparisons:

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