Over a decade ago the Institute of Medicine (IOM) issued two startling reports, To Err is Human: Building a Safer Health System and Crossing the Quality Chasm both of which highlighted inadequacies in the American healthcare practices. Those reports compelled healthcare professionals to evaluate the quality of the work they were performing and to consider new initiatives to better serve their patients. The recent restructuring of the American healthcare system has added urgency to the matter by linking quality of care and outcomes to reimbursement. These expectations have led healthcare organizations to find new methods to evaluate, change and/or improve processes of care. Commercial quality improvement methods, such as Six Sigma, are now being adapted and utilized in the healthcare industry. (Joshi, Ransom, Nash, & Ransom, 2014). Models of care are being developed to reflect the necessary continuum of quality improvement and safety. This report will discuss an individual perspective of the quality in healthcare and provide a representation of a quality care model based on evidence based principles and family centered care in maternity services. Quality Care Management
A single definition of quality is elusive. Every individual has its own standard for quality. The IOM defines quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with professional knowledge” (Joshi, Ransom, Nash & Ransom, 2014, p. 35). Despite the ongoing quality efforts and interests of providers and the industry, healthcare has not yet achieved a quality revolution such as that produced by Toyota in the 1970’s (Hienemann, Fisher & Gershon, 2008). National healthcare quality organizations, such as the Leapfrog Group, report that a majority of hospitals have demonstrated little progress in improving quality and safety (. Quality management, in healthcare, has been evolving as it attempts to meet or exceed customer satisfaction and expectations, and to address identified problems. Standardization of processes and procedures, continuing education, achievement of competencies all interact as we strive to achieve a higher standard and improve outcomes (Sherwood & Zomorodi, 2014). Healthcare is now attempting to adopt and adapt successful quality improvement initiatives used in other industries such as Motorola or Toyota. Model
As early as 1966 Adevis Donabedian developed a conceptual model which associates quality of healthcare services with the categories of structure, process and outcomes of care . This theory reflects the belief that patient satisfaction is a desired outcome and should be incorporated in the design of healthcare systems (Hienemann, Fisher & Gershon, 2008). Basing patient care on more than traditional practice is now supported by numerous reports (Phillips, 2003). The use of evidence based practices and evidence based leadership will be imperative to the success of this model. A balance between cost and health consequences will be maintained by recognizing the economic impact of decisions affecting the healthcare model. Ongoing review and improvement of processes and practices will occur in conjunction with continuing education in order to maintain desired quality standards.
The Maternity Care Model in this scenario will recognize the importance of family support and collaborative decision making. Family Centered Maternity Care will be the corner stone of this department. Childbirth will be viewed as a normal life event and not regarded as an illness. The approach will consider the psychosocial, physical, spiritual and cultural needs of the patient. Evidence and adherence to current standards will guide practice initiatives. Evaluation of success can be shown in measurable data such as the cesarean section rate or the number of deliveries which occur before 39 weeks gestation....
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