Assignment: Surgical Care Service
This assignment defines quality as it relates to a surgical care service. The author is a nurse working in a surgical ward in a hospital in India. The essay uses quality theory, models and tools to assess the quality of the surgical service provided. This assignment identifies a quality problem in the service provided by the surgical wards. The essay then critically discusses using change and service improvement theories and models and tools, and how change can be managed in ordered to address the quality problem. The essay concludes by summarising what the essay has covered and the key issue that is identified. Quality has become a top priority for healthcare providers all over the world. In fact, surgeons in developed countries like the USA are required to monitor their own performances in real time and effect changes in their work styles or operating procedures accordingly (Birkmeyer, et al., 2008). In the USA, the “Medical Joint Commission” also indulges in monitoring performance of surgeons all over the country as part of their procedures for providing credentials to doctors (The Joint Commission, 2011). Similarly, other countries also have their systems and procedures to ensure quality of the healthcare services provided. This essay focuses on the issues faced by the author in similar quality assurance for a hospital in India.
Definitions of Quality in Healthcare
The “World Health Organisation” defines quality in a healthcare setting as the “key component of the right to health, and the route to equity and dignity for women and children.” The “World Health Organisation” (WHO) advises that in order to adhere to good quality measures in healthcare, the delivery of health services should meet a particular criteria of either international standards set by the WHO or the standards of the particular region’s governing legislations. WHO urges that quality of healthcare is an aspect where quite a few healthcare institutions are lacking globally (World Health Organisation, 2020). Several aspects can be detailed to be the shortfalls of the overall current system of quality assurance in healthcare across several hospitals and clinics worldwide. Some of the methods that are at fault include, review of hefty medical records to measure quality, which is an immensely time consuming process, along with the alleged faulty accuracy of public report cards in regards to healthcare service quality (Ilminen, 2003). However the issue of quality in healthcare is not a recent one and has been ensuing since the past three decades. According to Harteloh (2003), quality in itself does not exist independently in healthcare. This author defines quality in healthcare as an “optimal balance between possibilities realised and a framework of norms and values”. The author further states that quality in healthcare is born out of interactions and communication between patients and healthcare workers to facilitate the transfer of right information (Harteloh, 2003). In the purview of the chosen situation where the author is working in a healthcare institution or facility in India, it may be noted that patient death due to medical negligence is a major cause of concern in the country. In the USA, the same is the third leading cause of death (Makary & Daniel, 2016). Coming back to India, the Supreme Court, which is the court of highest authority in the country, has legislated that the families of victims of medical negligence shall be compensated with an amount of INR 110 million, which is to be paid by the doctors, nurses and the hospital in question (Chandra & Math, 2016). All these facts demonstrate that the need for quality assurance and maintenance of service quality in healthcare is a pertinent issues globally as well as the focused country of the author. A “Quality Strategy” in healthcare report was published in 2016 by the “Centres for Medicare and Medicaid” wherein six goals have been identified with achievement of good quality in healthcare services (Centers for Medicare and Medicaid, 2016). These are listed as under –
- The harm caused in the delivery of care is to be reduced in order to make healthcare safer.
- Personal and family engagement is to be increased since they are the partners in healthcare.
- Effective coordination of healthcare is to be promoted.
- Effective prevention and treatment of chronic diseases is to be promoted to ensure quality of healthcare services.
- The best practices for healthy living need to be promoted at the community level.
- Healthcare should also be made affordable to generate a larger outreach.
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The “National Committee for Quality Assurance” in their “Essential Guide to Healthcare Quality” has appropriately stated the definitions for quality in healthcare services. One of the definitions that is, “safe, effective, patient-centred, timely, efficient and equitable”, has been provided by the “Institute of Medicine” of the “National Academy of Sciences”. The other definition that is, “doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results” has been provided by “Agency for Healthcare Research and Quality” (Steiner, 2017). The dimensions of quality care in surgical areas in hospitals of India relate to two specific areas, that is anaesthesia services and surgical services. These entail several indicators that can be measured in regards to the quality of healthcare service provided (H.K.Mahajan, et al., 2017).
The adverse effects of anaesthesia and unscheduled ventilation post-anaesthetic procedures as well as the mortality rates of anaesthesia related patients are major indicators, among others, to assess the quality of surgical services provided in hospitals of India. The percentages of anaesthesia plan modifications, unplanned ventilations, adverse effects, mortality rates etc. are all metric of this measurement. In regards to surgical services, the percentages of unplanned surgical operations, rescheduling of surgeries, non-adherence to organisational procedures of surgery, administration of appropriate prophylactic antibiotics post surgeries, among others are some important metric of the measurement of quality of surgical services in the hospitals of India (H.K.Mahajan, et al., 2017).
Maxwell’s Six Dimensions of Service Quality
After understanding and evaluating the definitions of quality in healthcare pertaining to the chosen situation, R. J. Maxwell’s theory that defines the six important dimensions of service quality which are explained as under –
Acceptability: Acceptability here means the extent to which a performance measure is deemed to be satisfactory or adequate for the patient. It is characterized by the characteristic of a service being subject to acceptance for the same purpose.
Accessibility: Accessibility in the sense considered here refers to the design of quality of care that is provided to the people. It will be a good product, good, device, and good environment if it is of two types. One is “direct access” and the second one is in “indirect access”. In direct access patient can be observed by means of direct observation. But in indirect they can be observed by computer or mobile means (Maxwell, 1984).
Appropriateness: It can be defined as the accuracy and appropriateness of the service of care that is provided to the patients of surgical wards. These can be measured by evaluation after the implementations of quality of care plan (Maxwell, 1984).
Effectiveness: It is the capability of producing a desired result or the ability to produce desired output. When something is deemed effective, it means it has an intended or expected outcome. It can be defined as the ability to be successful and produce the intended results in surgical procedures (Maxwell, 1984).
Efficiency: Efficiency is the ability to avoid wasting materials, energy, efforts, money and time in providing a service or in producing a desired result. It is the ability to do things well, successfully and without waste (Maxwell, 1984).
Equity: It is measured for accounting purposes by subtracting liabilities from the value of an asset. This is essential in healthcare in a number of ways (Maxwell, 1984).
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Analysis of the Quality of Surgical Services
Using the above descriptions of the six dimensions of Maxwell’s theory of service quality, the quality of provisions of surgical systems for this given situation of the author working in a hospital of India can be analysed effectively.
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