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Operations Management Assignment: Quality Control & Improvement Process Of NHS

Question

Task:
Operations Management Assignment Instructions: Using appropriate operational management tools, analyze a HealthCare process with which you are familiar, in order to make recommendations for improvement. It could be:

  • A design process; for example: changing technology; layout; workflow; ergonomics.
  • A planning and control process; for example: capacity planning; allocating work to resources; scheduling staff or equipment; managing queues; project planning; inventory management.
  • A quality control or improvement process; for example: failure prevention; total quality management.

Answer

Executive Summary
Herein operations management assignment, the study of operation management of the healthcare organisation of NHS England "National Health Service" begins with a brief introduction about the situation of the present service provided in NHS and the reason of the need of improvement of quality of the healthcare services. This NHS is a healthcare system which is publicly funded. The second and third part of the study is interrelated with each other. The second part is the strategic context which talks about how the analysis of the quality control and improvement process align with the objectives planned by the organization. The analysis process starts right from the root of the quality improvement management and then moves on to the some approaches which can be adapted to improve the quality. These approaches include reengineering of business process; co-design based on experience, lean, PDSA, Six Sigma, and control of statistical process, constraints theory and total quality management. The analysis also talks about the principles required to follow for appropriate application of the improvement process. This includes measurement and data collection, understanding and gathering the knowledge of the process, improvement of reliability and understanding the capacity, flow and demand. The principle even included engagement and involvement of the staffs and involvement of co-designs as well as patients. The fourth part gives suitable recommendations which will help to improve the quality and control process of the healthcare sector of NHS.

Introduction
NHS (National Health Service) situated in England provides healthcare service to wide range of patients all across the different regions of the UK. These services are provided by the clinical as well as the non-clinical staffs recruited by NHS England. The main focus of the analysis would be on quality control for improving the current process applied by the organisation. Improving quality of a healthcare process is all about turning healthcare safer, efficient, effective, timely, equitable, and patient- centred. Past records of NHS has not shown any kind of interest towards improving their health service qualities.This study of operation management with appropriate tools of operation management will help he health industry of NHS to improve their quality control and quality management. The study focuses on the main element of agenda of quality and that is quality improvement and aims in bringing marked improvement by the application of specific methods and tools within the healthcare setting (Dayan et al., 2018). The Foundation of Health finds it to be a very compelling situation for the application of organizational and industrial improvement of quality approaches towards the sector of healthcare. At present day, the problem with the healthcare sector is that it does not always ensure safety and thus can cause poor experience as well as outcomes of patients. As a result, the services of healthcare are questioned regularly. Hence these questions should be answered by improving their efficiency, increasing their quality and causing less harm to patients. Improvement and control of service quality within NHS is also one of the main requirements supported by certain initiatives, for instance accounts of quality and payment framework for Commissioning of Innovation and Quality (CQIN) (Castle-Clarke et al., 2017).

Strategic Context
The process which is taken into consideration in this study is the process of improvement of quality and offering good control of the service provided by the healthcare sector of NHS. To achieve this process of quality control and quality improvement, certain approaches of improvement are bringing into focus. The objective of the health industry of NHS is to bring a change in the leadership style, spreading of innovation, adapting new technologies, improvement of the methodology, rigorous delivery, and measurement done in a transparent manner, system drivers and engagement in order to mobilise. It is said that only two-thirds of improvements of healthcare moves forward to create a sustainable change in order to achieve the objectives planned earlier. Therefore it is the responsibility of the leaders to think carefully regarding the way they can create positive change to ensure making the process sustainable. The approaches of quality improvement such as reengineering of business process, will help the organization in identifying the areas with bad quality service and hence steps may be taken to make those areas streamlined. Improvements through co- designs based on experience will increase the value of service as through this process the staffs will have much more knowledge regarding the past and present experience of the patients. Through lean, the actual demand can be responded without investing time on matters which do not affect the service quality directly or which could be addressed in the later days. By the application of PDSA, answering the main three questions will help to analyse the areas which needs improvement and hence assure a safe and secured environment of the healthcare sector of NHS. This is because the main policy of the organization is to improve and control the quality of service.

Analysis Of Quality Control And Quality Improvement Process
Roots of Quality Control and Improvement

Most of the recent methods of quality improvement were created in industry, thereafter, adapted for utilisation in different other sectors, most importantly, the health sector. These approaches have been in use for more than 30 years within healthcare industry (Dimitri , 2019). But they were not embedded on all the healthcare organisations. With the improvement in science, effectiveness of these approaches is increasing. During the year of 1940s and during 1950s, techniques of quality improvement were created in Japan, and led by US experts such as W EdwardsDeming, Armand Feigenbaum and Joseph Juran and Kaoru Ishikawa,expert of Japan. These leaders built a foundation of knowledge regarding implementation and sustainable change throughout a wide variety of industries which included healthcare. Kaoru Ishikawa gave a lot of his contributions towards quality improvement involving techniques and tools. For instance, the effect and cause ‘fishbone ‘tool. He emphasised the quality of human side. The quality improvement concept is determined by the overall understanding and responsibility of every staff of the organization. The work of Ishikawa focuses on continuous management (Aiello et al., 2020). W Edwards Deming created an approach of quality improvement involving 14 point. In today’s world, this approach has been in use of quality improvement process within NHS. The US Institute of Healthcare Improvement (IHI) is top positioned in health as well as healthcare improvement innovations and had considerable influence regarding the implementation of methods of quality improvement within healthcare sector.

Operation management tool needed for quality improvement in NHS

  1. Reengineering of Business Process – The process of business reengineering involves fundamental rethinking regarding the designs of the central processes of the organization in which visionary leader will cover occurrence of any type of change (Kilbourne et al., 2018). Industries are restructured surrounding the key processes instead of the specialist functions. By diverting from the traditional silos, the organizations will be able to identify waste and problems and become much more streamlined.
  2. Co- design Based on Experience - This approach is concerned in improving the experience and satisfaction of patients regarding the services provided by the staffs operating in accordance with the design of services and pathways. Data and information are collected through the conduct of in-depth observations, interviews as well as group discussions. The ‘touch points’ that is the service aspects which are required and emotionally significant are identified through the anylasation of those collected data and conducted interviews. An edited and updated film based on the views of the patients is shown to the staffs of the organization. The film is about the customer’s previous and present experience. Based on this film, both the patients and staffs assemble in little groups in order to come up with service improvements (Cookson and Walden, 2017).
  3. Lean – This one is a system of quality management similar to the management of production processes of some industries manufacturing Japanese car, including Toyota. This approach involves five main principles. These are value of the customer, management of the stream of value, regulation of production flow in order to avoid bottlenecks and quiet patches, waste reduction and lastly to support the flow application of ‘pull’ mechanisms. Using ‘pull’ refers to the identification and answering of the actual demand instead of letting the needs of the organization to determine levels of production.
  4. Model for the improvement ( includes PDSA)- This approach supports continuous improvement because in here changes are checked and tested continuously in small cycles which involves planning, doing, studying, acting (PDSA) and again coming back to planning and in this way the cycle continues. These cycles is concerned with three questions – a) what is to be accomplished? b) How can one identify a change with improvement? c) What changes will lead to quality improvement? Each cycle initiates with ideas, hunches and theories and aid them to turn into useful knowledge which can generate action and thus produce good and positive outcomes (Tirada et al., 2019)
  5. Six Sigma- This approach is much more systematic in improving products and processes. This approach first brings into focus the understanding the way in which the customers of the organization define ‘defects’ existing within the services and products. It then operates in reducing factors which according to the customers are important to quality, draws statistics to study the differences in service quality (McGrath et al., 2020).
  6. Process Control through Statistics- This is an approach that examines the similarities as well as the dissimilarities between natural variation (which is also referred to as ‘common cause variation’) and controlled variation (which can also be referred to as ‘special cause variation’). This approach involves the use of control charts which shows the limitations regarding acceptable level of variation within a process. Over the time, data are gathered to find out if a process belongs with the limits of control for the detection of bad and deteriorating performance as well as targets which requires certain improvements.
  7. Constraints Theory- This constraints theory originated from a primary and simple concept which is almost same to the fact that the strength of a chain is proportional to the strength of the weakest link of the chain (Ahmed, 2019). It recognises the idea that a movement in the way of process or even task chain will flow at the speed of the task which has the lowest capacity. The approach is executed through two steps-
    • Identification of the constraint (bottleneck) present in process and receiving most of the thing through constraint as this step of rate-limiting determines the throughput of the system, the whole system value is determined by what goes through the bottleneck.
    • Recognisation of the effects of mismatches in between demand variation and capacity variation during process constraint.
  8. Total Quality Management (TQM) -Total quality management (TQM) is also referred to as continuous improvement of quality. This is an approach of management which brings into focus quality as well as the individual’s role in an industry to create alterations in processes, practice and culture. Instead of being a process, management of total is a type of philosophy which is implied to the entire organization, surrounding factors for instance, customer focus, decision making based on evidence, leadership and systematic approach towards change and management (Coles et al., 2020)

Principles of the Operation Tool of Quality Improvement Management
Measurement and Data for Improvement

Gathering and measurement of data are important elements during any attempt to develop and improve the quality as well the performance and assess of its impact on the healthcare sector. But, improvement measure differs from two other well-known measurement types which are research measuring that examines intervention works as well as judgement measure that aids the managers to gauge performance (Hignett et al., 2018).

In contrast, while measuring improvement, learning increases through process. Hence, hypothesis will alter throughout the entire project as well as data and information instead of being perfect will be ‘good enough’. Rather than asking if an intervention operates, it includes asking the way in which the intervention is operated in a particular situation as well as the thing that will constitute profit or ‘successes. It is significant to measure the alterations that take place over time, using the application which makes it possible in filtering out deterioration and improvement from the anticipated performance variation level.

Process Understanding
While assessing if there exists a problem or not, it is necessary to access the data and information. However this will not explain the reason of the existence of the problem. This is the point at which process understanding becomes important.

A tool based on process mapping is used in the examination of each and every step of the process. The tool is most commonly used in the process of mapping the pathway and journey of a part or the entire healthcare journey as well as supporting processes of the patient. Mapping process is very useful tool that engages the staffs and employees in understanding the way in which the various steps fit with each other, the steps that add value into the process as well the areas where there are possibilities of delays or wastes (Tunçalp et al., 2017).

The mapping process of the journey of the patient involves several providers and is invaluable in the identification of quality problems in between the interface of organisation and teams.

Improving realiabity
After the understanding of the process, the main focus of improvement of quality is to make the reliabity of clinical and system processes better. Ensurerance of reliabity removes the defects as well as waste generated in the process and reduction of ant type of harm and error.

Approaches in making improvement in quality in a systematic way for example Lean aims in the redesigning of the system as well as clinical pathways, creation of standardized working as well as development processes which are free from error and delivered good quality, steady care as well as efficient utilization of resources (Wells et al.,2018).

Flow, capacity and demand
Capacity problems occur from issues such as backlogs, service delays, and waiting lists. Capacity problems refer to insufficient stuffs, equipments or machines required in dealing with a huge number of patients. However, unless and until demand (Volume of patients demanding service) and flow (time of requirement of service) measurement is conducted, it is not possible to gauge is there exists a shortfall of capacity (Graber et al., 2018). To improve any kind of process related to healthcare sectors, detailed understanding regarding variation as well as the relationship between flow, capacity and demand is needed. For instance, demand is relatively consistent and flow may be anticipated in terms related to troughs and peaks. In here, it could be the differences in the available capacity which are the causes of the problem (for instance, unplanned leave or staff sickness).

Engaging, involving and enthusing staff
Successful improvement of quality is not entirely about the approach or method used but the way in which alteration is introduced. Factors which contribute to this principle include management of staff, leadership style, participation of patient and education and training.

It is vital that the importance of all staff including even the staff of non-clinical department is not underestimated as they are the initial point of interaction with the patient. To execute this type of multidisciplinary approach breaking down of traditional hierarchies is important for the esurance of ideas and perspectives. For any programme of quality improvement engagement of front line clinical worker is necessary.

Co- design and involvement of patients
Carers, publics and most importantly the patients have some important roles to execute. This includes designing of improvements along with monitoring if they have any desired impacts. This is vital as these patients are the one and only people those who go through the experience of the pathway of patient from the very beginning to the end.

Staff must interact with the patients with questions concerning good care of the patients. If carers and patients are engaged in the process of quality improvement, they will help in providing the answer (Harrison Dening et al., 2019).

Recommendations

  • Hence, in order to improve the quality and control of the healthcare sector of NHS, the main factors to be considered are that the healthcare industry must be effective, person- centred, safe, timely, equitable and efficient. Therefore, the leaders need to keep these six dimensions in mind and actively apply in real life. These dimensions work together and therefore complementary. There may occur tensions between these dimensions which need to be balanced in an appropriate way (Johnson et al., 2018).
  • The leaders must consider the views of the stakeholders regarding their feelings and the priority areas according to them which needs improvement in the organization.
  • Several factors of outside influences needs to be focused on. These factors include inititatives of centralised governments, professional requirements, initiatives as well as economic drivers, for instance payment framework of Commissioning Innovation and Quality (CQIN).
  • The healthcare industry of NHS should develop and decide their goals they want to fulfil using fill time involvement of the staffs and must apply an approach which is systematic and focus towards creating a change and monitor progress.
  • The industry must focus on understanding the issues, with a specific emphasis on the study of the data and information gathered. The healthcare sector needs to develop a knowledge regarding the systems and processes within the industry, especially the pathway of the patient.
  • NHS needs to analyse the capacity, flow and demand of their service and choose the appropriate tools which can effect a change that may include clinical engagement, leadership, and participation of patient and staffs and skills development (Mehta and Sharma, 2018).
  • The healthcare sector of NHS needs to evaluate and measure the effect of an alteration done on a regular basis.
  • The healthcare industry of NHS is susceptible as it operations is mainly concerned about the lives of several individuals. Therefore, even a small mistake may lead to dangerous and regrettable consequences. It is recommended that the workers may sometimes use their common sense and personal intuitions while attending or treating any patient rather than strictly follow the designed rules which they think can affect the patient’s life.
  • Staffs of the NHS should be given enough liberty to come up with processes that the workers think would save the life of their patients. Employees should avoid perceiving certain regulations and rules as punitive; instead they are recommended to view those rules positively.
  • To ensure safety of the patients, the nurses of the NHS are advised to check whether the equipment of the hospital wards is cleaned properly. Test results are needed to undergo cross-check by senior technicians as well the doctors. In simple words, the sector is recommended to not to rely upon the primary standards and should sometimes go beyond particular regulations in order to ensure the best possible services.
  • Incorrect application and use of the equipments may have adverse impacts on the lives of the patients. Even the experienced medical practitioners sometimes mishandle the medical equipments or some have grown unsafe habits which can harm the patient’s life. Therefore, to avoid such dreadful events, the healthcare sector of NHS is recommended to conduct unplanned sessions regarding testing of equipment to ensure compliance in the sector.
  • The employees of the organization needs to be tested and monitored on a regular basis regarding their handling of their equipment and also the way in which they interact with the patients as well the patient parties.
  • The healthcare sector of NHS needs to give importance to the views of their workers both the clinical staffs as well as the non- clinical staffs because they are the ones who directly connects with the patients and hence they will be able to identify occurrence of any error. Then according to those identified errors, improvements will be facilitated.
  • To ensure improvement of quality, the healthcare sector of NHS needs to maintain an operating environment which is friendly and most importantly clean. The surgical rooms as well as the equipments required in the medical process needs to be sterilized regularly to ensure safety of the service provided to the patients.
  • The healthcare sector of NHS is recommended to built a culture which promotes a secure and safe environment among the employees and workers of the organization.
  • The health industry of NHS is recommended to create policies in which the employees might be rewarded with incentives for maintaining high standards of cleanliness. At the same time, the employees who try to violate the rules of safety, security and cleanliness must be punished.
  • Facilities of healthcare industries depend on several types of equipments based on medical grounds in order to function effectually. Hence, the healthcare sector of NHS is recommended to conduct a program concerning good control of quality. This program will come up with the list of equipments necessary for the operation of the organization in an optimal manner. All authorized workers should have the proper knowledge regarding the place of keeping aside the spare parts of the equipment and must be trained in the replacement of such equipments (Kodra et al., 2018).
  • It is not easy to achieve good control of quality without proper application and implementation of strategy. It is always the management’s responsibility to come up with improved measures and make them familiar to their health workers. This is possible only with the acquire of great skiils and knowledge at various stages of the process of assurance of the quality.
  • The NHS must invest their time and focus on conducting training sessions of managers and making them much better in skills of communication, leadership, coaching and delegation. Training of the management team is vital for the system of healthcare as it is one of the main points when implementation of good control of quality is considered. As technology is rapidly changing, it is significant to train and educate the managers and workers and make them updated regarding the modern day equipment of medical.

APPENDICES

NHS Leadership in operations man 1

Fig 1. NHS Leadership Framework (Yeomans et al., 2017)

NHS Leadership in operations man 2

Fig 2. NHS Change model (Humphrey and Cleaver, 2018)

Reference
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Castle-Clarke, S., Edwards, N. and Buckingham, H., 2017. Falling short: why the NHS is still struggling to make the most of new innovations. London: Nuffield Trust.

Coles, E., Anderson, J., Maxwell, M., Harris, F.M., Gray, N.M., Milner, G. and MacGillivray, S., 2020. The influence of contextual factors on healthcare quality improvement initiatives: a realist review. Systematic reviews, 9, pp.1-22.

Cookson, R. and Walden, A., 2017. Inequality and the NHS hospital crisis: why social disadvantage needs attention. British Journal of Hospital Medicine, pp.64-65.

Dayan, M., Ward, D., Gardner, T. and Kelly, E., 2018. How good is the NHS?. King's Fund.

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Harrison Dening, K., Sampson, E.L. and De Vries, K., 2019. Advance care planning in dementia: recommendations for healthcare professionals. Palliative Care: Research and Treatment, 12, p.1178224219826579.

Hignett, S., Miller, D., Wolf, L., Jones, E., Buckle, P. and Catchpole, K., 2018, June. What is the relationship between human factors & ergonomics and quality improvement in healthcare?. In Contemporary Ergonomics and Human Factors 2015: Proceedings of the International Conference on Ergonomics & Human Factors 2015, Daventry, Northamptonshire, UK, 13-16 April 2015 (p. 213). CRC Press.

Humphrey, T. and Cleaver, K., 2018. General practitioners’ perceptions on their role in light of the NHS five year forward view: a qualitative study. London journal of primary care, 10(3), pp.54-58.

Johnson, J., Hall, L.H., Berzins, K., Baker, J., Melling, K. and Thompson, C., 2018. Mental healthcare staff well?being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions. International journal of mental health nursing, 27(1), pp.20-32.

Kilbourne, A.M., Beck, K., Spaeth?Rublee, B., Ramanuj, P., O'Brien, R.W., Tomoyasu, N. and Pincus, H.A., 2018. Measuring and improving the quality of mental health care: a global perspective. World psychiatry, 17(1), pp.30-38.

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Kodra, Y., Weinbach, J., Posada-De-La-Paz, M., Coi, A., Lemonnier, S.L., Van Enckevort, D., Roos, M., Jacobsen, A., Cornet, R., Ahmed, S.F. and Bros-Facer, V., 2018. Recommendations for improving the quality of rare disease registries. International Journal of Environmental Research and Public Health, 15(8), p.1644.

McGrath, B.A., Ashby, N., Birchall, M., Dean, P., Doherty, C., Ferguson, K., Gimblett, J., Grocott, M., Jacob, T., Kerawala, C. and Macnaughton, P., 2020. Multidisciplinary guidance for safe tracheostomy care during the COVID?19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP). Anaesthesia, 75(12), pp.1659-1670.

Mehta, R. and Sharma, K.A., 2018. Use of learning platforms for quality improvement. Indian pediatrics, 55(9), pp.803-808.

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Tunçalp, ?., Pena?Rosas, J.P., Lawrie, T., Bucagu, M., Oladapo, O.T., Portela, A. and Metin Gülmezoglu, A., 2017. WHO recommendations on antenatal care for a positive pregnancy experience—going beyond survival. BJOG: An International Journal of Obstetrics & Gynaecology, 124(6), pp.860-862.

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Yeomans, D., Le, G., Pandit, H. and Lavy, C., 2017. Is overseas volunteering beneficial to the NHS? The analysis of volunteers’ responses to a feedback questionnaire following experiences in low-income and middle-income countries. BMJ open, 7(10), p.e017517.

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