BUS6004

Quality Management in a Care Setting

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Question 1

The outcome-based care is a systematic and disciplined way of thinking and taking
appropriate actions that the communities and the service planner can use to formulate
strategies to enhance the lives of the people, children, families and communities. It makes a
clear difference between the accountability to the stakeholders and partners for strategies so
that the quality of life of the people is improved. In healthcare, a new strategy is being
followed, achieving the best outcomes for the patients at a lower cost and increasing the value
for patients. In this approach, the only measurement of the quality of the service is the
outcomes, which are most important for the patients. When outcomes are measured, it brings
improvement, and this is when the best practice is adopted, which further improves the
outcomes (Hennepin and Lowe, 2021). While providing value, understanding the outcome is
a central aspect of the outcome-based healthcare system.

In this approach, the value is created by enhancing the outcome of the patients suffering from
specific conditions over their full healthcare cycle, which generally involves various care
sites and specialities. To succeed, the key aspect of the outcome-based approach is working
as a team that revolves around the patient's clinical condition. In other words, value or
outcome maximization should be the goal of the healthcare teams (Vlaanderen, 2019).
However, improving the value requires any one of the items with an increased cost or lower
cost without affecting the outcome. This approach signifies a change in the healthcare
system, which moves towards patient-focused systems designed around the needs of the
patients. It entails meaningful discussion, awareness and engagement among patients,
families and healthcare workers. This approach has shown evidence that the outcomes have
been improved with the decreased cost along with improving the patient's experience and
quality of life.

There are various methods of treatment that are based on the outcome based. However, The
recover star method is one of the methods which has seen more success. In this method, a
questionnaire is provided to both the service user and caregiver, and then an analysis is
carried out to match the gap in the feedback. There are three stages or steps in outcome-based
care. The first stage is setting the goal, such as deciding what the service user intends to
perform—for instance, walking to the shops (Adida and Bravo, 2019). The second step is the
observation, where the service provider observes what has happened, and the intervention

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step, where the service provider acts to assist the service user. For example, a nurse assists
the patient from the mod way and gets a wheelchair for the patient.

Hence, monitoring and documenting the outcome is important in this method as the changes
in care can be identified. Suppose a health worker sees the service used daily and there is no
further improvement, or it has negative family feedback. In that case, the provider may
relocate the service user to a different caretaker or can recognize a loophole in the skill of the
healthcare worker. One of the important aspects of the outcome-based approach is capturing
and tracking items (National Academies of Sciences, Engineering, and Medicine, 2019). In
this approach, it is often required that the provider of outcome-based care monitor the
condition of the patient daily on the level of attainment concerning the outcome defined in
the care plan of the patient. To be able to do this, the service provider has to take the outcome
in a format that can be reported and analyzed. Taking the outcome in this format would help
the provider to track the progress over time and identify where and what kind of solutions and
interventions are required. One of the ways it can be done is by collecting the score of the
outcome in the paper and collecting them together and entering the data in the excel
spreadsheet manually from where it can be filtered and analyzed. However, this can be a
challenge if all the outcome is gathered together, and the staff entering those data can
potentially make an error that can arise due to manual entry (Porter et al., 2016). Moreover,
any delay in capturing the outcome score would result in a delay in analyzing the outcome-
based reports, which can further result in a delay in response, compromising the service
quality of the patients, which certainly undermines the potential or the capability of the
outcome that is achieved sooner or later.

Conversely, in this approach, the scores can be captured, recorded and monitored with the
help of a digital tool which removes the burden of manual entry and thus reduces the
administrative burden as the new outcome is automatically translated into various reports to
track outcomes. In addition, the digital tool can have the ability to provide the service
provider with alerts and reminders, which trigger automatically when any area of the service
user requires attention and intervention (Wagle, 2017).

With this arises the question of how information derived from outcome-based care is used.
The information related to outcome can be used in planning and implementing the
improvement based on the evidence gathered by remembering to take note of the actions that
are being taken and the outcome that is to be expected. Also, the information can be used to

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improve the skills of the healthcare provider by using both negative and positive feedback.
This can also be used as part of a training plan to help the health worker learn from the
positive or negative feedback. The information can also be used to provide to the health
regulatory boards. Furthermore, it also provides a regular update to the service user families
about the progress of the patients along with responding to the trends of the industry and its
issues as health, and social care are ever-changing environments. Hence, having access to the
information, whether historical or current, provides a way for improvement within the
process and to stay agile and gives scope to grow and succeed ((Wagle, 2017).

Overall, whatever the approach to outcome-based care, it is important to record and review so
that the important milestones are documented in the care plan. Also, the outcome-based plan
must be flexible and depend on the patient's progress. This approach also allows the
healthcare providers to carry the person-centred care and planning by tracking the
improvement of the patients. Through the outcome-based approach, the healthcare provider
can support the patient and their families to reach their goals. Also, this collaborative
approach to care enhances the experience for the healthcare worker and the service user,
which determines the quality of the outcome-based practice. This also helps in providing
benefits to both the service user and the service provider as they maintain the reputation and
satisfaction by knowing that they both can help make a difference in an individual experience
in receiving care (Adida and Bravo, 2019). However, the goal of outcome-based care can be
achieved with the right care and the right system, allowing this approach to raise its standard.
Hence, putting the outcome first in the healthcare setting can be a small change that can have
a huge advantage that will be evident in the short term but also help secure the future success
of the healthcare organization.

Along with this, the value of the outcome-based approach is significant as it provides a way
or tool to help create a better future for the service user, which moves the healthcare system
closer to people-centred care. In recent years, it has been proven to be a catalyst for change,
improving confidence and a secure feeling to better health and social relationships. When it
comes to personalized care, it is all about people as a whole, and that is what matters.

Recent years have witnessed many success stories based on the outcome-based approach.
And one of the factors which have led to the success of this approach is the use of
technology. Technology has helped eliminate the use of manual work which resulted in
errors. One of the success stories that come out for outcome-based care is based on the use of

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technology in this field. Use technology such as HopScore, an electronic outcome-based
emergency triage system that uses the patient demographic to forecast the risk for time-
sensitive outcomes. This is the success story from many angles, such as the use of live data
from the healthcare setting to inform about the decisions that are made in the healthcare
departments, which validates the clinical algorithm through the AHRQ funding system,
which provides an aid to grant mechanism to improve the systematic technological adoption
and diffusion throughout the health care system (digital.ahrq.gov, 2022).

Question 2

In the emergency room or paramedics treating patients or in the surgical team in the operation
room, teams are an essential part of healthcare that works professionally and in a disciplined
way. Although it is important for individuals to possess the expertise, it is also important for
the teams to combine and apply the expertise of a team member to ensure high performance.
To contribute effectively to a team, the individual must be able to engage and collaborate in
Teamwork effectively. In recent times, the expert's effective Teamwork holds safe. It
provides effective care at various stages in the healthcare system, which has led to the trend
of investment of healthcare institutes in team training and research (Grol et al., 2007).

To understand the effect and relationship between Teamwork on team performance and later
quality of the services, it is essential to understand the term. The term team implies two or
more people working with unique characteristics to provide service or social work. The
unique attributes include social and dynamic interaction having a meaningful dependency on
each other, shared values or goals with distributed expertise, and clearly allocated
responsibilities and roles (Guise and Segel, 2008). Hence, based on the term, it is evident that
the team must work dynamically to share the resources and information among the team
member and coordinate among themselves to fulfil a specific task. It can be said that team
needs to work together for Teamwork.

Hence, Teamwork refers to the process where a group of team members interact with each
other with the help of collective resources to resolve a given task. Teamwork also includes
task work which refers to the team's communication with the tools and tasks. Task work
generally refers to what the team is doing, while Teamwork refers to how a team member is
doing. Hence, teamwork and task work combine to make it a team performance.

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Team performance can be described as the input, processes and output which states that
quality care is the output influenced by processes of Teamwork such as coordination,
communication and decision-making (Johnston et al., 2019). Moreover, these processes are
influenced by different inputs such as the team members' experience, the complexity of tasks,
time constraints and more. This framework or the relationship between Teamwork and team
performance where the team members combine their efforts and resources to help solve a
given task demand. This relationship model has been criticized due to its simplicity.
However, this relationship model is the most used framework that helps analyze the
relationship between the team, Teamwork and performance.

Also, great Teamwork leads to high team performance, increasing service quality. However,
before analyzing the relationship between Teamwork, and team performance with continuous
quality improvement, it is essential to define what continuous quality improvement means.
Continuous quality improvement refers to the process focused on the tasks in response to the
community and population health needs. It is generally a continuous effort to get measurable
enhancement in efficiency, performance, effectiveness, outcomes and accountability
(Lacerenza et al., 2018).

In a healthcare setting, team and teamwork greatly contribute to continuous quality

improvement. Teamwork is a critical factor in improving the quality of the services provided
in the healthcare industry. With the help of Teamwork, the complexity of the task is reduced
as there are individual experts who contribute with their knowledge in a difficult situation,
thereby reducing the complexity of the task. Also, working in teams brings about more
synergy within the team members as their efforts are multiplied and hence they feel more
powerful; thus, there is a chance to maximize their potential, thereby improving the quality of
service, especially in healthcare settings. Teamwork in health institutions enables
improvement in the waiting time, service, care related to diabetes and other tasks that are
deemed to be important. This helps the health organization achieve significant and long-
lasting improvements. Hence, each individual's responsibility is to be a contributing and
active team member to achieve continuous quality improvement. Hence, Teamwork and
performance play a significant role in enhancing the quality of the healthcare service
(Lacerenza et al., 2018).

However, the need for more motivation among the workforce is an obstacle to achieving the
development goals concerning healthcare. The lack of motivation among the workforce leads

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to poor performance and poor provision of healthcare services. Hence, it is argued by Stefan
et al. (2020) motivation is a stimulus to do something. There are various shreds of evidence
which highlight the fact that motivation among workers leads them to higher performance.
Therefore, different theories argue that motivation in an individual is governed by the need of
the individual, which, if not satisfied, leads to demotivation among the healthcare staff.

In this context, Abraham Maslow formulated Maslow’s hierarchy of needs theory, which
highlights the human's five needs, which act as the main motivating factors. According to this
theory, the lower needs to be fulfilled to reach the next level of needs. Therefore, this theory
can also be called the hierarchy of needs, based on the level of influence on the behaviour of
humans.

Figure 1 - Maslow Hierarchy of Needs

Psychological needs are the lowest stage of Maslow's Hierarchy of needs, which includes a
human's requirements, such as food and water. When these are not fulfilled, a motivating
force is created within the individual to achieve the needs. When the person's psychological
needs are fulfilled, they move to the next need (Shoib et al., 2022). Therefore, healthcare
workers work with the maximum effort to avoid losing their job. The next need that an
individual focuses on after realizing the psychological need. The safety need implies the need
for security and shelter, which further comes with the desire for freedom, dependency,
protection, stability and security. For health workers, safety needs refer to the need for
security related to employment. Hence, health workers will be highly motivated to engage in
a high level of work, so they do not lose their jobs (Shoib et al., 2022). Subsequently, the
other needs, as per the Maslow Hierarchy of needs, includes the need for love and
belongingness, which is referred to as social needs. Health workers look for a sense of love
and belongingness in a healthcare setting through interaction with colleagues, subordinates

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and superiors. The ability of the individual or worker to work in peace and maintain a cordial
relationship with their colleagues motivates the worker to put their highest level of effort to
work because of the cordial and peaceful relationship with colleagues, which further
establishes good working conditions in healthcare settings (Shoib et al., 2022).

Once the social needs have been fulfilled, the health workers will look for esteem needs that
satisfy the workers' egos. The needs of esteem health workers seek to achieve self-esteem and
self-respect to be motivated to work. In this context, health managers need to understand that
their role is important in creating a sense of esteem and respect in the workers, which greatly
determines the motivation among workers. Therefore, highly educated or qualified health
managers know how to take care of the resources to ensure that the health workers' needs are
met by giving them the required motivation. According to Maslow's hierarchy of needs, self-
actualization is the highest stage with continuous development and self-realization (Chopra,
2021). At this point, the health workers seek to become the best version of themselves. This
is generally facilitated by enhanced career opportunities, which help health workers to
develop professionally. Career opportunities are one of t most vital aspects of individual
growth and success. Therefore, health managers should work on strategies to improve health
workers' career prospects by ensuring efficient and effective performance

Teamwork and team performance are vital in a healthcare setting to ensure quality
improvement. Also, to help in the enhancement of team performance and quality
improvement, Maslow's Hierarchy of needs has been applied as the motivational theory,
which states the different stages of human needs which satisfy one by one to get on to the
maximum level of needs that a person can achieve (Chopra, 2021). This is applied to
healthcare workers, where it has been identified that working as a team can improve the
quality of the service provided. And through the motivational theory, their needs and
motivational factors are analyzed.

Question 3

Before evaluating the Strategies, systems and structures used in health and social care
practice to promote the rights, responsibilities and diversity of service users, it is important to
find out the rights and responsibilities of the services user in the healthcare setting. The user
of the health care services has the right to take the healthcare service to participate in the

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decision-making that impacts their health. They also have the right to get emergency medical
treatment at any healthcare institution and to refuse heat treatment. However, this should not
pose a serious risk to the individual's health (Minican and O’Toole, 2020). Also, it is the right
of the individual to keep their health information confidential whether verbal or written or
through any electronic medium for any health condition or other health-related treatment. The
service user has the right to be in an environment which is not harmful to their health and,
finally, has the right to lodge any complaint against the healthcare service. Also, healthcare
user must fulfil their responsibilities to any healthcare service provider. The most important
responsibility of the healthcare user is to follow the rules of the healthcare establishment,
which is mainly concerned with the receipt of the treatment or using any healthcare service.
They are also responsible for providing accurate information to the health service provider
and cooperating with the healthcare providers while using the service. Another responsibility
of the service user is to treat healthcare providers with respect and dignity (Johnson et al.,
2004). Finally, the service user must complete all the formalities while getting discharged
from the healthcare establishment, which include a signature on the certificate related to
discharge.

Hence, to have the rights, responsibilities and diversity among the service user, the healthcare
provider must work on strategies and structures which allow them to be rightful and
responsible towards the healthcare providers. There should be a greater community among
healthcare providers (World Health Organization, 2015). Hence, there should be a feeling of
diversity which allows us to be compassionate with every race and gender and encourages us
to look beyond the differences. This will help the patients have a sense of equality where they
can feel confident enough to speak about their health condition freely. Also, the healthcare
service provider needs to show respect to the patients as patients have direct and indirect
requirements that impact the patient outcome. The level of patient education about the
medical, the constraints with finances and the access to care can influence the patients'
experience. Hence, acknowledging and caring about the patient's concerns illustrates that the
healthcare provider sees them as human beings (World Health Organization, 2015). this type
of healthcare service may help them to get the motivation to respect the journey of their
health and follow their healthcare plan.

Expressing gratitude is another way which shows that the healthcare provider can take care of
the patient and help in achieving their health goals. This can be done by simply thanking the
individual for choosing their service. Asking the patient about their goals and expectation can

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go a long way in promoting the rights and responsibilities of the service user in the healthcare
setting. Also, when healthcare practitioner shows that they trust the patient's expectations and
preferences, it is more likely that they may trust back and take the recommendation, which
enables them to become a loyal patient (Seeleman et al., 2015).

One of the strategies in recent times that is working wonders for many healthcare
establishments is rewarding the patient if they tend to refer the service to a family or friend
by spreading the word about the service and expertise of the healthcare establishment. Also,
enhancing the care of the patients irrespective of region, ethnicity, or social class helps the
patients to achieve better health outcomes. Furthermore, the healthcare institution should
enhance or structure its process of appointment in such a way that the patient does not have to
wait for their turn. For this, the healthcare establishment may use different technological tool
which enables them to manage the patient while meeting the requirement of the patients. This
will help promote a sense of belonging, eventually inculcating a sense of responsibility in the
patients towards the health service providers (Cattacin et al., 2013).

To generate a sense of diversity and inclusion, the healthcare provider must involve their
families and friends so that the patient can get emotional support while dealing with any
health issues. In thi approach, the healthcare provider allows the family member to be
involved in decision-making related to the patient's health. This approach can have a chance
of having a reduced healing time. It is also required for the health professional to provide
emotional support to improve the patient's experience and engage the patient in their health
care plan by encouraging new questions and showing that the health professional is open to
new ideas. This can help empower the patient. Requesting feedback is another way patients
can be kept engaged, such as asking about their experience while booking an appointment
(Cattacin et al., 2013). This will help a long way in promoting a sense of inclusion and
responsibility among the healthcare service users, which further makes them confident to
share their experiences, whether good or bad. One of the most important aspects the health
professional can work on is promoting the mental health of the patients. This will help in
keeping the patient out of anxiety and depression among the patient. Finally, delivering a
quality experience to the patient is one of the strategies that has helped in better outcomes for
the health care establishment. This can be done by focusing on the patient's touch points with
the health care establishment. Taking care of the patient by ensuring they have a quick
experience and compassionate treatment can help them to become more popular in the
healthcare industry (Cattacin et al., 2013)

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References

‌Cattacin, S., Chiarenza, A. and Domenig, D., 2013. Equity standards for health care
organizations: a theoretical framework. Diversity and Equality in Health and Care, 10(4),
pp.249-258.

Adida, E. and Bravo, F., 2019. Contracts for healthcare referral services: Coordination via
outcome-based penalty contracts. Management Science, 65(3), pp.1322-1341.

Chopra, K., 2021. Maslow’s theory for preventive healthcare in India–a content analysis
approach. International Journal of Pharmaceutical and Healthcare Marketing.
digital.ahrq.gov. (2022). Success Stories | Digital Healthcare Research. [online] Available at:
https://digital.ahrq.gov/program-overview/success-stories [Accessed 16 Nov. 2022].
Grol, R.P., Bosch, M.C., Hulscher, M.E., Eccles, M.P. and Wensing, M., 2007. Planning and
studying improvement in patient care: the use of theoretical perspectives. The Milbank
Quarterly, 85(1), pp.93-138.
Guise, J.M. and Segel, S., 2008. Teamwork in critical obstetric care. Best practice & research
Clinical obstetrics & gynaecology, 22(5), pp.937-951.
Hennein, R., Mew, E.J. and Lowe, S.R., 2021. Socio-ecological predictors of mental health
outcomes among healthcare workers during the COVID-19 pandemic in the United
States. PloS one, 16(2), p.e0246602.

Johnson, J.L., Bottorff, J.L., Browne, A.J., Grewal, S., Hilton, B.A. and Clarke, H., 2004.
Othering and being othered in the context of health care services. Health
communication, 16(2), pp.255-271.
Johnston, J.H., Phillips, H.L., Milham, L.M., Riddle, D.L., Townsend, L.N., DeCostanza,
A.H., Patton, D.J., Cox, K.R. and Fitzhugh, S.M., 2019. A team training field research study:
extending a theory of team development. Frontiers in Psychology, 10, p.1480.
Lacerenza, C.N., Marlow, S.L., Tannenbaum, S.I. and Salas, E., 2018. Team development
interventions: Evidence-based approaches for improving Teamwork. American
Psychologist, 73(4), p.517.
Minivan, C. and O’Toole, G., 2020. Exploring the incidence of culturally responsive
communication in Australian healthcare: The first rapid review on this concept. BMC health
services research, 20(1), pp.1-14.

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National Academies of Sciences, Engineering, and Medicine, 2019. Integrating social care
into the delivery of health care: Moving upstream to improve the nation's health.

Porter, M.E., Larsson, S. and Lee, T.H., 2016. Standardizing patient outcomes
measurement. N Engl J Med, 374(6), pp.504-506.

Seeleman, C., Essink-Bot, M.L., Stronks, K. and Ingleby, D., 2015. How should health
service organizations respond to diversity? A content analysis of six approaches. BMC health
services research, 15(1), pp.1-18.
Shoib, S., Amanda, T.W., Menon, V., Ransing, R., Kar, S.K., Ojeahere, M.I., Halabi, S.E.
and Saleem, S.M., 2022. Is Maslow’s Hierarchy of Needs Applicable During the COVID-19
Pandemic? Indian Journal of Psychological Medicine, 44(1), pp.98-100.
Ștefan, S.C., Popa, Ș.C. and Albu, C.F., 2020. Implications of Maslow’s hierarchy of needs
theory on healthcare employees’ performance. Transylvanian Review of Administrative
Sciences, 16(59), pp.124-143.
Vlaanderen, F.P., Tanke, M.A., Bloem, B.R., Faber, M.J., Eijkenaar, F., Schut, F.T. and
Jeurissen, P.P.T., 2019. Design and effects of outcome-based payment models in healthcare:
a systematic review. The European Journal of Health Economics, 20(2), pp.217-232.

Wagle, N.W., 2017. Implementing patient-reported outcome measures. NEJM Catalyst.

World Health Organization, 2015. WHO global disability action plan 2014-2021: Better
health for all people with disability. World Health Organization.
.

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