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Buy custom Responsibility for Healthcare Quality and Risk Management essay

The quality of services in any organization can only be achieved when all the involved stakeholders take responsibility in their roles. The responsibility for healthcare quality and risk management cannot be shifted to only one of the stakeholders. It is a collective responsibility that must be divided across all the involved parties. Therefore, building a high quality health care system requires all the stakeholders in health care to monitor their actions and behaviours. These stakeholders should also take responsibility of individuals and teams that work in the healthcare sector. This paper will identify the roles of the health care professionals and stakeholders in quality and risk management. It will cover the mission, goals, vision, and objectives of the healthcare environment that form the foundations of quality.

Professionals in risk management are faced with increasing challenges in the current healthcare environment. These professionals play a vital role in fulfilling the promises of the healthcare providers. These providers have a commitment of providing the best quality of healthcare as well as continuously assessing and improving the quality of services and care offered to patients. The changes in the healthcare sector have made it necessary for providers of healthcare to identify risks proactively and take the appropriate measures to prevent such risks. The new developments in medicine and the increased legal and regulatory requirements have brought new, complex, and unexpected issues of risk for providers of healthcare. In the United States, the arrival of managed care in health care has been an influential factor in the increment objectives and duties of risk managers. Managed care requires hospitals and physicians to evaluate the quality of care which is received under the various protocols of treatment. The cost of healthcare is also evaluated under these protocols (Kuhn & Youngberg, 2002).

An organization’s mission, goals, vision and objectives determine the quality of the healthcare delivery system. The systems of the healthcare system would not operate effectively when these foundations are not strong. These guidelines ensure that a person joining the health care sector operates within set rules and guidelines. For any successful industry or business, the key component is usually a supportive organizational culture that aims at improving the quality. Any organizational culture is measured by the ability to adapt to the changing demands in business, to remain competitive, and sustain high levels of performance. A shared mission in an organization is clear and concise. It also sets the direction of the group. The mission in all the healthcare delivery systems should demonstrate a commitment to serve patients, as they act as the customers. Therefore, the missions of healthcare should be developed with a sound awareness of the patients, their needs and preferences. They should incorporate the history of issues that should be addressed, and the values that should be held by the employees and volunteers. These missions should also be updated with the most recent issues of quality and risk management.

All risk management programs, including the healthcare industry, have goals and objectives. The risk management process, in healthcare, has a goal of identifying the areas which harbour risk or are potentially risky. This process also aims at preventing, as much as possible, any injuries to employees, visitors and patients. The risk management process also has a goal of preventing or limiting loss of finances loss to the hospital and its entire staff. The overall goal of these goals and objectives is to improve the quality of health care, and reduce the risks encountered during treatments (Department of Health, 1999)

According to a report released by the institute of medicine, all stakeholders, in the healthcare industry, have a national purpose to reduce the burden of injury, disability and illness and improve the health of all the American citizens. They have a duty to adopt a shared vision of six improvement aims. These aims are safety, effectiveness, equitability; ensuring services are patient centred, timelines and efficiency. Stakeholders should aim to avoid inflicting injuries to patients through improper administration of care. They also have an aim of ensuring that the care they provide respects and responds to the individual needs and preferences of patients. It is also an aim, of all stakeholders, to reduce waits and harmful delays for both physicians and patients (Committee on Quality of Health Care in America & Institute of Medicine, 2001)

A stakeholder is any person who is involved in a course of action. Any other person, who is affected by the course of action, is also referred to as a stakeholder. In health care, several stakeholders exist. Each of the stakeholders has a definite role that promotes the quality of the health care and also aids in risk management. The different stakeholders in healthcare include patients, the government, labor unions, hospital administration, insurance providers, medical schools and students of health care. Medical professionals, private licensing bodies and associations, protective associations and societies, other and health care providers are also part of the stakeholders in health care (Witherall, 2002).

In the United States, as with other countries, there exist both public and private stakeholders in the health care industry. However, the ownership of the health care system is largely controlled and owned by private institutions. The government owns healthcare facilities through the city, federal, county and state governments. The largest share of ownership is taken by the non-profit hospitals. The United States does not have a nationwide system of medical facilities, which are owned by the government, and are open to the general public (Roemer, 1991).

The military health system has field hospitals, which are operated by the federal department of defence. This field hospitals provide have a role of providing military funded care to the active military personnel. The Federal Veterans Health Administration also operates its own hospitals. These hospitals have a role of treating veterans only. However, veterans, who did not receive medical care in the military, are also treated and charged for the services. The Indian health service also operates its facilities that are only open to Native Americans originating from recognized tribes. The tribal facilities, Indian health service and other privately contracted services provide medical care to tribes’ people. Other government funded programs include the national institute of health, which treats patients who enrol in research for free, and the title X, which funds reproductive health care (Roemer, 1991).

The other key stakeholders are the insurance providers. Insurance in the US is provided by both public health insurance and private health insurance providers. The payments from insurance plans, coupled with payments from patients, fund the doctors and hospitals. The public health insurances are mostly provided by Medicare and Medicaid. Medicare, which is a federal program, covers the disabled individuals as well as individuals aged sixty five years and above. Medicaid is designed for the disabled and the low-income earners. It covers the elderly, children, parents, disabled and the poor and pregnant women. The other public insurance programs include the Veterans administration and the state children health insurance.

The private insurances are categorized into those sponsored by employers, and the individual market insurances (private non-group insurances). In the employer sponsored insurances, the employers provide the employer with the health insurance, which is part of the employer’s benefits. Private companies administer these plans both for profit, such as Aetna, and for non-profit, such as The Blue Shield insurance company. The individual market plans cover individuals who are self employed, retired or those who do not get insurance through their employers.

In healthcare, the patient acts as a customer. The patient is the core of the healthcare structure. Without the patient, the whole system would not be established as it would not have any customers to serve. The patient funds the health care sector and also plays a crucial role as an end user of the facilities provided. Much debate that surrounds the health care legislation and the policies that are formed are usually there for the improvement of the services given to patients. The patients have significant roles that help in risk management and improve the quality of services (Mike, BMJ 2002).

The other stakeholder in health care is the hospital administration. The hospital administrators, who also act as the employers, have three main goals. They aim to at containing the costs that are incurred by patients when receiving treatment. They also have an aim of giving quality care to their patients. Finally, they have a significant goal of encouraging healthier lifestyles among their customers.

Health care centers are run like small or medium sized business. The daily activities of hospital administrators involve all the formal business operations, procedures and practices. The role of the hospital administration is to manage the business side of the health care centers, and ensure a smooth running of the hospital. It is the work of the hospital administration, which is usually headed by a hospital administrator, to manage all the resources in a health center. The hospital administrator establishes procedures and policies for the health center, maintains computer systems and databases, manages the human resources and personnel, tracks accounts and finances, and allocates budgets (Fulop et al, 2011).

In the hospital administration, risk managers are in charge of the risk management process. These managers have several responsibilities, which include a number of basic duties such as risk and insurance financing. They also handle the management of claims, risk program education and occurrence reporting. These managers are charged with the duties of identifying and evaluating potential losses in a healthcare setup. They also select the appropriate methods, or combination of methods that can be used to treat loss exposures, and administer the program of risk management (Scott, Maulik & David 2004).

The hospital administration, as a stakeholder in healthcare, interacts with contractors, vendors, suppliers and insurance firms on a regular basis. Through these interactions, the administration ensures that the hospital is stocked with drugs, medicines, hospital equipment and food items. This administration also acts as the link between insurance companies and the patients. Through their day to day running of the health centers, the hospital administration ensures that the primary and tertiary needs of patients, together with the specialized needs of surgeons and doctors, are not overlooked. It also the duty of the hospital administrators to design work schedules for doctors and other personnel in the health center. They also follow up the activities of this medical staff and ensure that they perform their primary duty of treating and looking after patients in a professional and ethical manner. Most of the hospital administrators also interact with the external specialists when there are cases of emergency or specialized operations. Therefore, the hospital administration ensures that quality services are always available for patients, and they are delivered effectively, and on time (Scott, Maulik & David 2004).

The medical professional and other health care providers form the frontline workers in health care. This group of people provides health services to the patients directly. The medical professionals include doctors, nurses, paramedics, nutritionists, pharmacists, physiotherapists and laboratory scientists among others. The nurses perform several roles including working to prevent diseases, screening patients and examining their symptoms, assisting them to deal with their illnesses, administering injections and assisting physicians. The nurses also assist in treatments and surgeries and administer injections. The nurses are supposed to maintain records of patients and issue them to the doctors upon request (Alan, 2003).

In America, there are two groups of doctors, who are also called physicians. The first category consists of the physicians who are trained by the US medical education system. The second category consists of physicians who are international medical graduates, and have fulfilled the necessary requirements to enable them acquire a medical license of practice in the states. Doctors form a core part of the medical professionals. Their primary role is to treat patients. Besides the general practitioners, there are different types of doctors who are specialized and perform specified duties. These include the dermatologists, gynaecologists, neurologists and the psychiatrists. Their roles are specific to treatment of different parts of the body. The surgeons also fall into the group of medical practitioners. Surgeons take part in operations which range from minor surgeries to specialized surgeries such as cardiac and brain surgeries. In this group of medical practitioners, there exist a group of professionals known as the pharmacists. The pharmacists handle issues of medications. They assess the proper dosages and formulations that are used by patients. They also give patients the right prescriptions and directions of how to use the medicines. They ensure that patients are treated, and they are given the right medications whenever it is necessary. The medical practitioners either issue primary care, secondary care of tertiary care to patients. In primary care, the medical practitioners receive the patient at the first point of consultation. In secondary and tertiary care, the doctors do not have first contact with patients (National Academy of Sciences, 2001).

The professional licensing bodies and associations form an essential part of the stakeholders in health care. These bodies are usually formed by groups of professionals such as doctors or nurses. Therefore, the members who form these bodies are from a similar profession. Professional bodies are self regulated, and they have a code of ethics which governs their day to day professional duties. The professional bodies define the professional standards that should be achieved by all the professionals in health care sector. These bodies set the entry level standards for new employees who wish to join health care. They also ensure that its members do not progress in their careers automatically without meeting certain conditions. These bodies also enforce the standards of professional conduct among the members. They ensure that there is a clear basis for inviting new members to join them, and a clear basis for excluding and dismissing the members who are not performing as expected in each level. Through this, the professional bodies use their standards to enhance the quality (Scott et al, 2004).

The professional bodies are also mandated with the duty of accrediting the courses that are used to train the health care workers. This ensures that the workers who undertake these courses are effective in their duties and they have the necessary knowledge and experience. These bodies also set the minimum formal requirements for any person willing to start a career in health care. These professional bodies also provide networks where professionals meet and have discussions concerning their fields of expertise. The professional bodies also deal with cases of complaints against professionals and issue the necessary disciplinary charges (Guo, 2011).

Medical schools and students of health care are also a part of the stakeholders in health care. The medical schools have a vital role in ensuring that education is provided to aspiring medical professionals. Medical schools act as factories that constantly produce medical practitioners, as the end products. The quality of education offered in these schools affects the quality of medical practitioners in health care. Medical schools also play the role of providing labor to the health care sector. Most of the students are constantly taken for internships in their specialities. When the students are in these internships, they provide labor to hospitals, and other sectors of health care. The students, who are in these medical schools, pursuing studies in health care, represent the future practitioners such as doctors, physicians and nurses (Scott et al, 2004).

Medical schools also play a vital role in research and developments, in health care. The students who are enrolled in these schools act as a resource where innovations and new developments are made. Some of the students make new discoveries in their course of study. The research facilities in most of these medical schools encourage students to participate in research and developments. Therefore, the medical schools, together with the students in them, act as a fundamental stakeholder in healthcare (Armoni, 2000).

The other stakeholders in health care are the labor unions. In America, the labor unions are members of two superior umbrella organizations. These organizations are the Change to Win Federation and the American Federation of Labor-Congress of Industrial Organizations. These unions have varied functions in the health care sector. They usually advocate for legislation and policies which favor the workers in the US. The labor unions organize workers in the workplace and negotiate wages and other working conditions for the health care workers. They also protect the workers against unsafe working environments, and pressure the government to set minimum labor standards. It is also the role of the labor unions to campaign against discrimination of employees in the health care sector. Therefore, these labor unions engage in activities that seek to promote the welfare of the health care workers. They act as schools for democracy and educate the healthcare workers about their rights as employees (Kuhn and Youngberg, 2002).


The quality of healthcare is defined by the I.O.M (Institute of Medicine) as the extent to which health services for populations and individuals increase the possibility of desired health results. Quality is also determined by the consistency of services provided with current professional understanding. A satisfactory quality health care contains competent technical care, and it gives the patients a chance to make individual choices, and discuss their concerns and fears. According to Donabedian, technical quality refers to clinical factors, which are also known as best practices. The standardization of these best practices produces the clinical practice guidelines (Committee on Quality of Health Care in America & Institute of Medicine, 2000).

Quality is compromised when lapses occur in the practice of medicine. Such lapses include delayed response to the needs of a patient, lack of uniformity in care and the unreliability of medical care. This lapses lead to undesirable outcomes among the patients. Good quality in a nursing facility produces consistent delivery of services. These services maximize the mental, spiritual, social and physical well being of the residents; minimize the likelihood of undesirable consequences, and produces desirable outcomes. Quality in health care is quantified by measured domains including employee satisfaction, customer satisfaction, workforce stability, regulatory performance and clinical outcomes (Armoni, 2000).

The quality of any healthcare system can also be measured using the six dimensions of quality i.e. access, efficiency, effectiveness, acceptability, appropriateness and equity. For the health care system to be of acceptable quality, it has to be accessible to those who need the services. The services offered by the health care sector should be easily accessible without delay. The case of a child, who for twelve months had to wait to have an ear operation, in the U.K in the year 1992, is an example of an inaccessible health care system. A system that offers quality health care is always available at a reasonable time and speed (Alan, 2003).

Quality health care is also effective. When used in routine practice, the desired results are achieved. In this healthcare system, the patients are treated with effective interventions, and they get the full benefits of the treatments offered to them. Scientific knowledge is applied in the treatment of patients ensuring that patients do not get complications due to overuse or underuse of drugs and procedures. An effective health care is also timely, hence, reducing harmful delays and waits for both who receive and give the care. Such a system, though not perfect, provides a high success rate of helping patients overcome their ailments. Appropriate care is also an indicator of the quality of healthcare. This is the utilization of the most effective modes of treatment, chosen from a list of other possible treatment methods. These treatment methods produce the most desirable outcomes in an individual patient. Therefore, a quality health care system offers appropriate care to its patients (Roemer, 1991).

Quality health care should also be acceptable. The treatment procedures should be accepted by the inhabitants of the society in which they are practiced. The methods used should not provoke negativity from the society members. It should be able to respect the traditions and cultures of the society, without compromising its quality and effectiveness. The care provided should be patient centered. This ensures that it is responsive to individual patient’s preferences, values, and needs (Department of Health, 1999).

Quality health care is also based on the principle of equity. The availability of health care is related to need and not to other elements such as the ability to pay. The patients are not discriminated according to race, geographical location, socio-economic status, gender or colour, but they are treated according to urgency and need. A superb quality health care has an aura of equality surrounding all the practices carried out. The medical practitioners in such a system are gender balanced, and they are employed on the basis of merit rather than through corruption.

The issue of quality in health care is closely related with risk management. Risk management is a critical area of concern for all the healthcare stakeholders including the administrators, governing boards, insures, medical practitioners and the consumer organizations. Risk management is a facility wide program designed to reduce the preventable accidents and injuries, and also minimize financial severity of claims associated with such risks. The safety of the patient remains a paramount concern in healthcare. All the stakeholders try to reduce risks through all possible means. The functions of risk management include a broad range of administrative activities. These activities are there to reduce losses that are associated with the employees, patients, visitor injuries, and losses or damages of property. Some of the common and preventable risks include surgical errors, incorrect diagnosis and incorrect administration of drugs (Department of Health, 1999).

Risk management is usually a planned and systemic process that reduces or eliminates the probability of losses occurring in a clinical setting. The objectives of clinical risk management include the delivery healthcare services that are safe and of superior quality. They also aim to ensure the safety of the employees, patients and visitors. Clinical risk management also identifies and controls injuries and hazards with an aim of protecting assets and other useful resources (Quality and Risk Management within a Healthcare Delivery System, 2012).

A sound risk management program leads to a good relationship between customers and their healthcare providers. It also leads to increased sales and customer satisfaction. This good relationship, between customers and their health care providers, leads to an increase in profits for the healthcare providers. Therefore, risk management does not only improve the quality of healthcare, but it also increases the profits earned by the healthcare providers (Kuhn & Youngberg, 2002).

The issues of risk management and quality can only be enhanced when all the involved stakeholders participate actively. Everyone involved in a clinical setting, directly or indirectly, is responsible for ensuring quality and managing risks. Health care administrators are tasked with the duty of creating a culture of risk management and quality. They ensure that quality healthcare is available to all those in need without favor or discrimination (Kuhn and Youngberg, 2002).

The government as a key stakeholder is involved in the formulation of policies that govern the healthcare industry. In March 2010, the government, through congress, passed the Patient Protection and Affordable Care act.  This act brought significant changes to the issues of financing and delivery of health care in America. It produced widespread effects on all the stakeholders including private insurers, consumers, employers and providers. This act responded to a report named, to err is human, by the institution of medicine that had cited that many patients in America died because of medical errors that are preventable. This report estimated that large sums of money were wasted due to preventable adverse effects such as lost household productivity, health care, temporary and permanent disability and lost income.  Majority of medical errors were not caused by individual recklessness, but by faulty processes, systems and conditions. These conditions lead people to make medical mistakes or make it impossible to prevent adverse events (Committee on Quality of Health Care in America & Institute of Medicine, 2000).

According to this report, numerous risks in health care industry were varied and complex. The health care providers were often reluctant to participate in the quality review activities for fear of professional sanctions, harming their reputations or assuming liability. The scopes of the peer review protections that legally protect the activities of healthcare quality improvement were limited. They did not exist in all hospitals and in the hospitals they existed; they did not cover other areas of health care. The peer review information was not transmitted outside hospitals, making it hard to gather sufficient data to identify relevant patterns, which could be utilized to reduce risks and improve quality (Committee on Quality of Health Care in America & Institute of Medicine, 2000).

The sentinel initiative was another initiative by the US government, through the Department of Health and Human Services, aimed at improving risk management in the healthcare industry. This initiative aimed at applying technologies such as electronic prescribing, electronic decision support tools, and electronic health records in order to make the risk management systems more efficient. This initiative also had an aim of reducing the costs of healthcare, and improving the ability of healthcare centers to protect the public (Department of Health and Human Services, 2008).

The patients form part of the health care stakeholders. The involvement of patients in health care planning and development produces an effective healthcare system. A survey of the leaders of public initiatives of health system agencies was carried out in the United States in 1980. Respondents were asked to judge the effects of involving patients in planning and development of health care. Seventy six percent of the respondents replied to the survey, and seventy five percent of them said that involving the patients had improved the quality of services, and risk management in healthcare. Forty six percent of the respondents also stated that the involvement of patients had improved the health of the people. Therefore, the involvement of patients in decision making processes improves the quality of the health care sector (Mike, BMJ 2002)

The hospital administration plays a significant role in ensuring quality and risk management in health care. An administration concerned with quality observes the principles of sound governance. Good clinical governance contains principles such as transparency, probity, accountability, patient-centered care and an open culture. The management carries out its duties and observes the clinical and legal responsibilities in an ethical manner. The management involves the patients and the community in all aspects of health care. The ethical observance of clinical governance by the hospital management ensures that the quality of services in health care is always maintained (Alan, 2003).

Other stakeholders such as the professional bodies and labor unions also play a significant role in ensuring quality and risk management. The professional bodies regulate the code of ethics of its members. Regulation of employees ensures that all the staff in healthcare work professionally. They maintain high levels of quality and also take responsibilities in risk management. The labor unions campaign for the rights of employees. They ensure that the employees are content with their work, and they receive a justified salary. The happy and motivated employees give quality services to patients. The employees also work more keenly and reduce the risks that may be encountered in healthcare service delivery. The medical schools train personnel who are competent and careful. They also ensure that skilled labor is always available for the healthcare sector. The medical schools carry out research with an aim of improving on service delivery. This research carried out by the students improves the quality of health care. The medical schools also train the students on risk management practices, and equip them with useful skills that make them efficient medical practitioners (Witherall, 2002).

It is evident that the quality of services in health care can only be achieved when all the involved stakeholders take responsibility in their roles. All the key stakeholders have roles that are specific to them. Some roles and responsibilities, such as policy formulations, are shared amongst the stakeholders. Therefore, obtaining and maintaining quality and risk management in health care is a collective duty that should be met with collective responsibilities. The vision and mission of the health care sector should drive the stakeholders towards quality and risk management. The failure of any of the stakeholders leads to a decrease in quality of healthcare. It also causes failures in risk management practices (Alan, 2003).

The issue of risk management and quality improvement functions overlap when dealing with the safety of a patient. An improvement in the relationship between management of risk and quality improvement in any healthcare organization enhances the safety of a patient and minimizes amount of harm that occurs.

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