Application of Appreciative Inquiry and SWOT to Quality and Patient Safety Analysis

Introduction

Health quality and patient safety goals in a healthcare setting are never completely achieved. Instead, progress can be made continuously towards those goals. Different approaches have been used to analyze Xee Medical Center on its performance in terms of quality and patient safety. The appreciative inquiry and the SWOT methods give indications of significant commitment to quality and patient safety, and the need for the development of care plans.

Part 1: Appreciative Inquiry Discovery and Dream.

At Xee Medical Centre, there have been deliberate efforts towards achievement of the quality and patient safety goals. Reports given by different members of staff at the facility confirm success in patient safety efforts in various ways. The question asked concerned outcomes they have experienced that prove the effectiveness of progress towards quality and patient safety goals. One of the nurses applauded the efforts that have been made towards sanitation, asserting that the sanitation policy and practices at the hospital had improved significantly, resulting in reduced rates of infection and better health outcomes. A second respondent reported feeling that the hospital had effectively trained its staff, particularly the non-medical staff, on the importance of hand hygiene and that it was being practiced extensively in the organization. A third respondent felt that the use of electronic health recording had enabled them attend to patients more effectively, reducing the prevalence of medication errors and improving the overall healthcare outcomes.

The reports given by the respondents in this appreciative inquiry (AI) process confirm organizational commitment to and practice of measures to attain better quality and patient safety. AI helps to build upon strengths and to push for support towards improvement (MacCoy, 2014); the information collected helps to achieve just that. The different measures outlined in the reports are aligned to quality and patient safety objectives due to their impacts on health quality and patient safety outcomes such as hospital infections, medication errors and hospital stay. For instance, effective sanitation processes create a clean healing environment, which facilitates faster healing thus resulting in shorter durations of hospitalization. Hand hygiene helps to prevent transfer of infections within the healthcare setting, thus promoting patient safety, while electronic health recording reduces the possibility of medication errors thereby enhancing care quality and patient safety.

Several studies have been conducted to determine the effectiveness of these approaches towards care quality and patient safety. The environmental theory of nursing for instance, explains the role of the environment towards facilitation of healing. The theory posits that a clean environment promotes healing and should be the objective of all nursing professionals (Medeiros, Enders & Lira, 2015). Application of this theory to healthcare practice results in more positive health outcomes. Similarly, the WHO has also given standard procedures for healthcare facility sanitation and hand hygiene, both of which are aimed to promote patient safety by eliminating pathogenic microorganisms from the healing environment (Frigola-Capell et al., 2015). Electronic health recording has been reported to reduce the probability of medication errors, which is a major patient safety concern (Tanner et al., 2015). By reducing the probability of medication misinterpretations due to ineligible handwritings, electronic medical record helps physicians and nurses to understand patient history and to administer medications rightly.

The stories collected reflect the themes of commitment and awareness. The commitment is most visible through the deliberate actions of hospital staff as reported and the support of the management towards implementing the desired quality and patient safety measures. The theme of awareness is best seen in the efforts to train employees, including non-medical staff of the importance of various practices in healthcare. Buxton et al. (2019) report that one of the barriers to effective implementation of WHO standards on hand hygiene or sanitation is because of lack of awareness among healthcare professionals and support staff. Training, albeit short-term, is the first step towards effective implementation of the standards. The organization recently won the Golden Stethoscope award in the state, confirming the commitment of the management and front-line employees to leading efforts towards measurable patient safety outcomes.

While Xee Medical Centre has performed exceptionally in quality and patient safety in the past, there is still need to do more. For instance, some of the areas in which there is still need for improvement include development of care plans for various patient conditions and establishment of a functional patient safety committee that would initiate and facilitate the achievement of quality and patient safety objectives. It is therefore proposed that the hospital should work towards the goals of: 1.) Establishing a functional patient safety committee within 2 months; and 2.) developing the first set of care plans for at least 5 chronic health conditions within the next six months.

Achievement of these goals will not only result in ethical practice but will also promote the attainment of culturally centered practice. The patient safety team is responsible for developing those protocols and aligning them to the principles of culturally-sensitive practice. Once the care plans are developed, adhering to them will automatically result in cultural sensitivity in the pursuit of quality and safety. The goals are also aligned to the organizational vision, which is to be recognized as a leading of quality, safe and client-centered care to all patient categories. The organization mission, which is to reduce healthcare-initiated morbidity and mortality one patient at time, is also aligned to the stated goals. Values such as integrity, transparency, and compassion, which are espoused in the hospitals strategic plan, will be reflected in the care environment.

Part 2: SWOT Analysis.

Strengths

Commitment to quality and patient safety objectives.

Awareness of patient safety needs and standardized protocols.

The Golden Stethoscope Award improves reputation.

Existing implementation of electronic health recording.

Weaknesses

No developed care plans.

Absence of a patient safety committee to address the patient safety issues.

 

Opportunities

Expansion into a wider range of services.

Room for the development of a more elaborate quality and patient safety plan.

Development of better health technologies.

Threats

Financial constraints for technology improvement to enhance care.

A SWOT analysis was conducted on the facility based on an observatory approach and should be considered an outsider perspective. The commitment to patient safety goals and awareness of the organizational management to quality and patient safety are paramount towards success. According to Khoshakhlagh et al. (2019), factors such as the organizational commitment/managerial commitment, knowledge of the need for and protocols for quality and patient safety, and the use of new technology, all contribute to better healthcare quality and patient safety. The organization has performed well in these areas in spite of the absence of a patient safety committee, whose responsibility is to develop patient safety plans and facilitate their implementation. Moreover, the lack of care plans for various conditions is also a shortcoming as it is one of the factors based on which organizations are evaluated for patient quality and safety performance. Xee Medical Center therefore has an opportunity for improved quality and patient safety through increasing the range of services offered development of a more elaborate quality and patient safety plan under the leadership of the patient safety committee, and the use of advanced technologies such as automatic drug dispensing linked to the electronic health recording system. However, some of these actions such as the implementation of technology require financial investment, which may be a constraining factor.

These findings show that the hospital is moving towards the achievement of quality and patient safety goals in alignment with the stated organizational mission, vision and values. However, it is proposed that the hospital should address its key weaknesses, particularly the development of care plans for different patient conditions. Care plans do not require heavy financial investments, and will contribute to consistency and reliability of outcomes, which is a desirable outcome for the healthcare facility. The organizational mission and vision statements reflect the need for consistently in growth towards being recognized for the provision of value-based, culturally sensitive care. Pursuit of the stated goal will therefore facilitate the achievement of this goal.

Part 3: Comparison of Approaches.

Examining the healthcare setting using either the AI approach or the SWOT approach, results in outcomes that can be used for care improvement. When using the AI approach, the experience of obtaining information from others gives a richer outcome that can help to identify specific issues or even underlying issues that hinder the achievement of quality and patient safety goals. On the other hand, SWOT gives a superficial perspective, with no opportunity for further exploration. The results obtained from AI-based examination therefore confirm the practical/real experiences of employees in the organization, unlike SWOT which gives only the reported bits of information. In conducting either of these searchers, the evidence searched from literature was mainly on the indicators and standards for the achievement of quality and patient safety in healthcare. The methods are therefore similar in terms of what is considered a strength or weakness when communicating and interacting with colleagues, as well as the objectives of inquiry. On the other hand, they differ in that AI does not distinguish before-hand the negatives from the positives. The researcher segregates the information into themes upon inquiry, while in SWOT the mindset during information collection is already predetermined.

Part 4: Analysis of Relevant Leadership Characteristics and Skills

The potential for leadership towards attaining quality and patient safety is determined on a number of factors. In both AI and SWOT approaches, a leader needs to have strong communication skills, a strong drive towards organizational goals and commitment to attaining the goals. These characteristics and skills enable leaders to communicate their vision effectively, to enhance knowledge sharing among employees, and to facilitate the acquisition of project requirements if necessary. One of the core shared skills across the two approaches is that of change management, which depends on the ability to communicate effectively and to lead others towards success.

Conclusion

The progress of the healthcare organization towards the achievement of organizational goals and objectives is visible through the conducted organizational analysis. While there is evidence of commitments to quality and patient safety, the organization needs to develop a patient safety team that will facilitate and spearhead the development of care plans for different patient conditions, which is an essential step towards enhancement of patient safety outcomes.

 

References

Buxton, H., Flynn, E., Oluyinka, O., Cumming, O., Mills, J. E., Shiras, T., Sara, S., et al. (2019). Barriers and opportunities experienced by staff when implementing infection prevention and control guidelines during labor and delivery in healthcare facilities in Nigeria. Journal of Hospital Infection, 103(4), 428-434. https://www.journalofhospitalinfection.com/article/S0195-6701(19)30312-3/abstract

Frigola-Capell, E., Pareja-Rosell, C., Gens-Barber, M., Oliva-Oliva, G., Alava-Cano, F., Wensing, M., & Davins-Miralles, J. (2015). Quality indicators for patient safety in primary care. A review and Delphi-survey by the LINNEAUS collaboration on patient safety in primary care. The European Journal of General Practice, 21(1), 31-34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828619/

Khoshakhlagh, A. H., Khatooni, E., Akbarzadeh, I., Yazdanirad, S., & Sheidaei, A. (2019). Analysis of affecting factors on patient safety culture in public and private hospitals in Iran. BMC Health Services Research, 19(1009). https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4863-x

MacCoy, D. J. (2014). Appreciative inquiry and evaluation- getting to what works. Canadian Journal of Program Evaluation, 29(2), 104-127. https://evaluationcanada.ca/system/files/cjpe-entries/29-2-104.pdf

Medeiros, A. B. A., Enders, B. C., & Lira, A. L. B. (2015).The Florence Nightingale’s environmental theory: A critical analysis. Escola Anna Nery, 19(3). https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-81452015000300518&lng=en&nrm=iso&tlng=en

Tanner, C., Gans, D., White, J., Nath, R., & Pohl, J. (2015). electronic health records and patient safety: Co-occurrence of early EHR implementation with patient safety practices in primary care settings. Applied clinical Informatics, 6(1), 136-147. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377566/