The medical field must make strides in a world where technological advances are occurring rapidly and the continuous evolution of population health. However, the healthcare system’s performance might be improved to fulfill patient needs, ensure patient safety, and improve system efficiency through quality improvement initiatives. Patient satisfaction tends to diminish in medical environments when professionals predominantly utilize the traditional pen-paper method, memory, and a few more attempts to improve patient care. However, to improve the healthcare system’s reliability, effectiveness, and sustainability, the healthcare setting has to be purposefully redesigned through continuous quality improvement (Antony et al., 2019). Quality improvement aims to increase safety, effectiveness, and efficiency. Hence, adopting specialized methods and tools with a track record of promoting progress is necessary for restructuring the healthcare system.
Continuous Quality Improvement and Patient Satisfaction
Healthcare professionals executives embark on a process known as continuous quality improvement (CQI) to raise the standard of treatment by consistently exceeding patients’ expectations. One indicator of the caliber of care is patient satisfaction. Governments, healthcare professionals, and the general public prioritize improving quality and safety. Their efforts frequently center on making investments in modifications to how healthcare is structured and provided (system-level quality improvements). Continuous quality improvement (CQI) has gained considerable interest in the healthcare sector to enhance treatment quality while reducing costs, even though many additional methods may be employed (Hill et al., 2020). Quality control techniques and management ideas from the manufacturing and industrial realms have been incorporated into CQI throughout the 1990s and evolved.
The foundation of CQI comprises five guiding principles: an emphasis on organizational procedures and systems as opposed to the people that make up the system; the application of structured problem-solving techniques that are statistically and methodologically sound; multidisciplinary teamwork; staff members’ empowerment to help identify issues and areas in need of enhancement; and, an emphasis on clients (the general public) through a strong focus on providing an exceptional experience. The fundamental elements shared by various approaches have evolved as the use of CQI in healthcare has increased, and innovative quality improvement methods have arisen from the industry (total quality management) (Hill et al., 2020). systematic data-driven operations, iterative development, testing procedures, and designing with environmental circumstances in consideration are the three main components that constitute CQI in the healthcare sector. Lean Management, Six Sigma, PDSA cycles, and Root Cause Analysis are some approaches used in the health profession that address the fundamentals.
Decision-Making Models on Continuous Quality Improvement and Patient Satisfaction in palliative care
Spirituality’s impact on decision-making
A patient-centered, transcultural, and holistic approach, such as palliative care, is crucial for treating the patient. The spiritual beliefs of palliative patients may be taken into account by a CQT. Spiritual and cultural principles and convictions may influence palliative care decision-making. In palliative care settings, where illness-related issues, social or externally mediated components, and psychological and spiritual considerations all play a role, self-perception and a sense of independence emerge as facilitators for maintaining one’s sense of dignity. Improving patient communication, contentment, and ownership of their treatment are just some benefits (Rego et al., 2020). Improved patient communication, contentment, and increased dignity are benefits of integrating patients into their treatment. Nonetheless, if the patient’s wishes for end-of-life care are not discussed and considered, it might result in unwarranted suffering, pain, and resource inefficiency.
Intuitive Decision-Making
The hypothesis of intuitive decision-making among nurses heavily relies on accumulating experience through synchronizing memory and pattern recognition. Exposure to varied therapeutic settings ultimately leads to a deeper understanding of processes. As a result, when nurses encounter a situation where they must make an intuitive choice guided by a somatic state. The somatic state, which processes and transmits signals and alarms to take necessary action, is nonconscious and nonanalytical. As a result, the somatic condition gets processed and conveyed while making intuitive judgments in nursing practice. A decision-making technique known as intuitive decision-making focuses heavily on one’s perception and assessment of the circumstance rather than on scientific and evidence-based knowledge or expertise. Nurses, among other health care workers, learn to make choices quickly and without using critical thinking. Reaching this degree of intuitive decision-making, though, requires years of experience. Rapid and precise decision-making skills have a significant impact on patient care.
Healthcare professionals may utilize a continuous quality enhancement strategy to enhance patients’ satisfaction in palliative care through the Palliative Care Screening Test (PCST) and intuitive evaluation of palliative care (PC) requirements are the instruments required to detect patients approaching the EOL and provide those in need of them with palliative care services. Questioning hospital professionals if a patient might require PC services or the likelihood of passing away within 6–12 months is a practical method for assessing PC needs (Yen et al., 2022). Healthcare providers may extensively use it to help practitioners identify patients near end-of-life (EOL) and those appropriate for PC since professionals are not required to compile client clinical information or use a complex grading system to do an intuitive evaluation of PC requirements
Cultural Influences in Decision-Making
Healthcare professionals must be conscious of the cultural standards influencing their patients’ spiritual and emotional requirements to deliver comprehensive and effective palliative care. They must also seek to provide culturally appropriate treatment for these patients. Healthcare professionals must take cultural differences into account when developing individualized treatment plans. Healthcare professionals must be aware of how culture affects the needs for and provision of palliative care to offer accessible and comprehensive treatment. Healthcare professionals must undergo cultural competence training. Hospice and palliative care practitioners are accountable for fostering cultural competency(Monette, 2021). A CQT may be offered through training to organizations that provide palliative care. Training materials should commence with the cultural preferences of the patients. Learning about these preferences can lead to the development of training materials. If hospice volunteers and staff members represent all ethnicities within the served area, healthcare professionals will constantly be available to provide patients with culturally appropriate care (Monette, 2021). Retaining ethnic variety in volunteer and employee travel may also contribute to a higher level of cultural competency throughout the whole organization. Exposing oneself to various cultures also provides the chance to practice these abilities.
Evidence Decision-Making
Continuous quality improvement (CQI) methods in primary healthcare have increased client attendance frequency and enabled adherence to best practice clinical recommendations. Employing CQI methods has also resulted in the growth of a CQI workforce, useful support from the health system, and cooperation with other organizations and local actors. However, as the proportional impact of healthcare on health results is thought to only account for 10 to 20% of the gain, enhancing the effectiveness of the healthcare system by itself is insufficient to provide better health outcomes. A systematic approach will enable comprehensive primary health care services to integrate Governments, and the public is connected to CQI vertically, and other sectors are connected horizontally (McCalman et al., 2018). This will enable thorough primary health care services to make evidence-based and locally responsive determinations. Other governments and primary healthcare service investments are required for such CQI integration efforts to be supported and extended.
Ethical Decision Making
Healthcare practitioners should consider that providing appropriate and high-quality healthcare is a component of everyone’s human right to the best possible health, as their specific laws and policies demand palliative care. By addressing the emotional, legal, and spiritual issues connected to life-threatening diseases, palliative care adopts a comprehensive approach to help patients and their families live longer. It implies that it is essential to health and a fundamental human right. Ethical decision-making is necessary when a healthcare executive faces a dilemma or uncertainty regarding conflicting ideas, including those of the personal, the corporation, the profession, and society. End-of-life care services for terminally ill patients aim to alleviate or eliminate their pain while respecting their wishes (Akdeniz et al., 2021). Professionals nonetheless face a variety of ethical dilemmas while delivering end-of-life care. It is essential to uphold everyone’s rights, dignity, and health while making clinical ethical decisions since the decisions may significantly influence patients, their families, and society. Practitioners and their patients must understand the foundational pillars of biomedical ethics to properly manage the challenges they encounter in end-of-life care. The ethical principles are beneficence, justice, fidelity, autonomy, and non-maleficence.
Shared Decision-Making
Palliative care patients are entitled to input on their treatment decisions. Shared decision-making is a procedure in which a patient, members of the patient’s family, a medical professional, or an interprofessional team collaborate to make patient treatment decisions. Shared decision-making is essential to patient-centered care and promotes patient autonomy, a fundamental component of palliative care. Healthcare practitioners should empower patients to participate in shared decision-making and regard them as equal interdisciplinary team members. To provide the best palliative care, a CQT must incorporate shared decision-making, where the patient is acknowledged as an engaged participant in making determinations alongside the healthcare team. Moreover, in palliative care, patient autonomy should be multifaceted (Kuosmanen et al., 2021). Patients should be permitted to partake in medical determinations, routine care, and end-of-life options. Less invasive treatments, higher patient satisfaction, lower healthcare costs, increased patient safety, and more educated patients are all benefits of shared decision-making.
Rational Decision-Making
The Rational Decision-Making Model is a technique for detaching emotion from the decision-making process and proceeding forward logically in phases toward a solution. The model uses unbiased research, statistics, and other data to contrast options or alternatives. It appears that interdisciplinary communication and collaboration between health economists and the palliative care team are required. This will enhance knowledge of each other’s issues and ultimately aid in developing techniques to provide relevant, accurate, and dependable health and economic data. These findings may then be utilized as potent lobbying tools to persuade governments to increase funding for palliative care. This will ultimately cut costs and prevent unnecessary healthcare spending. In a market economy characterized by severe global rivalry, pharmaceutical researchers, suppliers, and marketers must investigate the necessity for assessing resources in relation to results for pharmaceuticals used in palliative care (May & Cassel, 2018). In the modern corporate environment, this might be an effective instrument for planning and implementing plans. Government entities might use the knowledge to reimburse pharmaceutical products and services to maintain the continuity of treatment.
Preferred Decision-making Approach
Evidence-based decision-making (EBDM) is the application of knowledge in the healthcare system of a facility or institution that utilizes empirical data and research-based principles at the case, agency, and system levels. According to the EBDM framework, public safety results will be enhanced when system stakeholders form meaningful collaborative relationships, rely on research to inform their work and collaborate to increase patient satisfaction and achieve favorable health outcomes (Brownstein et al., 2019). Quality improvement is the collaborative and ongoing efforts of all stakeholders, including healthcare professionals, patients, payers, planners, educators, and researchers, to think about and implement changes to improve patient outcomes, system performance (care), and professional development. The principles of quality improvement and evidence-based medicine function well together. Quality improvement is “translational,” implementing evidence-based medicine in healthcare systems and considering all types of incentives, including non-financial, reputational, and monetary ones. Evidence-based medicine, in contrast, bases clinical choices on scientific evidence. Quality improvement, however, is ineffective without proof and is difficult to assess or justify (Zamboni et al., 2020). Contrary to “quality,” which is primarily static and dependent on standards, quality improvement is a dynamic, thorough, and persisting process of testing and learning.
Evidence-Based Decision-Making in Practice
Adopting evidence-based approaches in health care is critical to enhancing care quality. Quality improvement, which is described as an organizational change intended to alter or enhance the clinical structure, procedure, and treatment outcomes, can be accomplished through various tactics. Palliative care is necessary for patients who are critically ill, suffer from severe disease, and are not anticipated to recover or stabilize, such as individuals with advanced cancer or patients in critical care units. Evidence-based healthcare practices are regarded as successful in delivering favorable patient outcomes/satisfaction and quality enhanced by interventions at the organizational and policy levels. Providers-centered interventions include reminder systems, facilitated medical information relay, audit and feedback, professional training, and support for quality improvement. Patient-centered interventions include patient/caregiver instruction and self-management, and reminders.
Nurses must employ information supported by investigation findings in a cautious, attentive, clear, and logical manner while also considering patients’ preferences when making decisions about their patient’s care using evidence-based practices in palliative care. Delivering efficient treatment to patients utilizing the available assets is the goal of evidence-based practice in palliative care. The purpose of evidence-based practice is to ensure that patients choose the most appropriate course of action feasible by educating them on the range of available treatment options and providing them with evidence-based, straightforward information on the benefits and risks of each option. Patients’ initiative and self-determination are increased via the use of the evidence-based practice. In addition to emphasizing the existence of an interdisciplinary team, the paradigm of evidence-based practice is not just focused on the work of physicians (Chapman et al., 2020). Guidelines for Clinical Practice in Quality Palliative Care from the National Consensus Project emphasize that a trained multidisciplinary team shall deliver palliative care services for patients and their families to encapsulate palliative care practices and distinguish them from other forms of care (Ferrell et al., 2018). The guidelines address the subjects that include the framework and processes of care, the physical aspects of care, the psychosocial components of treatment, the spiritual, religious, and existential elements of care, the cultural facets of treatment, the moral and legal aspects of care as it relates to treating individuals at the end of their lives. Each category is split into a series of evidence-based methodologies for palliative care team procedures.
Funding Sources of Palliative Care Initiatives
Funding for the quality improvement initiative to improve patient satisfaction and favorable outcomes may include organizations such as the American Cancer Society (ACS), the country’s largest private, non-profit funding source for cancer researchers. The ACS prioritizes investigator-initiated, peer-reviewed requests for funding. The International Cancer Research Portfolio database, a behavioral research center, funding possibilities, presently financed projects, and links to studies on cancer prevention are all available on this website. One of the eight organizations that comprise the Public Health Service (PHS), a division of the Department of Health and Human Services, is the National Cancer Institute. The principal federal organization for investigating and treating cancer is the National Cancer Institute (NCI) (Research funding and grant opportunities in Palliative Care, 2019). The National Cancer Program, which is under the direction of the National Cancer Institute, conducts research, provides training, disseminates health information, and supports other initiatives related to the causes, mitigation, diagnosis, and treatment of cancer, restoration from cancer, and ongoing care of patients with cancer and their loved ones.
The California Hospice and Palliative Care Association (CHAPCA), a non-profit group, educate patients, families, the community, and medical professionals about hospice and palliative care to improve the availability of high-quality end-of-life care. Its objective is to support the mission of providing patients and their caregivers with high-quality hospice and palliative care services and serve as a leader in advocating for these services in California (Welcome to the California Hospice and Palliative Care Association, 2019). The particular objective of this corporation shall be to seek and provide money to support and facilitate the provision of end-of-life care to individuals and their loved ones, as well as the delivery of hospice and palliative care.
Conclusion
Healthcare delivery systems attempting to improve patient experience may face significant challenges due to the organization’s need to coordinate behavioral and practice adjustments at various levels and domains. However, organizing, testing, and eventually implementing such modifications is relatively easy. Healthcare organizations may benefit from tried-and-true quality improvement concepts and methods already well-known to the many professionals involved in clinical quality improvement. CQI strives to standardize and configure procedures to minimize variance, produce predictable outcomes, and enhance patient experiences, medical practices, and institutions. Quality improvement methods should be ingrained in the culture of palliative care teams, constantly focusing on addressing challenges and obstacles methodically and systematically.
References
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