Quality Improvement in Psychiatry

Quality Improvement in Psychiatry

Part 1: Evaluation of the Quality Improvement Program

Quality improvement in psychiatry seeks to address the risks present in psychiatric care. Due to the complexities of care provision in this area of care, quality improvement strategies in psych care are vast and touch on infrastructure and personnel. The goal of psychiatric care is to maintain the safety and effectiveness of the care process. Quality improvement strategies such as the functional expansion of healthcare facilities handling these patients have greatly enhanced care processes. They have been implicated in significant reductions in morbidity and mortalities associated with these disorders. Programs on quality improvement in mental health care can be evaluated based on their merits in ensuring the well-being of mentally ill patients (Boland, 2019). This paper seeks to evaluate quality improvement programs in psychiatry.

The quality improvement program sought to provide infrastructural and functional expansion of healthcare facilities handling mentally ill patients. Infrastructural expansion entailed the acquisition of diagnostic and treatment equipment and the expansion of the hospital’s bed capacity to enable it to handle a larger volume of patients. Functional expansion as a quality improvement strategy entailed recruitment of more staff to handle the ballooning number of patients, expansion of skills and expertise required in handling psych patients, and sound management of psychiatric departments to ensure effective and efficient care provisions. Other quality improvement areas include enhancement of employee welfare to mitigate providers-related risks, enhancing access to mental health care to minimize risks to patients, and monitoring psych patients to minimize hazards that may befall them.

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Evaluating the effectiveness of these programs requires an depth assessment of the outcomes of these programs. The first step in evaluation is assessing the level of adherence or compliance to these programs within healthcare. This will give insight into whether the outcomes are consequential of the posited program. The second step is to examine how the new practice outlined in the program affects service delivery to the patients. This is then followed by in-depth scrutiny of the patient experience parameters and how they respond to the intervention (Brewster et al., 2018). Scrutinization of the patient’s experiences utilizes quality improvement indices such as the number of hospital readmissions, number of hospital visitations, mortality and morbidity rates, hospital bed days, hospital bed turnover rate, and costs of treatment. Evaluation is done periodically, and the success of these programs is informed by the assessment of these parameters.

The programs on infrastructural expansion can be evaluated using several parameters. These include the number of patient admissions and the hospital’s potential capacity. Hospitals’ potential capacity reflects the population covered by the hospital (Wang et al., 2018). As the bed capacity increases due to infrastructural expansion, hospital potential capacity is expected to increase, assuming that the number of patients with mental illnesses continues to increase in society. Moreover, with the acquisition of new effective and efficient diagnostic equipment, the number of patients being diagnosed with mental illnesses is also expected to rise. This is also true for patient admission since more patients will be diagnosed with cases that require hospital admissions when the hospital can diagnose these patients. Hospital visitations are expected to increase when the population has faith in the hospital’s care processes. Availability of diagnostic equipment and bed space can inform the decision-making process and influence them to visit the hospital.

The programs on the functional expansion of the hospital can also be assessed using several parameters. These include the number of hospital stay days, hospital readmissions, rate of morbidity and mortality, hospital bed turnover rate, and cost of treatment. The number of hospital stay days is expected to considerably reduce in the presence of competent healthcare professionals and treatment tools/equipment. This is because of the enhancement of quality of care provision in the presence of competent staff and treatment tools. Morbidity and mortality rates are also expected to decrease. In most circumstances, morbidity and mortalities in psychiatric care are accustomed to scarce or absent treatment tools such as medication and incompetent staff handling mentally ill patients. With the expansion of personnel and their functional capacities, care processes are expected to improve, thus enhancing care outcomes.

Hospital readmissions are also expected to decrease. Hospital readmissions are often due to ineffective care provision during primary visits. Development of complications, adverse events from treatment with drugs, and inadequate address of the underlying conditions contribute to hospital readmissions. Improving the treatment process by enhancing staff competency can considerably lower hospital readmissions. This is because the competent staff can accurately identify the cause of the patient’s problem and design effective therapeutic plans to address these problems. In addition, in the presence of diagnostic and treatment equipment, patient outcomes are enhanced, and readmissions are minimized.

Treatment costs are also expected to be lower with infrastructural and functional expansion in mental health care. The cost of treatment encompasses all healthcare costs incurred by the patients, including logistical costs. Improving the quality of care reduces costs of treatment by reducing the number of hospital visitations and readmissions, reducing the number of hospital stay days, and eliminating costs that would have otherwise incurred treating avoidable complications attributable to the treatment process. Increasing staff competency in handling mentally ill patients and acquiring treatment and diagnostic equipment may significantly lower the cost of treating mental illnesses by eliminating all these.

Part 2: Necessary Adjustments

Indicators and their Measurements

The high-risk area selected is psychiatry. The indicators chosen remain appropriate in the evaluation of quality improvement programs in psychiatric care. Several risks are apparent in psychiatric management. These risks may either be patient, provider, or healthcare-related. Patient risks are attributable to the patient’s actions, while provider risks affect the healthcare provider and may be attributable to their patients, the healthcare facility, or themselves. Quality improvement programs seek to safeguard the well-being of the patients by ensuring quality and safe care provision. Quality indices utilized in quality improvement include mortality rates, hospital readmissions and visitations, cost of treatment, and the number of hospital stay days. These indices adequately capture the risks that are apparent in psychiatric care.

While a majority of these indices focus on factors associated with the healthcare facilities and care provision processes, some capture factors associated with the patient’s risks. Such indices as mortality rates and hospital readmissions cover both aspects of the patients and the care provision processes. High mortality rates and hospital readmissions may sometimes result due to patient factors. Therefore, using them as indices provides a broader perspective of care stretching beyond the confines of the clinic. These indices may inform other factors impacting psychiatric care, such as poor patient compliance with their medications and inadequate monitoring of these patients during the continuum of care at home or in institutionalized care. Therefore, understanding their provisions is key as it enables the determination of causal factors for the risks and enables their address.

Fictional Incidents: Realistic and Plausible?

The fictional incidents outlined in this course are all realistic and plausible. The fictional incidents represented three case scenarios involving psychiatric management and exploited various aspects of the management process and risks commonly presented in the healthcare system. The case of Kevin Peterson depicted a patient with depressive disorders who presented with suicidal tendencies. The patients had had multiple suicidal attempts that all failed. His medical and medication history revealed that he was not compliant with his medications. This case is a representation of how patient-related psychiatric risks occur. In this case, suicidal ideation and tendencies are evident in the patient. Frequent suicidal tendencies and symptom exacerbations may be attributable to his poor compliance with antidepressant medication and comorbidity with substance and alcohol abuse. These are two factors that increase the risk of suicidal tendencies and are due to the patient’s behaviours.

The case of a private healthcare facility in Alaska is a replica of the deplorable state of mental healthcare management globally. Mental health has yet to receive the level of attention it deserves. This may be because it has been overshadowed by non-communicable diseases in the U.S. or by communicable diseases in lower- and middle-income countries (Haileamlak, 2017). The case study highlights several risks apparent in psychiatric care and the traditional healthcare disparity attributable to the geographical location of Alaska. First, the setting of the hospital is in the remote areas of Alaska, where access to care remains a challenge. Secondly, the establishment of the healthcare facility was in the backdrop of increasing cases of mental illnesses in the area. This is also the situation worldwide, as the WHO (World Health Organization) report indicates a global increase in the prevalence of mental disorders.

The third risk depicted is healthcare-related, as evidenced by inadequate diagnostic and treatment tools, inadequate personnel, and inadequate bed space to handle incoming patients. This came after a change in the hospital’s management. The significance of this risk is that it results in poor quality care provision. The result is often evident in longer hospital days and increased morbidity and mortality, hospital readmissions, and treatment costs. The case also acknowledged a specific index of quality improvement in the psychiatric care of hospital visitation as a marker for quality care. As evident in the case, the number of patients increased upon its establishment courtesy of better healthcare provision.

Filled Chart Consistency with Fictional Incident

The filled chart is consistent with the fictional case. The filled chart was a representation of the Alaska hospital case. The chart scrutinized quality concerns in the hospital using specific standards of quality assessment. The standards selected were medication management; provisions of care, treatment, and service; management of human resources; surveillance, prevention, and control of infection; and improving organizational performance. The basis for this selection was the conformity of these standards to the issues presented in the case study. In addition, the management of human resources was the causal factor in quality deterioration in the case study. Notably, provision of care, treatment, and care provision services deteriorated as a result of poor governance. Patient surveillance was also poor at the hospital, and the organizational performance was very poor. The hospital scored poorly upon assessment using these standards. Their level of compliance remained low in most aspects of the standards, revealing its overall deplorable state of operations.

Correctional Plans

The proposed correctional plans were feasible and addressed all the issues apparent in this healthcare facility. The correction plans focused on the functional and infrastructural expansion of the healthcare facilities and effective healthcare management. Issues of inadequate personnel are solvable by expanding the hospital workforce. Issues of employee dissatisfaction with the terms of service within the hospital can be corrected by recruiting a human resource manager who understands the organizational requirements and is willing to inspire change in their subjects. The infrastructural expansion was also proposed for issues such as poor care provision and treatment as well as low bed capacity.

All the outlined correction plans are feasible. In as much as some components of the change may require heavy financial implications, the benefits they are expected to produce outweigh the risks. Additionally, healthcare facilities always give prominence to measures that enhance the safety of their patients and employees. The quality improvement plan outlined can ensure this and ensure a long-lasting solution to the hospital’s predicaments.

Workability of the Correction Plan

The workability or effectiveness of the correction plan outlined will be assessed based on its outcomes. The plan will be said to have worked when, upon its full implementation, it will have met the expectations outlined in the plan. The plan will be evaluated using specific measures to ascertain its effectiveness. The specific measures that will be utilized in this evaluation process include hospital readmissions and hospital stay days, morbidity and mortality rates, employees’ satisfaction with their work environment and care processes, and patient approval ratings of the hospital’s services. The programs will be considered effective when the number of hospital readmissions and hospital stay days decreases; rates of morbidity and mortality decrease; when the organizational employees are happy with the care processes and the management of the hospital; when the patients’ approval ratings of the services offered in the hospital are high.

Conclusion

Quality improvement in psychiatric care remains a priority. The significance of quality improvement strategies in enhancing care outcomes underpins its necessity. Psychiatric care is an area in healthcare that requires attention. Functional capacity in this area of care remains low due to the scarcity of care specialties in this area of patient management. As evident in the previous case studies presented, several healthcare hazards are always apparent in psychiatry, and safeguarding the health of mentally ill patients is a key priority in psychiatry. Addressing these risks is the preliminary step towards this safeguard. Therefore, it is the responsibility of healthcare providers and organizations to establish a framework that enhances the effectiveness of care provision processes and optimizes care outcomes.

 References

Boland, B. (2019). Quality improvement in mental health services. Bjpsych Bulletin, 44(1), 30-35. https://doi.org/10.1192/bjb.2019.65

Brewster, L., Aveling, E., Martin, G., Tarrant, C., & Dixon-Woods, M. (2018). What to expect when you’re evaluating healthcare improvement: a concordat approach to managing collaboration and uncomfortable realities. BMJ Quality &Amp; Safety, 24(5), 318-324. https://doi.org/10.1136/bmjqs-2014-003732

Haileamlak, A. (2017). Mental health disorders: the deserted illnesses. Ethiopian Journal Of Health Sciences, 27(1), 1. https://doi.org/10.4314/ejhs.v27i1.1

Wang, F., Wang, L., & Wang, P. (2018). Estimation of Hospital Potential Capacity and Basic Reproduction Number. Abstract And Applied Analysis, 2014, 1-5. https://doi.org/10.1155/2014/875474

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This assignment has two parts.

Part 1:
Write a 2–3 page evaluation of the quality improvement program that you have created. This should be the annual summary of the hypothetical data. Make sure your hypothetical data are credible.

Quality Improvement in Psychiatry

Part 2:
As you may recall from Week 1, your Course Project was to prepare a total quality improvement program with a focus on one high-risk area. Continuous quality improvement covers many areas. Throughout the course, you have learned about the attributes that constitute a quality improvement team and what questions this team attempts to answer. The assignments toward this project that you completed each week can now be assembled into a single instructional document.

Make necessary adjustments to your document so that each segment flows smoothly into the next. Evaluate your project using the criteria given below.

Are the indicators and their measurements appropriate to the high-risk area? Do the indicators capture the risk?
Are the fictional incidents realistic and plausible?
Is the filled chart consistent with the fictional incident?
Is the plan of correction feasible? Will it prevent the occurrence of the incident in future?
How do you know the plan worked? What measures will you use to identify effectiveness?
Include an introduction, conclusion and reference page to this assignment.

To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Submission Detail:
Your assignment should be addressed in an 8- to 10-page document.
Submit your documents to the Submissions Area by the due date assigned.