The Killer Disease
The importance of database management is high since it decides the importance of different results obtained in the past for improving results in future and thus it can be seen that improvement of quality is dependant in part on the quality and application of databases within the organization. One of the leading reasons for death in United States is cardiovascular disease and according to Centers for Disease Control and Prevention the leading reason for death in the country is acute myocardial infarction.
According to available figures, this results in 40 percent of all deaths. In general about 900,000 patients are diagnosed with the disease and about 225,000 of them die. One of the saddest points about the whole issue is that of them 125,000 pass away before receiving any medical care. These unfortunate incidents led to the formation of a core team for acute myocardial infarction by the Joint Commission for the Accreditation of Health Care Practitioners the recommendations of this committee were adopted into practice by Meridian Health.
This hospital established a cardiac care process for this in 2004 which developed a process for the improvement of care. The attempt was to look into two specific measures against AMI and this was to administer aspirin and a beta blocker to the patients at the time of their admission to the hospital when they were suspected to be having AMI. (Quinn; Mannion, 2005) The implementation of this process took a little time and in December 2004, the second group of congestive heart failure process improvement team started implementing the decision.
This was with the assistance of the information technology department and the compliance was with the decision to use angiotensin converting enzyme, otherwise called ACE inhibitors, or angiotensin receptor blockers or ARB and thus evaluate or at least document the left ventricular function in the treatment of congestive heart failure. The first results of using AMI beta blockers at the hospital were positive and there was an increase of 10 percent within the first two months of use and to 14 percent by the third month. Except for the months of February and March, the compliance with the instructions has been 100 percent with the instructions.
During those two months, the physician who had written the initial orders for treatment had not used the established method of using the system of referring to the information technology concerned. If the method had been used, it is estimated by the doctors, mortality would have gone down by around 50 percent which makes a total of 50 lives during an eighteen month period in a hospital with 500 beds. (Quinn; Mannion, 2005) This clearly states that proper maintenance of records and ensuring that patients are treated in the accepted method leads to reduction of deaths.
The assurance of quality is a process and the process of quality control is checking that assurance of quality has been maintained. For all data entry, quality assurance has to depend on good standards and procedures backed up by properly configured data entry methods. The main reason for the assurance of good data is data management. Checks are generally carried out through audit of the data against the central data base that exists. Generally all data is now in a single storage with back up copies, and so it is not such a difficult task to check the data against each other.
Yet, the question of audit is left to especially trained persons. (Santoro, 1999) The situation today is that databases have become much easier to manage with modern computers and the entire business and healthcare activities concentrate on proper data storage. The earlier systems of storage of data in files are gone and the modern systems are much easier. There are many systems attached to databases for healthcare enterprises including database management, data warehousing and object oriented concepts for databases.
Along with this is the importance of quality management, for the data has to be of the highest quality. There is a tradition of having different systems and files for different units even within the same business, and this also leads to quality problems for the data of the total enterprise. (Johns, 2002) There are also systems that are written in common languages like Microsoft Access and that is a part of the common software Microsoft Office. The reason for this is that the basic system has been designed by a doctor though the final system was written by a consultant.
This has helped in required changes to the system on many occasions over a relatively short period of two years. The database system, however, keeps a track of all requirements from patients like test results, physiological parameters etc. keeps noting changes in the patient which can be seen graphically and even alerts the attending staff about the screening tests, due preventive care and educational sessions. (McLaughlin; Kaluzny, 1999) It can be seen clearly that management of database is very important and in the case of medical organizations, this also leads to improvement in services, or quality in many cases.
The question next comes to as to how one can develop plans that do not end up in a file on the bookshelf to collect dust over long periods. The first step is to make the plans interesting enough and simple enough so that they can be understood by the ordinary man. For this purpose, there are many systems and the entire system of decision making can be simplified through viewing it as a sort of a decision tree with branches going to the right and the left. In Japanese, this system is called Hoshin, which is based on a tree.
The methods are to develop, communicate, and implement strategic initiatives in a manner that will have the flexibility and acceptability throughout the organization for which the plans are being made. In many cases it will be seen that the objectives of the top management do not seem to be the same as the objectives of the departmental heads or related to their activities. This is one of the fundamental beliefs in Hoshin planning and it assumes that no decisions of seniors will be accepted by the juniors without questioning of the decisions.
The important part of seniors proceeding in the manner of Hoshin is to ensure that juniors understand and support the plan that is being made by the seniors. (Chapter 8 – Hoshin Planning and Chapter 9 – The Culture of Lean Production) Often the mistakes come as the end goals are taken to be the same as the means to achieve the goals. The end goals are positions where the organization has to reach and those cannot be compromised since they are correct descriptions of the achievements to be reached. The means to reach those goals can be different and there may be many paths to reach the same end.
An example will make this clear and let us say that for an individual the objective is to collect an entry for a prestigious show. One of the sources can be to win a contest where the prizes are entry tickets to the show, and an individual may feel that those must be won to get an entry. At the same time, one has to remember that the objective is to be present at the show and not win the contest. Even if the person loses in the contest, there are other methods through which one can reach that concert.
When the person fails to win the contest then the person should try to find another method of reaching the concert. On the other hand, the end goals have to be achieved and for this purpose fresh courage have to be built and that involves meeting new persons, learn and grow and contribute to the organization. For this purpose, even if the original path is blocked, then other methods must be found. (Pavlina, 2005) Thus it is important to review all plans regularly for them to be successful. When the method of Hoshin was first reviewed then it was learnt that a bi-monthly 2 hr review was scheduled.
This was to ensure that the plans that were made were not to lie on the shelf, but be utilized. The plans can also be viewed as a part of the check in process. The steps in the cycle according to Hoshin includes vision, 1 year plan, deployment of the individual and alignment of the plan, execution or process management, diagnosis on a monthly basis and finally an annual diagnosis. However the entire process according to Hoshin is a cycle and the steps have to come one after the other – there is no beginning or end.
Chapter 8 – Hoshin Planning and Chapter 9 – The Culture of Lean Production) This is a process that is realized by modern management and changes have to be made according to this process of thought. Even for healthcare, there is no end or beginning. In the case of hospitals, new methods are being developed to improve communications with patients and this will result in higher levels and quality of patient care. There are many methods of getting in touch with patients and that can help improve the no-show rate of any facilities and this is also the most expensive of patient care issues.
For this purpose, the patients have to be reminded of appointments which are scheduled within a few days. This is a method that provides patients with information that are not easily available otherwise or would require additional staff for the activity of outbound calling. There are self service applications which improve on methods of reaching the patients from the offices of the medical providers. There are now systems which make it easy for the patients to get the lab test results and the ability to refill prescriptions at anytime, anywhere and there are methods of providing information at all times.
This is also a responsibility for the hospitals and improves their relationship with the customers and utilizes their resources better. (INI Solutions for Government Healthcare Automating essential processes that support quality patient care) to achieve this, one would require the proper utilization of information that is with them. There are some organizations which claim to have solutions for this purpose also. When the volume of transactions for an organization grows, it is difficult to make changes that are required, and even levels of service that are promised by medical institutions are not provided.
The situation becomes worse with a continuous inflow of new information which has to be stored. (WellPoint Health Networks gains higher ROI and benefits from customer satisfaction) This is a problem of continued increase in database and managing it and maintaining it at the same quality levels. The problem requires much faster processing of information and that can be done only by modern methods. The solution for many organizations where previous information is the decider for future action ensures that the concerned organization has quality and proper database management.
