The compliance of health care workers (HCWs) with hand hygiene and disinfection quality practices is considered one of HHUMC principle objectives because of its direct impact on healthcare provision . Hand washing is the single most effective measure of preventing healthcare associated infections.

The Infection Control committee runs an ongoing hand hygiene campaign to raise compliance rates. The main elements of which are:

• Promotion of alcohol hand disinfectants which have been shown to significantly improve compliance.: Alcohol-based hand disinfection dispensers were installed in all hospital departments

• Staff training : the infection control committee conducts routine and scheduled training on hand hygiene and the importance of alcohol disinfectant use for all hospital staff

• Hand washing Message: the infection control team encouraged the placement of hand hygiene posters in all hospital hallways and departments.The graphic reminders are an effective measure in reaching a large number of the hospital population which includes staff and hospital visitors and promoting the messag about the importance of good hand hygiene practices and techniques.

• Observational Audit: The Infection Control team carried an observational audit of targeted staff that have direct patient contact in all hospital departments during the period January 2007 to November 2007. The IC/OH&S committee provided an annual schedule for the departments to be visited and audited. The audit entails monitoring the practice of all Health-care workers (HCWs) against the requirement that hands must be decontaminated before and after every contact with patients or invasive devices, prior to any aseptic procedure and after handling body fluids or contaminated materials. These contacts are described as hand hygiene opportunities.

“Compliance can be defined as either washing hands with liquid soap and water or rubbing with an alcohol disinfectant, in accordance with a hand hygiene opportunity”.

Compliance = Hand hygiene carried out x 100

Opportunity for hand hygiene (O)

In quarter I of 2007 the compliance rate was 73%. During the quarter II, compliance decreased to 71% and in the quarter III and IV the compliance rate were 72.2 %& 70 % respectively. The hospital-wide annual compliance average rate was 71.5 % which is an improvement from the 69% compliance rate of 2006 and a continued improment since compliance was measured in 2005. It is also above the hospital goal for the first time.

The annual score for each department is shown in the figure below. The HHUMC Infection Control Department set a QI score of 70% or more to be achieved in 2007 in order to continuously improve compliance. The pie chart below represents the hospital department scores divided into the percentage of hospital departments that have achieved the score.

The departments that received the lowest scores are the departments that will be closely monitored and already received extra attention in order to improve their compliance with the hand washing policy.

Most of the hospital departments reached their goal. Interventions such as staff training, promotion of alcohol hand disinfectants, putting posters and monitoring staff performance played a significant step in improving hand washing compliance in the hospital.

During the observations, barriers to hand hygiene were identified, e.g. no paper towels, alcohol disinfectants in dispensers. Some of the observations also gave concern about staff not decontaminating their hands following removal of gloves. Findings were identified and transmitted to the nursing director, department managers, and staff on duty after the audits.

Future plans for hand hygiene campaign

The infection control department plans to continue its activities to further promote and train the the hospital staff in the use of alcohol hand disinfectants.

The observational audits will be repeated at least twice each year. Additional engagement with the nursing departments that have scored the lowest in the recent audit has already begun and the root causes for the lack of compliance with the hand hygiene recommendations will be analysed. The causes that are associated with lower compliance are related to the infrastructure and ease of available sites for hand disinfection as well as the promotion of the “hand hygiene culture”.

Abstract

Patient centered care has been an ongoing topic for quite a few years. Healthcare policymakers understand that patient-centered care is very important in terms of both patient’s health outcomes and quality of care. These policymakers are endorsing changes within the structure of the healthcare delivery system to encourage patient centeredness and bringing in an approach in improving the quality of care.

Patient-centered care is a primary approach to improving the quality of health care. It builds a relationship between the clinicians and the patients. Patients relationship with the clinicians is like partners who not only takes care of them through clinical perspective but also forms relationships based on their emotional, mental and social needs. This policy paper will discuss the concept of patient-centered care and considers its benefits both in terms of patients and health care professionals. Also, Nurses contribution in providing the quality of care. Clinical decision making is also based on a combination of practices and preferences. There are various ways used to help patients accommodated their needs such as virtual visits, helping patient’s over the phone, emails and in-patient visits. As well as accommodation of new technology helps patients support their needs before, after and during the treatments through self-management tools which tracks their treatments.

As a healthcare professional It is one of our priority to focus the care more patient-centered. It is important for healthcare professionals to consider patients’ values, differences in culture, personal preferences and needs. Healthcare organizations should train clinicians to be more empathic and mindful when engaging with patients. A patient-centric approach will address these needs more effectively and will lead to improving relations between the patients and healthcare professionals. It is very important to welcome the involvement of families and caregivers so that the communication is more clear, trustful and tailored to the needs of the patient. Information should be delivered to the patient in a more meaningful way and not just assuming that the patient understood everything that the physician had to say about the diagnosis.  One advantage of Patient-centered care is that it enhances patient satisfaction. It improves quality of life and improves the outcomes of a disease Understanding patient’s preferences and personal uniqueness and finding a common solution to facilitate healing relationships is very important. Being able to get access to the healthcare facility builds a strong relationship with the clinicians as well as easiness in making appointments and payments and being flexible to accommodate the needs of the patients is very important from a healthcare providers perspective.

Policy Analysis and Core Competencies

The goal off the policy is to introduce a patient-centered approach with high-quality care into healthcare institutions. It is important for health care providers to be knowledgeable of the policies so that they can play a key role in making changes into the system. There are always barriers included in the implementation process of the policy. The barriers in this policy are stakeholder’s personal attitudes and perceptions. Limited integration and inadequate staffing for implementation as well as lack of support and interest. Considering what other organizational changes are needed at the time of implementation helps organizations get rid of these barriers.

The IOM (Institute of Medicine) defines patient-focused care as “providing care that respects every patient’s personal preferences, needs, and values as well as ensuring the patients clinical decisions”. The power to improve the current regulatory business and organizational conditions does not completely depend on any one entity, but rather requires that all must play a role. (Institute of Medicine, 2010). The key players in the implementation process of a policy are legislators, stakeholders, elected and or appointed state officials, regulatory boards, insurance companies, physicians, patients, and professional organizations. The main challenge is the diversity of the stakeholders involved in the program evaluations which determines the effectiveness of the strategies. Everyone has their own ideas about how a policy should work and coming down to one solution is difficult in a diverse group. The stakeholders under my policy are clinicians, organizations, and patients. And every stakeholder has their own perspective. Problems with the implementation of the policy refers to those interacting with the recipients of the policy or the program (Institute of Medicine, 2010).

This policy is relating to the core competency table in few ways. It helps NPs take leadership opportunities to bring changes in the organization. NP can apply leadership knowledge when making policy decisions which leads to effectively collaborating with other stakeholders and delivering the message to them about how important the changes are and how involvement in leadership can bring new policy to practice. NP can use best practice to improve the quality of care by considering relationships between cost, access to care and quality of healthcare delivery. They can help in implementing interventions to ensure that the quality of care is given to its patients. NP advocates for the political policies that promotes equity for everyone and gives the quality care and cost-effective care to every patient. However, they have to analyze and make sure that the policy they are trying to develop is ethical and legal and is in favor of the patients.

Policy Relevance to HP2020 Goals

The HP2020 goal is “The social determinants within HP 2020 is designed to create ways to identify social and physical environments that promote good health for everyone”. According to HP 2020 “The goal of the HP2020 is to gain a society filled with healthy people living long lives and high-quality life and to create environments that promote good health and quality of life across all stages of lives”. The goal of my policy correlates with the goal of HP2020 because the focus is to achieve high-quality care for patients. Lack of access or very limited access to the quality of care impacts on health. Healthy people 2020 access direct care to access healthcare services and incorporates these services. Barriers to access these services is high cost, no coverage, language barrier, as well as lack of access to the services. These barriers lead to unmet health conditions leading to delayed care and inability to prevent health conditions. Hence, HP2020 goal will help achieve all these barriers to promote quality of life across all stages of lives.

Literature updates

According to National academies press, it mentions that “The current reimbursement system does not give incentive to physicians to engage with their patients in communicating and sharing decisions. In addition, clinicians are lacking training in communications making it difficult for them to recognize and respond to patients mental and emotional needs”. This policy will help clinicians acquire and support skills needed and will relate to patient-centered care and it will encourage them to bring this culture to the organization.

As healthcare costs are increasing every year patients are expecting a better quality of care. People expect good quality when they pay more for insurance. Patient-centered care can lead to higher patient satisfaction which is very important when running a high-quality health care facility. The implementation of the affordable care act brought a lot of changes in the healthcare industry. “The number of patients entering the healthcare system was expected to reach 32 million leading to difficulties for the current healthcare system to accommodate these new consumers” (Torres, para5). The more availability of patients to use the insurance the more physicians and nurses are needed so that they can give high-quality care.

Financial Impact of Implementation and Sustaining it

The financial impact of implementing my policy would lead to cost savings, higher rate of patient satisfaction leading to improved patient’s health outcomes, reduced hospitals length of stay because of high-level quality of care which results in competitive advantage leading to better financial performance in the market and reducing unnecessary cost as well as significantly improving the care. Patient-centered care requires nurses and clinicians to involve families into the decision of the treatments given so that more trust is built, and results in quick recovery.  The sole purpose of this care policy is not to make the organizations financially better but to improve patient satisfaction. However, we cannot neglect the fact that it is also important to make sure the health care organizations are financially stable, because more stable a healthcare organization is better care is provided to patients. The direct cost of implementing this policy would be to improve patient to nurse ratios which will have a direct financial impact.

Health care organizations are reluctant to support the implementation of quality improvements unless it is accompanied by better payment or improved margins or equal compensation (Milstead, 2019, 174). This is because healthcare organizations are not paid enough to spend quality time with their patients they are always on clock and have to make sure that they see more patients in a shorter period of time. Mostly healthcare organizations ignore that patient care is more important than in taking more patients because that can lead to serious consequences such as patients being ignored and not answered to their concerns. Patient counselling in not done appropriately which leads to poor health outcomes in patients.

The patient-centered care is a basic shift in healthcare in our country resulting in expensive healthcare with poor health results for both the patients and the clinicians. This policy has developed a “2020 vision” which will bring affordable health insurances for all and access to high-quality care. (Davis et al, 2005). The more the patient is satisfied with the given care it results in fewer malpractices. The main problem with malpractices is communication, delivering poor information and not able to understand the patient’s perspective is the biggest problem (Kavalier, 2003). This policy really focuses on dealing with this issue and prioritizing it so that it involves not only the patient but their family members when discussing their care plans.

It is important for NP to be involved in the political process when implementing policies as they impact the quality of life of care given to the patients. “Professional organizations can bring their influence on the policy process in ways that a single person may not” (Milstead,2019). American nurse association the national league for nursing and signa state a commitment to advancing health and healthcare in this country. such organizations give RN’s opportunities to develop their personal skills as well as it encourages them to be a part of the political process and raise their voices or concerns.

Patients who engage in their own care decisions on a limited basis results in bad health outcomes because they may fail to communicate their needs, concerns, expectations, and preferences with their healthcare providers. (Epstein and street, 2007). Quality of care can certainly be improved in a few ways such as making information more understandable to the patient and their families. Developing plans that facilitate patient-centeredness as well as shared decision making.

we know that safe staffing is important and can provide the best quality care to the patients, however, the argument that stakeholders use is that it would be an extreme financial burden on healthcare organizations to provide and set a nurse to patient ratios. The healthcare organizations would have to hire more nurses to have a set ratio for each nurse, as well as patients, can be neglected care due to not having enough nurses at the facility at the current time which can cause a delay in the care given to patients due to laws set in place regarding the ratios.  Hiring more nurses and having set nurse to patient ratio will result in less nurse turnover rate as they are less burnout and more satisfied, nurses in return will give more satisfying care to the patients.

Conclusion

The purpose of this paper was to analyze patient-centered care and help improve the quality of care. Healthcare policymakers understand that patient-centered care is very important in terms of both patient health outcomes and quality of care. These policymakers are endorsing changes within the structure of the healthcare delivery system to encourage patient centeredness. However, these policymakers need to understand that physicians and other health care professionals need to be formally trained in the communication skills so that they can effectively deliver care to the patients when needed.

Table: Core Competencies

References

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