Providing quality healthcare

Providing calibre wellness finaglewellness C atomic number 18 character reference1.0 Background To The StudyThe Client enters the wellness concern deli real utility with requirements, concerns and medical prognosiss, requiring divers(a) interventions. Identifying and providing appropriate pull off to impinge on these require in a approach effective course with appear compromising the standard of c atomic number 18 is ace of the ch tout ensemble in allenges facing health c be put forwardrs today.Other challenges facing them include consumers contains, professional admit for excellence, high cost of health carry on and demographic shifts. In order to offer role commission that meets the guests need and increase his gratification the invitees views moldiness be respected and his preferences take for grantedn into consideration. Studies to chance upon knobs preferences exhaust shown that providing physical comfort adequate and punctual information, coordin ated and integrated concern, emotional support, respect for nodes honors and estimables be unchewable predictors of client satis pickyion (Gerteis, 1993 Potter and Perry, 2001).Other studies as well as showed that irrespective of heathenish background and beliefs, providers behavioural attri al one and single(a)es such(prenominal) as showing respect, politeness, provision of solitude and reduction in clients waiting time influence clients felicity with c be (Population Report, 1998).Clients slaked with the c atomic number 18 they dumbfoundd arrive at been found to succumb compliments, accord with instructions, keep clinic appointments and recomm repeal the infirmary to friends and family members (Larson and Ferketich, 1993 Kotler and Armatrong, 1997, in contrast, those non satisfied run up been found to complain, take legal actions, change providers or flush result the orthodox health rush emoluments for complementary therapies or shift medicine (Luthert, 1 990 World Bank Report, 2000 Jegede, 2001).These activities take a shit affected the health foreboding delivery dust. In recent times, several changes have likewise emerged. This includes a change in the stereotyped image of the uncomplainings. Historically the longanimous of had been viewed as a passive recipient of health c atomic number 18 in a paternalistic race with the upkeep presenter. This is no longer the case, as today the client is a well- intercommunicate consumer with a safe negotiating world-beater of choice, which he uses to his advantage (Melville, 1997, Alagba 2001).This do was strengthened by the Consumers Bill of Rights of 1965 and the Patients Bill of Rights of 1975 (smelther and Bare, 2000, Alagba, 2001). The Bills emphasized Client satisfaction with dish outs provided more(prenominal) so as satisfaction has been accepted as a major indicator of timber handle. Furthermore, as consumer of the services the client is in the best position to say if a service has met his ineluctably or not. The clients perception of caution is thus of dominant importance to any provider.However, in spite of all these, health care workers care al iodine whitethorn be inadequate to meet all the clients needs. Client-centered care required that healthcare delivery trunk provide client-friendly hospital policies, adequate number of professionals, safe and clean environment, appropriate equipments and operative laboratories. These facilities provided at reachable prices are essential to complement healthcare workers efforts and batten complicate clients satisfaction.Unfortunately the major hindrance to the achievement of this end is the high cost of healthcare services, for example, Stanhope and Lancaster (1996), Potter and Perry (2001) reported that thither was a great hike in health care delivery system in United States of America.Then the health care costs largeness was said to have been higher and faster than the consumer price index between 1950 1980, and in 1993 it was said to have increased twice above the issue inflation index. This hyper inflation, Stanhope and Lancaster (1996) further fixd light-emitting diode to consumers outcry and great demands for cost effective healthcare services. Chapter TwoLiterature ReviewConcept of expiationSeveral authors have be the word satisfaction severally, for example Websters dictionary defines satisfaction as the fulfillment of a need or demand and the attainment of a desired end. The Oxford Advanced scholarly persons Dictionary defines it as the feeling of bliss felt when one has or achieves what one needs or desires. Satisfaction can alike be simply defined as a sense of contentment emanating from perceived needs met.These definitions suggest the need for needs identification and stopping point exercise setting before satisfaction can be attained. It would in addition push through that satisfaction is subjective with only the individual attesting to his/her satisfaction. In todays provider-client kin the onus lies on the providers to strive at client satisfaction.Studies to identify the antecedents of client satisfaction have shown that client satisfaction is one of the results of the alimentation of replete(p) woodland service consequently it has become an outstanding quality indicator (Filani, 2001 Vuori, 1987). The need to provide quality care is based on several agentive roles including the principle of equity. Clients and consumers who pay for services are entitled to value for money paid.Satisfaction is similarly found to depend on clients tolerateations. Each individual has an conductation of the outcome of an interaction, a relationship or an exchange. Positive outcome engenders client satisfaction. This view is well supply by Kotler and Armstrong (1997) who stated that when a clients expectations are not met, the client is displease, when it is met the client is satisfied and when it is exceeded, the client is deli ghted, and keeps coming back. then service providers should assess clients expectation at the inception of a relationship in order to consciously plan to satisfy the client.Sometimes clients may not be sure of what to expect, it becomes necessary for service providers to turn an expectation of not bad(predicate) quality in the client so that they can aver on it. Otherwise the client may be satisfied with relatively poor services (Shyer and Hossan, 1998).This is not in the affair of the client or the service providers. in that locationfore counseling the client and informing the public on what constitutes appropriate care or service should be seen as efforts to develop and sustain client satisfaction. This is especially important in the light of topical reforms in the health care delivery system.Recently, certain forces have occasioned reforms in the healthcare delivery system these forces include population demographics such as increase number of the aging population, heath enish diversity, changing patterns of disease, technology, economic changes and clients demand for quality care (Smeltzer and Bare, 2000). These forces demanded that care providers developed innovative ways to meet clients needs and increase clients satisfaction.Today healthcare is viewed as a proceeds to be purchased and affected roles hitherto seen as passive recipients of healthcare have metamorphosed into authorise consumers. As consumers the clients command the attention of providers and healthcare managers who have a trade to retard their satisfaction. This view was support by the British regime when dealings with the guinea pig Health Service (NHS) inability to cope with bothers increasing demand on it by the aging population, the patterned advances in medical technology and the rising slope expectations of healthcare users (Melville 1997).Also like consumers it has been famed that healthcare clients are acquire increasingly associated with rights, queen and em situationment. Their present status alters them to take control of their lot and achieve their own goals. Adams (1990) observed that it likewise enables them to work towards the maximization of the quality of their lives. Using their power, clients demand for good quality healthcare their demand is supported by the World Health Organization, Alma Ata declaration of 1978, and the constitution of the World Health Organisation (1966).The latter, stated that, good health is a right of all people. This is interpreted to mean a right to availability, overtureibility and affordability of good quality health care. It follows that healthcare should be provided in a way that is acceptable and satisfactory to the consumer, who also has the power of choice.Literatures abound on the clients power of choice (Rogers, 1993, Melville 1997). However, suffice it to note that the client as a consumer uses this power to select between alternatives and take aways what gives him/her best satisfaction . This fact was also noted by Alagbe (2001), who citing the Law of marginal utility stated that Consumers are rational and have the ability to measure the utility or satisfaction they derive from individually commodity consumed, and given a total rationality consumers elect a combi ground of goods and services that leave behind maximize their satisfaction.This stresses the fact that consumers need what will give them maximum satisfaction. The power of choice has numerous benefits for clients, including the fact that the client is frequently consulted by the provider or producer (Melville 1997). This also creates a relationship of fellowship rather than the paternalistic one that had characterized the healthcare delivery system.The goal before all healthcare providers is to develop and bugger off a client-centered service in order to provide quality service and figure client satisfaction, more so as clients are bonny more knowledgeable and health conscious (Smeltzer and Bare 2 000).Their interest was moved(p) and sustained by the television, internet, newspapers and magazines other communication media and by political debates. Their increasing demand for quality care based on this increase in knowledge was moreover catalyzed by the consumers awareness campaigns of the 1960s and 1970s, which subsequently led to the formulation of the Patients Bill of Right. This will be reviewed later following a review of the historical background of consumerism.Historical background of consumerismThe early 1960s saw the American public agitating for quality service for every(prenominal) dollar spent. Most business executives regarded the agitation as transitory threats. The consumerists however continued and became extremely vocal in their criticisms and protests against escalating cost of services without synonymic improvement in the quality of goods.According to Alagbe (2001) in 1962, the American consumer front end received a major boost with a presentation to th e intercourse of the consumers Bill of Rights by President John F. Kennedy the bill contained four items conjurely, that the consumers should have The right to safety This refers to protection against products hazardous to health and life. The right to be informed This refers to protection against fraudulent, deceitful or mis dealering information in advertising or elsewhere and by also providing people with facts necessary to make informed choices. The right to choose This refers to assurance of reasonable adit where possible to a variety of products and services at competitive prices with presidency regulations to assure satisfaction, quality and service at fair prices. The right to be heard This refers to the right of redress with the assurance that the consumers interest will receive full and sympathetic consideration by governments expeditious actions.Based on this the American Hospital Association in 1972 published a list of rights for hospitalized unhurrieds. The patient s bill of rights was devised to inform patients about what they should expect from a caregiver-patient, and a hospital-patient relationship.The patients bill rightsThe patients Bill of Rights have strong implications for the healthcare worker, who is involved in independent, dependent and interdependent care of the patient. The care giver (Doctor, Nurse, Physiotherapist etc) form the most central and important part of the patients assay in the hospital. The care giver respecting patients right will suss out his satisfaction with care. Every healthcare worker therefore has a business to check that the clients right as enunciated by the Bill of Rights is always respected.The bill includes that, a patient has the right to considerate and respectful care. This implies that health services providers should consider such facts as individual preferences, developmental needs, cultural and religious practices and age differences in their care of the patient. S/he also has the responsibi lity of ensuring that their assistants offer the same level of care.The patient has the right to obtain from his medical student, complete authorized information concerning his diagnosis, word and prognosis, in the terms that the patient can reasonably understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate and tried person on his behalf. He has a right to know by name the physician, creditworthy for coordinating his care.The patient has the right to receive from his physician the information to give informed go for. Some patients may not necessity to know everything about them, so the care giver has the responsibility to justify to the client that it is their right to know all, as it is a legal requirement. This helps the patient appreciate his responsibility for his health. The average client also appreciates the honesty of these explanations in the long run, because he is beingness treated as a partner with decision power.The patient has the power to balk treatment to the extent permitted by the law, and to be informed of the medical consequences of his action. It is difficult for healthcare workers to understand wherefore clients refuse treatment that can benefit them, but this is a reality. Often, explaining in simple language the purpose solves the difficulty. If after the explanation of purpose and procedure, the patient still refuses, the care giver should remember that such action is the patients right. However, good planning of care that includes the patient in planning has tended to reduce the problem of refusing therapy.The patient has the right to consideration of his privacy. The patients right to privacy is readily break on busy wards especially where there are no curtains as is the case in most government hospitals in many third-world nations because of the current economic crunch.Healthcare workers as patients advocates should ensure that the ir rights to privacy are respected. Efforts to ensure clients privacy should include having discussions with clients conducted in private areas not at their bedsides for all to hear. Also patients conditions should not be discussed in the hearing of other patients. segmentation assignments must not identify a patient by name or position.The patient has a right to expect all communications and records pertaining to his care to be treated as confidential. Patients charts should not be odd to be read and discussed by unauthorized personnel. Laboratory result should be well documented and stored. Healthcare workers need to remind other acquired immune deficiency syndrome that patients records are confidential and not to be discussed at home with friends and relatives.The patient has a right to expect that within its capacity, a hospital must make reasonable response to the request of a patient for services. Nurses are often in drag down of coordinating services for the patient such a s x-rays, appointments with specialists, such as physiotherapist, etc. these should be available and provided in the order that is convenient for the patient. Also in the event of a transfer, the support should emphasize this to the reference hospital.The client has the right to obtain information as to any relationship of his hospital to any other healthcare and educational institutions or hospital personnel. Sometimes hospitals are affiliated to or are owned by some(a) religious organizations and universities this has implications for the client care. He therefore has a right to be informed about it.The patient has the right to be advised if the hospital proposes to engage in, or perform valet de chambre experimentation affecting his care or treatment. He has the right to refuse to recruit in such research projects. Most clinical trials take blank without the clients knowledge, or even when explained the language may be besides technical for the client to understand.After exp licit explanation, a client should be asked to sign a separate consent in addition to his consent for care if an experimental therapy is proposed to him. He can also withdraw at will without any reprisals. The patient has a right to refuse leave to any one to touch his body. His basic responsibility is to himself and not to the advancement of science or learning.A patient has a right to expect reasonable continuity of care. Healthcare must to continuous and of the same quality. A change in shift should not result in negligence.The patient has a right to examine and receive an explanation of his bill, regardless of the tooth root of payment. In places where bills are paid by third parties and damages, it is easy to put on that clients should not care about charges. The client has a right to receive explanations and demand for rational charges.The patient has a right to know what hospital rules and regulations apply to his conduct as a patient. Some hospital rules are very restric tive, however, if they are written down and given to patients, the patients are more likely to remember them. Patients have the right to be properly informed having the booklets to review at his leisure time and reminding them of these rules will help compliance.It is important that a client has access to the bill of rights as the consumers access to the bill of rights ensures that he is able to demand for his rights.However as the patients advocate, the healthcare worker has a responsibility of ensuring that these rights are respected as provided. These rights ensure that the consumer/clients basic needs are met. To guarantee this, Haskel and embrown (1998) recommended that hospitals should create a grow that focuses on patients.This, they argued will allow health workers to respond to patients needs and even go beyond their expectations. The Health care system determines the quality or services provided. Unfortunately today, healthcare financial backing is more economy driven t han patient-centered. (World Bank Report, 2000). This portends a danger for client care and needs to be examined.Healthcare systemsThis can be defined as the organ that organizes and stemmas health care services. Its goal is to provide an optional mix of access, quality and cost. Kielhorn and Schulenburg (2000) identified three basic exercises of health care system. These are the Beveridge model, the public-private mixed model and the private insurance model. The differentiating factor appears to be the funding and the coverage.Beveridge sense modalitylThis is funded through taxation and usually covers everybody who wishes to participate in the state. Countries using this model include United res publica, Canada, Demark, Finland, Greece and NorwayIn this model healthcare bud wee-wees compete with other government spending priorities such as education, housing and defence. Consequently budget cuts and run away inflation lead to high costs of healthcare services. One of the result ant effects is deficit of healthcare professionals, like doctors, nurses, physiotherapists etc. Regrettably this is feared to have affected the quality of healthcare.For example, Ferlman (2000), after a poll conducted on 2,000 adults for the British medical standstill reported that, the number of people satisfied with the health service dropped to 58% as compared with 72% percent in 1998. The population who were very dissatisfied or fairly dissatisfied rose from 17 percent to 28 percent This result may not be unconnected to the settle in the quality of healthcare services.Public Private Mix ModeThis model is funded primarily by a premium-financed social mandatory insurance, it has a mix of private and public providers, which allows for more flexible spending on healthcare. (Kielhorn and Schulenburg, 2000). Participants are judge to pay insurance premium into competing non- usefulness funds and the physicians and hospital are paid through negotiated contracts.The funds can also b e supplemented through additional voluntary payments. Countries that use this model according to Kielhorn and Schulenburg (2000) include France, Germany, Australia, Switzerland and Japan.Private Insurance ModelThis model exists exclusively in its arrant(a) form in the United State of America (USA). Healthcare there is funded through premium paid into private insurance companies. The health insurance is not mandatory, so most often people with low income and high-anticipated healthcare cost, like people with chronic diseases are often uneffective to afford insurance.This makes healthcare in this system selective and non- just. An estimated 15% of the population in USA where this model is practiced are said to be unable to have any insurance cover. (Kielhorn and Schulenburg, 2000).Any of these three basic healthcare funding models are utilized by most healthcare organizations to fund the healthcare delivery system. However due to the global changes occasioned by various factors heal thcare organizational developments became necessary, in order to contain costs and ensure quality care. (Stanhope and Lancaster 1996 Yoderwise, 1999).The United Kingdom Health outline In a bid to provide free healthcare services for all UK residents, National Health Service (NHS) was founded in 1948. Funds for running the NHS was got through frequent taxation and this fund is ad seeed by the department of health. Essentially, consumers of healthcare services do not pay at the point of receiving the services.Apart from the NHS, Private healthcare providers also exist in the UK but the consumers of their services either pay at the point of service or through insurance.The NHS Considerable changes have occurred in the structure of the NHS over time. There is however no tidy differences in the structure and functions of the NHS among the countries which make up the UK. In England for example, the department of health in collaboration with other regional bodies or agencies take charge of the overall strategy while the local branch of a particular NHS takes the key decisions about local healthcare.The secretary of state for health is the minister overseeing the NHS and he reports to or is accountable to the Parliament. The overall healthcare management is the tariff of the department of health, which formulates and decides the direction of healthcare.England has about 28 strategic health regimen which are concerned with the healthcare of their regions. They are the intermediary between the NHS and discussion section of health.Types of trusts Local NHS are called Trusts and they provide primary and secondary healthcare. England has about ccc Primary care trusts and these altogether receive of the total NHS budget.NHS Trusts these are responsible for specialized patient care and services. They run most hospitals in the UK. There are different types of NHS trust Acute trusts providing short term care e.g. accident and emergency care, maternity, x-rays and surger ies etc Care trusts mental health trusts and ambulance trusts.Foundation trusts self-control of these trusts is by the local community, employees, local residents. Patients here have more power to shape their healthcare based on their perceived health needs to their satisfaction.Private HealthcareThis sub-sector of the UK healthcare system is not as hulky as the NHS and does not enjoy similar structure of accountability as the NHS. They may be similar to the NHS in service provision but are not bound to follow any national treatment guideline and are not saddled with responsibility of the healthcare of the larger community.Regulation and inspection of healthcare system in the UK are carried out by a number of designated bodies. Some of these are the national give for clinical excellence the healthcare commission the commission for social care inspection and the national patients safety agency.Community Satisfaction with Healthcare SystemWorld Bank (2000) identified three basic t ypes of healthcare organizations providers in the healthcare system. These are the market or for profit co-operations, the government, and the not for-profit organizations. The live on group includes the mission hospitals run by religious and non-governmental organizations. For them their main documental is to provide quality care for the citizens. Although scarce resources often limit their efforts, they are reported to be providing quality care to clients within their means. (World Report, 2000).In Government run systems especially in many resource-constrained nations, the main complaint is the bankruptcy of the Government run systems, which are supposed to be the most equitable and cheapest system for providing care, is being run down for ideological reasons in some countries, (World Bank, 2000). This jeopardizes the availability of healthcare services to the individual, resulting in the clients non-satisfaction with one.Lastly, are the for-profit co-operations. These, accordin g to World Bank (2000) have problems of care and affordability, which parallel their profit. The affordability is noted to be most acute in the market-listed companies. This is because the prime objective of these groups move into the health market is to make profit from the sickness the most pricy and least affordable healthcare providers. Unfortunately while share holders are getting profit the clients for whom health care is provided are receiving poor quality care.World Report (2000) documented declining care and increasing dissatisfaction with healthcare in most countries. The greatest dissatisfaction was reported in the market-based systems and when market placed systems replaced state funded ones.The market system in the USA, which was supposed to help the citizens, is criticized for deliberately exploiting them. Critics argued that the strong competitive measures encouraged, have destroyed the ethics of USAs hospitals Samaritan culture and the professionals of the healthcar e providers.Patients were reported to have had to suffer as a result. paleness was also said to have become a problem, as healthcare is no more available to all citizens. This was attributed to the effect of the market systems on the health care delivery service.The market based systems are also reported to have wide spread incidences of denial of care of patients, mis-use of patients for profit and neglect of the frail and vulnerable (World Bank, 2000). These were said to have occurred when profits were being earned and shared by corporate bodies to shareholders. Information from the market place were said to have revealed receptive marketing, and mis-information which covered up the misdeeds of the corporate bodies.In response proponents of the market system defended their policies and argued for its usefulness, and value in healthcare reforms. For examples Samuel (2000) argued that competition, a fall out of the market system encourages efficiency, reduces costs, enhances respon ses to consumer demands and favours innovations.Consumer empowerment, he stressed is one of the dividends of competitive healthcare systems. He added that introducing competition would provide consumers the freedom to choose between different services and different delivery mechanisms that meet their needs. It is also expected that this would increase their satisaction.Competitive pressures, Samuel (2000) pointed out will break down self-regulatory practices by service providers, developed essentially to serve their interest, so that clients interest will eventually be served. While the above argument is appreciated, it is also observed that the problem of equity is more profound here, as it appears that only the few that can afford quality care can get it. In the light of the what Alma Ata declaration of 1978, all nations have a responsibility and an obligation to attend to the health needs of all their citizens.It is obligatory to make healthcare available, accessible, affordable and acceptance to all. These places on the government of every nation the responsibility to ensure that there is equity in health care services distribution. In order to ensure this, countries like the United Kingdom entirely funded the National Health Service (Kielhorn and Schulenburg, 2000). As a result, even in the face of health care cuts and shortages the NHS clients were found to be very supportive of the system. (Walsh, 1999).In most other countries, clients have reacted to the healthcare system and services provided in various ways. In some places, they have responded with an discernable move away from conventional medical care. This trend, most argue, can be traced to the high cost of the latter.There is also the argument that clients expectations are no longer met through conventional healthcare services. This is said to be so especially for clients with less serious disorders. For example, Manga (1993) found that clients were considerably less satisfied with medical phys icians management of their low back distract than chiropractic management of the same ailment. These observations, were also corroborated by Cherkin and Maccomak, (1989) and Harris Poll, (1994).Processes of a health service systemThe processes of a healthcare service system refer to the genuine performance of the activities of care. Stanfeld (1992) identified two components of the processes. These are the activities of the providers of care and the activities of the population.Activities of health care providersEvery interaction between an individual or community and a care provider begins with need or problem identification. Starfield (1992) stated that the problem recognition implies an awareness of the existence of situations requiring attention in a health context.Diagnosis, planning and intervention follows after that assessment, is carried out. Evaluation is done intermittently and the end of the intervention to determine if the original diagnosis, plan and interventions wer e appropriate and adequate for the recognized need.In nursing, models of care such as the nursing process are utilized to facilitate systematic and scientific provision of quality care and client satisfaction. Also care provided is guided by established institutional standards of care. Effective assessment of clients needs and its resolution is expected to have an outcome of client satisfaction. It is therefore important that the healthcare provider intervention should be client centered, in order to achieve the set goal.Activities of the clientPeople decide whether or not, and when to use the health care system (Starfield 1992). It is in coming in contact with the health care system that clients recognize what services are offered and the quality of the services offered. The clients experiences enable them to form their opinions, deciding if they are satisfied or not (Starfield 1992).The affectionateness process involves the performance of the activities of car