RESEARCH PROPOSAL – “Enhancing Quality in Patient Care”

1. RELEVANT BACKGROUND OF THE PROPOSED WORK:

Patient care has gained immense importance in recent years due to the increased number of medical disorders and increasing awareness amongst people and patients. Increased demand in hospitals and healthcare centres to improve the patient’s health condition has become a formidable factor for all the health care professionals at every hierarchy level. Errors have become a part of the system, due to increase in the number of challenging issues that affect the deteriorating health condition of the patient. Improving the health condition by minimising system and human errors has become a crucial concern in the health industry. Health professionals have identified several causative factors for poor quality and implemented various measures to improve the quality of the situation. Unlike the old paradigm, the person approach, where the percentage of errors recorded was high, the system approach came into existence and is these days reducing the percentage of errors and increasing the complexity of the system (Warburton. 2005). In addition to the improvement of organisation, there are many other improvements underway, which include the public involvement in primary health research (Jonathan et al., 2010). According to the current situation, the health care team is also getting educated to reduce the risk of errors (Colin. 1995). Awareness of errors also created a significant impact on the safety of the patient and hence many resources were created and modified to reduce the risk (Warburton. 2005). These days, usage of health information technologies lead to improvement of the health. In the study by Connie and David (2010), through the innovative technology, the system can be advanced globally to reduce the socioeconomic barriers in various countries. Appropriate use of technology at the right time would cause miracles in the health sector (Connie et al., 2010). Many health care changes initiated in certain categories of patients decreased the risk of errors. Some of the measures included direct, personal supervision and decreased adverse reactions in case of paediatric and geriatric patients (Cambern. 2009). Another main implementation is an introduction of rapid assessment and initial patient treatment team (RAPT) in accident and emergency patients, reducing the risk to life (Cronin et al., 2005).

Summarising all the developments, quality in health care can be achieved by the academic and technical knowledge of the physician along with the communication of the health care assistants and public. In addition, appropriate utilisation of resources and tools is also essential to achieve the improvement of patient’s health condition as a target (Michelle. 1996).

2. HYPOTHESIS:
Objective of the current project is to demonstrate new techniques based on studies done in previous years and to improve the quality of patient care, which is a considerable challenge for the health sector.

The tasks to accomplish include:

1. To increase safety of patients by relevant initiatives.
   12/16/2010 Research Proposal
2. Team working within the health care sector and involvement of patients and public in primary research.
3. Implementing innovations in patient care.

3. SCOPE:
The following tasks would be undertaken as a part of proposed research:

• Task 1: To investigate the past studies on existing and improved health care system.
• Task 2: To appreciate the improvements in the health sector in the recent years.
• Task 3: To design research in order to increase quality in health care system and patient safety by reducing errors and implementing innovations.

4. METHODOLOGY AND APPROACH:

1. Patient Safety Initiatives:
Although lots of experiments were done in patient safety in recent decades, it still remains a challenge for health professionals. These days, hospitals are spending enormous resources to reduce errors, which are appreciated. However, implementing all the proposals is not easy (Warburton. 2005). It is cost involving and depends on manpower to a greater extent, which is difficult to control.

The safety improvements cannot be implemented and always be accurate as it changes according to the situation. Improper design and rapid enforcement of safety measures would only cause meagre improvement to patients (Warburton. 2005).

There are several approaches and studies for obtaining maximum benefit out of the available resources. They are:

1. Setting up a committee of professionals across the health sector to highlight vital safety measures in the hospital according to the patient conditions (Warburton. 2005).
   This method is time consuming and complicated. The results obtained were vague and could not improve the quality of patient.
2. Another approach, which is my area of research interest, is setting up an Economic Evaluation Loop (EEL), based on the recommendation of Leape and others (1999) which would be based on utilising available evidence to establish priorities. In this approach, priorities would be set according to the analysis of available resources and outcomes of the changes (Warburton. 2005).

Accordingly, evaluation would be based on the benefits and resources available for research. Later, detailed research would be completed according to Warburton (2005), by which alternative assumptions could be identified and compiled. Finally, an additional research network would be framed to fulfil the requirements in the best possible way to reduce critical gaps (Warburton. 2005). This loop is a variant of Technology assessment iterate loop, called TAIL (Tugwell et al., 1986; Tugwell et al., 1995).

By this EEL approach, critical gaps in the research area can be identified by discussions among the health professionals and these gaps, which are usually overlooked, would be considered to provide the best safety measures within the scope of resources.

Increasing research on safety implementation to patients often raises a question of how much safety is essential. Warburton (2005) describes that there is no upper bound for providing safety to patient as demands of improving safety measurements never drop. He explains this fact by the figure depicted in figure 2 of this paper.

The curve depicts total costs of errors to the society against the level of safeguards and clearly reveals that the safety measures are implemented based upon the cost effectiveness. When initial safety methods are employed it is initially cheap, and then with the increase of costs, negligible benefits are obtained due to less reduction of adverse effects when cost measures increases. This continues uphill, further reducing the benefits with increased cost (Warburton. 2005).

The curve depicts total costs of errors to the society against the level of safeguards and clearly reveals that the safety measures are implemented based upon the cost effectiveness. When initial safety methods are employed it is initially cheap, and then with increase of costs, negligible benefits are obtained due to a drop in the reduction of adverse effects when cost measures increases. This continues further reducing the benefits with increased cost (Warburton. 2005).

Figure 2: Cost to the society versus level of safeguards
Figure adopted from Warburton (2005).

In my research project, EEL with regards to one of the patient safety will be studied in the clinical environment and conclusions would be compiled accordingly in the thesis work.

2. Patient and Public Involvement in Primary Research:
Involvement of potential patients and the public is an import contribution to primary research.

According to Beresford’s argument, the research experiments tend to be more accurate when the distance between the potential patients and the investigator is minimal (Beresford. 2005).

Furthermore the public, the part owners for research as taxpayers, have an equal right to subscribe for the success of research, which would improve their lives directly (Boote et al., 2010).

Additionally, public involvement at all stages of research, especially the primary level, would reduce the initial value of resources by direct focus on potential treatment areas and thus contribute to the quality of care (Boote et al., 2002; Thompson et al., 2009).

One of the approaches by which quality of patient care would be enhanced is performing clinical trials in a particular diseased population. In these clinical trials, design of the study would be based on their relevant experiences. Questionnaires would be prepared accordingly to consider general experiences and needs in that category of patients. These questionnaires are then compiled together to establish a basic structure of description and would form the research theme. Initially consent forms would be taken from the patients, and research would be carried out by contacting them regularly for feedback. All the issues the public need to be addressed would be collected for better supervision and analysis would be carried on to ensure results favouring the potential patients. This attempt ensures that questions of the potential patients would be answered and treatment becomes patient friendly, reducing the stress on the investigator, and the patient.

In this project, clinical trial is closely observed on a class of patients. Later analysis would be done on how the involvement of public and potential patients influences quality of patient care.

3. Team Working
Team working is essential for effective health care management, especially in critical conditions like chronic health disorders. To achieve quality team working amongst all the health care professionals, interaction among them in day-to-day service is necessary. To ensure team-working skills in hospitals and health care centres, educating the team would be required.

Education should be a dynamic process that is patient-centred (Coles et al., 1995). Education amongst the health professionals should be multidisciplinary rather than self-centred research.

Patients and their cares should get an education alongside to improve care and hygiene. Thus, quality in health care would be achieved by a patient-centred approach.

In addition, regular team meetings and interaction between the physicians, care takers and patients would improve the quality of patient care. Discussion among patients and physicians during the treatment would be useful to record the treatment procedure, which could be useful in future investigation of the same kind.

In this project, team-working skills within a selected hospital would be improved and quality of patient care would be compared.

4. Innovations in Delivering Patient Care
Many advances have been introduced in the health sector in the recent years. Use of modern technology is one that simplified the administration of health sector. Health information technologies (HIT) include mobile phones, computers, self-administration equipment, health decision-making management devices, life style modification devices, monitoring chronic illness and patient education devices (Gustafson et al., 2002). Socioeconomic barriers cause slow penetration of HIT in developing countries (Connie et al., 2010).

Setting up an appropriate HIT within a health sector is a challenge for technologists as many factors would be taken into account while considering it, and to facilitate the system, a framework would be employed. By the use of this framework, approaches could be studied and the best HIT would be employed (Connie et al., 2010). Some factors that would be taken into consideration include situational factors like setting and clinical domain, technological factors and work force (Connie et al., 2010).

Other remarkable innovations include the establishment of RAPT, which is a rapid assessment and initial patient treatment team within accident and emergency, where the patient would be allocated 4 hr of comprehensive treatment in an emergency condition (Cronin et al., 2005).

Personal care within the department of paediatrics and geriatrics is one of the other innovations (Cambern et al., 2009). This would reduce the incidence of risk and errors causing adverse reactions in them.

My intention of study would be to try and implement some of the innovations in a hospital environment and examine the quality in terms of health care. 12/16/2010 Research Proposal.

5. FACILITIES TO BE USED:
Many facilities would be used to perform the following objectives in accordance with available resources and these include:

• Discussion with various people across the health sector to set up the economic evaluation loop in order to set up priorities in patient safety.
• Seeking clearance to participate in some clinical trials which would enable to understand the association of public and patients in primary health research.
• Visiting hospitals and health care organisations to examine and record the facilities for a certain group of patients.
• Getting initial training in the system of control within the primary health sector to minimise the occurrence of errors.
• Many paper and poster articles analysing different approaches of patient education.
• Certain use of technology to study the improvement of quality with the use of innovation.

6. PROGRAM SCHEDULE AND DELIVERABLES:
(A basic gnat chart without dates, client should set up dates appropriately)

7. FUNDS AVAILABLE:
Client has to decide according to available funding

8. REFERENCES:
Warburton, R.N. (2005) Patient safety-how much is enough? Health policy,71, pp.223-232.

Perrow, C. (1984) Normal accidents: living with high risk technologies. New York Basic Books.

Leape, L. L., Forward, I.N (1999). Error reduction in health care: a systems approach to improving patient safety. Jossey-Bass.

Tugwell, P.,Bennett, K.,Feeny, D.,Guyatt, G.,Haynes, R.B. (1986) A frame work for the evaluation of technology. Institute in research and public policy, pp.41-56.

Tugwell, P.,Sitthi-Amorn, C.,O’Connor, A.,Hatcher-Roberts ,J.,Bergevin, Y.,Wolfson, M (1995)

Technology assessment. Old, new and needs-based. International Journal of Technology Assesment in Health care, 11(4), 650-662.

Jonathan, B.,Wendy, B.,Claire.,B. (2010) Public involvement at the design stage of primary health research: A narrative review of case examples. Health policy, 95, pp.10-23.

Boote, J.,Telford, R., Cooper, C. (2002) Consumer involvement in health research: a review and research agenda. Health policy, 61(2), pp.213-236.

Beresford, P. (2005) Developing the theoretical basis for service user/survivor-led research and equal involvement in research. Epidemiologia e psichiatria Sociale, 14(1), pp.4-9.

Thompson, J.,Barber, R.,Ward, P.R.,Boote, J.D.,Cooper, C.L.,Armitage, C.J. (2009) Health Researchers’ attitudes towards public involvement in health research. Health expectations, 12(2), pp.209-220.

Coles, C. (1995) Educating the health care team. Patient Education and Counseling, 26, pp.239-244.

Connie, V.C.,David, R.K. (2010) A technology selection frame work for supporting delivery of patient-oriented health interventions in developing countries. Journal of Biomedical Informatics, 43, pp.300-306.

Cambern, K. (1952) A quality improvement program. Pediatrics and child health, pp.5172-5175.

Cronin, J.G.,Wright, J.RN. (2005) Rapid assessment and initial patient treatment team-a way forward for emergency care. Accident and Emergency Nursing, 13, pp.87-92.

Gustafson, D.H.,Hawkins, R.P.,Boberg, E.W.,Mc Tavish, F.,Owens, B.,Wise, M. (2003) 10 years of research and development in consumer health informatics for broad populations, including the underserved. Med inform, 65(3), pp.169-177.

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