Towards the Future: Highlighting Quality in Healthcare Industry

Introduction

“Consumers pay only for what is of use to them and gives them value. Nothing else constitutes quality...”

Peter F Drucker

In 21^st century, quality is such an inherent concept that no industry can ignore the importance of it. In this era of digital revolution, with the touch of button, one receives all groceries, vegetables, fish, and meat delivered fresh and crisp on the doorstep within minutes of request. Along with quality of the product, efficiency and comfort also creates the biggest difference in the life of a commoner, aka consumer.¹ There are numerous options to choose for best services among the consumers but quality still remains a significant factor in the competition. And with the drop of a hat, consumers decide to change the service provider if not satisfied with the performance of delivery or the behavior, because quality of product is more important.² Hence, quality is not only about finished product which reaches to the consumer, but the processes, systems and people that are behind the product, or delivering the product at consumer's end. So, it is clearly understood that managing quality means constantly pursuing excellence i.e., making sure that what the organization does is fit for the purpose, and not only stays that way, but keeps improving and getting ahead of competitors.^3,4

If one loosely connects the term quality (how good or bad something is) and healthcare industry (an organization which caters to the need of health of human beings), one can conclude that quality must be an essential impression of an enterprise while delivering any service to someone in need. For ensuring quality in any service industry, the biggest challenge is the basic nature of the industry itself. It is seen that in manufacturing industries, product or goods are the output which is visible and hence can be objected to assessment of its quality or standard as per expectation or requirements. The output of healthcare industry is purely intangible and subjected to perception of the people who is receiving the service.

Hence, the concepts such as consumer satisfaction, consumer delight etc. are the mantras which turns out to be the most important and critical output standard which any service industry tries to measure, monitor and project to ensure quality.

According to the surveys and evidence, it was found that healthcare industry is a canopy term which incorporates various healthcare services and their support pillars always focus on patient's satisfaction. There are different cadres of healthcare professionals who provide care to the patients through assessment, diagnostic facilities, planning and evaluating the progress of health care services. Yet, they faced a lot of challenges in their track of commitment and compassion, but still maintenance of quality and uplifting the notion of quality continually in providing care to patients is an attainable goal for them.⁵ They perform many procedures such as laboratory and diagnostic imaging techniques, respiratory therapy etc. which requires skill. Yes, skill is an important ingredient and it constantly demands quality assurance which will give confidence to the professionals and helps in upgrading their standards.^6,7

How a consumer of healthcare service thinks about quality?

A patient always approaches the best quality within their hands. They demand healthcare service to be effective, client centered, efficient, goal oriented and most importantly cost effective. However, service fairness, service quality and authenticity perception constitute subjective well-being of the consumer, which further influences their behavioral intentions.^8,9 Hence, behavioral intention of the consumer will decide the brand value of the healthcare industry. It has also been noted that there is a causal relationship between service quality and emotional brand attachment which ultimately leads to consumer loyalty.

Even, some studies put forth an idea regarding innovation and consider it as the major latent construct of consumer satisfaction, if we bring innovation in provision of healthcare services, it may boost the interest of the consumers.¹⁰

The main five characteristics which overtly define healthcare service quality from a patient's point of view are as demarcated: -

1. Tangibility (Employee demeanor and facility's appearance)- The appearance of all group of healthcare professionals plays an important role and they should take pride in wearing the uniform who provides the care to the needy patients.

2. Reliability (Ability to consistently provide its services in a way that meets the patient's need)- To ensure reliability, there should be established standard operating procedure (SOP) for each of its processes as per the roles and objectives of the healthcare institution. This SOP must undergo regular revisions depending on the needs of institution, patient requirements, and change in the regulations concerned. Each healthcare worker should have thorough knowledge and understanding of her/ his role in executing these processes. Hence, training and formal communication to healthcare workers who will use such processes plays a pivotal role in maintaining quality.

3. Empathy (Ability to deliver services in a way that shows that the healthcare sector cares about its patients and their concerns)- Every healthcare worker must behave within the set boundaries with the patients in each touch points and be eager to deliver the services. Mere physical presence does not ensure empathy, rather be responsive to the needs and concerns and communicating the same in a respectful manner brings the difference. The patient should feel that healthcare professionals are in favor of their needs.

4. Assurance (Healthcare sector can develop a certain level of assurance if patients have high level of confidence and trust)- Assurance happens at personal level of the consumer of the healthcare service. Hence, a feedback mechanism to capture the disappointments and actively working at system level to make necessary corrections is required. Therefore, corrective actions will not only increase the satisfaction level of patients but it will also create loyal consumer base.

5. Responsiveness (Ability to provide prompt services and quick replies to patient's queries)- Time is the most important dimension in the life of consumer. The healthcare sector should utilize every interaction with their patients intelligently to assess the individual need and deliver the tailor-made customized communication system which may response within few minutes. Communication of difficulties at interim stage keeps the consumer engaged and gives a sense of assurance that their concerns are acknowledged and getting addressed. Here, telling the truth is always the best option as well as a pathway to maintain trust of the patients.^1,2,3,11

Necessity of quality in healthcare service

Quality is not only a requirement which has to be fulfilled by the healthcare service providers but also a track which has to be followed by the institution to achieve their looked-for ends. It is continuum of both consumer and supplier, basically it is symbiotic relationship between them to achieve personal and professional gains. If healthcare sector maintains quality in their services, the consumers will be the one to give them value in the market.

Few variables hold a countless importance in maintaining the quality of a health care institution i.e., right thing at right time in right method to achieve the right results. Quality in healthcare means, when a consumer or patient get right treatment at right time without unnecessary investigations and can achieve the state of well-being within limited cost.¹²

Nowadays, patient or consumer knows well about their health or illness and they are more aware regarding the healthcare services and constantly searching the measures to maintain their health. Here, the technology is the one which plays a big role and make them conscious about newer modalities in healthcare market. Evidences suggested that nearly more than 40% of the patients know well about their status of health as well as the measures to control it on time. As a healthcare professional, role is not only defined to provision of care to consumers but quality management is a vital aspect, because the consumers somewhere expect that the information and healthcare services be more logical, rational, evidence based, need based and deliberates their feedback too.^13,14

Quality is also needed to have clarity about novel ideas, improving the patient care, minimizing the gap in provision of healthcare services. It is needed for empowering the healthcare staff in their professional services.

In India, now healthcare industries become more competitive and focus on customer satisfaction to maintain their reputation and constantly discovering that how the patients perceive their services and improve the healthcare outcomes accordingly. Somewhere, quality becomes an integral component which catches the attention of the consumers in this competitive world.

Ladder of Quality Management: Leadership for healthcare staff

Till now, satisfaction of patients is discussed, but the role of quality is totally incomplete without inclusion of efforts of healthcare staff who provides services. The healthcare staff also needs a track to work according to the goals and then evaluation through superiors is also needed regarding their performance. Here, the leadership comes into the frame for healthcare professionals. Let's have a glimpse into the ladder of quality management i.e. leadership which forms a base to make it stabilize or to maintain its peak of success.^13,14 But most importantly, leadership should be agreeable for both the parties and followed by them.

Here, two critical questions arise towards the leadership are: -

1. Does the leadership want a quality management system, or does it wish to take up systematic process-oriented approach to bring about a change?

2. Does leadership understand how the current “pain” areas can be minimized or eliminated if the organization has more efficient process?

If the answers to both questions are yes, then leadership need to be understood to ensure quality delivered at consumer's (both internal and external) end. Following are the points to manage healthcare workers for enhancing quality: -

1. Patients 'focus

2. Strong and transparent leadership

3. Involvement of patients

4. Decision making based on facts

5. System approach

As every employee has variable needs, few activities can lead to employee (healthcare worker) retainment: -

1. Scope of individual development of all necessary skills required to meet the needs of the patients

2. Manpower planning to create an inventory of good prospects for future

3. Setting a standard of performance which is understood by every healthcare worker and monitoring of the same on technical proficiency, attitude, and communication

4. Career progression through in-service education and development programs

5. Opinion survey of the patients where open and frank participation is encouraged, and feedback is shared among them

6. Fair and equal treatment for the patients

Extents of Healthcare Quality

Till now, healthcare worker performance and patient's satisfaction with the goal of achieving the quality was discussed, still concept of quality in healthcare sector requires few dimensions. Quality in healthcare sector not merely associated with positive outcomes, but also focuses on use of current professional knowledge and skills to bring about a sense of satisfaction among the patients. Healthcare quality emphases on few dimensions such as effectiveness, safety for the patient and patient-oriented services with core principles of timeliness and appropriateness. These are the strategies if adopted by healthcare system can bring about a revolutionary change in healthcare system and lead to better achievement of goals.¹⁵

Bringing revolution in healthcare industry: Quality Control

So, for a health service industry, quality control of employee's attitude and performance is equivalent to the product quality control for a manufacturing industry. Technically speaking, everything depends on “quality control” of the personnel.

Quality control is not a task of an individual, rather it requires a huge amount of workforce, resources, time to achieve threshold of patient's satisfaction. So, credentialing and recruitment of skilled manpower is of paramount importance in healthcare industry. Retaining efficient, loyal, and engaged employees through few techniques will eventually lead towards a happy workforce who can deliver high standard services to the patients.⁴

Quality control includes assessment of quality in services and inspects whether it is stick to preset standards and criteria and meeting the expectations of the consumer's demands. It generally requires an atmosphere of creativity, integrity, intellectual capacity and good interpersonal relationship within healthcare institution and always strive for the excellence of both patient and healthcare workers.¹⁶ Quality control not only measures the output of the service but also adheres to variations in the demands of consumer. It is importantly required to enhancing the benevolence among the providers of healthcare services and maintenance of esteem among the competing world. Good quality not merely good product or good service, there are certain aspects for fulfilment of good quality such as morale of patients, cost effective, meeting the standards laid out by hospital policy.¹⁷

Approaches to implementing good quality in health sector

1. Need based- To ensure good quality of the service, it should be based on the need of the patient or the individual of any healthcare industry. Need assessment not only provides a direction about managing quality control in the hospital, it will also provide the number of resources required to achieve better standards of quality and this will manage patient's satisfaction level and meeting their expectations.

2. Enquiring and Introspection- Self-observation is required from the perspectives of both healthcare industry and patients to meet a common point of goal attainment. The healthcare industry may enquire the consumer's needs and respond immediately to maintain and sustain its name and fame.¹⁸

3. Honesty with familiarity- The healthcare services should be focused on performance with honesty so as to gain the ultimate point of satisfaction from the patients and it should be familiar towards their needs.

4. Feedback- Feedback is not only required from patients, but it should be taken from peers, other healthcare industry in the market. It will also highlight those aspects which requires improvement and make a healthcare service more consumer oriented.³

A robust quality management system helps the healthcare service industry to achieve optimum cost efficiency by delivering quality service standards. Inspiring and empowering the staff in their efforts is supportive in reforming the health care service industry¹⁹. Hence, one can conclude, role of quality in any service industry is not only paramount but a mandate.

Total Quality Management (TQM)

The question is how to maintain quality assurance programs in healthcare industry and the answer is that there is need to implement a system for delivering high quality service in a measurable way which is TQM, a system which is concerned with people and work processes which focuses on consumer satisfaction and ultimately improves organizational performance.^18,19

Many evidences interpreted that the key principles of TQM are consumer focus, obsession with quality, scientific approach, long-term commitment, teamwork, continual improvement systems, education, and training, freedom through control, and unity. It addresses not only the direct medical services of diagnosis and treatment but indirect operations such as administration and purchase. The nurses are the main personnel that contribute to achieve the success of implementation of such programs.^4,5

So, one may put a thought that quality maintenance or management is a tool which requires many hands to make a unit of consumer satisfaction and enhancement of name of profession in healthcare industry. It is a need to uphold and upbring the matter of quality control with its aspects in provision of healthcare services. In the time of putting big footprints on the track of production with competing demands, it is a vast necessity to maintain the integrity of consumer with the service industry and here, only quality is an instrument which hoards the honor.

For healthcare sector, service quality can also be enhanced through proper coordination and management among healthcare workers, administration and higher authorities. The overall process of provision of facilities to patients should be on priority, with inclusion of availability of required staff, fast and accurate services with proper laboratory investigations, competent technology and management of resources either manpower or money etc. Quality can also be enhanced by patients: communicating with them, making them aware with current information about health and its aspects and regularly seeking their feedback.²⁰

Overall, the only attention should be on patient's loyalty and satisfaction and expansion of healthcare services at the core level. Primary healthcare services are the ground level of building of healthcare industry. Therefore, quality management models or approaches can be implied here and make desired change in the society.

Conclusion

Health care industry is a dedicated and scientific enterprise which enforces the responsibility for ensuring high quality standards and quality of care in healthcare facilities. The higher and competent authority should be decisive in formation of the curriculum to ensure training of future professionals to increase patient satisfaction. It is the necessity, the task and the upcoming pathway for the success. WHO (World Health Organization) also stated that the central line of focus should be on strengthening of primary health care so as to provide healthcare services as well as increase in global life expectancy. Ultimately, the goal is to focus on preventive health care services with inclusion of quality in healthcare. It should not only be a subject of private healthcare providers for curative domain only but must be incorporated by government and government funded healthcare services which renders promotive and preventive healthcare services.