Service Quality in Critical Care

• Prince Rupert Ramirez

SERVICE QUALITY IN DEPARTMENT OF CRITICAL CARE MEDICINE, AUCKLAND CITY HOSPITAL

SERVICE QUALITY

Figure 1

Dimensions of Service Quality, Department of Critical Care Medicine

Service quality can be defined as the scope wherein a particular service rendered meets customers’ needs or expectations (Lazakidou, 2011). Department of Critical Care Medicine (DCCM) is committed in providing safe and quality health care service in accordance with the mission, vision, and values of Auckland District Health Board. To ensure that customers’ expectations are being met, the following dimensions are given top priority:

• Tangible: A wide range of specialized services is highly accessible to all New Zealanders requiring critical care which include complex abdominal surgery, multiple organ failure, post kidney and liver transplant, and neurocritical (brain) conditions (Auckland District Health Board, 2015). The unit encompasses state of the art monitoring equipment and spacious area for some rooms that can be used as operating theatre and some non-invasive procedures that can be performed in bedside. This dimension is given the highest priority as this is one of the major attributes of service quality as cited by Parasuraman et al. (1985).

• Reliability: In ensuring the continuity of patient care, ADHB ensures that patient’s records are readily accessible to all the members of the healthcare team to safeguard multidisciplinary collaboration. Patient care are being guided by clinical pathway to make certain that treatment approach is being done holistically.

• Responsiveness: This dimension refers to the healthcare member’s attitude in extending their help to customers and their skill to provide prompt service (Arlen, 2008). For instance, a deterioration in patient’s condition would alert the team to perform prompt intervention. One innovation achieved in this unit is the convenience of built-in point-of-care laboratory facility for prompt processing of blood samples.

• Assurance: To make sure that each member of the healthcare team are competent in performing their duties, various trainings and seminars are being conducted regularly. These enhancements are not only done for professional improvement but also to gain trust and confidence of the patient when providing care (Lazakidou, 2011).

• Empathy: Providing care to patients are individualized based on their needs and preferences. During admission, these component is being assessed by the nurse. The perceived needs and the actual needs are being communicated to the team. DCCM provides a hospitable atmosphere for guests and visitors as this is one of the values being inculcated by the institution.

SERVQUAL MODEL

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Figure 2

SERVQUAL Model of DCCM

SERVQUAL Model is currently used to illustrate the service quality features and how a gap between customers’ expectations and management affect health service delivery (Teisberg, 2007). These dimensions of quality and establishing a GAP play an important role for outlining and quantifying service quality (Yarimoglu, 2014). Figure 2 illustrates how the gaps happened in DCCM. Proposed strategies are created as well to bridge this gap.

• Gap 1: Management Perception Gap happens when the Management and Customers perceptions of health service delivery is different. For instance, in this case, the increasing number of patients in DCCM would require additional manpower. If this was not perceive by the management; then, they would have problems with staffing which will highly affect patient care since most patients in this unit require close supervision. This gap could be narrowed by hiring additional manpower to augment patient census.

• Gap 2: Quality Specification Gap transpires when there is a variance with the management perceptions of what customers expect in accordance with the standards of quality service. Even the institution invested a lot in machineries but deprived of manpower, then the delivery of quality care would be compromised. To resolve this gap, there should be a balance between the quality and quantity of services.

• Gap 3: A Service Delivery Gap occurs when there is a mismatch between the actual service delivery and organizational standards. In this model presented above, there is no actual problem presented.

• Gap 4: Market Communication Gap arises when there is a divergence between the actual service and the promised one. This gap can be managed by providing factual data to the consumers in order for them to make sensible choices.

• Gap 5: Perceived Service Quality Gap is the combination of the four gaps previously identified. If these gaps were not managed properly, it will result to negative image of the institution, loss of customers and bad reputation in the industry. In this gap, it is very important that a healthcare facility not only focuses on healthcare delivery but also on other factors such as cultural background, preferences, target market and evaluating services rendered against the standards of care.

KANBAN

Kanban is a new innovation for handling various process in a highly well-organized way. This concept was first presented by Toyota to ensure productivity while maintaining sufficient supply of resources. This concept is very easy and simple to follow: it comprises of big board on a wall divided into three columns (may be revised based on the needs of the institution) placed with sticky notes with numbers at the top. Each card denotes a task then they are slide horizontally and for every step of the process, the quantity of tasks are restricted to prevent oversupply (Peterson, 2015).

DEPARTMENT OF CRITICAL CARE MEDICINE
PATIENT DASHBOARD
TO DO (8)	ONGOING (4)	COMPLETED (8)
Bed 1- Xray		Bed 10- Bedside Endoscopy	Bed 6- Admission
Bed 3- OR		Bed 15- CT Scan	Bed 12- OR
Bed 5- Transfer		Bed 14- Physiotherapy	Bed 13- MRI

Figure 3

A patient dashboard in Department of Critical Care Medicine Utilizing Kanban Principle

Figure 3 provides information regarding how Kanban is being utilized in DCCM. The board is divided into three major tasks: To Do, Ongoing and Completed. It is shown that for every task, precise numbers were placed to guarantee that the nurses will not be burden by the ongoing tasks because of the limited number of staff in the unit. The charge nurse can perceive that before starting a new task, the ongoing patient procedures should be accomplished first. This concept is very good in maximizing the output when there are limitations brought by manpower and availability of equipment in a procedure.

There are advantages in utilizing this method in improving quality and maximizing output. First benefit is the versatility in planning. Each healthcare team can focused on the task in progress. Once the team finishes a work note, they can choose from the task on the backlog based on their perceived level of priority. Secondly, it minimizes cycle time. It refers to the duration of the whole task to be accomplished and it one of the metrics for healthcare teams accomplishing the Kanban. In this framework, the team’s accountability is to make certain that tasks are moving smoothly. Lastly, efficiency is being achieved by focusing on the amount of work in progress.

LEAN PROCESS

The concept of lean is widely used in business organizations as this aims to maximize productivity while minimizing wastes. To make this model feasible, this focuses on improving technologies to improve the course of products and services that flows horizontally or vertically across service providers. By eliminating waste, it reduces process to be repeated, less human effort, minimizes capital expenses and more production of services (Jones, 2003)

DCCM utilizes a two-bin system to replenish healthcare supplies. This automated process affects supply chain costs by constantly improving processes, minimizes waiting time and cost of logistics, enhances labour efficiency and shortage/ oversupply of hospital materials.

TEN PRINCIPLES OF GOOD BUSINESS PROCESS MANAGEMENT

1. Context Awareness: The organization provides orientation to newly hired staff members. These gives them an idea on what to expect and what deliverables is expected to them. In DCCM, the nurses undergone preceptorship and supervised practice prior to handling individual patient. This program of area provides an opportunity for them to adjust with the new environment. In every modifications that are being done to improve quality of patient care, all staff are being oriented to ensure compliance.

2. Continuity: To ensure safe and quality patient care, a set of policies and procedures has been established. These are being reviewed habitually by the Quality Assurance Team of the institution to ensure that practices are evidence-based and up-to-date.

3. Enablement: Each staff member is involved in activities that enrich patient care. For instance, one healthcare provider is part of a team which prevents healthcare associated infections or a nurse who loves teaching are being trained to provide health education to patients and colleagues.

4. Holism: The workflow in DCCM is simplified to guarantee that everyone perform their designated work.

DEPARTMENT OF CRITICAL CARE MEDICINE STAFF ASSIGNMENT DASHBOARD
STAFF	DESIGNATION	PATIENT	SPECIAL ASSIGNMENT	CODE ASSIGNMENT	REMARKS
David	Doctor	Bed 1-5	None	Team Leader
Patrick	Charge Nurse	None	Staffing	Medications
Jacob	Nurse 1	Bed 1-2	Patient Stocks	CPR
Joseph	Nurse 2	Bed 3-4	Medications	Airway
Ronald	HCA	None	Unit Supplies	CPR

Figure 4

Staff Assignment Dashboard to illustrate Principle of Holism

Figure 4 illustrates the principle of holism. Each staff has a specific task to do per day to avoid duplications or omissions. A staff assignment dashboard has been done to guide healthcare providers in carrying out their duties and responsibilities in patient care and unit maintenance.

5. Principle of Institutionalization

In various organizations, the process of business management is included in the organizational structure. This principle ensures that roles and responsibilities are being complied by people across all departments to fulfil customers’ welfare (Brocke, 2014). This is made possible by creating policies and procedures. During the orientation phase of newly hired nurses, they are given time to read and comprehend the institutional and unit specific policies and procedures.

6. Principle of Involvement

When new policies are implemented to advance patient care, this opportunity is typically intimidating to employees and often initiate resistance. In this principle, it is emphasized that associated who are affected by BPM should be involved. Since introducing BPM affects many people, company’s assurance is critical to the success in BPM (Brocke, 2014). This principle is being implemented by involving members of the healthcare team in reviewing the policies for enhancement.

7. Principle of Joint Understanding

This principle serves as a mechanism to make use of a universal language by allowing various sponsors to visualize, plan and scrutinize organizational system. In DCCM, use of common technical terms to all healthcare workers to ensure that all of them will have the same interpretation of the guidelines.

8. Principle of Purpose

Establishment of strategic value is highlight of this principle of BPM to accomplish governmental transformation and generate worth. Specifically, it entitles the prerequisite of BPM to align with the organizational mission, vision and values. In this organization, every protocol is being aligned with the institutional strategic priorities.

9. Principle of Simplicity

Setting up an organization consumes massive volumes of resources. This principle advocates that the amount of machinery, manpower, monetary and time invested to BPM is economical without compromising customer satisfaction (Ohtonen, 2015). DCCM invests a lot in infection control prevention since healthcare-associated infection increases the length of patient stay and healthcare costs (Centers for Disease Control and Prevention, 2015).

10. Principle of Technology Appropriation

Use of Information Technology can be used to nurture efficiency and effectiveness of business development. This emphasizes that BPM make use of technology in optimizing patient care and service delivery. Patient’s data and organizational policies are kept stored in a central database so that everyone involve in patient care can access the databank anytime they need it.

References

Arlen, C. (2008, October 24). The 5 Service Dimensions All Customers Care About. Retrieved from Service Performance Inc: http://www.serviceperformance.com/the-5-service-dimensions-all-customers-care-about/

Auckland District Health Board. (2015, January 27). Auckland DHB Critical Care Medicine. Retrieved from Auckland District Health Board: http://www.healthpoint.co.nz/public/intensive-care/auckland-dhb-critical-care-medicine/

Brocke, V. (2014). Ten Principles of Good Business Process. Retrieved from Universitat Liechtenstein: http://my.uni.li/i3v/publikationen/00065700/03944267.PDF

Centers for Disease Control and Prevention. (2015, January 9). Healthcare-associated Infections (HAIs). Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/HAI/surveillance/

Jones, J. P. (2003, March). Lean Thinking. Retrieved from Lean Organization: http://www.lean.org/WhatsLean/

Lazakidou, A. (2011). Quality Assurance in Healthcare Service Delivery, Nursing and Personalized Medicine: Technologies and Processes. United States of America: IGI Global.

Ohtonen, J. (2015, May). BUSINESS PROCESS MANAGEMENT CAPABILITIES . Retrieved from Slide Share. Net: http://www.slideshare.net/ohtonen/ae62015

Peterson, D. (2015). Kanban Explained. Retrieved from Kanban Blog: http://kanbanblog.com/explained/

Yarimoglu, E. K. (2014). A Review on Dimensions of Service Quality Models. Journal of Marketing Management, 79-93.

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