Contemporary Healthcare Specific Management and Leadership Practice Essay

If there is one word which describes the American health care environment during the last decade, that word is change. Professionals joining the health care industry during the 1990s will find little resemblance to the work environment their predecessors found a mere 10 years earlier. Physical therapy practice during the 1960s and 1970s was largely limited to three settings: the hospital, private practice and extended care institutions. Private practice followed the medical practice model and served primarily ambulatory outpatients. Hospital-based practice accounted for the majority of practice opportunities. Along with some limitations on professional autonomy, employment in hospital-based practice generally offered the greatest opportunities for variety in clinical practice.

Literature Review

Change is constant and usually affects an entire organization. Change sometimes can cause chaos and stress, but which must be acknowledged and dealt with in order to make an organization effective. Improving high-quality patient care is the most important issue for everyone in a physical health institution, and this improvement needs to remain a central focus of and the main reason for the change. Discussions with hospital executives reveal:

There is a need for an action plan to meet the needs of a more culturally diversed population.

Adverse patient care incidents are under-reported because there are different interpretations about what should be reported. The hospital has not been able to invest in training hospital staff on reporting requirements. There are no systematic report mechanisms in place.

Further study on the case reveals that the peer review processes of the hospital are weak if not minimally compliant.

The number of patient complaints about hospital care has been rising. Complaints are often complex, and may involve the hospital’s other health care facilities, and health professionals, as well.

Medication errors have been a major concern for the hospital this lately. Though deficiencies were cited, the potential for patient harm was not clearly identified. Still, it has important influences on the quality of care for the medical facility.

Faith also noted that their premium cost are decreasing, and is becoming a significant concern for the hospital.

The lack of clear and concise ethics guidelines for medical personnel, especially on issues requiring ethical decisions.

Each group of stakeholders has somewhat different concerns. That is, each cares more about some aspects of an organization’s activities and less about others.

Customers. Many organizations say that they put the concerns of their customers or clients first. For U.S. companies, that often means improving the quality of the service while keeping costs in check. Interviews with the customers reveal that the health care organization’s Teamwork Competency account illustrates that using teams to improve quality is one approach that organizations can use to address the concerns of customers.

Employees. Many of the concerns that employees have today reflect changes in the structure of organizations and the fact that work is a major activity in their lives. How a company treats employees during times of change is a key issue raised by this company. Pay is another area of concern to employees. The desire to receive equal pay for equal work is among the most important of workplace issues, according to a national survey of 40,000 women.

Owners and Shareholders. For many organizations, the concerns of owners—that is, taxpayers and contributors—often are essentially those of society at large. But for privately owned companies, and those whose shares are publicly traded, the concerns of owners—that is, shareholders—may be quite different from those of society in general. Most shareholders invest their money in companies for financial reasons. At a minimum, they want to preserve their capital for later use. Because the job of institutional investors is to make money by choosing which companies to put their investment in, their perspective on corporate issues is to make profit generation the firm’s top priority. As professional investors, these shareholders have considerable power to influence management’s decisions.

Physical therapy health care service product is a bundle of tangible and intangible benefits that satisfy patient’s needs. Factors as job design, role clarity, and autonomy affect employee attitudes, which in turn affect patient experience in the institution. These observations emphasize the need to look beyond the immediate and obvious aspects of satisfaction and to consider other aspects, which affect patient perception of their experience.

In dealing with the hospital’s problems with respect to organizational processes, ethics and communication issues, it must be considered from three perspectives: structure, process and outcome. To assure that the hospital services are being appropriately provided, each dimension of hospital care provision must be considered.

Quality of Life has different meanings as compared to the other health-related subject matters. It is used to describe a patient’s health status, a description of how he perceives himself and his point of view about his life.  But Quality of Life Concept encompasses more than the health status or one’s perception about self and life.  This concept analysis nursing paper serves to provide the most comprehensive definition about this concept and how it is used in medical terms at present.

Quality of Life Concept has become an “impressive ‘explosive’ trend” talked about by medical field professionals, published in journals, books and various quality life articles for the last 10 years now.  Within this period, its concept continues to evolve and has reached three phases. In the first phase, there is the formal assessment made and classified as ‘physician’s judgment of the patient’s health’. In the second phase, the points of view of the patients were given focus and the tools used in the study were those applied from psycho-social fields. In the third phase, multi-dimensional questionnaires were adopted and the concept of Quality of Life and health status begin to have different meanings (Apolone and Mosconi, p.66, 1998).

Today, the trend continues to evolve as patient-oriented measures are applied and studied from functional disability scales to spiritual quality of life and economic measures. It is also a lot of other possible factors that have effects on a patient’s perception about what quality of life is in relation to his health.  The patient’s point of view in quality and effectiveness is taken into consideration and is treated as a more comprehensive humanistic approach that determines what to him is quality of life (Apolone and Mosconi, p. 68, 1998).

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Definition of Quality of Life

When we speak about quality of life in layman’s terms, it literally pertains to a number of definitions. It connotes with standard of living, available resources or conditions that tell about either the comforts or discomforts of life and such other identifiable meaning and perception about an ideal life.  There are many indicators about what quality of life a patient can perceive and most of these indicators depend variably on one’s cultural values.

Defining Quality of Life for the purpose of this nursing concept paper is variable because it pertains to a “subjective experience”. Hence, it can not be measured with “object indicators.”  Being the case, according to Skevington, studies show that the “best person to assess quality of life is arguably the individual himself” (Skevington, par. 4, 1999). When questions are asked to a patient and he, in turn, answers the questions, the medical professional likely gets a limited clinical success in the study of the patient’s history because of limited information.  He is unable to get the necessary data that may be of help in assessing the health condition of the patient.  Hence, there is a need to come up with a good quality-of-life measure that will enable health and interventions to be properly evaluated.

The World Health Organization (WHO), Geneva, in collaboration with the WHOQOL Group, designed an instrument called WHOQOL-100 that is used in “multinational clinical trials for the evaluation of quality-of-life outcomes during all types of health care interventions like surgery, counseling and medication.” (Skevington, par.1, 1999).   It is useful also for making cross-cultural function about perceived quality of life relating to health and at a one-to-one level, in improving communications between doctors and their patients in the consulting room (Skevington, par. 1, 1999). The WHOQOL has up come with such instrument and made it as comprehensive as possible to reach out to various global dimensions that are workable internationally. Moreover, it is intended for use by persons with chronic diseases, informal caregivers and people living in highly stressful situations.

WHO defines health as a “state of complete physical, mental and social well-being, not merely the absence of disease or infirmity”.  On the other hand, the WHOQOL Group defines Quality of Life as “an individual’s perception of their position in life, in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns (Sousa).  It is so broad a concept that it affects the patient’s physical health, psychological state, level of independence, and social relationships with his environment in a very complex way.  In addition to this definition, WHOQOL Group has added the sixth domain to the list, which is “spirituality, religion, and personal beliefs.” (Skevington, par 5, 1999). Furthermore, the WHOQOL 100 is an instrument that is applied to heterogeneous cross-section of sick and well people in order to examine its internal consistency reliability, construct validity, and discriminant power (Skevington, par. 1999)..

Concept of Quality of Life in Health Care

The Quality of Life came about when the disciplines of sociology and psychology became an issue related to health care. It has emerged into a larger issue when technological advances were aimed at increasing life span. Quality of Life has become a means to guide a patient in deciding on whether to pursue a treatment or not for his or her ailment.  According to clinicians, Health-related Quality of Life is an appropriate focus for a patient who has a disease or who is ill, and whose aspects in life become health-related (Haas, p. 730, 1999).

A)    Defining Attributes of Quality of Life. The Walker and Avant’s 1995 method of concept analysis of Quality of Life took note of the various characteristics or critical attributes recurring in the process of their studies and they are grouped according to four recurring themes.  The first theme is the “multi-dimensional and dynamic nature of the QOL.  Authors have stressed that QOL is a multi-dimensional concept considering that it is “based on values; is dynamic, ever changing and depends largely on the context in which it is measured” (Haas, p. 733, 1999). The second theme is that QOL includes an assessment.  In this case, the authors include words such as response, appraisal, measure, experience and assessment in defining and using QOL (Haas, p. 733, 1999).  The third theme is centered on the subjective nature of QOL. Grouped within this theme are words like perception, well-being, and satisfaction. (Haas, p. 733, 1999). The fourth and final theme recognizes the objective nature of QOL, with authors using “behavior, functioning, and environment as measures of QOL.” (Haas, p. 733, 1999).

These defining attributes were sourced from the definitions and use of QOL. It mainly shows that QOL is indeed an individual’s current life circumstance. It further shows that it is multi-dimensional in nature and in being so, is based on values and is dynamic. It is also composed of both subjective and/or objective indicators. Finally QOL is subjectively measured by persons capable of self-evaluation.  (Haas, p. 733, 1999)

(B) Congruence of the Concept with the Assumptions and Other Concepts within the Model/Theory.

The QOL Model was formulated to provide a measure that takes into consideration both the components and determinants of health and well being that are consistent with the concept of Quality of Life. The QOL Model or Profile emphasizes on the person’s physical, psychological and spiritual functioning and his connections with his environments as well as opportunities for maintaining and enhancing skills (The Quality of Life Model, par 3, 2005).

The Conceptual framework of the Quality of Life has three life domains which are aimed at providing a person to enjoy the more essential potentials of his life. (The Quality of Life Model, par 4, 2005) Each of the three domains has three sub-domains and they are as follows:

(a)    Being pertains to who one is.  Its three sub-domains are: (1) Physical Being, which relates to a person’s or patient’s physical health, personal hygiene, nutrition, exercise, grooming and clothing, and general physical appearance; (2) Psychological Being, which relates to his psychological health adjustment, cognitions, feelings, self-esteem, self-concept and self-control; (3) Spiritual Being, which relates to his personal values, personal standards of conduct and spiritual beliefs. (The Quality of Life Model, par. 5, 2005)

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(b)   Belonging pertains to the person’s connections with his environment. Its three sub-domains are: (1) Physical Belonging, which relates to his connections with his home, work place/school, neighborhood and community; (2) Social Belonging, which relates to his connections with his intimate others, family, friends, co-workers, neighborhood and community; (3) Community Belonging, which relates to his connections with matters pertaining to adequate income, health and social services, employment, educational programs, recreational programs or community events and activities. (The Quality of Life Model, par 5. 2005)

(c)    Becoming pertains to achieving personal goals, hopes and aspirations. Its three sub-domains are: (1) Practical Becoming, which relates to achieving personal goals in domestic activities, in work, in school or volunteer activities or seeing to health and social needs; (2) Leisure Becoming, relates to activities that promote relaxation and stress reduction; (3) Growth Becoming, relates to activities that promote the maintenance or improvement of knowledge and skill and adapting to change. (The Quality of Life Model, par. 5, 2005)

Ferrans Conceptual Model of Quality of Life. Ferrans has developed a model based on the adoption of the individualistic ideology, which recognizes that quality of life depends on the unique experience of individuals. He maintains that the individual person is the only accurate judge of his quality of life because people differ in their perceptions and values. (Ferrans, par. 1, 1996)  This model uses qualitative methodology and has identified four domains of quality of life: health and functioning as psychological/spiritual, social and economic, and family. (Ferrans, par 1, 1996)  Patient data are analyzed in relation to these domains of quality of life.

Researchers, physicians, policy makers adopt the Quality of Life concept as an instrument that tests the validity, reliability and effectiveness of different and relevant sub-domains for the purpose of evaluating the impact of medical interventions on the population (Apolone and Mosconi, p. 68, 1998). Since the concept is considered non-medical determinant, it is treated as confounder, a complementary way for effectiveness of care to a patient. This is because medicine still plays the major role in determining the final health outcome of a patient. (Apolone and Mosconi, p. 68, 1998)

Since patients are the proper judge of their quality of life, there are ways to enhance the well-being of patients who may have a poor quality of life.  Studies show that the presence of positive feelings in patients is the most important feature of the kind of quality of life he has. Patients, with positive feelings most likely enjoy a pleasant quality of life than those who are in-patients and sick. A person has control of his emotions which can generally affect his state of mental being.  It is a matter of developing the positive attitude and containing oneself into thinking of a positive outlook in life.

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