Description of the Article and Relevance to the Provision of Health Care
The Ethical Review of Health Care Quality Improvement Initiatives: Findings from the Field seeks to provide answers to questions that continue to be raised concerning the review processes undertaken for quality improvement (QI) initiatives that encompass ethical perspectives. According to the article, most of the questions that have concerned QI initiatives on whether the programs are in line with the regulatory criterion used for conducting the initiatives. Consequently, if that is the case, Taylor et al. (2010) are of the opinion that it is important to ensure that such issues of concern relating to the regulatory criterion are considered at all times. Additionally, in this study, Taylor et al. (2010) based their study surveys on hospital leaderships across the platform to include CEOs and relevant professionals, to broaden the spectrum of their research on matters that affect QI initiatives within the healthcare industry. From the surveys they conducted, the researchers found out that in most instances, the form of reviewing QI initiatives takes place internally within an organization, but a review by the institutional boards rarely exists. Additionally, a review by any form of an independent body for overseeing specifically the ethical issues surrounding the review of QI initiatives hardly exists. Because of this scenario, Taylor et al. (2010) proposed that it is imperative for all healthcare-providing institutions to encompass a better understanding concerning structure, parties involved, review processes, and ethical considerations, concerning the mechanisms for reviewing proposed initiatives on QI.
This article is relevant in the provision of quality healthcare services because it focuses on finding out the ethical discrepancies that can hinder successful implementation of QI initiatives within the healthcare industry. The research outcomes will go a long way in helping organizations realize the ethical issues they overlook during the assessment, implementation, and review of QI initiatives, by providing empirical evidence obtained from successfully concluded studies. Consequently, the adoption of these study findings can help organizations to improve healthcare provision services because the evidences are based on actual occurrences within organizations.
The first survey Taylor and his team undertook involved institutional QI practitioners (QIPs) who had previously participated in a campaign dubbed Institute of Healthcare Improvement’s (IHI) “100, 000.” IHI had recruited various health systems and hospitals to adopt various initiatives that focused on the safety of patients to reduce incidences of medical harm. Taylor et al. (2010) indicate that of the 500 QIPs who received invitations to participate, 25% of them responded (126 participants). From this study, the researchers found out that most if the IHI respondents identified themselves as either managers or individuals who worked in the QI department. 83% of the participants indicated that some form of review took place prior to the implementation of various QI initiatives done by staffs affiliated to their organizations. 85% indicated that reviews are conducted always. Additionally, three mechanisms of reviews came up often from the respondents. These were reviews by the QI initiatives team, intuitional leadership, and a third party independent body.
The second survey was that of Hospital CEOs in which only 5% (126) of the 5807 anticipated respondents undertook the survey. 71% of the CEOs who provided responses indicated that QI initiatives done by affiliated staffs were always reviewed prior to implementation, by an internal entity. Conversely, 26% indicated that the review of QI initiatives prior to the implementation process only happened ‘sometimes’. On funding of the review process of QI initiatives, most of the CEOs responded that funding took place internally. On ethical considerations, Taylor et al. (2010) observed that most respondents acknowledged a form of oversight mechanism existed and was doing ‘well’ (56%) while 26% indicated ‘very well’.
A comparison of the two surveys showed that many more CEOs (70%) than QIPs reported that a form of review was in place. On the other hand, of the QIPs who had indicated that QI initiatives always underwent some form of review before implementation, 33% indicated that a review always takes place, while 50% indicated that ‘sometimes’ a review before implementation occurs. Additionally, many interviewees responded that the mechanism that oversees the QI initiatives review pays attention to ethical issues: CEOs - 56%, QIPs - 45%.
What the Article is trying to Say
The statistical evidence provided by the article appears to emphasize that some form of QI initiatives do exist within healthcare organizations and are reviewed routinely by various internal mechanisms before implementation. However, independent bodies dealing specifically with ethical issues concerning the reviews hardly exist. Consequently, the review may be largely biased because of missing an independent body to oversee the QI initiatives review. From my opinion, I think Taylor et al. (2010) are trying to show that there is a need to adopt the use of independent bodies to oversee the review of QI initiatives if institutions want to achieve utmost quality in the delivery of quality services to their clients. Simply put, internal mechanisms instituted by institutional managements are not sufficient to provide adequate considerations of ethical issues involved during the review of QI initiatives. According to Taylor et al. (2010), the primary challenge, consequently, lies in the development, implementation, dissemination, and evaluation of effective QI review systems aimed at improving the safety and quality of service delivery in the health care industry.
Taylor, H. A., Pronovost, P. J., Faden R. R., Kass, N. E., & Sugarman J. (Aug 2010). The Ethical Review of Health Care Quality Improvement Initiatives: Findings from the Field. Commonwealth Fund Pub. 1436, 95. Retrieved November 24, 2014 from: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2010/Aug/1436_Taylor_ethical_review_hlt_care_qual_improve_ib_v4.pdf