Assignment Front Cover Sheet

Student Name: Adityakumar Hareshbhai Ukavala

Student ID: 14560031
Degree Title: MBA Global Healthcare Management and Leadership
Level: Level 7
Module Title: Risk, Governance and Patient Safety
Module Code:
Seminar
Dr. Stella Nalwanga
Lecturer:

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Executive Summary
Table of Contents
PART ONE
  Introduction:-

The main aim of the assignment is to conduct a critical analysis of the risk,
governance and patient safety tools and techniques with in the healthcare
sector. This analysis evaluate the current clinical practices and policies that
are important for the patient safety and safe delivery of the high quality care,
and the key indicators those are crucial for measure the clinician’s and
healthcare staff’s performance. Moreover the impact of the performance on
the professional behaviour and the well-being.

Clinical governance is the framework through which all the healthcare

professionals and organisations are responsible for improving the healthcare
services and safeguarding the high quality of care (NIH, 2019). Clinical quality
is rightfully assigned centre stage by ‘placing duties and expectation on the
local healthcare organisation as well as individuals’ to provide clinical
excellence (McSherry, 2010 p.1)

The first part critically analyses and presents the existing policies and practice
framework, accountability and performance, Risk management, audit and
evaluation, and information management tools and practices with in the global
healthcare organisation.

The second part is the case study focuses on the risk identification, risk
management and control in the Kidney care Provider organization in India.

LITERATURE REVIEW OF THE GLOBAL HEALTHCARE SECTOR

  Policy and Framework:-

Various definitions are available for the Policy depending upon the context.
But in the context of global healthcare it is define as ‘the formal written
documents, rules, and guidelines that present policymakers’ decisions about
what actions are deemed legitimate and necessary’ to improve the healthcare
system and the health of the population (sheikh et al., 2011).

The World Health Organization (WHO) defines health policy as 'the decisions,
plans, and actions (and inactions) undertaken to achieve specific health care
goals within a society or undertaken by a set of institutions and organizations,
at national, state, and local level, to advance the public's health' (Health Policy
Open (1), December 2020).

Healthcare policies include legal and safety rules or regulations formulated by

the executive branch of government regarding how care and specific
treatment and services are delivered by the healthcare organization
(University of St. Augustine for Health Sciences, 2021). Laws are very crucial
to assign responsibility and accountability. Healthcare policy is vital because it
helps to set guidelines that benefit patients, healthcare organizations, and our
healthcare system. Having protocols in place can help to reduce human error
and poor communication in medical choices (University of St. Augustine for
Health Sciences, 2021).

A vision for safe and high-quality care is presented, together with the activities
required to attain this vision. The Framework outlines three fundamental
concepts for providing safe and high-quality care. These are that care is
consumer-centred, driven by information and organised for safety (Australian
Commission on Safety and Quality in Health Care PDF, p.1)

Implementation is where the rubber hits the road, where abstract policies and
rules have real impacts on people, where intergovernmental relations are
solidified in practice. Without implementation, policies are worthless. As a
process, implementation turns out to be every bits as political as rulemaking.
Analysis of implementation reveals that in a collaborative effort to make the
program work, broader national safeguards remained even as states regained
some autonomy (Doonam Michael, 2013).

Policies and procedures are detailed standards that provide critical

information to employees throughout a healthcare company, ranging from
patient discharge processes to staff hygiene requirements. Policies guide
daily operations and assure legal compliance. The complicated structure of
healthcare necessitates a comprehensive policy and procedure library that
covers a wide range of content to protect patients, staffs, visitors and the
organisation. But for this policies are routinely assessed to reduce the change
of clinical accident and improve efficiency of healthcare organization (Rldatix
marketing, 2020).

 Accountability and performance:-

Policies are very crucial for establishing and maintaining accountability in

global healthcare sector. Accountability is the principle that individuals and
organisations are responsible for their actions and may be required to explain
them to others (Dennis R. Van Kerkvoorden et al., 2023).

Accountability is a crucial tool in global healthcare for assigning responsibility

and, more especially, benchmarking staff’s and organisation performance
(Swarthout et al., 2023). Accountability and performance are related to each
other. Performance accountability is the process that makes use of evaluation
finding and many other source of key information to achieve goals and track
performance of the organisation (Mark Friendman, 2023).

Some study suggests that accountability can be seen as multi interpretable

concept in global healthcare. Accountability between an actor and a forum
can be seen as social and relational. Secondly, accountability can be seen as
three emerging factor (i) the institutional frame (ii) the organisational frame (iii)
the complex environments frame. And the final concept of the accountability is
related with governance activities, initiated by government to influence social
activity (Dennis R. Van Kerkvoorden et al., 2023) Continue…

 Risk Management:-

Risk management is a systemic process of identification, assessment and

evaluation of risk. In the global healthcare context it is not only report and
identify events or incidents, but also decreases the harm that occurs due to
human error and any circumstances to the patients as well as staffs and
organisation (Charlotte Cottee, 2008).

In the context of healthcare, Risk is a defined as an internal and external

factor that has an ability to make a significant impact on an organisation and
preventing organisation to achieve its goals, providing its services and pilling
out of opportunities (KPMG).

Currently, UK healthcare institutes aware of the importance of risk

management in healthcare organisation. Although, the primary objectives of
risk management is patient safety and enhancing quality of services, but it
extends from preventing medication errors to organisation reputation, market
share, social factor such as public trust and many more (Alice dean, 2023).

Several framework has been developed to minimise the risk in global

healthcare according to different prospective, some frameworks take risk
management and governance prospective, while others are depend on
decision making theory (Ingrid Glette-Iversen, 2023).

Australia has developed risk management framework (National safety and

quality in Health care [NSQHS]) to support the standards of health services
which ensures that healthcare organisations implement systemic way to
identifying, assessing and managing risks to patient safety and quality
(ACSQHC publication report, 2021). In Canada, the Canadian Patient safety
institute (CPSI) influences high quality care and a culture of patient safety
across the healthcare system. The CPSI has implemented risk management
strategies through incident reporting, patient feedback, staff education and
training, and evidence-based practices to mitigate risk in healthcare
organisation (CPSI patient safety learning, 2020).

Overall, risk management framework helps to identify the risk and control it for
patient and organisation safety in the global healthcare settings.

 Audit and evaluation:-

Clinical audit is a quality improvement tool that involves systemic review of

clinical practices ensuring that all set standards are met and modifying
practice where required. Clinical audit has a positive impact on patient care
and safety (Howlett et al., 2023).
All hospitals in USA follow the principles suggested by the Centers for
Medicare &Medicaid Services (CMS). In the USA, the audit framework
includes clear objectives, Data collection, Evidence-based criteria, analysis
and reporting, and action plan (Centers for Medicare & Medicaid Services,
2021). However it makes clear path to evaluate or modify practices according
to data. On the behalf of NHS in the United Kingdom, the Healthcare Quality
improvement Partnership (HQIP) is managing National Clinical Audit and
patient outcome programme (NCAPOP). In this audit, the data collected by
local doctors are analyzed to provide quality of care standards for the specific
condition. Moreover, Clinical audit helps to enhance healthcare quality and
improvement by involving clinical staff and manager to learn from their
mistake and other relevant data (NHS, 2023). In Australia, Clinical audit are
generally regulated by agencies such as the Australian commission on safety
and Quality in Health Care (ACSQHC) and professional institutes.
Overall, the similarity between all country and the main objectives of this
clinical governance tool is to enhance patient safety and improvement of the
quality care by analysing the collected data from Clinical Audits.
The last and important part of Clinical Governance is Information
management tools and practices to be discussed in this literature review.
  Information management tools and practices:-

An information management is an arrangement of data, people, processes

and information technology that works together to collect, process and store,
and provide as output the information that support the organization (Whitten &
Bentley, 2007). Information technology (IT) plays important role in information
management system. In health care, information management system
includes the processes, people and information technology that come
together to provide healthcare related data to support healthcare organization.
Technology and computers are necessary to support both clinical and
administration processes. Now a days, Electronic Health Record (EHR) is
widely used system in most of the health care organization that integrates to
manage their patient populations effectively while reducing the costs and
improving the quality of care. The lack in information management system
makes significant negative impact on organization. (e.g., the same data and
information are often collected by different department of the organization,
while at the same time there are gaps where important data are not get
reported). Continue….
  PART 2:-

EVIDENCE BASED REFLECTIVE ACCOUNT OF KIDNEYCARE

PROVIDER ORGANIZATION IN INDIA

 Introduction:-

This section of the research examines the various risks and hazards
associated with kidney care provider organizations in India. The report uses
pestle analysis and the risk matrix to identify the most important risks and
harms. It also discusses existing risk communication practices and how to
avoid, share, transfer, reduce or accept the risks.

 Types of risks in kidney care provider healthcare organization in

India:-

Various risks appear over kidney care provider healthcare firms in India,
ranging from operational and financial uncertainties to patient safety concerns
and regulatory compliance issues. The PESTLE analysis below shows factors
that risks to owner and all stakeholders.

Political Factor:-

Kidney care hospitals in India are subject to a range of government policies

and rules that affect various types of operations such as facility standards,
equipment standards, staffing, licensing and quality care measures (NIH,
2022).

Changes in this rules and implementation of new rules can make a significant
impact on organization such as increase staff workload, need to train staff and
it can also increase cost. As per the patient prospective, changes in regulation
and rules can increase treatment charges. Most of the equipment such as
dialysis machine, renal replacement machines are imported from out of the
country so changes in importation tax law increases the overall cost.
Economic Factor:-

Economic growth can influence the accessibility and affordability of healthcare

services in India. Moreover, other economic factor such as individual’s income
and currency exchange rate can also make a significant impact on demand
for services and importation cost of equipment & medication respectively.

Additionally, Unemployment is one of the factor that affect not only kidney
care hospital but all over business industry. Because of low unemployment,
more worker are able to obtain employer-sponsored benefits, yet both
employer and employees are paying more for these benefits from their
income (AON, 2023)

Social Risk:-

Technological Factor:-

Technological factor is very crucial for Kidney care hospital and patient as well
to provide high quality care. Up to date dialysis machine and diagnostic tools
and services protocols are necessary to achieve maximum outcomes.

Environmental Factor:-
Legal Factor:-
References:-

 https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC7808043/#:~:text=Clinical%20governance
%20may%20be%20defined,safeguarding%20high
%20quality%20of%20care'.
 https://ebookcentral.proquest.com/lib/coventry/
reader.action?docID=822488
 https://ebookcentral.proquest.com/lib/coventry/
detail.action?pq-origsite=primo&docID=2006616
 https://www.usa.edu/blog/healthcare-policy/
#:~:text=For%20nurses%20and%20health
%20administrators,learn%20more%20about%20their
%20rights

 https://www.safetyandquality.gov.au/sites/default/
files/migrated/ASQFHC-Guide-Policymakers.pdf

 Doonan, Michael. American Federalism in Practice : The

Formulation and Implementation of Contemporary Health Policy,

Brookings Institution Press, 2013. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/coventry/detail.action?
docID=1358568

 https://resources.rldatix.com/en-us-blog/top-5-types-
of-healthcare-policies-and-procedures
 https://onlinelibrary.wiley.com/doi/full/10.1002/
hpm.3743

 American Journal of Medical Quality (AM J MED QUAL), 2023

Supplement; 38: S77-S78. (2p)

https://web.p.ebscohost.com/ehost/detail/detail?
vid=3&sid=adb06ddc-343a-497f-ae96-fd79b150436e
%40redis&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRl
PWVob3N0LWxpdmU%3d#db=cul&AN=176174585
 https://clearimpact.com/3-4-what-is-the-relationship-
between-performance-measurement-performance-
accountability-and-evaluation/#:~:text=is%20worth
%20replicating.-,Performance%20accountability
%20is%20a%20management%20and%20oversight
%20process%20that%20makes,to%20stakeholders
%20and%20improve%20performance.
 https://onlinelibrary.wiley.com/doi/full/10.1002/
hpm.3743
 Cottee C, Harding K. Risk management in obstetrics. Obstet Gynaecol
Reprod Med 2008; 18: 155–62 10.1016/j.ogrm.2008.04.003
https://www.obstetrics-gynaecology-journal.com/
article/S1751-7214(08)00078-X/abstract
 https://assets.kpmg.com/content/dam/kpmg/ke/pdf/
idas/thought-leaderships/managing-risk-global-
health-ti-outline.pdf
 https://nursesgroup.co.uk/risk-management-in-
healthcare
 https://www.sciencedirect.com/science/article/pii/
S092575352300259X
 https://www.safetyandquality.gov.au/standards/
nsqhs-standards
 https://www.pslhub.org/learn/organisations-linked-to-
patient-safety-uk-and-beyond/international-patient-
safety/cpsi/cpsi-patient-safety-and-incident-
management-toolkit-r3478/
 Limb C, Fowler A, Gundogan B, Koshy K, Agha R. How to
conduct a clinical audit and quality improvement project. Int J
Surg Oncol (N Y). 2017 Jul;2(6):e24. doi:
10.1097/IJ9.0000000000000024. Epub 2017 Jun 8. PMID:
29177218; PMCID: PMC5673151.
 https://www.proquest.com/healthcomplete/docview/
2807183399/664F093AE6B34FBEPQ/4?
accountid=10286&sourcetype=Scholarly
%20Journals
 https://www.cms.gov/files/document/2022-program-
audit-process-overview.pdf
 https://www.england.nhs.uk/clinaudit/
 https://books.google.co.uk/books?
hl=en&lr=&id=io1SEAAAQBAJ&oi=fnd&pg=PR15&dq
=information+management+tools+and+techniques+in
+global+healthcare+management&ots=X6Ghpn99ba
&sig=n1YCihxUicQMbYOD89D6Aak4ukg#v=onepage
&q&f=false
 https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC10513032/
 https://www.aon.com/en/insights/reports/global-risk-
management-survey/top-risks-facing-healthcare-
organizations
