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Demonstrated  the ability to define and provide a rationale for a relevant topic,Location of a range of relevant literature.Capacity for critical review and analysis of the literature, which highlights the relevance of the selected to literature to practice.Academic standards of writing and referencing


Strategies to improve patient health care in terms of quality and cost effectiveness

Improving the patient healthcare system is an immediate priority for all the healthcare facilities with the target of establishing a patient friendly system having minimal medical errors and maximum patient safety and satisfaction. Improved knowledge and awareness among the people, improved care conditions in hospitals and healthcare settings, strict and prompt regulation of healthcare, among the public, increasing demand for better care, keener competition, better health care regulation are some of the concerns in this area. 

The degree of the healthcare quality is dependent on the type of services offered to the patient, the amount of time and care given to every incoming case, the degree of precision maintained in providing medical care/ laboratory testing support, availability of trained staff and paramedical staff, use of ethical practices at every step of patient care and the cost effectiveness of the healthcare facilities for the patients. The quality of patient care is essentially determined by the quality of infrastructure, quality of training, competence of personnel and efficiency of operational systems. The basic necessity is the acceptance of a patient friendly system. The complication in the present healthcare systems are contributed by various factors and come under the scope of this literature review. Health care systems across various middle income, low income and even developed nations face these challenges everyday and this necessitates the need to address these issues in terms of patient care quality and cost effectiveness.

As per the definition by IOM, patient safety is defined as ‘the freedom from any accidental injury’ (IOM, 2000). The IOM simultaneously defined ‘health care quality’ as ‘‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’’ (IOM, 2001). The Institute of Medicine (IOM) reported that medical errors lead to around 98,000 patient deaths annually in hospitals. It has been already been stressed on various platforms and thinking podiums that strategies for providing better patient care that too in terms of quality of patient care given keeping in mind its economic aspect for the patients, are warranted. Necessary steps are needed to plan, conceptualise, asses and implement strategies for ensuing patient quality and cost effectiveness. One of the most significant problems for improving patient care, at an affordable cost to every incoming patient, is the lack of accessibility of the healthcare facilities to the common population in some geographical locations, lack of knowledge regarding the rights of patients and ineffective or complete lack of strategies to define quality and cost effectiveness in present healthcare settings. To influence and improve quality of healthcare in various settings we need to formulate and strategize on this important aspect. As discussed above the rationale behind choosing this topic is completely justified keeping in mind the importance and urgency of providing better quality patient care in terms of cost effectiveness and quality of healthcare facilities. This supports the rationale in favour of choosing this topic for reviewing. 

To ensure that all applicable literature in the given subject was captured, a broad literature search was performed on 2 Sept 2015 for the period between 01 January, 2005 through 31 Aug 2015 in Embase and Medline via Ovid, Scopus and PubMed. The results were noted and then full text, abstract, key words and title were searched using the library and other facilities. After screening against the eligibility criteria, some of the articles were identified as eligible and included in this literature review. With respect to the strength of the body of evidence, the included studies were assessed according to the degree of evidence as per the oxford level of evidence.

On assessment of peer reviewed literature many studies were noted worth discussing within the scope of this literature review. As per the studies reviewed, good and efficient leadership support, concern and involvement of the healthcare providers with patients and consistency among the plans and committed strategies for providing good quality patient care along with real time improvement, were found to be important aspects contributing to crucial changes in this field (Buhr and White, 2006; Guinane and Davis, 2004; Mills et al., 2005; Pronovost et al., 2000; Thompson, Wieck and Warne, 2003; Willeumier, 2004; Leape et al., 2006; Smith and Haig, 2005). As evidenced by literature, Six Sigma is reported to be successful in lowering errors as well as deviations (Printezis and Gopalakrishnan, 2007; Johnstone et al., 2003; Guinane and Davis, 2004) and also the operating costs (Guinane and Davis, 2004) and improve the endpoints in various health care settings in carious measurable process models.

Six Sigma can be seen as an important model to improve healthcare facilities which can be taken was taken to differentiate between the reasons causing variation causes and the measurable endpoints (Guinane and Davis, 2004). Also it was reported that the effectiveness of the model improves with experience in using the model and the prescribed strategy specially in healthcare settings. Still it was evident that effective implementation of this strategy was successful only after contributory factors like availability of committed staff,


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