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FOCUS Methodology, FOCUS sample
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  Program:  Master of Arts in Nursing Major:  Maternal and Child Nursing Course:  N 205 Nursing Administration Professor:  Dr. Federico V. Nagtalon Student:  Eunice Aimee R. Laxamana Paper III: Think about your last clinical rotation experience. Identify one process that you  believe could be improved and describe how you would begin improving the process. Using the FOCUS Methodology would be helpful. Date: September 13, 2014 The day-to-day cycle at the City Health Office of Batac (CHO-Batac) starts with the nurses and ends with the nurses. The CHO- Batac‟s processes have adapted the functional delegation scheme to individually cater to the client/patient‟s needs, especially at this point where they have a large pool of nurses including „Sagip Nars‟  by the Provincial Government of Ilocos Norte (PGIN), Nurse Deployment Program(NDP) by the Department of Health, and Volunteers approved by the City Government of Batac (CGB). The nurses are delegated to tasks under “Information”, “Admitting”, “Weight Monitoring”, “Laboratory”, “Consultation” and “Pharmacy”. Information Nurses are responsible in controlling the number of patients that the City Health Officer (CHO) checks in the morning and in the afternoon by  providing patient numbers; in searching patient family folders; and in directing clients to the CHO-Batac Departments  –   Dentist, Sanitation, Cashier, Laboratory. Admitting Nurses performs primary assessment of patients and jots down the patient chief complaints including its quality and duration. Weight Monitoring Nurses are responsible in weighing pediatric and maternal clients for their admitting information, and in weighing “Pantawid Pamilyang Pilipino Program” or 4P‟s clients, in which their weight is being recorded in logbooks. Laboratory Nurses assist in phlebotomy and in recording of requests and results. Consultation Nurses assist the CHO in organizing folders of patients according to their order at the information desk. Pharmacy Nurses assist in dispensing prescribed medications to  patients who came from the CHO consultation, and in organizing the available medications by inventory. When the patient or client is directed to the dentist, the dental aide assists them and the dentist in the dental clinic. When the client is directed to the Sanitation department, the Sanitation inspectors identify the client according to their catchment areas and are properly assisted in acquiring a sanitary permit.  When the client is directed to the cashier, the cashier breaks down the payment and provides an official receipt (OR) provided by the CGB. When the client is directed to the laboratory with a request, the nurse or the medical technologist available will promptly collect blood sample and/or provide the appropriate specimen collector with proper instruction; and then immediately process the collected specimen, in which results are being jotted in the logbooks for references. Every Wednesday is “Immunization Day”, and a function for Immunization Nurse is added, where the nurse is responsible in vaccinating Expanded Program on Immunization (EPI) target clients. The midwives, on the other hand, without the Sagip Nars,  NDP and volunteers are responsible for the delegated tasks on top of maintaining records of immunization, maternal cases, tuberculosis (TB) and multi-drug resistant TB (MDR-TB) Cases, Consultation Census within their catchment area and community visits. Clients/Patients who need wound dressing are attended by available the available nurses/midwives. This is the life at the CHO-Batac. Deming, who is considered to be a quality management hero, introduced the plan-do-check-act cycle which was later adapted to the acronym FOCUS-PDCA  –   a methodology for continuous quality improvement. FOCUS-PDCA stands for (F) Find a process to improve; (O) Organize a team that knows the process; (C) Clarify current knowledge of the process; (U) Understand causes of process variation; (S) Select the process improvement; (P) Plan the improvement and continue data collection; (D) Do the improvement, data collection and analysis; (C) Check the results and lessons learned from the team effort; (A) Act to hold the gain and continue to improve the process. (Ann Marinner-Tomey). Undertaking the FOCUS-PDCA Methodology in all the processes an organization is a painstaking job for a manager/leader. It needs careful analysis of all the processes. Quality assurance and quality improvement goes hand-in-hand in developing organizations  –   it never ceases and it constantly changes for the better. Indeed, evaluating then planning and implementing again and again is a vicious cycle and it can get tiresome  –    uncomfortable. However, it needs to be done to continually cater to the organization‟s constantly varying clientele.  Applying the FOCUS Methodology to CHO-Batac Process Find a process to improve.  This step of the method involves: a complete organization self-assessment (determining if the organization meets the clinical standards in the provision of care); area for improvement selection (completing an Identifying Improvement Worksheet (IIW)); data collection to understand scope of problem and possible reasons for problem (reviewing records and reviewing findings on IIW). Does the CHO-Batac meet the clinical standard in the provision of care? According to the Philippine Health Service Delivery Profile (PHSD Profile) in 2012, the Local Government Units (LGUs) like the CHO-Batac, as part of the provider network for healthcare services, deliver health promotion, disease prevention, primary, secondary, and long-term care. In the Summary of Health Services and  providers in the Philippines, 2012 under the PHSD Profile, the CHO-Batac is classified to be under the Public Sector in Category A: Primary Care Facility and can be considered as a health center, local government unit, community health team and are supposed to have the following services: under health  promotion  –   health education, family planning, maternity care, prenatal care for mothers, child care, nutrition and food safety, lifestyle-related or non-communicable diseases, communicable diseases, environmental health and sanitation; under disease prevention  –   childhood immunization, TB, Malaria, Leprosy, Filariasis, Schistosomiasis, Rabies, Dengue Fever, and Severe Acute Respiratory Syndrome (SARS), Human Immunovirus (HIV) and other Sexually Transmitted Infections (STI), environmental and health sanitation, diabetes, hypertension, and cancer; under primary services - out-patient, dental and laboratory services, disease programs like TB, Malaria and Dengue; under secondary services  –   outpatient care, acute and emergency care, and dental care; and under long-term care or rehabilitative services  –   long-term care for the elderly and disabled and programs for the disabled.  Although the PhilHealth Benchbook outlines all standars of quality processes and outcomesfor hospitals, primary health care facilities and lower level hospitals are bypassed because of similar  perceptions of low quality. Clearly, the CHO-Batac is providing the services it is supposed to offer. However, being a  primary health care facility, it is being looked down. Therefore, there must be some areas that need improvement when it comes to the quality of delivery of the services being provided. The IIW briefly assesses what the problem, challenge or opportunity is and the evidences that the problem, challenge or opportunity needs fixing. In the case of the CHO-Batac, there is a national problem in which its counterpart primary health care facilities are being looked down to. Down to the level of the CHO-Batac, it is explicitly evident that some of its clientele are displeased or unsatisfied with its performance as it can no longer function as a consultation clinic with readily available medicines when the CHO is not around. Moreover, the CHO-Batac only has one physician and this further limits the number of clientele being catered to. This problem gives the target clientele the idea that the CHO-Batac is worthless, especially those that do not meet the cut-off for patients  –    which defies “easy access” a s pillar of primary health care. In addition, this may reflect that the disease prevention services of the CHO-Batac are not effective or good enough that more clients come by for treatment each day. Organize to Improve the Process. This process involves creating a team with appropriate staff for addressing the problem and determining a goal statement for improvement. An effective team is the key to achieving improvement and its members should be based on knowledge of, and involvement in  process directly impacting patient care. There should be a champion  –   who is expert about the topic, a decision-maker  –   who has the authority to promote or enhance the implementation of the improvement, and day-to-day leaders  –   who have expertise or special knowledge about the core process. (Primaris Healthcare Business Solutions).

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