Workplace Culture

Cultural Shift: How to Improve Quality of Care in Healthcare

By: Starling Minds

Published | Mar 6, 2020

In recent years, healthcare organizations have been working to define quality that is grounded in evidence-based practices, with an understanding that health and wellness need to be holistic and consider the whole person.

The term “health and wellness” has many definitions, leading to a lot of confusion over its meaning and practices. According to healthcare experts, health and wellness should capture the full continuum of support for addressing people’s needs and helping them sustain their health. Health and wellness consider the person’s physical, mental, emotional, spiritual, and social well-being, in addition to their past, present, familial, social, cultural, and environmental context. It helps identify the barriers preventing patients from getting the physical and mental health they need to be well. 

A standard definition of quality provides a common language and understanding for those who engage with, deliver, support, manage, and govern health and wellness services. It represents a shared vision of quality for health and wellness to support people.

7 Dimensions of Quality 

There are seven dimensions of quality in healthcare, and each can be used at multiple levels, from planning the distribution of health services to evaluating a health service or developing a measurement plan for a local improvement project. 

Respect: Honouring a person’s choices, needs, and values 

Upholding human dignity by minimizing the power imbalances between healthcare providers and patients. Mutual respect empowers patients to take ownership of their health and wellness. For healthcare providers, respect includes being responsive to and making decisions in partnership with a patient, their family, caregiver, and community.

Safety: Avoiding harm and fostering security 

Involving processes and environments that ensure physical, cultural, and psychological safety. Safety is the extent to which services prevent or minimize harm that could unintentionally result from the delivery of care, and the extent to which they promote trust.

Accessibility: Ease with which health and wellness services are reached 

Accessibility is the extent to which patients can readily obtain care when and where they need it. This dimension aims to overcome physical, financial, cultural, and psychological barriers to receiving information and care. This includes a welcoming entry and seamless transitions between and within services.

Digital solutions like Starling Minds can help remove barriers to mental health as a result of accessibility issues such as cost, geographical location, mobility, and psychological stigma.

Appropriateness: Care that is specific to a person’s or community’s context 

Appropriate care is informed by best, evidence-based practices to optimize care and achieve a specific health and wellness goal in patients. It weighs the benefits and risks of interventions to prevent the overuse or underuse of treatments or services. 

Effectiveness: Care that is known to achieve intended outcomes

Effective care is informed by evidence and best practices to achieve the best possible outcome for patients or a populations’ health and wellness. Effectiveness is demonstrated by continuously studying the results of care as well as a commitment to pursue new methods that may improve health and wellness for all.

Equity: Fair distribution of services & benefits according to population need

Equity does not mean the same care for everyone because individuals have different circumstances, histories, and needs. Equity involves understanding the patient being served, focusing on the social determinants of health, and removing structural barriers and systemic oppression to address gaps in experience and outcome. Equity is achieved when every person has the opportunity to achieve their health and wellness goals regardless of social, economic, or geographic location. 

Digital e-health solutions are tackling the equity treatment gap for all. To learn how Starling Minds helps remove equity barriers to mental health for workforces, reach out!

Efficiency: Optimal and sustainable use of resources to yield maximum value

A commitment to efficiency is demonstrated by the thoughtful use of financial, environmental, and human resources to deliver health and wellness services today and in the future. This includes maximizing the capacity to deliver more or better services by minimizing and eliminating waste throughout health systems, such as unnecessary energy and medical materials. 

6 Elements of a Just Culture

Just culture refers to a values-supportive model of shared accountability. It’s a culture that holds organizations and its leaders accountable for the systems and policies they design, as well as how they respond to staff behaviours fairly and justly.

To achieve a just culture, organizations and their leaders should consider: 

Cultural Safety that recognizes and addresses power imbalances within the healthcare system. It results in an environment free of racism and discrimination, where people feel safe when receiving health care.

Cultural Humility is a process that encourages self-reflection and learning to understand one’s own personal and systemic biases and another’s experience. It aims to develop and maintain respectful processes and relationships based on mutual trust.

Relational Nature of Care means to build compassion at the core of health and wellness through relationships at the individual and organizational levels. It involves connecting, collaborating, and nurturing relationships with each unique patient to promote safety and security, belonging, accountability, support, purpose and meaning, continuity achievement, and significance.

GUIDE: How to create a culture of compassion and safety in healthcare

Psychological Safe Environment to encourage workers to share concerns without fear of embarrassment or retribution, to speak up and know they won’t be humiliated, blamed, or ignored, and to ask questions openly, honestly, and frequently.

Accountability needs to be differentiated from “unsafe” behaviours. To create a just culture, leaders should consider each scenario and determine if an individual failed as a result of system errors, or due to unsafe behaviour. Accountability is the product of an organization’s values and expectations of their workforce, which leads to their design systems and behavioural choices. 

Human error is often a product of current system designs and behavioural choices including, processes, procedures, training, environment, and resources. In the event of a human error, accountability should be held at the systems level and not at the individual level. Although for unsafe behaviours, disciplinary action is required to ensure the organization does not encourage reckless behaviour or a conscious disregard for system designs, rules, and policies.  

Reporting Culture should focus on continually identifying, reporting, and mitigating sources of risk and hazards. Employees need to know they are safe before they are comfortable talking about or reporting errors, near misses, and system failures. 

Healthcare Model for Indigenous Communities

Healthcare organizations have been looking to improve the quality of care for indigenous people and their communities.

First Nations health and wellness is based on a holistic model of health. The model takes a preventative approach to treating chronic conditions and promoting health and wellness. It focuses on the balance and inter-relationships of the physical, mental, emotional, and spiritual aspects of a patient. 

First Nations’ Health and Wellness approach has become an emerging field and viewed as the way to bridge the gap between mainstream health organizations and First Nations communities. To help healthcare providers treat First Nations communities and improve quality of care, here are best practices proven to enable successful recovery within Indigenous communities, including:

  • Putting Indigenous voices at the center of cultural safety
  • Relationship building and relational of care
  • Greater engagement of patients and families
  • Cultural shift in trauma-awareness specific to Indigenous communities
  • Protecting Indigenous knowledge, traditions, and practices

To improve the quality of care, it will be essential for healthcare organizations to give Indigenous communities and families the voice and opportunity to co-design systems and policies. The role of compassion will also help healthcare providers nurture better relationships with indigenous patients. It will educate healthcare workers on the different types of traumas indigenous people face, and the stigma and systematic biases preventing them from getting equity treatment. Traditional Indigenous principles, knowledge and their way of life such as land-based healing and spiritual practices should also be protected, and considered when developing healthcare policies within their communities.

To create a psychologically safe environment and tackle equity and accessibility issues, it starts with leaders deploying the right mental health and wellness solutions to build resilience in healthcare workers and their communities.

To learn how Starling helps with that, reach out to us!

Starling Minds

Starling Minds™ is a digital mental health platform that reduces absence and disability costs by delivering immediate, unlimited, and personalized online Cognitive Behavioral Therapy (CBT). Developed by leading psychologists, Starling’s digital therapy is powered by an expert system that emulates the processes and practices of human-guided therapy to remove the greatest barriers preventing employees from accessing affordable and effective mental health care—cost, access, and stigma.

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