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The Implementation of Soft Skills in Quality Improvement

In workplace, quality improvement isdefinedas a formal approach to the analysis of performance and systematic efforts to improve it. It acts as ongoing effort to make performance better and the focus of quality improvement in medical practice is to reduce medical errors and needless morbidity and mortality. (Department of Community and Family Medicine, Duke University Medical Center, 2005).Based on this statement, I believe healthcare profession or specifically nursing profession is not limited to medical treatment but it is beyond that as healthcare workers interact with patient more often at the hospital compared to their own family. It is the duty of nurse to act as a bridge between doctor and patient as nurses face patients almost all the time and they are the one who hear their patients problems compared to doctor who faces them in a short interval of time. Thus, soft skills need to be nurtured in each of health care employees self as this will develop a better individual that works in health care services as A nations health is a nations wealth. (Journal of Public Health Management & Practice). TheQuality Improvement process involves everyone on the improvement team and encourages everyone to make contributions. This style of participative management enhances job satisfaction and makes employees feel valued as team members who can really make a difference.Therefore, it is undeniable fact that soft skills are needed especially when it comes to improve Quality Improvement in healthcare services.

Basically, Quality Improvementprocess (QI process) is vital in healthcare and it is structured to plan, implement, and evaluate changes in healthcare activities. It involves six steps and can be easily applied to clinical situations. Firstly, the most important thing in quality improvement process is identify the need of consumer of healthcare services. Nurse Managers or staff nurses can identify the patients need by conducting an interview or survey to know more about their experiences during nursing care. The studies should not focus on physical tasks only, but also interpersonal care as well. This interaction will help the patient to feel the appreciation given by the nurse.

Secondly, nurse needs to assemble a multidisciplinary team to review the identified consumer needs and services. Teamwork is very important to develop effective QI team. Essentially, team working focuses on passing responsibilities over to working teams, so that they can get on with what they have to do without referring to high level management every particular time.(Successful Team Management, Nicky Hayes). It is also means that the team has enough authority to make day-today decision about their work. So, team leader should consider briefing or educating team members about their roles before starting the QI process. Thirdly, members can collect data to measure the current status of these services, various data tools can be used such as flowcharts, line graphs , histograms, Pareo charts and fishbone diagrams. Nurse can use various data tools to measure the quality of their work. Next, nurse must be able to establish measurement outcomes and quality indicators. For example, the benchmarking is one way to evaluate the quality of outcomes for the healthcare institution. It is done by comparing one agencys performance against that of similar organizations. Other than that, it is important to select and implement a plan to meet the outcomes.If the outcomes did not meet the standard qualification the change strategies must be done and it should emphasize on open communication and education of staff affected by the new standards or outcomes. Finally, to improve the Quality Improvement process in hospital, nurse can collect data to evaluate the implementation of the plan and the achievement of outcomes. If an outcome is not met, revisions on the implementation process are needed. The nurse manager must also evaluate the work of the team members and the ability of individual team members to work together effectively. This is where the evaluation is needed to know exactly where the team stands on the team performance curve and to do that nurse may follow Katzenbach and Smith (1993) ideas on how to identify distinctive signs that a group of people is really functioning as a team.

According to the demonstration of Quality Improvement process above, the application of all the steps in QI process can be creatively applied in the issue of soft skills. Nowadays, emphasis is being given on soft skills in order to find holistic employees for company. The healthcare management is included in this mission and it is stated that soft skills are needed to improve hospitals services given by the healthcare workers. Usually, the lacking of soft skills in workplace especially by healthcare workers can create problems in term of the relationship between patients and nurse/ doctor. A nurse that treats patient without hospitality will create tension in relationship. For example, when the undesirable attitude of nurse happens such as the nurse speaks without manner. She should realize that her actions may stir the emotion of patients and sometimes if it is not being handled professionally, a fight will take place. It is crystal clear that if this situation occurs at the workplace it is compulsory for each member of healthcare services to act professional by understanding and apply soft skills while doing their work. First of all, let us look at the definition of soft skill. It can be defined as the range of general education skills that are not domain- or practice-specific, which include communication and interpersonal skills, problem solving skills,

conceptual/analytical and critical skills, visual, aural and oral skills, judgment and synthesis skills.(Boyce et al 2001, p37) .Based on this definition,soft skills are essential in workplace and the issue of soft skill has been long debated for the purpose to enhance quality improvement among workers. There are many aspects in soft skills and one of them is EQ (Emotional Intelligence Quotient). EQ is the cluster of personality traits, social graces, communication, language, personal habits, friendliness, and optimism that characterizes relationships with other

people(Lippincott Williams & Wilkins, 2010). It is mentioned that a person's emotional intelligence ( EQ) will contribute to a greater success of an individual for organization specifically in hospital. Nurses that have a good EQ will become an efficient nurse particularly because they are dealing with customers face-to-face and they must train themselves to use and integrate this skill. Furthermore, Health Ministry of Malaysia has realized the

importance of this skill and they require employees/health staff that meets the standard qualifications and now on they are focusing on soft skill. As we can see,

a health staff needs to have a high level of EQ as theywill deal with a lot of patients that have different behavior. It is a challenge for them to handle their patients and if they cannot confront the problems it will eventually lead to the feeling of anger.

This is where emotional intelligence is needed by healthcare workers basically for handling their patients effectively as being stated in Maslows Hierarchy of Needs Theory which emphasized social needs as a basic factor that is parallel with soft skills. Maslow has mentioned in social need people require the need of love, affection and sense of belongings in ones relationships with other person. Here, hospital staff has to ensure they have high level of emotional intelligenceso that they can interact better with their patients.For example, research has been conducted in St. Lukes Hospital that was founded April 1872 in South Bethlehem, Pennsylvania entitled Bolstering Staff Soft Skills Helps Hospital Face Major Challenges, A Case Study of St. Lukes Hospital & Health Network. The case study focuses on the problems of patient dissatisfaction. The hospital has overcome this problem by creating a leadership steering committee and they have used the Myers-Briggs Type Indicator (MBTI) as a useful tool to maintain the effective hospital management because it has a feature of Press Ganey scores that helps to monitor the whole aspect of hospitals performance from staff to the environment. The scores surveys patients as they leave the hospital, soliciting ratings in such areas as friendliness of the staff, courtesy of nurses, and waiting times. The QI process has highlighted the establishment of benchmarking as one way to evaluate the quality of outcomes. So, in order to be an effective healthcare member we must create a benchmarking tool similar to this Press Ganey score. The survey results can help hospitals to benchmark against one another and better understand their strengths and weaknesses in terms of customer service. This case study obviously has showed the function of soft skills (emotional intelligence) in

hospital and makes us realize that the communication and understanding between management may result in effective and productive outcome. This is an evidence of how important emotional intelligence is in developing soft skill.

Other than that, the second aspect of soft skill is in the keyword of promoting good team-work among staff and it is mentioned in QI process as assemble a multidisciplinary team In hospital, a good teamwork among staff will ensure the operation procedures run smoothly and without fatal. A proper understanding and cooperation among team members are essential for example the team members in operation room must understand each other well and they have to know the tasks within the responsibility of each person. They cannot disobey the instruction given by the leader who is the doctor as it will create difficulty in managing the operation effectively. Regular consultations are also needed among team members so that decisions could be made on a corporate basis and thus reduce changes of errors of judgment. (Singapore Medical Journal). In the practice of Health Ministry of Malaysia, team work is considered as a vital aspect in evaluating soft skill and the value of team work is defined as one team works together in order to obtain harmony as a mutual goal. According to a book entitled Pengukuhan Soft Skills untukAnggotaKementerianKesihatan Malaysia by RoslanJohariMohdGhazali and et al he has mentioned there are 8 elements in team work which are togetherness, united in goal, leadership, trustworthy, accountability, knowledge/skills, creativity /innovation and cooperation. All of these elements will contribute to a successful team building which is considered as a sequence of planned action steps designed to gather and analyze data on the functioning of a group and implement changes to increase its operating effectiveness.(Schermerhorn, Managing Organizational Behaviour) . As a

conclusion, a good team building occurs among hospital staff will increase the competencies level of staff in term of giving good services to patients. The third aspect of soft skill is related to interpersonal communication. Communication has been defined by O Reilly and Pondy (1979, p.121) as the exchange of information between a sender and a receiver and the interference of meaning between organizational participants. There is a type of communication that always happens among individual that is interpersonal communicationthat will take place between or among two or more individuals. It is perhaps the most common form of communication in organizations, because it includes all communications among employees, including co-workers, and between

management and employees.(Steers, Ungson, Mowday: Managing Effective Organizations ) .

In the situation of giving good hospital services, interpersonal communication has to be instilled in order to produce effective communication and negotiation. Healthcare worker should avoid the misunderstanding between members. For example, when the communication did not run smoothly between nurse and doctor, it will affect the patients. Many problems can happen such as nurse gives different type of medication to patients because of ineffective communication. Thus, it is the responsibility of the nurses to act according to situations and in order to do that they need to develop themselves the professional behavior in listening, interpersonal, social and communication skills, and ethical attitudes to interact with patients. (International Conference on Primary Health Care). Other than that, the effective interpersonal communication can be increased by using Sandwich Method or another name is PNP method (positive-negativepositive). The method explained that in whatever situation given, the communication has to be started with a positive remarks first and then will be followed by negative comment and after that a positive comment again. If we end a communication by giving a positive remarks/comment this will create a better relationship among our colleagues also between staff and patient. The fourth issue of soft skills is professionalism. Professionalism isthe conduct, aims or qualities that characterize or mark a profession or professional person. (Nursing Professionalism, Porterville College).In fulfilling their

responsibilities, nurses are often challenged with clinical situations that have ethical conflicts. So, nurses need skills and guidance to help resolve ethical conflicts and through Malaysian nursing education, nurses are taught to adhere to the values of the nursing profession. According to RoslanJohari in his book Pengukuhan Soft Skills untukAngotaKementerianKesihatan Malaysia, he has stated five elements in order to create professionalism which iscommitment, discipline, the best way, ethics and lastly working standard.

The element of commitment can be seen when the individual is working with full motivation and confidence. There is a dedication in term of managing the given tasks and the individual can be reliable enough when he or she does not need proper evaluation and they are able to work independently. Professionalism also occurs when the individual has a discipline. According to Stephen P. Robbins, he has stated that discipline refers to actions taken by manager to enforce the organization standards and regulations. If the member of organization believes in discipline and continue to obey the laws in the system they can maintain their good image. It is important for healthcare workers especially doctor and nurse to have discipline in their works. For example, in the hospital there has been a law not to smoke and healthcare workers must obey this law effectively. It is a given responsibility to each of hospital members to uphold the law and project a good image of hospitals employees to the patients. Other than that, the best way element in professionalism can be seen when an individual can work faster than the given time without affecting the quality of work. For example, a nurse must always work in the best way and is willing to improve herself, be in the effective level and lastly always eager to achieve betterment in work. The code of ethics has also been decoded as the behavior of an individual or their moral. (Cambridge Dictionary). Ethics is a type of control tools to ensure all workers behavior is parallel to the system. An example of the lacking of ethics in the hospital is when a doctor does not smile to patients and eventhough he did not smile there is no action can be taken against him because he does not break the law of discipline. The last conduct of professionalism is in the term of the quality of work. A worker is considered as professional if he or she is able to outreach the target work. For example, when she is conducting a survey which needs many participants and she can get more than the requirement targets. This is a level of professional and it is not judged as for the quantity but for quality as well. As conclusion the quality of work can be achieved when the norms of work has met the certain standard. Basically, the four aspects of soft skills can be improved to help nurses excel in the workplace by various methods. One of the methods is by organizing a course in developing soft skills. The Ministry of Health can play a role by organizing this type

of course to promote soft skills among their staff. Other than that, a role model can be selected by the manager to project a good image of worker. Every month, the manager can select the best worker of the month and he or she will become a role model to the other members. Every successful company has done this activity and it is proved that everyone is willing to compete to become the best worker. Next, a mentor- mentee session can be done by using a top-down approach. For example a manager can coach their supervisors, who can coach their team members. Another successful attempt to improve soft skills is the members itself must have a desire to learn and be trained as cited by Mohan Rao, a technical director with Emmellen Pharmaceuticals Ltd Mumbai defines a good attitude as behavioral skills which cannot be taught however can be developed through continuous training. Furthermore, soft skills can be improved by giving a counseling session to the selected worker who did not meet certain criteria. Based on William Glasser, the founder of Reality Therapy, he stated counseling as a proper way to help client cope with their unsatisfying behavior. Lastly, the environment plays a critical role to foster soft skills in workplace. A positive environment that promotes competition, good management and positive reinforcement will create a development in soft skills. So, an organization must always remember to instill Quality Improvement process to maintain the quality of worker. In conclusion, the soft skill has been chosen as the common issue that happens in workplace due to the specific characteristics given above. The relationship between soft skill and Quality Improvement process is intertwined due to each of them complete each other needs. Quality Improvement helps hospital workers to work efficiently and soft skills is a compulsory need for healthcare members because it is the essential key to produce a holistic individual especially nurses who meet the criteria of good clinical member. Hereby, I stressed once again that soft skills are important in nursing career as in the developing world nurses need to present themselves capable of handling the challenges in the globalization world. The world demands them to become holistic as parallel to Human Capital concept that needs an individual to be good in physical, intellectual, spiritual and emotional.