Quality Improvement in Healthcare Paper

Quality Improvement in Healthcare Paper

This paper will cover the quality improvement process in healthcare. It will also focus on the similarities and differences between the quality improvement plan processes that the Department of Veteran Affairs (VA) followed, against the quality improvement plan process listed in the book. The VA Hospital wanted to establish a quality improvement plan that would allow them to expand services and improve the quality of care being provided. The quality improvement plan must work in conjunction with the strategic plan in achieving the same goals for the organization. Managers can develop a quality improvement program to measure levels of performance.Quality Improvement in Healthcare Paper

The relationship between the concepts in the book and the plan that was obtained on the VA’s improvement plan in quality of care has provided insight on how the VA uses the same concepts that have been around for years. They have structured these concepts to fit their patient population. Their patient population consists of veterans who have suffered from traumatic and psychological injuries from serving their country. The Veterans Health Administration, the second largest government-operated health-care system in the United States, has been actively engaged in quality improvement activities since 1990 (Rand, 2005). These activities have been implemented on both a system-wide and facility-specific basis. Some quality improvement efforts have been targeted to specific clinical services; others relate to the overall process of providing patient care (Rand, 2005). The VA uses the same quality management concepts that W. Edwards Deming had instilled.

The Quality Improvement (QI) Program is designed to provide a formal ongoing process by which the health plan, participating providers and practitioners utilize objective measures to monitor and evaluate the quality of clinical and administrative services, provided to patients. A quality improvement plan addresses both general medical and behavioral health care and services, defines and facilitates a systematic approach to identify and pursue opportunities to improve services and resolve identified problems. Healthcare providers must establish outcome measures to determine how they are going to monitor treatment effectiveness (McLaughlin & Kaluzny, 2006). There are three areas of care that managers can measure. The areas are structure, process and outcomes.Quality Improvement in Healthcare Paper

The first level of care that is stated in the book is structure. Structure is the resources available to provide adequate health care. VA hospital’s have an organizational structure that many other hospitals can replicate. The first phase of the Department of Veteran Affairs quality improvement plan was the introduction/purpose. The introduction/purpose explained why the VA wanted to improve the quality of care an services they were providing. Managers at this facility wanted to design a plan that provided a framework to systematically assess, evaluate and improve structure, process and outcome related to activities both in care and services. In order to accomplish this task managers will have to ensure there is a collaborative and interdisciplinary effort among VA healthcare providers. It is critical that managers allow staff to have input on the quality improvement plan as their recommendations can benefit the organization as well.

The second level of care that is stated in the book is process. Process is the extent to which professionals perform according to accepted standards. The Department of veteran Affairs hold their employees to the highest ethical and professional standards. VA medical employees follow a chain of command to ensure there is communication at each level. In order to implement the highest standards of care the VA has teamed up with Joint Commission. An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 17,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards (Joint commission, 2010). VA medical centers work in conjunction with Joint Commission to ensure they are providing quality service to veterans.

Joint Commission employs surveyors who are experts in their related healthcare field. These surveyors are responsible for conducting surveys of the various VA medical centers. There are various surveys conducted to measure the level of care the VA is providing. Joint Commission lets the VA know areas that are weak and may need reorganization to ensure quality care is being provided. The documentation of these processes will allow organizations to gather data that will be relevant in determining whether they are providing quality care. Processes are generally documented in patient records. Since the VA has a computerized record system they are able to track different types of data.Quality Improvement in Healthcare Paper

The third level of care that is stated in the book is outcomes. Outcomes are changes in the patient condition following treatment. The VA prosthetic department has been looking for ways in which the can measure the outcome of veterans receiving artificial limbs. VA staffs are required to follow up with patients that receive limbs to ensure they are effectively using the limb. The VA has done a remarkable job in documenting outcome measure in the veteran’s record. VA hospital mail surveys to patients so that they can provide veterans with questions that will help the surveyors determine the outcome measure for the level of care the veteran received. The overall goal of outcome measures is to provide data on quality of care.

Healthcare organizations currently demand information on cost, quality and outcomes as they negotiate contracts. In order to provide quality care organizations must negotiate contracts that will provide them with the quality products and service they need to provide patients with quality services. As new benefits were added, it was necessary to analyze whether they were worth what they cost. In some cases, it was necessary to evaluate the performance of providers in order to decide whether to offer certain types of care at medical facilities. Quality improvement in the health care industry can best be defined by examining the driving forces that are affecting the industry. The evolution of health care in this country is driven by a single purpose. How can health care organizations lower cost, raise quality, and still remain competitive? The implementation of patient-focused quality improvement programs are at or near the top of the list for the Department of Veteran Affairs in their efforts to lower cost (Rogers & Joyner, 2010).Quality Improvement in Healthcare Paper

Health care managers must have a way to measure patient satisfaction. There are various ways in which patient satisfaction can be measured. It is critical that managers get feedback from patients on the service or products they have received. One question we must ask is how should we measure patient satisfaction? First managers will need to understand the purpose of measuring patient satisfaction. Measuring patient satisfaction helps us to identify patients expectations. Expectations are important because patients judge the quality of the care they receive based on their internal standards of what defines quality. These internal standards are based in expectations. In addition, it allows us to learn about patients perceptions of our service. By understanding their expectations and perceptions, we can begin to bridge the gap between how health care providers and patients define quality service (Tarantino, 2004).

In conclusion healthcare managers that use the quality improvement process should focus on satisfying their internal and external customers. The satisfying of their internal and external customers can not be accomplished without the guidance and leadership of management. Management must communicate their expectations to junior level managers. Mangers must understand that the main goal of the organization is to provide quality services to patients and employees. When managers take care of their employees, employees will be motivated in taking care of patients. Quality improvement activities emerge from a systematic and organized framework for improvement. This framework, adopted by the hospital leadership, is understood, accepted and utilized throughout the organization, as a result of continuous education and involvement of staff at all levels in performance improvement (Business balls, 2009).Quality Improvement in Healthcare Paper

? A healthcare provider may view quality in a technical sense, such as whether an accurate diagnosis is made, whether a surgical procedure is performed proficiently and whether the patient’s health has improved.Quality Improvement in Healthcare Paper

From this view, quality is the difference between what is technically sound and possible, and the actual practice and delivery of healthcare services. ? The health care manager, payer, or purchaser (employer health plan, or government program) may want to know if the healthcare services provided are cost effective. ? Public health officials may want to know if resources are being utilized appropriately to optimize population health and provided equitably within the population.

Quality as defined in Clair G. Oppenheimer book, Improving Quality: A Guide to Effective Programs, is “. . . the totality of features and characteristics of a health care process that bear on its ability to satisfy stated or implied needs; a process or outcome that consistently conforms to requirements, meets expectations, and maximizes value or utility for the customer. For the customer: getting what you were expecting and more; for the supplier: getting it right the first time, every time. The Institute of Medicine of the National Academies (IOM), a not-for-profit, non-governmental organization whose purpose is to provide national advice on issues relating to biomedical science, medicine, and health, and to serve as adviser to the nation to improve health, defines healthcare 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. ” (Retrieved July 11, 2009 from http://www. iom. edu). Further expounding the definitions provided, the IOM developed six dimensions of quality healthcare: 1.Quality Improvement in Healthcare Paper

Timeliness – refers to the length of time it takes to provide care to patients. For example, how long it takes a patient to receive a treatment or follow-up care once a breast mass is detected. Delays should be shortened to increase the efficacy of treatments and to ease the patient’s fears. 2. Safety – refers to the ability or need to avoid injuries that result from the provided care that is intended to help the patient. Injuries such as those resulting from administering the wrong drug or wrong dosage, incorrect diagnoses, etc. 3.

Effectiveness – the extent to which healthcare service is provided based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit, that is avoiding over-and underused of resources. 4. Equity – the extent to which quality care is provided without regards to a patient’s gender, geographic location, gender and socioeconomic status. 5. Efficiency – the extent to which equipment, supplies and energy waste is avoided. 6. Patient-Contentedness – the extent to which the patient’s preferences, values and needs are taken into account when providing healthcare service.

Care should be provided respectful of and responsive to the patient. Comparatively, in his book An Introduction to Quality Assurance in Health Care, Ave dis Macedonian provides seven components of what he considers quality in health care. Three of these components are included in the IOMs dimension of quality healthcare; effectiveness, efficiency and equity. The remaining four are: 1. Efficacy – the extent to which healthcare technology and science are able to bring about health improvements when used under the most ideal circumstances. 2.

Optimal – balancing the cost of healthcare improvements against the actual improvements, or in other words, by use of cost/benefit analysis ensuring that costs are not incurred which do not result in benefits do not exceed the cost or investment required. 3. Acceptability – the extent to which the expectations, desires and wishes of the patient and responsible members of their families are conformed to. There are five parts to the development of this definition: ? Accessibility – the ease with which patients can obtain healthcare ?Quality Improvement in Healthcare Paper

The patient-provider relationship – the extent to which the healthcare provider exhibits towards the patient personal concern, good manners, honesty, truthfulness, attention to the preferences of the patients, making efforts to provide explanations, patience, empathy, respectfulness and the avoidance of condescension. ? Amenities of care – the desirable aspects of the circumstances and/or environment under which healthcare is provided and includes cleanliness, adequate parking, convenience, privacy, comfort, restfulness, availability of refreshments, good food, etc. Patient preferences regarding the risks, cost and effects of care – recognition that the patient’s value of the consequences of care may differ for that of the healthcare provider and from patient to patient. Healthcare providers should take the time to explain to the patient the expected cost, risk and effects of alternatives and be guided by the informed opinions of the patients or responsible family member. ? Patient’s definition of fair and equitable As initially mentioned there are various legitimate definitions of what constitutes healthcare quality.

In developing this research paper, each of the definitions above will be utilized to address the issue of improving healthcare quality. The State of Quality Healthcare Surveys show growing concern over the eroding performance of the health care system. In November of 1999, the Institute of Medicine released a report entitled To Err Is Human: Building a Safer Health System, which concluded that 44,000 to 98,000 people die each year in hospitals due to preventable medical errors. In 2003 The National Committee for Quality Assurance (NCQA) released their first annual State of Healthcare Quality e port which found: More than 57,000 Americans die needlessly each year because they do not receive appropriate health care. The majority, almost 50,000 die because known conditions – high blood pressure or elevated cholesterol – are not adequately monitored and controlled. Others die or are at increased risk of death because they have not received the right preventative or follow-up care. [This is because] people with high blood pressure do not have it controlled, . . . people who have suffered a heart do not have their cholesterol levels monitored . . . and] smokers receive no advice to quit. Put simply, the healthcare system regularly fails to deliver care we know to be appropriate. (Nash & Goldfarb (2006) p 7-8) Although quality improvements have been made in some areas since that first report, the NCQA’s 2007 report illustrated significant room for improvement. In the area of medication management and prescription, the report found inappropriate use of some treatment medications, specifically antibiotics. Americans suffer an estimated one billion upper respiratory infections or common colds annually.Quality Improvement in Healthcare Paper