Value Based Purchasing - Research Paper Example

? Value Based Purchasing s Value Based Purchasing Value Based Purchasing is a tool which aids in linking the national quality policy and lower cost goals. Value Based Purchasing is an exceptionally critical driver for revamping the manner in which services are paid. It links directly the payment to the quality of care offered to a patient. To improve the quality of its service delivery, in 2007, the center for Medicare and Medicaid services (CMS) embarked on the program of Value Based Purchasing. This was one of the strategies employed by CMS to renovate its payment system to necessitate rewarding of its service providers with the aim of offering efficient and top quality clinical care. Hospital acquired condition is a health complication acquired by patients during their stay in hospital (Gagliardi, Eskicioglu, McKenzie, Fenech, Nathens, & McLeod, 2008). This condition is mostly brought about by negligence among hospital professionals. Common hospital acquired conditions include manifestation of poor glycemic control, air embolism, blood incompatibility, and vascular catheter-associated infection. In most cases, surgery site infection occurs in surgery location. Frequent symptoms of surgical site infections entail: fever, severe pain, redness around the surgery location, and cloudy fluid around surgical wounds. Surgical site infections are treated using antibiotics. The antibiotics used to treat surgery site infections depend on the bacteria which have caused the infection. However, the affections are always preventable (The Victorian Quality Council Guide, 2010). Prevention of surgical site infection requires taking simple precautions such as cleaning of hands with antiseptic before the surgery, wearing special masks, gowns, hair covers during surgery, giving antibiotic to patient before and after the surgery, cleaning of hands with alcohol based hand or soap and water before and after treating each patient, as well as cleaning the skin at surgery location with soap that kills germs. Comprehensive prevention of surgical site infection is an indicator of quality healthcare practices. This is due to the fact that observing hygiene in surgery process is the core method of reducing infection. Hygiene in hospital setting is a clear indication of quality health practices. On the other hand, prevention of surgical site infection is an indication of competent professionals who can offer quality healthcare services (Anderson, Kaye, Classen, Arias, Podgorny, & Burstin, 2008). Legal implications Communication is essential in preventing surgical site infections. To start with, it is imperative for patient and the family to discuss with the doctor any previous medical problem. Some health problems such as diabetes, obesity, and allergies can lead to surgical site infections. Legally, patients have the right to get adequate information concerning their health condition. Communication will also help the practitioner in understanding the best measures to take after the surgery to prevent any form of infection. On legal issues, adequate communication also prevents emergence of court cases, especially on issues where communication failure may be treated as negligent. The health provider could be reluctant in discussing the development of surgical site infection due to some legal issues. According to health professional regulations, the emergence of health complication due to service provider negligence may result in a court case (O’Daniel & Rosenstein, 2009). The legal procedure used to communicate surgical site infections is sometimes very complicated. Confidential legal issues can also be an additional hindrance towards disclosing the development of surgical site infections. Deterioration of the patient health condition constitutes the main ramifications for not discussing the development of the surgical site infections with the family or patient. Legally, the healthcare providers may be accused of diligence in their work. In this case, the physician may be accused of failing to comply with the set professional standards. The law provides for immediate disclosure of any complication that may emerge in the course of treatment. Failure to disclose the surgical site infection is pure violation of the patient rights. The communication of surgical site infection can be done in two ways. To start with, the information can be communicated to the patient through notice of privacy practices. The notice must be written in simple terms, include a heading that describes the purpose of the notice and describe the patient rights under privacy rule. Secondly, patient can be informed about his/her condition through obtaining authorization from the client. The patient should be consulted before being informed about the complication. This will help in the reduction of any negative outcome that might emerge as a result of receiving the frustrating information. The information can be disclosed to the patient either in absence or presence of family members. There exists close relationship between disclosure and ligation. Disclosing of patient health conditions by health practitioners to other parties without the permission from the patient can lead to litigation. Legally, physicians are expected to keep client information confidential. On the other hand, failure to follow the laid down procedure in disclosing client information can also result into litigation. Accreditation expectations More than 82% of hospitals in the United States of America have received the official approval from the joint commission. This is after meeting the required standard in health care service delivery. The joint commission expects the following conditions to be met regarding to the prevention of surgical site infections. Licensed practitioners and other staffs should be educated about the surgical site related infections as well as the relevance of taking prevention measures. The educations should take place during the recruitment exercise and in the process of treatment. Patients and their families ought to be educated about the surgical site infections prevention measures. Policies intended to prevent the risks associated with surgical site infection should be fully implemented. These policies must meet the regulatory requirements as well as the evidence based guidelines. On the other hand, in the removal of hair in the surgery location, practitioner should follow the scientific requirement that is sited and endorsed by international professional organization (Gaudette, 2010). Assessment by Surveyors during Accreditation Survey The core purpose of assessment in the accreditation survey is to examine the level in which hospitals have complied with the laid down regulations in regard to prevention of surgical site infections. In the accreditation survey, surveyors conduct periodic evaluation on surgical site infections in accordance with the time frame given by the hospital. In the assessment, surveyors evaluate the individual performance using evidence-based guidelines as well as best practice regulations. Surveyors also monitor patient complaints in reference to the evidence-based guidelines. Surveyors also monitor the relevance and effectiveness of prevention measures available in a hospital. Outcomes related to cost and quality There are various continuous quality improvement strategies that an individual can use for purposes of involving health care members in implementing and planning improvements related to surgical site infection issue. The improvements consist of the following actions: the reduction of four surgical complications that are common such as dangerous blood clots, surgical wound infections, and pneumonia associated with ventilator and preoperative heart attacks. The improvement strategies can take the form of mailing an information package to all health care providers and hospitals including a participation form, some materials and a video tape. These help in explaining what Surgical Care Improvement Project (SCIP) entails and how it conducts its operation. Another strategy is via educating caregivers and hospitals on various practices demonstrated through studies and research to diminish surgical complications. The practices include antibiotics administering prior to surgery to eliminate surgical site infection, ventilator patient’s beds head elevation following surgery to reduce cases of pneumonia, and blood thinner administering to patients at high risk prior to surgery to stop blood clots. In addition to resources and tools provision for purposes of adopting these safety practices, Surgical Care Improvement Project participants will be allowed to benchmark their performance against their competitors. (Surgical Care Improvement Project, 2005). Performance improvement levels Continuous quality improvement (CQI) under its distinct labels is a perspective, an approach, and a group of activities. It is applied to four distinct categories of performance improvement levels undertaken within a certain institution (Pham et al., 2006). The levels are such as evidence-based medicine and management, localized improvement, organizational learning and process reengineering. Localized improvement results when an expertise team is developed in order to examine a specific process opportunity or problem. Organizational learning results when the process in localized improvement is documented and leads to the development of procedures and policies. The policies and procedures are then implemented. Examples are such as the development of procedures, protocols and clinical pathways among others. Process reengineering occurs when there is investment in both external and internal resources. This is done with the aim of initiating change. The changes include information system development which impacts radically on the principal organizational processes. Evidenced-based medicine and management consist of the identification of the best management and clinical practices. These practices are determined via professional literature examination and internal experience consideration. The demarcation line between the discussed performance levels is not clear. This is because the occurrence of performance improvement is across a continuum of clinical content, project size, involvement of external consultant, impact and departure from the norms that are in place (Johnson & Sollecito, 2009). Role of Education, Research, Collaboration, information technology, leadership and team work in addressing surgical site infection Leadership: Strong leadership is the mother of everything. Strong leadership should not tolerate unethical behaviors such as “exceptionalism” attitudes when it comes to matters dealing with procedures and policies as every individual has to be held accountable and responsible for their actions. Effective leadership should support and expect inter-disciplinary and personal training and education. All these need a commitment to allocate time and funding for personnel to accomplish the above even in hard economic times. With this in mind, leaders can establish a culture of expectation for staff to offer medical devices and surgical instrumentations that are cleaned properly, sterilized and decontaminated. This eliminates these devises as possible avenues of surgical site infections. Education: Given the multi-faceted and complexity of health care institutions, personnel training is vital. It focuses on the understanding of the relationship and interactions between various departments highlighting personal competency, data and outcomes reporting, and the use electronic medical records in dealing with surgical site infections. Collaboration: Collaboration is a fundamental tenet of a team work that is successful. Whether operating across or within teams, individual responsibilities and roles mutual understanding, learning how to effectively work together, comprehending the need to share information among staffs and acknowledging the significance of regular interactions enhances effective collaboration. Taking into consideration the number of disciplines and people who contribute to home experience of a surgical patient, sustainable and effective collaboration has to occur. In addition to that, all must be empowered, educated and engaged. Information technology: Information technology advances, disparate data standards harmonization and the ability to integrate and connect with types and sources of multiple data – all come up with new opportunities for Health and Human Services Department and federal agencies to refine and re-think strategies. The strategies are to focus better on the improvement of the national capacity to measure, prevent and monitor the occurrence of surgical site infections. Information technology aids in achieving more complete and rapid detection of surgical site infections via increasing the capability of individuals to exploit future and current data sources. In addition to that, it increases the dissemination rate of reporting data to various agencies resulting in rapid detection of trends and patterns of surgical site infections. Teamwork: With regard to quality healthcare provision, teamwork is extremely essential. This is because no single health care provider can deliver a healthcare complete episode. However, there exists little research done on the training and education needs of the professionals in the health care to trigger their participation in workplace teams. This is because they do not acknowledge the personal competences needed for team success (Dubnicki & Limburg, 2001). Research: Research helps in identifying the need to control factors that are physiologic that play a great role in the spread of surgical site infections. In addition to that, research helps in the evaluation of new data on nasal decontamination and skin antisepsis as surgical-site infection prevention strategies. Moreover, it helps in recognizing strategies for overcoming surgical-site infections barriers to the implementation of preventive recommendations. Of the four strategies discussed above, team work can generate positive outcomes and is the least expensive to implement. This is because it involves employment utilizing their area of expertise to improve on the performance of the institution. As a matter of fact, each member in a team has unique skills experience, value, attitudes, role personality and perception. This determines what they are able and willing to contribute, their motivation level and their interaction methods with group members, their acceptance degree of organization goals and group norms. Management competencies are a source significant for an organization competitive advantage (Sicotte et al., 1993). References Anderson D., Kaye K., Classen D., Arias K., Podgorny K., & Burstin H. (2008). Strategies to prevent surgical site infections in acute care hospitals. Infection Control and Hospital Epidemiology, 29, 51-61. Dubnicki, C., & Limburg, W. J. (2001). How do healthcare teams measure up? The Healthcare Forum Journal, 34, 10–11. Gagliardi, A., Eskicioglu, C., McKenzie, M., Fenech, D., Nathens, A., & McLeod, R. (2008). Identifying opportunities for quality improvement in surgical site infection prevention. American Journal of Infection Control, 37 (5), 398-402. Gaudette, V., (2010). Clinical Care Improvement Strategies: Preventing Surgical Site Infections. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations. Johnson, J. K., & Sollecito, W. A. (2013). The global evolution of continuous quality improvement: from Japanese Manufacturing to Global Health Services. New York: Jones & Bartlett Learning. Surgical care improvement project. (2005). Trustee, 58(9), 4-4. O’Daniel, M., & Rosenstein, A. (2009). Professional communication and team collaboration. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Pham, H. H., Jennifer, C., & Ann, S. O. (2006). The Impact of Quality-Reporting Programs on Hospital Operations. Health Affairs, 25(5). Sicotte, C., Pineault, R., Lambert, J. (1993). Medical interdependence as a determinant of use of clinical resources. Health Services Research. The Victorian Quality Council Guide. (2010). Promoting effective communication among healthcare professionals to improve patient safety and quality of care. Journals of Health Communications, 23, 13, 89-123. Read More