Quality in Health Care Administration - Essay Example

LESSON 3 1. Chapter 7 of our text has assessed the transformation in health services, explored the changing roles of CQI, and evaluated new approaches to transformation and organization learning. a. Explain the differences between the professional model for health services and the transformational model, using Figure 7-1 of our text as reference The transformational model for health services was developed in order to address the evolving scope of health care practice by providing a framework to support the requirements of effective patient care and professional practice strategies (Upshaw, Kaluzny & McLaughlin, 2005, P192). This model engages the processes involved in developing health care delivery in the 21st century and how these processes may impact the health service industry. The Transformational Models consists of four major areas. These are 1. Professional Practice Component; 2. Process Component; 3. Primary Outcomes; 4. Strategic Outcomes. The Professional Practice Component involves analysis of professional interactions and associations that represent effective care management strategies (Upshaw, Kaluzny & McLaughlin, P192) The Process Component involves a critical assessment of the factors required for the delivery of effective patient care that is individualized to meet the needs of each patient, and the effective management of resources and professional associations required to address patient needs. Primary Outcomes addresses issues such as quality care from the perspective of patient and health professional. Strategic Outcomes involves a broader perspective of outcome in relation to health organizations and healthcare consumers. The Professional Model has a more restricted focus than the Transformational Model as it concentrates on the professional health care delivery system from the vantage point of the caregiver (Upshaw, Kaluzny & McLaughlin, P193). The focus is more traditional, based on the autonomous decision-making role of the individual caregiver. The Transformational model is collaborative and reflects the increasing organizational complexity of the healthcare delivery system. This model incorporates many aspects of professional development that are critical to successful health care delivery, and many aspects of the Professional Model are included in the Professional Practice Component of the Transformation Model. The major areas of focus in this area of the Transformational Model overlap the Professional Model, including Professional Growth, Transformational Leadership, Collaborative Practice and care Delivery. The Professional Practice Component is the most important area of the Transformational Model, and is more dynamic and expansive in its professional goals and overall global perspective on health care delivery than the Professional Model.  b. Discuss the distinguishing characteristics fundamental to CQI that are found in the transformational model. The Transformational Model contains many elements that are central to CQI. Continuous Quality Improvement is an important management concept that has been applied to the delivery of health care services to achieve the most effective practices from the perspective of health consumer and health professional (Upshaw, Kaluzny & McLaughlin, 2005, P193). These concepts intrinsic to CQI are encompassed in the Transformational Models as its primary focus is to achieve effective health care delivery in the context of a dynamic and evolving health care system. Both philosophies engage the concept that responsiveness to changing conditions is an essential component of effective management practice. The Transformational Model incorporates this vision in that it has broad-spectrum application to a diverse health care system. It also accommodates the principle of continuity of effective approaches in that it a processive model built on incoming data and in that its application may be customized to meet the needs of differing health care delivery structures. These contemporary management models combine the need for an integrated approach to the management of diverse areas of infrastructure with the need to preserve individuality, cultural conditions and dynamic responsiveness to changing conditions that define health care systems today (Upshaw, Kaluzny & McLaughlin, 2005, P195). CQI as applied to health care delivery systems overlaps many areas of the Transformational Model, including a focus on improvements in clinical professional performance in the areas of evidence-based medicine, case management and an increased focus on individualized patient care. These principles of CQI are at the hearty of the Transformational Model. The Transformational Model provides the necessary tools for the implementation of CQY into health care systems (Upshaw, Kaluzny & McLaughlin, 2005, P197). Among the distinctive characteristics of CQI found in the Transformational Model are: 1. importance of collective as well as individual responsibility throughout the healthcare organizational delivery system; 2. individuals at all levels of institutional hierarchy are outcome driven in their management approaches, focusing on the collective outcome goals in their decision-making processes and management criteria; 3. Individuals involved in institutional management engage in shared decision-making that reflects the input and needs of diverse areas within the organization; 4. continuous planning is required as a management strategy to meet the changing needs of the organization; 5. Management should address prospective institutional needs in the future and engage in strategic planning approaches; 6. Performance enhancement appraisals should be conducted on a regular basis to reward exceptional and innovative management and leadership. 7. The model for responsiveness to a changing healthcare organizational dynamic is a continuous innovation approach. 2. Explain the ways that managed care has transformed health care by changing the way we provide health care and manage our organizations. Managed care has had a profound effect on health care delivery and organizational management (Haas, 2006). These changes have been driven by market forces that reflect an increased emphasis on cost management and health consumer satisfaction. The outcome of the changing perspective has been the implementation of regulatory controls that directly affect the delivery of primary health care and the organization of the healthcare delivery system. These regulatory controls are both governmental and private-industry driven. While these structural management changes evolved to meet the needs of an increasingly sophisticated and expensive health care system, its profound effects on healthcare delivery and management may negatively affect the long-term quality of the healthcare industry. Some of the specific ways that managed care has affected the health care system delivery have involved financial incentives to physicians and, more recently, to healthcare consumers to influence decision-making processes at the level of provider and consumer (Flynn et al, 2002). Healthcare management procedures also utilise extensive procedural policies and reviews that have placed a tremendous regulatory and bureaucratic burden on healthcare providers. The regulatory component has had a highly restrictive effect on the delivery of patient services and in some cases has undermined the professional authority of the healthcare physicians to mange critical aspects of patient care. The element of health consumer choice has also been increasingly affected by limited provider networks. In all of these areas, efforts at cost-control have come with an expensive price-tag. The challenges encountered in the managed-care approach to healthcare delivery systems may only continue to increase in the foreseeable future as the healthcare system becomes increasingly complex (Dudley et al, 2000). It is extremely difficult to assess the individual effects of management approaches on healthcare system organization and delivery as so many interrelated variables are influenced by specific managed-care initiatives. Moreover, so many aspects of management have changed so rapidly that the healthcare industry is in a state of flux that is difficult to assess using empirical approaches. 3. Physician participation and involvement in organizational change and transformation is of utmost importance. Discuss the strategies that managers can use to secure participation from their physician leaders involved in this important process. Physician involvement and participation in organizational change for the purpose of improving and streamlining healthcare delivery mechanisms is essential to achieve systemic change; however, it is difficult to engage many physicians in this process (Upshaw, Kaluzny & McLaughlin, 2005, P202). Among the important strategies developed to enhance physician participation are educational approaches to inform physicians directly about the importance of participating in institutional change. These informational strategies could take the form of professional association meeting sessions devoted to this area of instructtion as well as printed materials widely distributed to bring about greater physician awareness of this critical health care issue. Another strategy involves the recruitment of physicians to engage in leadership roles in organising small professional groups charged with the goal of addressing healthcare management issues. Physicians have many leadership qualities that could be well-utilised if an organizational approach is used to address issues of organizational change and management (Upshaw, Kaluzny & McLaughlin, 2005, P204). The medical profession needs to facilitate physician networking strategies to foster better communication about organizational and management issues (Upshaw, Kaluzny & McLaughlin, P207). The perspective must become more global, as physicians are encouraged to interact with each other across institutional boundaries to effect organisational changes and to provide their input into decision-making processes that affect their capacity to deliver high quality health care to their patients. 4. Define the terms safety and adverse events, as they relate to patient safety in healthcare. In your discussion, also explain the adverse monitoring and detection systems that are used in healthcare organizations today. Patient safety is of the utmost importance to healthcare providers and, as such, is a critical component of CQI (Savitz & Bernard, 2005, P211). Healthcare quality may be defined as the achievement of a beneficial patient outcome that is limited only by the professional bounds of knowledge in the treatment of disease or dysfunction. Problems in patient safety in the context of healthcare delivery may arise in the misuse, under-use or overuse of services (Savitz & Bernard, 2005, P212). This is related to structure, process and outcome, in the context of patient care. Structure involves the healthcare system and the individuals who engage in patient care services. Processes involve procedures, tests and other measures taken to diagnose or provide care for a patient. Outcome characterizes the patient’s state of health as a result of the intervention. Adverse events may be characterized as the failure or unintended result of a planned action designed to provide care for a patient that results in a poor outcome (Savitz & Bernard, 2005, P213). Medical errors may active, resulting directly from physician-patient interactions or may be latent, resulting from indirect events, such as poor training resulting in lack of expertise. The assessment of adverse events in clinical settings indicates that many are the result of long-standing conditions, the proverbial “accident waiting to happen”. In this context, ongoing assessment may have an important preventive effect in decreasing the frequency of adverse events in healthcare delivery. It has been estimated that system safeguards and staff alertness and awareness of potential problems could dramatically decrease the frequency of occurrence of AMEs in clinical settings. There are multiple sources of AMEs that may be characterized by a systems approach to include aspects of the treatment approach, the condition of the patient and the environment. Each of these parameters may contribute to latent conditions that may result in AMEs (Savitz & Bernard, 2005, P213). While it is recognized that it will never be possible to eradicate AMEs completely, current approaches stress internally driven management approaches designed to foster improvements in health care delivery that will simultaneously reduces the occurrence of AMEs. In this regard, evidence-based practice guidelines have been very important in constructing models for quality improvement in healthcare delivery. Adverse event monitoring involves the detection of warning signals that require intervention (Savitz & Bernard, 2005, P216). These signals may be generated wither prospectively, retrospectively or concurrently with patient care. Adverse event detection systems using internet technology/software then analyses groups of data to identify potential areas requiring intervention or further assessment. These patient safety indicators (PSIs) can be used to assess data from multiple institutions to formulate more sensitive response indicators. Patient safety systems are also increasingly utilizing the IT model as it can give a more comprehensive assessment than individual observations. Evidence based quality improvement parameters are available (such as the AHRQ Quality Indicators) that assess Prevention, In-Patient and Patients Safety QIs (Savitz & Bernard, 2005, P219). These IT systems assess patient discharge data using software to incorporate this information into quality improvement design applications. 5. Describe the “Failure Mode and Effects Analysis (FMEA)” tool and explain how it is structured and how it is used in excavating adverse medical events. Failure Mode and Effects Analysis (FMEA) is involved in probabilistic risk assessment (Savitz & Bernard, 2005, P225). Traditionally used in hazardous industries, it is becoming an important tool for risk assessment in hospital settings. FMEA represents a structured approach to risk assessment and interpretation. It can also be used in process conceptualization and in preventive design approaches. FMEA has been incorporated into CQI management approaches to provide greater structure to the prevention and assessment of AMEs (Savitz & Bernard, 2005, P226). The US FDA has recommended the implementation of FMEA in the Process Safety Management Act. It is rapidly becoming a global tool for safety and risk management. There are a number of structural components to FMEA as it relates to patient safety and AME prevention (Savitz & Bernard, 2005, P227). These include the formation of groups of experts to engage in high risk care management who function under the direction of a trained facilitator to discuss, analyse and apply results obtained from data input. The goal is to identify the causes of AMEs, to characterize their occurrence and frequency and to strategise approaches designed to reduce risk of occurrence. The ultimate goal is overall quality improvement in patient healthcare delivery and a minimization of AMEs in the clinical setting to the extent possible. LESSON 3.2 1. After you have read the “Historical Underinvestment in Health Care Information Technology” in Chapter 10 of our text, please briefly discuss the history, beginning in the 1980’s, that relates to the adoption of information technology into our health care industry. Also, explain why you think it took us so long to start investing in healthcare information technology. The adoption of Information technology (IT) in the healthcare industry began in the 1980s when large-scale IT providers began implementation of IT technology in hospitals and other patient-care facilities. (McLaughlin & Kibbe, 2005, P244). The providers assumed that the technology would be rapidly incorporated into the medical infrastructure with little outside intervention or modification of existing systems IT. The pace was slow and the healthcare industry soon fell behind other industries in the successful implementation of IT. There was also extreme reluctance of physicians to convert to IT forms of communication regarding prescriptions and patient orders. Only 2.2 % of revenue was invested by the healthcare industry in IT in 2004, about 25% of the investment of many other major industries. While Physicians have been reluctant to fully adopt IT practice, their offices are generally equipped with computers used for appointments and billing. (McLaughlin & Kibbe, 2005, P245). Electronic medical record (EMRs) and health records (EHRs) are increasingly available and physicians have been encouraged to adopt their use. Moreover, increasing concerns in the area of patient safety has created an imperative that physicians incorporate more highly integrated IT tools for patient management into their practices The long delay in implementing IT in the health care industry as compared to many other areas was in part to the highly fragmented organization of the health care industry which made implementation a highly complex process. All aspects of the decision-making process, including the acquisition of financial and technical resources required to develop IT infrastructure within the healthcare industry were slow to materialise. The process of internet “conversion” has been made even more difficult by HIPAA (Health Insurance portability and Accountability) requirements for confidentiality that might be more easily breached in IT modes of communication. (McLaughlin & Kibbe, 2005, P247). In addition, physicians have been very reluctant to standardize their practices to fit the specifications of IT. Physicians tend to be very independent and continue to work in small practices that emphasise personalized patient care. They may not see the need to extensive computerized records or communications. All these factors have contributed to the slow progress of the successful utilization of IT systems in patient healthcare management. 2. Explain how and why the traditional QA system uses centralized data and information, and how and why CQI uses mostly decentralized management of data, information and knowledge. The switch from management systems based on quality assurance (QA) to CQI demands a greater reliance on organized IT approaches to patient management. (McLaughlin & Kibbe , 2005, P248).The scope of CQI is far broader than traditional QA, and requires input from a greater range of data sources which is circulated to and assessed by multiple individuals who then communicate with each other in decision-making processes. CQI thus requires an interdepartmental multifaceted approach to information flow and assessment that requires IT. In contrast, traditional QA generally involves a one-way flow of data/patient information from patient to QA departments and then to peer review committees for assessment (McLaughlin & Kibbe, 2005, P248). This reflects a centralized approach in which data from multiple departments is funneled to a central processing department and then ultimately to a more centralized assessment committee. There is little data feedback unless a problem occurs. QA was also very focused on administrative and financial data that is more easily adapted to this centralized approach. CQI assessment is multi-faceted and is designed to promote ingoing quality improvement by facilitating the exchange of information in a two-way flow from patient to physician to CQI management and then back to physicians and other clinicians to enhance the quality of patient care (McLaughlin & Kibbe, 2005, P250). CQI is based on an interdisciplinary approach requiring extensive feedback and inter-departmental communication. This approach reflects a more decentralized approach to data management that relies heavily on IT. CQI management systems require extensive use of IT networking by well-trained staff to accomplish these management goals. 3. Discuss the Data-to-Decision Cycle and how it works, and define the terms data, information, and knowledge that are used in the Cycle. Also, include in your discussion how the data, information, and knowledge process works and supports decisions and actions for improved performance. The Data-to-Decision Cycle is a theoretical construct designed to facilitate the understanding that outstanding performance at the organizational level is directly linked to successful information management and technology (McLaughlin & Kibbe, 2005, P253). The cycle represents that data is the source of information, that information is the source of knowledge and that knowledge is the basis of effective decision-making. Good decisions produce actions that comprise the source of excellent performance (outcome). The components generate a cycle indicating that feedback is continuously evaluated to impact data collection giving the system flexibility and responsiveness to changing conditions, essential to CQI. Data are defined as isolated facts that convey no intrinsic meaning, but comprise the essential elements that are input into the system/cycle ( McLaughlin & Kibbe , 2005, P255). Information is defined as meaningful data. Data that have been classified organised and compared with similar or reference data facts may be converted into useful information (McLaughlin & Kibbe , 2005, P255). Knowledge results from the synthesis and interpretation of information. The information is assessed with a view towards prediction. Patterns of information suggest trends and/or reproducibility that provide a knowledge base for prediction. The knowledge can then be used for decision-making purposes based on its predictive value (McLaughlin & Kibbe , 2005, P256). 4. Discuss the information management issues, concepts, and technologies that are needed for information management that health care professionals involved in CQI need to know about. Please explain why this knowledge is important to the healthcare professionals working in CQI. Healthcare professionals working in CQI need to be informed about a diverse spectrum of information management issues concepts and technologies central to the effective implementation of CQI principles. CQI involves a dynamic, broad spectrum approach to management issues that reflect continuous and evolving efforts to deliver high quality healthcare in the context of a complex, multifaceted healthcare system (McLaughlin & Kibbe, 2005, P260). The capacity to achieve this goal require the skill to assess many forms of data from varied sources, the technological tools to evaluate multiple and diverse data sources and the ability to utilize IT to communicate rapidly and effectively with management teams at all levels. One important Issue relates to the effective organization odf data to obtain useful information that ultimately becomes the source of effective decision-making (McLaughlin & Kibbe, 2005, P263) . Expertise in data management is essential to assess diverse data sources and entries to generate meaningful information. The implementation of useful database management systems using IT is an essential component of this process. Interface standards are also required that facilitate the rapid communication between departments, individuals and institutions. CQI management professionals should be trained to utilize these IIT communications tools (McLaughlin & Kibbe, 2005, P266). The electronic maintenance and transmission of healthcare records is another essential component of effective CQI. This is an extremely important issue as it relates to quality healthcare but must be highly protected to ensure patient privacy. A system of universal patient identifiers is a very useful tool for reliably communicating patient data and care protocols via the internet. Each of these areas is critical to the development of effective CQI healthcare management approaches. References McLaughlin, C. & Kibbe, D. (2005). Information management and technology for CQI. In Continuous quality improvement in health care: theory, implementations, and applications (Chapter 10, 243-277). Curtis P. McLaughlin & Arnold D. Kaluzny (eds.) Boston: Jones & Bartlett Publishers. Van Matre, J., Slovensky, D. & McLaughlin, C. (2005). The human face of medical error: classification and reduction. In Continuous quality improvement in health care: theory, implementations, and applications, Curtis P. McLaughlin & Arnold D. Kaluzny (eds.) Boston: Jones & Bartlett Publishers. Dudley, R., Landon, B., Rubin, H., Keating, N.. Medlin. C. & Luft, H. (2000). Assessing the relationship between quality of care and the characteristics of health care organisations. Medical Care research and Review, 57(3), 116-135. Flynn, K., Smith, M. & Davis, M. (2002). From physician to consumer: the effectiveness of strategies to manage health care utlisation. Medical Care research and Review, 59(4), 455-481. Liang, S., Phillips, K. & Haas, J. (2006). Measuring managed care and its environment using national surveys: a review and assessment. Medical Care research and Review, 63(6s), 9s-36s. Read More