Quality Improvement Report
Health care quality improvement focuses on promoting the best possible outcomes for patients. Historically, quality was determined by individual providers and lacked standardization. “How care is provided should reflect appropriate use of the most current knowledge about scientific, clinical, technical, interpersonal, manual, cognitive, and organization and management elements of health care” (Ransom, Joshi, Nash, & Ransom, 2008, p. 3). This paper will discuss the foundational frameworks of quality improvement, the various stakeholders involved, quality management needed in the industry, and accrediting and regulatory agencies involved in quality improvement.
The Foundational Frameworks of Quality Improvement
The foundational frameworks of quality improvement can be traced back to the “influential contributors and thought leaders of quality improvement systems and theories intent on improving process and producing sustainable quality results at highly productive levels” (Ransom, Joshi, Nash, & Ransom, 2008, p. 63). Walter Shewhart is one inspirational leader who addressed reliability of a process by focusing on limiting variation through statistical analysis (Ransom, Joshi, Nash, & Ransom, 2008). He is also credited with acknowledging the importance of establishing a common language for what is being measured, which is known as operational definitions (Ransom, Joshi, Nash, & Ransom, 2008). “Shewhart introduced the concept of statistical process control (SPC), which has since become the cornerstone for process control in industry” (Ransom, Joshi, Nash, & Ransom, 2008, p. 64).
Edward Deming is another foundational leader in quality who built upon Shewhart’s work. Incorporating data based principles with the work started by Shewhart, Deming believed that “organizations can increase quality and customer loyalty and simultaneously decrease costs by reducing waste, rework, and staff attrition” (Ransom, Joshi, Nash, & Ransom, 2008, p. 64). Deming introduced the concept of continuous improvement and systems thinking (Ransom, Joshi, Nash, & Ransom, 2008). The Plan-Do-Study-Act cycle is a contribution from Deming, which is still being used today.
Health Care Stakeholders
There are various stakeholders invested in quality improvement, and each stakeholder brings their own perception of quality. The CEO of a company might be interested in the compliance of meeting regulatory standards, as compliance may directly affect payer reimbursement and therefore, financial health. The provider as a stakeholder would have to buy in, and follow clinical guidelines and charting required that support the evidence based regulatory standards (Dlugacz, 2006). If the provider does not agree with the regulatory guidelines, the organization may find themselves at financial risk. Depending on the motivation of the stakeholder, quality improvement may have different definitions.
Clinicians as well as patients should engage in active roles to support quality improvement. Caregivers should be informed of the regulatory and accreditation requirements that pertain to quality. Operational leaders should create an environment that is conducive to meeting the identified quality requirements. Senior leaders should also support a culture that holds everyone accountable to quality improvement. Patients can become involved through Patient Advisory Committees (PAC). Operational leaders may include the chairman of the PAC at their leadership meetings. Including a PAC member at leadership meetings would ensure that the voices of patients are heard while operational and process decisions pertaining to quality are being created (Ransom, Joshi, Nash, & Ransom, 2008).
Quality Management Needed in Health Care
Quality management is needed in the health care industry because the payers of health care expect the highest degree of care to be delivered for the least amount of money possible. “The CMS contracts with medical organizations to ensure that the medical care paid for with Medicare funds is reasonable and necessary, meets professionally recognized standards, and is provided economically” (Dlugacz, 2006, p. 4). Data on identified metrics provide objective information in which value can be demonstrated to all quality improvement stakeholders. “Through using measures an organization can prove that its product is good, reassuring the public about safety and thus maximizing revenue” (Dlugacz, 2006, p.6-7). Areas to monitor for quality include operational excellence, clinical excellence and service excellence. “Measures can be used to correlate clinical, organizational, and financial performance” (Dlugacz, 2006, p. 10).
Accrediting and Regulatory Organizations Involved in Quality Improvement
Accrediting and regulatory organizations involved in quality improvement include the Joint Commission, and the Centers for Medicare and Medicaid (CMS). “The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), CMS, and other such agencies define the quality indicators health care organizations are expected to collect for evaluation and for accreditation” (Dlugacz, 2006, p. 18). Helpful resources that affect quality improvement include the Agency for Healthcare Research and Quality (AHRQ). This is “the health services research arm of the U.S. Department of Health and Human Services (HHS), complementing the biomedical research mission of its sister agency, the National Institutes of Health” (AHRQ, n.d. para. 1). Thee AHRQ focuses on “quality improvement and patient safety, outcomes and effectiveness of care, clinical practice and technology assessment, health care organization and delivery systems, primary care (including preventive services), and health care costs and sources of payment” (AHRQ, n.d. para. 1).
Conclusion
In conclusion, robust health care quality improvement is essential to support desired quality health care outcomes. There are various stakeholders, who have their own perspectives on health care quality. Health care quality management is necessary because payers demand efficient, safe, high quality care that is effective. Accrediting and regulatory agencies involved in quality improvement include the Joint Commission and CMS.
References
AHRQ. n.d. What is AHRQ? Retrieved from: http://archive.ahrq.gov/about/whatis.htm
Dlugacz, Y. D. (2006). Measuring health care: Using data for operational, financial, and clinical improvement. San Francisco, CA: Jossey-Bass.
Ransom, E. R., Joshi, M. S., Nash, D. B., & Ransom, S. B. (Eds.). (2008). The healthcare quality book: Vision, strategy, and tools. (2nd ed.). Chicago, IL: Health Administration Press.
