Question

PLEASE TYPE YOUR ANSWERS

CASE STUDY

Missy Mendez, a nurse manager of a 95-bed medical-surgical unit in Yucatan, Kansas, would like to have her health care organization, Yucatan Memorial Health Center, embrace the concept of a high-performance organization. She would like administration to develop a culture of a high-performing organization. Nurse Mendez knows that high-performance organizations have leaders who communicate a strong and clear mission and vision to employees, engage in strategic thinking that anticipates customer needs and market changes, commit to ongoing identification of problems, have a preoccupation with potential failures, are resilient and flexible, and use creative and improvisational problem solving to address failures or near-misses. Nurse Mendez approaches the director of nursing and provides multiple resources and contacts about the high-performance organization concept. The director asks her several questions about how she could coordinate hospital-wide efforts to describe this concept and support a customer-focused, team-based organization to support quality efforts. Yucatan Memorial Health Center, although it has a good quality improvement process, historically has emphasized individual successes and unit-based projects and tends to be punitive when managing clinical incidents.

1. Nurse Mendez proposes a change from the punitive culture to a system in which staff is rewarded for reporting errors. The director of nursing is concerned, however, that “this will obviously make it look as if we commit more errors than other nursing units in other health centers who do not use this system.” How can Nurse Mendez alleviate the director’s fears on this particular issue?
2. Part of the quality improvement process, of course, involves nurse managers implementing what Nurse Mendez refers to as a health care quality toolbox. For example, one unit frequently grapples with the problems encountered in scheduling radiology for patients. Some patients are scheduled specifically for diagnostic procedures, while others at the center are sent to radiology spontaneously by their physicians during a medical appointment. To eliminate as many scheduling problems as possible, she asks affected nursing managers to diagram causes of each scheduling conflict as it arises, including unclear policies or protocols, poor placement or number of equipment and machines, and time each patient spends in radiology awaiting either tests or results. This particular strategy is an example of what sort of tool?

3. Describe what health care quality means to you and include examples from your job site.

Answer 1

Health care quality is a level of value provided by any health care resource, as determined by some measurement.Health care quality is the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes.

Quality of care plays an important role in describing the iron triangle of health care relationships between quality, cost, and accessibility of health care within a community.

Principles of quality improvement in healthcare system:-

• Work as Systems and Processes – An organization needs to understand its own delivery system and key processes, rather than considering it as small and simple or big and complex.
• Focus on Patient – The major concept behind the quality improvement in healthcare is to get the patient’s needs and expectations which include-----Patient Safety, Patient Engagement, Systems that support patient access, Evidence-based care provision, Patient-centered communication, Health literacy of patients
• Focus on the use of data – Data is the cornerstone of quality improvement. It describes how current systems are working, tracks the changes, allows comparison and monitoring for sustainable improvements.
• Focus on Care-coordination – It is the coordination of care activities.

quality of care in health:

• safe – avoiding injuries to patients from care that is intended to help them
• effective – avoiding overuse and misuse of care
• patient-Centered – providing care that is unique to a patient's needs
• timely – reducing wait times and harmful delays for patients and providers
• efficient – avoiding waste of equipment, supplies, ideas and energy
• equitable – providing care that does not vary across intrinsic personal characteristics

Methods to assess and improve

1. Cost Efficiency Cost Efficiency, or cost effectiveness, determines whether the benefits of a service exceed the cost incurred to provide the service.
2. Critical Pathways Critical Pathways are outcome-based and patient-centered case management tools that take on an interdisciplinary approach by "facilitating coordination of care among multiple clinical departments and caregivers".
3. Health professional perspective The quality of the health care given by a health professional can be judged by its outcome, the technical performance of the care and by interpersonal relationships.

• Clinical Practice Guideline "Technical performance" is the extent to which a health professional conformed to the best practices established by medical guidelines.
• Risk Management Risk management consists of "proactive efforts to prevent adverse events related to clinical care" and is focused on avoiding medical malpractice.

4. Patient perspective Patient satisfaction surveys are the main qualitative measure of the patient perspective.

5. Technology and security perspective

six goals in the delivery of quality healthcare:

• Make care safer by reducing harm caused in the delivery of care.
• Strengthen person and family engagement as partners in their care.
• Promote effective communication and coordination of care.
• Promote effective prevention and treatment of chronic disease.
• Work with communities to promote best practices of healthy living.
• Make care affordable

Patient Safety Measures

1. Percentage of surgery patients with surgical complications or postoperative infection.
2. Rates at which patients fall and incur injury during a hospital stay.
3. Use of electronic systems for entering medication orders.
4. Patient mortality rates by type of condition (e.g., heart attack, hip fracture, pneumonia) or by type of procedure (e.g., coronary artery bypass graft surgeries, valve surgeries, hip replacement).

Effectiveness Measures --Percentage of patients receiving recommended hospital care for specific conditions such as heart attack, pneumonia care, and prevention of surgical infection.

Patient-Centeredness Measures

1. Patients’ reports on the care and service they received from the hospital.
2. Provision of care instructions upon hospital discharge for certain conditions.

Timeliness Measures --Patients’ reports on the timeliness of care and service they received from the hospital

Efficiency Measures --Utilization of hospital services or procedures as measured by the hospital discharge rate or average length of stay.

Equity Measures --Examples include:

1. Number of beds and the types of services available.
2. Whether the hospital is accredited or has other types of specialty certification.
3. The use of electronic patient medical records or prescription ordering systems.
4. Percentage of physicians who are board-certified.
5. Nurse-to-patient staffing ratios.

Clinical Examples of Quality Improvement in Healthcare

• Pharmacist-led Medication Therapy Management Reduces Total Cost of Care.

• Optimizing Sepsis Care Improves Early Recognition and Outcomes.

• Boosting Readiness and Change Competencies Key to Successfully Reducing Clinical Variation.

• New Generation Activity-Based Costing Accelerates Timeliness of Decision Support.

• Systematic, Data-Driven Approach Lowers Length of Stay and Improves Care Coordination.

• Clinical and Financial Partnership Reduces Denials and Write-Offs by More than $3 Million.