Question

In light of receiving news that the federal government compliance team would be evaluating their program, Mario Rinaldi, director gathered his staff to hold an emergency meeting and inform them that an evaluator was coming in. When Rinaldi presented the information to his staff, they were frustrated and felt like they were carrying out their responsibilities like they were supposed to, well, for the most part, but the information required in the evaluation indicated otherwise. As part of the evaluation, the team had to complete a form that required all of the demographic information of the patients served in the program. The team grew more and more frustrated. Think about legislation enforcement and what you have read so far, why do you think the team is frustrated? Would you be frustrated? Why or why not?

Answer 1

The proper functioning of healthcare system needs a market-based functioning.

Customers should be benefitted from healthy market-based competitions and which is ensured by antitrust laws. The competition of health care providers leads to cheap and best care for the consumers.

The consolidation trends among healthcare providers is not a good sign of healthcare system. Quality improvement systems play a key role in this aspect.

Quality improvement strategies in health care system play a crucial role in maintaining the standardized care. The main forms of quality improvement system are, provider notification system, transmission of clinical data when needed, audit and feedback, patient and provider education, organizational change, incentives, regulation and policy.

Tools for enforcement monitoring are:

Research and surveillance program to monitor trends and patterns in health care.

Epidemiological data and public awareness.

Monitoring mechanism - like free means to report violations

Inspections by experts

Fines for non – enforcement of law

Audit and feedback are one of the forms of quality improvement system.

Presence of the evaluator must be appreciated in this situation. The team members must understand the need for an assessment and the importance of the evaluation and re-planning. Every program must have an evaluation strategy and that should be communicated to the team well in advance. The inadequacy of data and frustrations could have been avoided by that. Continuous Quality Improvement (CQI) in healthcare involves the structure- process –outcome model. The effective use of CQI improves the grade of care and the practice standards of the healthcare personnel.

The team lacks a little in process of implementing CQI in their practice. The data must have been collected during the stage of care itself. Lack of proper policies and procedures played a role here.

The team frustrations must have been avoided by formulating and communicating policies and procedures. Winning the confidence of the team is very important in an organization.