Question

Even after accounting for patient’s severity of illness and population demographics, there are significant variations in hospital outcomes. What are some of the actions that can be taken in order to reduce the outcome variation? Provide at least one example of a policy (state or national level) in recent history (passed in the last 15 years) which was introduced to reduce these variations. Provide a brief history of the policy and a brief summary of it, as well as key aspects of the policy.  

Answer 1

1) Reducing unnecessary variation continues to be a hot topic in healthcare. Knowing where and how your organization plans to address variation is key to measurable, sustainable improvement.
Working with leading healthcare organizations across the continuum has led our team to identify a framework for success in efforts to reduce variation in care.

1. Identify Opportunity

Understand which areas are not meeting benchmarks, and dive into what actions and procedures are driving the variation in outcomes. This effort should examine clinical outcomes andfinancial and operational data, along with observations and discussion amongst clinical improvement teams. Clinical outcomes are incredibly important, as patients and reimbursements are impacted, but hospitals and health systems also have to operate sustainably in order to continue to provide essential care. Between January 2010 and January 2018, 83 rural hospitals closed their doors – and the trend is not expected to slow.As with any effort, organizations should prioritize their efforts – whether based on the expected results or system-wide goals, choosing a focus area or areas is a key component of performance improvement. Weighing clinical variation against issues that are creating a significant financial burden will allow organizations to prioritize high-impact initiatives.

2. Align Initiatives
Getting the clinicians and providers who do the work on board is essential – and their input can provide insight into where processes are breaking down. By creating specific action plans that assign accountability to care teams and providers, organizations can measurably improve outcomes and reduce variation.Too often, system-wide initiatives diverge from what stakeholders are being asked to do, which creates conflicting priorities and decreases the chances of success. Care teams are already overwhelmed and doing the best they can, and assigning performance goals that are not aligned to organizational objectives creates an unnecessary conflict.

3. Change Behavior
Behavior change is often the hardest part of reducing variation, and in truth involves two fundamental elements (at least).

Written Standards of Care
Without written processes for normal and abnormal cases, variation is an expected outcome. This is an important data point in understanding why certain outcomes are negative and a fundamental element of empowering providers. Drilling into specific cases where variation exists often reveals that standards were not followed – if there are no clear, documented standards, then the argument can be made that whatever outcome resulted should be expected.

Care teams should also be able to reduce their cognitive load by referring to a clear standard of care. Burnout is rampant in healthcare, and asking providers and clinicians to store standard processes mentally in high-stress situations involving patient lives places additional strain with no real gain.

Understanding of Knowledge and Skill Gaps

Identifying where care teams are lacking knowledge or skills helps your organization gain insight into why variation continues to exist. With continuing education often centered around compliance or organizational goals, knowledge or skill deficits go unaddressed and can contribute to negative patient outcomes.

4. Assess Outcomes
Monitoring improvement efforts and adjusting efforts as necessary ensures that change is happening. The same data that was used to identify and prioritize improvement efforts should be used to measure the success of initiatives. As efforts to reduce variation produce sustainable improvement, organizations can reassess areas of focus and continue to deliver better patient outcomes, reduced costs of care, and improved population health.Every team will approach these key components in their own way, but using these building blocks to approach change will help your organization to overcome common barriers and increase the likelihood of success.

2) Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over numerous persons. By estimating the overall risk of health riskand health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement.[1] The benefit is administered by a central organization such as a government agency, private business, or not-for-profitentity.According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. It includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment.

A policy is a deliberate system of principles to guide decisions and achieve rational outcomes. A policy is a statement of intent, and is implemented as a procedure or protocol. Policies are generally adopted by a governance body within an organization.A policy is a deliberate system of principles to guide decisions and achieve rational outcomes. A policy is a statement of intent, and is implemented as a procedure or protocol. Policies are generally adopted by a governance body within an organization. Policies can assist in both subjective and objective decision making. Policies to assist in subjective decision making usually assist senior management with decisions that must be based on the relative merits of a number of factors, and as a result are often hard to test objectively, e.g. work-life balance policy. In contrast policies to assist in objective decision making are usually operational in nature and can be objectively tested, e.g. password policy.The term may apply to government, private sector organizations and groups, as well as individuals.Presidential executive orders, corporate privacy policies, and parliamentary rules of order are all examples of policy. Policy differs from rules or law. While law can compel or prohibit behaviors (e.g. a law requiring the payment of taxes on income), policy merely guides actions toward those that are most likely to achieve a desired outcome.Policy or policy study may also refer to the process of making important organizational decisions, including the identification of different alternatives such as programs or spending priorities, and choosing among them on the basis of the impact they will have. Policies can be understood as political, managerial, financial, and administrative mechanisms arranged to reach explicit goals. In public corporate finance, a critical accounting policy is a policy for a firm/company or an industry that is considered to have a notably high subjective element, and that has a material impact on the financial statements.
Brief history of development policy :- In its most general sense, development is a process that has gone on throughout human history as individuals and societies have attempted to better themselves. In Europe, concerted efforts to improve the conditions of disadvantaged sectors in society began in the 19th and early 20th centuries often spearheaded by religious or socialist groups. Such efforts were accompanied by the study of disadvantage, and eventually led, inter alia, to legislation and the establishment of government departments concerned with improving or protecting social welfare. However, the 'development' as a major government activity and field of endeavour extending beyond national borders emerged only after the Second World War, as a result of the need to rebuild the war-torn countries in Europe. European, US, and international organisations involved in reconstruction in Europe then turned their attention to the problems faced by countries in Africa, Asia, and Latin America as they began to gain their independence and as people and governments in former colonial countries recognised that they faced both obligations and opportunities in raising economic activities and living standards in their former colonies.Development rapidly became mixed up with the Cold War, as international development assistance was seen as an extension of foreign policy, and the capitalist West (US, Canada, Europe, and Australasia) competed with the socialist East (Soviet Union, Eastern Europe, and China) to attract and keep Asian, African, and Latin American countries within their spheres of influence and trade. Understandings of 'development' changed, and became increasingly contested, with different theorists, northern and southern governments, international agencies and others, putting different emphases on political, social, economic, and technological change as the key constraints to and drivers of change. The collapse of the Soviet Union and the end of the Cold War led to, and coincided with, important changes in the practice and theory of international development, which has since largely been dominated by the west. There have, however, been continuing alternative currents, notably in some Latin American countries, such as Venezuela, Cuba, and Bolivia, in some non-governmental organisations (NGOs), and anti-globalisation and environmental movements in the West, and most recently in the emergence of China as a major investor and economic player in Africa.
Theory and practice in international development are closely but not simply related. It is possible to identify different streams of development theory that have emerged over time. These have influenced and been influenced by development policies of governments in developed and developing countries, by international or multilateral development agencies (such as the World Bank and different UN agencies), and by NGOs. Interactions between theory and practice and among different organisations are complex and varied. Dominant practices of donor governments and international agencies are influenced by dominant theories, but they also support the development of dominant theories as they fund research and practice in line with dominant theory. However, failures of dominant practice throw up questions about the theories on which they are based, questions which are often explored and championed by NGOs, by alternative movements, and by alternative streams of academic research, writing, and teaching. Development theory and practice are also affected by the domestic interests of donor governments, and by wider economic and social ideologies in donor countries.The main streams of development theory and practice that emerged in the 20th century are very briefly summarised.

Every policy has three key elements: a problem definition, goals to be achieved, and the policy instruments to address the problem and achieve the goals.

1. A statement of what the organisation seeks to achieve for its clients
2. Underpinning principles, values and philosophies
3. Broad service objectives which explain the areas in which the organisation will be dealing
4. Strategies to achieve each objective