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Introduction Everyday the media bombards us with evidence that we are in the midst of a healthcare quality revolution: a newspaper article or radio account of the latest Kaiser Foundation survey results, a special feature in Time or Newsweek, or the lead story by the local television news medical reporter. The Institute of Medicine’s 1999 report on quality in health care, “To Err is Human: Building a Safer Health System,” describes up to 98,000 American deaths per year due to medical mistakes. One out of two-hundred Medicare admissions to New York hospitals die of causes unrelated to the medical problems for which they were admitted. Being a doctor is no longer limited to understanding human disease and treating individual patients. Physicians must have many new competencies to be able to effectively practice medicine in the 21st century. These competenecies include the ability to measure and optimize quality outcomes in the health of pateients and populations using a complex and integrated delivery system. Our patients have become active, vocal “customers” who daily engage in the national debate on the issue of quality in the healthcare industry. Quality, service and cost effectiveness are no longer abstract, socially provocative ideas. They have become the criteria for decision-making that you, as a physician, will exercise every day. In fact, quality and service aren't even separate issues anymore—they go hand-in-hand. Physicians must realize that pateinet satisfaction is not just a marketing issue. Patient satisfaction is a valid outcome indicator of quality. Dissatisified patients are less likely to seek appropriate care, are less likely to comply with care, and are less likely for follow-up care. Patient satisfaction directly affects health outcomes. For permanent success as a healthcare organization, and to run a successful medical practice, the service you will provide will be a monumental part of what makes up quality care. Throughout Unit 3 (Quality Measurement and Improvement), you will learn how and why so many healthcare managers have restructured, redesigned, and reengineered their organizations in the pursuit of improved performance—only to experience failure due to the manner in which their programs were implemented and their inability to continue their application over the long haul. You will also come to understand that many healthcare managers have failed because they defined performance strictly within the context of financial success, without taking into account other key components of quality. The purpose of this unit is to help you understand how any improvements in our healthcare organizations must take place in the context of value to the patient, the “customer.” We'll examine the roles that quality, Qualitys, customer service, productivity, customer service and cost effectiveness play in performance improvement. Health Care is a Business: Saving Lives vs Saving Dollars For the past two decades, the healthcare industry in the United States has been under tremendous pressure to change. Scrutiny of the health care system began with a concern for increased costs. Early efforts centered on reducing these costs through increased efficiencies and limiting use of resources. The rate of cost increases were slowed, but at the expense of limiting patient access to services. Recently, attention has focused on the quality of care and a demand for best outcomes at the lowest cost. The situation will certainly continue to present many challenges in years to come. Where do the scrutiny and subsequent demands come from? State and federal government Taxpayers Patients and their families Physicians Regulatory agencies Professional organizations Yet if all these groups are concerned with issues of improvement in healthcare, then why are we hearing physicians and healthcare workers constantly using phrases such as downsizing, lean organizations, mergers and acquisitions? Because healthcare in the United States is BIG BUSINESS. As with any business, a health care organization must be profitable. Many providers in the healthcare "industry" find the business model offensive. Comparing services to product lines and equating patients to customers and primary care services as loss leaders, is perceived as degrading medicine’s honorable tradition of caring for patients. The fact of the matter is, however, that services provided by health care organizations are bundled as Diagnosis Related Groups (DRGs). Our reimbursement system is evolving into a system where services are packaged and purchased with prospectively determined prices. Under federal government’s medical insurance, the Prospective Pricing System (PPS), hospitals are reimbursed a set amount for a specific DRG no matter how much the service actually costs. For example, if a hospital is treating a patient for pneumonia the reimbursement is the same, whether it takes three days or seven days. Providers and society must know how much care costs and how effective it is in order to determine how much it is worth. The challenge facing healthcare professionals is to maintain quality of care while running a fiscally responsible business. According to Dr. W. Edwards Deming, the American statistician who helped revitalize the Japanese economy during the 1950s and the leader of the international quality control movement, a chain reaction occurs as improved quality leads to decreased costs and increased productivity. All of this will, according to Vincent Omachonu, an expert on Continuous Quality Improvement (CQI), "enhance the ability to capture the market, stay in business, and have satisfied customers” (Omachonu 1999,7). Therefore, as someone who is going to become a healthcare professional, you need to understand how costs , productivity and information technology play a roll in quality care, measurement and improvement.
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This unit include two case studies and the review of of a quality care patient survey. Each case study is intended to engage you in basic issues in quality care and improvment. Your guides to these activities are Dr. Alex Mechaber and Dr. Hilit Mechaber of the
By the end of this unit, you will: 1. Define basic principles of Quality Improvement (QI) 2. Give examples of standards by which quality is measured 3. Value (or rank as important) Quality Improvement (QI) as an integral part of practice in modern health care delivery systems 4. Recognize the dynamic between delivery of quality care and patient perception of quality of care received.
Case Study 1: Mrs. Sena: The Reluctant Clinic Patient After you have read through each case study and the survey analsysis, you will be asked to consider a series of questions and responses to the Quality Care issues raised. Our Quality Improvement consultants , Dr. Hilit Mechaber and Dr. Alex Mechaber will respond to the issues raised in both case studies and in the survey analysis.
This module incorporates a number of required readings. Some questions on the test for this unit will be drawn from these readings. Click on the stack of books and journals.
To complete your work for the quality unit complete the two case studies and the survey activity, and then proceed to the test for the quality measurement and improvement unit.
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Hospitals are looking for new sources of revenue.
They're having to adopt "product and service diversification strategies," that move them beyond traditional inpatient and outpatient care, such as
rehabilitation and fitness facilities, skilled nursing and home healthcare agencies, and follow-up care for discharged patients.
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