Factors Influencing the Realization of Quality Improvement in Healthcare Discussion
This document discusses several factors that have influenced quality improvement in healthcare, including:
1) Historical, social, political, and economic trends over the last century such as rising costs, an aging population, and legislation like the Affordable Care Act.
2) Reports from the Institute of Medicine in the 1990s and 2000s that helped establish a framework for improving safety and quality in the 21st century healthcare system.
3) Initiatives from organizations like the Joint Commission and Agency for Healthcare Research and Quality that have aimed to decrease errors, establish standards, and improve outcomes.
The National Academies Health and Medicine DivisionAbout U.docxdennisa15
The National Academies
Health and Medicine Division
About UsPublicationsActivitiesMeetings
Announcement
Crossing the Quality Chasm: The IOM Health Care Quality Initiative
In 1996, after releasing America's Health in Transition: Protecting and Improving Quality, the IOM launched a concerted, ongoing effort focused on assessing and improving the nation's quality of care.
The first phase of this Quality Initiative documented the serious and pervasive nature of the nation's overall quality problem, concluding that "the burden of harm conveyed by the collective impact of all of our health care quality problems is staggering" (Chassen et al., 1998).
IOM Definition of Quality
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
This phase built on an intensive review of the literature conducted by RAND to understand the scope of this issue (Schuster) and a framework was established that defined the nature of the problem as one of overuse, misuse and underuse of health care services (Chassen et al). More specifically, the report Ensuring Quality Cancer Care (1999) documented the wide gulf that exists between ideal cancer care and the reality many Americans with cancer experience.
During the second phase, spanning 1999-2001, the Committee on Quality of Health Care in America, laid out a vision for how the health care system and related policy environment must be radically transformed in order to close the chasm between what we know to be good quality care and what actually exists in practice. The reports released during this phase—To Err is Human: Building a Safer Health System(1999) and Crossing the Quality Chasm: A New Health System for the 21st Century(2001)—stress that reform around the margins is inadequate to address system ills.
The series of IOM quality reports have included a number of metrics that illustrate how wide the quality chasm is and how important it is to close this gulf, between what we know is good quality care and what the norm is in practice.
To Err is Human put the spotlight on how tens of thousands of Americans die each year from medical errors and effectively put the issue of patient safety and quality on the radar screen of public and private policymakers. The Quality Chasm report described broader quality issues and defines six aims—care should be safe, effective, patient-centered, timely, efficient and equitable—and 10 rules for care delivery redesign.
Phase three of the IOM's Quality Initiative focuses on operationalizing the vision of a future health system described in the Quality Chasm report. In addition to the IOM, many others are working to create a more patient responsive 21st century health system, including clinicians/ health care organizations, employers/consumers, foundations/research, government agencies, and quality organizations. This collection of efforts focus reform a.
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, DioneWang844
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Page | 1
Quality
Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:
· Focusing on creating a stronger foundation of education on patient safety
· Mandating a nationwide reporting system to encourage timely reporting of errors
· Increasing the standards of performance for healthcare providers
· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)
Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.
Challenges for Patient Safety and Steps for Improvement
Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.
Tap each image to know more.
Data Collection and Monitoring Systems
This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.
Tribalism and Lack of Staff Engagement
Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.
Convince People That There's a Problem
Use hard data to secure emotional e ...
A Study of Healthcare Quality Measures across Countries to Define an Approach...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The National Academies Health and Medicine DivisionAbout U.docxdennisa15
The National Academies
Health and Medicine Division
About UsPublicationsActivitiesMeetings
Announcement
Crossing the Quality Chasm: The IOM Health Care Quality Initiative
In 1996, after releasing America's Health in Transition: Protecting and Improving Quality, the IOM launched a concerted, ongoing effort focused on assessing and improving the nation's quality of care.
The first phase of this Quality Initiative documented the serious and pervasive nature of the nation's overall quality problem, concluding that "the burden of harm conveyed by the collective impact of all of our health care quality problems is staggering" (Chassen et al., 1998).
IOM Definition of Quality
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
This phase built on an intensive review of the literature conducted by RAND to understand the scope of this issue (Schuster) and a framework was established that defined the nature of the problem as one of overuse, misuse and underuse of health care services (Chassen et al). More specifically, the report Ensuring Quality Cancer Care (1999) documented the wide gulf that exists between ideal cancer care and the reality many Americans with cancer experience.
During the second phase, spanning 1999-2001, the Committee on Quality of Health Care in America, laid out a vision for how the health care system and related policy environment must be radically transformed in order to close the chasm between what we know to be good quality care and what actually exists in practice. The reports released during this phase—To Err is Human: Building a Safer Health System(1999) and Crossing the Quality Chasm: A New Health System for the 21st Century(2001)—stress that reform around the margins is inadequate to address system ills.
The series of IOM quality reports have included a number of metrics that illustrate how wide the quality chasm is and how important it is to close this gulf, between what we know is good quality care and what the norm is in practice.
To Err is Human put the spotlight on how tens of thousands of Americans die each year from medical errors and effectively put the issue of patient safety and quality on the radar screen of public and private policymakers. The Quality Chasm report described broader quality issues and defines six aims—care should be safe, effective, patient-centered, timely, efficient and equitable—and 10 rules for care delivery redesign.
Phase three of the IOM's Quality Initiative focuses on operationalizing the vision of a future health system described in the Quality Chasm report. In addition to the IOM, many others are working to create a more patient responsive 21st century health system, including clinicians/ health care organizations, employers/consumers, foundations/research, government agencies, and quality organizations. This collection of efforts focus reform a.
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, DioneWang844
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Page | 1
Quality
Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:
· Focusing on creating a stronger foundation of education on patient safety
· Mandating a nationwide reporting system to encourage timely reporting of errors
· Increasing the standards of performance for healthcare providers
· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)
Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.
Challenges for Patient Safety and Steps for Improvement
Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.
Tap each image to know more.
Data Collection and Monitoring Systems
This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.
Tribalism and Lack of Staff Engagement
Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.
Convince People That There's a Problem
Use hard data to secure emotional e ...
A Study of Healthcare Quality Measures across Countries to Define an Approach...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
DQ 3-2Integrated health care delivery systems (IDS) was develope.docxelinoraudley582231
DQ 3-2
Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources.
Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system.
Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf
Dq 3-1
1.
In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
Assignment 1 Legal Aspects of U.S. Health Care System Administrat.docxbraycarissa250
Assignment 1: Legal Aspects of U.S. Health Care System Administration
Due Week 3 and worth 200 points
Prevailing wisdom reinforces the fact that working in U.S. health care administration in the 21st Century requires knowledge of the various aspects of health laws as they apply to dealing with medical professionals. Further, because U.S. health care administrators must potentially interact with many levels of professionals beyond the medical profession, it is prudent that they be aware of any federal, state, and local laws that may be applicable to their organizations. Thus, their conduct is also subject to the letter of the law. They must evaluate the quality of their professional interactions and be mindful of the implications and ramifications of their decisions.
Nearly 65 million surgical operations were performed in 2015 in the U.S. resulting in an estimated 200,000 deaths from complications or other post-operative issues (Ghaferi, Myers, Sutcliffe, & Pronovost, 2016). Ongoing innovation in healthcare can improve patient outcomes. According to the Harvard Business Review article, The Next Wave of Hospital Innovation to Make Patients Safer, over the past several decades, there have been three distinct waves of surgical improvement: technical advancements, standardizing procedures, and high reliability organizing.
Assume the role of a top health administrator at We Care Hospital. You are interested in propelling the hospital to the next level by applying for the Malcolm Baldrige National Quality Award. However, you want to ensure surgical outcomes for patient morbidity and mortality rates. You begin by researching the Surgical Care Improvement Project (SCIP) aimed to improve adherence to quality protocols. You need to ensure the hospital policy is consistent with the law and that the hospital is correctly reporting Sentinel Events to the Joint Commission, a hospital regulatory agency.
Note: You may create and / or make all necessary assumptions needed for the completion of this assignment.
Write a three to four (3-4) page paper in which you:
1. Analyze how standardizing procedures and documenting steps can improve outcomes when performing a complex procedure. Review the peer-reviewed journal article, The Next Wave of Hospital Innovation to Make Patients Safer. Articulate your position as the top administrator concerned about the importance of professional conduct and negligence in SCIP quality guidelines.
2. High Reliability Organizing emphasizes the varying actions that can affect patient safety given that standardized systems ignore the fact that each patient is different. Ascertain the major ramifications when the health care team “fails to rescue” the patient. Identify what hospital policies should be in place and identify previous case laws.
3. Analyze the four (4) elements required of a plaintiff to prove medical negligence.
4. Discuss the overarching duties of the health care governing board in mitigating the effects of medical non- ...
2 8 5L e a r n I n g o b j e c t I v e sC H A P T E R.docxlorainedeserre
2 8 5
L e a r n I n g o b j e c t I v e s
C H A P T E R 1 0
Q U A L I T Y M A N A G E M E N T I N
T H E P H Y S I C I A N P R A C T I C E
Quality and reliability are system properties.
—W. Edwards Deming
➤ Articulate the nature of performance management.
➤ Describe the approaches to performance improvement.
➤ Appreciate the impact of variation on performance.
➤ Discuss the components of the Triple Aim.
➤ Describe process improvement.
In t r o d u c t I o n
One of the most important issues to address in the medical practice is the quality and
safety of the care provided to patients. The Institute of Medicine (IOM 2001), a presti-
gious branch of the National Institutes of Health, stated in its landmark report Crossing the
Quality Chasm: A New Health System for the 21st Century, “In its current form, habits, and
environment, American health care is incapable of providing the public with the quality
health care it expects and deserves.”
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EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 4/16/2020 7:48 PM via SUNY CANTON
AN: 1839064 ; Wagner, Stephen L..; Fundamentals of Medical Practice Management
Account: s8846236.main.ehost
F u n d a m e n t a l s o f M e d i c a l P r a c t i c e M a n a g e m e n t2 8 6
Another historic IOM (2000) report, To Err Is Human: Building a Safer Health
System, indicated that a shocking number of people—an estimated 44,000 to 98,000 per
year—are harmed by the healthcare system. A more recent study found that this number
has increased since publication of the 2000 IOM report despite substantial efforts to
improve. Medical errors have now become the third leading cause of death in the United
States (Makary and Daniel 2016).
The complexity of medical service and the inconsistency with which these services
are delivered, not to mention the fragmented nature of the system, have led to a number
of quality concerns (Mosadeghrad 2014), including a lack of systematic approaches to care
delivery and quality improvement. Efforts to improve quality in the medical profession
have a long tradition of focusing on individual performance versus system performance.
Exhibit 10.1 illustrates the potential flaw in this thinking. The bell-shaped curve, P-1,
represents the overall performance of any given system. Curve P-2 illustrates an improved
system of performance where the median performance is moved from M-1 to M-2. If an
organization seeks to improve by only focusing on the low performers, it experiences only
a small improvement, shown as I-1. By improving th ...
12242014 Print Continuous Quality Improvement in Health Ca.docxhyacinthshackley2629
12/24/2014 Print | Continuous Quality Improvement in Health Care
https://online.vitalsource.com/books/9781449679606/print?from=514&to=549&skip_desktop=true 1/8
PRINTED BY: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted
without publisher's prior permission. Violators will be prosecuted.
CHAPTER 18 Accreditation: A Global Regulatory Mechanism to Promote Quality and Safety
David Greenfield, Marjorie Pawsey, and Jeffrey Braithwaite
“What has eluded us thus far, however, is maintaining consistently high levels of safety and quality over time and across all health care services
and settings.”
—Chassin and Loeb (2011, p. 562)
The accreditation of health care organizations is a regulatory mechanism used in many countries around the world. Accreditation is an important
strategy by which improvements in quality and safety have been advocated and institutionalized. The purpose of this chapter is to provide an
overview of accreditation of health organizations. The chapter has five sections. The first section considers the purpose of accreditation, noting that
it has become a global phenomenon found in many industries and sectors of health care. The second section discusses the extent of the
accreditation of health organizations, the maturing of accreditation 513514program philosophy from quality assurance to quality improvement, and
the selfgoverning system that has been developed. The third section explores the commonalities and differences in accreditation programs, where
increasingly a common model of accreditation is enacted but with variation in standards. The evidence base for accreditation is examined in the
fourth section. Finally, the fifth section considers the issues and challenges for accreditation stakeholders.
AN OVERVIEW OF ACCREDITATION
What Is Accreditation?
Accreditation is the formal declaration by a designated authority that an organization, service, or individual has demonstrated competency,
authority, or credibility to meet a predetermined set of standards. Accreditation is a mechanism that seeks to reassure external stakeholders that
quality and safety standards are demonstrated. A secondary and more recent goal in some applications, notably health care, is to provide a basis for
quality improvement initiatives (Davis et al., 2009; Gibberd et al., 2004; Williams et al., 2005). The shift to accreditation, notably from the 1970s
onward, is representative of a shift in philosophy by governments whereby they have sought to provide a framework for the governance of
services rather than to provide those services themselves. Through accreditation and other regulation strategies, governments have sought
abatement or control of risks to society by indirect means (Sparrow, 2000).
Accreditation has become a ubiquitous part of our modern world. For example, it can apply to any of the following:
• Industries, including organic food (Gabriel, 2007), tourism (Austral.
Paper #1 - Due March 8Posted Feb 22, 2018 949 AMPaper #1 - Ad.docxbunyansaturnina
Paper #1 - Due March 8
Posted Feb 22, 2018 9:49 AM
Paper #1 - Advice for Success
Please, use: File Name: HCAD610-Paper1-[Last Name]-Spring-2018
(And it would be nice if each page had your name and a page number...!)
Given how rapidly HIT has evolved over the last decade, HIT references greater than 5 years old need to have a relevant historical context or clear justification for their use. Every assertion that you make needs to have a clear source and be supported by references. EVERY factual statement Must be referenced, individually, from a credible and verifiable source...
No Abstract or Cover Page Needed...
I hope the guidance below helps...!
Dr Freeman
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You are the director of strategic communication for a non-profit suburban community hospital. The CEO has asked you to prepare a 3-7 page briefing paper that answers the following questions posed by the Board of Directors:
What does the US government mean by the concept “meaningful use?” How do myriad HIT systems support each other? Or do they?
Due End of Week 4.
1. Explain Gov’t term: “meaningful Use”; (15 points)
2. What US HIT systems have Problems and WHY? (25 points)
3. What Changes are needed in US HIT Systems? (25 points)
4. What HIT Strategy Steps are needed BY Hospital? (25 points)
5. Grammar, Referencing, Page Restrictions (10 points)
Evaluate U.S. HIT
Compare with that of other advanced nations? What contributes to this?
U.S HIT is behind when compared to other developed countries in the world. According to Davis, Stremikis, Squires, and Schoen (2014), “other countries have led in the adoption of modern health information systems, but U.S. physicians and hospitals are catching up as they respond to significant financial incentives to adopt and make meaningful use of health information technology systems.” What baffled me the most is that the U.S healthcare system remains the most expensive in the world and there is nothing to show for the high cost when compared to performance rating with other developed nations. The U.S remains at the bottom when it comes to healthcare performance in terms of quality care, access, efficiency, equity, and healthy lives (Davis et al., 2014).
I believe our government is to be blamed for poor HIT advancement in the U.S. This is because the U.S government is ten years late in making HIT a national major concern to support and invest in. I was surprised to find out that the U.S is one of the first nations in the world to fund and use HIT. So the question is how did end on the back bench when it comes to HIT advancement. Sullivan, Watkins, Sweet, and Ramsey (2009) reports that most of the early initiatives such as government funding and policies put in place to foster the growth of HIT have been either changed or stopped as a result of political, financial, and commercial pressures. “A National Center for .
Running head U.S. HEALTHCARE EXECUTIVES 1U.S. HEALTHCARE EX.docxjenkinsmandie
Running head: U.S. HEALTHCARE EXECUTIVES
1
U.S. HEALTHCARE EXECUTIVES
7
Week 2 Assignment-Operational challenges, trends and issues for the U.S. Healthcare Executives
Student’s Name
Institutional Affiliation
Introduction
A healthcare system is an organization of funds, individuals, and institutions which provide healthcare to satisfy the health requirements of a society. Globally, healthcare systems vary depending on the specific healthcare needs of particular states. Nevertheless, the common aspects of public and private care are often similar (Drummond, Sculpher, Claxton, Stoddart & Torrance, 2015). Over the years, we have witnessed the systems evolving, and with this constant change, it is vital to analyze operational challenges, trends, and issues for the U.S. healthcare executives. In this paper, the main areas that will be discussed are operational challenges, trends, and problems experienced in the United States health care executives.
Challenges experienced in the healthcare workplace
Various problems have been experienced in the healthcare workplace relating to healthcare provision in the United States. Financial difficulties are one of the main challenges being experienced in the healthcare workplace in the United States. The vital financial problems arise due to lack of enough finances for implementation of new technologies to improve healthcare delivery process (Mayes, 2017). Most healthcare facilities lack adequate funds to implement advanced technologies that can be used to increase the quality of healthcare delivery. As a result, this has reduced healthcare quality improvement plans in the United States. Therefore, there is a need for federal governments to meek proper arrangements to fund all healthcare activities to improve services delivery in the health sector.
Besides, healthcare professionals to comply with federal requirements for electronic health records is another challenge that has been experienced in the United States healthcare workplace. For the past year, some healthcare professionals have failed to comply with federal government guidelines regarding health care delivery (Mayes, 2017). Furthermore, the increasing number of patients who cannot pay for health care services is a significant challenge that has been experienced in the United States healthcare delivery systems. These finance challenges adversely affect healthcare delivery system in the United States.
Work overload is another major challenge that has been experienced in the United States health sectors (Mayes, 2017). Observations for past years reveal that work overload at the workplace affects the performance of health care professionals in the United States. Most healthcare professionals are assigned many responsibilities at workplaces, which reduces their efficiency.
Another cause of the rising cost of healthcare is the introduction of government programs. For example, Medicare assists those without insurance, which led to an incre.
DQ 3-2Integrated health care delivery systems (IDS) was develope.docxelinoraudley582231
DQ 3-2
Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources.
Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system.
Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf
Dq 3-1
1.
In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
Assignment 1 Legal Aspects of U.S. Health Care System Administrat.docxbraycarissa250
Assignment 1: Legal Aspects of U.S. Health Care System Administration
Due Week 3 and worth 200 points
Prevailing wisdom reinforces the fact that working in U.S. health care administration in the 21st Century requires knowledge of the various aspects of health laws as they apply to dealing with medical professionals. Further, because U.S. health care administrators must potentially interact with many levels of professionals beyond the medical profession, it is prudent that they be aware of any federal, state, and local laws that may be applicable to their organizations. Thus, their conduct is also subject to the letter of the law. They must evaluate the quality of their professional interactions and be mindful of the implications and ramifications of their decisions.
Nearly 65 million surgical operations were performed in 2015 in the U.S. resulting in an estimated 200,000 deaths from complications or other post-operative issues (Ghaferi, Myers, Sutcliffe, & Pronovost, 2016). Ongoing innovation in healthcare can improve patient outcomes. According to the Harvard Business Review article, The Next Wave of Hospital Innovation to Make Patients Safer, over the past several decades, there have been three distinct waves of surgical improvement: technical advancements, standardizing procedures, and high reliability organizing.
Assume the role of a top health administrator at We Care Hospital. You are interested in propelling the hospital to the next level by applying for the Malcolm Baldrige National Quality Award. However, you want to ensure surgical outcomes for patient morbidity and mortality rates. You begin by researching the Surgical Care Improvement Project (SCIP) aimed to improve adherence to quality protocols. You need to ensure the hospital policy is consistent with the law and that the hospital is correctly reporting Sentinel Events to the Joint Commission, a hospital regulatory agency.
Note: You may create and / or make all necessary assumptions needed for the completion of this assignment.
Write a three to four (3-4) page paper in which you:
1. Analyze how standardizing procedures and documenting steps can improve outcomes when performing a complex procedure. Review the peer-reviewed journal article, The Next Wave of Hospital Innovation to Make Patients Safer. Articulate your position as the top administrator concerned about the importance of professional conduct and negligence in SCIP quality guidelines.
2. High Reliability Organizing emphasizes the varying actions that can affect patient safety given that standardized systems ignore the fact that each patient is different. Ascertain the major ramifications when the health care team “fails to rescue” the patient. Identify what hospital policies should be in place and identify previous case laws.
3. Analyze the four (4) elements required of a plaintiff to prove medical negligence.
4. Discuss the overarching duties of the health care governing board in mitigating the effects of medical non- ...
2 8 5L e a r n I n g o b j e c t I v e sC H A P T E R.docxlorainedeserre
2 8 5
L e a r n I n g o b j e c t I v e s
C H A P T E R 1 0
Q U A L I T Y M A N A G E M E N T I N
T H E P H Y S I C I A N P R A C T I C E
Quality and reliability are system properties.
—W. Edwards Deming
➤ Articulate the nature of performance management.
➤ Describe the approaches to performance improvement.
➤ Appreciate the impact of variation on performance.
➤ Discuss the components of the Triple Aim.
➤ Describe process improvement.
In t r o d u c t I o n
One of the most important issues to address in the medical practice is the quality and
safety of the care provided to patients. The Institute of Medicine (IOM 2001), a presti-
gious branch of the National Institutes of Health, stated in its landmark report Crossing the
Quality Chasm: A New Health System for the 21st Century, “In its current form, habits, and
environment, American health care is incapable of providing the public with the quality
health care it expects and deserves.”
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EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 4/16/2020 7:48 PM via SUNY CANTON
AN: 1839064 ; Wagner, Stephen L..; Fundamentals of Medical Practice Management
Account: s8846236.main.ehost
F u n d a m e n t a l s o f M e d i c a l P r a c t i c e M a n a g e m e n t2 8 6
Another historic IOM (2000) report, To Err Is Human: Building a Safer Health
System, indicated that a shocking number of people—an estimated 44,000 to 98,000 per
year—are harmed by the healthcare system. A more recent study found that this number
has increased since publication of the 2000 IOM report despite substantial efforts to
improve. Medical errors have now become the third leading cause of death in the United
States (Makary and Daniel 2016).
The complexity of medical service and the inconsistency with which these services
are delivered, not to mention the fragmented nature of the system, have led to a number
of quality concerns (Mosadeghrad 2014), including a lack of systematic approaches to care
delivery and quality improvement. Efforts to improve quality in the medical profession
have a long tradition of focusing on individual performance versus system performance.
Exhibit 10.1 illustrates the potential flaw in this thinking. The bell-shaped curve, P-1,
represents the overall performance of any given system. Curve P-2 illustrates an improved
system of performance where the median performance is moved from M-1 to M-2. If an
organization seeks to improve by only focusing on the low performers, it experiences only
a small improvement, shown as I-1. By improving th ...
12242014 Print Continuous Quality Improvement in Health Ca.docxhyacinthshackley2629
12/24/2014 Print | Continuous Quality Improvement in Health Care
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without publisher's prior permission. Violators will be prosecuted.
CHAPTER 18 Accreditation: A Global Regulatory Mechanism to Promote Quality and Safety
David Greenfield, Marjorie Pawsey, and Jeffrey Braithwaite
“What has eluded us thus far, however, is maintaining consistently high levels of safety and quality over time and across all health care services
and settings.”
—Chassin and Loeb (2011, p. 562)
The accreditation of health care organizations is a regulatory mechanism used in many countries around the world. Accreditation is an important
strategy by which improvements in quality and safety have been advocated and institutionalized. The purpose of this chapter is to provide an
overview of accreditation of health organizations. The chapter has five sections. The first section considers the purpose of accreditation, noting that
it has become a global phenomenon found in many industries and sectors of health care. The second section discusses the extent of the
accreditation of health organizations, the maturing of accreditation 513514program philosophy from quality assurance to quality improvement, and
the selfgoverning system that has been developed. The third section explores the commonalities and differences in accreditation programs, where
increasingly a common model of accreditation is enacted but with variation in standards. The evidence base for accreditation is examined in the
fourth section. Finally, the fifth section considers the issues and challenges for accreditation stakeholders.
AN OVERVIEW OF ACCREDITATION
What Is Accreditation?
Accreditation is the formal declaration by a designated authority that an organization, service, or individual has demonstrated competency,
authority, or credibility to meet a predetermined set of standards. Accreditation is a mechanism that seeks to reassure external stakeholders that
quality and safety standards are demonstrated. A secondary and more recent goal in some applications, notably health care, is to provide a basis for
quality improvement initiatives (Davis et al., 2009; Gibberd et al., 2004; Williams et al., 2005). The shift to accreditation, notably from the 1970s
onward, is representative of a shift in philosophy by governments whereby they have sought to provide a framework for the governance of
services rather than to provide those services themselves. Through accreditation and other regulation strategies, governments have sought
abatement or control of risks to society by indirect means (Sparrow, 2000).
Accreditation has become a ubiquitous part of our modern world. For example, it can apply to any of the following:
• Industries, including organic food (Gabriel, 2007), tourism (Austral.
Paper #1 - Due March 8Posted Feb 22, 2018 949 AMPaper #1 - Ad.docxbunyansaturnina
Paper #1 - Due March 8
Posted Feb 22, 2018 9:49 AM
Paper #1 - Advice for Success
Please, use: File Name: HCAD610-Paper1-[Last Name]-Spring-2018
(And it would be nice if each page had your name and a page number...!)
Given how rapidly HIT has evolved over the last decade, HIT references greater than 5 years old need to have a relevant historical context or clear justification for their use. Every assertion that you make needs to have a clear source and be supported by references. EVERY factual statement Must be referenced, individually, from a credible and verifiable source...
No Abstract or Cover Page Needed...
I hope the guidance below helps...!
Dr Freeman
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You are the director of strategic communication for a non-profit suburban community hospital. The CEO has asked you to prepare a 3-7 page briefing paper that answers the following questions posed by the Board of Directors:
What does the US government mean by the concept “meaningful use?” How do myriad HIT systems support each other? Or do they?
Due End of Week 4.
1. Explain Gov’t term: “meaningful Use”; (15 points)
2. What US HIT systems have Problems and WHY? (25 points)
3. What Changes are needed in US HIT Systems? (25 points)
4. What HIT Strategy Steps are needed BY Hospital? (25 points)
5. Grammar, Referencing, Page Restrictions (10 points)
Evaluate U.S. HIT
Compare with that of other advanced nations? What contributes to this?
U.S HIT is behind when compared to other developed countries in the world. According to Davis, Stremikis, Squires, and Schoen (2014), “other countries have led in the adoption of modern health information systems, but U.S. physicians and hospitals are catching up as they respond to significant financial incentives to adopt and make meaningful use of health information technology systems.” What baffled me the most is that the U.S healthcare system remains the most expensive in the world and there is nothing to show for the high cost when compared to performance rating with other developed nations. The U.S remains at the bottom when it comes to healthcare performance in terms of quality care, access, efficiency, equity, and healthy lives (Davis et al., 2014).
I believe our government is to be blamed for poor HIT advancement in the U.S. This is because the U.S government is ten years late in making HIT a national major concern to support and invest in. I was surprised to find out that the U.S is one of the first nations in the world to fund and use HIT. So the question is how did end on the back bench when it comes to HIT advancement. Sullivan, Watkins, Sweet, and Ramsey (2009) reports that most of the early initiatives such as government funding and policies put in place to foster the growth of HIT have been either changed or stopped as a result of political, financial, and commercial pressures. “A National Center for .
Running head U.S. HEALTHCARE EXECUTIVES 1U.S. HEALTHCARE EX.docxjenkinsmandie
Running head: U.S. HEALTHCARE EXECUTIVES
1
U.S. HEALTHCARE EXECUTIVES
7
Week 2 Assignment-Operational challenges, trends and issues for the U.S. Healthcare Executives
Student’s Name
Institutional Affiliation
Introduction
A healthcare system is an organization of funds, individuals, and institutions which provide healthcare to satisfy the health requirements of a society. Globally, healthcare systems vary depending on the specific healthcare needs of particular states. Nevertheless, the common aspects of public and private care are often similar (Drummond, Sculpher, Claxton, Stoddart & Torrance, 2015). Over the years, we have witnessed the systems evolving, and with this constant change, it is vital to analyze operational challenges, trends, and issues for the U.S. healthcare executives. In this paper, the main areas that will be discussed are operational challenges, trends, and problems experienced in the United States health care executives.
Challenges experienced in the healthcare workplace
Various problems have been experienced in the healthcare workplace relating to healthcare provision in the United States. Financial difficulties are one of the main challenges being experienced in the healthcare workplace in the United States. The vital financial problems arise due to lack of enough finances for implementation of new technologies to improve healthcare delivery process (Mayes, 2017). Most healthcare facilities lack adequate funds to implement advanced technologies that can be used to increase the quality of healthcare delivery. As a result, this has reduced healthcare quality improvement plans in the United States. Therefore, there is a need for federal governments to meek proper arrangements to fund all healthcare activities to improve services delivery in the health sector.
Besides, healthcare professionals to comply with federal requirements for electronic health records is another challenge that has been experienced in the United States healthcare workplace. For the past year, some healthcare professionals have failed to comply with federal government guidelines regarding health care delivery (Mayes, 2017). Furthermore, the increasing number of patients who cannot pay for health care services is a significant challenge that has been experienced in the United States healthcare delivery systems. These finance challenges adversely affect healthcare delivery system in the United States.
Work overload is another major challenge that has been experienced in the United States health sectors (Mayes, 2017). Observations for past years reveal that work overload at the workplace affects the performance of health care professionals in the United States. Most healthcare professionals are assigned many responsibilities at workplaces, which reduces their efficiency.
Another cause of the rising cost of healthcare is the introduction of government programs. For example, Medicare assists those without insurance, which led to an incre.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
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As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
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Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
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Factors Influencing the Realization of Quality Improvement in Healthcare Discussion.pdf
1. Factors Influencing the Realization of Quality Improvement in Healthcare
Discussion
Factors Influencing the Realization of Quality Improvement in Healthcare Discussion ON
Factors Influencing the Realization of Quality Improvement in Healthcare DiscussionRead
Chapter 10 answers the questions in APA Format, Times New Roman 12 font1. In the last
century, what historical, social, political, and economic trends and issues have influenced
today’s health-care system?2. What is the purpose and process of evaluating the three
aspects of health care: structure, process, and outcome?3. How does technology improve
patient outcomes and the health-care system?4. How can you intervene to improve quality
of care and safety within the health-care system and at the bedside?2. Select one nonprofit
organization or one government agencies that influences and advocates for quality
improvement in the health-care system. Explore the Web site for your selected
organization/agency and answer the following questions: •What does the
organization/agency do that s the hallmarks of quality? •What have been the results of
their efforts for patients, facilities, the health-care delivery system, or the nursing
profession? •How has the organization/agency affected facilities where you are practicing
and your own professional practice?chapter_10_issues_of_qUnformatted Attachment
Previewchapter 10 Issues of Quality and Safety QI at the Organizational and Unit Levels
Strategic Planning Structured Care Methodologies Critical Pathways Aspects of Health Care
to Evaluate Structure Process Outcome Risk Management The Nursing Shortage and Patient
Safety Factors Contributing to the Nursing Shortage Safety in the U.S. Health-Care System
Types of Errors Error Identification and Reporting Developing a Culture of Safety
Organizations, Agencies, and Initiatives ing Quality and Safety in the Health-Care System
Government Agencies Health-Care Provider Professional Organizations Nonprofit
Organizations and Foundations Quality Organizations Integrating Initiatives and Evidenced-
Based Practices Into Patient Care Influence of Nursing Conclusion use good judgment when
making decisions about care. As nurses we need to understand that we work within a
system, and whenever there is a breakdown somewhere within the system, the risk for
error increases. This chapter discusses quality and safety in health care, presents reasons
for errors, and offers ways nurses can help to create a culture of safety. Historical Trends
and Issues Many forces drive the rapidly changing health-care delivery system (Baldwin,
Conger, Maycock, & Abegglen, 2002; Davis, 2001; Elwood, 2007; Ervin, Bickes, & Schim,
2006; Menix, 2000; Milton, 2011). In this time of global health-care reform, regulation at the
2. global, national, state, and local levels has taken on a new significance (Milton, 147 148 unit
3 ? Career Considerations 2011). The impetus to decrease costs and improve outcomes
influences the current movement toward improved quality and safety. These forces include
economics, societal demographics and diversity, regulation and legislation, technology,
health- care delivery and practice, and environment and globalization. Economics. Many
economic trends and issues affect the U.S health-care delivery system. Busi- nesses,
government, and the media criticize the cost of health care within the United States when
compared with that of other developed nations ( Jackson, 2006; Kersbergen, 2000; Milton,
2011). The costs of research and the costs to develop new treatments and technology
continue to rise. Edu- cated consumers expect safe, quality care with asso- ciated
satisfaction and positive health outcomes. Nurses need to be prepared to consumers with
a thorough knowledge of quality, account- ability, and cost-effectiveness (AACN, 2008,
2012). This means that they must have the knowledge to educate patients regarding the
technology used in their treatments and explain the rationale behind the treatment
selection. While initial expenses may increase, improvements in quality and safety will
reduce costs in the long term (Aiken et. al., 2012; Cronenwett et al, 2007; Institute of Medi-
cine [IOM], 2003a; Weiss, Yakusheva, & Bobay, 2011). Societal demographics and diversity.
Increased numbers of racial and ethnic groups influence health-care delivery (Billings &
Halsted, 2011; Davis, 2010; Factors Influencing the Realization of Quality Improvement in
Healthcare DiscussionElwood 2007; Health and Human Services [HHS], 2011; Heller, Oros,
& Durney- Crowley, 2000; World Health Organization, 2009). Increased numbers of the
elderly, longer life expec- tancy, and improvements in technology result in an emphasis on
specialized geriatric care. Both the elderly and ethnic minorities are at-risk popula- tions
who suffer disadvantages in access to care, payment for care, and quality of care (Affordable
Care Act, 2010; Anderson, Scrimshaw, Fullilove, Fielding, & Normand, 2003). It is hoped that
the passage of the Affordable Care Act (ACA) will minimize these disparities as more of
these indi- viduals will have access to health-care services (Davis, 2010). Regulation and
legislation. The diverse interests of consumers, insurance companies, government, and
regulation affect health-care legislation. For health-care leaders and providers of care,
unprecedented challenges continue despite the attention that quality and safety have
received during the evolution of the existing health-care system. The ACA now provides
health care to individuals who previously lacked coverage. This access to care will increase
the numbers of individuals who will need providers as well as force changes in regulation
and cost management. Technology.The use of technology and the incor- poration of the
electronic health record are pro- jected to decrease costs and improve clinical outcomes,
quality, and safety (IOM, 2003a; Poon et al., 2010). Nursing practice must adjust to these
health-care delivery trends with the inclusion of concepts in interprofessional collaboration,
patient- focused systems, and information literacy (Booth, 2006; Sargeant, Loney, &
Murphy, 2008). Addi- tionally, nurses must utilize technology and infor- matics to
incorporate evidenced-based practices for improved quality and safety in the health-care
delivery system (Hunter, 2011). Technology also produces advancements in disease
treatments, especially in the areas of genet- ics and genomics, and all professionals must
inte- grate these advancements into practice (Calzone, Cashion, Feetham, Jenkins, Prows,
3. Williams, & Wung, 2010; Lea, Skirton, Read, & Williams, 2011).The current advances in
genetics and genom- ics continue to allow the redesign of treatments for a variety of genetic
disorders, quality improvement (QI), and outcomes in clinical practice often related to
pharmacotherapeutics Factors Influencing the Realization of Quality Improvement in
Healthcare Discussion(Trossman, 2006; Lea, Skirton, Read, & Williams, 2011). Health-care
delivery and practice. Health-care professionals should be prepared to provide safe, quality
care in all settings, including acute care and community settings. Nurses and other health-
care professionals need the knowledge, skills, attitudes, and competencies to function in a
variety of set- tings and the ability to the needs of the increasingly diverse population
(Anderson et al., 2003; Ervin, Bickes, & Schim, 2006; Heller, Oros, & Durney-Crowley, 2000).
The integration of evidenced-based practice serves to improve quality and safety for
patients, and improves collaboration and interprofessional teamwork (IOM, 2003a; O’Neill,
1998). Both the IOM (2003a) and the Pew Health Professions Commission (PEW, 1998)
identified the need for the health-care delivery system and its profession- als to improve
collaboration and to work in an interprofessional team to improve quality and safety.
Environment and globalization. The emergence of a global economy, the ease of travel, and
advances in communication technology affect the move- ment of people, money, and disease
(Heller, Oros, & DurneyCrowley, 2000; Kirk, 2002). Global warming and climate change
have been linked to the emergence of new drug-resistant organisms and an increase in
vector-borne and waterborne disease as warmer temperatures promote changes in organ-
ism structure and increase the growth rate of bactable 10-1 Historical Timeline teria.
Increased ease of travel allows for migration of affected populations. Safe, quality health
care will need to confront the challenges of increasing multiculturalism, potential for
pandemic, and the effect of climate change and pollution on health. In addition, many
health-care professionals, government agencies, and ing organizations have contributed to
the evolution of quality and safety within the health-care system. The Histori- cal Timeline
(Table 10-1) highlights significant organizations and initiatives of importance to quality and
safety. chapter 10 ? Issues of Quality and Safety 149 1896 1906 1918 1930s 1945 1951
1955 1966 1970 1979 1986 1989 1990 1990 1991 1996 1996 1998 1999 2001 2001 2001
2001 2003 2003 2003 2004 2004 2005 2006 2014 Nurses Associated Alumnae of the
United States and Canada formed, later called the American Nurses Association (ANA)
Factors Influencing the Realization of Quality Improvement in Healthcare DiscussionFood
and Drug Act signed, which began the regulation of food and drugs to protect consumers
American College of Surgeons founded, which initiated minimum standards for hospitals
and on-site hospital inspections for adherence to standards Employers began offering
health benefits, and the first commercial insurance companies arose Quality management
principles developed by Edward Deming were applied successfully to industries such as
manufacturing, government, and health care Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) founded; currently referred to as The Joint Commission
(JC) Social Security Act passed; hospitals that had volunteered for accreditation by JCAHO
were approved for participation in Medicare and Medicaid Quality of health-care services
defined in the literature IOM established as a nonprofit adviser to the nation to improve
health in the national academies National Committee on Quality Assurance (NCQA)
4. established National Center of Nursing Research founded at the National Institutes of Health
(NIH) Agency for Healthcare Research and Quality (AHRQ) established NCQA began
accrediting managed care organizations by using data from Health Plan Employer Data and
Information Set (HEDIS) Institute of Healthcare Improvement (IHI) founded Nursing’s
Agenda for Health Care Reform published by the ANA National Patient Safety Foundation
(NPSF) founded; JC established Sentinel Event Policies IOM launched three-part initiative to
study health-care system quality IOM National Roundtable on Health Care Quality released
Consensus Statement IOM published To Err is Human: Building a Safer Health System IOM
published Crossing the Quality Chasm: A New Health System for the 21st Century IOM
published Envisioning the National Health Care Quality Report ANA’s National Database for
Nursing Quality Indicators (NDNQI) demonstrated the positive impact of the appropriate
mix of nursing staff on patient outcomes JC mandated hospital-wide patient safety
standards IOM published Priority Areas for National Action: Transforming Health Care
Quality, which established priority areas for national action to improve quality of care and
outcomes (Box 10-1) JC established first set of National Patient Safety Goals (NPSG) IOM
published Health Professions Education: A Bridge to Quality IOM published Keeping
Patients Safe: Transforming the Work Environment of Nurses IOM published Patient Safety:
Achieving a New Standard of Care ANA updated its Health Care Agenda, urging system
reform IOM published Preventing Medication Errors: Quality Chasm Series JC updated
National Patient Safety Goals 150 unit 3 ? Career Considerations box 10-1 Institute of
Medicine Priority Areas (IOM, 2003b) and strategy for health system reform (Box 10-2).
Two in particular, To Err is Human: Building a Safer Health System (IOM, 2000) and
Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001), provide
a framework upon which the 21st-century health-care system is being built. In 2011 the
IOM released a report on The Future of Nursing: Leading Change, Advancing Health (IOM,
2011). Factors Influencing the Realization of Quality Improvement in Healthcare
DiscussionThis report describes the changes needed in nursing practice and nursing
education to promote nursing’s role in the new era of health-care delivery. To Err is Human,
discussed later in this chapter, quantified unnecessary death in the U.S. health- care system
and placed emphasis on system failures as the foundation for errors and mistakes. Accord-
ing to the report, it is the flawed systems in patient care that often leave the door open for
human error. The report made a series of eight recommendations in four areas (Box 10-3)
that aimed to decrease errors by at least 50% over 5 years. The goal of the box 10-2 IOM
Quality Reports (IOM, 2006) • Crossing the Quality Chasm: The IOM Quality Health Care
Initiative (1996) • To Err Is Human: Building a Safer Health System (2000) • Crossing the
Quality Chasm: A New Health System for the 21st Century (2001) • Envisioning the National
Health Care Quality Report (2001) • Priority Areas for National Action: Transforming Health
Care Quality (2003b) • Leadership by Example: Governmental Roles (2003) • Health
Professions Education: A Bridge to Quality (2003a) • Patient Safety: Achieving a New
Standard of Care (2003) • Keeping Patients Safe: Transforming the Work Environment for
Nurses (2004) • Academic Health Centers: Leading Change in the 21st Century (2004) •
Preventing Medication Errors: Quality Chasm Series (2006) box 10-3 Focus Areas of To Err
is Human Recommendations (IOM, 2000) • Enhance knowledge and leadership regarding
5. safety. • Identify and learn from errors. • Set performance standards and expectations for
safety. • Implement safety systems within health-care organizations. • • • • Asthma Cancer
screening Care coordination Children with special care needs • • • • • • Diabetes End-of-life
issues Frail elderly Health literacy Hypertension Immunizations • Ischemic heart disease •
Major depression • Nosocomial infections • Obesity • Pain control in advanced cancer •
Pregnancy and childbirth • Self-management • Severe, persistent mental illness • Stroke •
Tobacco dependence in adults The Institute of Medicine and the Committee on the Quality
of Health Care in America The Institute of Medicine (IOM) is a private, non- profit
organization chartered in 1970 by the U.S government. The IOM’s role is to provide
unbiased, expert health and scientific advice for the purpose of improving health. The result
of the IOM’s work s government policy making, the health- care system, health-care
professionals, and consum- ers (Box 10-1). In 1998 the IOM National Roundtable on Health
Care Quality released Statement on Quality of Care (Donaldson, 1998), which urged health-
care leaders to make urgent changes in the U.S. health-care system. The Roundtable reached
con- sensus in four areas regarding the U.S. health-care system: 1. Quality can be defined
and measured; 2. Quality problems are serious and extensive; 3. Current approaches to
quality improvement (QI) are inadequate; and 4. There is an urgent need for rapid change.
This IOM statement launched today’s movement to improve quality and safety for the 21st
century U.S. health-care system. In 1998 the IOM charged the Committee on the Quality of
Health Care in America to develop a strategy to improve health-care quality in the coming
decade (IOM, 2000). The Committee completed a systematic review and critique of lit-
erature that highlighted and quantified severe shortcomings in the heath-care system. Its
work led to the series of reports that serves as the foundation box 10-4 Ten Rules to Govern
Health-Care Reform for the 21st Century (IOM, 2001, p. 61) 1. Care is based on a continuous
healing relationship. 2. Factors Influencing the Realization of Quality Improvement in
Healthcare DiscussionCare is provided based on patient needs and values. 3. Patient is
source of control of care. 4. Knowledge is shared and free-flowing. 5. Decisions are
evidence-based. 6. Safety is a system property. 7. Transparency is necessary; secrecy is
harmful. 8. Anticipate patient needs. 9. Waste is continually decreased. 10. Cooperation is
needed between health-care providers. recommendations was “for the external environ-
ment to create sufficient pressure to make errors costly to health-care organizations and
providers, so they are compelled to take action to improve safety” (IOM, 2000, p. 4). The
recommendations sparked public interest in health-care quality and safety and caused
prompt responses by the govern- ment and national quality organizations. Crossing the
Quality Chasm addressed broad quality issues in the U.S. health-care system. The report
indicated that the health-care system is fun- damentally flawed with “gaps,” and it proposed
a system-wide strategy and action plans to redesign the health-care system. The report
stated that the gaps between actual care and highquality care could be attributed to four
key inter-related areas in the health-care system: the growing complexity of science and
technology, an increase in chronic conditions, a poorly organized delivery system of care,
and constraints on exploiting the revolution in information technology. With the
overarching goal of improving the health-care system by closing identifiable gaps, the
report made 13 recommenda- tions, some of which are in Box 10-4. Additionally, the report
6. addressed the importance of aligning and designing healthcare payer systems, profes-
sional education, and the health-care environment for quality enhancements, improved
outcomes in care, and use of best practices. The Future of Nursing: Leading Change, Advanc-
ing Health discusses the role of nursing in the 21st century.This document recognizes that
the nursing profession confronts many challenges in the chang- ing health-care system. It
identifies recommenda- tions for an “action-oriented blueprint for the future of nursing”
(RWJF, 2008, p. s-2). As a professional nurse, you have a responsibility to acknowledge the
complexity and deficits of the health-care system. In managing patient care, you must
continually consider the impact of the system on the care you provide and participate in the
quality and safety initiatives at the bedside, in your unit, and within your organization to
promote quality and safety within the system. Quality in the Health-Care System The IOM
defines quality as “the degree to which health services for individuals and populations
increase the likelihood of desired health outcomes and are consistent with current and
professional knowledge” (IOM, 2001, p. 232). This definition is used by U.S. organizations
and many international health-care organizations, and it is the basis for nursing
management of patient care. Box 10-5 elaborates on this definition by outlining six primary
aims of health care. Quality Improvement (QI) QI activities have been part of nursing care
since Florence Nightingale evaluated the care of soldiers during the Crimean War
(Nightingale & Barnum, 1992). To achieve quality health care, QI activities use
evidencebased methods for gathering data and achieving desired results. Before the 1980s,
health-care institutions focused on quality assurance (QA) rather than QI. QA outlined an
inspection process to guarantee that hospitals continued to follow minimum box 10-5 Six
Aims for Improving Quality in Health Care (IOM, 2001, p. 39). Health care should be: 1. Safe:
Avoiding injuries to patients from the care that is intended to help them 2. Effective:
Providing services based on scientific knowledge to all who could benefit and refraining
from providing services to those not likely to benefit (avoiding underuse and overuse) 3.
Patient-centered: Providing care that is respectful of and responsive to individual patient
preferences, needs, and values and ensuring that patient values guide all clinical decisions 4.
Timely: Reducing waits and sometimes harmful delays for those who receive and those who
give care 5. Efficient: Avoiding waste, in particular that of equipment, supplies, ideas, and
energy 6. Equitable: Providing care that does not vary in quality because of characteristics
such as gender, ethnicity, geographic location, and socioeconomic status chapter 10 ? Issues
of Quality and Safety 151 152 unit 3 ? Career Considerations standards of patient care
quality. This approach used retrospective chart audits and fixed errors after problems were
found. QA places very little empha- sis on change or assuming a proactive approach. In
contrast, QI infers a system-wide approach to maintaining quality. The Joint Commission
(2010) vision identifies the core of quality improvement as “All people should always
experience the safest, highest quality, best value health care across all set- tings” (para. 1).
QI usually involves the following common char- acteristics (McLaughlin & Kaluzny, 2006, p.
3): ? ? ? ? A link to key elements of the organization’s strategic plan A quality council
consisting of the institution’s top leadership Training programs for all levels of personnel
Mechanisms for s