Navigate 2 Scenario for Health Policy Episode 1: Policy Analysis and Development Overview In this episode, you will be in a health care policy internship program in a Senator’s office in Washington, D.C.  The Senator wants to develop policy that requires all health care organizations that receive federal funds to implement the recommendations presented in the Institute of Medicine reports on quality care. You will develop a policy, so that it can become proposed legislation. You must collect data, describe the problem, solutions and related ethical issues, examine the cost-benefit analysis, identify stakeholders (such as lobbyists from American Hospital Association, health care providers, health care corporations, pharmaceuticals, insurers, etc.), and impact.  Based on this information, you will create a policy description that will be the foundation for a bill. You will describe critical issues that would be in the bill such as requirements of hospitals to: Monitor and report medical errors to the Department of Health and Human Services Use root cause analysis on a certain percentage of errors Track and report patient outcomes focused on the clinical problems identified in the National Health Care Quality Report Integrate the 5 health care profession core competencies into staff education and track outcomes Establish a no-blame culture *I suggest for you to do some research on your own, and if you use outside sources to help your compile your policy description, be sure to reference them (following an APA format) at the end of your post. Assignment You will post a policy description to this discussion board forum. Make sure to identify a plan that addresses legal and ethical issues in a health care policy. You must also respond to 2 of your peers' posts and make sure to reference any outside sources you may have used in your recommendation. Below are the characters from this LearnScapes scenario (LearnScapes for Health Policy 1): The Student (which is you), Health Care Policy Intern for Congress The student used to work within the Bright Road Health Care System, and had a special interest in policy. The student is thinking about moving into politics, hoping to make a difference at that level. The student has just been accepted into the internship; this is the student’s first big project. Peter Shackley, Senior Policy Staff Member The student’s mentor, Peter, is a young and feisty staff member. In his late 20s, Pete has been interested in politics since he was President of his high school student body. He’s especially passionate about policy-making and how the process works. Pete will help guide the student through the policy-making process. Gretchen Wilde, Senator Chief of Staff Gretchen is in her 30s and has been the Senator’s Chief of Staff for about 2 years now. She’s very professional, and holds high expectations for everyone in the Senator’s office, including interns. Gretchen is responsible for reviewing polic.

1. Navigate 2 Scenario for Health Policy
Episode 1:
Policy Analysis and Development
Overview
In this episode, you will be in a health care policy internship
program in a Senator’s office in Washington, D.C. The Senator
wants to develop policy that requires all health care
organizations that receive federal funds to implement the
recommendations presented in the Institute of Medicine reports
on quality care. You will develop a policy, so that it can
become proposed legislation. You must collect data, describe
the problem, solutions and related ethical issues, examine the
cost-benefit analysis, identify stakeholders (such as lobbyists
from American Hospital Association, health care providers,
health care corporations, pharmaceuticals, insurers, etc.), and
impact. Based on this information, you will create a policy
description that will be the foundation for a bill. You will
describe critical issues that would be in the bill such as
requirements of hospitals to:
Monitor and report medical errors to the Department of Health
and Human Services
Use root cause analysis on a certain percentage of errors
Track and report patient outcomes focused on the clinical
problems identified in the

2. National Health Care
Quality Report
Integrate the 5 health care profession core competencies into
staff education and track outcomes
Establish a no-blame culture
*I suggest for you to do some research on your own, and if you
use outside sources to help your compile your policy
description, be sure to reference them (following an APA
format) at the end of your post.
Assignment
You will post a policy description to this discussion board
forum. Make sure to identify a plan that addresses legal and
ethical issues in a health care policy. You must also respond to
2 of your peers' posts and make sure to reference any outside
sources you may have used in your recommendation.
Below are the characters from this LearnScapes scenario
(LearnScapes for
Health Policy
1):
The Student (which is you), Health Care Policy Intern for
Congress
The student used to work within the Bright Road Health Care
System, and had a special interest in policy. The student is
thinking about moving into politics, hoping to make a
difference at that level. The student has just been accepted into
the internship; this is the student’s first big project.

3. Peter Shackley, Senior Policy Staff Member
The student’s mentor, Peter, is a young and feisty staff member.
In his late 20s, Pete has been interested in politics since he was
President of his high school student body. He’s especially
passionate about policy-making and how the process works.
Pete will help guide the student through the policy-making
process.
Gretchen Wilde, Senator Chief of Staff
Gretchen is in her 30s and has been the Senator’s Chief of Staff
for about 2 years now. She’s very professional, and holds high
expectations for everyone in the Senator’s office, including
interns. Gretchen is responsible for reviewing policy ideas and
descriptions before giving the approval to
create
a bill.
Marian Powers, Senator
Senator Powers is a Senator in her late 40s. She’s extremely
busy with legislative issues, and trusts her staff members
implicitly so does not spend a lot of time working directly with
the team on this policy.
However, the student and other staff members sometimes
contact her for information about state issues, reaction of
stakeholders, etc.
Student 1 to reply too
There is increasing concern on the part of Congress regarding

4. healthcare quality and cost, particularly that as costs rise there
are not necessarily commensurate increases in quality or
outcome. Policy is sought that would encourage
healthcare providers
and institutions to meet certain quality and error-reduction
guidelines in order to qualify for federal (Medicare) funding.
Medical errors, in particular, have become a significant burden
to the United States Healthcare System, as they are the 3rd
leading cause of death in the US, behind only heart disease and
cancer (Makary & Daniel, 2016). Policy is needed that
encourages systematic investments in new systems and
processes that simultaneously manage risk and improve value,
while not placing undue burden on rural access hospitals, health
centers, or similar entities serving the underserved. These
groups often lack the resources to invest in technology,
processes, and human capital than could help. Health
disparities in access to quality care are also recognized, and
policy is sought to simultaneously address equalizing both
access and quality.
ERs are often overwhelmed, primary care is not sought
regularly, doctors have little time for patients, and multiple
electronic systems (or lack thereof) do not communicate and
cause delays in information transmission when it is needed
most. The measurable, streamlining of processes, patient flow,
and data sharing are also of utmost importance.
The department of Health, HHS, AHRQ are groups that can
encourage healthcare institutions to follow IOM guidelines
regarding self-disclosure of medical errors and engage them in
proactive behaviors focused on quality and prevention, but
policy is needed to address all of the following:
Monitor and report medical errors to the Department of Health

5. and Human Services
Use root cause analysis on a certain percentage of errors
Track and report patient outcomes focused on the clinical
problems identified in the National Health Care Quality Report
The following policy solutions are offered for the above
priorities:
Legislation that supports voluntary reporting of near misses and
rewards
innovation following RCA to address negative trends
(innovation grants or awards could be provided by HRSA,
Agency for Healthcare Policy and Research, state DOH’s or
others. There should be a biannual or quarterly award process.
Healthcare entities with fewer resources and serving the
underserved should be held same standards, but should be
eligible for grant dollars aimed at needed technology or basic
reporting assistance to track outcomes. This would avoid
inequities and level the playing field.
Center for Quality Improvement and Patient Safety (CQuIPS)
has a national quality strategy (AHRQ, 2015) – incentivize
organizations who align themselves with this strategy, and
similarly, empower ARHQ to hold insures and others
accountable for such outcomes, not just provider groups. The
responsibility for outcomes should be shared, as should the
reduction of health disparities, like mental health for minorities
(Bussing & Gary, 2012)
Establish a quality award system to reward consistently good
outcomes that reduce health disparities and medical errors
(administered by AHRQ)

6. Establish a way to encourage the identification of
hidden
barriers to quality and safety (RCA, Gemba walks, lean six
sigma approaches), like health literacy (AHRQ, 2015) and fund
nonprofits through time limited grants so they can initiate such
processes and then sustain them once they start seeing results
In order to: Integrate the 5 healthcare profession core
competencies into staff education and track outcomes, the
following solution should be considered: Develop an
organizational assessment for the quality program and
leadership of various institutions – must be tailored to the type
of institution and staff education with outcome evaluations in
key priority areas established by AHRQ. Make federal funding
contingent upon a baseline level of performance in the
following areas: Team base care, 1) patient-centered care, 2)
teamwork and collaboration, 3) evidence-based practice, 4)
quality improvement, and 5) informatics (IOM, 2003).
Alternatively, influence all accrediting agencies to make this
part of re-accreditation and avoid setting up a duplicative
system if an existing one can be leveraged.
In order to establish a no-blame culture, I offer the following
policy comment & solution: CMS can also set the stage for
incentivizing the reporting of near misses and medical errors,
along with root cause analysis for errors. It would be more
important for policy to focus on preventive reporting (near
misses) rather than simply error reporting. There are already
quality incentives for certain patient outcomes (HG AIC for
diabetic control for instance) which policy should continue, but
it would be sensible to add near miss and error reporting to this
program. What’s needed is simplification, however. The way it
stands now, each payor has their own quality outcome
requirements and quality award structure. There needs to be
legislation that allows for a publicly available report card for

7. payors in terms of their outcome performance (actually this is
just now happening in Florida under Secretary Mayhew)
While making federal payments contingent upon compliance
with reporting does not facilitate a collaborative relationship
with government agencies and healthcare entities, it could be a
final step after iterative warnings and opportunities are
afforded. It would be better to encourage full disclosure by
participating organizations to self-disclose – allowing increased
payment for self-reporting and then altering a process or
identifying root cause.
Lastly, payor and provider groups need to be aligned. Shared
goals and shared savings offered back to the provider/entity
should be the norm, and should be legislated as such. Similarly,
prevention needs to be paid for – so that fewer folks wind up in
the hospital where medical errors are most costly.
Bussing, R. & Gary, F.A. (2012). Eliminating mental health
disparities by 2020: Everyone's actions matter.
Journal of the American Academy of Child and Adolescent
Psychiatry
, 51 (7) , pp. 663-666
Institute of Medicine (IOM). (2003).
Health professions education: A bridge to quality.
Washington, DC:National Academies Press
Makary, M.A., & Daniel, M. (2016). Medical error: The third
leading cause of death in the US. Retrieved November 12th,
2016, from
https://www.bmj.com/content/353/bmj.i2139 (Links to an
external site.)
U.S. Department of Health & Human Services, Agency for

8. Healthcare Research and Quality: Health literacy: hidden
barriers and practical strategies. Retrieved January 25th, 2019,
from
http:// (Links to an external site.)
www.ahrq.gov/professionals/quality-patient-safety/quality-
resources/tools/literacy-toolkit/tool3a/index.html (Links to an
external site.)
Center for Quality Improvement and Patient Safety (CQuIPS).
Content last reviewed December 2015. Agency for Healthcare
Research and Quality, Rockville, MD.
https://www.ahrq.gov/cpi/centers/cquips/index.html
Student 2 Reply too
Problem Statement
Healthcare costs in the US are increasing and the quality of care
is not keeping pace. According to the Institute of Medicine’s
report Crossing the Quality Chasm, US health care deliver
systems do not provide consistent, high-quality medical care to
all people (Institute of Medicine, 2001). Health care providers
have a difficult time keeping up with the ever-increasing
advances in technology along with the growing population.
Background
‘Health care spending growth is expected to increase an average
annual rate of 5.8 percent. By 2024, health spending is
projected to account for 19.6 percent of GDP, up from 17.4
percent in 2013’ (Keehan, et al., 2015). The deaths considered
preventable with timely and effective care (amenable mortality)

9. is the worst out of ten other ranked countries (Sawyer &
McDermott, 2019).
Landscape
People over 60 are projected to increase from 11% of the
population to 22% of the population between 2000 and 2050,
with an average life expectancy of 80 years (Jin, Simpkins, Ji,
Leis, & Stambler, 2015). This will put significant impact on the
health care system.
Physician burnout is a significant concern and must be
considered with any new regulatory requirements. ‘Physicians
have to navigate a rapidly expanding medical knowledge base,
more onerous maintenance of certification requirements,
increased clerical burden associated with the introduction of
electronic health records (EHR’s) and patient portals, new
regulatory requirements (meaningful use, e-prescribing,
medication reconciliation), and an unprecedented level of
scrutiny (quality metrics, patient satisfaction scores, measures
of cost) (Shanafeld, MD, Dyrbye, MD, MHPE, & West, MD,
PhD, 2017).
Rural hospitals are closing at an increasing rate since 2010
(Kaufman, MSPH, et al., 2015). Low profitability, patient
volumes, and staffing are some of the contributing factors. Any
new regulations need to be mindful of these financially fragile,
yet important health care facilities.
Option
Implementation of the Institutes of Medicine’s Ten Rules for
Redesign:
1. Care is based on continuous relationships.

10. 2. Care is customized according to patient needs and values.
3. The patient is the source of control.
4. Knowledge is shared and information flows freely.
5. Decision making is evidence-based.
6. Safety is a system property.
7. Transparency is necessary.
8. Needs are anticipated.
9. Wasted is continuously decreased.
10. Cooperation among clinicians is a priority.
Recommendation
In order to receive federal funds health care organizations must
abide by the following four of the ten quality recommendations
from the IOM’s Crossing the Quality Chasm report:
• Implementation of evidence-based medicine. Care should be
standardized based on scientific knowledge.
• Safety is a system property. Patients should be safe from
injury caused by the care system.
• Transparency is necessary. Patients and their families should
have information that enables them to make informed decisions
related to their health care.
References

11. Institue of Medicine. (2001). Crossing the Quality Chasm: A
New Health System for the 21st Century. Washington: National
Academy Press.
Jin, K., Simpkins, J. W., Ji, X., Leis, M., & Stambler, L. (2015).
The Critical Need to Promote Research of Aging and Aging-
related Diseases to Improve Health and Longevity of the Elderly
Population. Aging and Disease.
Kaufman, MSPH, B. G., Thomas, MPP, S. R., Randolph, MRP,
R. K., Perry, J. R., Thompson, K. W., Holmes, PhD, G. M., &
Pink, PhD, G. H. (2015). The Rising Rate of Rural Hospital
Closures. The Journal of Rural Health.
Keehan, S. P., Cuckler, G. A., Sisko, A. M., Madison, A. J.,
Smith, S. D., Stone, D. A., . . . Lizonitz, J. M. (2015). National
Helath Expenditure Projections, 2014-24: Spending Growth
Faster Than Recent Trends. Health Affairs.
Sawyer, B., & McDermott, D. (2019, March 28). How does the
qualit of the US healthcare system compare to other countries?
Retrieved from Peterson-Kaiser Health System Tracker:
https://www.healthsystemtracker.org/chart-collection/quality-u-
s-healthcare-system-compare-countries/#item-start
Shanafeld, MD, T. D., Dyrbye, MD, MHPE, L. N., & West, MD,
PhD, C. P. (2017). Addressing Physician Burnout: The Way
Foward. JAMA, 901-902.