Accreditations and quality assurance systems have also been observed to reduce the average cost of hospitalization. This clearly indicates that accreditations and quality assurance systems help hospitals to streamline their functions and processes, minimize wastage and thereby aid in enhancing quality and reducing cost of care.
Has Accreditation made a difference in Healthcare Delivery in India by Dr.Mah...Healthcare consultant
There is consistent evidence that shows that accreditation programs improve the process of care provided by healthcare services. There is considerable evidence to show that accreditation programs improve clinical outcomes of a wide spectrum of clinical conditions. Accreditation programs should be supported as a tool to improve the quality of healthcare services.
Lannes - Improving health worker performance The patient-perspectivelaurencelannes
PBF programs in developing countries aim to improve health worker performance through financial incentives tied to meeting targets. This document analyzes data from a PBF program in Rwanda to assess its impact on patient satisfaction. It finds that PBF had a positive effect on satisfaction with clinical services by improving productivity, availability, and competencies of health workers. PBF also positively impacted satisfaction with non-clinical dimensions, suggesting it incentivized improvements in those areas as well. The study concludes PBF can be an effective strategy for increasing patient satisfaction if programs include assessing satisfaction in their incentive mechanisms.
This document discusses assessing and improving the quality of mental health services. It proposes an eight-dimensional model for evaluating mental health services quality, including dimensions like accessibility, acceptability, effectiveness, and safety. Each dimension contains indicators that are defined and have targets outlined. The purpose is to provide a standardized way to measure quality across mental health systems and identify areas for improvement.
This document summarizes a study that assessed patient satisfaction with antenatal care services provided at primary health centers in Ejigbo Local Government Area of Osun State, Nigeria. 234 antenatal patients across multiple health centers were surveyed using a questionnaire to evaluate their satisfaction. Key findings included:
- 60.3% of respondents reported being greeted warmly by health workers, establishing good rapport.
- 77.4% felt privacy and confidentiality were inadequate.
- 48% felt waiting times were too long.
- There was a relationship between satisfaction and quality of interactions with health workers.
- 74% overall were satisfied with antenatal care services.
- Satisfaction was also related
INFLUENCE OF HEALTH SERVICE PROVIDER COMPETENCY ON UTILIZATION OF UNIVERSAL H...Premier Publishers
This study assessed the influence of healthcare provider competency on universal health coverage utilization in Seme Sub-County, Kenya. A cross-sectional study was conducted using a sample of 377 community members and 8 health facility managers. Logistic regression found that healthcare provider competency statistically influenced utilization of universal health coverage. Respondents who perceived that providers had adequate health knowledge were over twice as likely to use universal health coverage services. Those who experienced misdiagnosis were half as likely to solely rely on universal health coverage. Most respondents agreed that providers had sufficient knowledge, though some raised concerns about competency in pharmacy departments due to staffing shortages. In conclusion, healthcare provider competency levels significantly impact utilization of universal health coverage.
An enhanced care management program achieved lower health care costs through broader outreach, personalized health coaching, and engagement of higher-risk populations. A randomized controlled trial of 175,000 individuals found that the enhanced program led to a $7.96 lower average monthly medical cost per member and over a 4:1 return on investment. Key aspects of the enhanced program included targeting a wider range of chronic and preference-sensitive conditions, more frequent outreach, and deeper health coaching relationships.
Assessment of Patients Satisfaction in Accredited and Non–Accredited Primary ...Mohammad Shishtawy
Master Thesis in Family Meidicne about Assessment of Patient Satisfaction in Accredited and Non-Accredited Primary Health Care Facilities in Nabaroh Health District
Zagazig University
2015
AHRQ Quality and Disparities Report, May 2015Joe Soler
The document is a presentation from the National Healthcare Quality and Disparities Report Chartbook on Care Coordination from May 2015. It discusses trends in care coordination measures from the report and provides data on various measures of care coordination, including rates of patients receiving discharge instructions, hospital readmission rates, and preventable emergency department visits. The goal is to assess quality of care coordination and identify areas for improvement, particularly in reducing disparities. Several charts display care coordination measure results over time and differences between demographic groups to examine health equity.
Has Accreditation made a difference in Healthcare Delivery in India by Dr.Mah...Healthcare consultant
There is consistent evidence that shows that accreditation programs improve the process of care provided by healthcare services. There is considerable evidence to show that accreditation programs improve clinical outcomes of a wide spectrum of clinical conditions. Accreditation programs should be supported as a tool to improve the quality of healthcare services.
Lannes - Improving health worker performance The patient-perspectivelaurencelannes
PBF programs in developing countries aim to improve health worker performance through financial incentives tied to meeting targets. This document analyzes data from a PBF program in Rwanda to assess its impact on patient satisfaction. It finds that PBF had a positive effect on satisfaction with clinical services by improving productivity, availability, and competencies of health workers. PBF also positively impacted satisfaction with non-clinical dimensions, suggesting it incentivized improvements in those areas as well. The study concludes PBF can be an effective strategy for increasing patient satisfaction if programs include assessing satisfaction in their incentive mechanisms.
This document discusses assessing and improving the quality of mental health services. It proposes an eight-dimensional model for evaluating mental health services quality, including dimensions like accessibility, acceptability, effectiveness, and safety. Each dimension contains indicators that are defined and have targets outlined. The purpose is to provide a standardized way to measure quality across mental health systems and identify areas for improvement.
This document summarizes a study that assessed patient satisfaction with antenatal care services provided at primary health centers in Ejigbo Local Government Area of Osun State, Nigeria. 234 antenatal patients across multiple health centers were surveyed using a questionnaire to evaluate their satisfaction. Key findings included:
- 60.3% of respondents reported being greeted warmly by health workers, establishing good rapport.
- 77.4% felt privacy and confidentiality were inadequate.
- 48% felt waiting times were too long.
- There was a relationship between satisfaction and quality of interactions with health workers.
- 74% overall were satisfied with antenatal care services.
- Satisfaction was also related
INFLUENCE OF HEALTH SERVICE PROVIDER COMPETENCY ON UTILIZATION OF UNIVERSAL H...Premier Publishers
This study assessed the influence of healthcare provider competency on universal health coverage utilization in Seme Sub-County, Kenya. A cross-sectional study was conducted using a sample of 377 community members and 8 health facility managers. Logistic regression found that healthcare provider competency statistically influenced utilization of universal health coverage. Respondents who perceived that providers had adequate health knowledge were over twice as likely to use universal health coverage services. Those who experienced misdiagnosis were half as likely to solely rely on universal health coverage. Most respondents agreed that providers had sufficient knowledge, though some raised concerns about competency in pharmacy departments due to staffing shortages. In conclusion, healthcare provider competency levels significantly impact utilization of universal health coverage.
An enhanced care management program achieved lower health care costs through broader outreach, personalized health coaching, and engagement of higher-risk populations. A randomized controlled trial of 175,000 individuals found that the enhanced program led to a $7.96 lower average monthly medical cost per member and over a 4:1 return on investment. Key aspects of the enhanced program included targeting a wider range of chronic and preference-sensitive conditions, more frequent outreach, and deeper health coaching relationships.
Assessment of Patients Satisfaction in Accredited and Non–Accredited Primary ...Mohammad Shishtawy
Master Thesis in Family Meidicne about Assessment of Patient Satisfaction in Accredited and Non-Accredited Primary Health Care Facilities in Nabaroh Health District
Zagazig University
2015
AHRQ Quality and Disparities Report, May 2015Joe Soler
The document is a presentation from the National Healthcare Quality and Disparities Report Chartbook on Care Coordination from May 2015. It discusses trends in care coordination measures from the report and provides data on various measures of care coordination, including rates of patients receiving discharge instructions, hospital readmission rates, and preventable emergency department visits. The goal is to assess quality of care coordination and identify areas for improvement, particularly in reducing disparities. Several charts display care coordination measure results over time and differences between demographic groups to examine health equity.
This document outlines concepts related to health care quality assessment. It describes key definitions, such as quality referring to services that increase health outcomes and are consistent with current knowledge. It also discusses perspectives on quality from practitioners, patients, and communities. Additionally, the document outlines different levels of quality analysis from national policies to individual care provision and lists examples of common quality indicators assessed in the US, such as patient satisfaction, mortality rates, and adherence to treatment protocols.
This document summarizes a study assessing performance measures at a tertiary hospital in central India over a one-month period. Key findings include:
- Bed occupancy rate was 71.07%, meeting WHO standards. ICUs like SICU and MICU had high occupancy.
- Average length of stay was 4.02 days, matching WHO guidelines.
- Bed turnover ratio was 5 patients per bed, higher than WHO standards and indicating more bed needs.
- ICU mortality rate was 40.27%, much higher than the WHO 1-15% standard. Overall hospital mortality rate was also higher at 11.89%.
Patient satisfaction the importance of its measurement in improving the quali...Alexander Decker
This document summarizes a study on measuring patient satisfaction in a public pediatric department. The study aimed to identify factors influencing patient satisfaction related to access and care delivery. Researchers conducted surveys of 105 patients to assess satisfaction with various aspects like wait times, facilities, and staff interactions. Statistical analysis found the main dissatisfaction factors were long wait times and the waiting room conditions. Multiple factor analysis identified different patient profiles. Based on the results, the department implemented several actions to improve patient satisfaction.
This article analyzes annual cost profiles and consumption patterns of Medicare beneficiaries with diabetes from 2000 to 2006. It finds that while the percentages of beneficiaries and expenditures in different consumption clusters (ranging from "crisis consumers" to "low consumers") remained generally constant year to year, there was significant movement of individuals between clusters over time. Notably, a large proportion of those in the lowest clusters in one year transitioned to the highest clusters in subsequent years, representing a significant portion of inpatient costs. This dynamic migration between clusters, with individuals moving from low to high usage, was a previously unrecognized trend with important implications for targeting of disease management programs.
A study on patient satisfaction with special reference to government hospital...Tapasya123
In this study researchers analyse the satisfaction level of patients regard to facilities
available in government hospitals. A sample of 100 patients is taken from Pandit Brij
Sundar Shama Government General Hospital (GGH) at Bundi District in the state
of Rajasthan in India. Four dimensions of perceived quality were identified—Admission
Procedure, Diagnostic Services, Behaviour of the staff, Cleanliness. The developed
scale is used to evaluate perceived quality at a range of various types of facilities
for patients. Perceived quality at public facilities is only marginally favourable, leaving
much scope for improvement. Better staff and physician relations, interpersonal skills,
good diagnostic and cleanliness service can improve the level of satisfaction among
employees.
Keywords:
The document discusses New York State's efforts to promote the patient-centered medical home model. It notes that while New York spends a lot on healthcare, the quality and health outcomes are only middle of the pack. The Commissioner of Health believes the PCMH model can help strengthen primary care, improve chronic care management, and reduce avoidable costs. New York has promoted multipayer PCMH initiatives through legislation and programs. Initial PCMH pilot programs showed promising results, and the state has seen significant uptake of PCMH recognition across practices. Evaluations are still early, but results so far are encouraging regarding patient experience and quality measures.
The document outlines a research grant application to study the effectiveness of an educational intervention program on strengthening leadership qualities among nursing managers in a hospital in Nepal. It includes sections on the title, investigators, duration, budget, and declaration by the investigators. It also provides details of the study aims, objectives, design, participants, intervention, and outcomes. A literature review covers topics on quality of healthcare, leadership, nursing education, and factors influencing nursing. The rationale is that continuous education is needed for healthcare workers to improve quality as fields advance and expectations rise. The study aims to assess and strengthen leadership skills of nursing managers through an educational program.
Patients' satisfaction towards doctors treatmentmustafa farooqi
The mood of the care recipient to see if the impression (expectations) of service are met by the patient may be defined as patient satisfaction. The current perspective on service efficiency tends to be that patient treatment meets public standards and requirements in terms of interpersonal support as well as professional assistance. (Hardy et al. 1996).
For various reasons, customer satisfactions in the healthcare industry have been investigated. First it was important to decide on the extent and the degree to which patient care seekers, the meeting of drugs criteria and the continuous use of these services have effect, satisfaction as a quality of service metric, as well as allowing doctors and health services to better appreciate and use the input of the patient. (Ong et al. 2000).
Consumer satisfaction with healthcare services is a multi-panel term that refers to the core facets of treatment and suppliers, while PS medical services with the quality enhancement systems from the patient context, full control of quality and the intended outcomes of services are considered to be of primary importance (Janicijevic et al. 2013).
The Pakistani health system is being changed somewhat and there are wonderful scope for applying standard of services to health care. Patients in Pakistan now have access to increased quality health care. Obviously, the staff and staff are the most important winners of a successful health care environment of every community sector framework (Bakari et al. 2019).
The medical clinic of today's study is the product of a long and complicated war of civilization to quantify produce and study and to give thought to the thoughtful (Fullman et al. 2017).
The influence of clients’ perceived quality on health care utilizationSYCHRISTO
The document discusses a study on the influence of clients' perceived quality of healthcare on utilization of health services in Ghana. The study analyzed data from 400 clients accessing care at 10 health facilities. Major findings included: 1) Most clients reported waiting over 3 hours to receive care; 2) Over 75% reported satisfaction as good or excellent with care quality; 3) While most clients could easily access medicines, over a third did not receive all prescribed drugs. The study concludes that clients' perceptions of quality influence their use of health insurance and that improving quality could increase insurance enrollment and utilization.
The document discusses essential components for transforming healthcare delivery systems. It identifies leadership, collaboration, balancing regulation and creativity, health information systems, and research as key elements. It provides examples of research studying the adoption of evidence-based practices and the impact of interventions on outcomes like costs, falls, and pain management.
CMS Case Study_Brown and Toland Physician's Approach to Serving High Ris...marcus zachary
Brown and Toland Physicians developed a tiered care management program to improve health outcomes and lower costs for high-risk, high-cost patients. They identify these patients through predictive modeling, hospital visits, and physician referrals. Patients are provided different levels of care management based on their needs, including transitional care after hospitalization, outpatient care for chronic conditions, and home-based care for frail patients. This approach aims to address patients' medical and social needs through coordinated care across settings.
Dr Dev Kambhampati | NCCAM- Exploring the Science of Complementary and Altern...Dr Dev Kambhampati
The National Center for Complementary and Alternative Medicine (NCCAM) 2011-2015 Strategic Plan outlines goals to advance research on CAM interventions over the next decade. NCCAM's goals are to: 1) Advance the science and practice of symptom management for conditions like pain that CAM is often used to treat; 2) Develop effective strategies for promoting health and well-being using CAM approaches; and 3) Provide objective evidence to enable better decision-making about CAM use and integration into healthcare. NCCAM's first decade of research investment has grown the evidence base on CAM safety and efficacy through clinical trials and basic research, influencing public use of certain CAM products and practices.
Introduction: The patient’s perception of quality of care is fundamental to utilization of health services. Health utilization would partly depend on clients’ perception of the quality of care.
Methods: A cross-sectional study involving health clients (18 to 70 years) who accessed health services in the Bantama submetro
in the Kumasi metropolis was conducted. A total of 400 clients were recruited from ten health facilities for the study.
Data was collected through interviewing using semi-structured questionnaires using SPSS and analyzed into descriptive and
inferential statistics with STATA 11.
Results: Majority of subscribers assessed healthcare with their National Health Insurance (NHI) cards. Eight percent (8%) had
never accessed healthcare with their NHIS cards. Respondents’ reasons included not falling sick and low quality of healthcare
under the NHIS. Respondents 216 (54%) indicated delays in seeing a doctor, getting laboratories done, and accessing health care as a whole. Seventy-four percent (74%) of the entire population attributed both NHIS and cash and carry systems as the
payment methods associated with delays in health facilities. Clients who viewed the overall the quality of health provision as good or very good were more likely to access healthcare with NHIS card as compared to those who rated the overall health provision as poor or very poor (OR=2.1; p<0.01).
Conclusion: Clients’ perceptions and experiences with quality of health provision influence their utilization of healthcare under the NHIS scheme. Increased enrolment in the scheme should be supported with provision of quality services to enhance clients’ satisfaction.
This document outlines Dan Hausman's critique of economic evaluations of health that rely on eliciting and aggregating individual preferences. Hausman argues that preferences are an unreliable guide to the value of health states for several reasons. People's preferences can be distorted by cognitive flaws and irrelevant factors. They are also often uninformed since health states are unfamiliar alternatives. Rather than relying on preferences, Hausman believes health economists should directly evaluate health states based on their effects on well-being, opportunities, autonomy, and other considerations.
This document discusses evidence-based practice (EBP) and its application to a case study of a patient with diabetic peripheral neuropathy. It begins by defining EBP and outlining its key principles. It then presents the case study, formulating the clinical question using the PICO framework. It describes searching relevant literature databases using search terms derived from the PICO elements to address the clinical question. The goal is to evaluate pharmacological and alternative treatments like acupuncture for diabetic peripheral neuropathy based on the best available evidence.
The Personalized Medicine Coalition 2015 Annual Report summarizes the organization's work in education, advocacy, and impact over the past year. It highlights key events including a Congressional briefing on personalized medicine that educated over 125 people, including 50 Congressional staffers. The report also outlines challenges to personalized medicine such as obstacles in science, regulation, and reimbursement, but notes the biopharmaceutical industry remains committed with over 40% of drugs in development being personalized medicines.
1) The Quality and Outcomes Framework (QOF) in the UK introduced pay for performance in primary care on a large scale, providing financial incentives for general practices to meet performance criteria in clinical care, organization, patient experience, and additional services.
2) Studies found mixed results on the impact of QOF, with some evidence that it improved processes of care for certain conditions like diabetes but unintended consequences like a focus on financial targets over patient-centered care.
3) There is concern that pay for performance could undermine intrinsic motivations if it does not align with professional values or leads to unfair exclusions of complex patients, and some experts argue for transparency and feedback over financial incentives.
The document provides guidelines for assessing hospitals based on operational standards outlined in the Ethiopian Hospital Transformation Guidelines. It includes standards related to hospital leadership, management and governance, liaison and referral services, emergency medical services, outpatient services, inpatient services, medical records management, and nursing and midwifery care services management. Each standard includes the method for evaluation and whether the standard is met or unmet. The assessment is intended to help hospitals improve performance in key areas.
Why Electronic Health Records are Ill Suited for Population Health 012616infomc
Electronic health records are ill-suited for population health management for several reasons. EHRs were designed to manage patient data within individual healthcare systems and have limited ability to track health information from outside sources or support integrated care across multiple providers. Population health management requires more sophisticated technology that can perform functions like enrollment tracking, provider networking, utilization review, claims processing, and quality reporting that are beyond the scope of most EHRs. While EHRs are important for individual medical practices, organizations taking on financial risk for patient populations need systems designed for the specific demands of population health management.
The word "hospital" comes from the Latin "hospes" which refers to either a visitor or the host who receives the visitor. From "hospes" came the Latin "hospitalia", an apartment for strangers or guests, and the Medieval Latin "hospitale" and the Old French "hospital." It crossed the Channel in the 14th century and in England began a shift in the 15th century to mean a home for the elderly or infirm or a home for the down-and-out.i
Hospital is an institution or the organization for the treatment, care, and cures of the sick and
wounded, for the study of disease, and for the training of physicians (teaching hospitals), nurses,
and allied health care personnel.ii
This case study examines a Lean Manufacturing initiative involving three aerospace suppliers - Haynes International Ltd, Precision Parts Engineering Ltd, and Merc Engineering Ltd - and their customer, Unison Engine Components. The objective was to reduce costs and improve delivery performance to combat low-cost competitors. A Lean consultant introduced tools like 5S, improved layouts, kanban systems and visual controls. Early results included a 15-22% improvement in on-time delivery, better awareness of customer needs, and more efficient operations.
This case study examines efforts to improve customer satisfaction and reduce costs at an IT call center. The project team conducted a Define phase to understand key customer requirements around quick response, accurate information, and issue resolution. They mapped the call resolution process and identified opportunities in long wait times and multiple transfers. In Analyze, the team found problem and change calls had higher costs, and Mondays/Fridays were more expensive. They verified staffing levels and training affected transfer rates. In Improve, solutions tested included promoting a web portal, focused training, and staffing adjustments. A pilot found wait times decreased with the new approaches.
This document outlines concepts related to health care quality assessment. It describes key definitions, such as quality referring to services that increase health outcomes and are consistent with current knowledge. It also discusses perspectives on quality from practitioners, patients, and communities. Additionally, the document outlines different levels of quality analysis from national policies to individual care provision and lists examples of common quality indicators assessed in the US, such as patient satisfaction, mortality rates, and adherence to treatment protocols.
This document summarizes a study assessing performance measures at a tertiary hospital in central India over a one-month period. Key findings include:
- Bed occupancy rate was 71.07%, meeting WHO standards. ICUs like SICU and MICU had high occupancy.
- Average length of stay was 4.02 days, matching WHO guidelines.
- Bed turnover ratio was 5 patients per bed, higher than WHO standards and indicating more bed needs.
- ICU mortality rate was 40.27%, much higher than the WHO 1-15% standard. Overall hospital mortality rate was also higher at 11.89%.
Patient satisfaction the importance of its measurement in improving the quali...Alexander Decker
This document summarizes a study on measuring patient satisfaction in a public pediatric department. The study aimed to identify factors influencing patient satisfaction related to access and care delivery. Researchers conducted surveys of 105 patients to assess satisfaction with various aspects like wait times, facilities, and staff interactions. Statistical analysis found the main dissatisfaction factors were long wait times and the waiting room conditions. Multiple factor analysis identified different patient profiles. Based on the results, the department implemented several actions to improve patient satisfaction.
This article analyzes annual cost profiles and consumption patterns of Medicare beneficiaries with diabetes from 2000 to 2006. It finds that while the percentages of beneficiaries and expenditures in different consumption clusters (ranging from "crisis consumers" to "low consumers") remained generally constant year to year, there was significant movement of individuals between clusters over time. Notably, a large proportion of those in the lowest clusters in one year transitioned to the highest clusters in subsequent years, representing a significant portion of inpatient costs. This dynamic migration between clusters, with individuals moving from low to high usage, was a previously unrecognized trend with important implications for targeting of disease management programs.
A study on patient satisfaction with special reference to government hospital...Tapasya123
In this study researchers analyse the satisfaction level of patients regard to facilities
available in government hospitals. A sample of 100 patients is taken from Pandit Brij
Sundar Shama Government General Hospital (GGH) at Bundi District in the state
of Rajasthan in India. Four dimensions of perceived quality were identified—Admission
Procedure, Diagnostic Services, Behaviour of the staff, Cleanliness. The developed
scale is used to evaluate perceived quality at a range of various types of facilities
for patients. Perceived quality at public facilities is only marginally favourable, leaving
much scope for improvement. Better staff and physician relations, interpersonal skills,
good diagnostic and cleanliness service can improve the level of satisfaction among
employees.
Keywords:
The document discusses New York State's efforts to promote the patient-centered medical home model. It notes that while New York spends a lot on healthcare, the quality and health outcomes are only middle of the pack. The Commissioner of Health believes the PCMH model can help strengthen primary care, improve chronic care management, and reduce avoidable costs. New York has promoted multipayer PCMH initiatives through legislation and programs. Initial PCMH pilot programs showed promising results, and the state has seen significant uptake of PCMH recognition across practices. Evaluations are still early, but results so far are encouraging regarding patient experience and quality measures.
The document outlines a research grant application to study the effectiveness of an educational intervention program on strengthening leadership qualities among nursing managers in a hospital in Nepal. It includes sections on the title, investigators, duration, budget, and declaration by the investigators. It also provides details of the study aims, objectives, design, participants, intervention, and outcomes. A literature review covers topics on quality of healthcare, leadership, nursing education, and factors influencing nursing. The rationale is that continuous education is needed for healthcare workers to improve quality as fields advance and expectations rise. The study aims to assess and strengthen leadership skills of nursing managers through an educational program.
Patients' satisfaction towards doctors treatmentmustafa farooqi
The mood of the care recipient to see if the impression (expectations) of service are met by the patient may be defined as patient satisfaction. The current perspective on service efficiency tends to be that patient treatment meets public standards and requirements in terms of interpersonal support as well as professional assistance. (Hardy et al. 1996).
For various reasons, customer satisfactions in the healthcare industry have been investigated. First it was important to decide on the extent and the degree to which patient care seekers, the meeting of drugs criteria and the continuous use of these services have effect, satisfaction as a quality of service metric, as well as allowing doctors and health services to better appreciate and use the input of the patient. (Ong et al. 2000).
Consumer satisfaction with healthcare services is a multi-panel term that refers to the core facets of treatment and suppliers, while PS medical services with the quality enhancement systems from the patient context, full control of quality and the intended outcomes of services are considered to be of primary importance (Janicijevic et al. 2013).
The Pakistani health system is being changed somewhat and there are wonderful scope for applying standard of services to health care. Patients in Pakistan now have access to increased quality health care. Obviously, the staff and staff are the most important winners of a successful health care environment of every community sector framework (Bakari et al. 2019).
The medical clinic of today's study is the product of a long and complicated war of civilization to quantify produce and study and to give thought to the thoughtful (Fullman et al. 2017).
The influence of clients’ perceived quality on health care utilizationSYCHRISTO
The document discusses a study on the influence of clients' perceived quality of healthcare on utilization of health services in Ghana. The study analyzed data from 400 clients accessing care at 10 health facilities. Major findings included: 1) Most clients reported waiting over 3 hours to receive care; 2) Over 75% reported satisfaction as good or excellent with care quality; 3) While most clients could easily access medicines, over a third did not receive all prescribed drugs. The study concludes that clients' perceptions of quality influence their use of health insurance and that improving quality could increase insurance enrollment and utilization.
The document discusses essential components for transforming healthcare delivery systems. It identifies leadership, collaboration, balancing regulation and creativity, health information systems, and research as key elements. It provides examples of research studying the adoption of evidence-based practices and the impact of interventions on outcomes like costs, falls, and pain management.
CMS Case Study_Brown and Toland Physician's Approach to Serving High Ris...marcus zachary
Brown and Toland Physicians developed a tiered care management program to improve health outcomes and lower costs for high-risk, high-cost patients. They identify these patients through predictive modeling, hospital visits, and physician referrals. Patients are provided different levels of care management based on their needs, including transitional care after hospitalization, outpatient care for chronic conditions, and home-based care for frail patients. This approach aims to address patients' medical and social needs through coordinated care across settings.
Dr Dev Kambhampati | NCCAM- Exploring the Science of Complementary and Altern...Dr Dev Kambhampati
The National Center for Complementary and Alternative Medicine (NCCAM) 2011-2015 Strategic Plan outlines goals to advance research on CAM interventions over the next decade. NCCAM's goals are to: 1) Advance the science and practice of symptom management for conditions like pain that CAM is often used to treat; 2) Develop effective strategies for promoting health and well-being using CAM approaches; and 3) Provide objective evidence to enable better decision-making about CAM use and integration into healthcare. NCCAM's first decade of research investment has grown the evidence base on CAM safety and efficacy through clinical trials and basic research, influencing public use of certain CAM products and practices.
Introduction: The patient’s perception of quality of care is fundamental to utilization of health services. Health utilization would partly depend on clients’ perception of the quality of care.
Methods: A cross-sectional study involving health clients (18 to 70 years) who accessed health services in the Bantama submetro
in the Kumasi metropolis was conducted. A total of 400 clients were recruited from ten health facilities for the study.
Data was collected through interviewing using semi-structured questionnaires using SPSS and analyzed into descriptive and
inferential statistics with STATA 11.
Results: Majority of subscribers assessed healthcare with their National Health Insurance (NHI) cards. Eight percent (8%) had
never accessed healthcare with their NHIS cards. Respondents’ reasons included not falling sick and low quality of healthcare
under the NHIS. Respondents 216 (54%) indicated delays in seeing a doctor, getting laboratories done, and accessing health care as a whole. Seventy-four percent (74%) of the entire population attributed both NHIS and cash and carry systems as the
payment methods associated with delays in health facilities. Clients who viewed the overall the quality of health provision as good or very good were more likely to access healthcare with NHIS card as compared to those who rated the overall health provision as poor or very poor (OR=2.1; p<0.01).
Conclusion: Clients’ perceptions and experiences with quality of health provision influence their utilization of healthcare under the NHIS scheme. Increased enrolment in the scheme should be supported with provision of quality services to enhance clients’ satisfaction.
This document outlines Dan Hausman's critique of economic evaluations of health that rely on eliciting and aggregating individual preferences. Hausman argues that preferences are an unreliable guide to the value of health states for several reasons. People's preferences can be distorted by cognitive flaws and irrelevant factors. They are also often uninformed since health states are unfamiliar alternatives. Rather than relying on preferences, Hausman believes health economists should directly evaluate health states based on their effects on well-being, opportunities, autonomy, and other considerations.
This document discusses evidence-based practice (EBP) and its application to a case study of a patient with diabetic peripheral neuropathy. It begins by defining EBP and outlining its key principles. It then presents the case study, formulating the clinical question using the PICO framework. It describes searching relevant literature databases using search terms derived from the PICO elements to address the clinical question. The goal is to evaluate pharmacological and alternative treatments like acupuncture for diabetic peripheral neuropathy based on the best available evidence.
The Personalized Medicine Coalition 2015 Annual Report summarizes the organization's work in education, advocacy, and impact over the past year. It highlights key events including a Congressional briefing on personalized medicine that educated over 125 people, including 50 Congressional staffers. The report also outlines challenges to personalized medicine such as obstacles in science, regulation, and reimbursement, but notes the biopharmaceutical industry remains committed with over 40% of drugs in development being personalized medicines.
1) The Quality and Outcomes Framework (QOF) in the UK introduced pay for performance in primary care on a large scale, providing financial incentives for general practices to meet performance criteria in clinical care, organization, patient experience, and additional services.
2) Studies found mixed results on the impact of QOF, with some evidence that it improved processes of care for certain conditions like diabetes but unintended consequences like a focus on financial targets over patient-centered care.
3) There is concern that pay for performance could undermine intrinsic motivations if it does not align with professional values or leads to unfair exclusions of complex patients, and some experts argue for transparency and feedback over financial incentives.
The document provides guidelines for assessing hospitals based on operational standards outlined in the Ethiopian Hospital Transformation Guidelines. It includes standards related to hospital leadership, management and governance, liaison and referral services, emergency medical services, outpatient services, inpatient services, medical records management, and nursing and midwifery care services management. Each standard includes the method for evaluation and whether the standard is met or unmet. The assessment is intended to help hospitals improve performance in key areas.
Why Electronic Health Records are Ill Suited for Population Health 012616infomc
Electronic health records are ill-suited for population health management for several reasons. EHRs were designed to manage patient data within individual healthcare systems and have limited ability to track health information from outside sources or support integrated care across multiple providers. Population health management requires more sophisticated technology that can perform functions like enrollment tracking, provider networking, utilization review, claims processing, and quality reporting that are beyond the scope of most EHRs. While EHRs are important for individual medical practices, organizations taking on financial risk for patient populations need systems designed for the specific demands of population health management.
The word "hospital" comes from the Latin "hospes" which refers to either a visitor or the host who receives the visitor. From "hospes" came the Latin "hospitalia", an apartment for strangers or guests, and the Medieval Latin "hospitale" and the Old French "hospital." It crossed the Channel in the 14th century and in England began a shift in the 15th century to mean a home for the elderly or infirm or a home for the down-and-out.i
Hospital is an institution or the organization for the treatment, care, and cures of the sick and
wounded, for the study of disease, and for the training of physicians (teaching hospitals), nurses,
and allied health care personnel.ii
This case study examines a Lean Manufacturing initiative involving three aerospace suppliers - Haynes International Ltd, Precision Parts Engineering Ltd, and Merc Engineering Ltd - and their customer, Unison Engine Components. The objective was to reduce costs and improve delivery performance to combat low-cost competitors. A Lean consultant introduced tools like 5S, improved layouts, kanban systems and visual controls. Early results included a 15-22% improvement in on-time delivery, better awareness of customer needs, and more efficient operations.
This case study examines efforts to improve customer satisfaction and reduce costs at an IT call center. The project team conducted a Define phase to understand key customer requirements around quick response, accurate information, and issue resolution. They mapped the call resolution process and identified opportunities in long wait times and multiple transfers. In Analyze, the team found problem and change calls had higher costs, and Mondays/Fridays were more expensive. They verified staffing levels and training affected transfer rates. In Improve, solutions tested included promoting a web portal, focused training, and staffing adjustments. A pilot found wait times decreased with the new approaches.
This document provides an overview of Total Productive Maintenance (TPM), including:
1) TPM aims to optimize manufacturing productivity through comprehensive equipment-focused efforts involving all employees. It is based on teamwork to achieve world-class equipment effectiveness.
2) The document reviews TPM concepts and literature, examining organizational structures, tools, and success criteria for TPM implementation.
3) TPM is defined in various ways focusing on continuous improvement, optimizing equipment reliability, and bringing production and maintenance together through teamwork and good practices. Both Japanese and Western definitions emphasize maximizing equipment effectiveness through preventative maintenance and cross-functional participation.
This document outlines a presentation on Total Productive Maintenance (TPM). It begins with an introduction of the presenter and then covers topics such as the definition of maintenance, types of maintenance, what TPM is, the history and objectives of TPM, similarities and differences between TPM and Total Quality Management (TQM), the eight pillars of TPM, why TPM is popular, benefits and losses of implementing TPM, and concludes with how TPM can help increase quality and productivity.
The document provides guidance for establishing a quality improvement committee at Rumbek State Hospital in South Sudan. It outlines 7 steps for the committee: 1) Identifying problems and areas for improvement through methods like chart reviews and observations. 2) Setting clear and measurable improvement aims. 3) Selecting quality indicators to measure progress. 4) Developing changes to address root causes of problems. 5) Identifying solutions and strategies. 6) Reviewing progress using tracking tables. 7) Evaluating the process and outcomes through tools like client satisfaction surveys and health facility assessments. The committee will aim to continuously improve quality of clinical services at the hospital.
Master's in Hospital Administration (MHA) Prospects by Dr.Mahboob Khan Phd Healthcare consultant
ALL labour that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence, said Martin Luther King, Jr. The Master’s in Hospital Administration course is meant for those people who share these sentiments, because job responsibilities range from giving astute guidance in administration to managing the daily affairs of the hospital.
Efficient management can play a role in saving more lives. With the advent of medical tourism and rapid development in technologies the health sector is emerging as one of the fastest growing sectors in India. Several corporates and business organisations have forayed into the healthcare sector, thus resulting in the healthcare delivery system becoming more organised, systematic and efficient.
The document discusses Kaizen and its implementation at a national bank through a 5-day Kaizen event. It describes the Kaizen schedule and methodology used which involved identifying problems, creating value stream maps, brainstorming solutions, testing solutions, and presenting findings. Results of the event included reducing cycle times by 30-95%, reducing an administrative process time from 20 to 12 minutes, and reducing complaint resolution time from 30 to 8 days. The Kaizen event was considered a powerful improvement tool as it allowed focused problem solving and creativity to generate immediate productivity and quality gains.
This case study examines applying lean manufacturing principles to reduce waste in material handling processes at Hughes Christensen, a leading drill bit manufacturer. The methodology developed involves defining management objectives, assessing current operations, selecting lean tools, and implementing solutions. For the crown machining cell, a staging device was added to reduce queue time, travel, and parts handling. The future state value stream map shows an estimated 865 minute or 14.4 hour total time variance from implementing lean improvements to material flow.
The document discusses the concept of Poka-Yoke, which aims to eliminate defects at their source by preventing mistakes from occurring. It was developed by Shigeo Shingo in the 1960s for Toyota's production system. Poka-Yoke focuses on identifying risks and managing mistakes before they can cause defects through methods like identification, prevention and detection. The document provides examples of how small design changes can make errors impossible, like using different sized holes to prevent inserting terminals incorrectly. It also explains that Poka-Yoke is needed to achieve zero defects and reduce costs from scrap and rework.
This document summarizes a research article from the International Journal of Management about implementing kaizen in an Indian petrochemical plant. The article defines kaizen as continuous improvement and discusses how it is a core part of total quality management. It then describes the kaizen implementation process, principles, variables that influence organizational performance, and aspects of an effective kaizen system including employee participation, management support, and skills development. The article concludes with a case study of kaizen implementation in a large Indian petrochemical plant and areas for further improvement.
Thousands of little & medium scale markets are present in India. All are dealing with Specific troubles causing shortage of manufacturing as well as high quality problems. This 10 case study deals with the kaizen implementation in an industry in an assembly line in India.
Six Sigma is a methodology that seeks to improve processes by reducing defects and variation. It was developed by Motorola to help improve quality and lower costs. The Six Sigma methodology uses a data-driven approach to identify and remove causes of defects and minimize variability in manufacturing and business processes. It aims to achieve as close to zero defect levels as possible.
Total Productive Maintenance (TPM) is a company-wide effort to optimize equipment effectiveness through autonomous maintenance and operational involvement. TPM aims to eliminate accidents, defects, breakdowns and other sources of inefficiency. It combines preventative maintenance practices with total quality control and employee engagement. The goals of TPM include improving equipment effectiveness, developing autonomous maintenance practices, implementing planned maintenance systems, training all staff, and achieving early equipment management. TPM has been shown to increase overall equipment effectiveness, quality, and productivity while reducing maintenance costs and downtime.
This document discusses Total Productive Maintenance (TPM). It provides background on maintenance concepts and the evolution of maintenance philosophies. TPM aims to maximize equipment effectiveness through preventative maintenance involving all departments. The document outlines TPM goals and pillars. It also discusses key performance metrics like Overall Equipment Effectiveness (OEE), which is calculated based on availability, performance efficiency, and quality rate. Examples are provided for computing various loss times that factor into OEE calculations.
The document discusses Total Productive Maintenance (TPM), including its definition, principles, pillars, implementation process, strategies, benefits, and a case study. TPM aims to maximize equipment effectiveness through autonomous maintenance by operators and planned maintenance. The eight pillars of TPM are education and training, safety, autonomous maintenance, planned maintenance, equipment improvement, quality management, early equipment management, and TPM in offices. Human-oriented and process-oriented strategies are described for implementing TPM. Benefits include increased productivity, uptime, capacity and ROI. A case study found that both strategies positively impact TPM implementation levels.
Six Sigma Project Case Study Overview, from the General Electric "At the Customer, For the Customer" Six Sigma Program, led by Lean Six Sigma Master Black Belt and President of the International Standard for Lean Six Sigma (ISLSS) and Owner of the Lean Six Sigma Group
The document discusses failure mode and effects analysis (FMEA). It provides information on:
- The types of FMEA including system, design, process, and service FMEA.
- How FMEA works by identifying potential failure modes, analyzing their effects, and prioritizing them according to severity, occurrence, and detection.
- When FMEA should be used including during design, improvement planning, and when analyzing process or product failures.
- A case study on how FMEA was used to analyze errors in a knitting industry and identify critical errors to focus corrective actions on.
This document provides a literature review on studies related to the service quality of public and private sector hospitals. It summarizes 25 studies conducted between 2004-2013 that evaluated patient perceptions and assessments of various dimensions of hospital service quality in India. The studies examined factors like infrastructure, personnel quality, clinical care processes, communication, and relationships that influence patient satisfaction. Some findings indicated private hospitals performed better than public hospitals in most quality dimensions except reliability. The review concludes that further research is needed evaluating service quality in the understudied regions of Indore and Ujjain cities in Madhya Pradesh, India.
A Study of Healthcare Quality Measures across Countries to Define an Approach...iosrjce
This document summarizes a study that examines healthcare quality measures across different countries to define an approach for improving healthcare quality. It discusses factors such as increasing population growth and changing disease patterns that pose challenges for healthcare systems. It also reviews healthcare quality definitions, metrics like structure, process and outcomes, and approaches some countries use to enhance quality, including developing quality strategies and addressing various quality domains.
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.
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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 ...
The study found that:
1) Ward in-charges' leadership characteristics were average, scoring 69.2% on assessments, indicating a need for continued nursing education.
2) Ward in-charges' performance on managerial activities was below average, at 48.28%, showing room for improvement in nursing management quality.
3) Nursing care status was satisfactory, at a 72.32% assessment score.
4) Environmental sanitation levels were also satisfactory, scoring 65.9% on evaluations.
5
The study aimed to assess the quality of nursing services provided at B. P. Koirala Institute of Health Sciences, Nepal. Data was collected using questionnaires to evaluate ward in-charges' leadership qualities, functional capabilities, nursing care status, environmental sanitation, and documentation. The results showed that ward in-charges had average leadership skills (69.2%) and managerial performance (48.28%). Nursing care status (72.32%) and documentation (73.23%) were satisfactory. Environmental sanitation was also satisfactory (65.9%). The findings indicate a need for continuous nursing education to improve leadership skills and the quality of nursing services.
Unit 1Emergency Department Overcrowding Due to L.docxwillcoxjanay
This study aims to evaluate factors contributing to overutilization of emergency departments for non-urgent care through a questionnaire. It will be conducted in a rural North Carolina county at the local emergency department, which sees an average of 1300 visits per month. Participants will complete an informed consent and anonymous survey assessing reasons for their emergency department visit and potential influences on their decision to seek care there rather than primary care, such as availability of appointments, transportation barriers, and convenience. The goal is to understand utilization patterns to help address overcrowding challenges faced by many hospital systems.
Patient Satisfaction Survey as a Tool Towards Quality Improvement by Dr.Mahbo...Healthcare consultant
A mixed bag of poorly evaluated methods leaves patients frustrated, and doctors little wiser.The best way to ensure that services are responsive to those they aim to serve is to elicit feedback on people’s experiences and encourage providers to deal with any problems thus identified. This has been axiomatic in health policy for many years, but have we got the balance right in primary care? Patients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process.
BENCHMARK 1
Evidence-Based Practice Project: PICOT Paper
Daysha Y. Polk
NUR 550
Grand Canyon University
June 1st, 2021
Evidence-Based Practice Project: PICOT Paper
Generally, a high level of patient satisfaction for the clients in the emergency department (ED) is vital, especially at this time when the healthcare system is shifting towards patient-centered care. Prakash (2010) notes that patient satisfaction levels significantly impact on medical malpractice claims, patient retention, and clinical outcomes. That is, it affects quality healthcare’s timely, efficient, and patient-centered delivery, making it both a proxy but a very effective key indicator for measuring the hospitals and doctors’ success. Consequently, supporting the improvements of patient satisfaction levels can positively affect several healthcare organizations’ components, such as preventive possible malpractice lawsuits, securing a positive local reputation, and enhancing patient retention rates. Thus, there is an increased need to develop strategies to improve ED patient’s satisfaction with the provided care services. Increasingly, the use of real-time location systems (RTLS) by hospitals to track patients, instead of relying on the traditional, manually-entered status updates, is increasingly being viewed as a better strategy to decrease the number or rate of Left Without Being Treated (LWBT) patients, and thus, improve ED patient’s satisfaction levels and hospital’s revenue collection (Boulos & Berry, 2012). Thus, the paper will explore whether the utilization of RTLS in the hospital’s ED, compared to manually-entered status updates to tract patients, help decrease the rate of LWBT and to raise revenue collection within 6 months, for ED patients with decreasing satisfaction levels with the provided healthcare services.
A wide array of factors is responsible for the decreased rate of satisfaction levels amongst ED patients. The current delays, long waits, leaving without being treated, decreased revenue collection from the ED unit, and reduced patient satisfaction scores have negatively portrayed the hospital's reputation to the public. As a result, the daily patient visits have continued to decrease as people attribute the facility to poor emergency care services delivery. All these complications result from the use of combined data resources and manual entry status updates when tracking patient records. This manual tracking cannot meet the demand for many patients and leads to overcrowding due to and reduced patient flow in the ED. Therefore, there is a need to install an automatic patient tracking system to increase the flow.
Patient satisfaction level, especially for hospital’s emergency department (ED) is increasingly becoming a key health quality indicator. Patient satisfaction regards the degree to which patients are happy with their healthcare (Heath, 2016). Patient satisfaction levels is a care quality measure and gives healthcare providers infor ...
Patients' satisfaction towards doctors treatmentmustafa farooqi
This document provides an introduction, literature review, and proposed framework for a study on patient satisfaction towards doctor treatment at state hospitals in Multan, Pakistan. The study aims to examine if patients are satisfied with the healthcare process, doctor treatment and behavior, and information/communication. The conceptual framework identifies background variables, independent variables related to doctor treatment, and dependent variables of patient satisfaction. The literature review discusses several prior studies that examined factors influencing patient satisfaction like doctor competence, communication, and attitudes. The theoretical framework discusses social identity theory and satisfaction theory in understanding patient attitudes and expectations.
The study aimed to investigate associations between regulatory policy, workforce capacity, and health outcomes using Medicaid data from four states. However, the analysis found significant data quality issues. Key variables like service provider specialty were missing or incomplete, preventing valid conclusions about the proportion of services provided by nurse practitioners and physician assistants. At best, Alabama had 85% reporting but showed nurse practitioners and physician assistants providing significantly fewer services than medical doctors for selected chronic conditions despite making up over half of primary care workforce capacity. Overall, the Medicaid data proved inadequate for the research purposes due to inconsistent and missing coding across states.
Running Head PERTINENT HEALTHCARE ISSUE1PERTINENT HEALTHCAR.docxtodd581
Running Head: PERTINENT HEALTHCARE ISSUE 1
PERTINENT HEALTHCARE ISSUE 2
Analysis of Pertinent Healthcare Issue
Students Name:
Institutional Affiliation:
Impact of increasing cost in a health organization
Introduction
The cost of receiving healthcare service is becoming a serious national healthcare concern. It has been established that the United States spend more on healthcare, in relation to the national income than any other industrialized nation. However, achieving minimum cost means having to make certain hard compromises which have never been easy. For example, low expenditure on research and development, limitation in terms of the choices of health coverage or healthcare providers and having to wait for long before using new technologies. The health system has gone through a series of transformational changes that has seen the cost of healthcare provision sky-rocket. The most affected are among the 41 million uninsured Americans who are unable to cater for the cost of insurance as well as the underinsured whose coverage program cannot cater for their overall health needs. The major catalyst behind the rising cost of healthcare has been; the rising number of aging population that take great benefit from the technologies created for lengthening life span, lifestyle choices like adoption of sedentary lifestyle and unhealthy eating habits resulting to obesity and cardiovascular disorders among others.
Cost impact on health organization.
Increasing cost has impacted the national health organization/system in so many ways. The impacts are not only experienced by the patients but the providers, employers, payers (insurance bodies) and even other employees within the health organization. Firstly, an array of transformational changes has been made i.e. payment transformation where a shift has been made from volume-based (fee-for service payment) which has high cost implications to value-based models and also the development of primary care in attempt to counter increasing cost. The turnover of healthcare providers has also faced a fair share of cost impact. The providers burdened by the feeling of denying patients services due to inability to cater for cost or lack of insurance loses meaning of services and morale to continue with the service. Consequently, advancement in training and education improve the providers’ patient service and more enhanced application of Evidence-Based practice appears costly and unaffiliated hence promoting low morale. Morbidity and mortality cases has been on the rise. Advanced technology used in diagnosis/treatment of serious medical conditions has become expensive and some of them are not covered by the insurance (core payments) hence late interventions taken after serious damage. The is also an indication of lowered patient engagement as far healthcare decision making is concerned since patients with financial challenge have limited options and are sometimes forced to comply with the physici.
Running Head PERTINENT HEALTHCARE ISSUE1PERTINENT HEALTHCAR.docxglendar3
Running Head: PERTINENT HEALTHCARE ISSUE 1
PERTINENT HEALTHCARE ISSUE 2
Analysis of Pertinent Healthcare Issue
Students Name:
Institutional Affiliation:
Impact of increasing cost in a health organization
Introduction
The cost of receiving healthcare service is becoming a serious national healthcare concern. It has been established that the United States spend more on healthcare, in relation to the national income than any other industrialized nation. However, achieving minimum cost means having to make certain hard compromises which have never been easy. For example, low expenditure on research and development, limitation in terms of the choices of health coverage or healthcare providers and having to wait for long before using new technologies. The health system has gone through a series of transformational changes that has seen the cost of healthcare provision sky-rocket. The most affected are among the 41 million uninsured Americans who are unable to cater for the cost of insurance as well as the underinsured whose coverage program cannot cater for their overall health needs. The major catalyst behind the rising cost of healthcare has been; the rising number of aging population that take great benefit from the technologies created for lengthening life span, lifestyle choices like adoption of sedentary lifestyle and unhealthy eating habits resulting to obesity and cardiovascular disorders among others.
Cost impact on health organization.
Increasing cost has impacted the national health organization/system in so many ways. The impacts are not only experienced by the patients but the providers, employers, payers (insurance bodies) and even other employees within the health organization. Firstly, an array of transformational changes has been made i.e. payment transformation where a shift has been made from volume-based (fee-for service payment) which has high cost implications to value-based models and also the development of primary care in attempt to counter increasing cost. The turnover of healthcare providers has also faced a fair share of cost impact. The providers burdened by the feeling of denying patients services due to inability to cater for cost or lack of insurance loses meaning of services and morale to continue with the service. Consequently, advancement in training and education improve the providers’ patient service and more enhanced application of Evidence-Based practice appears costly and unaffiliated hence promoting low morale. Morbidity and mortality cases has been on the rise. Advanced technology used in diagnosis/treatment of serious medical conditions has become expensive and some of them are not covered by the insurance (core payments) hence late interventions taken after serious damage. The is also an indication of lowered patient engagement as far healthcare decision making is concerned since patients with financial challenge have limited options and are sometimes forced to comply with the physici.
An Overview of Patient Satisfaction and Perceived Care of Qualityijtsrd
This paper aims to audit the patient satisfaction literature, precisely survey methods used, which fundamentally analyses its hypothesis and use at that point to introduce proof for perceived service quality as a discrete and further advanced construct. Findings Patient satisfaction has been widely reviewed and significant efforts have gone into creating survey instruments to estimate it. Although, most surveys have been critical of its utilization, since there is seldomly any hypothetical or calculated development of the patient satisfaction theory. The construct has little normalization, low accuracy and undetermined validity. It keeps on being utilized interchangeably with, and as an intermediary for, perceived health service quality, which is a conceptually extraordinary and predominant construct. Practical Implications The persistent utilization of patient satisfaction to assess the patients perception of the quality of a healthcare service is truly flawed. The way to settling this dilemma might be for the healthcare division to concentrate on perceived healthcare service quality by considering the particular theories and models that can be found in the administrations advertising literature. This literature offers further developed consumer theories which are preferred differentiated and tried over existing healthcare satisfaction models. Conclusion This paper brings up that there is a critical requirement for differentiation and normalization of patient satisfaction and healthcare service quality definitions and constructs, and argues for examination to concentrate on estimating perceived healthcare service quality. Shubham Chaurasia | Shivani Dadwal Salaria | Rakhi Ahuja | Amit Sharma "An Overview of Patient Satisfaction and Perceived Care of Quality" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd31548.pdf Paper Url :https://www.ijtsrd.com/management/public-sector-management/31548/an-overview-of-patient-satisfaction-and-perceived-care-of-quality/shubham-chaurasia
Submission Id ab299d7c-b547-4cf3-958a-07922ca71f2765 SIM.docxdeanmtaylor1545
Submission Id: ab299d7c-b547-4cf3-958a-07922ca71f27
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Patience Nehikhare
healthcaredeliverysystemchanges.docx
Summary
1175 Words
Running Head: HEALTHCARE DELIVERY SYSTEM
THE U.S. HEALTHCARE DELIVERY SYSTEM 2
Healthcare Delivery System
Patience Nehikhare
Grand Canyon University
December 22, 2019
The U.S. Healthcare Delivery System
There is a rapid change within the healthcare system in the United States. The
changes that have occurred were made for the purpose of improving quality,
rewarding value and not volume, as well as integrating and coordinating the care
(Seshamani & Sen, 2018). As such, this paper will seek to put into consideration
current healthcare laws within the U.S. and the nurse’s role within this continuously
changing environment; the manner in which quality measures and pay for performance
affect patient outcomes. Furthermore, the emerging trends in the healthcare system,
professional nursing leadership, and management roles will be discussed.
The Emerging Health Care Laws and their Effects on Nursing Practice
One of the most crucial healthcare legislat ions that has been enacted in the United
States since the inception of Medicare and Medicaid in 1965 is the Affordable Care
Act (Obama, 2016). The ACA was enacted in 2010. Issues relat ing to affordability,
ease of access, and the care quality within the United States healthcare system were
some of the driving factors that formed the list of many t ime spanning challenges
that compiled the init iat ion of this legislat ion. Between 2010 to 2015 there was a
decrease in the number of uninsured cit izens in the U.S. by forty three percent as an
effect of the Affordable Care Act.
The payment systems in healthcare are undergoing some changes and the access to
care has also improved (Obama, 2016). The ACA promotes preventive healthcare
models that put emphasis on quality care, primary care, and the funding of community
health init iat ives (Lathrop and Hodnicki, 2014). Millions of previously uninsured cit izens
are also provided insurance coverage and also some healthcare areas that need
reforms so as to meet the needs of patients’ improved healthcare outcomes are
highly focused by the act. The act has an effect on nursing practice in several ways.
The first effect is that the act creates a high demand for healthcare professionals
that are sufficiently trained to provide healthcare services that are up to the acts’
standards. The second effect is that Advanced Practice Registered Nurses (APRNs)
who hold the Doctor of Nursing Practice (DNP) are required to be prepared so that
they can meet the increased needs through the provision of leadership skills in
community health centers. These professionals are also held accountable for direct ing
and advocating for future init iates as well as ser.
Running head QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES .docxtoltonkendal
Running head: QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 1
QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 6
Quality Improvement for Public Health Facilities
Qualitative Research Methods Evaluation
AIU ONLINE
HLTH 335 1701A - 01
UNIT 2 IP
The type of study in the four listed articles include the following. Article one by Chaudhry et al., (2006) was a qualitative study. The authors conducted a system review from expert opinion and literature review to determine the role that information technology had played in enhancing health care quality, efficiency and costs of medical care. The authors hypothesized that information technology had played a significant role in improving the quality of medical care by increasing adherence to medical guidelines, improving disease surveillance and decreasing medication errors. The type of study for the second article was also a qualitative study that examined 260 hospital on the issue of pay for performance strategy. The authors compared their results to other hospital that did not have the current nationwide pay for performance system, (Werner et al., 2010). The authors hypothesized that pay-for-performance system improved quality health care among hospitals in this system. The third article was also a qualitative study where the authors hypothesized that public reporting of hospital quality data and the pay for performance have emerged as the widely advocated tools for these that accelerate health facility’s improvement (Lindenauer et al., 2007). The fourth article was also a qualitative study article. The authors of the article hypothesized that the Keystone ICU project was associated with a significant decrease on the hospital mortality within Michigan as compared to the surrounding areas, (Lipitz-Snyderman, et al., 2011).
Article one utilized data from published expert opinion and literature search from academic data bases. There was no direct involvement of the human subject when collecting data for this article. Article two utilized data from 260 hospitals. The authors chose acute care hospitals that began operating in 2004. The author’s excluded four critical-access hospitals. Researchers of the third article used 2490 health services providers nation-wide who met the criteria for Hospital Quality Alliance (HQA). In the fourth article, the authors chose the patients who were treated in Michigan’s 95 study hospitals from 238, 937 total admissions. All the samples and the populations for these studies were appropriate.
During the study documentation Chaudhry et al., (2006) reported that hospital facilities documented and reported data on costs and contextual factors. Limitations of data in this article is that the systematic review utilized a mixed data of private and public initiatives into hospital systems. The public and private initiatives have different agendas. Werner et al., (2010), study results indicated that the two groups of hospitals were simil ...
This document outlines a proposal to measure performance of access to primary care for patients over 65 with chronic illnesses. It discusses several subdomains of accessibility that will be measured, including timely access, access to non-face-to-face care, access to regular primary care, access to after-hours care, and access to home-based primary care. For each subdomain, 1-2 indicators are identified that can be used to monitor accessibility within that area. Limitations of each indicator are also discussed. The goal is to evaluate different dimensions of access to primary care in order to identify areas for improvement and inform policy changes.
An Empirical Study on Patient Delight and the Impact of Human and Non-Human F...IOSR Journals
Health, one of the Fundamental Human Rights has been accepted in the Indian Constitution. Today the healthcare industry has emerged as one of the most challenging sectors as well as one of the largest service sector industries in India. Patient perceived service quality become the prominent aspect to choose between hospitals. The purpose of this paper is to evaluate patient perceived service quality in Indian hospitals. Further the impact of the dimensions on patient satisfaction and patient delight is examined. A questionnaire was administered to the in-patients and multiple regression analysis has been used to examine the impact of the dimensions on patient satisfaction and patient delight. Findings emphasize eight distinct dimensions of patient perceived service quality and the impact on patient satisfaction and patient delight. A positive and significant relationship with patient satisfaction and patient delight has been found, except two dimensions. The results of this study are limited, as they are based on Indian hospitals. The contribution of this research paper, incorporate patient delight in health care sector. In addition, this paper highlights the importance of emotional attachment for patient satisfaction and patient delight in health care.
This document discusses quality improvement in health care in developing countries. It defines quality as the degree of excellence and doing the right thing in the right way. Quality is viewed from the perspectives of clients, service providers, and managers. Elements of quality include structure, process, and outcomes. Improving quality requires addressing factors like resources, training, and cultural norms. While resource constraints are an issue, high quality care is still possible with limited resources. Ensuring quality providers through training is important for improving health outcomes in developing nations like Nepal. Economic benefits of quality include individual and social gains like increased productivity and reduced costs.
This document discusses a proposed study to assess factors of patient satisfaction in dermatology practices and link provider reimbursement to patient satisfaction scores. The study would develop and administer a questionnaire to patients at UPMC dermatology clinics to measure satisfaction with various aspects of care. Satisfaction scores would determine Medicare reimbursements to those clinics. The document provides background on pay-for-performance programs and reviews previous studies on factors influencing patient satisfaction in dermatology, such as provider communication and treatment effectiveness. It acknowledges limitations like recall bias but aims to advance quality by incentivizing high patient satisfaction.
Similar to Quality and Cost of Accreditation's In Healthcare by Mahboob ali khan ,MHA,CPHQ (20)
In India, Young Graduates Struggle by Dr. Mahboob Khan to Get Jobs.pdfHealthcare consultant
In the world’s most populous country, tens of thousands of graduates and postgraduates, many with professional degrees, such as engineering, spend years studying at the tutoring centers that have mushroomed in Indian cities, hoping to qualify for a highly sought-after government job. The chances are slim. Less than one-half of 1% of the more than 1 million who take the exam each year pass.
The middle class in India is growing unexpectedly, however they're still dealing with demanding situations in accessing excellent and low-priced healthcare. This is because of a number of of factors, such as inefficient healthcare gadget, high price of healthcare, and lack of know-how.
Chat GPT for Doctors -Revolutionizing Healthcare Communication by Dr.Mahboob.pdfHealthcare consultant
Learn how Chat GPT for doctors can revolutionize healthcare communication by improving efficiency and accuracy of patient-provider interaction.
In recent years, there has been a growing interest in the potential of artificial intelligence (AI) to transform healthcare. One area that has received particular attention is communication between patients and healthcare providers. The emergence of chatbots powered by AI has provided a new tool for improving the efficiency and effectiveness of healthcare communication. One of the most promising applications of AI-powered chatbots is Chat GPT for doctors.
As an expert in hospital management and administration i have written this book -Hospital Management is a new theory in management faculty. Earlier a senior doctor used to perform the role of a hospital manager. However, nowadays everything demands a specialist. Almost all the things related to hospital have changed. Many categories concerning medical sciences and hospital have altered totally. There are various types of hospitals today, including ordinary hospitals, specialty hospitals and super specialty hospitals. The categories are regarding to the types of facilities they offer to the people.
Steve Jobs logged off too soon. He was a serial innovator whose illness cost the world a bright talent who was also a great company leader. I hope that the music from the hymns of praise sung to him in his waning days is playing on his iPod as he ascends into the firmament of the greatest American business leaders. If there were a Nobel prize for business, surely he would have won it. He did what he set out to do and more. He saw the potential for computing power for the masses, useful and accessible to everyone. In a phrase that drove the early Apple, he created bicycles for the mind.
The document discusses psychopathic traits in corporate CEOs. It notes that around 4-12% of CEOs exhibit psychopathic personality traits, much higher than the general population. Psychopaths can often disguise their lack of empathy and manipulate others with charm. They seek power and dominance. Stories from CFOs describe their experiences with CEOs exhibiting psychopathic behaviors like intimidation, lack of empathy, narcissism, and manipulation. While their behavior may not meet the clinical definition, it can still be damaging. There is no consensus on how to deal with psychopathic CEOs, but carefully documenting concerning behavior is advised.
Some of the lower vibrations, as you can see on the chart are anger, grief, shame, fear. Some of the higher vibrations are love, joy, appreciation and excitement.
Going to higher vibrations means more energy ,lower vibration is easily achieved and is default in everyone of us and is easily aggravated by gravity.
thats why anger, grief,shame and fear are more common than love ,joy appreciation and excitement.
Hospitals profitability can be increased by boosting patient satisfaction, reducing readmissions and understanding revenue cycle performance.
In this period of healthcare reform, numerous organizations continue to change their business practices so they can obtain more hospital profitability while also delivering quality care. Healthcare expenditures are expected to reach $4.4 trillion by 2022, and this high level of spending activity has hospitals currently under a lot of pressure to reduce costs.
Development of the digital economy started way before COVID-19. The exact date of the beginning may be defined in different ways, depending on different definitions of “digital economy.” The popularly understood “digital economy” phenomenon began when T-Mall was set up in 2003 and when Alipay came online in 2004. While the digital technology brings about the fourth industrial revolution, just like the steam engine, electrical machines, and computers, respectively.
Strategy is not complex. But it is hard. It’s hard because it forces people and organizations to make
specific choices about their future—something that doesn’t happen in most companies. Dr .Mahboob
Khan
Couch potatoes as they are called are the ones who stick on to their sofas just watching the idiot box that has caused many such unwarranted developments in health.
Probably a long vacation could be a precipitating factor for inactivity while the unexpected strife in the country’s developments has brought with it some unexpected holidays. This is the time when children tend to relax but when they cross the line the human body becomes mentally and physically inactive.
While Metaverse is evolving, it holds new potential in healthcare that combines the technologies like Artificial Intelligence, Virtual Reality, Augmented Reality, Internet of Medical Devices, Web 3.0, intelligent cloud, edge and quantum computing along with robotics to provide new directions to healthcare.
Robotic Process Automation in Healthcare-An Urgency! By.Dr.Mahboob KhanHealthcare consultant
Robotic process automation (RPA) can help the healthcare industry address current challenges by automating repetitive manual tasks. This allows staff to focus on higher value work while improving efficiency. RPA has the potential to save $350-410 billion annually in the healthcare sector by 2025 by streamlining processes like patient scheduling, claims management, and treatment workflows. As healthcare workers are overburdened during the pandemic, RPA can reduce their workload and risk of exposure by handling administrative tasks digitally. Widespread adoption of RPA in the Indian healthcare system is urgently needed to address staffing shortages and enhance response efforts amid the ongoing crisis.
Apply This to Your Life
We know this is boring, but you know you need to do it!
Clear an hour in your schedule somewhere in the next week, and set your filing system up!
Many inventions originated in wealthy countries and these were responsible to produce global public goods and medical goods.In which everyone got benefitted even developing and poor countries too.This transfer of knowledge is now compromised by the extension of intellectual property rights and held by high-income countries.
New standards of care have emerged in response to the COVID-19 pandemic. Healthcare facilities and professionals have had to rapidly adopt new protocols for treating COVID patients, including guidelines for management, vaccines, telemedicine, and increased use of personal protective equipment. Some key new standards include wearing face masks, social distancing, treatment guidelines, mobile health apps, limiting gatherings and travel, and increasing sanitization and hygiene practices. As the pandemic evolves, precision medicine approaches may drive new standards, with a focus on using the right tests and treatments tailored for individual patients.
Ways That Quantum Technology Could transform Health Care. By.Dr.Mahboob KhanHealthcare consultant
You probably don’t grasp the finer points of how quantum mechanics works, but scientists are using its tricky rules to make medicine faster, less painful, and more personalized.
How is COVID-19 Reshaping the role of Institutional strategy? By.Dr.Mahboob KhanHealthcare consultant
While workers around the globe are keeping essential services running, it is imperative for business leaders, particularly senior strategy executives, to reflect on the lasting implications of COVID-19 and what they can do to best position their people, their businesses, and society to recover and thrive in the long term. Five key shifts can help chief strategy officers (CSOs) successfully guide their organizations through the pandemic.
Retaining Healthcare Quality During COVID-19 and Future of Care Delivery. By....Healthcare consultant
With the onset of COVID-19, healthcare delivery organizations around the world were collectively faced with one primary challenge: How to effectively deliver quality healthcare to all patients, regardless of the entry point into the system, while protecting the well-being of non-COVID-19 patients and the healthcare workforce.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Quality and Cost of Accreditation's In Healthcare by Mahboob ali khan ,MHA,CPHQ
1. 1
QUALITY AND COST OF HEALTHCARE: AN INDIAN PRESPECTIVE
AN ASSESSMENT OF DIRECT COST OF QUALITY ACROSS HOSPITALS IN INDIA
Mahboob ali khan, MHA,CPHQ, Consultant Healthcare Management and Quality at Durdans
Hospital Colombo (2013-2014).
ABSTRACT: With recent advances in healthcare, quality has become a pertinent issue. As
the demand for healthcare is rapidly rising with increasing population base and increasing
levels of affordability, so is the demand for quality healthcare services. Superior quality of
medical care is often associated with higher costs of hospitalization. This paper attempts to
explore the relationship between quality of medical care services and the cost of
hospitalization across hospitals in India. The findings have indicated a strong positive
association between the cost of hospitalization and infrastructure, while a negative association
was observed between staff to patient ratios. Though both these parameters affect and
contribute to superior quality of care their impact of cost of hospitalization differs
significantly.
Key Words: Quality of Medical Care, Cost of healthcare, Average cost of hospitalization,
Quality indicators
1. PRELUDE
Rapidly rising cost in healthcare is an increasing cause of concern across the world. Indian healthcare
is also experiencing a change, with increasing focus on better quality of medical care services. With a
large section of healthcare practitioners in the private sector, the government has realized the need to
improve medical care services and has stepped in to regulate the quality of medical care services by
introduction of various quality accreditation norms like the JCI,NABH and NABL.
As per available information the healthcare spending per capita per annum in India was about $109,
with total healthcare spending in the range of 4.9% of the country's GDP . Most of the spending
occurs from the private sector with public sector contributing to a mere $ 19 per capita per annum.
Concurrently, the average spending per capita per annum in the United States during the same time
frame was approximately $4271 whilst United Kingdom the spending was $ 1675. These figures
clearly indicate that healthcare in India is fairly cheaper, a strong reason for a growing medical
tourism market in the country. However, when compared with paying power parity and affordability,
the cost of medical care is escalating. It is worthwhile to note that as per World Bank estimates more
than 44% of Indian population earns less than one dollar a day.
As per the Finance Ministry, the overall inflation rate in India was about 9.4 percent during
April- December 2013, while inflation in medical expenses was in excess of 10 percent for the
fourth year in a row . There are several other factors that have been contributing to the escalation
in cost of medical care. These factors include increasing demand for medical care services with
consistently limited supply, increased penetration of health insurance, improvement in medical
technology with new innovations improving diagnostic capabilities and increasing dependence of
doctors on diagnostic procedures. Increasing demand for quality in medical care services plays a
critical role in increasing the overall cost of medical care services.
2. 2
While empirical evidence suggests that there is an increasing demand for healthcare services
across India, affordability remains a pertinent issue. This has resulted in market segmentation
where on one hand there is an increasing demand for quality medical care services while on the
other hand there is a demand for medical care services at affordable cost . The demand for the
latter has inevitably resulted in poor quality of medical care services with poor health outcomes.
It is simple to compute the direct costs for various medical services, however to compute the cost
of quality is not only difficult but rather elusive, which has resulted in over dependence on
subjective criterions . Various modalities like manpower ratios, infrastructure, medical
technological capabilities, accreditation and quality assurance policies and mortality rates, have
been considered as quality indicators and have been used to evaluate the quality of healthcare
services. The paper attempts to explore the implication of these quality indicators on the direct
expenses incurred by patients whilst seek healthcare services across India.
2. UNDERSTANDING QUALITY IN HEALTHCARE: COMPONENTS OF QUALITY
Quality in healthcare may comprise of newer technology, newer and effective medication, and
higher staff to patient ratios, affordability, efficiency and effectiveness of healthcare delivery.
Quality as defined by the Institute of Medicine, USA, is 'The degree to which health services for
individuals and populations increase the likelihood of desired health outcomes and are
consistent with current professional knowledge.'
Conceptually, Quality refers to any intervention made to improve the health outcome in totality.
At a macro-level, quality for health systems comprises of six building blocks namely healthcare
services, healthcare workforce, Healthcare Information System, Technology and Medications,
Healthcare financing and Leadership and Governance.
Though the sequence in terms of priorities may change, these building blocks are also essential at
micro-level to have a pertinent impact on the overall healthcare outcomes.
For a hospital or a healthcare institution, it is imperative to understand the components which can
influence the overall quality of medical care services. Quality hence can be understood based on
their overall implication on health outcomes of the patients. The various components that impact
the health outcomes and thereby influence quality include,
1. Comprehensive and integrated services, based on the demand, with adequate
infrastructure and logistics. Building, equipments, water supply, sanitation, power, etc
play a crucial role and considerably influence quality of medical care.
2. Manpower skills, knowledge, qualification, technical knowhow, training and their
availability is also critical for improving the healthcare outcomes and hence enhancing
quality.
3. An information system helps retrieve data and information easily and also aids in
planning for expansion and need based requirement of the population. Quality is affected
by the nature and comprehensiveness of the information system, which helps identify
existing lacunae and take corrective action.
4. Availability of safe and effective drugs, technology and medications directly impact on
the health outcome and should be considered as an integral part of quality
3. 3
5. Accountability improves health outcomes and hence enhances quality. Effective and
efficient governance is a cornerstone to ensure quality medical care services
6. Finally, cost effectiveness plays a crucial role. Quality can be acceptable only if it
affordable for the general population.
Though the aforementioned parameters have direct impact on health outcomes, it is difficult to
measure their influence on quality of medical care. It is vital to convert these parameters into
specific indicators, which can be used to define and measure quality more rationally.
3. DEFINING THE QUALITY INDICATORS: LITERATURE REVIEW
In healthcare, health outcomes play a crucial role in determining quality. However, the
importance of customer experience and customer delight can't be underestimated. Hospitals and
Healthcare institutions have consistently focused on improving the patients experience and
providing services in timely and orderly fashion. However it is often difficult to rate the quality
of services (both clinical and non clinical), using similar indicators.
Healthcare providers often use patient satisfaction surveys to understand the lacunae in quality of
care provided and identify critical areas of improvement. Patient satisfaction surveys can be used
to measure the quality of services from the prospective of subjective opinion of the
patients/beneficiaries. As per a study conducted in Taiwan, it was concluded that patients lack
the ability to judge the quality of care in healthcare institutions are in general lack awareness
regarding the various quality indicators . The study indicated that patients are not able to rate the
infrastructural and technological capabilities of the institution or the technical competences of
their physicians or medical staff.
A healthcare institution hence has to depend on various objective parameters to ascertain quality.
For the purpose of this research, some quality indicators have been identified, which have been
presumed to be directly linked with the ability of the institution to provide quality medical care
services. Relevant literature review to support these views has also been provided.
Asset value: Asset value is indicative of the medical technology along with the other
infrastructural amenities like elevators, air conditioning units, fire fighting services, etc.
These services will implicate the overall quality of medical care as it directly impacts on
patient safety, infection control rates and ability of the institution to provide critical care
services, etc. In a study conducted in Mexico, it was observed that the infrastructure of the
hospital determines the mortality rate among its beneficiaries . In another study conducted
across 87 hospitals in Massachusetts a clear positive correlation between the investment in
plant, machinery and property was observed with the quality of care and patient outcomes .
Manpower ratios: Hospitals and healthcare institutions are human resource intensive units.
Higher nurse to bed and higher staff to bed ratio are indicative of reduced burden on the staff,
which in turn directly enhances their ability to pay greater attention to details of patient care.
In a study conducted it was observed that the educational qualification, attitude and behavior
of the staff impacted their overall ability to provide medical services and fulfilling patient
expectations . The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
found that staffing levels have been a factor in 24% of sentinel adverse events that resulted in
4. 4
death, injury, or permanent loss of function . Another research study conducted in the United
States indicated that a ratio of 8 patients to one nurse was least expensive but associated with
highest patient mortality and the effectiveness of the staff increased with improvement in the
ratio . These studies reiterate the importance of better staff to patient ratios and their
significance in enhancing quality of medical care.
Accreditations and quality assurance systems: There are various accreditations and quality
assurance systems presently available. These accreditation and quality assurance systems
help organizations to streamline their processes, provide timely services and thereby enhance
patient outcomes. Evidence from JCI has indicated that accreditation tends to help enhance
the overall quality of patient care services and cost reduction, based on select case studies
from across the globe . Unfortunately there is little documented evidence about the
effectiveness of NABH in improving patient outcomes and quality.
Mortality Rate: Though this research study has not been able to evaluate the quality of
medical care based on this parameter due to ethical issues, standardized mortality rates are
used as a parameter to evaluate quality by many. However, there is considerable opposition
to this concept and standardized mortality rate is considered a bad parameter to judge quality
of medical care. Though risk adjustment is aimed at standardizing the mortality rate and
identifies the preventable deaths, it still has several limitations.
Patient Experience: In the era of consumerism, the role of patient experience is undisputed
and impacts the assessment of total quality of medical care. Timely service provision,
promptly addressing patient grievances, etc play a crucial role in the impression the hospital
management creates on patients and thereby influences the perception of the patient about the
overall healthcare services provided by the institution. However the use of patient
satisfaction should be ideally limited to a few parameters aimed at enhancing patient
experience.
4. EXPENDITURE ON MEDICAL CARE: DOES QUALITY IMPACT COST?
A hospital which rates high in its performance of the quality indicators can be improve patient
outcomes, which would explicitly affect the quality of healthcare services. Evidence from across
the globe indicates that improvement in healthcare has direct relationship with the resources
diverted for healthcare services. Table.1. Per capita Expenditure on Healthcare Vs Key
Health Indicators,provides an overview of the performance of various health systems across the
globe.
Table 1. Per capita Expenditure on Healthcare Vs Key Health Indicators
Country Per Capita
Expense on
Healthcare per
annum (in
US$)
Infant
Mortality
Rate (per
1000 live
births)
Life
Expectancy
(in years)
United States 6096 6.1 78.2
United
Kingdom
2560 4.7 79.9
Australia 3123 4.7 81.7
Kenya 86 53.5 58.8
Sudan 54 68.07 55.42
5. 5
Table.1. indicates that the expenditure on healthcare has a direct impact on the outcomes, using life
expectancy and infant mortality rates, as a measure of quality of a health system. However this
doesn't imply that quality comes at a cost.
Figure.1. Life Expectancy Vs Spending on Healthcare Globally, explains why?
It can be observed in Figure.1. that with a life expectancy of 76.9 years, Cuba ranks 28th
in the
world, just behind the US. However, its spending per person on health care is one of the lowest
in the world, at $186, or about 1/25 the spending of the United States. The countries ability to
utilize its resources optimally determines its ability to improve its health outcomes.
Figure 1. Life Expectancy Vs Spending on Healthcare Globally
Then can better health outcomes (and overall quality of medical care) be improved without
increasing the healthcare expenditure? For a nation, the answer lies in its ability to optimally
utilize its resources and maximize the outcomes. The role of public sector and government in
enhancing health outcomes of its population is crucial. Provisions for safe drinking water, health
awareness, sanitation, availability of essential drugs, etc are public goods, which need to be
provided by the government.
Private sector in India has evolved primarily due to lack of the State to provide some of the basic
services to its population. Quality has often been considered to be one of the crucial aspects
governing the higher utilization of private sector institution; however it is not always the case .
Private Sector is often driven by profit orientation and hence, over utilization of private sector in
India can be assumed to be one of the reasons for increasing cost of medical care services in
India. Role of quality in escalating medical cost remains debatable.
6. 6
5. METHODOLOGY AND STUDY DESIGN
This research paper aims at understanding the implication of the quality (as derived from the
various quality indicators identified above) on the direct cost incurred to purchase medical care
services. This paper compares the data from various hospitals across India, to appreciate and
ascertain if higher quality of care is associated with higher patient bills.
A review of discrete primary data collected between 2009-2011, from twelve different private
sector hospitals from across India, was used to understand the implication of quality on cost of
medical care. The hospitals were categories as Tertiary care hospitals (n=3), Multispecialty
Hospitals (n=4) and secondary care hospitals (n= 5), depending upon the service mix and focus
areas. The focus areas of the various categories of hospitals included,
Tertiary care Hospitals- Cardiac care, Neurology, Gastro-entrology, Oncology and
Advanced Trauma rehabilitation.
Multi Specialty Hospitals- Ophthalmology, Orthopedics, Nephrology, ENT, Respiratory
Medicine, etc.
Secondary care hospitals and Nursing Homes primarily focusing on Gynecology,
Obstetrics, General Medicine, General Surgery, General Medicine and Pediatrics
It should be noted that the list of services provided above was not exclusive, but indicative of the
level of advanced specialty services provided by the hospital. Tertiary care hospitals and Multi-
specialty hospitals, surveyed in the study, provided the secondary care services, in addition to the
aforementioned services.
5.1 Analysis Considerations
The average cost of hospitalization, for these institutions was evaluated against the various
quality indicators, to identify an association between cost of medical care services and quality
standards. The average cost of hospitalization only included the direct expenditure incurred by
the patient and didn't include other tangible and non tangible costs like income lost due to
sickness, travel expenditures, etc.
The average cost of hospitalization was computed based on the revenue generated by the
hospital, over a period of preceding six months, since individual patient bills could not be
evaluated. Revenue generated by the hospital is indicative of the expenditure made by the
patients; however the components of total hospital revenue were different in different hospitals.
Some hospitals (in the survey sample), provided support services like canteen and pharmacy in-
house while others have outsourced the services and don't reflect in the direct revenue of the
hospital. In such situations, the pharmacy and canteen sales were incorporated separately to
provide a comparative estimate
No separate patient satisfaction surveys were conducted. Already existing data from the same
time frame was collected, codified and the comments were categories to reflect patient opinion
about specific parameters.
5.2 Limitations of the Study design
1. Fifteen different hospitals of different bed capacities, different facility and service mix
were evaluated. It should be noted that perception of quality is affected by a wide range
7. 7
of factors including purchasing power parity, educational status and awareness of the
population and general healthcare trends in the region. The selected hospitals were
located in different regions (Mumbai, Kolkotta and Delhi). These inherent differences in
the population dynamics could have acted as confounding variables in the analysis of the
study.
2. Internal comparison was made to provide a realistic picture; but considering the small
sample size for internal comparison, the findings could not be substantiated.
3. No data regarding the mortality rates was shared and hence it could not be used to
evaluate the quality of healthcare services with specific reference to patient outcomes.
6. FINDINGS OF THE STUDY
The direct cost of healthcare services (in terms of average cost of hospitalization per bed per day)
was evaluated against the various quality indicators described in section.3, which have been
associated with quality of medical care services. This was aimed at understanding the overall
implication of cost of quality of healthcare services.
6.1 Asset Value and Impact on Direct Cost of Hospitalization
Literature Review shows that the Asset value of a healthcare institution is directly related to the
healthcare outcomes, which higher asset value associated with better quality of care.
The asset value in terms of medical equipment technology varies primarily due to variation in the
installed infrastructure capacity of the healthcare institution. A secondary care hospital has
limited diagnostic and imaging services (like CT scan, MRI, Immunoassay, etc), which in turn
affects the ability of the physician to diagnose and treat the patient appropriately. Further,
equipments and technology, like a well equipped Intensive care unit improved the chances of
patient survival This directly impacts the overall outcome and thereby has an implication on
quality of medical care. The cost of infrastructure includes various aspects like evidenced based
design of the hospital, hospital ambiance, furniture and finishing of the facility. It also is
indicative in terms of availability of various amenities like clean drinking water, toilet facilities,
etc.
Also operating costs for these institutions may vary considerably depending upon the infrastructure.
In institutions with a centralized chiller plant the average consumption of energy per bed per day was
observed to be approximately 80 units, whereas in institutions without a centralized unit, the average
energy consumption per bed per day was as low as 25 units. A centralized unit plays a crucial role
in enhancing patient experience and providing comfort but also plays a crucial role in controlling
the infection rates (15), which in turn have a direct impact on the outcome and quality of care.
Table.2. Indicative Asset Value Vs Av Revenue per bed (n=12) provides average estimates for
the cost of infrastructure and the average cost per hospitalization in the hospitals. While
considering the estimated cost of medical technology, estimates were based on the audited
financial sheets of the hospital, which included deprecation of older equipments. Pearson Liner
correlation coefficient for the cost of infrastructure verses the average cost of hospitalization was
R=0.975. Figure.2. Relation of Asset Value with Cost of Hospitalization (n=12), shows that
higher asset values were linked with higher cost of hospitalization.
Table2. Indicative Asset Value Vs Av Revenue per bed (n=12)
8. 8
Type of
Hospital
Cost of
Infrastructure/bed
in million INR
(Std. Deviation)
Cost of
Medical
Technology/
bed in
million INR (
Std.
Deviation)
Av Cost of
hospitalization per
day in INR ( Std.
Deviation)
Tertiary
care
4.6 (0.3) 0.44 ( 0.054) 14,167 (1527.5)
Multi
Specialty
3.225 (0.263) 1 (0.141) 9,075 (1281.6)
Secondary
Care
1.36 (0.114) 1.7 (0.1) 1,680 (238.7)
Figure 2. Relation of Asset Value with Cost of Hospitalization (n=12)
Asset value of a healthcare institution is considered as a quality indicator and higher asset value
is strongly associated with better quality of care. The findings of this study indicate that cost of
hospitalization increases with the overall asset value of the healthcare institution.
6.2 Manpower Ratios and Direct Cost of Hospitalization
The deployed manpower at different facilities varies depending upon the complexity of the
medical care services provided. Though some studies in the United States have shown that
staffing can't be considered as a measure of quality of care, evidence for other studies indicates
staffing affects morbidity patterns of hospitals and hence is crucial measure of quality. For the
purpose of this study, we have assumed that staffing plays a strong role in quality of medical
care, however comparing staffing parameters across different hospitals with different facility
9. 9
matrix may not provide a rational and realistic picture. Hence this assessment has to be based on
internal comparison of the three categories of hospitals covered in the survey. The relationship in
presented in the Figure.3. Nurse to bed ratio versus average cost of hospitalization per bed
per day
Figure 3. Nurse to bed ratio versus average cost of hospitalization per bed per day
The figure clearly depicts that the average cost of hospitalization per bed per day is related to
Nurse to bed ratio. Pearson Liner correlation coefficient for secondary care hospitals was -0.15,
for multispecialty hospitals was -0.19 and for tertiary care hospitals was -0.5.
Different studies have indicated that higher Nurse to patient ratios reduce hospitalization stay,
which impact the cost of care .Though these studies have computed cost of hospitalization in
terms of reduction of average length of stay, the reduced requirement for intensive care also
reduces the cost of hospitalization significantly. This reiterates the findings of this study which
observed a negative correlation between nurse to bed ratio and the average cost of
hospitalization. Negative correlation was also observed when staffs to patient ratios were
compared with cost of hospitalization. This implies that higher patient to nurse/staff ratio, tend to
reduce the hospitalization cost, while enhancing quality of medical care services.
While evaluating the manpower deployed in healthcare institutions, the other basic parameters
that need to be evaluated is the basic training and qualification of the deployed staff. In the
Indian context, hospitals may have designated nurses in its staff, but most of them lack formal
degree or qualifications. Higher the proportion of qualified staff is an indication of better quality
of medical services provided and the proportions are depicted in Figure.4. Percentage of
Qualified Nursing Staff Vs the Average Cost of hospitalization per day per bed of the
hospital.
10. 10
Figure 4. Percentage of Qualified Nursing Staff Vs the Average Cost of hospitalization per
day per bed of the hospital.
A similar negative correlation was observed when hospitalization costs were compared with the
percentage of qualified nursing staff deployed at the hospital.
6.3 Accreditation and Quality Assurance and Direct Cost of Hospitalization
National Accreditation Board for Hospitals and Healthcare institution is the nonprofit
organization that provides accreditation to Indian hospitals that comply with certain quality
standards. The process of accreditation is voluntary and lack of certification doesn't imply that
the overall quality of services of the healthcare institution are poor, however accreditation
standardizes certain quality protocols which impacts the quality of medical care. Some hospitals,
in India opt for Joint Commission International (JCI) accreditation to attract medical tourists.
The NABH guidelines are similar to JCI with a basic difference in cost and overall flexibility.
Similar, certain hospitals also opt for ISO certification, which unlike accreditation is a quality
assurance system. Though, similar to accreditation, lack of ISO certification doesn't imply poor
quality, but it points towards the organizations commitment to provide quality services to its
beneficiaries.
Analysis of data with hospitals with and without accreditation pointed out towards marginal
variation in cost of medical care services. The Figure.5 Accreditation and cost of
Healthcare depicts the impact of accreditation on cost of medical care.
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Figure 5. Accreditation and cost of Healthcare
The analysis of the findings was two dimensional. For secondary care hospitals, accreditation
resulted in increase in cost of medical care services, which was due to the need to comply with
various mandatory requirements. On the other extreme, accreditation for tertiary care hospitals
actually helped in reducing the cost of medical care to a considerable extent, due to standardized
procedures and policies. Hence the role of accreditation, especially for larger hospitals has been
proven beneficial in improving quality of care and relatively affordable costs.
6.4 Patient Experience and Direct Cost of Hospitalization
Data from Patient satisfaction surveys conducted internally by the twelve surveyed hospital, was
codified and integrated to evaluate patient satisfaction across three basic categories including the
quality of medical staff, infrastructure and cost effectiveness. Figure.6. Average cost of
hospitalization Vs Overall patient perception suggests the relationship between average cost
of hospitalization against the overall patient experience (using the patient satisfaction survey).
Figure 6. Average cost of hospitalization Vs Overall patient perception
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The analysis suggests a clear association between patient satisfaction index and the average cost
of hospitalization. It should be noted that patient satisfaction is a subjective evaluation of the
quality of care, but is crucial in understanding the deficiencies in service provision. On
comparing data internally, a positive correlation was observed for secondary care services with
R= 0.656 while a strong positive correlation was observed for multispecialty hospitals and
territory care hospitals at R= 0. 0.97 and 0.923 respectively.
7. CONCLUSION AND DISCUSSION
Cost of healthcare depends upon a host of modalities including the disease condition, insurance
coverage, age of the individual, etc. In addition, cost of healthcare is influenced by other
institutional factors namely the service mix, the treatment modalities, brand image of the
institution, etc. Whilst defining quality of care is difficult and subjective, quality parameters can
be used to assess the overall quality of medical care services.
Studies have shown that there is a non linear U shaped association between quality and hospital
charges. This implies that for the lowest quality will have the lowest price and as quality
improves the hospitalization charges are bound to increase . However, to generalize the findings
of this study to all contexts may lead to misinterpretations, as the methodology used was purely
exit interviews and patient opinions. In another study conducted in the United States, it was
observed that there was no relation between patient satisfaction levels and the expenditure made
on healthcare services . Taking lessons from the United States and Cuba example, optimum
utilization of resources plays a crucial role in controlling costs in a healthcare institution.
Quality indicators namely manpower ratios, infrastructure and asset value, accreditation and
quality control procedures can be used to ascertain of the quality of healthcare services. Patient
satisfaction surveys also play a crucial role in assessing the quality of care provided by the
healthcare institutions Patients appreciate better quality of medical care services . Though several
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organizations use patient satisfaction reports to evaluate the quality of medical care services, the
findings are often not very compelling. Patients are often considerably biased towards reporting
satisfaction depending upon various factors including their underlying condition, ethnicity, age,
improvement in the condition, etc . However, careful and appropriate evaluation of patient
satisfaction surveys could also act as a vital quality indicator can provide insights into areas of
improvement. Though other factors like disease standardized mortality rates may be used, their
application is constrained due to technical issues and statistical limitations.
Asset value of hospitals, implying the infrastructure, medical equipment technology, basic
amenities and additional services provided play a crucial role in cost of hospitalization. This
study observes that with higher asset value the average cost of hospitalization increases. Reports
indicate that hospitals with centralized air conditioning units are associated with higher cost of
hospitalization .
Nurse to patient ratios and staff to bed ratios also influence quality of care. Though it may appear
that higher staff would increase the cost of medical care borne by the common man, the findings
of the study indicate otherwise. The rational for higher staff to bed ratio, results in provision of
better quality of care, which in turn reduces the average length of stay and hence average
hospitalization cost. Higher staff to bed ratio reduce the need for intensive care services and
medical equipment support, which in turn reduce the cost of hospitalization.
Accreditations and quality assurance systems have also been observed to reduce the average cost
of hospitalization. This clearly indicates that accreditations and quality assurance systems help
hospitals to streamline their functions and processes, minimize wastage and thereby aid in
enhancing quality and reducing cost of care.
Then, does higher quality of care imply higher costs? On considering the intangible cost
including man days lost due to morbidity or life years lost due to premature mortality, poor
quality of services actually increase the overall cost of medical care services .
As per the latest estimates by the Central Statistical Organization, the per capita income of Indian
population stands at INR 46,492 which is about 14.5% higher than the previous year
estimates (25). As per the Human Development Report, 2009 of the UNDP, the estimated
income in US dollars was $ 2753 (adjusted by purchasing power parity).
The public expenditure on healthcare was about $21/inhabitant (adjusted to Purchasing Power
Parity), which implied that the overall expenditure on healthcare was approximately
$140/inhabitant (adjusted to PPP).
This paper attempts to answer this question by evaluating the various quality indicators and their
association with cost of hospitalization. The findings have indicated the role of each specific
indicator in cost of hospitalization, but fail to answer the pertinent question. The various quality
indicators evaluated in the study impact the overall quality of care, with varying degree of
intensity. This makes it difficult to estimate the contribution of each specific indicator to quality
of care, which in turn results in failure to understand the overall association of quality of care and
cost of hospitalization.
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8. ACKNOWLEGMENT
I would like to acknowledge Indian Healthcare Consultants, which provided most of the primary
data to conduct the aforementioned study. The data used for the study was part of assessment
data collected for specific clients by Healthcare Consultants.
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2. Medical bills rising faster than inflation. Business Today, 2010, March 31: Sect 2
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