Quality Management Plan Course Project Task 1/ WEEK 3 PROJECT
MHC6303 QUALITY PERFORMANCE AND MGMT WEEK 3 LECTURE NOTES
A Small Rural Hospital
Bill was the administrator of a small rural hospital located in the upper Midwest. He had been a healthcare manager for over ten years and was accustomed to dealing with all types of problems, ranging from physician complaints to staffing shortages to upset customers. His current problem, however, was different; it was personal. He had to decide whether his wife should deliver their second child at his hospital. It was not an easy decision.
Bill had moved up through the management ranks by working as a business office manager and then a project coordinator at a large medical center. During this time, he had completed his master's degree in healthcare administration from a distance learning university.
While Bill enjoyed working for a large facility in a big city, he realized it would probably be many years before he was promoted to a senior management position. On the other hand, with his experience and education, it wasn't long before he was able to land the top position in a small facility, which consisted of a forty-bed acute care hospital and a sixty-bed skilled nursing home.
Three physicians served the community; two were family practitioners, and the third specialized in internal medicine. However, they all functioned as general practitioners, treating what they could and referring more complex care to a larger facility 75 miles away.
This review is about rural healthcare services. While smaller in scale the issues are similar. Next you will look specifically at an example of medical care. Review the following resources for more information on this topic.
Resources:
Pati, D., Gaines, K., & Valipoor, S. (2016). Delivering rural health in a changing health model. HERD : Health Environments Research & Design Journal, 10(1), 76-86. doi:http://dx.doi.org.southuniversity.libproxy.edmc.edu/10.1177/1937586716656
Lee, D. (2012). Implementation of quality programs in health care organizations. Service Business, 6(3), 387-404. doi:http://dx.doi.org.southuniversity.libproxy.edmc.edu/10.1007/s11628-012-0141-2
A Good Doctor
One family practitioner, Dr. Able, had been delivering babies ever since he established his practice over twenty-five years ago. Although all three physicians shared calls for other emergency services, only Dr. Able delivered babies. Dr. Able was so committed to his "moms" that he would not take a vacation when someone was due and remained available 24/7 for obstetrical services.
Many people in the community were loyal to Dr. Able and thankful for his services. Others, including many people who did not grow up in the community (like Bill and his wife), were concerned because Dr. Able was not board certified in obstetrics and there was no backup for his services. Bill was under pressure from his mother-in-law, a nurse, who said she didn't know how Bill could let his child be born in a hospital that did not have a pediatrician available in case of complications with the newborn.
From a business perspective, Bill knew that delivering babies was good for the hospital, not because it made money but because patients who were born in the hospital (and their mothers) were loyal customers. However, like many small healthcare facilities, Bill's facility faced the challenge of convincing the community to accept the quality of care provided locally instead of traveling to larger hospitals for more sophisticated services.
If Bill wasn't willing to let his wife deliver in his hospital, how would anyone else have confidence in the quality of services? In addition, if Bill and Sharon went elsewhere for the delivery, it might cause a strain in Bill's relationship with Dr. Able.
So far you have learned about understanding the patients perspective on satisfaction in healthcare leads organizations to make changes. Next you will review how patient satisfaction and quality of care make a difference in the patient's outcomes. Review the following from more information on these topics.
Resources:
Farmer, J., & Nimegeer, A. (2014). Community participation to design rural primary healthcare services. BMC Health Services Research, 14(1), 130-139. doi:10.1186/1472-6963-14-130
Akinci, F., & Patel, P. M. (2014). Quality Improvement in Healthcare Delivery Utilizing the Patient-Centered Medical Home Model. Hospital Topics, 92(4), 96-104. doi:10.1080/00185868.2014.968493
A Question of Quality
As Bill sat in his office pondering this issue, he wished he knew more about how to measure the quality of healthcare services. He remembered reading that Donabedian said that quality consisted of both a technical component and an interpersonal component. Dr. Able never had the proper technical training, and a review of his staff file revealed that he rarely attended obstetrical continuing education seminars. However, his interpersonal skills with his patients and the nursing staff were outstanding.
How important is patient satisfaction to quality outcomes? Bill knew that his hospital didn't handle deliveries like the larger facilities (process), but Dr. Able's record (outcome) was outstanding. No one could remember a single case when Dr. Able had complications with a normal delivery. Was outcome more important in the measurement of quality than process?
Bill also had to consider the role of his hospital in the healthcare system. Lower-cost, high-quality, and increased access to care are everyone's objectives. Does enhanced access to care justify a different standard for quality?
References:
Donabedian, A. (1980). Explorations in quality assessment and monitoring, (Vol I): The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press.
Ward, M. M., Baloh, J., Zhu, X., & Stewart, G. L. (2017). Promoting action on research implementation in health services framework applied to TeamSTEPPS implementation in small rural hospitals. Health Care Management Review, 42(1), 2-13. doi:10.1097/HMR.0000000000000086
Mekoth, N., & Dalvi, V. (2015). Does quality of healthcare service determine patient adherence? evidence from the primary healthcare sector in india. Hospital Topics, 93(3), 60-68. doi:10.1080/00185868.2015.1108141
Joynt, K. E., Harris, Y., Orav, E. J., & Jha, A. K. (2011). Quality of care and patient outcomes in critical access rural hospitals. Jama, 306(1), 45-52. doi:10.1001/jama.2011.902
Additional Material
A Question of Measurement
Measuring the quality of healthcare services had become personal for Bill. You may have it a little easier. When you complete your assignments for this week, you will understand how quality is defined, measured, and reported. For example, you will read about and analyze two types of measurement, relative ranks and absolute values.
As a father and husband, Bill wants to ensure the well-being of his wife and child. As an administrator, he is concerned with how to prevent medical errors. You will read about a medical error this week and then suggest ways to prevent similar errors in the future. While Bill is familiar with the hospital he manages, most consumers are not knowledgeable about the quality of healthcare services. The Center for Medicare and Medicaid Services (CMS) publicizes quality information for hospitals and nursing homes.
Although Bill is primarily concerned with obstetrical services, he must analyze all aspects of his organization. Similarly, you will also consider all aspects of a healthcare organization in your first course project task this week. You will analyze internal strengths and weaknesses as well as external opportunities and threats. For Bill, the current high level of patient satisfaction is a strength but any concerns about the quality of care would be a threat. Throughout the course project, imagine you are a healthcare administrator seeking to provide high-quality care at a reasonable cost and adequately serve all members of the community.
Review the following from more information on this topic
Resources:
Schulingkamp, R. C., & Latham, J. R. (2015). Healthcare performance excellence: A comparison of baldrige award recipients and competitors. The Quality Management Journal, 22(3), 6.
Joshi, M., Ransom, E. R., Nash, D. B., & Ransom, S. B. (2014). The healthcare quality book: Vision, strategy, and tools (Third;3; ed.). Chicago, Illinois;Arlington, Virginia;: Health Administration Press