Healthcare Qlty Risk Reg Cmpl 1

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The Regulatory Environment

Quality of Services

Within the healthcare industry systematic reviews of quality and a promotion of Affordable Care Organizations (ACOs) and High Reliability Organizations (HROs) have led to leaders focusing their efforts on obtaining value through increased quality and safety. The goal of the healthcare leader and organization is to constantly assess and prepare for the potential of risk and manage and prevent it before it reaches our consumer, the patient.

Potential Risks

Implicit within the quality care delivery process is the identification of potential risks, which may ultimately affect patient care. As the delivery of care standards are increasingly refined, cost-related metrics also must be monitored. The U.S. government, insurance companies, and other private payers are carefully watching the evolution of care standards and cost metrics. Healthcare leaders must be up to speed with quality care standards, identification of potential risks, and compliance with relevant regulations.

Regulatory Requirements

It is important to consider the National Center for Healthcare Leadership competencies (NCHL). Think of what types of skills will be needed to lead your organizations toward the goal of demonstrating quality and balancing costs. You may even wish to assess your own current competency levels relative to the healthcare industry's movement toward performance measurement and increased accountability (NCHL, 2018).

In healthcare settings, there are various levels of oversight for organizations. Healthcare leaders must be aware of the standards required to successfully provide quality care. Organizations need to comply with both regulatory standards as well as quality indicators set by accrediting bodies. For example, the Joint Commission is an accrediting body that sets standards for hospitals and other healthcare organizations. Organizations that are accredited by the Joint Commission are held to a higher standard. Voluntary accreditation allows healthcare organizations to benchmark themselves to ensure they are in line with national standards.

Benchmarking

Most of us have heard about benchmarking and are somewhat familiar with the concept. But, if your supervisor walked into your work setting today and asked you to provide some internal benchmarking data and compare it against national best practices, would you know what action or steps to take? Furthermore, would you know what organizations develop benchmarking standards and provide guidance for quality improvement? Youngberg (2011), a healthcare patient safety and risk management expert, describes benchmarking as the process of collecting and analyzing data to identify trends in performance and, when compared with other collectors of the same data, identifying best performers and determining if interventions that were introduced to address identified problems yielded the desired results. (p. 24) Benchmarking is not only a quality improvement tool but a condition of

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participation for some government and other payer sources. An example of this can be found in the requirements for accountable care organizations. Healthcare leaders must be familiar with the standards provided by both licensing bodies and accrediting organizations. It is important for healthcare leaders to understand how their organization stands in comparison to its peers as well as what standards it needs to meet for licensure, accreditation, and other regulatory compliance.

References

The Joint Commission. (n.d.). http://www.jointcommission.org/

National Center for Healthcare Leadership. (2018). NCHL Health Leadership Competency Model 3.0. https://nchl.member365.org/publicFr/store/item/19

Youngberg, B. J. (2011). Principles of risk management and patient safety. Jones & Bartlett.