WK7

Week 7

DHA-7005 v1: Healthcare Quality Ma…

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Quality Assurance through Accreditation in Healthcare Organizations As you already know, the healthcare system is rather complicated, considering the number of stakeholders—including providers, payers, plans, and patients—involved. Like the healthcare system, the quality improvement landscape also consists of numerous and varied actors. Having a better understanding of these varied actors (agencies, associations, etc.) will give you the prerequisite knowledge you need on how these actors help ensure quality within the healthcare arena.

As you will find out in your reading this week, quality improvement organizations play different roles to improve healthcare quality. The majority of these organizations can be placed into four different buckets.

 

Figure 8. Buckets of quality improvement organizations

As a healthcare manager working to improve quality in the healthcare facility or organization you serve, you will need to have a solid understanding of the major organizations that fall into the four buckets highlighted above. Your understanding of the mission of these organizations and their key objectives will provide you with the requisite information needed to position the healthcare facility or organization you manage for success.

The table below provides an excellent list of healthcare organizations and the role they play in helping to shape healthcare quality in the United States. To delineate the type of quality functions these organizations engage in, this list further maps—with abbreviations for the roles—specific types of quality functions.

 

Agency/Organization Quality Function

Agency for Healthcare

Research and Quality (M,

P)

Supports research and funding designed

improve the quality, safety, efficiency, a

effectiveness of healthcare.

AQA (M)

(Formerly Ambulatory Care

Quality Alliance)

Improves healthcare quality and patient

through a collaborative process of meas

performance, collecting data, and report

meaningful quality information for the p

improving outcomes.

American Medical

Association Physician

Quality Reporting Initiative

(M)

Develops, tests, and maintains evidence

clinical performance measures and meas

resources for physicians.

Centers for Medicare &

Medicaid Services (I)

Promotes accountability and transparenc

through quality initiatives. CMS has dev

standardized approach for the developm

quality measures known as the measure

management system (MMS).

Hospital Quality Alliance

(P)

A public/private collaborative that increa

transparency for consumers on hospital

performance.

Institute for Healthcare

Improvements (P)

An independent, not-for-profit organizat

serving in an advisory role. IHI works ac

improvement by guiding the will for cha

Introducing concepts for improving patie

and helping healthcare systems put thos

into action.

National Quality Forum (E)

 

Member organizations develop, validate,

implement national strategies for health

quality measure and reporting of consen

standards. Promotes attainment of natio

through education and outreach program

HHS contractor tasked with establishing

portfolio of quality and efficiency measu

evaluation of healthcare spending efficie

The Joint Commission (I) Nonprofit, the quasi-government accred

agency for healthcare institutions.

The Leapfrog Group (P) A consortium of insurers, private parties

businesses, and others influential in driv

improvements in safe practice within ho

transparency, and mobilized employee

purchasing power (value-based purchas

Quality Improvement

Organizations (M, P)

State-organized groups are organized an

contracted by CMS to develop quality m

Many of these organizations published re

cards based on their quality measures.

VHA, Inc. (Formally:

Voluntary Hospital

Association)

A for-profit cooperative serving 1,400 no

profit hospitals and more than 24,000 n

care facilities and provides supply chain

management services. Promotes and su

the formation of regional member netwo

allow healthcare organizations to collabo

including on QI through its Clinical Impr

Services and Comparative Clinical Measu

tool.

KEY:

Measure development and validation (M)

Measure endorsement and approval for enforcement and publication (E)

Measure implementation and enforcement through credentialing and financial incentive mechanisms (I)

Promoters who publicize quality measure performance and leverage opinions of the public, legislators, purchasers, and insurers of healthcare, and professional organizations (P)

Figure 8: Professional Organizations and Other Agencies: Participating in Healthcare Quality in the United States

Source: http://www.sccm.org/Communications/Critical- Connections/Archives/Pages/Mapping-the-Quality- Improvement-Landscape.aspx

In addition to learning about the mission and objectives of quality organizations, your understanding of how these organizations implement their programs or projects will further strengthen your understanding of how they influence healthcare quality in the United States. For example, you will learn how the Center for Medicare and Medicaid Services (CMS) uses financial incentive to drive quality improvement agendas. Specifically, you will learn about CMS’s pay-for- performance initiative, otherwise called value-based purchasing. You will also gain an appreciation for CMS’s regulatory role with hospitals, ambulatory care facilities, and nursing homes.

Besides learning about the roles of organizations driving healthcare quality in the United States, you will also have the

Books and Resources for this Week

Acquaviva, K. D., and Johnson, J. E. (2014). The quality improvement landscape. In M. S. Joshi, E. R. Ransom, D. B. Nash, and S. B. Ransom (Eds.)...

Link

opportunity to review resources on the mechanisms by which these organizations work to improve healthcare quality such as accreditation, certification, and licensure. In addition, you will learn about the accreditation process and how accreditation is being applied in the healthcare space.

Be sure to review this week's resources carefully. You are expected to apply the information from these resources when you prepare your assignments.

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Association of State and Territorials Health Officials. (n.d.). Understanding licensing, credentialing, certification, and privileging [Fact sheet].

Link

Brown, D. S., and Park, K. (2014). Accreditation: Its role in driving accountability in healthcare. In M. S. Joshi, E. R. Ransom, D. B. Nash, & S...

Link

Week 7 - Assignment: Assess Hospitals Based on Key Healthcare Quality Measures

The purpose of this assignment is to expose you to external healthcare quality resource (tools and data) you can use to inform quality improvement efforts in the facility that you manage. Some of the information you can glean from external resources can be used for benchmarking and quality improvement.

For this assignment, you have just been hired as the new healthcare administrator for Good Samaritan Medical Center in the Boston, Massachusetts, area. Upon settling in your new position, you learn that your facility is struggling with

some healthcare quality issues (particularly with fall-related incidents) and you are poised to do something about it. To ensure you are making an informed decision about some of the issues at hand, you decide to visit Hospital Compare—the CMS resource aimed for guiding healthcare facilities in improving the quality of healthcare services.

Go to Hospital Compare and select Good Samaritan Medical Center, for comparison with New England Baptist Hospital. In your previous conversation with your quality team, the New England Baptist Hospital (NEBH) has been reported to have one of the best quality standards in your community.

Upon comparing your facility to NEBH, report on the following measures:

• Star Ratings • Type of Hospital • Patient Experiences

1. Patients who reported that they always received help as soon as they wanted.

2. Patients who reported that, yes, they were given information about what to do during their recovery at home.

In your report, discuss your facility results with that of NEBH, the state of Massachusetts, and the United States. Also, include a recommendation section in your report with suggestions for improvement and how much of a percentage increase you are aiming for within the next year or so. You can refer to last week’s assignment submission for recommendation pointers.

Length: 1-2 pages, not including title and reference pages

References: Include a minimum of 3 credible resources, one of which must be scholarly and peer-reviewed.

Your assignment should reflect scholarly academic writing, current APA standards, and adhere to Northcentral University’s Academic Integrity Policy.

Upload your document and click the Submit to Dropbox button.