Outline
Quality Improvement in Healthcare
Arriel Concepcion, Kaylee Morgan, Derrick Heim, Hazel Hernandez
BUSI 511 Healthcare Administration
Liberty University
November 25, 2022
Healthcare systems are almost always seeing people at their worst and attempting to make them
feel better. The quality of care being delivered varies significantly across the different healthcare
delivery systems. There is a relationship between internal and external stakeholders as they both
want quality care at their facilities used while keeping costs contained. This research paper looks
at how quality improvement is changing the landscape of healthcare delivery and will give
insight of why there is a need for improvement, techniques for improvement, advantages,
disadvantages, challenges, and recommendations for future research Health care is an ever-
changing system. There is constant need for improvements due to the fact things in the world are
improving.
Quality Improvement is a systematic, formal approach to the analysis of practice performance
and efforts to improve performance (Basics of Quality Improvement, 2018). In order for quality
improvement to be effective you need to be able to track the processes, which can be done by
using different models and methods. One way to track quality improvement is by the use of
benchmarking. Benchmarking in health care is defined as the continual and collaborative
discipline of measuring and comparing the results of key work processes with those of the best
performers in evaluating organization performance (Hughes, 2008). By using this process, this
helps health care providers understand and record the results of the system they are currently
using and comparing it to the system that they are interested in adopting.
Internal benchmarking is used to identify best practices within an organization, to compare best
practices within the organization, and to compare current practice over time (Hughes, 2008).
Although internal benchmarking can be an effective use, you would also need to use external
benchmarking. External benchmarking involves using comparative data between organizations to
judge performance and identify improvements that have proven to be successful in other
organizations (Hughes, 2008). By utilizing both internal and external benchmarking you are able
to understand what would work best in your practice as well as what works in other practice to
decide which would be beneficial for your organization to adopt. When it comes to quality
improvement, there are certain models that can be following to ensure you are improving the
aspects of quality health. Quality health care is defined as “the degree to which health services
for individuals and populations increase the likelihood of desired health outcomes and are
consistent with current professional knowledge (Hughes, 2008). The plan do study act (PDSA)
model is a way to understand the way quality is defined and how it can Health care providers are
one of the first people to determine the specific areas that need to be improved in their practice.
Collecting information and data on how the system works will help understand what needs to be
done.
The best way to obtain this information is to ask your employees as well as the patients.
Employee's opinion matters because they are the ones that are working in the practice everyday
and know what things work best. Patients are also ones benefiting from improvements because
they are able to give their opinions on what they would like to see improved. If the patients are
complaining of long waits or poor communication in your practice, come up with an idea that
can improve those areas. Then, once you have decided what change needs to be done, you need
to implement the changes. It is important to make sure everyone understand his or her roles in
the change. This includes the patient; they need to be aware of changes in the systems so they are
able to give their feedback as well. Once everyone is aware of the change you need to implement
it and continue to reevaluate to make sure the change is beneficial to your practice.
Six sigma is another model that the health care industry has adopted to help improve quality
improvement. Six sigma is used to identify and remove defects cause or errors and reduce
variability to improve processes (Kaplan, 2009). It uses a problem solving method of define,
measure, and analyze, improve, and control (DMAIC). In health care most errors come from
doctors not entering the correct information in a chart for the nurses to follow. This could lead to
death in patients. The DMAIC method has show increasing results in allowing health care
professionals to make it clear the patients problem, collecting information on the problem,
making a diagnoses, and then proposing a remedy (Liberatore, 2018).
This is helpful because it allows everyone to know what the problem is and how to resolve it.
Quality improvement is a continuous process. These models are very helpful in the health care
system, but in order for quality improvement to be successful you have to continue to access the
problems and solutions. Once you make a change, it is very important to reassess the change
after a few months to make sure the improvement is still successful or if it needs to be assessed
again to have a better outcome.
Quality Improvement in Healthcare
"The process-based, data-driven approach to improving the quality of a product or service. It
operates under the belief that there is always a room for improving operations, processes, and
activities to increase quality" (Robert-Wood Johnson Foundation). Quality improvement is
defined improvement process and the continuous and ongoing effort to achieve measurable
improvements; it is also defined by the quality on stakeholders, the client/customers (patients),
management (hospital/clinical settings), and payers. Quality improvement is meeting the needs
and exceeding the expectations of those who receive the services. Delivering all the needs and
the care that the patient and their family’s needs, and improvement is required to improve the
system and the change the system of healthcare.
Quality 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,
quality improvement is a process of innovation and adaptation designed to bring about positive
change in delivery of health care in particular settings. (IOM.org).
To ensure healthcare affordability and deliver of the best patient experience is to improve the
health of populations by accessing the community needs and the healthcare delivery system
availability to improve their health. Population health is important in determining the efforts of
healthcare delivery. Health of populations and individual health exist within our community and
there are stakeholders that are interested in population health, patients, public health/government,
and community groups all collaborate to improve the outcome and reduce disparities in
healthcare for the improvement of the quality of care delivered.
Patient experience and involvement help with the quality improvement of healthcare such as
communication with the nurses and the physicians, the responsiveness of hospital and or the
clinical settings, pain management, communication and patient teaching about medication,
communication and information about discharged and the overall ratings. The stakeholders also
take part with the improvement of population by recognizing the value of patient experience and
to adopt the strategies to improve it, and the consideration of potential strategies that are
meaningful to pursue, ensure the adequate educational resources to be available to all the staff
and that each person that is involved in the care of the patient has the ability to impact the patient
experience, and to champion the cause of improvement in patient experience. The Quality of
patient care is important by determining the quality of infrastructure, quality of training,
competence of personnel and efficiency of the operational systems. (Ncbi.nlm.nih.gov).
By improving the quality of care delivery this means a better patient care and lower the cost with
potentially higher reimbursement for pay for performance. Health care cost spending per person
is expected to increase and the projection that the national health care spending was $4.3 trillion
in 2017 due to inappropriate and or overutilization of medical care, administrative inefficiency
associated with payer/provider/patient interface, growing uninsured population, insufficient
preventive services, patient's lack of price sensitivity, too small evidence-based, poor lifestyle
choices. To improve the quality of healthcare and to reduce the per capita cost of healthcare here
are possible solutions by purchasing to improve quality/patient safety, pay for performance,
tiered networks, strengthening primary care and care coordination (medical homes), improve
efficiency, promoting health and disease prevention, wellness programs, information technology
and evidence-based medicine.
Improving the patients experience by targeting patient satisfaction, the experience of care that
they receive and by the activities and how each focus on care coordination to improve data
collection methods such as prioritizing care coordination and patient engagement, understanding
the effects of new care delivery models on patient experiences and outcomes, developing a
measurable approach that will proved a timely manner and improving data collection methods
and procedure to provide fair and accurate assessments of individual providers.
There are five recommendation for improving the patient experience of care and they are as
follows health system soughs use patient satisfaction as a balance measure and not a driver for
outcomes, evaluate entire care teams and not by just individual providers, use healthcare
analytics to understand the act on data, leverage innovative technology, and to improve
employee engagement Safety is avoiding injury to patient from the care that is intended to help
them examples are the prescription of medication that patient is allergic to, failure address an
abnormal labs or x-ray results, and failure to perform the correct proceed are a few example to
improve the quality of care.
Effectiveness is to avoid the overuse of ineffective care and the underuse of effective care,
Patient centered provide care that is respectful and responsive to undivided patient preferences,
needs and values, examples are shared decision making for the treatment and options. Timely
reduces the waits and harmful delays for both those who receive care and there's who gave care,
it should also be efficient to avoid waste including waste of supplies, equipment, ideas and
energy examples are necessary supplies, personnel and medications in room for patient
procedure, and it should also be equitable providing care that does not vary in quality because of
personal characteristics such as gender, ethnicity, geographic location and socioeconomic status.
(Ahrq.org).
The service of delivery of models that impact the quality improvement are as follows
Accountable Care Organizations (ACO's) are group of doctors, hospitals and other healthcare
providers who voluntarily come together to provide coordinated, high-quality care to Medicare
patients to ensure they receive the right care at the right time, ACO is designed to give incentives
to the providers to deliver high quality of care at a low possible cost, this help with the managing
a population of patients.
Patient-Centered Medical Home (PCMH) are integrated care models focus on providing a high-
quality care across the continuum, the implementation of PCMH for rehabilitation care model
enables comprehensive and integrated care across the continuum, Telemedicine is influenced by
quality of allowing a faster response and cost savings. Quality improvement organizations
(QIO's) and Quality improvement networks (QIN's) are private, most not-for-profit organizations
staffed with doctors and other healthcare professionals trained to review medical care and help
with the quality of care, Quality innovation network works with providers and communities
across the country on a data-driven quality improvement initiatives using a variety of strategies
such as provide technical assistance, convene learning action networks for sharing best practices
and collect and analyze data for improvement.
All quality improvement should be continuous using the Plan, Do, Study, Act or the PDSA this
plan's objective is to constantly measure and evaluate. To plan is t to ask questions and
predictions, to Do is to carry out the plan, document problems, spot new ideas, to Study is to
analyze data, compare to predictions and the summaries while to Act is to be ready to implement
the next cycle. The PDSA enables rapid testing and learning, it allows for incremental testing
and allows lesser time in planning out a comprehensive change, then putting it into procedure,
the PDSA cycle can help with the development of change, testing a change and implementing a
change.
The problem is by knowing the chief complaint of each patient, we can change that by executing
the model for improvement, the aim is to measure the change by testing and using the PDSA
cycle then implementing change that works. The Aim is knowing what you are trying to
accomplish, it is a strong measureable aim with a clear time frame that will help keep your
project on course, it has to be important to those involved, a good aim is specific, measurable,
determines a time frame, addresses who the change is for and what has to be achieved and it is
also sustainable. Measurement is how we will know that a change is an improvement, it is
critical for testing and implementing changes, different from measurement and for research, the
measurement for research is to discover new knowledge.
There are also 3 types of measures for quality improvement outcome measures and they are the
process measures, balancing measures and change. How can we measure our goal is met is
through critical thinking using a flow chart and diagram, flow charts allows us to visualize the
system that we are trying to chance, with flow chart it helps to clarity the complex processes and
so help the team gain a clear understanding of the process and use this knowledge to collect data
identify problems, focus discussions and identify resources, eliminate waste and such activity or
resources that does not add value, it improve work flow, optimize inventory and manage time,
focus on variation and above all focus on error proofing.
Benchmarking also is a best practice by using technology by barcodes for medication, and by
using this change concept it helps with the goal in improvement of quality care. The problem- all
successful quality improvement programs starts with an in-depth understanding of the problem,
the goal is determining the appropriate quality improvement goal that can be challenging for
most healthcare system, the aim is the breakup of the works that will be achieved in a
manageable pieces, and the measurement is a baseline in determining the improvement and how
we can improve by using interventions. (IOM.org).
Adaptive leadership, culture and governance is where individuals or teams within a health
system that may have the aptitudes and dedication to make continuous improvements and this of
course require senior leadership that will support and adopt the learning culture. Analytics it is an
evidence and consensus bases best practice are the foundation upon which successful quality
improvement Analytics it is an essential ingredient for sustained quality improvement and plays
an important role in each phase of the quality improvement lifecycle. Adoption is necessary in
adaptive leadership and best practices because it won't be successful quality imprudent program
unless they dedicate resources to implement outcome initiatives. Financial alignment is another
important part of successful quality improvement in healthcare because of financial incentives
and payment models have to align with its quality initiatives.
Advantages
CQI, Continuous Quality Improvement, is a systematic approach to achieving ongoing
improvements in a product or service. CQI users define the problem, map the process, identify
improvement opportunities, implement the improvements and continually monitor the results for
improvement opportunities. There are several benefits of using Continuous Quality Improvement
(Taylor, 2017).
Errors are defined as the state or condition of being wrong in conduct or judgment. No one is
perfect. Making mistakes is a normal part of life. We often beat ourselves up over making both
minuscule and large mistakes. Even the glue that holds patients' health care journeys together
falls short from time to time. Healthcare facilities are critical to the delivery of high quality,
efficient care. Although these medical facilities have daily goals to minister to and improve
patients' health, medical errors are very common mistakes that can negatively affect patients'
care. Continuous quality improvement can help reduce the number of errors made in healthcare.
Errors can become costly, if mistakes continue to be made while providing services.
Focusing on continuously identifying potential sources of errors and fixing them can avoid
problems that might otherwise crop up overtime. Error reduction is defined as a crucial way to
keep the workplace safe, efficient, and productive through advanced human and organizational
systems (Hamel, 2008).
Although change might not be easy, it is definitely beneficial and mostly importantly required in
order to be successful in healthcare. Growing accustomed to certain routines and processes can
hinder the adaption of new opportunities that can produce improved operations or the
development of new services. A philosophy of continuous quality improvement can make a
business better equipped to adapt to changes in an industry, take advantage of opportunities, and
threats.
Processes in a company pursuing continuous quality improvement continually undergo
incremental changes. Companies use to continually implementing changes are better equipped to
adapt their businesses to changing markets than those that employ rigid processes (Hamel,
2008,). Increased adaptability begins with an eagerness to adapt which can result in a triumphant
end.
Productivity is a measure of how efficient a business is at utilizing its resources to produce goods
and services, calculated by dividing total output by the total resources, such as labor and capital,
devoted to production. When a company increases productivity, it is able to produce more with
the same amount work and equipment, which can lead to several important benefits (Hamal,
2008). Increased productivity allows healthcare facilities to lower the number of wasteful
practices while increasing the number of ways to operate productively. A boost in productivity
can create opportunities of growth by means of increased profitability and competitiveness.
Increasing productivity lets medical facilities offer more products and services without
increasing costs.
Producing more also allows facilities the opportunity to make more revenue. According to
Hamel, higher productivity can increase a company's profit margin in addition to raising total
profits. Profit margin is the measure of how much profit a company makes for each dollar that it
spends. Increasing productivity can boost the level of competition in a market. When one firm is
able to be more efficient with its resources, it encourages other companies to improve
productivity as well in order to compete. More and more medical facilities are investing in EHR,
new electronic filing software. This software was created to switch medical records from being
filed by paper to electronic. An EHR system allows healthcare facilities to collect, manage, and
share patients' information securely and efficiently.
Implementing a better process, will ultimately lead to a decrease in production slowdowns and
increase productivity. Medical staff with high morale is more productive. They tend to be more
devoted and eager to work hard in order to attain the necessary goals. The use of continuous
quality improvement helps improve employee morale by not blaming the employee for the
problems in the system. Instead, it focuses on the problems in the process, not the people
performing the process (Taylor, 2017).
Ultimately, improved morale deals directly with employee satisfaction. Two essential factors,
used to determine one's morale, are communication and interaction with management. Staff must
value the vision of their employer and feel valued as an employee. When an employee is pleased
with their employee, they exhibit high morale. Medical facilities are changing from the
traditional fee for service model and are adapting to value-based model of care. Previously, the
more services that medical facilities rendered the more profit they would make. Now, these
facilities are being held accountable for their patients' end results. Patient treatment outcomes
versus cost are compared and medical facilities who meet the requirements receive a bump in
federal payments (Ellis & Razavi, 2012).
QPP, Quality Payment Program, offers eligible clinicians to participate in payment tracks.
One of the payment tracks is MIPS, Merit-based Incentive Payment System. MIPS adjusts
payments based on performance in four categories which includes quality, cost, promoting
interoperability, and improvement activities. Each performance category is weighed completely
different. According to the Secretary of the U.S. Department of Health and Human Services,
2018 performance period is projected to weigh quality at 50%, cost at 10%, promoting
interoperability at 25%, and improvement activities at 15%. The weighted percentages are used
to calculate the clinicians' final scores.
Each eligible clinician or group's final score is compared to a performance threshold to determine
payment adjustments. The performance threshold for the 2018 performance period is 15 points.
Scores ending higher then threshold will receive a positive payment adjustment. Those ending
lower will receive a negative payment adjustment. In addition, eligible clinicians with smaller
medical facilities automatically receive five bonus points added to their MIPS scores. And
eligible clinicians can receive an additional five bonus points to their MIPS scores for delivering
healthcare to complex patients.
Disadvantages
The cost can be expensive of changing the negative feedback from quality improvement into
positive changes. Allen (2016) conferred that "there is mounting evidence that an intervention
that has been successful in one location will not necessarily deliver the same results elsewhere"
(p. 672). Management must determine an improvement plan that will work for the agency that
needs improved, not a generic plan developed for a different agency.
"Lean Six Sigma is a business strategy and methodology that increases process performance
resulting in enhanced customer satisfaction and improved bottom line results" (Snee, 2010, p. 9).
There are companies with teams of consultants that specialize in developing future plans for
agencies but come at a steep cost, but give an honest look into how the organization needs to
change to meet the needs of the future.
Another disadvantage is that you have to show employees that there is a problem with what is
currently taking place with their work. We all need to be held accountable for our actions
because everyone can improve. Some employees will feel as if leadership is peaking over their
shoulders evaluating everything they do. There are three different accounting measures
highlighted by Pfleuger (2015). "Standardized measurement, public reporting, performance
evaluation and managerial control - has become increasingly central to efforts" (Pflueger, 2015,
p. 178).
"Nurses are extremely valuable to the healthcare industry; however, today's nursing profession is
challenged by nurses' fatigue and its negative consequences on nurses' health and the quality of
patient care they provide" (Nejati, Rodiek, & Shepley, 2015, p. 512). Sometimes, quality
improvement has nothing to do with the work, but with the fatigue the workers are experiencing
from issues like long shifts, consecutive days worked, lack of sleep, or poor nutrition.
The real issue is running the risk of unintended consequences. The national strategy for
improving quality is public reporting. What is put out in the public can't be taken back and can
show the agency in a light that was not hoped for. The purpose of public reporting is to: (1)
provide information to Consumers to make choices based on quality and therefore provide us to
do better (2) give Health Care Providers comparative information about their quality of care to
improve (Mason 2016).
"Communities must place a high degree of trust in their hospitals, but occasionally the behavior
of some hospitals has called this trust into question" (Shi & Singh, 2017, p. 214). Administrators
have a responsibility to overcome these issues with other agencies in order to show that they are
different from the bad ones who seem to get a lot of media coverage when things go bad.
A healthcare system needs to benefit the community it is involved in regardless if it is for-profit
on non-profit. For-profit systems have a harder time at community integration because they need
to continue making money for its stakeholders. Quality improvement may project that
management is more worried about the needs of the patients/consumers over the needs of the
employees. Healthcare administrators must be concerned over how the general public is rating
their services.
Social media is a newer concept that is aiding in the discovery of what the general public truly
thinks about the delivery of the services. Ranney & Genes (2015) described "it's tempting to
conclude that positive tweets are flection of superior hospital care and thus decreased
readmissions, other possibilities merit investigation (positive tweets may reflect increased
medication adherence, or a tendency to avoid complaints that would prompt readmission)" (p.
390).
The Affordable Care Act (ACA) has aided in administrators needing to worry more about
patients then employees. The federal government, thru the ACA, can now deny payment to
health care providers who do not meet certain standards on care for Medicare beneficiaries (Shi
& Singh, 2017). Ranney & Genes (2015) further stated "We can imagine a future state where
hospital administrators review patient comments about their care on social platforms in real time,
just as marketers monitor brand mentions today" (p. 391). An answer for some administrators to
quality improvement problems is to invest more into technology to aid a healthcare systems
employee. Technology may mask quality of care issues that are occurring; only making quality
improvement issues harder to discover. Shi & Singh (2017) stated "Americans generally equate
high-technology medicine to high-quality care, but such an association is not always accurate"
(p. 122). The challenge on health care workers is using the technology correctly. Some
technologies may be a waste of resources or may actually harm a patient further. Technology
may be changing how care is delivered, but as Nejati et al. (2015) stated, "Physical and mental
fatigue can lead to decreased staff performance and higher odds of a medical error, sometimes
with drastic implications for patients" (p. 513).
References
Agency for Healthcare Research and Quality (AHRQ). (n.d.). Health Care Policy and Politics A
to Z. doi:10.4135/9781452240121.n17
Allen, D. (2016). The importance, challenges and prospects of taking work practices into account
for healthcare quality improvement: nursing work and patient status at a glance white board.
Journal of Health Organization and Management 30(4), pp. 672-689. Retrieved
romhttps://www-emeraldinsight-com.ezproxy.liberty.edu/doi/full/10.1108/JHOM-04-2014-0062
American Academy of Family Physicians. (2017, November 2). Retrieved from
https://www.aafp.org/practice-management/payment/medicare-payment/mips.html
Basics of Quality Improvement. (2018, March 27). Retrieved from
https://www.aafp.org/practice-management/improvement/basics.html
Ellis, J. & Razavi, A. (2012). Pros and Cons of Healthcare Reform for Hospitals. Retrieved from
https://www.healthcarefinancenews.com/blog/pros-and-cons-healthcare-reform-hospitals
Hamel, G. (2008). Benefits of Continuous Quality Improvement (CQI). Retrieved from
https://smallbusiness.chron.com/benefits-continuous-quality-improvement-cqi- 40534.html
Hamel, G. (2008). The Advantages of a Firm of Increasing Productivity. Retrieved from
https://yourbusiness.azcentral.com/advantages-firm-increasing-productivity-17626.html
Home - Centers for Medicare & Medicaid Services. (2018, October 12). Retrieved from
http://www.cms.gov
Hughes, R. G. (2008). Tools and Strategies for Quality Improvement and Patient Safety.
Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2682/
J. Liberatore, M. (2013). Six sigma in healthcare delivery. International Journal of Health Care
Quality Assurance, 26 (7), 601-626. doi:10.1108/IJHCQA-09-2011-0054
Kaplan, S., Bisgaard, S., Truesdell, D., & Zetterholm, S. (2009). Design for six sigma in
healthcare: Developing an employee influenza vaccination process.
Journal for Healthcare Quality, 31 (3), 36-43. doi:10.1111/j.1945-1474.2009.00029.x
Mason, D., Gardner, D., Outlaw, F., & O'Grady, E. (2016). Policy & politics in nursing and
healthcare. Retrieved from https://ovidsp-tx-ovid-com.ezproxy.liberty.edu/sp-
3.31.1b/ovidweb.cgi?
