Health Situations

REFERENCE

Textbook: Carroll, R. L. (Ed.). (2009). Risk management handbook for health care organizations (Student ed.). San Francisco, CA: Jossey-Bass.

Please write up 150 to 200 word count for Question 1 to 8; try and relate the material to real-life applications and also to the textbook and health care risk management. Cite and Reference all work!

1. Review the scenario below.

ABC Hospital is a small, privately owned community hospital. It has been struggling to survive financially, as reimbursement rates have declined and consumers are being drawn to the larger state-of-the-art hospital facilities in urban areas that are perceived to have better quality. ABC Hospital was built in 1960 and has been operating in the same manner for decades. The hospital meets legal and regulatory requirements but has not kept pace with some of the newer technologies and patient conveniences becoming more prevalent in the health care industry.

Write a 50-100 word response to each of the following questions:

Mandatory Question: What strategies can the organization take to survive, improve its performance, and compete with other hospitals over the next 5 years?

Mandatory Question: What are some advantages or disadvantages of these strategies? Provide specific examples to support your answers.

2. XYZ Health Department provides services to county residents. Budget cuts have forced the department to cut back on some services and lay off staff, increasing the workload of the remaining staff. Morale among staff has declined, and county residents have complained that they are not treated with dignity and respect and are not receiving high quality care and service.

Write a 50-100 word response to each of the following questions:

Mandatory Question: What strategies can XYZ Health Department implement to provide high quality care and services to the county residents and to help increase customer satisfaction?

Mandatory Question: How can these strategies help minimize risk and improve quality? Provide specific examples to support your answers.

3. RMF: What approach and tactics may organizations use to stay abreast of the rapid changes occurring in the health care industry?

4. SUMMARY

This week, you focused on strategies organizations may use for ongoing performance improvement in the changing health care industry and current and future trends in risk and quality management in health care. By implementing a strong performance-management system that incorporates risk management and quality management, organizations will be better equipped to comply with regulatory and accreditation requirements and better positioned to address the many challenges that lie ahead: improving patient safety, delivery of care and services, health outcomes, communication, employee morale, customer satisfaction and decreasing errors, negative events, and litigation. With the attention of the health care reform movement and the millions of people who receive health care services, these challenges require extraordinary focus and commitment from all stakeholders.

What are some of the challenges organizations encounter in determining and agreeing on which strategies to use to improve performance?

How can organizations communicate, educate, and train staff on the changes that have a direct effect on their daily operations?

5 . Chap 11- CONCLUSIONS- Read the conclusion below and share your thoughts on what you think about Classifications and Reduction of medical errors.

Given the complexity of health care situations and how they produce

medical errors, it is important to have a conceptual schema for their classification and analysis. We have outlined one schema, drawing heavily on

the work of James Reason. It is offered because it is practical and draws on

the extensive work done on the psychology of human error and human

factors in health and other fields, as well as organizational antecedents

of errors and more recent studies involving the introduction of checklists.

It is applicable to a wide array of situations and leads to the use of

some, if not all, the techniques of continuous quality improvement, but

overcomes some of the biases exhibited by both those who espouse such

techniques and those who avoid them. The next step is a continuing dialogue to improve our ability to identify and further codify both individual and organizational responses associated with each category of error, keeping in mind that any system must be capable of handling the multiple individual and systemic causations behind medical errors and enhance access to relevant arrays of responses and tactics.

Past Improvement and Future Expectations

On the 10th anniversary of the publication of To Err Is Human, Wachter

(2010) evaluated the success of the patient safety movement. Although

his overall grade was a moderate B–, he noted a few areas of more significant

improvement. His highest assessment of A– was in the category

of national and international interventions, particularly the efforts of the

Institute of Healthcare Improvement (IHI), the state of Michigan’s intensive

care units (ICUs), and the WHO. Notably, all these efforts involved

the use of checklists, mentioned earlier as an effective approach.

The Michigan success was led by Peter Pronovost of Johns Hopkins.

The goal was to reduce the level of central line infections, and 103

participating ICUs reported data before and after the introduction of

checklists and associated changes such as safety training and the provisioning

of key supplies, such as chlorhexidine soap (Pronovost et al.,

2006). The overall median rate of central line infections for the ICUs

fell from 2.7 infections per 1,000 catheter-days to zero within 3 months

of implementation, and this median of zero was maintained during

18 months of follow-up. Results like this prompted Lucian Leape to

comment, “It is now apparent that we can use perfection as a benchmark”

(Buerhaus, 2007). The patient safety movement has, at least in

the area of hospital-acquired infections, begun “chasing zero,” a goal

reminiscent of the industrial quality movement’s “zero defects” from

the 1970s (Denham et al., 2009).

The IHI’s successful 100,000 Lives Campaign focused on six initiatives

(referred to by IHI as “bundles”) to save lives; three of these involved

checklists: the central line bundle, the surgical site infection bundle, and

330 CHAPTER 11 CLASSIFICATION AND REDUCTION OF MEDICAL ERRORS

the ventilator bundle (Rao and Hoyt, 2008). Finally, the WHO effort

led by Gawande (2009) developed a 2-minute, 19-step surgical checklist

that decreased major complications by 36% and deaths by 47% in eight

widely diverse international hospitals.

On the other hand, Livingstone (2010), citing these and other efforts,

suggests that harsh penalties and top-down organizational programs are

less likely to improve patient safety than physician-led efforts. He also

notes that the alternative driver of patient accountability is still available

and suggests future consideration of adding the use of checklists and team

training and other safety process measures alongside currently mandated

reporting of quality-of-care measures.

6. Read the conclusion below and share your thoughts on what you think about ’The Role of the patient in Continuous quality improvement’.

As we have shown, the involvement of patients in CQI and other forms

of quality improvement is no longer in question. What is also without

dispute is that, despite a decade of sustained effort by governments,

services, and clinicians, error rates have not significantly been reduced

(Wachter, 2010) across the board, and disparities in the quality and accessibility of care continue. Determining the best way to involve consumers

in reducing those errors, improving the quality of care they receive, and

maximizing the benefits of that involvement, remain problematic. Each

health care system and service, across the world, will rightly need to

take into account its unique funding and governance structures, planning

strategies, and quality improvement mechanisms in deciding which

patient involvement strategy is most suitable to its needs. Whatever the

particulars involved, whatever method or mechanism the service chooses,

it is clear that patients will have a greater level of involvement in their care

and in ensuring higher quality. The years of token and “one-size-fits-all”

involvement are over.