Health Care Management (Ambulatory Care Admin)

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what_is_care_quality-_week_3.ppt
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  • Definitions of service or outputs:
  • Value= providing the most effective and appropriate care given the available resources
  • Efficacy=ability to produce the desired effect
  • Appropriate=applied to the right patient at the right time
  • Effective=combination of efficacy and appropriateness

  • Definitions of organizational performance:
  • Productive=ratio of outputs to inputs
  • Efficient=costs per unit of output
  • Brought in the patient experience
  • Safe
  • Timely
  • Effective
  • Efficient
  • Equitable
  • Patient centered
  • 5 interrelated domains:
  • Consumer satisfaction
  • Employee satisfaction
  • Workforce stability
  • Clinical outcomes
  • Regulatory performance
  • Regulation is a legal mandate for minimum level of quality
  • Accreditation aims for a higher standard
  • A difficult aspect of quality management
  • Structure
  • Process
  • Outcome
  • Reliance on structure and process due to difficulty in measuring outcomes
  • Are outcomes always related to structure and process?
  • Stakeholders may want emphasis on what they have most control of:
  • Management=structure
  • Providers=process
  • Clients=outcomes
  • Challenge to account for factors outside of provider control
  • What is the ‘baseline’ or starting point
  • What is influenced by factors apart from the organization
  • Quality assurance focuses on eliminating poor providers
  • Has resulted in a documentation driven system; providers need to “cover themselves”
  • Little effectiveness, a minimum standard
  • Little focus on changing processes
  • Quality improvement seeks to continuously move forward
  • Demands cultural change and engaged leadership
  • Key concepts:
  • Organizational work is process driven
  • Quality is obtained by altering processes
  • The customer is central
  • Lack of quality is costly
  • Involve every worker
  • Set high standards
  • Focus on priorites
  • Management that lacks focus
  • Little feedback or rewards for progress
  • Difficulties of culture change decrease morale
  • Lack of time for QI activities
  • Only involving upper management
  • Evangelistic devotion to QI, irrationality
  • What is assessed and why based upon the purpose (mission) and future goals (vision) of the organization
  • Ex: a organization designed to produce cars would rely heavily on measures of efficiency
  • Managers balance between a business model and meeting a larger social need
  • Also level of openness and interconnectedness
  • Internal and external measures of improvement
  • Motivate
  • Set criteria for evaluation
  • Legitimize activities
  • Remember the balance between organizational goals and legitimized means; are all activities working toward the goal, or have some become ritual
  • Send a message to those outside the organization

  • What is measured should reflect organizational goals
  • Should be easy to answer the “ why” questions
  • Need to know which stakeholders are getting the information
  • Physicians want different info than consumers
  • Health care organizations may perform well in one domain, poorly in another
  • Need a representative view
  • Remember complexity theory…
  • Improving each subunit may not improve the whole; based in interaction between the parts
  • Small changes can have large effects
  • Measurement should assess the big picture, not is lab meeting it’s productivity goals but is the patient experiencing a quality experience
  • Goals may be incompatible
  • Efficiency versus customer satisfaction
  • Restraints: safety or QOL
  • Some change may be ineffective currently but needed for future adaptability
  • Preventative care
  • Presence of subunits that are affected differently by QI
  • Multiple Stakeholders
  • Some more powerful than others
  • Needed peer review among physicians
  • Hx of MD’s evaluating MD’s
  • Can lead to dual lines of authority
  • Need for both standardized procedures and procedural flexibility
  • Most measures do not address the complexity of the care giving situation
  • Frustrating for employees
  • Well trained professional staff
  • High organizational standards
  • Experience
  • Coordination of professional staffs, including conflict resolution procedures
  • Culture of employee participation, diverse input
  • Timely and accurate feedback
  • Active management of work environment
  • Compensation mechanisms
  • Assess for areas of needed improvement
  • Facilitate team approaches to change, diverse input
  • Allow professionals flexibility
  • Assure adequate resources for data collection and analysis
  • Reward performance
  • Don’t blame individuals, however, for process failures
  • Maintain outside relationships to acquire resources
  • Know:
  • Why get accredited?
  • What do you need to be eligible for accreditation?
  • Understand:
  • Standard=the goal
  • Rationale=why the goal is important
  • Elements=process to meet goal
  • The survey process
  • 4 steps to gather information