The goal of effective accreditation and performance management in the healthcare sector is based on the desire to advance the performance of the public health departments, and ultimately to enhance the health status. In the United States health care, accreditation, and quality improvement emphasis more on the improvement of patients experience and satisfaction. Currently, the United States healthcare is pursuing the national accreditation and quality improvement through Healthcare Effectiveness Data and Information Set (HEDIS) and ORYX quality metrics. The purpose of this paper is to develop a change management plan, for improvement of health quality in an acute care hospital in my community. The reason the hospital requires quality improvement is the current reports which indicated that the acute health care has poor Healthcare Effectiveness Data and Information Set (HEDIS) and ORYX quality metrics. Moreover, the reports indicated that there is low patient satisfaction, and the hospital is not meeting the government regulations and Joint Commission accreditation standards, while their financial ruin looks imminent. From the hospital report, it is clear that performance data need to be evaluated so that the plan can effectively address some of the issues identified in the report which are effective the effectiveness of the services offered at the acute hospital in my community.
Goals and Objectives That Are Expected To Be Met
St. Mary Hospital offers inpatient and outpatient health care services to Minnesota community. According to the report, there are various issues facing St. Mary hospital. Some of the goals and objectives that are expected to be met in the process of ensuring the hospital is adhering to the standards and regulation include; the healthcare management will need to offer adequate training to the employees, regarding the importance of following the government regulations and Joint Commission accreditation standards. This will ensure the hospital is running efficiency based on the accreditation standards and government regulations, which primary purpose is to offer the hospital guideline on achieving high-quality health care services. Also, the plan will come up with performance management strategies where the hospital will be able to actively use their performance data, to improve the quality of services they are offering. Additionally, the other goals of the plan are to help the hospital come up with an effective strategy, to help address the issues of patients’ satisfaction, which is a major element of quality improvement in the health sector. The last objective is to help St. Mary Hospital improve the measures in both Healthcare Effectiveness Data and Information Set (HEDIS) and ORYX quality metrics in both reactive and proactive manner.
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An Overview of HEDIS and ORYX Measures
In the last few years, the United States government and other agencies have been striving towards achieving high-quality health care services in the country. However, to ensure the quality of services being offered in the hospitals is standardized, an overview of HEDIS and ORYX quality metrics were introduced. Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standardized quality measures used by the public in comparing the performance of the organization in the entire nation. Currently, the program is being used by more than 90% of the United States health care facilities. To ensure effectiveness in the program, the National Committee for Quality Assurance was mandated with the responsibility of coordinating and administering the program (Kelly, 2012). The HEDIS 2017 is made of 91 measures, spread across seven domains of care. Some of the specific areas HEDIS measures focus on includes prevention, screening, access to care, conditions across the entire system, patient satisfaction, and proper utilization of the specific health care procedures and settings. On the other hand, according to the Joint Commission, ORYX quality metrics is the ability to effectively generate both internal and external comparisons where the internal comparison entails analysis of the participating organizations over a specific period and the external comparisons among all participating organizations. The initiative was launched in 1998 as the first national program for measurement of the quality of hospital which requires the report of only unstandardized data on the process of measuring the performance. the initiative has been experiencing major improvements, with the most essential being 2002, where all the accredited hospitals were requested by the Joint Commission to gather and report data on at least two core measure sets including pregnancy, pneumonia, acute myocardial infarction and heart failure (Harris, 2015).
The Importance of Those Measures to the Hospital
HEDIS and ORYX Measures have major important to St. Mary Hospital, where they can help the hospital understand their current position in terms of the quality of the healthcare they are offering to their patients. Using the HEDIS and ORYX Measures, insurance companies in the United States are able to understand the quality of health care patients is being offered. For example, the United States government is currently using HEDIS as the main tool for awarding insurance companies’ scores, and significant Medicare financial incentives for insurers and providers, whenever their scores exceed specified thresholds. Therefore, the measures have major importance in all the stakeholders in the health industry, where they provide information which can be used to access the quality of health care, and identify some of the areas that need improvement (Harris, 2015). Also, using HEDIS and ORYX Measures, the government and other health care agencies are able to increase preventive care, by accessing the number of overall doctors visit, hence ensuring better experience among the customers and lastly, enhanced patients satisfaction. However, the effectiveness the measures depend on the communication between the health plan members and primary care providers.
How the Hospital Can Improve Metrics in Both Measures
HEDIS and ORYX metrics are being used most frequently to measure the quality of care by health plans. Today, quality metrics are being developed by different organizations, while the health plans are allowed to develop their own internal quality policies and guidelines. Being the two most widely used metrics today, HEDIS and ORYX Measures can be improved by creating ways health plans can share the information with one agency. For example, HEDS is being utilized by more than 90%, while there are other measures such as Medicare Star, CAHPS offering the same services (Kelly, 2012). Therefore, there is a need to create one system, which will be offering complete report detailing the health plans internally developed quality metrics, offering credibility on different elements in an organization, health panelist’s perspective on the quality improvement among others.
The Role That Patient Satisfaction Plays In Reimbursement
According to a study conducted by Robert Wood Johnson Foundation., & Institute of Medicine (2011), patients satisfaction is counting more today, as compared to decades ago for hospitals. Since the implementation of the Affordable Care Act (ACA), major changes were imposed in the United States healthcare industry, where although the number of patients entering the health is system increased to 32 million, the government demanded the health care providers ensure they reach scores set in a certain threshold, so that they can be able to benefit from the various reimbursement initiatives. Health care facilities which have the ability to offer high customer satisfaction are being impacted positively by the ACA in the form of consumerism and reimbursement (Latifi, 2015). The scores obtained under various measures metrics are being tied directly to the reimbursement of the physicians and healthcare facilities through a pay-for-performance model.
Communication Approaches for Change Management among Clinicians and Nonclinicians throughout the Organization
Good communication approaches are good in ensuring effectiveness in change management among clinicians and non-clinicians throughout the organization. Therefore, for the change management at St. Mary Hospital, the communication strategies will include the use of Health information technology (HIT) to ensure effectiveness in communication between the clinicians and patients, hence address the safety risk (Sherwood, & Barnsteiner, 2017). The strategy will entail the use of automated functions and decision support by the use of EMR as a way of supporting the memory, reminding and bringing forward information such as potential drug-drug interaction, or any allergies. The second communication strategy will be Rounds, which is a time-honored method that clinicians will use in communication, by bringing together the group of clinicians offering services to a specific patient. Using the strategy, there will be effective communication between the patients and the clinicians; hence, all the activities will be based on regularly scheduled time, and will always take place in a structured format, and all key team members will be included (Sherwood, & Barnsteiner, 2017).
The Quality Improvement and Evaluation Method(S) That Will Be Utilized To Determine the Progress of the Change Management Plan
The evaluation process is one of the integral components of quality improvement in healthcare. Some of the quality improvement and evaluation methods that I will use to determine the progress of the change management plan include focus audit studies and development studies method. When using focus audit studies, the plan will be evaluated on a specific component, such as how a particular condition is being treated in the healthcare organization (Sharma, & Petosa, 2014). Using the focus audit studies method, an explicit assessment of the impact of implementing the changes planned for a specific practice will be evaluated, hence further changes done where necessary, and for areas where the system was effective, the management will find ways of celebrating and maintaining the improvement. On the other hand, using the developmental studies method, I will be able to assess the actions needed to improve or refine the design of the plan, or the various health care interventions being introduced in the healthcare organization. Using the method at the informal level will involve observation or conducting discussions with colleagues, regarding the progress of the accreditation and quality improvement plan (Sharma, & Petosa, 2014).
A Quality Improvement Plan
Various issues were identified on different functions of St. Mary Hospital, Minnesota. Using the United States Department of Health and Human Services module, among other things, the St. Mary Hospital quality improvement plan will include the development of a clear statement of quality vision, followed by a description of the accreditation and quality improvement program (Johnson et al., 2014). Then, a diverse membership for quality management team will be conducted, following a meeting schedule. Then, the quality management team will come up with the most appropriate process for conducting the plan, followed by a list of priorities and improvement goals that will be specific, measurable, achievable, relevant, and time-bound (Koch, 2017). Then, the management team will develop a plan to demonstrate how the set goal and plan will be evaluated, and lastly, a plan for how performance data will be gathered and reported.
References
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