Strategic healthcare organizations strive to ensure better and quality healthcare to people of the United States of America. Examples of such organizations are the Agency for Healthcare Research and Quality (AHRQ) and the Leapfrog Group. Both organizations have different strategic healthcare quality initiatives that help them focus on attaining specific goals.
AHRQ aims at supporting research in an attempt to improve the quality of healthcare. The role of AHRQ is to determine standards of quality health care and ensure healthcare providers meet the set standards (Berkman et al., 2013). AHRQ uses a four quality indicators to identify and monitor standards of different aspects of health care quality. Prevention Quality Indicator (PQI) concern is in providing higher quality outpatient care for patients who experience return visits. In-patient Quality Indicator (IQI) focuses on quality patient care inside a hospital to reduce patient mortality rates. Patient Safety Indicators (PSI) is also concerned with reducing patient mortalities that result from related available complications like old hospital machinery (Ramanathan et al., 2013) . Pediatric Quality Indicators, on the other hand, focuses on the provision of quality healthcare to the pediatric population.
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The mission of the AHRQ is to ensure that all Americans can access improved quality, efficient, and safe health care. The organization's primary initiative is to conduct health services research. Health Service Research analyze how people get access to health care, how much it costs Americans to access such care, and the outcomes of the received health care to patients. Analysis of the health service research aims at identifying practical ways that the government can manage, organize, finance and deliver quality care to Americans. The focus of health service research is to minimize the occurrence of medical errors as much as possible and to improve patient safety (Berkman et al., 2013) .
AHRQ’s has developed many research initiatives in a bid to promote efficiency in the organization of public and private healthcare systems of healthcare delivery. The initiatives fall into three broad categories. The first initiative is to invest in evidence based research to identify effective ways to improve the quality of the health care system. An important area of focus is how to reduce bloodstream infections. Bloodstream infections are usually deadly and result in loss of billions in meeting health care costs. AHRQ funds academic and research organizations to review clinical and health services topics (Ramanathan et al., 2013) .
The second initiative for the AHRQ is to teach and train healthcare providers to enhance extensive improvements in the delivery of healthcare. Development of the Comprehensive Unit-based Safety Program (CUSP) was brought by AHRQ's credibility in forging of excellent relationship with healthcare professionals. Development of CUSP has led to increased focus on teamwork and improved safety culture in health facilities. CUSP aims at bringing together thousands of hospitals with practical resources and learning experiences to help healthcare providers understand principles that increase the safety of patients. Application of CUSPS in hospitals has led to a reduction of central line infections. A 15 percent reduction in Catheter-associated urinary tract infection has been witnessed from 2011 to 2015 (Berkman et al., 2013).
The third initiative of the AHRQ is to generate data and measures to track, improve and evaluate the progress of the healthcare system. Data generated is used to provide information to health care providers, patients, and policymakers who identify problem areas and apply necessary improvements (Ramanathan et al., 2013) . Data resources on health care are available from organizations such as the Medical Expenditure Panel Survey, and from Consumer Assessment of Healthcare Providers. Extracted data are further used by policymakers to identify trends in trends in health care which are harmful to patients and devise potential interventions to reduce such harms. For example, between 1993 and 2012, data from AHRQ indicated that 153 percent increase in adult hospitalization was as a result of opioids overuse . (Ramanathan et al., 2013) . The Department of Health and Human Services (HHS) used the data to launch an initiative to reduce opioid use among adults.
The Leapfrog Group is a non-profit organization that comprises of the broader public and private health care purchasers. The Leapfrog Group is a voluntary program that aims at providing health benefits to Americans in all 50 states. The Group's strategy involves employer purchasing power mobilization to drive improvements in health care safety and quality (Austin et al., 2014) . The group was formed after the purchasing health care model in the 1990s turned to be ineffective. Therefore, jumping to new innovative means of purchasing health care was inevitable. The focus of the innovation was on all stakeholders in the healthcare sector, that is, patients and health care professionals. Leapfrogging ensured that efforts of those involved in to improving quality in health care in the marketplace are rewarded.
The primary initiatives of the Leapfrog Group are (1) to provide easy access to healthcare information and (2) promoting high-value health care by rewarding hospitals that have proven a record of safety of quality and health improvement (Austin et al., 2014) . These initiatives are based on four principles. The first principle states that the American health care still lacks safety and quality levels needed in providing customer value. The second principle asserts that improvement in the health industry will be rapid if health care purchasers recognize and reward individuals who offer safety and overall value in health care. The third principle assumes that adherence to purchasing principles by America's largest employers will encourage other purchasers to join Leapfrog Group. The last principle states that focus should be given to innovations offering change that maximizes support for consumers (Moran, & Scanlon, 2013).
There are a lot of issues surrounding the Leapfrog Group. Various hospitals have voiced their frustrations challenging the group’s safety grades. A handful of hospitals call the grading methodology flawed as it only favors hospitals participating in voluntary reporting system of the group (Moran, & Scanlon, 2013). Other hospitals argue that that the safety grades used by Leapfrog Group are outdated and do not reflect current care quality. American Hospital Association (AHA) also had some issues with the group’s grading system. AHA advised patients to ignore Leapfrog’s grading system when making decisions about health care (Austin et al., 2014). However, there is an opportunity for improvement to validate and establish the grading system acceptable to all. First, Leapfrog Group should update its grading system to be up-to-date with current care quality. Secondly, the groups need to maintain neutrality and factor hospitals that report voluntary data to it and those that do not. Such improvement would minimize scoring disparities between hospitals that report to AHA.
Various challenges and potential issues prevent AHRQ from assuring the quality of American health care. They include variations in the practice of medicine across the United States, and misuse of health care services (Ramanathan et al., 2013) . The AHRQ has collaborated with health care professionals and consumer advocates to develop strategies of measuring and improving quality of health care. Some of the policies include ensuring that comparative information on health care quality is comprehensible and readily available in the public domain, conducting physician education, and patient education (Berkman et al., 2013) . Consequently, the AHRQ is providing support for the focused development of quality measures that enhance the ability to improve and evaluate health care.
References
Austin, J. M., D’Andrea, G., Birkmeyer, J. D., Leape, L. L., Milstein, A., Pronovost, P. J., ... & Wachter, R. M. (2014). Safety in numbers: the development of Leapfrog’s composite patient safety score for US hospitals. Journal of patient safety , 10 (1), 64-71.
Berkman, N. D., Lohr, K. N., Ansari, M., McDonagh, M., Balk, E., Whitlock, E., ... & Hartling, L. (2013). Grading the strength of a body of evidence when assessing health care interventions for the effective health care program of the Agency for Healthcare Research and Quality: an update.
Moran, J., & Scanlon, D. (2013). Slow progress on meeting hospital safety standards: learning from the Leapfrog Group’s efforts. Health Affairs , 32 (1), 27-35.
Ramanathan, R., Leavell, P., Stockslager, G., Mays, C., Harvey, D., & Duane, T. M. (2013). The validity of Agency for Healthcare Research and Quality Patient Safety Indicators at an academic medical center. The American Surgeon , 79 (6), 578-582.
