External agencies such as the Healthcare commission increasingly scrutinize Healthcare organizations to ascertain the level of the quality of care patients receive. Besides this, the organizations make of such measures as the process measures to evaluate the performance of the clinical quality of the health workers. Process measures refers to the voice of the working system, since it captures any changes realized in the quality improvement and contribute to desired outcome ( Measurement for quality improvement , 2013). Application of the process measure is useful to determine the root cause of problems that arise within the healthcare organizations. Based on the research by Burton (2017), the problems do not usually stem from the people but from the process. For this reason, the systems often fail to highlight this fact. This is because stigma is always associated with the filling of the report due to overemphasis of the outcome measures. In addition, the failure of the systems is attributed to the absence of culture based on the learning surrounding. Using the process measures, the root cause can be pinpointed. As such problems can be evaluated and solved irrespective of their magnitude.
Evaluation of the Quality Assurance tools
The tools for measuring the quality improvement of the health workers and the services provided vary in their capacities. Application of the process measures is often more significant than the structure and outcome measures in evaluating the stability and growth of the quality improvements. However, it is essential that the health care institutions rely on multiple outcome measures to enhance the quality. In addition, inclusion of solid foundation of the evidence-based process measures is useful in the provision of granular data and stabilization of the metrics examined through balance measures (Lilford, Brown, & Nicholl, 2008). Process measures with respect to the other methods, are quite essential as they entail evidenced-based practices. For instance, to reduce the extent of bed sores on a patient, an organization can make use of the baseline rate among other risk assessments to predict the pressure of the ulcer risk.
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The metrics exhibit several benefits in the healthcare organization evaluations. These measures are useful in enhancing quality and costs by enabling organizations eliminate the quantity of variation in the delivery of care. Case in point, the value stream map has been realized to be a significant tool in the outline of the care process and determination of the potential points of variation (Burton, 2017). For this reason, using these tools, the healthcare administration can standardize the processes to obtain the highest quality care within the lowest possible cost irrespective of the unit they visit.
Evaluation of the Quality measurement approaches
The quality measurement approaches aims at improving the results of care and evaluate improvement and examine the level of satisfaction among patients. Although much of the evaluation of the improvement have been met, there is need to undertake more studies to ascertain the effectiveness of the collaboration of the instruments. This is based on previous findings on complications related with evaluation of the quality of care in settings where Medicare and Medicaid beneficiaries receive care (Quality Measure and Quality Improvement, 2017). The challenge is more pronounced since the performance measurement and quality measurement initiatives have been conducted separately. Nevertheless, the approaches have enabled measurement of the quality, effective and efficient services provided. The primary premise of these approaches is that the patients will benefit the most from most of the quality management programs. One useful approach has been thinking of the organizations as a system. As such, small units of administrators, caregivers, and the workers generate the services of health care (Quality Measure and Quality Improvement, 2017). Once these microsystems have been identified, then implementation of the measurement and performance feedback is conducted to learn and improve.
Although the QI models differ in terms of the methods and approaches, they are nevertheless a continuous activity. For this reason, as implementation is done, issues and challenges do arise, contributing to failure of achieving excellence. The primary approach in the process improvement, the PDSA cycle is systematic in gaining invaluable learning and knowledge for enhancement of the process. There are numerous sources, which offer excellent and comprehensive starting points within and outside the healthcare. One useful approach to develop and learn innovative approaches is through choosing concepts, which provide significant advantages over prevailing practices between the patients and the providers (AHRQ, 2018).
Appropriate Quality measures
Using data quality measurement evaluates the performance of the plans and care providers in relation to the identified quality standards. Using varied forms, the measures examine the care across the care settings (Families USA, 2014). Structure measures are tools applied in the evaluation of the features of the care setting such as the facilities, workers, and the policies concerned with care delivery. These forms of measures are quite useful in the intensive care unit to access the number and expertise of the care specialist all through. The process measures are useful in identifying the kinds and consistency of services provided to patients in relation to the routine clinical care. The measures can be applied, therefore, to evaluate such cases as whether the medical professionals have ensured that the patients they serve have received the recommended disease screenings. Using patient experience measurements, researchers can collect the feedback of the patients’ experiences in relation to the care they receive. As such, they can be applied in such instances as to verify whether patients record that their care providers clarify certain forms of treatment alternatives through comprehensible terms. Lastly, the outcome measures are essential in the evaluation of the patient health based on the kind of care they receive. For instance, the measure can be applied in determining the survival rate for the patients with incidences of heart attacks.
Impact of the QI on legal and Ethical aspects
Legal and ethical concerns often arise in QI due to the endeavors to enhance quality in health care organizations. These concerns result in harm, wastage of the resources and unfair effects on the patients (Fiscella, Tobin, Carroll, He, & Ogedegbe, 2015). For instance, efforts of a previous management of antibiotics for pneumonia may result in overuse. In addition, applications of the QI methods are often termed as studies that use patients as subjects. This brings the studies under ethical requirements that control the use of human beings as subject research (Lynn et al, 2008). Placing improvement activities within research regulations precipitate substantial delays and costs. On this regard, there has been a heated debate on the limits between the research and QI and the QI practitioners, organizations, and agencies which fund research as they are uncertain regarding ethical and legal requirements. The effect has attributed to discouragements to keep in QI.
Analysis of the financial and technological impact
Based on the report by Alhazme, Haque, Wiggin, Rana (2016), organizations have had statistically negative effects on the health centers. Forms of QI implementations encompass manual data collection, electronic health documents, lab and the radiology report systems (Alhazme, Haque, Wiggin, Rana, 2016). Notably, the performance-based payment incentives improve the care services but also contribute to the additional financial burdens to the institutions, which manage uninsured populations. For this reason, it is necessary to consider the provider’s payer’s mix in the design of the QI programs as in sustainability instances rises (Cheung, et al. 2008).
Evaluation of the risk management programs
Healthcare administration identifies and analyzes risks to eliminate injury to patients and workers within a company. By working proactively and reactively, managers prevent or reduce risk levels. This implies that no single model fits all the risks. Several approaches can be assumed to reduce instances of risks. For instance, risks involving the health of patients require constant evaluation of the treatment and patient management. Continuous evaluation of the quality of care and the process prevents health providers from making potential medical errors. Evaluation of the successes of the federal regulations and policies results to improved quality implementation within organizations. On the other hand, failing to prepare for potential issues bear significant and long-term effects, such as compromised patient care, increased liability risks and financial losses.
QI plan for a Healthcare Organization
Within a healthcare organization, a QI plan has been developed to implement intensive care management for patients with poorly controlled diabetes. In such a case, the primary care physicians should be equipped with chart audits and surveys for QI education courses. These chart measures must entail patient demographics, adherence to medication, A1C changes, and BMI records. These records are to assess medication related side effects and provide patient counseling on the medication risks and benefits, adherence and modification of lifestyle. Clinical performance measures can be applied to determine the rates of the baseline compliance. This is to include the measures of adherence of medication and the outcome. The professionals must also record their clinical knowledge and confidence in relation to health condition. Thereafter, it is necessary to run the improvement cycles where the QIE program is aligned directly with the educational interventions. The strategy focuses on the personalized areas and approaches of improvement.
References
AHRQ. (2018). Section 4: Ways to approach the quality improvement process . Retrieved from https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.html
Alhazme, H. R., Haque, S. S., Wiggin, H., & Rana, M. A. (2016). The impact of health information technologies on quality improvement methodologies’ efficiency, throughput and financial outcomes: A retrospective observational study. BMC Med Infor Decis Mak. 16; 154. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139044/
Burton, T. (2018). Why process measures are often more important than outcome measures in healthcare. Klas . Retrieved from https://www.healthcatalyst.com/process-vs-outcome-measures-healthcare.
Cheung, K., et al. (2008). The perceived financial impact of quality improvement efforts in community health centers. J Ambul Care Manage . 31(2): 111-19. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291345/
Lilford, J. R., Brown, A. C., Nicholl, J. (2008). Use of process measures to monitor the quality of clinical practice. BMJ , 335 (621): 648-50. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1995522/
Lynn, J. et al. (2008). The ethics of using quality improvement methods in health care. Annals of Internal Medicine . Retrieved from http://annals.org/aim/fullarticle/734470/ethics-using-quality-improvement-methods-health-care
Families USA. (2014). Measuring health care quality: An overview of quality measures. Issues Brief . Pages 1-16.
Fiscella, K., Tobin, N. J., Carroll, K. J., He, H., & Ogedegbe, G. (2015). Ethical oversight in quality improvement and quality improvement research: New Approaches to promote a learning health care system. BMC Med Ethics . 16(63). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574354/
Measurement for quality improvement . (2013). Health Quality Ontario.
Quality Measure and Quality Improvement. (2017). CMS. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-.html
