Posted: July 20th, 2024

HCA 4307, Health Care Quality Management

HCA 4307, Health Care Quality Management
Course Learning Outcomes for Unit VII

Upon completion of this unit, students should be able to:

Compare and contrast components of traditional quality assurance programs in the healthcare industry.
Apply various quality improvement methods used in the healthcare industry.
2.1 Plan for quality improvement in future health care challenges.
Explain the key measures used to assess performance outcomes in healthcare organizations.
Required Unit Resources
Chapter 14: Future Trends and Challenges for Continuous Quality Improvement in Health Care

In order to access the following resources, click the links below.

Trzeciak, S., & Rivers, E. P. (2003). Emergency department overcrowding in the United States: An emerging threat to patient safety and public health. Emergency Medicine Journal, (20)5. https://link-galecom.libraryresources.columbiasouthern.edu/apps/doc/A108693603/AONE?u=oran95108&sid=AONE&xid=de113974

Cryts, A. (2019). New trends move healthcare to the home: Innovative care solutions bring the health system and medical procedures to patients’ homes. Managed Healthcare Executive, (2)29, 5–7. https://libraryresources.columbiasouthern.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bsu&AN=134951725&site=ehost-live&scope=site

Unit Lesson

Introduction
The landscape of the healthcare industry and the scope of the quality and care it provides has historically changed at a rapid pace and is expected to do so in the future as the national and global population evolves. When strategizing ways to meet challenges and emerging trends, multiple factors and expectations of the future of the healthcare industry must be taken into consideration. According to Allen (2019), these include (but are certainly not limited to):

a growing and aging population;
a shortage of skilled healthcare workers;
the higher prevalence of chronic medical conditions and diseases;
changing consumer expectations;
exponential growth of technological innovations in medical diagnosing, treatment, and rehabilitation;
the necessary transition to electronic health records;
care models that are evolving from fee-based sick care to value-based preventative care;
evolving health insurance options and regulations; and
major health systems expansion and partnerships with retail or other industry stakeholders.
Some Challenges Facing the U.S. Healthcare Industry

Emergency Department Overcrowding. Long Emergency Department (ED) wait times are often signals of overcrowding or staff shortages. As Trzeciak and Rivers (2003) discuss in an article in this unit’s Required Resources, in the United States have long dealt with overcrowding in the Emergency Department and the problem continues to worsen with a population that is growing, living longer, and requiring more emergency healthcare services than ever before. The problem is not new; in 2006, the Institute of Medicine deemed it a national epidemic (Stead, Jain, & Decker, 2009), yet the problem persists. There are consistent reports of ambulance diversion, operating at levels over capacity, and understaffing. These conditions lead to increased risks of failing to provide effective and timely care, ultimately resulting in increased waiting times, medical errors, higher mortality, and increased financial implications for both the patient and the hospital. Many EDs have successfully implemented quality improvement initiatives in this area, but there is still a long way to go to ensure the same quality is a nationwide standard.

Maternal Health. Studies have found that the United States has the worst maternal health outcomes and mortality (GBD 2015 Maternal Mortality Collaborators, 2016). In their report, nine maternal mortality review committees, in cooperation with the Centers for Disease Control (CDC), report that over 60% of general pregnancy-related deaths were preventable, while 68% of cardiac deaths and 70% of hemorrhage deaths in maternal patient were preventable (Building U.S. Capacity to Review and Prevent Maternal Deaths, 2018). Provider factors were considered one of the largest contributors to maternal death. These factors include misdiagnosis, ineffective treatment, and poor and untimely care, all of which can and should be addressed by quality improvement initiatives.

The Opioid Crisis. In 1996, Purdue Pharma launched a campaign informing patients and doctors that a new, safe drug was available to combat pain. This started a cultural shift in how American clinicians treated pain, as well as how patients viewed their options to relieve their pain. It began what is now known as opioid crisis, a crisis which led the U.S. Department of Health and Human Services (HHS) to declare it a public health emergency (HHS, 2017). By 2012, the United States was responsible for 99% of sales for hydrocodone and 81% of oxycodone globally (International Narcotics Control Board, 2017). Today, overdose and/or death from opioid addiction has skyrocketed, with numbers still continuing to rise. Compounding the problem are increased deaths related to drugs such as heroin, which opioid addicts increasingly turn to as a cheaper and easier to obtain alternative. Frieden and Houry (2016) found that death by prescription overdose in the United States more than quadrupled in a 15-year period.

Most critics will argue the opioid crisis that is plaguing the United States was brought on by the health care industry itself. Chase and Emerick (2017) argue that U.S. healthcare systems and practitioners are at the same time both victims and unwitting accomplices who have either intentionally or unintentionally enabled the crisis. Increased addiction and death from opiates directly correlates to the high rates of prescribing. This high prescribing rate has historically been due to inconsistent standards regarding appropriate use and dosing, and pharmaceutical marketing, but also reflects the increased demand among addicts who began prescriber “shopping” to get continued prescriptions.

While the crisis has loomed for a long time, to date there has been no end-all solution. That is not to say that stakeholders are not working toward a solution and that most are critically aware of the imperative to end the epidemic. Change will have to come from a collaboration of a myriad of stakeholders, such as:

federal entities, such as lawmakers and the Food and Drug Administration,
health plan and insurance providers,
pharmaceutical companies,
all healthcare facilities and clinicians,
community-based healthcare organizations, and
patient support groups.
Advanced in other areas can help facilitate an end to the opioid crisis. Blockchain systems and electronic health records that can be accessed by any provider can help mitigate abuse. Using innovations in technology to assist in prescription monitoring programs will also help in efforts to curb misuse and overprescribing.

Patients Desiring Personalized and Technology-Based Healthcare Options. The new generations of patients not only embrace technology, they demand it. Allen (2019) reports that almost half of those 45 years or younger surveyed prefer a digital medium to manage their health and receive health care, as opposed to office visits. This means there will be an increased demand for the use of telemedicine, wearables, and virtual care marketplaces, as well as a long-sought after electronic health record system. This demand will also see new players and stakeholders in the industry, as companies like Microsoft and Amazon continue to leverage technology with their proven business strategies and global market share to deliver quality health care options and improve patient experiences.

Conclusion
The challenges the healthcare industry will face in the future are undoubtedly as numerous as the opportunities for positive growth that will present for quality improvement. When strategizing to stay on top of new challenges and emerging trends, one common denominator exists: the healthcare industry at all levels, from law and policymakers to administrators and clinicians, must collaboratively work toward a collective focus and imperative to shift the present paradigm of primarily providing care after a patient becomes ill to a new mentality and system focused on health care that attends to supporting the physical and well-being of a population, mitigates negative social determinants of health, and provides prevention and early intervention programs.

References
Allen, S. (2019). 2020 global health care outlook. Laying a foundation for the future. Deloitte Insights. https://documents.deloitte.com/insights/2020globalhealthcareoutlook

Building U.S. Capacity to Review and Prevent Maternal Deaths. (2018). Report from nine maternal mortality review committees. https://www.cdcfoundation.org/sites/default/files/files/ReportfromNineMMRCs.pdf

Chase, D., & Emerick, T. (2017). CEO’s guide to restoring the American dream: How to deliver world class healthcare to your employees for half the cost. Health Rosetta Media.

Frieden, T. R., & Houry, D. (2016). Reducing the risks of relief–the CDC opioid-prescribing guideline. New England Journal of Medicine, (374), 1501–1504. http://www.nejm.org/doi/full/10.1056/NEJMp1515917

GBD 2015 Maternal Mortality Collaborators. (2016, October 8). Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31470-2/references#articleInformation

International Narcotics Control Board (2017). Comments on the reported statistics on narcotic drugs. International Narcotics Control Board. https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2017/7_Part_2_comments_E.pdf

Stead, L. G., Jain, A., & Decker, W.W. (2009). Emergency department overcrowding: a global perspective. International Journal of Emergency Medicine (2)3, 133–134. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760705/

Trzeciak, S., & Rivers, E. P. (2003). Emergency department overcrowding in the United States: An emerging threat to patient safety and public health. Emergency Medicine Journal, (20)5. https://link.gale.com/apps/doc/A108693603/AONE?u=oran95108&sid=AONE&xid=de113974

U.S. Department of Health and Human Services. (2017, October 17). HHS acting secretary declares public health emergency to address national opioid crisis. https://www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html

Suggested Unit Resources
In order to access the following resources, click the links below.

The following article is referenced in the unit lesson, and you are encouraged to read it for a more in-depth understanding of the issue of poor maternal health outcomes in the United States.
GBD 2015 Maternal Mortality Collaborators. (2016, October 8). Global, regional, and national levels of maternal mortality, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. The Lancet, (388)10053, 1775-1812. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31470-2/references#articleInformation

You are encouraged to view the PowerPoint Presentation: Chapter 14: Future Trends and Challenges for Continuous Quality Improvement in Health Care for a review of our textbook’s authors’ perspectives on the collaboration, leadership, and responsibilities that are critical to future quality improvement in health care.

PDF of Chapter 14 PowerPoint presentation

While this course has focused on continuous quality improvement within U.S. health care, the following chapter in your textbook expands the conversation to the global environment. Specifically, it explores the quality gap in health care and public health programs in low- to middle-income countries. While globally focused, this chapter offers insight on challenges and potential solutions specific to areas with limited income or resources. In a broader context, the information presented may also be applicable to communities or areas in the United States, where there are limited resources, health care accessibility issues, or limiting factors such as education and income.

Chapter 13: Quality Improvement in Low- and Middle-Income Countries
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Part 1 Assignment Content

The Required Unit Resources for this unit examined how a growing population that is living longer and requiring more healthcare services than ever before will contribute to many challenges in the future of health care. The readings highlighted that while an ongoing issue, emergency department (ED) overcrowding and quality of service is certain to continue to worsen as a result without innovation and quality initiatives. For this project, you will synthesize many concepts covered in this course to analyze this problem and outline a quality improvement initiative that can create positive change.Problem: This hospital in the District of Columbia ranks as one of the worst in the entire nation for ED timely and effective care. Goal: Create a systems-wide approach to substantially improve aspects of ED operation and care that will dramatically improve wait times to be seen, wait times until admission, and reduction of left-without-being-seen rates to meet or register below national averages. You will need to perform any additional research on this hospital that is needed to support your project. Note: As you research this hospital, you will find it is ranked highly in other areas and specialties, even having received The Joint Commission’s Gold Seal of Approval. Researching this hospital’s initiatives that led to this may be helpful. Your project should reflect theories discussed in this course (e.g., lean, Six Sigma) and must utilize the Plan, Do, Study, Act (PDCA) approach. It must include the following:

a brief summary of the problem, to include data supporting the need for change;

a quality improvement initiative proposal, to include specific desired outcomes;

suggested implementation strategies that will be most effective to achieve quality improvement;

social marketing approaches to ensure widest awareness and participation in the initiative;

a measurement plan, to include the tools that will be most effective to measure change, and how ongoing performance will be monitored to prevent regression and loss of the positive change that has taken place,

an analysis of the roles leadership, staff, and patients will play in the improvement initiative; and

a summary of the benefits and long term effects if the desired outcomes are achieved.

include a detailed analysis of the historical impact of quality management goals within the healthcare industry.

determine the connections between managed care processes and how these assist with the goals of a health care organization.

interpret the major role a healthcare accreditation organization plays in the U.S., and include at least one example of an accreditor.

Your project will be a minimum of four pages, not counting any title or reference pages. You must use at least four scholarly sources to support your project. These sources do not include any hospital statistical or data sources that you utilize. All sources used must be properly cited. Adhere to APA Style when creating all citations and references for this assignment.

PART 2 Assignment Content

Identify one activity or concept covered in this course which you found to be most valuable, and explain why. Then briefly discuss how the material presented in this course will benefit you in your future professional or academic pursuits. Your journal entry must be at least500 words in length. No references or citations are necessary.

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Emergency Department Overcrowding: A Quality Improvement Initiative for a Washington D.C. Hospital

Emergency department (ED) overcrowding remains a critical issue plaguing healthcare systems across the United States, threatening patient safety and quality of care. This paper proposes a quality improvement initiative to address severe ED overcrowding at a hospital in Washington D.C. that ranks among the worst nationwide for timely and effective ED care. By implementing a systems-wide approach utilising lean methodologies and the Plan-Do-Study-Act (PDSA) cycle, this initiative aims to dramatically reduce wait times, improve patient flow, and decrease rates of patients leaving without being seen.

Problem Summary and Need for Change

The hospital in question faces significant challenges in its emergency department operations, with key performance metrics falling well below national averages. According to publicly available data from the Centers for Medicare & Medicaid Services (CMS, 2023), the average time patients spend in the ED before being seen by a healthcare professional is 93 minutes, compared to the national average of 28 minutes. Additionally, the average time patients spend in the ED before being admitted is 534 minutes, far exceeding the national average of 290 minutes. Perhaps most alarmingly, the percentage of patients who leave the ED without being seen is 5%, compared to the national average of 2%.

These statistics clearly demonstrate a pressing need for change. Prolonged wait times not only lead to patient dissatisfaction but also increase the risk of adverse outcomes, as delays in treatment can exacerbate medical conditions (Morley et al., 2018). The high rate of patients leaving without being seen represents a significant patient safety concern and potential loss of revenue for the hospital.

Quality Improvement Initiative Proposal

The proposed quality improvement initiative aims to achieve the following specific outcomes:

Reduce the average time patients spend in the ED before being seen to 25 minutes or less.

Decrease the average time patients spend in the ED before admission to 250 minutes or less.

Lower the percentage of patients leaving without being seen to 1.5% or less.

These targets are designed to bring the hospital’s performance in line with or below national averages, significantly enhancing patient care and operational efficiency.

Implementation Strategies

To achieve these outcomes, the initiative will employ a multi-faceted approach based on lean principles and the PDSA cycle:

Streamlined Triage Process: Implement a rapid assessment zone staffed by a senior nurse and physician to quickly evaluate patients and initiate necessary tests or treatments.

ED Process Redesign: Apply lean methodologies to identify and eliminate non-value-added activities, optimising patient flow through the department.

Enhanced Care Coordination: Establish a bed management team to facilitate prompt inpatient admissions and discharges, reducing ED boarding times.

Technology Integration: Implement an electronic tracking system to provide real-time visibility of patient status and department capacity.

Staff Optimisation: Adjust staffing levels and skill mix based on historical patient volume patterns to ensure adequate coverage during peak hours.

Social Marketing Approaches

To ensure widespread awareness and participation, the initiative will employ the following social marketing strategies:

Internal Communication: Develop a comprehensive communication plan to inform all hospital staff about the initiative, its goals, and their role in its success.

Patient Education: Create informational materials explaining the new ED processes and expected improvements in wait times and care quality.

Community Outreach: Engage with local media and community organisations to share information about the initiative and its potential benefits to the community.

Digital Engagement: Utilise the hospital’s website and social media platforms to provide regular updates on the initiative’s progress and impact.

Measurement Plan

The initiative will employ a robust measurement plan to track progress and ensure sustained improvement:

Key Performance Indicators (KPIs): Continuously monitor the primary metrics of wait times and left-without-being-seen rates through the ED information system.

Statistical Process Control Charts: Utilise control charts to visualise trends and identify special cause variation in the KPIs.

Patient Satisfaction Surveys: Conduct regular surveys to assess patient experience and perception of care quality.

Staff Feedback Mechanisms: Implement a system for staff to report issues and suggest improvements.

Regular Audits: Conduct periodic audits of ED processes to ensure adherence to new protocols and identify areas for further improvement.

To prevent regression and sustain positive changes, the initiative will establish a continuous improvement team responsible for ongoing monitoring and rapid response to any performance deterioration.

Roles in the Improvement Initiative

The success of this initiative relies on the active involvement of various stakeholders:

Leadership: Hospital executives and department heads will provide strategic direction, allocate necessary resources, and champion the initiative throughout the organisation.

Staff: ED physicians, nurses, and support staff will be crucial in implementing new processes, providing feedback, and continuously seeking ways to improve patient care.

Patients: As the primary beneficiaries of the initiative, patients will play a vital role in providing feedback on their experiences and suggesting areas for improvement.

Benefits and Long-term Effects

Successful implementation of this initiative is expected to yield numerous benefits:

Improved Patient Outcomes: Shorter wait times and more efficient care processes can lead to better clinical outcomes and increased patient satisfaction.

Enhanced Staff Satisfaction: Streamlined processes and reduced overcrowding can improve the work environment and staff morale.

Financial Improvements: Decreased left-without-being-seen rates and improved operational efficiency can positively impact the hospital’s financial performance.

Reputation Enhancement: Improved ED performance metrics can boost the hospital’s reputation and attract more patients.

In the long term, these improvements could position the hospital as a leader in emergency care, potentially influencing best practices across the healthcare industry.

Historical Impact of Quality Management Goals

Quality management goals have significantly shaped the healthcare industry over the past few decades. The focus on continuous quality improvement, patient safety, and evidence-based practice has led to substantial enhancements in care delivery and outcomes. Initiatives such as the Institute for Healthcare Improvement’s 100,000 Lives Campaign demonstrated the potential for quality improvement efforts to save lives and reduce healthcare costs on a large scale (Berwick et al., 2020).

Connections between Managed Care Processes and Organisational Goals

Managed care processes play a crucial role in supporting healthcare organisational goals. These processes, which include utilisation review, case management, and disease management, align with the overarching aims of improving health outcomes while controlling costs. By promoting preventive care, ensuring appropriate resource utilisation, and coordinating care for complex patients, managed care processes contribute to both the quality and efficiency goals of healthcare organisations (Sekhri, 2020).

Role of Healthcare Accreditation Organisations

Healthcare accreditation organisations play a major role in the U.S. healthcare system by setting standards for quality and safety, conducting evaluations, and providing recognition to healthcare organisations that meet these standards. The Joint Commission, for example, is a prominent accreditor that evaluates and accredits more than 22,000 healthcare organisations and programs in the United States. Their accreditation process encourages continuous improvement in patient care and safety practices, thereby driving overall quality enhancement in the healthcare industry (The Joint Commission, 2024).

In conclusion, this quality improvement initiative represents a comprehensive approach to addressing the critical issue of ED overcrowding at the Washington D.C. hospital. By leveraging established quality improvement methodologies and engaging all stakeholders, the initiative has the potential to significantly enhance patient care, operational efficiency, and overall hospital performance.

References

Berwick, D.M., Feeley, D. and Loehrer, S. (2020) ‘Change from the inside out: Health care leaders taking the helm’, JAMA, 323(2), pp. 124-125.

Centers for Medicare & Medicaid Services (2023) Hospital Compare. Available at: https://www.medicare.gov/care-compare/ (Accessed: 15 July 2024).

Morley, C., Unwin, M., Peterson, G.M., Stankovich, J. and Kinsman, L. (2018) ‘Emergency department crowding: A systematic review of causes, consequences and solutions’, PloS one, 13(8), p.e0203316.

Sekhri, N.K. (2020) ‘Managed care: the US experience’, Bulletin of the World Health Organization, 78(6), pp. 830-844.

The Joint Commission (2024) About our standards. Available at: https://www.jointcommission.org/standards/about-our-standards/ (Accessed: 15 July 2024).

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