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This paper will cover the quality improvement process in healthcare. It will also focus on the similarities and differences between the quality improvement plan processes that the Department of Veteran Affairs (VA) followed, against the quality improvement plan process listed in the book. The VA Hospital wanted to establish a quality improvement plan that would allow them to expand services and improve the quality of care being provided. The quality improvement plan must work in conjunction with the strategic plan in achieving the same goals for the organization. Managers can develop a quality improvement program to measure levels of performance.
The relationship between the concepts in the book and the plan that was obtained on the VA's improvement plan in quality of care has provided insight on how the VA uses the same concepts that have been around for years. They have structured these concepts to fit their patient population. Their patient population consists of veterans who have suffered from traumatic and psychological injuries from serving their country. The Veterans Health Administration, the second largest government-operated health-care system in the United States, has been actively engaged in quality improvement activities since 1990 (Rand, 2005). These activities have been implemented on both a system-wide and facility-specific basis. Some quality improvement efforts have been targeted to specific clinical services; others relate to the overall process of providing patient care (Rand, 2005). The VA uses the same quality management concepts that W. Edwards Deming had instilled.
Below there is a list which shows the process that the VA uses in managing quality improvement.
The VA finds a process to improve.
The VA organizes teams that know the process.
The VA clarifies current knowledge of the process.
The VA understands causes of process variation.
The VA selects the process improvement.
Below there is a graphical representation of the process that the VA follows.
Are there similarities?
There are similarities in the process that the VA uses and the one displayed in the book.
Are there differences?
There are no difference between the plan that the VA uses and the plan that is explained in the book.
The following paragraphs describe the features in the plan with the concepts in the book.
The Quality Improvement (QI) Program is designed to provide a formal ongoing process by which the health plan, participating providers and practitioners utilize objective measures to monitor and evaluate the quality of clinical and administrative services, provided to patients. A quality improvement plan addresses both general medical and behavioral health care and services, defines and facilitates a systematic approach to identify and pursue opportunities to improve services and resolve identified problems. Healthcare providers must establish outcome measures to determine how they are going to monitor treatment effectiveness (McLaughlin & Kaluzny, 2006). There are three areas of care that managers can measure. The areas are structure, process and outcomes.
The first level of care that is stated in the book is structure. Structure is the resources available to provide adequate health care. VA hospital's have an organizational structure that many other hospitals can replicate. The first phase of the Department of Veteran Affairs quality improvement plan was the introduction/purpose. The introduction/purpose explained why the VA wanted to improve the quality of care an services they were providing. Managers at this facility wanted to design a plan that provided a framework to systematically assess, evaluate and improve structure, process and outcome related to activities both in care and services. In order to accomplish this task managers will have to ensure there is a collaborative and interdisciplinary effort among VA healthcare providers. It is critical that managers allow staff to have input on the quality improvement plan as their recommendations can benefit the organization as well.
The second level of care that is stated in the book is process. Process is the extent to which professionals perform according to accepted standards. The Department of veteran Affairs hold their employees to the highest ethical and professional standards. VA medical employees follow a chain of command to ensure there is communication at each level. In order to implement the highest standards of care the VA has teamed up with Joint Commission. An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 17,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization's commitment to meeting certain performance standards (Jointcommission, 2010). VA medical centers work in conjunction with Joint Commission to ensure they are providing quality service to veterans.
Joint Commission employs surveyors who are experts in their related healthcare field. These surveyors are responsible for conducting surveys of the various VA medical centers. There are various surveys conducted to measure the level of care the VA is providing. Joint Commission lets the VA know areas that are weak and may need reorganization to ensure quality care is being provided. The documentation of these processes will allow organizations to gather data that will be relevant in determining whether they are providing quality care. Processes are generally documented in patient records. Since the VA has a computerized record system they are able to track different types of data.
The third level of care that is stated in the book is outcomes. Outcomes are changes in the patient condition following treatment. The VA prosthetic department has been looking for ways in which the can measure the outcome of veterans receiving artificial limbs. VA staffs are required to follow up with patients that receive limbs to ensure they are effectively using the limb. The VA has done a remarkable job in documenting outcome measure in the veteran's record. VA hospital mail surveys to patients so that they can provide veterans with questions that will help the surveyors determine the outcome measure for the level of care the veteran received. The overall goal of outcome measures is to provide data on quality of care.
Healthcare organizations currently demand information on cost, quality and outcomes as they negotiate contracts. In order to provide quality care organizations must negotiate contracts that will provide them with the quality products and service they need to provide patients with quality services. As new benefits were added, it was necessary to analyze whether they were worth what they cost. In some cases, it was necessary to evaluate the performance of providers in order to decide whether to offer certain types of care at medical facilities. Quality improvement in the health care industry can best be defined by examining the driving forces that are affecting the industry. The evolution of health care in this country is driven by a single purpose. How can health care organizations lower cost, raise quality, and still remain competitive? The implementation of patient-focused quality improvement programs are at or near the top of the list for the Department of Veteran Affairs in their efforts to lower cost (Rogers & Joyner, 2010).
Health care managers must have a way to measure patient satisfaction. There are various ways in which patient satisfaction can be measured. It is critical that managers get feedback from patients on the service or products they have received. One question we must ask is how should we measure patient satisfaction? First managers will need to understand the purpose of measuring patient satisfaction. Measuring patient satisfaction helps us to identify patients' expectations. Expectations are important because patients' judge the quality of the care they receive based on their internal standards of what defines quality. These internal standards are based in expectations. In addition, it allows us to learn about patients' perceptions of our service. By understanding their expectations and perceptions, we can begin to bridge the gap between how health care providers and patients define quality service (Tarantino, 2004).
In conclusion healthcare managers that use the quality improvement process should focus on satisfying their internal and external customers. The satisfying of their internal and external customers can not be accomplished without the guidance and leadership of management. Management must communicate their expectations to junior level managers. Mangers must understand that the main goal of the organization is to provide quality services to patients and employees. When managers take care of their employees, employees will be motivated in taking care of patients. Quality improvement activities emerge from a systematic and organized framework for improvement. This framework, adopted by the hospital leadership, is understood, accepted and utilized throughout the organization, as a result of continuous education and involvement of staff at all levels in performance improvement (Businessballs, 2009).