MHA668 Belhaven University Healthcare Quality Management Discussion Question

MHA 668
Healthcare Quality Management
Belhaven University
Unit 1
Understanding the U.S. Healthcare System and the

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Healthcare Organization
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Welcome to Healthcare Quality
Management
This course is an advanced study of how to
achieve quality within the structure and
relationships of the complex system of a
healthcare organizations. We will explore the
concepts of systems thinking, improving and
managing process change, performance
measurement, and examine case studies.
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Format for Unit Sessions
 Class Topics
 Understanding the U.S. Healthcare System
 Understanding the Healthcare Organization
 General Concepts of Quality
 Current State of Quality Management: Internal
Dynamics
 Current State of Quality Management: External
Dynamics
 Measuring Quality of Inpatient Care
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Format for Unit Sessions, cont.
 Course topics, cont.
 Understanding Quality and Performance
 Quantifying the Quality Performance Gaps
 Closing the Gaps
 Case Studies in Healthcare Quality
Learning Tools
 Class lectures
 Hearing and seeing
 Textbook
 Reading
 Individual homework
 Analyzing
 Discussion forum
 Applying and examining
 Completing all
components is very
important to
accomplish the
objectives of the
course.
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Online Learning
 Characteristics
 Online learners must
be highly selfmotivated.
 Online learners must
have high responsibility
for assignments and
discussions.
 Facts
 Online learning is not
easier than traditional
classroom learning.
 Learners must meet
deadlines.
 It’s easy to think we’re
anonymous because
there’s no face time.
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Tips for Success
 Course Page
 Activities
 Individual homework
 Discussion forum
 Weekly discussions
 Media
 Module
 Handouts & links
 Class lectures
 Schedule
 Be attentive to
deadlines.
 The week (unit)
begins on Sunday
and ends on
Saturday.
 Observe the Sabbath.
 Manage your time.
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Tips For Success, cont.
 Do not
procrastinate.
 It’s easy to get behind
in an online course.
 False security that
there is time to catch
up
 Each week builds on
the previous week
 Set your schedule.
 Assigned readings
 View Lecture
 Initial post to
discussion boards
 Written assignment
 Quiz
 Final response to
the discussion
boards
Class Objectives
 In this course, we will:
 Apply biblical principles to the formation and
application of quality management strategies and
performance concepts relative to the
administration of healthcare facilities.
 Utilize scriptural references to identify and
propose quality strategies for resolution of various
performance issues in healthcare administration.
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Class Objectives, cont.
 Develop sound ideas for integrating quality into
planning processes for healthcare organizations.
 Discuss approaches that address quality and
performance in the implementation of healthcare
reform initiatives.
Biblical Foundation
 “Give and you will receive. Your gift will
return to you in full—pressed down, shaken
together to make room for more, running
over, and poured into your lap. The amount
you give will determine the amount you get
back.”
Luke 6:38 (New Living Translation)
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What is Quality Healthcare?
The Institute of Medicine’s (IOM) definition is
“The degree to which health services for
individuals and populations increase the
likelihood of desired health outcomes and are
consistent with current professional
knowledge.”
(IOM, 2001)
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Stakeholders in the U.S. Healthcare
System
 Regulatory and Policy Makers
 Payers
 Advocacy Organizations
 Providers
 Suppliers
 Consumers
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Regulatory Agencies & Policy Makers
 Federal
 U.S. Department of Health and Human Services
(HHS)
 Centers for Medicaid & Medicare Services (CMS)
 Food & Drug Administration (FDA)
 Centers for Disease Control and Prevention
(CDC)
Regulatory Agencies & Policy Makers,
cont.
 State and Local
 Legislatures
 Health Departments
 State Medical Boards
 State Insurance Commissions
Payers
 Public Sector
 Federal, State, and Local Governments
 Private Sector
 Private Insurers
 Consumers
 Self-pay and Out-of-pocket Expenses
Advocacy Organizations
 American Medical Association (AMA)
 American Hospital Association (AHA)
 American Nurses Association (ANA)
 America’s Health Insurance Plans (AHIP)
 National Patient Advocate Foundation
(NPAF)
Providers and Suppliers
 Providers
 Individual practitioners and practice groups
 General and specialty hospitals
 Ambulatory facilities ▫Integrated healthcare
systems
 Suppliers
 Pharmaceutical companies
 Medical equipment companies
Consumers
 Sick or Healthy People
 Depend on the advice of a physician in making
“consumption” decisions
 Mostly unaware of the full costs of medical
choices and decisions
Performance of the U.S. Healthcare
System
 The World Health Organization (WHO) frames
performance based on three fundamental goals:
 Improving health (increase in health status
and decrease in health inequities)
 Enhancing responsiveness to the expectations
of the population (i.e. dignity, confidentiality,
and autonomy)
 Ensuring fairness of financial contribution
(protection from financial risks due to
healthcare)
Variations in Performance
 Variations are the results of four key
functions:
 Stewardship
 Financing
 Service Provision
 Resource Generation
Differences in Performance of the U.S.
Healthcare System and Other Systems
 The U.S. is the only industrialized country that
does not offer universal coverage.
 Infant mortality has steadily declined in other
industrialized countries but increased in the U.S.
 Deaths from diabetes per 100,000 people is 99,
three times as high as other countries.
 Life expectancy at birth is 1.3 years lower than
the median of other countries.
Differences in Performance of the U.S.
Healthcare System and Other Systems,
cont.
 The U.S. has the second highest rate of hospital
admissions for asthma (121 per 100,000).
 The U.S. spends significantly more on
healthcare, both per capita and percentage of
Gross Domestic Product (GDP).
 The U.S. healthcare system has the highest
administrative costs per capita.
Major Issues Faced by the U.S.
Healthcare System
 Outcomes
 Access to Healthcare
 Expenditures
Rising Costs of Care and Its Major
Components
 Changes in prices
 Aging population
 Increase in population
 Professional services
 Hospital care
 Prescription drugs
 Nursing homes
 Administrative costs
 Chronic disease
management
 Demographic factors
 Geographic variations
 Waste
 Unnecessary care
 Fraud
 Administrative inefficiency
 Provider Errors
 Preventable conditions
 Lack of care coordination
Access and Lack of Universal Coverage
 The U.S. does not offer universal health
coverage for its citizens.
 A significant number of the population does
not have insurance coverage.
 The ACA requires most U.S. citizens and
legal residents to purchase qualifying health
plans or pay a penalty.
The History of Healthcare Reform
 The Social Security Act of 1935
 The Clinton Reform and the Health Security
Act of 1994
 The Medicare Prescription Drug,
Improvement, and Modernization Act of 2003
 Patient Protection and Affordable Care Act of
2010
Social Security Act of 1935
 This act was intended to provide some
economic security to citizens and to the
states for the purpose of medical care after
the Great Depression.
 An amendment to the Act in 1965 provided
health benefits (Medicare) to all Americans
above age 65.
Health Security Act of 1994
 This proposed act was intended to assure
care for all Americans and control healthcare
costs.
 Although the Act was never enacted, it
addressed expansive coverage, patient
choice, retention of providers, and quality of
care.
Medicare Prescription Drug,
Improvement, and Modernization Act
of 2003
 This act was the largest expansion of
Medicare since 1935 when it was created.
Patient Protection and Affordable
Care Act of 2010
Major parts of the Act:
 Aims to improve healthcare coverage for all
Americans
 Provides access to insurance for the
uninsured with preexisting conditions
 Focuses on quality management and
improvement
 Implemented value-based purchasing
programs
Reforms and Performance Challenges
 Healthcare Cost Containment
 Healthcare Access
Healthcare Cost Containment
 Investment in information technology
 Improvement in quality and efficiency
 Adjustment of provider compensation
 Preventive medicine
 Increase in consumer involvement
 Price transparency
 Tax incentives to expand coverage
 Reduction of waste in the system
Healthcare Access
 Greater share of costs passed on to
individuals and families
 Increased premiums
 Higher deductibles
 Other out-of-pocket expenses
 Exclusion of preexisting conditions
Strategic Plans
 Reflect a sense of future direction and
priorities of an organization
 Begin with a mission statement and
anticipated results
 Range from 3 to 10 years (usually 5 years)
 Articulate the organization’s strategy
Organizational Performance/Mission
Accountability
Answers three questions:
1. How much mission-related activity is done?
(volume)
2. How well is it done? (quality)
3. How efficiently is it done? (finance)
All of these questions are connected.
Organizational Structure
 Design of the organization used to carry out
targeted performance objectives which will
fulfill the organization’s mission
 Varies by organization
“Form follows function”—Louis H. Sullivan (1896)
What’s next?
 Complete the reading assignments.
 Complete the writing assignments.
 Answer the discussion questions.
 Complete the unit quiz.
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Reference
Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M.
(2013). Integrating quality and strategy in
health care organizations. Burlington, MA:
Jones & Bartlett Learning.
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