Select one of the following organizations and the associated quality improvement
ID: 436408 • Letter: S
Question
Select one of the following organizations and the associated quality improvement initiative:a. The Joint Commission (National Patient Safety Goals)
b. Centers for Medicare & Medicaid Services (Never Events)
Describe the overarching goal of the initiative. Describe key strategies this organization has recommended to improve quality in the healthcare setting. In your opinion, what are the potential barriers associated with implementing this strategy in the healthcare setting?
Your initial post should be 250-300 words and utilize a minimum of two scholarly sources from the Ashford University Library, cited in APA format.
Respond to at least two of your classmates’ posts
Explanation / Answer
The necessity for quality and safety improvement initiatives permeates health care.1, 2 Quality health care is defined as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”3 (p. 1161). According to the Institute of Medicine (IOM) report, To Err Is Human,4 the majority of medical errors result from faulty systems and processes, not individuals. Processes that are inefficient and variable, changing case mix of patients, health insurance, differences in provider education and experience, and numerous other factors contribute to the complexity of health care. With this in mind, the IOM also asserted that today’s health care industry functions at a lower level than it can and should, and it put forth the following six aims of health care: effective, safe, patient-centered, timely, efficient, and equitable.2 The aims of effectiveness and safety are targeted through process-of-care measures, assessing whether providers of health care perform processes that have been demonstrated to achieve the desired aims and avoid those processes that are predisposed toward harm. The goals of measuring health care quality are to determine the effects of health care on desired outcomes and to assess the degree to which health care adheres to processes based on scientific evidence or agreed to by professional consensus and is consistent with patient preferences. Because errors are caused by system or process failures,5 it is important to adopt various process-improvement techniques to identify inefficiencies, ineffective care, and preventable errors to then influence changes associated with systems. Each of these techniques involves assessing performance and using findings to inform change. This chapter will discuss strategies and tools for quality improvement—including failure modes and effects analysis, Plan-Do-Study-Act, Six Sigma, Lean, and root-cause analysis—that have been used to improve the quality and safety of health care. Measures and Benchmarks Go to:Top? Efforts to improve quality need to be measured to demonstrate “whether improvement efforts (1) lead to change in the primary end point in the desired direction, (2) contribute to unintended results in different parts of the system, and (3) require additional efforts to bring a process back into acceptable ranges”6 (p. 735). The rationale for measuring quality improvement is the belief that good performance reflects good-quality practice, and that comparing performance among providers and organizations will encourage better performance. In the past few years, there has been a surge in measuring and reporting the performance of health care systems and processes.1, 7–9 While public reporting of quality performance can be used to identify areas needing improvement and ascribe national, State, or other level of benchmarks,10, 11 some providers have been sensitive to comparative performance data being published.12 Another audience for public reporting, consumers, has had problems interpreting the data in reports and has consequently not used the reports to the extent hoped to make informed decisions for higher-quality care.13–15 The complexity of health care systems and delivery of services, the unpredictable nature of health care, and the occupational differentiation and interdependence among clinicians and systems16–19 make measuring quality difficult. One of the challenges in using measures in health care is the attribution variability associated with high-level cognitive reasoning, discretionary decisionmaking, problem-solving, and experiential knowledge.20–22 Another measurement challenge is whether a near miss could have resulted in harm or whether an adverse event was a rare aberration or likely to recur.23 The Agency for Healthcare Research and Quality (AHRQ), the National Quality Forum, the Joint Commission, and many other national organizations endorse the use of valid and reliable measures of quality and patient safety to improve health care. Many of these useful measures that can be applied to the different settings of care and care processes can be found at AHRQ’s National Quality Measures Clearinghouse (http://www.qualitymeasures.ahrq.gov) and the National Quality Forum’s Web site (http://www.qualityforum.org). These measures are generally developed through a process including an assessment of the scientific strength of the evidence found in peer-reviewed literature, evaluating the validity and reliability of the measures and sources of data, determining how best to use the measure (e.g., determine if and how risk adjustment is needed), and actually testing the measure.24, 25 Measures of quality and safety can track the progress of quality improvement initiatives using external benchmarks. Benchmarking in health care is defined as the continual and collaborative discipline of measuring and comparing the results of key work processes with those of the best performers26 in evaluating organizational performance. There are two types of benchmarking that can be used to evaluate patient safety and quality performance. Internal benchmarking is used to identify best practices within an organization, to compare best practices within the organization, and to compare current practice over time. The information and data can be plotted on a control chart with statistically derived upper and lower control limits. However, using only internal benchmarking does not necessarily represent the best practices elsewhere. Competitive or external benchmarking involves using comparative data between organizations to judge performance and identify improvements that have proven to be successful in other organizations. Comparative data are available from national organizations, such as AHRQ’s annual National Health Care Quality Report1 and National Healthcare Disparities Report,9 as well as several proprietary benchmarking companies or groups (e.g., the American Nurses Association’s National Database of Nursing Quality Indicators).
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