Question

Missy Mendez, a nurse manager of a 95-bed medical-surgical unit in Yucatan, Kansas, would like to have her health care organization, Yucatan Memorial Health Center, embrace the concept of a high-performance organization. She would like the administration to develop a culture of a high-performing organization. Nurse Mendez knows that high-performance organizations have leaders who communicate a strong and clear mission and vision to employees, engage in strategic thinking that anticipates customer needs and market changes, commit to ongoing identification of problems, have a preoccupation with potential failures, are resilient and flexible, and use creative and improvisational problem solving to address failures or near-misses. Nurse Mendez approaches the director of nursing and provides multiple resources and contacts about the high-performance organization concept. The director asks her several questions about how she could coordinate hospital-wide efforts to describe this concept and support a customer-focused, team-based organization to support quality efforts. Yucatan Memorial Health Center, although it has a good quality improvement process, historically has emphasized individual successes and unit-based projects and tends to be punitive when managing clinical incidents.

1. Nurse Mendez proposes a change from the punitive culture to a system in which staff is rewarded for reporting errors. The director of nursing is concerned, however, that “this will obviously make it look as if we commit more errors than other nursing units in other health centers who do not use this system.” How can Nurse Mendez alleviate the director’s fears on this particular issue?

2. Part of the quality improvement process, of course, involves nurse managers implementing what Nurse Mendez refers to as a health care quality toolbox. For example, one unit frequently grapples with the problems encountered in scheduling radiology for patients. Some patients are scheduled specifically for diagnostic procedures, while others at the center are sent to radiology spontaneously by their physicians during a medical appointment. To eliminate as many scheduling problems as possible, she asks affected nursing managers to diagram causes of each scheduling conflict as it arises, including unclear policies or protocols, poor placement or a number of equipment and machines, and time each patient spends in radiology awaiting either tests or results. This particular strategy is an example of what sort of tool?

Answer 1

Ans-

Health care quality is defined as the level of health care value provide by the resources and determine by the some measurements.

Health care quality is the degree to of health care services for individuals and populations increase the of desired health outcomes.

Quality of care plays an important role in describing health care relationships between quality, cost, and accessibility of health care within a community.

Principle if quality improvement in health care system-

1)Focus on Care co-ordination – It is the coordinatiFocus on Patient.

2)Focus on the Patient-The major concept behind the quality improvement in healthcare is to get the patient’s needs and expectations which include Patient Safety,systems that support patient access, Evidence-based care provision, Patient centered communication, Health literacy of patient of care activities.

3) work as Systems and Processes – organization needs to understand its own delivery system and key processes, rather than considering it as small,simple,big and complex.

*quality in healthcare system-

1)safe – avoiding injuries to patients from care.

2)effective – avoiding overuse and misuse of care.

3)timely – reducing wait times and harmful delays for patients and providers.

4)efficient – avoiding waste of equipment, supplies, ideas and energy.

5)equitable – providing care that does not vary across intrinsic personal characteristics

*Methods to assess and improve-

1)Cost Efficiency and cost effectiveness, determines whether the benefits of a service where exceed the cost incurred to provide the service.

2)Critical Pathways Critical Pathways are outcome-based and patient-centered case management tools that take on an interdisciplinary approach by "facilitating coordination of care among multiple clinical departments and caregivers".

3)Health professional perspective The quality of the health care given by a health care professional can be judged by its outcome.Risk Management Risk management consists of "proactive efforts to prevent adverse events related to clinical care" and is focused on avoiding medical malpractice.

4. Patient perspective Patient satisfaction surveys are the main qualitative measure of the patient perspective.

*Equity Measures -

1)Percentage of Physician certified by board.

2)Number of beds and the types of services which are available in hospital Health care.

3)Whether the hospital is accredited or has other types of specialty certification.

4)The use of electronic patient medical records.

5)Nurse-to-patient staffing ratio.

6) prescription ordering Systems.

Measures for patients care-

Effectiveness Measures --Percentage of patients receiving tratement from recommended hospital care for specific conditions such as heart attack,pevention of surgical infection.

Patient-CenterednessMeasures-

Patients’ reports on the care and service they received from the hospital.Provision of care instructions upon hospital discharge for certain conditions.

Timeliness Measures -Patient reports on the timeliness of care and service they received from the hospital,from nurses.

Efficiency Measures --Utilization of hospital services or procedures as measured by the hospital discharge rate or average length of stay.

Equity Measures --Examples include:

*goals in the delivery of quality healthcare:

1)Promote effective communication and coordination of care.

2)Work with communities to promote best practices for healthy living.

3)Make care safer by reducing harm and injury caused in the delivery of care.

4)care affordable.

5)stenghth in the family and person engagement as parents care.

*Clinical example to improve quality-

1) Readiness and Change Competencies Key factor to Successfully Reducing Clinical Variation.

2)Pharmacist-Medication Therapy Management Reduces Total Cost of Care.

3)Systematic Data-Driven Lowers Length of Stay and Improves Care Coordination.

4)Clinical and Financial Partnership Reduces Denials and Write Of by More than $5 Million.

5)epsis Care Improves Early Recognition and Outcomes.