Describe some of the regulations and quality standards (e.g., CMS, NCQA, AHRQ, The Joint Commission) that you must maintain as a health care manager. Why is CQI/process improvement so important in a healthcare workplace?
As a healthcare administrator, it is my responsibility to adhere to the regulations and quality standards of healthcare organizations such as NCQA, CMS, and AHRQ in order to strive through a complex regulatory field. Patient capabilities, data assurance, and system assurance are the three most important pillars of different organizations, as well as CMS and NCQA standards. These standards need to be adhered to so that a health centre can qualify as a patient-centred medical home and for aspiring general excellence in quality patient care based on standards and quality. The AHRQ is another implementing partner that has accreditation from the Joint Commission to enhance evidence-based standards for the organization, which is bound by safety and high-quality standards. The accreditation also nurtures a climate of research and continuous quality improvement for the campaign of reimbursement as a pledge of quality. Moreover, continuous quality improvement (CQI) is the most important process of arrangement, and advancements continually shape the industry of patient enforcement and success (Hill et al., 2020). The case of CQI in the dynamic healthcare environment ensures that both administrative and clinical processes are organized and optimized for the identification of areas that need improvement and the provision of the best possible patient care. Emphasizing Continuous Quality Improvement aligns with the strategies to foster a culture of continuous improvement to manage the industry’s shift towards value-based care that can contribute to the long-term success of the organization.
What are the impacts on a health care facility (e.g., hospital, doctor’s office) of external regulations and quality standards (e.g., CMS regulations, state regulations, The Joint Commission)? As a manager, how would you ensure that your department is compliant with external regulations and quality standards?
The impacts of external regulations and quality standards on healthcare facilities are significant as compliance with these standards and regulations is crucial for upholding reputation, ensuring patient safety, and maintaining the eligibility of healthcare organizations for healthcare programs funded by the government. Centres for Medicare and Medicaid Services established CMS regulations for healthcare organizations that rely on reimbursement in order to provide services to Medicare and Medicaid beneficiaries, which are widely recognized by different organizations (Blackstock et al., 2021). Therefore, the Joint Commission provides accreditation standards that are often customized for needs according to the region-drawn care facilities to influence patient trust and facility reputation. Penalties, in case of non-compliance to such standards, may include fines, disqualification, and overtime hours that serve as a benchmark of excellence to foster quality of care. The achievement of such standards indicates the organizational commitment to negotiate contracts, provide quality care, and maintain the competitive positioning of the organization in the market. As a healthcare manager, I will ensure that internal assessments and audits are regularly undertaken while actively managing the training programs and educating employees so that areas of non-compliance can be identified and steps can be taken for the immediate remediation of non-compliance at the workplace. In addition, clear communication channels should be observed to ensure the continuation of quality standards and adherence to outside regulations.
Why is the CQI process so important for the quality of direct patient care? What are the outcomes on patient care if the health care organization does or does not have a good CQI process in place? As a healthcare manager, how would you ensure that continual improvements in quality are being made?
The CQI process is of great importance for improving the quality of direct patient care as continuous evaluative monitoring helps healthcare facilities to be responsive to changing care needs. The embedded systems within CQI ensure that selection is sensitive to create a culture of performance and permanent improvement while providing a better patient outcome by eliminating imperfections in the systems (Hill et al., 2020). The process of CQI also facilitates a framework for decision-making relevant to advanced technology to help patients benefit from the systematic CQI process to foster higher levels of patient satisfaction and better clinical care outcomes. As a healthcare manager, stimulating the PDSA (Plan-Do-Study-Act) cycle and initiating regular performance audits guarantee that enhancements are made to ensure proper adherence to evidence-based methods and identify avenues for strategic and vigorous advances. Companies with continuous improvement strategies and efforts can be successful with CQI processes to promote a progressive way of quality improvement in the long term while maintaining knowledge of new protocols. Moreover, supporting a culture of learning and promoting openness at the workplace can help continue guiding the healthcare team through an open sharing communication process to streamline care coordination and improve the quality of care.
What are approaches that health facilities and agencies take to ensure the aptitude and competency of their clinical and non-clinical staff members? As a manager, what are some things you can do to ensure that your team has the proper resources to consistently deliver high-quality care?
To ensure the competency and aptitude of the clinical and non-clinical staff, human resource management uses many initiatives and strategies that can be carried out through the scrutiny of skills and qualifications in the formal hiring process. Regular training and performance evaluations can be applied to both clinical and non-clinical roles to keep everyone updated with the latest practices and guidelines, which will ensure that individuals have the necessary qualifications and expertise for their roles. Regular evaluations would also help identify areas for improvement and maintain high standards for care to create a supportive environment and promote continuous learning. These evaluations will also help determine the team and individual competencies that contribute to the overall success of the company. Orientation programs are also a significant initiative that aims to provide general information on the policies, regulations, procedures, and standards for consistently delivering high-quality care to patients (Zheng et al., 2018). However, a manager has to ensure that appropriate resources should be made available along with adequate staffing to reduce burnout and meet patient needs while providing employees with a quality work life. Adequate budgeting for necessary tools or equipment and investment in changing technology such as Electronic Health Records (EHRs) can support efficient record-keeping and security of patient data to ensure that the employees have access to the latest care resources (Cowie et al., 2017). Moreover, creating a culture of performance improvement, establishing clear channels for communication, and seeking skill enhancement opportunities can also help a manager to make everyone well-informed about the changes in industry policies, standards, and protocols. As a healthcare manager, fostering a culture that values education, availability of resources, and collaboration within the team can contribute effectively to the consistent and competent delivery of high-quality patient care for the team’s overall performance.
What is the role of technology in direct patient care quality and safety? As a manager, how could you use technology (e.g., Microsoft Excel, Tableau) to help your department stay on track?
The role of technology in direct patient care quality and safety contributes to the overall improvement in healthcare outcomes by promoting clinical decision support systems, thus improving healthcare safety. For instance, EHRs promote timely access to relevant patient information that is now digitalized and create a central database for electronic data so that healthcare professionals can make informed clinical decisions (Mc Cord & Hemkens, 2019). A healthcare manager, in this regard, can use the available technology, such as Tableau or Microsoft Excel, in different departments of the healthcare facility to keep track of what can be done for performance improvement and patient outcomes. These technological tools allow monitoring metrics of patient data, resource availability, employee information, and organizational protocols to get a more insightful look into the performance of healthcare facilities. These tools allow different users to observe emerging trends in the care industry and ensure compliance with relevant quality standards and organizational regulations. Adopting these tools and technological practices in various departments to keep tracking results and achievements of the organizational objectives can help managers make logical decisions based on data from information systems to improve patient care quality and safety.
References
Blackstock, S. C., Richards, A. C., & Fleisher, L. A. (2021). Shaping Medicare’s Health Care Regulations. JAMA Health Forum, 2(10), e213017–e213017.
Cowie, M. R., Blomster, J. I., Curtis, L. H., Duclaux, S., Ford, I., Fritz, F., Goldman, S., Janmohamed, S., Kreuzer, J., & Leenay, M. (2017). Electronic health records to facilitate clinical research. Clinical Research in Cardiology, 106, 1–9.
Hill, J. E., Stephani, A.-M., Sapple, P., & Clegg, A. J. (2020). The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: A systematic review. Implementation Science, 15, 1–14.
Mc Cord, K. A., & Hemkens, L. G. (2019). Using electronic health records for clinical trials: Where do we stand and where can we go? Cmaj, 191(5), E128–E133.
Zheng, N. T., Wiener, J. M., & Feng, Z. (2018). Strengthening regulations, standards, and quality assurance for long-term care. Options for Aged Care in China, 243.
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