MHA 668 Healthcare Quality Management Belhaven University Unit 1 Understanding the U.S. Healthcare System and the Healthcare Organization 1 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. 2 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 3 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   Textbook   Reading Individual homework   Hearing and seeing Analyzing Discussion forum   Completing all components is very important to accomplish the objectives of the course. Applying and examining 5 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. 6 Tips for Success  Course Page  Activities    Weekly discussions Media    Schedule  Individual homework Discussion forum   Module Handouts & links Class lectures  Be attentive to deadlines. The week (unit) begins on Sunday and ends on Saturday.   Observe the Sabbath. Manage your time. 7 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. 9 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) 11 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) 12 Stakeholders in the U.S. Healthcare System       Regulatory and Policy Makers Payers Advocacy Organizations Providers Suppliers Consumers 13 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   Private Sector   Federal, State, and Local Governments 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. 2. 3. How much mission-related activity is done? (volume) How well is it done? (quality) 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. 38 Reference Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. (2013). Integrating quality and strategy in health care organizations. Burlington, MA: Jones & Bartlett Learning. 39 
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