Quality Improvement Organizations (Q.I.O.s)


Health Medical

Question Description

1.   What is the role and function of the Quality Improvement Organization program?

2.    In your opinion, has the quality of health care received by Medicare beneficiaries improved or declined over time as a result of the QIO program? 

This is the reading for the week: With a presence in every state and most federal territories, QIOs have been called “the nation’s main infrastructure for quality improvement” (Hsia, 2003). In this chapter, we describe the history and evolution of QIOs, provide examples of how QIOs apply CQI in the Medicare program, and examine potential future roles for QIOs. The methods described provide an overview of CQI techniques that are applicable on a national level.

There are several major professional certification organizations that allow individuals to get national certifications. Two that I am member of include Regulatory Affairs Professionals Society (RAPS) and the American Society for Quality (ASQ). The Regulatory Affairs Professionals Society (RAPS) is the largest global organization that offers Regulatory Affairs Certification (RAC), the only post-academic professional credential to recognize regulatory excellence. This site can be found at http://www.raps.org/.

Role of the Change Agent

Although people resist change, change is important to innovation, competitiveness, and growth. “The rate of change in your organization must exceed the rate of change on the outside”, said Jack Welsh, Six Sigma advocate and former CEO of General Electric in summarizing the importance of change in the context of being successful and remaining competitive. Frequently, Six Sigma improvements lead to process change. One of your roles as the project’s leader is to help others work through change and understand the importance of change. Cultural Resistance By their very nature, improvement efforts create change in the organization. The intended effect of change is to offer something better to internal and external customers – an enhanced product or service, a more efficient work process, reduced waste and so forth. The actual effect, even though technologically sound and appealing, has a social consequence. Any change might be viewed by those affected as a threat, and until the threat is neutralized, change will be difficult to achieve. This objection to change on the part of those affected is defined as “cultural resistance”.

Cultural resistance is a natural consequence of change, particularly any abrupt change that alters established habits, traditions, beliefs, status, or practices. Cultural resistance to change can occur even among those who would benefit from the proposed change. Hence the organization must allow time for changes in its culture and its structure to take hold. Restructuring business processes for improvement takes time, both for acceptance of the new system and for retraining employees in their new roles within the system. The future of health care is tied directly to improvements in quality and safety and our ability to meet the challenges of adapting new ideas to everyday practices in health care. In much the same way that continuous quality improvement (CQI) in health care has evolved over the last 60 years, we are now experiencing an acceleration in ideas, technology, and research that affects both health care and CQI. The gap from data to decisions is closing. This trend is further fueled by vast amounts of easily available information that leads to greater awareness of choices and expectations on the part of internal and external customers, including payers, providers, and patients, as well as their families and communities. These trends lay the foundation for the next wave of CQI ideas and initiatives. As the field of quality improvement in health care is rapidly evolving, the organization and delivery of health care are becoming more complex, and health care professionals are continuing to grapple with the best ways to improve quality of care and add value to the patient experience. The aim of this chapter is to create a road map for those who will be leading the transformation of health care. (Sollecito, 2012)


McLaughlin, C. P., Johnson, J. K., and Sollecito, W. A. [Eds.]. 2012. Implementing Continuous Quality Improvement in Health Care: A Global Casebook. Sudbury, MA: Jones & Bartlett Learning.)

Hsia, D. C. 2003. Medicare quality improvement: Bad apples or bad systems? JAMA, 289(20): 2648.

Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool's honor code & terms of service.

Final Answer

PO4HTRG (268)

Excellent! Definitely coming back for more study materials.