Assignment: Decentralizing Quality Efforts
Healthcare organizations that have adopted a reactive strategy have responded in several ways to accrediting agencies and quality consultants, including
◆ ensuring quality by centralizing quality efforts in a quality assurance department, then decentralizing quality efforts to clinical departments, and then further decentralizing quality efforts to all departments;
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I n t r o d u c t i o n ➤ t o ➤ t h e ➤ F i n a n c i a l ➤ M a n a g e m e n t ➤ o f ➤ H e a l t h c a r e ➤ O r g a n i z a t i o n s1 2
◆ ensuring quality by studying clinical outcomes, then studying clinical processes, then studying all outcomes and all processes, and finally studying key outcomes and key processes;
◆ improving quality by continuous attention and total management; and
◆ assessing quality by identifying key processes and desired outcomes.
Since 1986, The Joint Commission has focused on quality, the customer, work processes, measurements, and improvements. To its primary goal of accrediting healthcare organizations, The Joint Commission added the goal of developing and implementing a national performance measurement database. For a description of the current require- ments regarding performance measures and performance measure data, consult the chapter “Performance Measurement and the ORYX Initiative (PM)” in the Joint Commission’s Comprehensive Accreditation Manual for Hospitals (Joint Commission 2016).
In response to the Institute of Medicine’s report To Err Is Human (IOM 1999) that as many as 98,000 Americans die each year as a result of errors in hospitals, The Joint Commission announced a new set of patient safety and medical error reduction standards that took effect July 1, 2001 (Joint Commission 2001). The IOM report was reinforced by three 2006 studies that measured not only deaths caused by hospital-acquired infections but also the increased costs associated with preventable hospital errors (Conn 2006). The Joint Commission standards required accredited hospitals (Lovern 2001) to
◆ make their doctors tell patients when they receive substandard care or care that differs significantly from anticipated outcomes;
◆ implement an organization-wide patient safety program with procedures for immediate response to medical errors;
◆ report to the hospital’s governing body at least once annually on the occurrence of medical errors; and
◆ revise patient satisfaction surveys to ask patients how the organization can improve patient safety.
In July 2002, The Joint Commission approved the first National Patient Safety Goals (NPSGs) for hospitals. The NPSGs help accredited organizations address specific areas of concern regarding patient safety. Each goal includes a number of evidence- or expert- based requirements. Each year the goals are reevaluated, and the goals may be continued or replaced based on new patient safety priorities. The 2016 Joint Commission NPSGs for hospitals include the following (Joint Commission 2016):
◆ Improve the accuracy of patient identification.
◆ Improve the effectiveness of communication among caregivers.
National Patient Safety
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C h a p t e r ➤ 1 : ➤ F i n a n c i a l ➤ M a n a g e m e n t ➤ i n ➤ C o n t e x t 1 3
◆ Improve the safety of using medications.
◆ Reduce the harm associated with clinical alarm systems.
◆ Reduce the risk of healthcare-associated infections.
◆ Identify safety risks inherent in the hospital’s patient population.
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