Healthcare Quality

key organizational components - Healthcare Quality Concepts (3)

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Yassir Shibeika
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Organizational components
key organizational components 

key organizational components
Healthcare Quality Concepts (3)

Clinical review activities in healthcare settings have traditionally fallen within one of the key organizational components below.

  1. Quality Management (QM).
  2. Utilization Management (UM).
  3. Risk Management (RM).
  4. Infection Control (IC).
  5. Case Management/Discharge Planning (CM/DP).
  6. Practitioner credentialing, privileging, and competency appraisal.
  7. Continuing medical/ clinical education.

QM, UM, RM, and IC require:

  • Data collection, summarization, and aggregation.
  • Information analysis, display, and presentation.
  • Information interpretation, sharing, and use.
  • Ongoing communications within the organization.

The success of the effective use of information is directly proportional to the degree of:

  1. Integration of data/information.
  2. Coordination of improvement efforts. Timely effective communication.

Healthcare Delivery Settings

Emergency Care

Transitional / Subacute Care

Urgent care

Long Term Care

Acute / Inpatient Hospital Care

Behavioral Health

Ambulatory Care

Retail Health Clinics

Home Care

Wellness and community health

Hospice Care

 

Emergency Care

Generally, in:

  1. Designated hospital trauma centers.
  2. Emergency departments of hospitals. 
  3. Urgent care centers.

Emergency rooms are perfect for a life-threatening conditions

Such conditions include:

  • Chest pain.
  • Difficulty breathing.
  • Stroke.
  • Seizures.
  • Poisoning.
  • Head trauma.
  • Severe bleeding.
  • Loss of vision.

Urgent care

An urgent care can treat those needing immediate, less serious care.
Conditions not requiring treatment at a fully equipped emergency or trauma center e.g.

  1. Minor fractures, X ray.
  2. Back / muscle pain.
  3. Nausea, vomiting and diarrhea
  4. Minor headaches.
  5. Stitches, lacerations.

Acute / Inpatient Hospital Care

Including intensive/critical care, elective. For cases considered unsafe as outpatient, depending on:

  • Type of diagnostic or therapeutic procedure.
  • Patient condition; need daily physician visit and 24-hour nursing care.

Ambulatory Care

  • Provide outpatient services only.
  • Including primary care, specialty care, and ambulatory surgery centers that provide outpatient services only.
  • Primary care, is the point of entry into the healthcare system for non-emergency care.
  • Special problems for quality management in ambulatory care:

  1. No common medical record and inadequate communication systems.
  2. The best diagnostic and therapeutic strategies to follow at the primary level still are not well established.
  3. Patients at the primary level remain in control of their own diet, medications, personal habits and lifestyle.
  4. Expected outcomes of ambulatory treatments are difficult to predict.

Hospice care

  • A service provided to individuals (and their families) diagnosed with terminal illnesses who have limited life spans.
  • The service is provided either in outpatient or non-acute inpatient settings.
  • Provided by an interdisciplinary team.
  • In typical home health care, visits decrease over time, while, Hospice care services usually increase with the patient's declining health and subsequent rising family stress.
  • Services include:
  1. Palliative management of pain and other physical symptoms. Expertise in pain management is essential.
  2. Management of nutrition, family teaching, death and dying counseling.
  3. Meeting psychosocial and spiritual needs of the patient, family, and other primary caregivers.
Hospice patients' rights include:
  • Participating in treatment planning.
  • Receiving effective pain management.
  • Refusing treatment. Choosing their physician.

Home care 

Providing certain treatments services and nursing care in the patient's home e.g. rehab, physical therapy, alimentation, teaching, daily care.

Transitional care/ Subacute Care  

  1. A program designed for medically stable patients; medically complex, but chronic conditions who require acute care e.g. ventilator care, on a longer-term basis.
  2. A stage of care between acute hospital and supportive care.

General Differentiation from Acute Care

  • Serves stable patients, but with complex care requirements.
  • Under the general supervision of skilled (licensed) nursing personnel. –
  • Costs may be 20 to 60 % less than acute inpatient.

Long Term Care (LTC)

  1. Supportive nursing services (sometimes called custodial services).
  2. Ongoing care provided to residents who are at least partially dependent for assistance with activities of daily living in addition to chronic clinical care needs. –
  3. Do not require skilled licensed professional intervention.
  4. Supportive services may include, but are not limited to, the following:
    • Routine medication administration.
    • Care of indwelling catheters.
    • Prophylactic or palliative skin care.
    • Incontinence treatment.
    • Administration of medical gases (and teaching).
    • Supervision of patient exercises. 
    • Assistance with activities of daily living.

Behavioral Health and Substance Abuse Programs

  • Partial hospitalization or "nonresidential" including day or evening treatment. 
  • Crisis stabilization in the home; and residential.

Retail health clinics

  • Drug stores and pharmacy, supermarkets.
  • Offering patients fast access to routine medical services ("limited care”).
  • Provide treatment by nurse practitioners under protocols and physician supervision.
  • About half the cost of a typical doctor visit.

Wellness and community health

Centers provide special training, education, and monitoring for certain healthcare needs, such as stop-smoking, weight control, or stress reduction programs; or for patient groups with certain conditions.

Certification for the healthcare professional

Certification Benefits for Individuals

  • Certification demonstrates that you hold advanced expertise in your field.
  • Be hired or promoted within an organization.

Certification

Certificate

Granted by a nongovernment entity. Voluntary.

Awarded by Educational programs or institutions and related to program education.

Requires a set amount of professional experience in the certification area. - Additional education in specialty or competency.

Receiving a certificate after an education program. - Both newcomers and professionals alike.

Content is broad in scope.

Beyond minimum requirements.

Content is narrow in scope.

Validates proficiency.

Based on a knowledge test, but not necessarily a proficiency test.

- A time-limited recognition. - Requires no more education on the topic. - Requires ongoing education; Holder has to demonstrate continued proficiency with the requirements

- Requires no more education on the topic.

Such as CPHQ

Such as a master's certificate.

Certification Benefits for Patients and Families

They may choose to have their healthcare provided at particular facilities because many patients know that professional certification leads to higher competency in individuals.

Certification Benefits for Employers

  • Highly valued in a highly competitive market.
  • Some insurance providers for healthcare organizations offer discounts for certification of employees.

Certification for the healthcare professional

Healthcare Quality Certifications

  1. Certified Professional in Healthcare Quality (CPHQ) from the National Association for Healthcare Quality (NAHQ).
  2. The Health Care Quality and Management (HCQM) certification from the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).
  3. The Certified Manager of Quality/Organizational Excellence (CMQ/OE) from the American Society for Quality (ASQ). 
  4. There are also certifications in specific areas such as Patient Safety, Credentialing, Risk Management, Health Information Management and other parts of healthcare quality.

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