Performance Improvement in Health Care
Assignment Content
Hopefully you have all learned a lot over the past 13 weeks related to quality improvement, have enjoyed it and taken an interest in this essential area to the healthcare arena. Please complete a one page reflective journal on what areas/topics were most interesting to you, what you learned and how you feel QI might be useful to your current or future employment and/or career goals.
At least one page, APA Format.
Links to view and read:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703697/
I was looking at chapter 7-
Health Care Compare
Nursing Home Compare
Nursing Homes Requested
Isabella-Health Inspections-2 STARS
Staffing-2 STARS
Quality Measures-5 STARS
Kings Harbor
Jewish Home
Isabella
| Health Inspection rating | 2 out of 5 stars Below Average |
| Date of most recent health inspection | 10/30/2018 View full report |
| Total number of health citations | 10 |
| Average number of health citations in New York | 5.4 |
| Average number of health citations in the U.S. | 8.2 |
| Date(s) of complaint inspection(s) between 4/1/2019 – 3/3/2020 | No Complaint Inspections |
| Number of complaints in the past 3 years that resulted in a citation | 0 |
| Number of times in the past 3 years a facility-reported issue resulted in a citation | 0 |
Deficiency Category Inspection Date: Detailed Results for Survey Date10/30/2018
Complaint Reporting Period:
4/1/2019 – 3/3/2020 Inspection Date: Detailed Results for Survey Date09/08/2017
Complaint Reporting Period:
4/1/2018 – 3/31/2019 Inspection Date: Detailed Results for Survey Date06/17/2016
Complaint Reporting Period:
4/1/2017 – 3/31/2018
Freedom from Abuse, Neglect, and Exploitation Deficiencies 0 0 0
Quality of Life and Care Deficiencies 1 0 2
Resident Assessment and Care Planning Deficiencies 2 0 1
Nursing and Physician Services Deficiencies 1 0 1
Resident Rights Deficiencies 4 0 0
Nutrition and Dietary Deficiencies 0 0 1
Pharmacy Service Deficiencies 1 0 1
Environmental Deficiencies 1 0 1
Administration Deficiencies 0 0 0
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Detailed Result for Inspection on 10/30/2018
Detailed Result for Inspection on 10/30/2018
Date of last standard health inspection: 10/30/2018 View Full Report – Opens in a new window- Opens in a new window
Date(s) of complaint inspection(s) between 4/1/2019 – 3/3/2020:
No Complaint Inspections
Total number of Health Deficiencies for this nursing home: 10
Average number of Health Deficiencies in New York: 5.4
Average number of Health Deficiencies in the United States: 8.2
Freedom from Abuse, Neglect, and Exploitation Deficiencies
No Freedom from Abuse, Neglect, and Exploitation Deficiencies were found during this inspection period.
Quality of Life and Care Deficiencies
Quality of Life and Care Deficiencies
Inspectors determined that the nursing home failed to: Inspection Date Date of Correction Level of Harm
(Least to most) Residents Affected
(Few, Some, Many)
Provide appropriate treatment and care according to orders, resident's preferences and goals. 10/30/2018 12/27/2018
2 = Minimal harm or potential for actual harm Few
Resident Assessment and Care Planning Deficiencies
Resident Assessment and Care Planning Deficiencies
Inspectors determined that the nursing home failed to: Inspection Date Date of Correction Level of Harm
(Least to most) Residents Affected
(Few, Some, Many)
Ensure each resident receives an accurate assessment. 10/30/2018 12/27/2018
2 = Minimal harm or potential for actual harm Few
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. 10/30/2018 12/27/2018
2 = Minimal harm or potential for actual harm Few
Nursing and Physician Services Deficiencies
Nursing and Physician Services Deficiencies
Inspectors determined that the nursing home failed to: Inspection Date Date of Correction Level of Harm
(Least to most) Residents Affected
(Few, Some, Many)
Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. 10/30/2018 12/27/2018
2 = Minimal harm or potential for actual harm Few
Sample of Hospitals Requested
| WYCKOFF HEIGHTS MEDICAL CENTER374 STOCKHOLM STREET BROOKLYN, NY 11237 (718) 963-7272 Overall rating : 1 out of 5 stars Survey Results-Overall rating : 1 out of 5 stars | ELMHURST HOSPITAL CENTER79-01 BROADWAY ELMHURST, NY 11373 (718) 334-1141 Overall rating : 1 out of 5 stars Survey Results-Overall rating : 1 out of 5 stars | KINGS COUNTY HOSPITAL CENTER451 CLARKSON AVENUE BROOKLYN, NY 11203 (718) 245-3901 Overall rating : 1 out of 5 stars Survey Results-Overall rating : 1 out of 5 stars |
| Percentage of patients who left the emergency department before being seen Lower percentages are better | 2% | 6% | 8% | 2% | 2% |
| Percentage of patients who came to the emergency department with stroke symptoms who received brain scan results within 45 minutes of arrival Higher percentages are better | 52% | 75% | Not Available1 | 71%25 | 72%25 |
| Emergency department volume | Very High | Very High | Very High | Not Available | Not Available |
| Average (median) time patients spent in the emergency department, after the doctor decided to admit them as an inpatient before leaving the emergency department for their inpatient room A lower number of minutes is better | 139 Minutes2 | 352 Minutes2 | 298 Minutes2 |
| Other Very High volume hospitals: Nation: 138 Minutes25,26 New York: 184 Minutes25,26 | Other Very High volume hospitals: Nation: 138 Minutes25,26 New York: 184 Minutes25,26 | Other Very High volume hospitals: Nation: 138 Minutes25,26 New York: 184 Minutes25,26 | |
| Average (median) time patients spent in the emergency department before leaving from the visit A lower number of minutes is better | 176 Minutes | 261 Minutes | 241 Minutes |
| Other Very High volume hospitals: Nation: 169 Minutes25,26 New York: 182 Minutes25,26 | Other Very High volume hospitals: Nation: 169 Minutes25,26 New York: 182 Minutes25,26 | Other Very High volume hospitals: Nation: 169 Minutes25,26 New York: 182 Minutes25,26 |
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Chapter 7: The Role of the Patient in Continuous Quality Improvement
Contents
Introduction and background
Patient involvement in healthcare improvement overview
Rationale for Patient Involvement in CQI
Methods for Involving Patients in CQI
Factors Affecting Patient Involvement
The MAPR Model of Patient Involvement
Partners to Owners
Conclusion
Introduction
The primary function of health systems is to care for the health and wellbeing of populations in an effective and efficient way.
A range of mechanisms exist for measuring the quality of care provided by health systems
The role of the patient, family, and caregivers is much less clear
History, policy, and causality are conflicted on the role of and outcomes from the patient in CQI
Background
Most CQI systems value the involvement of the client in systemic change and development
Patient safety inquiries show that patients and carers often flagged problems first but were ignored
These inquiries were not isolated to one part of the health system – problems are diverse in type and location of occurrence
How can CQI help avoid these problems, halt their recurrence and improve systemic approaches?
Patient Involvement in Healthcare Improvement Overview
Patients are expected to be involved in health care as health systems have developed – CQI is a part of this
Social and health sector changes have contributed to the call for patient involvement
The dominance of medicine has been questioned by patients, advocates and health practitioners
The HIV/AIDS epidemic has been a major force for change in traditional health system approaches
Technological shifts have/are having a huge impact e.g. knowledge base, global contacts, volunteers for trials etc.
Rationale for Patient Involvement in CQI
Greater knowledge of health has increased knowledge of errors in the media and public domains
High profile cases continue to get major news coverage e.g. The Shipman Inquiry in the U.K.
Health systems have been forced to acknowledge the patient/client/carer perspectives
CQI is part of the shift to patient-centered health care e.g. Insurance systems, co-payments etc. also make patients customers
Methods for Involving Patients in CQI
Three important levels of patient involvement in CQI:
Micro-level involvement – active patient involvement as acknowledged in the concept of the self-managing patient;
Meso-level involvement – patients involved in health service or even whole system planning, management and evaluation;
Macro-level involvement – here patients are involved in national/international safety activities e.g. The WHO London Declaration
Factors Affecting Patient Involvement
The evidence base for patient involvement is small but growing
Patient willingness to participate is affected by several factors e.g. self-efficacy in the role, health literacy, shift/changes required in role
Inhibitory factors include e.g. type/severity of condition, SES factors (minority social position), the health setting and issues around power relations
Clinician attitudes are also a factor including training, personal beliefs and organizational issues such as time
Measuring Patient Involvement in CQI
Patient satisfaction surveys (like customer satisfaction surveys) have become widespread in healthcare
Satisfaction is a problematic measure for a range of reasons e.g. Individual patient/carer reactions to error versus health care provider/system responses
Data collection needs to more closely reflect the kind of knowledge we are trying to produce in patient safety CQI – not just surveys because surveys are the common tool
The MAPR Model of Patient Involvement
The MAPR model aims to canvas all three levels of patient involvement and span most types of health system
Two dimensions of involvement are addressed – (1) active-proactive and (2) passive-reactive
Dimension 1 involves direct patient involvement in identifying, confronting and addressing the sources of error prior to events
Dimension 2 involves responses from patients after error events have occurred e.g. Complaint letters, participation in root cause analysis etc.
The MAPR Model
Dimension of Patient Involvement in Quality Improvement: The M-APR Model
The MAPR Model (continued)
Dimension of Patient Involvement in Quality Improvement: The M-APR Model
Partners in Health: Kaiser Permanente
The program is now more than 10 years old with a focus on chronic disease self-management
Based on the Stanford CDSMP model and research on patient outcomes
The Healthwise Handbook and related resource supports both low and high intensity interventions
Research and RCTs showed a range of positive outcomes for both patients and providers
Kaiser indicated that many of these interventions could be implemented by smaller organizations lacking Kaiser’s resource base
National Patient Safety Goals in the United States
The Joint Commission (TJC) accreditation agency has National Patient Safety Goal 13 to involve patients in their own (safe) care; in 2010 this goal became part of TJC’s standards for accreditation
In 2007 TJC published a Patients as Partners toolkit to support patients and carers in identifying safety issues
TJC has emphasised the role of diversity as a key issue in safety e.g., meeting patient/staff language needs and effective communication more broadly
Patients as Partners Program
Impact British Columbia, an NFP, implemented a patients as partners program based on the BC Health Charter
The focus was chronic disease patients who are English-speaking emphasising diversity effects on health care design and provision
Outreach activities target both health care recipients and health care providers
From Partners to Owners
The SouthCentral Foundation (SCF) in Alaska took on management of all Native health services in its area in 1999
Ownership and control caused a shift in the design and delivery of services
Native people were consulted about their ideas for service delivery and fit
This new model shifted from patient-centered to patient-owned
Conclusion
Patient involvement is now an accepted part of health systems development
In spite of this, error rates have not yet fallen much The key issue is to identify how patient involvement can have a positive impact on this situation
Each system in each country is likely to have a unique response to this problem
The important thing is, whether exclusively unique or similar, that effective responses have a positive impact through CQI