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HCA375DiscussionsWeek 2 – DiscussionComparative PerformanceFor this discussion, you are tasked with comparing two hospitals, one that is considered a safety-net hospital (public hospitals who care for a large segment of the population who are uninsured or underinsured) and one hospital from a more affluent area in the state where you live.Visit The Joint Commission: Quality Check (Links to an external site.)Links to an external site..Take the following steps to find two hospitals:Enter a city and state, and then select Locate.A list of hospitals for that city and state will populate on the page. Select View Report.Select View Accreditation History. Next, select the most recent Quality Report, which will open as a PDF document. Scroll down to the pages that list the National Patient Safety Goals and then the National Quality Improvement Goals. Choose one from either list.If you choose a National Patient Safety Goal,State the goal and the procedure(s) indicated in the Organization ShouldDiscuss the implications to the patient, staff (physicians, nurses, medical assistance, pharmacists, etc.) and hospital if the health care professional fails to follow the procedure indicated.If you choose a Quality Improvement Goal,State the measure and explanation of that goal.Discuss how the hospital can improve their performance to meet the target.Repeat the above steps for a second hospital. Reminder, one hospital should be a safety-net hospital and one should serve an affluent community.Next, compare and contrast the differences between the two facilities. After review of the two hospitals, discuss your opinion about the reasons these hospitals could have disparities.Your initial post should be 250 to 300 words and utilize at least one scholarly source from the Ashford University Library to justify your recommendations for improvement. Cite all sources in APA format as outlined in the Ashford Writing Center’s Introduction to APA (Links to an external site.)Links to an external site.. The Research, Keywords, Databases: An Overview (Links to an external site.)Links to an external site. video tutorial is available to help you become more familiar with the library database search features and how to generate keywords.Guided Response: Choose two classmates, and respond as a patient who has experienced the issue identified in your classmates’ posts. Answer the questions listed below. Your guided response posts should be a minimum of five well-developed sentences.What role does customer satisfaction play in your decision to utilize the health care facility in the future based on the findings?What would you expect as the patient? Explain your answer.
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1
3
What
is Special Education?
The Healthcare
Industry:
Structure, History, and
Continuous Quality Improvement
Associated Press/J.
Scott Applewhite
iStockphoto/Thinkstock
Learning Objectives
Pre-Test
After
reading
this
you should
behandicap
able to dointerchangeably.
the following: T/F
1.
You
can use
thechapter,
terms disability
and
2. • The
history
special
began
in Medical
Europe. Center
T/F to better understand how continuous
Analyze
the of
case
studyeducation
at Virginia
Mason
quality
improvement
works.
3. The first American legislation that protected students with disabilities was passed in the 1950s. T/F
4. • All
students
disabilities
should
be educated
in special
education
Evaluate
thewith
structure
of the U.S.
healthcare
system
and how
multipleclassrooms.
players haveT/F
a role in quality
improvement.
5. Special education law is constantly reinterpreted. T/F
• Relate
major
healthcare
reforms
U.S. history to the current state of quality improvement.
Answers
can
be found
at the end
of theinchapter.
• Describe quality management in managed care.
• Examine quality improvement in hospitals and the effect on healthcare.
• Show how physicians and physician practices implement quality improvement projects.
41
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Section 3.1
A Story of Continuous Quality Improvement
Introduction
In 2004, Virginia Mason Medical Center in Seattle admitted Mary McClinton for a complex but
routine procedure to treat a brain aneurysm, which is an abnormal or weak spot on a blood
vessel in the brain that causes an outward ballooning of the arterial wall. This can be lifethreatening, as a ruptured aneurysm with subsequent bleeding into the brain is lethal. Doctors intended to inject a contrast dye through a catheter in her leg as part of the procedure,
but instead they injected her with antiseptic, which blocked the blood flow in her leg and
caused her organs to fail, one by one. She died 19 days later as a result of this medical mistake
because the antiseptic had been placed in an unlabeled container on the same tray as the dye.
Virginia Mason has come a long way since 2004 and was named a top hospital of the decade
in 2010 by The Leapfrog Group (http://www.leapfroggroup.org), a consortium of businesses
that purchase health insurance for their employees and focus on improving the quality of
healthcare. However, even before Ms. McClinton’s death, the hospital had begun to improve
its safety procedures, developed checklists for surgeries and drug dispensations, established
patient safety alerts, and encouraged all hospital employees to advocate for patient safety
(AARP, 2013). Virginia Mason became one of the best hospitals in safety and quality standards
within a few years of that tragic event. This was accomplished by the coordinated efforts of all
hospital employees.
3.1 A Story of Continuous Quality Improvement
The story of Virginia Mason Medical Center demonstrates how one healthcare system successfully used continuous quality improvement to improve the care of its patients.
In 2001, Virginia Mason began to examine ways it could change its healthcare delivery to
improve both quality and safety. During the search for a management method to achieve
those goals, medical center leaders
became aware of how the Boeing airplane manufacturer had used a system
created by a Japanese car manufacturer to improve its processes. Called
the Toyota Production System (TPS,
sometimes also called lean production
or lean theory), Boeing used the system to eliminate waste and improve
quality in manufacturing its airplanes.
You will find more on lean theory and
how Virginia Mason put it into practice
in Chapter 7.
But what similarities do car and airplane manufacturing have with healthcare? Virginia Mason leaders found
that the Toyota Production System
principles—the customer comes first,
Shizuo Kambayashi/Associated Press
The Virginia Mason Medical Center used the
principles of the Toyota Production System to
improve the quality and safety of its healthcare
delivery.
42
© 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution.
Section 3.1
A Story of Continuous Quality Improvement
dedication to the highest quality, obsession with safety, the aim for high staff satisfaction, and
a successful economic enterprise—translated very well to healthcare.
While patients are certainly not cars, manufacturing and healthcare are both filled with complex production processes. In healthcare, those processes include admitting a patient, conducting a clinic visit, or performing surgery. As with manufacturing, these processes should
embrace the concepts of quality, safety, customer satisfaction, staff satisfaction, and cost
effectiveness—each of which Virginia Mason’s quality improvement system tries to optimize
on behalf of its patients.
Virginia Mason adopted the Toyota system and began to apply the tenets that worked successfully in car manufacturing through a number of quality improvement initiatives, naming
its program the Virginia Mason Production System (VMPS). Its goal was to eliminate waste
and improve quality and safety through tools and techniques adapted from the manufacturing world.
Early on in the quality improvement process, Virginia Mason used VMPS to develop a new
Patient Safety Alert (PSA) system, which requires all staff members who encounter a situation likely to harm a patient to make an immediate report and stop any activity that could
cause further harm. This is called “stopping the line,” or stopping the activity and correcting the problem, in the same way a worker at the Toyota plant could pull a cord to signal a
problem and stop the production line rather than allowing a potential product defect. Senior
leaders would respond to the most serious of these PSAs. If the safety of a patient is indeed
at risk, an investigation is immediately launched to correct the problem. From the program’s
inception in 2002 through 2009, more than 14,500 PSAs were reported and most were processed within 24 hours (Virginia Mason Medical Center, 2014, “VMPS Success Stories”). That
contrasts sharply with the years prior to 2002, when reports took 3 to 18 months to resolve.
Mary McClinton’s death occurred early in the VMPS implementation. The hospital had
recently switched antiseptics (the solution used to clean skin before and after procedures)
from a brown iodine-based solution to a colorless liquid (Perry & Ostrom, 2004). She was
accidentally injected with an antiseptic, which was one of three clear liquids in bowls on
the surgical tray; the other liquids were contrast solution, to make blood vessels visible on
x-rays, and saline. This mistake caused Mary to suffer kidney failure, a sudden drop in blood
pressure, and a stroke. The hospital publicly explained what had happened and apologized
for the error.
The case sparked sweeping changes in patient safety protocols at Virginia Mason. The hospital mistake-proofed the process by purchasing swabs with solution already on them to prevent future errors. As part of a legal settlement with Mary’s family, Virginia Mason used her
case to teach medical staffers the importance of proper labeling of medications. She became
the namesake of the hospital’s patient safety award, which is given annually to the team that
develops and implements the most significant measures that enhance patient safety. Mary’s
death was a watershed moment, further demonstrating the need to integrate the calling out
of errors and defects in the organization’s culture.
The problem also went beyond the walls of Virginia Mason and resulted in other hospitals
changing their processes. Following Mary’s death, as well as several other high-profile cases,
The Joint Commission (TJC) included the requirement that hospitals label all medication containers and solutions in procedure areas in its 2006 National Patient Safety Goals.
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Section 3.2
The United States Healthcare System
The purpose of continuous quality improvement programs is to improve healthcare by identifying problems, implementing and monitoring corrective actions, and studying its effectiveness. In this case, the problem at Virginia Mason was clearly identified by the preventable
death of a patient and the hospital immediately began looking for ways to keep this situation
from recurring.
It is important to remember that CQI focuses on system issues. Beyond the mix-up that
occurred during this specific procedure at Virginia Mason, it was important that the hospital
look at the overall issue of properly labeling all medications and solutions to prevent errors
throughout the system. By sharing its error, Virginia Mason also highlighted the problem so
other healthcare organizations could make changes to their own systems.
Questions to Consider
1. Discuss how, despite such major differences between manufacturing cars and caring for
patients, the same quality improvement method can be used in healthcare and manufacturing.
2. When a patient death or major injury occurs, do you think a hospital should publicly
explain what happened and offer an apology for the error? How can this benefit a hospital? How can such a public admission hurt the organization?
3. Can you think of an error that might occur at one hospital that could result in changes
to other hospital systems?
3.2 The United States Healthcare System
The U.S. healthcare system is a fiscally driven entity that spends more on healthcare than
any other developed country in the world (Organization for Economic Co-operation and
Development, 2013). Despite the limited access to basic healthcare by the millions of uninsured, healthcare costs continue to rise rapidly. In 2010, annual national health expenditures totaled $2.6 trillion, in comparison to $27.3 billion in 1960 (U.S. Census Bureau, 2012).
By 2018, it is estimated that the United States will spend more than $4.3 trillion per year,
or 20.3% of the gross domestic product (GDP), which is the monetary value of all finished
goods and services produced within the United States in a year (Centers for Medicare and
Medicaid Services, 2011a).
In 2011, the United States spent 17% of its GDP on healthcare. This spending level far exceeds
that of other Organization for Economic Co-operation and Development (OECD) nations: the
next highest spender is France, which spent 11.2% of GDP in 2011 (OECD, 2013). In equal
dollar terms, in 2011 the United States spent $8,175 per person, as compared to $3,970 per
person in France. Despite spending more than double the amount of money on healthcare,
health outcomes (such as life expectancy) are no better, and often worse, in the United States.
Of course, there are many reasons for the high cost of healthcare in the United States, which
must be balanced with the medical care the system provides. Take for instance, the fact that
other countries place major restrictions on the amount of damages that can be awarded in
malpractice lawsuits. That is the not the case in the United States, where a jury can decide
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Section 3.2
The United States Healthcare System
to award millions of dollars to settle malpractice lawsuits brought against physicians and
healthcare organizations. Malpractice reform, which has long been discussed, would help
bring down healthcare costs in the United States.
It’s also necessary to look at the care various countries are able to provide. Consider that
technology is advanced in the United States and is far better than in many other countries.
Access to medical services is also good in America compared to the wait times to see a doctor
or schedule a surgery in many other countries. Costs would also go down if the healthcare
system could address major health problems and create a healthier population of patients.
For instance, obesity rates in America are among the highest in the world, leading to many
health complications.
The healthcare system has multiple players including employers, insurance companies, and
managed care companies; health service professionals, which include physicians, nurses,
and therapists; health service organizations such as hospitals, integrated delivery systems,
and nursing homes; and the government. The players with substantial political and financial
power try to influence decisions and maximize their interest in the largest industry in the
nation. Each player has a different economic interest, but none can dominate the industry
except the government. Quality improvement efforts to reduce medical errors, such as injuries and deaths, are made by all parties involved in the healthcare delivery system. These
efforts are ongoing and steady progress has been made to improve patient safety records and
medical errors.
While different players have their own interests in the healthcare system—an insurance company may look to keep costs under control while a physician may want to order many tests
to diagnose a patient’s problem—all of the players benefit from quality improvement projects that reduce patient injuries. For example, a hospital may launch a quality improvement
project to reduce patient falls. It is beneficial to the insurance companies who would have to
cover a longer hospital stay if a patient fell and broke his or her hip, needing more days in
the hospital as well as possible rehabilitation. Or hospitals that follow best practices, such as
prescribing beta blockers to heart attack patients, can keep them healthier, allowing them to
return to work and cutting future healthcare costs.
Insurers, providers, employers, and healthcare professionals can all cooperate in creating a
system that can reduce total healthcare costs and premiums while achieving better outcomes
for patients. The Institute for Healthcare Improvement (IHI) calls this the “Triple Aim”: better
care for individuals, better health for populations, and a lower per capita cost. The IHI supports initiatives to move the country to a system that achieves these goals.
Web Field Trip
For an overview of the healthcare system, visit the Kahn Academy website (http://www
.khanacademy.org) and search for the video Healthcare System Overview. In the video, Professor Laurence C. Baker, Stanford University, considers some of the basic who, what, and how
elements of the healthcare system.
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Section 3.2
The United States Healthcare System
Employers and Insurance
The United States has a fragmented healthcare delivery system in comparison to other developed countries such as England, Germany, and France. The system is described as fragmented
because of the large number of insurers, health systems, and physicians that lack effective
mechanisms to coordinate care. The system is unique because many working citizens receive
their health insurance from their employer with a shared financial responsibility. Employers
screen health insurance plans before offering a small number of these plans to employees.
Screening is based on price, quality, and coverage, which is a layer of competition health
insurance companies are required to successfully pass.
F1 ONLINE/SuperStock
The U.S. healthcare system includes about 1,000
insurance companies.
Health Service Providers
This system allows approximately 195
million Americans to obtain insurance through their employer, while
another 105 million are covered by
two major government programs:
Medicare and Medicaid (Shi & Singh,
2013). This combination of employerand government-based insurance left
approximately 47 million Americans
without any health insurance in 2012
(Kaiser Family Foundation, 2013).
The healthcare system includes about
1,000 insurance companies, 70 Blue
Cross and Blue Shield plans, 452 health
maintenance organizations (HMOs),
and 925 preferred provider organizations (PPOs) (Shi & Singh, 2013).
Individuals who provide healthcare are at the center of the delivery system, making crucial
decisions to treat patients. The types of providers who drive care decisions include physicians, physician assistants, nurse practitioners, therapists, and others. These providers are
also in a position to make decisions to improve financing, delivery, and quality of healthcare.
Generally, the central point of healthcare delivery is the provider’s diagnosis and treatment
plan. Quite often, quality improvement projects focus here because the patient’s journey typically begins with a visit to a primary care provider or specialist.
Nurses are the largest group of healthcare professionals in the healthcare system, with
approximately 2.8 million registered nurses (RNs), including advanced practice registered
nurses, and about 690,000 licensed practical nurses (LPNs) (Health Resources and Services
Administration, 2013). They are employed as caregivers in various settings to provide healthcare to patients alongside physicians and other providers. Nurses with advanced training and
certification (such as nurse practitioners) are assuming an increasingly important role in
care delivery.
Therapists are health professionals whose role is to improve a patient’s functional movement (physical therapist) or to teach the patient how to carry out activities of daily living and to cope with working environments (occupational therapist) in the context of any
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Section 3.2
The United States Healthcare System
limitations imposed by their health. Respiratory therapists and speech therapists are frequently employed in the healthcare system to help patients with breathing problems and
speech impediments.
While these healthcare professionals provide direct care to patients, they cannot do their jobs
well without support from many other professionals who work in healthcare organizations.
For instance, clinical safety and facility safety go hand in hand. Facility managers can make
vital contributions to patient safety efforts. Patient safety, employee safety, and facility safety
programs can work in conjunction to create a safe environment for everyone. Look at it this
way: If a nurse gives out one wrong medication dose, it jeopardizes the safety of one patient.
If a nursing home does not have a fire safety program, with a plan to evacuate all of its elderly
residents in an emergency—some of whom are confined to bed and can’t get themselves out
in case of a fire—everyone in that building can be put at risk.
While physicians and nurses provide care to newborn babies in a hospital nursery, the facility’s security manager helps put in place the security system to protect those babies from
abductions—a rare but frightening occurrence in hospitals. The hospital security guards will
be the first to respond if someone tries to take a baby from that nursery without authorization.
Patients count on having a secure and accurate medical record. That happens because of the
work of health information management managers and staff who oversee a hospital’s medical records. HIPAA compliance officers put measures in place to ensure a patient’s protected
health information—whether on paper or on a computer—is kept safe and isn’t accessed by
unauthorized individuals.
From housekeeping managers and staff to food services, it takes many people in different
roles to keep healthcare organizations running.
Health Service Organizations
There are numerous organizations that provide health services, including hospitals, integrated delivery systems, and nursing homes.
Hospitals are a central point to healthcare delivery, as they offer patient services (diagnostic and therapeutic) for med …
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