Assignment:
Part 1
The origins of quality improvement can be linked to the work of several US contributors: Walter A. Shewhart, W. Edwards Deming, Joseph M. Juran, Armand V. Feigenbaum, and Philip B. Crosby (McLaughlin and Kaluzny 1999). The study of quality began in factories during the 1950s and focused on improving the efficiency of the individual worker. Shewhart, considered the father of modern quality control, was one of the first to be published in the field. He is most widely recognized for developing statistical process control and the plan-do-check-act (PDCA) cycle, both of which are still used today.
The PDCA cycle, also called the Shewhart cycle, combines management thinking with statistical analysis (Best and Neuhauser 2006). When Shewhart worked at Hawthorne Plant in Cicero, Illinois, he met Deming and Juran, both of whom would go on to champion his methods in other fields (Best and Neuhauser 2006). Shewhart, while working for Bell Laboratories, also promoted the idea that price was not an indication of value.Deming, an American mathematical physicist, worked in Japan during the 1950s to help rebuild the country's economy after World War II. Although the Japanese implemented Deming's processes in the 1950s, US industries did not adopt them until the 1980s (Saunders and Saunders 1994).
Deming also worked as a consultant to a variety of companies, including Ford Motor Company, Xerox, and Florida Power and Light. He was a proponent of statistical process control (SPC) based on the work by Shewhart. According to Deming, quality can be defined by what customers want and are willing to pay forand building quality into a process is less expensive than attempting to eliminate defects after the fact (Saunders and Saunders 1994). Juran is known for emphasizing the management aspect of quality control. His Quality Control Handbook, published in 1951, introduced the idea that quality control
Interest in continuous quality improvement (CQI) began to take shape in the healthcare sector in the early 1990s, driven by the continuous need to improve medical quality and management. Having previously been applied in other industries, beginning with Shewhart's work in the 1920s with Western Electric Company, CQI practices were first implemented in healthcare in hospitals and inpatient settings. In these settings, they helped monitor procedures and reduce medical errors that could result in malpractice or increased mortality rates (Kritchevsky and Simmons 1991). Total quality management (TQM), which has roots in the principles set forth by Deming, Juran, and Feigenbaum, is a "participative, systematic approach to planning and implementing a continuous organizational improvement process" (Kaluzny, McLaughlin, and Simpson 1992, 257). It is characterized by its commitment to customer focus, con-tinuous improvement, and teamwork.
The TQM concept was not implemented in US industries until the 1980s, but organizations in the healthcare sector soon took notice. About a decade later, TQM in clinical health settings was helping to improve medical, administrative, and clinical care processes. Avedis Donabedian, who came to be known as the father of healthcare quality, identified the need to focus on systems in healthcare to improve quality. His framework assessed healthcare quality by looking at the structure of the setting in which care is provided, the process of clinical care (i.e., how care is provided), and the outcomes that are directly associated with the care. Structure includes the characteristics, including physical plant and personnel, of the care setting. Process measures are focused on whether the patient received the "standard" of requisite care (e.g., beta blockers on arrival for patients with acute myocardial infarction, smoking cessation counseling for patients with conges-tive heart failure). Outcome measures refer to a person's health status or change in health status (e.g., mortality and morbidity rates, 30-day readmission rates, rates of nosocomial infections such as bloodstream infections and urinary tract infections).
The Institute of me dicine and the need to Implement Quality Improvement Around the turn of the millennium, the Institute of Medicine (IOM) published two major reports, titled To Err Is Human (2000) and Crossing the Quality Chasm (2001), that identified significant deficiencies in the quality of US healthcare. The reports documented problems of overuse, misuse, and underuse of healthcare services, all of which contributed to a widening gap between ideal and actual patient care (Health Affairs 2011; IOM 2016). Perhaps the most startling finding from the reports was that between 44,000 and 98,000 inpatient hospital deaths per year were caused by preventable medical errors (Health Affairs2011; IOM 2000). As a result of these findings, the IOM turned its efforts toward defin-ing healthcare quality more clearly, identifying ways to measure and evaluate quality, and improving access to quality. The IOM defines high-quality care around six specific aims for improvement, and it offers ten principles for redesigning healthcare systems to achieve
MLA 8th Edition (Modern Language Assoc.)
Mary Helen McSweeney-Feld. Dimensions of Long-Term Care Management: An Introduction, Second Edition. Vol. Second edition, Health Administration Press, 201
Submit your responses as an attached document (MS Word is preferred). Include question numbers to indicate which question you are answering.
Here are this questions:
1. What are some of the key drivers for the improvement of quality of care and quality of life for residents of nursing facilities?
2. Why is the Minimum Data Set an important tool for both quality and financial improvement initiatives in nursing facilities?
3. Describe the importance of IOM's six aims for quality improvement.
4. What are the main sources of payment for long-term care services in the United States? How does the US financing structure compare with long-term care financing in other countries?
5. What impact will the baby boom generation have on the cost of long-term care services over the next decade and beyond?
Part 2
Quality initiatives and ongoing improvements in long-term care have led to many positive outcomes for consumers, and they have changed the face of long-term care from a reactive to proactive environment. Today's organizations are faced with a combination of demands, including expectations of person-centered care and good state and federal survey results, as well as changes in consumer wants and needs. The long-term care industry is committed to the process of ongoing quality improvement. It realizes that the best way to achieve and maintain excellence is by identifying best practices and understanding what needs to be improved.
David Rogers, a retired machinist, moved into the Sunset by the Sea continuing care re-tirement community in 2012 with his wife, Daniella. Daniella had fallen and had difficulty walking on her own. In September 2014, during a seven-day stay in the hospital, Rogers was diagnosed with abnormal heart rhythms and given Coumadin, a popular blood thinner that could help reduce the risk of stroke.Both the hospital and Rogers's doctor instructed the long-term care community to give him a specific test to assess his clotting rate, but the test was never done. Instead, the staff gave him a test intended for patients taking heparin, a different blood thinner.
During early October, staff members made notes in Rogers's chart about bruising on his body. One entry noted a large bruise on his stomach that was purple in the center and green and yellow on the outside. The nurses reasoned that the bruises must have come from the lift used in transferring him.Rogers was brought to the emergency room after midnight on October 15 because of bleeding from his gums. At the emergency room, a test showed that his clotting rate was so slow that he might never stop bleeding on his own.
The doctor found Rogers's bruises so severe and unusual that she asked the hospital to photograph them. Desiree, Rogers's daughter, remarked that the nurses must have noticed the bruising, and she asked why they failed to do something about it.At the hospital, doctors gave Rogers vitamin K in an attempt to counteract the Couma-din, but Rogers grew agitated and confused and had difficulty breathing. Rogers's daughter grew troubled by the lack of improvement and asked the doctor if there was any hope.
The doctor said, "He's weak, but we are doing all we can."As Rogers's condition worsened, his wife became ill as well. Daniella was taken to the same hospital, and the family moved the two to the same room so they could be together.Rogers was mostly unresponsive when he was brought into the room. But when the staff placed Daniella's hand in his, he woke up and was able to speak.Rogers died the next morning. Daniella passed away three weeks later. "After Dad passed away," Desiree said, "she gave up."
QUESTIONS.
1. Describe the event briefly. What safety technique could be used to investigate this event? Discuss the key contributory factors that led to this event.
2. What type of quality management and safety processes should have been in place to prevent this medical error? Provide a rationale for your interventions.
3. How will you know that care has improved at the nursing home and such events can be prevented in the future? Discuss measures that you will track to assess improvements.
4. What was the impact of this medical error on Mr. Rogers's wife and family?
MLA 8th Edition (Modern Language Assoc.)
Mary Helen McSweeney-Feld. Dimensions of Long-Term Care Management: An Introduction, Second Edition. Vol. Second edition, Health Administration Press, 2017.