Comparison/ MHC6303 Week 2 Discussion

Week 2 Discussion Due: Wednesday 9/30/2020

 

Before beginning work on this discussion forum, please review the link “

Doing Discussion Questions Right

,” the expanded grading rubric for the forum, and any specific instructions for this topic.

Before the end of the Week, begin commenting on at least two of your classmates’ responses. You can ask technical questions or respond generally to the overall experience. Be objective, clear, and concise. Always use constructive language, even in criticism, to work toward the goal of positive progress. Submit your responses in the Discussion Area.

Refer back to the structure-process-outcome (S-P-O) model discussed in Week 1.

In addition, refer to the text reading pertaining to the quality management system (QMS) and answer the following questions:

· Compare how the two models define and measure quality outcomes.

· Which model best supports the framework of evidence-based medicine in defining and measuring quality outcomes? Why?

· How can an organization ensure that healthcare services are providing value to the patient? Justify using examples.

Submission Details:

· To support your work, use your course and textbook readings and also use the 

South University Online Library

. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

· Your initial posting should be addressed at 300-500 words. Submit your document to this Discussion Area by the due date assigned of this Week. Be sure to cite your sources using APA format.

· Respond to your peers throughout the Week. Justify your answers with examples, research, and reasoning. Follow up posts need to be submitted by the end of this Week.

From Teacher:

For W2 Discussion, you first compare Donabedian’s structure-process-outcome (S-P-O) model with the quality management system (QMS). You will find Exhibit 5.1 on page 66 of the textbook that describes the Quality Management System.

 EXHIBIT 5.1 Quality Management System Often, quality efforts focus on managing the inputs and conversion process that make up the system. The healthcare field regulates the quality of personnel inputs by various means, including licensure requirements, continuing education, and performance appraisals. Clinical trials and US Food and Drug Administration approval are two examples of ways to control the quality of technology inputs such as drug therapies. Clinical guidelines, process improvement, and standardization help maintain high standards for conversion processes. Controlling the quality of the inputs and conversion processes is intended to improve the quality of the outputs, such as patient clinical and functional status, satisfaction with services, cost-effectiveness, employee behaviors, and organizational culture. Adding a feedback loop creates a more dynamic process—one that leads to a more mature quality management approach. Feedback about the quality of the outputs guides efforts to improve the quality of the inputs and the conversion processes (see exhibit 5.1). Continuous feedback promotes continuous improvement. The Donabedian (1980) categories of medical quality measures and their relationship (structure → process → outcomes) support this continuous improvement model. In chapter 3, systems thinking is defined as “a view of reality that emphasizes the relationships and interactions of each part of the system to all the other parts” (McLaughlin and Olson 2012, 39). A system’s thinking approach to quality management involves improving the quality of the parts and understanding and improving the quality of the relationships between the parts. This system’s thinking approach requires managers to view health services organizations in a systems context. Four models are presented in this chapter to help managers better understand system relationships: the interconnected systems model, the three core process model, the Baldrige Performance Excellence Program framework, and the socioecological framework.

EXHIBIT 5.1 Quality Management System

Improve Inputs Improve Conversion ProcessesOutputs

–––––––––––––––––––––––––––––––––––––––––––––––––

Feedback

Source: Adapted from Tagg (2007).

From the customer’s perspective, the value proposition includes the whole bundle of benefits the product/service promises to deliver, not just the benefits of the product itself (Burns, Bradley, & Weiner, 2020). The organization determines value by assessing whether its transactions are profitable, whether it is proving value to stakeholders by creating a completive advantage, and whether it is providing value through its value chain.  As Burns, Bradley, and Weiner (2020) stated, it is a key challenge for healthcare organizations to deliver value, “defined as the quotient of quality divided by cost (p.4).  

An increasingly competitive environment, pressures to contain costs, and payers’ increasing demands for outcomes-based evidence are all emerging challenges to the healthcare organizations. Given that, healthcare organizations have revaluated its internal and external environments. To confront these challenges, healthcare organizations have to offer value-added services alongside existing products/ services as a means to improve health outcomes and gain a competitive advantage. 

Reference

Burns, L. R, Bradley, B. H., & Weiner, B. J. (2020). Shortell and Kaluzny’s healthcare management: Organization design and behavior (7h ed.).  Delmar Cengage Learning. 

· Use the following rubric as a guide to complete your discussion responses.

Response

No Submission

0 points

Emerging (F-D: 1-27)

27 points

Satisfactory (C: 28-31)

31 points

Proficient (B: 32-35)

35 points

Exemplary (A: 36-40)

40 points

Criterion Score

Quality of Initial Posting

No initial posting exists to evaluate.

The information provided is inaccurate, not focused on the assignment’s topic, and/or does not answer the question(s) fully. Response demonstrates incomplete understanding of the topic and/or inadequate preparation.

The information provided is accurate, giving a basic understanding of the topic(s) covered. A basic understanding is when you are able to describe the terms and concepts covered. Despite this basic understanding, initial posting may not include complete development of all aspects of the assignment.

The information provided is accurate, displaying a good understanding of the topic(s) covered. A good understanding is when you are able to explain the terms and topics covered. Initial posting demonstrates sincere reflection and addresses most aspects of the assignment, although all concepts may not be fully developed.

The information provided is accurate, providing an in-depth, well thought-out understanding of the topic(s) covered. An in-depth understanding provides an analysis of the information, synthesizing what is learned from the course/assigned readings.

/ 40

This table lists criteria and criteria group name in the first column. The first row lists level names and includes scores if the rubric uses a numeric scoring method. Participation

No Submission
0 points

Emerging (F-D: 1-13)

13 points

Satisfactory (C: 14-16)

16 points

Proficient (B: 17-18)

18 points

Exemplary (A: 19-20)

20 points

Criterion Score

Participation in Discussion

No responses to other classmates were posted in this discussion forum.

May include one or more of the following:
*Comments to only one other student’s post.
*Comments are not substantive, such as just one line or saying, “Good job” or “I agree.
*Comments are off topic.

Comments to two or more classmates’ initial posts but only on one day of the week. Comments are substantive, meaning they reflect and expand on what the other student wrote.

Comments to two or more classmates’ initial posts on more than one day. Comments are substantive, meaning they reflect and expand on what the other student wrote.

Comments to two or more classmates’ initial posts and to the instructor’s comment (if applicable) on two or more days. Responses demonstrate an analysis of peers’ comments, building on previous posts. Comments extend and deepen meaningful conversation and may include a follow-up question.

/ 20

This table lists criteria and criteria group name in the first column. The first row lists level names and includes scores if the rubric uses a numeric scoring method.Writing

No Submission
0 points
Emerging (F-D: 1-13)
13 points

Satisfaction (C: 14-16)

16 points
Proficient (B: 17-18)
18 points
Exemplary (A: 19-20)
20 points
Criterion Score

Writing Mechanics (Spelling, Grammar, Citation Style) and Information Literacy

No postings for which to evaluate language and grammar exist.

Numerous issues in any of the following: grammar, mechanics, spelling, use of slang, and incomplete or missing citations and references. If required for the assignment, did not use course, text, and/or outside readings (where relevant) to support work.

Some spelling, grammatical, and/or structural errors are present. Some errors in formatting citations and references are present. If required for the assignment, utilizes sources to support work for initial post but not comments to other students. Sources include course/text readings but outside sources (when relevant) include non-academic/authoritative, such as Wikis and .com resources.

Minor errors in grammar, mechanics, or spelling in the initial posting are present. Minor errors in formatting citations and references may exist. If required for the assignment, utilizes sources to support work for both the initial post and some of the comments to other students. Sources include course and text readings as well as outside sources (when relevant) that are academic and authoritative (e.g., journal articles, other text books, .gov Web sites, professional organization Web sites, cases, statutes, or administrative rules).

Minor to no errors exist in grammar, mechanics, or spelling in both the initial post and comments to others. Formatting of citations and references is correct. If required for the assignment, utilizes sources to support work for both the initial post and the comments to other students. Sources include course and text readings as well as outside sources (when relevant) that are academic and authoritative (e.g., journal articles, other text books, .gov Web sites, professional organization Web sites, cases, statutes, or administrative rules).

/ 20

Rubric Total ScoreTotal

/ 80

Overall Score

Overall Score

No Submission0 points minimum

There was no submission for this assignment.

Emerging (F to D Range)1 point minimum

Satisfactory progress has not been met on the competencies for this assignment.

Satisfactory (C Range)56 points minimum

Satisfactory progress has been achieved on the competencies for this assignment.

Proficient (B Range)64 points minimum

Proficiency has been achieved on the competencies for this assignment.

Exemplary (A Range)72 points minimum

The competencies for this assignment have been mastered.

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Kelly, P.L.S.D. L. (2017). Applying Quality Management in Healthcare. [South University]. Retrieved from 

https://digitalbookshelf.southuniversity.edu/#/books/9781567938821/

A mother arrives at the pediatrician’s office for her daughter’s six-month well-child checkup. As she has for previous checkups, she arrives 10 minutes early. Her daughter’s scheduled appointment time of 10:00 am passes and she is still waiting at 11:30 am. The front desk receptionist politely tells the mother that the pediatrician has been called to an emergency, saying, “I’m sure you understand. If it was your child, you would want the doctor to attend to her.” Although the mother understands the reason for the delay, this explanation does not change the fact that she has to pick up her son from preschool at noon. The mother asks if her daughter can at least get the immunizations today and have the rest of her checkup at another time. A clinic nurse hurriedly administers the child’s immunizations while quietly complaining to the mother that she is often too busy to get a lunch break. Dissatisfied with the hours wasted at the pediatrician’s office and disappointed with the need to return to finish her daughter’s checkup, the mother begins to investigate other healthcare options for her children. While the doctor at her current pediatric clinic seems highly trained and knowledgeable, the mother has concerns about the organization in which the doctor practices. The organizational aspects of the pediatric clinic are not meeting the mother’s expectations. In the broadest definition, an organization is a structured system designed to accomplish a goal or set of goals. In this example, the care providers and office staff are a pediatric health services organization designed to deliver healthcare to children.
Page 3

Why Focus on Managing Systems?

Providing the medical care (e.g., performing cardiac surgery) and producing the service (e.g., maintaining a clean environment) are functions of the clinical and technical professionals. Creating and managing the structured system in which clinical and technical professionals work is the role of management. The manager’s perspective and tactics may vary depending on his organizational level (e.g., senior administrative, middle management, frontline supervisory) and his scope of responsibilities (e.g., team, project, department, division, agency, organization-wide). Regardless, all persons holding management responsibilities in an organization are charged with finding ways to carry out, coordinate, and improve the organizational functions. As illustrated by the mother’s experience at the pediatric clinic, patients may not receive the benefits of good medical care when the system of delivery is poorly managed. Quality is not simply the obligation of clinical and technical professionals. The task of achieving quality outcomes from healthcare organizations is a shared responsibility belonging to those who provide medical care and produce services and the management professionals who oversee the system. Management determines how and what organizational goals are set; how human, fiscal, material, and intellectual resources are secured, allocated, used, and preserved; and how activities in the organization are designed, carried out, coordinated, and improved. The material presented in this book is intended to assist managers in the decision-making processes related to quality and safety in health services organizations.
Page 4

Systems Perspective

Whether US healthcare is a system is not only an academic question. Only under a systems view would one argue that there is benefit in improving interaction and coordination among healthcare organizations. Without the systems perspective, a manager would devote efforts to improvements within one area of the organization.

Even if US healthcare is viewed as a system, is it a good system? There are those that argue that the US health system is not effective in meeting the needs of all people and not always efficient in meeting the needs of patients. It is difficult to rationalize the goals of a system that invests in the most sophisticated and expensive services to save individuals while cutting back on the relatively inexpensive and effective services that would have prevented many poor outcomes in the first place.

As you read about systems models that can be applied to healthcare, try to relate them to situations you have observed. You will find that different models fit different situations. You may even have a preference for certain models. Remember, a model is a tool for viewing a system; it isn’t inherently right or wrong in itself. What matters is how well you use it to understand the system and, eventually, to improve it.

Reference:

Wiig, S., Robert, G., Anderson, J. E., Pietikainen, E., Reiman, T., Macchi, L., & Aase, K. (2014). Applying different quality and safety models in healthcare improvement work: Boundary objects and system thinking. Reliability Engineering & System Safety, 125, 134-144. doi:10.1016/j.ress.2014.01.008

Elton, J., & O’Riordan, A. (2016). Healthcare disrupted: Next generation business models and strategies (1st ed.). Hoboken, New Jersey: Wiley.

Chaos Theory

Chaos theory can also be used to describe how the US healthcare industry functions. Chaos theory explains that in large and complex systems, a small change in one condition can cause large and unpredictable changes in future conditions. Suppose a system comprises a large number of parts with many complex interrelationships among the parts. Even a small change in one part can lead to large changes in other parts or in the system as a whole. Where the interrelationships are not understood, the changes may be unpredictable.

In the past, every tinkering effort to address one of the three basic problems of the healthcare system—costs, quality, and access—has resulted in significant changes in one or both of the others. Others also suggest using chaos theory to study the healthcare industry. Perhaps systems theory is inadequate as the primary basis for curriculum design. The current health system may be equally well explained by chaos theory, which is based on the premise that the unfolding of the world over time is unknowable

References:

Richardson, M., & Schneller, E. S. (1998). Out of the box: Health management education in the 21st century. The Journal of Health Administration Education, 16(1), 87–97.

Baird, James,C.A.H.I., F.A.C.H.E. (2014). Leadership amidst chaos: How great managers transcend chaos, lean economic times, and lead their staff to success. Paper presented at the 99-103. Retrieved from https://search-proquest-com.southuniversity.libproxy.edmc.edu/docview/1639529639?accountid=87314.

Elton, J., & O’Riordan, A. (2016). Healthcare disrupted: Next generation business models and strategies (1st ed.). Hoboken, New Jersey: Wiley.

Measurement and Comparison

How would you determine which country provides better healthcare? This raises questions about the measurement of healthcare performance.

Would you compare an average hospital in Minneapolis to one in Winnipeg or Havana? Or should you include all hospitals in the country, as well as nursing homes and physicians? Or do population statistics, such as life expectancy and infant mortality, provide a better measure of performance?

There are organizations—public and private, not-for-profit and proprietary—that compare healthcare organizations and provide performance information to the public. You will read about such organizations this week. Pay particular attention to the performance measures they use.

Try viewing measurement questions from the perspective of a healthcare program or an organization manager and ask, “How would I like my program to be evaluated?” Use this perspective in your assignment on developing standards for measuring the performance of a specific healthcare service. After completing this exercise, you will be ready to start thinking about how to compare healthcare in Canada and in the United States.

This review of questions brings the manager to the realization that it is up to them to take the lead in defining quality for an organization. Read the following information for more information on these topics.

Resources:

Burstin, H., Leatherman, S., & Goldmann, D. (2016). The evolution of healthcare quality measurement in the united states. Journal of Internal Medicine, 279(2), 154-159. doi:10.1111/joim.12471

Polites, S. F., Habermann, E. B., Zarroug, A. E., Wagie, A. E., Cima, R. R., Wiskerchen, R., . . . Ishitani, M. B. (2015;2014;). A comparison of two quality measurement tools in pediatric surgery–the american college of surgeons national surgical quality improvement program-pediatric versus the agency for healthcare research and quality pediatric quality indicators. Journal of Pediatric Surgery, 50(4), 586. doi:10.1016/j.jpedsurg.2014.10.049