April 18, 2015
HCA 410: Quality Improvement Methods
Professor John Bruning
The objective that drives Continuous Quality Improvement (CQI) programs is the idea of improving health care by pinpointing problems areas, carrying out corrective action, reviewing the results and closely examining the effectiveness of the process. A crucial part of Continuous Quality Improvement is the observation of both high risk, excessive volume or predisposed problem areas of health care; it is not necessary or the goal to study and observe all aspect of health care. The deal target areas of study would be the intake process, access to care, emergency care, the continuity of care and adverse patient events, as well as all patient fatalities. Continuous Quality Improvement goes far beyond the level of hospital care. There have been organizations devoted to implementing Continuous Quality Improvement directly and indirectly. These organizations offer accreditations that impact how business is done in healthcare but most importantly they highlight and stress the safety of patient while providing the physician with the most current methodology of practice. According to McLauglin, “there are three basic CQI strategies: true process improvement, competitive advantage, and conformance to requirements. Some institutions genuinely desire to maximize their quality of care as defined in both technical and customer preference terms. Others wish simply to increase their share of the local health care market. Still others wish to do whatever is necessary to maintain their accreditation status with bodies such as The Joint Commission (TJC) and National Committee on Quality Assurance (NCQA)” (McLaughlin 2013). Both these organizations are somewhat similar in ways and both offer services that can emphasize the quality of care delivered by each medical facility. Accreditation is very much like a seal of approval that a medical facility has met the minimum standard and has gone beyond what has been set forth by organizations like NCQA and TJC. The Joint Commission was formally known as Joint Commission on Accreditation of Healthcare Organization (JCAHO). This simple renaming changed nothing within the organization or their process. Simply, “The Joint Commission” was the name used by most professionals in the healthcare field. The Joint Commission is a self-governing, nonprofit organization that assesses and certifies nearly 20,500 healthcare organizations and their programs nation wide. By TJC’s standards, healthcare organizations must go through an in person evaluation by a Joint Commission team of surveyors, at a minimum of every three years.
The extent of assessments by TJC is general; it contains medical facilities, in home care agencies, providers of medical equipment, home for the elderly, rehabilitation centers, and surgical and medical laboratories.
In 1997, The Joint Commission introduced the ORYX Initiative by incorporating process outcomes and other medical facility performance data into their accreditation process. “The ORYX initiative represents one of The Joint Commission's first steps in focusing the accreditation process on key patient care, treatment, and service issues. Using ORYX as a tool, The Joint Commission has been changing the accreditation process from one in which health care organizations take a "snapshot" of their performance every three years to one in which they have more of an ongoing picture of their performance from which to continuously focus their quality improvement activities” (TJC 1995). The information gathered from the ORYX Initiative allowed TJC to develop “National Patient Safety Goals”. The purpose of TJC’s National Patient Safety Goals is to improve the safety of patient while at the hands of a medical facility. These safety goals underline the issues that are most prevalent and aims to correct them by introducing the process as a standard application