BUS4123 Quality Assurance and Risk Management
Unit 1 Discussion
DQ1 Quality Management Organizations
Read the Discussion Participation Scoring Guide to learn how the instructor will evaluate your discussion participation throughout this course.
You will investigate one national organization that is focused on quality management or quality assurance.
If your last name begins with A–C: you have the National Committee on Quality Assurance (NCQA).
If your last name begins with D–F: you have the Institute for Healthcare Improvement (IHI).
If your last name begins with G–J: you have the Agency for Healthcare Research and Quality (AHRQ).
If your last name begins with K–N: you have the Ambulatory Care Quality Alliance (AQA).
If your last name begins with O–R: you have The Joint Commission (TJC).
If your last name begins with S–U: you have the Leapfrog Group.
If your last name begins with V–Z: you have the National Quality Forum (NQF).
Carefully investigate the organization that you were assigned (linked in Resources). You may consult the organization's website, your textbook, and the Capella library. Post a 250-word substantive post on the role of that organization in monitoring and promoting quality efforts in health care. Make sure to create this post using your own words; do not copy and paste information from the website or readings.
Response Guidelines
Reply to two learners who have been assigned to a different national organization than the one that was assigned to you. Give examples of how the quality efforts of the organization your peer mentioned affect patients directly and indirectly. Give examples of how those quality efforts can affect medical administrators directly and indirectly.
Finally, give your assessment of the quality of those monitoring and quality efforts in the organizations your peer mentioned.
Resources
Discussion Participation Scoring Guide.
National Committee for Quality Assurance (NCQA).
Institute for Healthcare Improvement (IHI).
Agency for Healthcare Research and Quality (AHRQ).
AQA.
The Joint Commission.
The Leapfrog Group.
National Quality Forum.
DQ2 Case Studies in Measuring Quality
Chapter 1 of Dlugacz (linked in Resources) provides foundational discussion to what quality measures actually measure. Chapter 2 provides several case studies demonstrating the value of quantifying and measuring quality. Pick one of the following:
Case Example: Cardiac Mortality (p. 24).
Case Example: Intensive Care Unit (p. 26).
Case Example: Falls (p. 30).
Provide a 250–300 word analysis of your chosen case. Discuss what precipitated data collection for your case, what data was collected, and how that data applied to change or improve business practices. Is there anything different from what you would do in the face of a similar case?
Response Guidelines
Respond to two learners who have analyzed a case different from the one you chose. Give your opinion as to how the data could have changed or improved business practices differently. Explain your reasoning.
BUS4123 Quality Assurance and Risk Management
Unit 2 Discussion
DQ1 National Organizations: Measuring Quality
Based on the national quality management organization you were assigned in Unit 1, consider the types of measures that your organization is involved in on the national and local health care scene.
In a 250- to 300-word response, discuss one specific measure or quality assurance activity that your assigned national organization works on. Do you see evidence of these efforts in your own organization or in your community?
Response Guidelines
Respond to two learners who have been assigned a different organization. Comment on the specific measure or quality activity your peer chose. Do you see evidence of these measures or qualities in your organization or community? How are you indirectly or directly affected by these measures as a member of your organization or community?
DQ2 Using Data to Improve Organizational Processes
Chapters 3 and 4 of Measuring Health Care Quality focus on data collection methods and ways to use this data for organizational process improvement. Both chapters provide several case studies to demonstrate this process. Consider the quality process called PDCA (Plan Do Check Act) cycle. From your own work experience or work within an health care organization, consider other situations where data may be collected and used to improve an organizational process.
In a 250–300 word substantive post:
Provide your own unique case study of a process that could be improved within your own organization.
Discuss what types of data would need to be collected and how that data would be used to seek improvements.
Provide your post following the Plan Do Check Act (PDCA) method.
If you are not employed, feel free to search the Capella databases for real cases that have used the PDCA method to improve a specific process, and use those to complete the bulleted list of instructions above.
Response Guidelines
Assume the role of quality management director. Respond to two other learners with feedback that might improve the project suggested or ask a thoughtful question of a piece that may require more investigation. What would you suggest for improving the PDCA method your peer provided? Be specific. As the quality management lead, are there any potential gaps? Are all areas answered sufficiently?
BUS4123 Quality Assurance and Risk Management
Unit 3 Discussion
DQ1 Data-Driven Organizations
Health care organizations rely on data to:
Define value for their products.
Improve market share.
Maintain efficient use of resources.
Ensure that patients receive evidence-based care.
Reduce variation in treatment.
Understand the relationship between intervention and outcomes.
Communicate leadership goals.
Compare one organization to other similar organizations across the country.
Improve accountability of staff.
Identify problems and evaluate solutions.
Establish guidelines for delivery of care (Dlugacz, 2006, pp. 63–64).
You are the CEO of an ambulatory care clinic. Your facility provides outpatient, orthopedic procedures. Your facility directly competes with the local hospital. The hospital participates in several quality initiatives and is accredited by The Joint Commission (TJC). The hospital has created care maps to ensure evidence-based care is provided to all orthopedic patients. Your facility is owned by a physician group. This same physician group also staffs the hospital. You are not aware of any types of care maps or evidence-based practice polices and procedures within your ambulatory clinic.
The hospital administrator is coming to meet with you in two days. This administrator is concerned about the financial loss of patients from the hospital due to the increasing trends of these patients being served by the ambulatory care clinic. The physicians have come to you to ask for a positive solution. What type of data will you collect? How will you respond to issues of quality? What do you project the outcome should be?
In a 250- to 300-word post, present an outline of the steps (in prioritized order) you will take to resolve this current issue.
Response Guidelines
Consider the viewpoint of the Hospital Administrator. Respond to two learners. What are the pros and cons to sharing doctors between the hospital and clinic? What ethical issues might arise in this situation for doctors and patients? Is there a way that the hospital and clinic can differentiate services to create a new solution (different from the solution your peers mentioned)?
DQ2 Health Care Disparities
Providing care differently to those who may be of an ethnic minority, speak a different language, or be of a different socioeconomic class, is a significant problem in the way health care is delivered and measured. Health care managers need to constantly be aware of the specific issues related to health care disparities.
Health care managers can use the Agency of Healthcare Research (AHRQ) as a resource. The AHRQ created a National Healthcare Disparities report to educate health care professionals in this area. Please review this report and any other resources you may locate related to health care disparities from the Capella library or Internet. These resources will help you create your post.
You are the CEO of a major organization that manages multiple primary care clinics across a geographic area. Within your service area are two new groups of immigrants that represent Hmong people from Southeast Asia and Somali refugees from the war-torn African nation of Somalia. Further, in the summertime you also have a significant population of legally present Hispanic farm workers who bring their entire families to the area.
Considering the information from AHRQ, the Office of Minority Health, along with other sources, discuss how you will ensure that your organization provides quality medical care to those who are of an ethnic minority and likely have a language other than English.
Provide a 250–300 word post of the top three things you would do to begin to become a culturally competent health care organization. Respond to at least two other learners with your perspective or support.
Response Guidelines
Take on the role of a minority patient seeking primary care. Respond to two learners. Discuss several barriers to quality medical care for minorities. Suggest ways to overcome those barriers that you feel an administrator should be responsible for.
Also, your peers suggested ways to ensure the organization provides quality medical care to minorities. Based on your research, suggest at least one more idea for how to provide quality care to minority populations.
BUS4123 Quality Assurance and Risk Management
Unit 4 Discussion
DQ1 Determining Accountability
You are the owner and CEO of group homes that serve those with mental impairments. Each group home services six to ten adult residents. Your group homes are located in neighborhoods throughout the community. The group homes are staffed with caregivers who have been trained as Certified Nurse Assistants (CNAs) or Home Health Aides (HHAs). You have a Director of Nursing (DON), an RN, who is responsible for writing the medical care plans and ensuring the needed medications and treatments are provided for each resident. The medications are given by the caregiver staff of each building.
The DON has come to meet with you. The DON reports that the medications at one facility are not being given on time, and some appear to be missing. The DON is particularly concerned about pain medications for one resident with rheumatoid arthritis. This client has been experiencing more pain symptoms and seems to be in tears often in the later day due to pain. The DON is concerned that this resident's pills have actually been stolen.
You contemplate your next steps. What will you do? Design a plan of what needs to happen and who may be accountable. How do you follow the PDCA model while moving swiftly on this issue?
In a 250- to 300-word post, outline your plan. Be sure to highlight who is accountable for each step of your plan. Your plan should have a minimum of five steps.
Response Guidelines
In the role of the DON of the facility, respond to the PDCA plan of at least two other learners. Provide your thoughts on the CEO's plans. What is your role in the PDCA plan designed by the CEO? Is the role appropriate? Who is most accountable–the CEO or the DON?
DQ2 Media Messages
The media carries messages rapidly across all areas of the nation. The media has been successful at uncovering fraud, discovering specific health issues, and disseminating helpful information. The media also may create challenges for health care managers faced with different crises and situations. Health care managers must be aware of the impact the media may have on their own organization.
Response Guidelines
You are the administrator of a local nursing home. During the evening shift, one of the cognitively impaired residents eloped (escaped from the facility). This resident was found several miles from the facility six hours later huddled in a ditch, cold, and dirty. You have spent most of the night dealing with the staff involved, the resident's family, and local law enforcement. As you turn toward your office door at 8 a.m., a reporter is waiting for your statement.
In a 250- to 300-word response, develop your "media release" statement. Carefully word this piece recognizing that you want to continue to present your facility in a favorable light in the community and do not wish to pinpoint (in the media) who the accountable staff may be. Provide a response to at least two other learners.
For two other learners, respond to the media release as a patient advocate. Does the media release provide a balanced response to the incident? Is the public's right to know balanced by the rights of privacy for the patient? Is there a feeling that the facility responded correctly?
BUS4123 Quality Assurance and Risk Management
Unit 5 Discussion
DQ1 Using the FMEA Tool
Visit the website of the Institute for Healthcare Improvement (IHI) (linked in Resources), which provides a forum for health care organizations to share their FMEA success stories. There are at least 22 different categories included in this database. Peruse a wide variety of reports. Choose one FMEA success story.
Response Guidelines
Provide a 250–300 word overview of your chosen FMEA report from the IHI website. Describe the facility, the process that this facility chose to work on, and the outcomes found. Suggest any other improvements this facility might consider as it builds on this success.
Respond to at least two other learners. Compare and contrast the highlights of your own FMEA report to that of the other learner. Do you see value for organizations to publicly report their own quality initiatives to the IHI? Who would need to approve such submissions from a facility?
Institute for Healthcare Improvement (IHI).
DQ2 Emergency Department Case
You are the CEO for a hospital that constantly experiences overcrowding in the Emergency Department (ED). Your facility struggles with appropriate staffing and is currently providing uncompensated care to as many as 20% of all patients who come to the ED. Your current data-gathering efforts point out a problem with treating those who come to the ED with pneumonia. Current Centers for Medicare and Medicaid (CMS) guidelines and The Joint Commission (TJC) standards both require that patients with pneumonia receive antibiotics within four hours of admission to the ED. Your facility's current data demonstrates an average of six hours. You are out of compliance. Continued noncompliance will result in negative financial outcomes.
Response Guidelines
In a 250- to 300-word response, discuss what your plan of action will be. What should you do with this data? How will you turn this situation around? Create a short outline of your steps. Who will you involve in this plan?
Respond to two other learners with your perspective or support. Take on the role of the nurse manager of the ED. Are you satisfied with the proposed plan of action by the CEO?
BUS4123 Quality Assurance and Risk Management
Unit 6 Discussion
DQ1 Risk Management: A Profile of the Role
Risk management is a developing field in health care. The readings for this week, along with the link to the Health Care Compliance Association (HCCA), discuss what risk manager or compliance officer responsibilities are in different health care organizations. Job titles for this area include compliance officer, risk manager, chief risk officer, and compliance consultant.
Exhibit 2.5 on page 59 of the Carroll textbook (linked in Resources) provides a lengthy list of major responsibilities for a chief risk officer. Review this exhibit. Pick one area of responsibility from this exhibit and discuss the possible activities that are related to this responsibility area.
In 250 to 300 words, discuss a particular area of responsibility for a chief risk officer in a health care organization.
Response Guidelines
As the director of quality management, respond to at least two other learners with a substantive post of support, new learning, or alternative viewpoint. In your post, consider how the chief risk officer and the director of quality management will work on this particular responsibility area. Is there room for collaboration? Is this a role only held by the chief risk officer? Who reports to whom?
Risk Management Handbook for Health Care Organizations.
DQ2 Creating a Just Culture
Health care organizations are working toward a just culture. Formerly, the medical culture was one of the "ABCs of Accuse, Blame, and Criticize" (Carroll, 2009, p. 95). With the patient safety movement now in full force, the idea of a new organizational culture has emerged. The just culture of safety provides for a set of values, guiding principles, or ways of thinking to be shared by all members of the organization.
Pick a health care organization or area (hospital, skilled nursing facility, physician's office, dental office, health plan, group home, or assisted living facility, for example). You are a risk management consultant. Discuss how you would introduce the idea of a just culture within this type of organization.
Response Guidelines
As the administrator for the organization discussed, respond to at least two other learners. Provide a substantive viewpoint on why you agree, disagree, or have additional thoughts to improve a just culture for your organization. Raise questions for the consultant. Is the plan feasible for your organization?
Reference
Carroll, R. (2009). Risk management handbook for health care organizations (5th student ed.). Hoboken, NJ: Wiley. ISBN:9780470300176.
BUS4123 Quality Assurance and Risk Management
Unit 7 Discussion
DQ1 The OIG Work Plan: Fraud Focus
The Office of Inspector General (OIG) develops a yearly work plan. This work plan outlines the many different areas that the OIG will focus on for fraud issues in the next year. A link to the 2009 OIG Work Plan has been provided in this unit's study. This is a lengthy document–It is 115 pages long. Please be patient while it loads. You will need to use this document as the source for this discussion thread.
Review the 2009 OIG Work Plan. Select one topic area within the work plan. As the risk manager responsible for this area, discuss what you would do to ensure that your facility is in compliance.
Begin your post with an introduction of the specific area and the OIG's concern. Delineate the steps that you will take to ensure that your facility is in full compliance with this area. This post should be 250 to 300 words in length.
Response Guidelines
You are a new OIG inspector charged with ensuring that health care organizations are adhering to regulations. As the OIG inspector, respond to at least two other learners with a substantive post. Compare and contrast your own thoughts as the inspector to the steps outlined by your colleague, the risk manager. Are there any missing steps for the plan? What other types of concerns might you have?
DQ2 Early Warning Systems in Risk Management
Chapter 6 of the Carroll (2009) textbook includes discussions on early warning systems that should be used to minimize risk. The chapter focuses on national organizations along with various state laws and examples of how such systems have impacted and reduced risk for many different health care organizations.
Investigate early warning systems in risk management. Pick a specific health care organization type (for example, hospital, emergency department, physician's office, laboratory, dental office, health plan, et cetera). Describe at least two elements that would be needed for an effective early warning system for this specific health care organization.
Response Guidelines
You are clinical lead for the organization. Respond to at least two other learners. In a collegial format, provide additional thoughts of at least one other element that could be considered for the early warning system designed by that learner. Provide your thoughts on the potential impact that an early warning system might have on your own role or the way you provide care to patients. Will the way you supervise others change due to this system? What would be the implications for such change?
BUS4123 Quality Assurance and Risk Management
Unit 8 Discussion
DQ1 Corporate Board Responsibility
Corporate boards are responsible for ensuring that the organization remains in compliance with all areas of operation. Boards need to work in tandem with the administrative staff. Boards must ensure that they review all areas of health care organizations from financials, operations issues, medical error reporting, credentialing of providers, and other potential risk areas. Review the readings and the PowerPoint presentation in this week's readings.
What should the board know? Create a one-page, single-spaced memo as a member of a governing board for a health care organization addressing the organization's CEO. List the reports that you would like to have prepared for next month's board meeting.
Response Guidelines
Assume the role of the CEO who received the memo. Respond to the memos of at least two other learners. You may wish to suggest other information that may be considered or another perspective that could be considered. Does the memo reflect collegiality and a sense of collaboration? Do you feel compelled to act? Should you react to this situation or should you take a proactive approach? Why? How?
DQ2 The Credentialing Function
Credentialing of clinicians is a specific area that requires integration of quality improvement with risk management functions.
Credentialing is an official process that all health care organizations must complete. Organizations should use The National Practitioner Data Base (NPDB) for ensuring that licensed providers have no records of fraud, lawsuits, et cetera. In addition, state licensing boards must also be consulted to confirm that the clinician is licensed and may be employed by your organization.
You are the risk manager in charge of credentialing of a large teaching hospital. All health care providers must be credentialed prior to working with patients. Consider one of the following:
foreign-trained medical students.
on-call registered nursing from a staffing agency.
a physician with three pending lawsuits from patients injured by the physician.
What type of credentialing needs to be considered for your choice? Which databases should be checked? What type of background should be collected? Create a 250–300 word response.
Response Guidelines
You are the staffing coordinator for the large teaching hospital. Staffing is very tight. You need every available body to work. The medical students are needed for help with care on the nursing floors as well as in the ER. The urgent care is staffed by several medical students too. Nursing staff is so short that you have relied on on-call and staffing agencies for at least 10 percent of each shift for the last month. You have had complaints that several nurses seemed to have difficulty understanding English and two have been caught smoking in a medication room. The physician is badly needed in orthopedic. Patients with fractures have had to wait upwards of 24 hours to have surgeries.
As the staffing coordinator, what response do you have to the risk manager in credentialing? Will you wait to make sure that credentialing is complete? Will you look at ways to circumvent the system? What additional perspectives do you have? Compare and contrast your own thoughts on this post to those provided by a colleague.
BUS4123 Quality Assurance and Risk Management
Unit 9 Discussion
DQ1 Changes for Improvement
Organizational risk can be managed through many different methods. The Institute for Healthcare Improvement (IHI) offers a variety of resources to assist with organizational risk analysis, change methods, and applications. There are best practice examples and planning documents too. This discussion will focus on ways to develop a culture of safety through organizational risk analysis.
Go to the IHI's Web page "Develop a Culture of Safety" (linked in Resources). Scroll to the "Changes for Improvement" section. Choose one of the topics listed in this area. In a 250–300 word post, synthesize this topic. Propose how this particular topic may be used for your own organization.
Response Guidelines
Respond in a compare-and-contrast mode to at least two peers who chose a topic different from the one you chose. Discuss the similarities and differences between yours and other learners. Does the other learner's topic have merit for your own organization?
DQ2 Incident Reporting
For all of the efforts put forth in risk analysis and risk management, errors and incidents will continue to occur. All health care organizations need incident and accident reports. This discussion concentrates on this type of reporting and analysis.
Based on the discussions in Chapter 6 of the Carroll text (linked in Resources) and the additional resources found on the IHI and HCCA websites, create a one-page incident report. Please state the type of health care environment (hospital, physician's office, et cetera), and the type of incident your report would be used for in this environment. Attach your Word document to this discussion.
Response Guidelines
Respond to at least two peers by completing the incident report created by each learner. Provide a paragraph discussion of the strengths and weaknesses of each incident report that you completed as a response to this discussion thread. Are the directions clear? Do you understand what your responsibilities are to report an incident?
BUS4123 Quality Assurance and Risk Management
Unit 10 Discussion
DQ1 Risk Management in Information Technology
Information technology is a specific area of concern for risk managers in health care. Health care organizations are beginning to create risk management information systems (RMIS) to automate and provide comprehensive databases for information tracking. In addition, the mandates toward electronic health records (EHRs) also require unique consideration in risk management programs.
You are the risk manager working with an organization getting ready to implement a new electronic medical record (EMR) system. After reading the textbook chapters and the additional resources, create a security checklist that will be important for you to complete prior to the EMR system "going live." This checklist should have at least six steps highlighted and discussed. Consider any potential barriers.
Response Guidelines
Respond as the chief medical officer (the physician lead for the organization) to at least two other learners and their checklists. Provide two additional checklist items that could be considered for each of the other learner's security checklist. What are important issues that the risk manager should consider when dealing with the physician group? What role might the chief medical officer play in this "go live" project?
DQ2 Risk Management Analysis
For the Unit 7 assignment, you identified one specific risk management issue that you would use to create an Organizational Risk Management Plan for your Unit 9 assignment. For this discussion, explain how you would implement the Plan, Do, Check, and Act (PDCA) method for your chosen risk management issue. PDCA is considered a quality improvement method based on Deming's 1950 work: "PDCA is based on the scientific method of proposing a change in process, implementing the change, measuring the results, and taking appropriate action" (Carroll, 2009, p. 459). Be sure to reflect on the use of the PDCA analysis we also completed in the quality management portion in Unit 2 of this class.
Plan: Determine goals for a process and changes needed to achieve them.
Do: Implement the changes.
Check: Evaluate the results in terms of performance.
Act: Standardize and stabilize the change or begin the cycle again, depending on the results (p. 459).
Describe how you would apply the PDCA cycle to your risk management issue choice. In a 250–300 word analysis, discuss each step. Be sure to provide at least a sentence on recommendations that you would make to senior management, the board of directors, or the facility administrator or CEO.
Response Guidelines
Respond to at least two other learners. Assume the role of the CEO for each organization. Provide input to the learner, suggesting ways that this PDCA analysis data would be collected and reported within the organization. Point out any potential flaws or gaps in the analysis provided. Discuss how you would see the value in continuing to analyze this particular risk management issue.
Reference
Carroll, R. (2009). Risk management handbook for health care organizations (5th student ed.). Hoboken, NJ: Wiley. ISBN: 9780470300176.
