Continuous Quality Improvement (CQI) has a much-documented history in healthcare. Dating back to 1916, a Boston surgeon, Ernest Codman, established a set of criteria that sought to improve hospital care (Lombardozzi, 2011, internet). The five criteria later evolved into the Joint Commission on Accreditation of Hospitals, which set minimal standards for healthcare in hospitals, especially surgical departments (Lombardozzi, 2012, internet). The 1970s marked the beginning of a period known as divergence, when non-physician stakeholders, such as administrators, began to "define, measure, and report healthcare outcomes" (Lombardozzi, 2011, internet). By the 1980s, the CQI movement was nearly in full swing.
In 1986, the federal government began to play an active role in CQI in healthcare. The Omnibus Budget Reconciliation Act of 1986 greatly assisted the US Congress in studying healthcare outcomes with respect to Medicare (Lombardozzi, 2011, internet). Later, organizations such as the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), and, in 1999, the NQF was created by the 1998 President's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry (Lombardozzi, 2011, internet). By 2010, many of the pieces of the puzzle were put together for the passage of the Affordable Care Act (ACA), which required all stakeholders to coordinate "advisory work groups", such as Ad Hoc Safety and Dual Eligible Beneficiaries (Lombardozzi, 2011, internet). Indeed, the CQI movement has come a long way, and promises to become leaner and more efficient in the years to come.
Strengths: A comprehensive system that incorporates the skills of many overlapping agencies, more openness to public scrutiny, a leaner and more cost-effective approach, more accessibility to those who are uninsured.
Weaknesses: Overlap of agencies creates redundancy of processes, focus on cost-effectiveness can lead to lower-quality services, expanded bureacracy.
References
Lombardozzi, K.A.K., (04 Aug, 2011). Understanding the evolution of our national healthcare quality improvement process. Society of Critical Care Medicine. Retrieved from http://www.sccm.org/Communications/Critical- Connections/Archives/Pages/Understanding-the-Evolution-of-Our-National-Healthcare- Quality-Improvement-Process.aspx
Discussion of Initial Post by Sequoia
Sequoia,
References
US Department of Health and Human Services. (n.d.). Health Resources and Services Administration. Retrieved from http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/part2.html
Great post, Blendine. With regards to this particular case that involved the loss of $16,800 over a 58-day period, their strategy entailed more accurate bookkeeping on the part of the pharmacy department by tracking a variable. You addressed this very well. Although there were 15 other reasons why this problem could have occurred, the main reason for the error was that documentation was not properly entered into the Medication Administration Record (MAR). You also mentioned this aspect. Overall, the strategy was to prevent monetary loss, and improve the efficiency of IV medication delivery without making mistakes. Currently, there is a lot of waste caused by errors made in the administration of patient care. These problems affect patient care, but they also affect healthcare costs, which are spiraling out of control. I agree with you that the healthcare system is a growing operation. Unfortunately, its quick growth places an immense burden on the efficient delivery of quality healthcare (Patton, 2015, internet). As there was a system of checks and balances in place, the financial problem was discovered and corrected immediately -- a definite strength of the hospital's TQM. Moreover, a small team, as you pointed out, was a strength of overall TQM. Hence, the TQM team found the monetary loss, and proved that TQM was an effective administrative decision. Thus, in this respect, TQM was strong, and the hospital rebounded quickly, despite the financial loss. Weaknesses in TQM included the fact that, although a team was formed that discovered one major financial MAR error, 15 other errors were not identified and corrected by the team. Another weakness of TQM was the fact that the inefficient situation had been allowed to continue for so long without the implementation of new protocols. Corporate headquarters should always be made aware of new protocols, as well as departmental losses such as the $16,800. This was yet another weakness of TQM at the time. In such a situation, corporate might do well to install even more TQM safeguards. Many staff disliked the changes, causing dissent among the ranks. Although they realized TQM was necessary, they did not like change, and many chose to quit their jobs, or were terminated by their supervisors. The next step in TQM should be to further refine the MAR, and require that nursing staff make entries in a timely manner. In addition, the 15 other types of medical errors need to be identified and corrected, before further medication documentation mistakes are made. Overall, I thought your post was very informative, Blendine.
References
Patton, M. (29 Jun, 2015). U.S. health care costs rise faster than inflation. Forbes. Retrieved from http://www.forbes.com/sites/mikepatton/2015/06/29/u-s-health-care-costs-rise- faster-than-inflation/
