Obtaining Measuring and Enhancing Quality in the Delivery of Health Services Research Paper

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Project Management, Sustainability and Whole Lifecycle Thinking

Healthcare Services Delivery

Discuss briefly who or what should be drafting quality standards in medicine. Should we trust insular professional groups to protect the public interest? How about politicians? Litigation attorneys?

The realm of administering healthcare services and medicinal care has historically been considered to be a higher calling of sorts, and like the sciences, arts, or religious studies, it has been difficult for society at large to quantify the crucial quality standards necessary to regulate the industry. One would reasonably expect nurses, doctors, surgeons, and other healthcare workers to maintain a certain level of professional pride within the hospital or private practice setting, but the disconcerting rise in medical malpractice litigation throughout America demonstrates that medicine, like any other product or service, must be strictly controlled if it is to be brought to market in safely and effectively. The role of government in monitoring and regulating the healthcare industry has been long debated, and the bitterly contested passage of President Obama's Affordable Care Act, a law aimed at revising the country's health insurance system through the creating of a federal health insurance exchange to facilitate increased competition among insurers, has rekindled the debate over who holds the ultimate responsibility for regulating the care provided by hospitals, community clinics, and private practices. Solving any complex problem requires the collaborative cooperation of all key stakeholders involved, which is why I believe an annual forum should be used to provide healthcare workers, patients, medical malpractice litigators, government regulators, and insurance company representatives to contribute their valuable input to the process. From there, an independent panel comprised of experts in each field could integrate empirical data from contemporary research studies to formulate the most effective and efficient quality control standards currently feasible.

2.) Describe your experiences in the arena of quality assurance or risk management. What were your specific duties? With whom, if anyone, did you coordinate your work? How was an untoward event handled?

During my internship at a local community clinic, I assisted the primary nursing staff with their intake/outtake process, screening patients for vital information by having them complete a set of standardized forms. The information gathered during the intake process represented the first level of quality control and risk management, because by ascertaining possible allergy risks, prior injuries or illnesses, and other risk factors for each individual patient, customized care plans were developed to meet their particular needs. By coordinating my efforts with the head nurse, who ostensibly had a personal history with the vast majority of patients at the clinic, I was able to confirm that the information I had gathered with the forms was accurate and updated. In certain high-stress situations, such as a toddler developing an unexpectedly high fever, parents filling out the necessary intake forms have been known to rush through the process, skipping sections that they do not believe to be important in an effort to have their child treated sooner. Occasionally, this presents a major problem for the medical staff, as in the case of a child with severe allergy to aspirin who was brought to the clinic with a bronchial cough in mid-winter. The child's mother was understandably frantic, and in her haste she forgot to include her son's aspirin allergy on the intake form. This seemingly simple oversight resulted in a serious complication when the attending nurse administered a small dose of aspirin to soothe the child's head and body aches.

3.) Recent reports by the National Academy of Sciences, the NYS Department of Health and Harvard University identified many thousands of documented medical errors causing serious injuries, claims and other ill effects. Many, if not most, of these errors were foreseeable, if not preventable. In light of these findings, what can we say about the state of QA/RM programs? Are they effective?

A recent article published by The New York Times quoted federal investigators who recently concluded that "hospital employees recognize and report only one out of seven errors, accidents and other events that harm Medicare patients while they are hospitalized" (Pear, 2013). According to the reporting contained therein, hundreds of thousands of patients experience adverse medical events in hospitals every month, with these complications including "medication errors, severe bedsores, infections that patients acquire in hospitals, delirium resulting from overuse of painkillers and excessive bleeding linked to improper use of blood thinners (Pear, 2013). The underlying premise of the article is that although the nation's healthcare delivery system has implemented a comprehensive network of incident reporting systems, which require nurses, doctors, and other healthcare professionals to document the occurrence of adverse events for reporting to hospital management and to federal agencies, the vast majority healthcare workers engage in wanton underreporting or simply neglect to fulfill this aspect of their duties. In light of this reporting, it appears that the state of QA/RM programs throughout America's healthcare system is irrevocably broken, which would necessitate a fundamental restructuring from self-reporting practices to independent oversight. As the article makes clear, "federal investigators identified many unreported events by having independent doctors review patients' records" (Pear, 2013), which is why individual states should maintain a review board of independent doctors who conduct quarterly reviews of a hospital's QA/RM efforts.

4.) Discuss the best methods of which you are aware to measure the efficacy of health care. For example, double-blind placebo clinical trials are the 'gold standard' for investigational drug activities.

The fact that health is a relatively subjective term, with one patient feeling fine and another suffering immensely while both experience the same illness, it is often difficult to accurately measure the efficacy of healthcare delivery efforts. Despite this inherent obstacle, it is clear that many aspects of the modern healthcare apparatus must be refined and improved to increase the efficiency and effectiveness of treatment. A threefold approach to assessing the quality of healthcare services has been advocated by independent researchers, with a primary focus on the structure, the process, and the outcomes of a treatment option. Structure is defined as a healthcare provider's continual capability to deliver services to a broad spectrum of patients, with a special emphasis on a hospitals funding, resources, and personnel. Process is also known as performance, and this parameter should be used to quantify the actual administration of injections, the monitoring of pharmaceutical consumption, and other day-to-day medical responsibilities. Outcomes include the eventual result of a given treatment option, and by maintaining a national database of healthcare outcomes, it may be possible to identify systemic flaws and make the appropriate improvements.

5.) What role does medical malpractice litigation play in enforcing adherence to accepted standards of professional conduct? Are there better ways to enforce standards?

The astronomical increase in medical malpractice lawsuits filed against hospitals and healthcare professionals has wreaked havoc on the entire industry, with insurance companies transferring the costs to doctors through exorbitant malpractice insurance premiums. While the threat of a devastating lawsuit may force many healthcare workers to play by the proverbial rules, reducing the instance of negligent treatment, the pendulum has swung decidedly too far, with skyrocketing malpractice premiums forcing many respected, experienced doctors to abandon their careers for fear of being sued into oblivion. According to the National Bureau for Economic Research (NBER), the unending rise in "malpractice premiums has the potential to profoundly affect the health care system (because) premiums may influence physicians' decisions to join and leave the labor force, their choice of a medical specialty" (2002). Another especially dangerous consequence of rampant medical malpractice litigation is the fact that "rising malpractice premiums may also encourage physicians to practice 'defensive medicine,' performing more tests and procedures than necessary in order to reduce exposure to lawsuits" (NBER, 2002).

6.) "Since hospital-acquired infections and hospital induced illnesses are very wide-spread, foreseeable and an expected if regrettable part of a patient's experience, it's ludicrous, if not hypocritical, too make too much out of such problems. Disciplining health care providers for such incidents are both unjust and impractical." Do you agree with this statement? Why or why not?

The threat of additional infections afflicting a patient who requires treatment for an original condition is prevalent throughout American hospitals, and according to the U.S. Department of Health and Human Services "healthcare-associated infections (HAIs)" or "infections that patients acquire while receiving treatment for medical or surgical conditions & #8230; occur in all settings of care, including hospital acute care units and same day surgical centers, ambulatory outpatient care clinics, and long-term care facilities, such as nursing homes and rehabilitation centers" (HHS Action Plan, 2011). Whether one attempts to gauge the overall price of healthcare-associated infections in terms of the financial expenditure, the human suffering or the diversion of valuable resources they impose on the healthcare system, it is quite clear that these typically preventable occurrences inflict significant costs across the country.

Purely from a financial standpoint the medical industry has every incentive to address the rampant rise in healthcare-associated infections because "HAIs in hospitals impose significant economic consequences on the nation's…[continue]

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