¶ … categories of variation in health care: process variation, outcome variation and performance variation. Process variation reflects differences in established processes. Outcome variation reflects differences in outcomes that are occur versus those that are expected. Performance variation is variation in how things are done. Process variation occurs when there is a defined process, and then the person expected to undertake that performance deviates from the specifications. A benign example would be the process for cleaning a room after a patient is discharged, before the next patient arrives. There is a checklist that represents that process, and if something is not done, that would be a process variation.

Outcome variation occurs when even if something is done according to the right process, for one reason or another it does not work out that the outcome is as expected. For example, suppose that the nurse does everything that was part of the role, but the patient suffered a negative outcome that was against the odds. In such a situation the outcome would be different than expected, but not because of the process.

Performance variation is when the performance is not up to the standards as set by the process. So the process is basically designed in the right way, but the person tasked with implementation of the process made a mistake and the outcome was less than optimal as a result of this.

In health care quality management, understanding these different types of variations matters. The quality manager looks at outcome variance to know when something went wrong, but just knowing that something went wrong is not enough. The manager needs to be able to recognize which different type of variation occurred, because these different types reflect quite different approaches to solving the problem. When the problem is the process, you redesign the process. When the problem is performance, you work with the staff to improve performance. When the problem is outcome, that means that the issue lies somewhere else; maybe random chance but maybe some other variable that has yet to be accounted for.

Q3. Quality assurance is finding ways to ensure that quality is at a steady rate. It reflects management that is focused on determining and maintaining standards of quality. So this is the set of tactics and strategies that results in consistently high levels of quality.

For the health care manager, quality improvement reflects understanding what the current level of quality is, and undertaking changes to raise that level of quality. Quality...

Basically, managers have the ability to influence quality within the organization. The quality control process seeks to identify mistakes, or otherwise the sources of error, and then eliminate those error sources. Quality control consists of the measures that identify where gaps in quality exist, and then the steps that are taken to eliminate such issues, thereby ensuring a higher standard of quality than existed previously (Investopedia, 2016).
Total quality management is a quality management approach that began in the 1950s. The TQM approach "seeks to integrate all organizational functions to focus on meeting customer needs and organizational objectives" (Hashmi, 2016). TQM is a foundational approach, and its customer focus is built into the organization's other quality-related activities.

All of these four things are important in health care organizations. First, health care organizations need to define quality, but then they also need to understand the steps that should be undertaken to ensure quality. The TQM approach is useful here, because it orients quality to the customer, and asks that all parts of the organization are oriented towards this one conceptualization of quality. Furthermore, the organization needs to set quality standards, and then implement the means by which those standards can be attained. So overall, achieving a consistently high level of quality is fairly difficult, but this something that health care managers need to be concerned about because of its influence on the average business.

Case Q1. Good indicators of patient-centeredness would include having the right amount of staff on hand to look after the patient. In this case, Mr. Gee would have benefitted from having someone there more frequently. Part of this was psychological -- he was in a fragile state -- but part of it was physical. Having mucus always getting in the way of his breathing was surely going to be an issue for him, but he simply did not have the attention that he would have needed. His spirits sagged as the result of the physical issues he was facing, and being already in a fragile mental state he was ill-equipped to fight for himself.

Q2. A) In terms of patient safety, it seems that the nurse realize that Mr. Gee needed more attention than the other patients. The nurse aide was present for much of the time on the day that Mr. Gee died. The error was really to have Mr. Gee in a position where there was nobody to look after the mucus buildup that he was facing -- this was a holdover from his prescription drug issue, and it was something that was going to threaten his…