Implementation of Continuous Quality Improvement

History The campaign for quality improvement dates back to nineteenth-century obstetrician, Ignaz Semmelweis’s time; Semmelweiz campaigned for the significance of healthcare providers washing their hands prior to caring for patients. Furthermore, legendary British nurse, Florence Nightingale, determined the link between high mortality rates among army hospital inpatients and inferior living conditions. Surgeon Ernest Codman initiated hospital standards development, adopting and stressing the significance of healthcare outcome assessment approaches (Colton, 2000).

Former US President Johnson, in the year 1965, signed the bill that made Medicare a component of the nation’s Social Security scheme. This bill which was enforced in July of 1966 expanded the three-decade-long Social Security initiative and offered nursing home and hospital care, outpatient treatment and home nursing services to individuals aged above 65 years (QIO News, 2014). Numerous major attempts at quality improvement have been made in the last 50 years, largely initiated by academicians’ health quality campaign.

Examples of such attempts are patient care delivery system reengineering and reorganization, incentivizing inter-institutional/provider competition, and peer review encouragement. Additional efforts were determination of medical procedures influencing patient health, performance assessment, offering rewards for good performance, penalizing poor performers, improving monitoring techniques, public quality data reporting, adopting swiftly-advancing quality improvement instruments, and professional medical education reform (Pearson & Batch, 2010). History reveals that PROs (the predecessors of QIOs) largely carried out utilization reviews for ensuring Medicare paid for only medically essential care.

The preliminary attempts at quality improvement were chiefly restricted to case reviews (i.e., retrospective reviews of individual patient care), and dealing with early de-hospitalizations’ beneficiary appeals.

In the year 1992, as a reaction to a report by the IOM (Institute of Medicine) which reinforced the idea that distinct cases of inferior quality typically hinted at broader, systemic quality issues, the HCFA (Health Care Financing Administration, now Center for Medicare and Medicaid Services) declared its intent of redirecting PROs’ Medicare efforts to system-based programs for quality improvement, in direct and voluntary collaboration with healthcare providers (McGlynn et al, 2003).

Types of Care-Delivery Organizations and Issues They Face Large general hospitals and other such healthcare organizations offer a broad array of services like acute care which stretch across several care continuum areas. Meanwhile, hospices and other healthcare organizations that are specialized offer only certain services covering a distinct area of the care continuum. Hospitals can be specialized as well (e.g., rehab centers or psychiatric hospitals).

Another form of healthcare organization is the doctor’s office and medical group practices, which can offer only one specialty service or multiple healthcare services including cardiology, neurology and pulmonology. A number of medical groups currently provide services like outpatient surgery, diagnostic testing, and on-site therapeutic services. Ambulatory healthcare organizations cater to individuals who visit to receive care but don’t remain at the center overnight (e.g., outpatient diagnostic centers that carry out medical imaging, laboratory tests, and similar diagnostic services).

There are other ambulatory services as well such as surgery centers, psychiatric health centers, primary care centers and urgi-care centers to address minor health issues. Home care institutions offer a range of home-based therapeutic and nursing services. Lastly, nursing homes and similar organizations serve individuals who require prolonged care (Ahluwalia et al, 2017).

Besides the abovementioned healthcare organizations which offer hands-on patient care and directly influence patient health, other key organizations include the American Lung Association and American Cancer Society, which influence public health through financing research projects, supporting patients and coming up with academic programs. Johnson & Johnson, and similar pharmaceutical and medical supply corporations, manufacture and supply the myriad of medicines, instruments and other supplies, used by other healthcare organizations for providing patient care.

GE and other corporations make MRI (magnetic resonance imaging) scanners, robotic surgical systems and other high-tech clinical equipment. Further, less complex equipment, intravenous solutions, antibiotics, catheters, bandages, wheelchairs, and other items are manufactured and sold by other firms. The Blue Cross and similar health insurance organizations form another kind of healthcare organization that support healthcare service funding and payment. The American Hospital Association and other trade organizations and the American College of Healthcare Executives and other professional associations are also healthcare organizations.

Lastly, universities and colleges which prepare healthcare workers of all kinds also represent healthcare organizations (Ahluwalia et al, 2017). As the US is equipped to offer the best care standards and conduct the most complicated of clinical procedures, healthcare quality issues’ universality and magnitude have typically been ascribed to issues of resource abuse, underutilization or overutilization.

Such problems have complex, multifaceted underlying causes, including prior non-accountability for inferior quality service provided and the steep incurred expenses, measurement of outcomes, processes and structures only discursively informing goals without essentially improving care, and the presence of vague, verbose goals. Additionally, they include the presence of inadequate data on relative efficacy and healthcare results and unreasonably incentivized systems of payment which encourage volume whilst failing to consider value.

But though quite a lot is yet to be accomplished, an analysis of the clinical care quality campaign’s historical progression indicates that in the last hundred years, productive measures to aid providers in enhancing superior quality care delivery capability have been adopted. QIOs, legislative action, and healthcare improvement programs continually offer providers requisite.