Quality of Services Following the Institute of Medicine (IOM) initial reports on patient safety and medical errors, an increased attention and accountability has been placed on providers to improve the quality of services (2000, 2001). Within the industry, the IOM of the National Academies released a report in 2011 regarding systematic reviews for the promotion of patient safety and related standards.
Potential Risks Implicit within the quality care delivery process is the identification of potential risks, which may ultimately affect patient care. As the delivery of care standards are increasingly refined, cost-related metrics also must be monitored. The U.S. government, insurance companies, and other private payers are carefully watching the evolution of care standards and cost metrics. Health care leaders must be up to speed with quality care standards, identification of potential risks, and compliance with relevant regulations. An example of the integration of these concepts can be found in the launch of the accountable care organization (ACO) concept by the Department of Health and Human Services Center for Medicare and Medicaid Services (CMS). Secretary of Health and Human Services Kathleen Sibelius (2011) conveyed that the HHS “team carefully weighed the interests of hospitals, doctors, patients, and other stakeholders” when formulating the ACO roles and responsibilities. Risk assessment, quality care, and cost considerations are incorporated into the ACO concept (Lee, Casalino, Fisher, & Wilensky, 2011).
Regulatory Requirements It is important to consider the National Center for Healthcare Leadership Competencies (NHCL). Think of what types of skills will be needed to lead your organizations toward the goal of demonstrating quality and balancing costs. You may even wish to assess your own current competency levels relative to the health care industry’s movement toward performance measurement and increased accountability (NHCL, n.d.). Dr. Donald Berwick, who headed the HHS ACO efforts, discusses ACO concepts in his 2011 White House blog entitled Improving Care for People With Medicare. Dr. Berwick relates that:
Thanks to the Affordable Care Act, the Department of Health and Human Services (HHS) today released proposed new rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs are designed to create and support a team of health care providers who treat individual patients by working together across care settings.
Dr. Berwick (2011) adds that “ACOs would have to meet high-quality standards in five key areas:
1. Patient/Caregiver Experience of Care. 2. Care Coordination. 3. Patient Safety. 4. Preventive Health. 5. At Risk Population/Frail Elderly Health.”
Assessment 1 Context
2 MHA-FP5014 Assessment 1 Context
Regulatory Bodies In health care settings, there are various levels of oversight for organizations. Health care managers must be aware of the standards required to successfully provide quality care. Health care organizations need to comply with both regulatory standards as well as quality indicators set by accrediting bodies. For example, the Joint Commission is an accrediting body that sets standards for hospitals and other health care organizations. Organizations that are accredited by the Joint Commission are held to a higher standard. Voluntary accreditation allows health care organizations to benchmark themselves to ensure they are in line with national standards.
Benchmarking as a Condition of Participation Most of us have heard about benchmarking and are somewhat familiar with the concept. But, if your supervisor walked into your work setting today and asked you to provide some internal benchmarking data and compare it against national best practices, would you know what action or steps to take? Furthermore, would you know what organizations develop benchmarking standards and provide guidance for quality improvement? Youngberg (2011), a health care patient safety and risk management expert, describes benchmarking as the process of collecting and analyzing data to identify trends in performance and, when compared with other collectors of the same data, identifying best performers and determining if interventions that were introduced to address identified problems yielded the desired results. (p. 24) Benchmarking is not only a quality improvement tool but a condition of participation for some government and other payer sources. An example of this can be found in the requirements for accountable care organizations. Health care leaders must be familiar with the standards provided by both licensing bodies and accrediting organizations. It is important for health care leaders to understand how their organization stands in comparison to its peers as well as what standards it needs to meet for licensure, accreditation, and other regulatory compliance.
References Berwick, D. (2011). Improving care for people with Medicare [Blog post]. Retrieved from
Institute of Medicine. (2000). To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: The National Academies.
Lee, T. H., Casalino, L. P., Fisher, E. S., & Wilensky, G. R. (2010). Perspective roundtable: Creating accountable care organizations [Web video]. Retrieved from http://www.nejm.org/doi/ full/10.1056/NEJMp1009040
National Center for Healthcare Leadership. (n.d.). NCHL Health Leadership Competency Model. Retrieved from http://www.nchl.org/static.asp?path=2852,3238
U.S. Department of Health & Human Services. (n.d.). Accountable care organizations. Retrieved from http://oig.hhs.gov/compliance/accountable-care-organizations/index.asp
Youngberg, B. J. (2011). Principles of risk management and patient safety. Sudbury, MA: Jones & Bartlett.
- The Regulatory Environment
- Quality of Services
- Potential Risks
- Regulatory Requirements
- Regulatory Bodies
- Benchmarking as a Condition of Participation
Overview Assessment 1-6.docx
Create a 3–4-page executive summary of tools and best practices for quality improvement, risk management, and learning guidelines. Include a summary table that describes the status of an organization’s compliance with regulatory requirements.
Note: The assessments in this course build upon each other, so you are strongly encouraged to complete them in a sequence.
The scope of the regulatory environment and its requirements are ever-changing. Health care leaders need to know where they can find information about the requirements (within the subsector of the industry) to respond appropriately to issues. In addition, health care leaders need to proactively set strategies in place to mitigate future risks to their patients and organizations.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
· Competency 1: Conduct an environmental assessment to identify quality- and risk-management priorities for a health care organization.
· Conduct a proactive assessment based on the existing regulations and requirements.
· Describe strategies to influence, impact, and monitor the needed changes for quality improvement.
· Develop a value proposition for change management that incorporates quality- and risk-management concepts.
· Create an executive summary of a risk-management issue that describes an organization’s compliance with a regulatory requirement.
· Competency 4: Analyze applicable legal and ethical institution-based values as they relate to quality assessment.
· Integrate legal and ethical principles and also organizational mission, vision, and values into the decision-making process.
· Competency 5: Communicate in a manner that is scholarly, professional, and consistent with expectations for professionals in health care administration.
· Write clearly and concisely, with well-organized communication that is supported by relevant evidence.
· Use correct grammar, punctuation, and mechanics as expected of a graduate learner.
It is an exciting time in health care as all of us experience the implementation of the Patient Protection and Affordable Care Act of 2010. The change will likely affect your current or future health care job. Leaders in our industry are rethinking how business is to be conducted.
Understanding relevant terminology is an important step in addressing the topics of health care quality, risk management, and regulatory environment.
Read further in the Assessment 1 Context (attached) [PDF] document, which contains important information related to the following topics within the regulatory environment:
· Quality of Services.
· Potential Risks.
· Regulatory Requirements.
· Regulatory Bodies.
· Benchmarking as a Condition of Participation.
Questions to Consider