Quality Concepts in Healthcare Management

Quality Concepts

• The "appropriateness" of care is primarily a focus of utilization management and a key dimension of quality care. It is equivalent to the degree to which healthcare services are coherent and unbroken, not "case management."

• A medication's capacity to improve health status, as a dimension of quality, is its efficacy, not effectiveness, potential, or appropriateness.

• The dimension of quality/performance that depends on recipient and/or observer evaluation is respect/caring, not safety, continuity, or availability.

• To improve customer satisfaction and care outcomes, respect/caring and effectiveness/competency must be part of all quality management activities.

• For ambulatory care, access to specialty care is more problematic than reimbursement, appropriateness of treatment setting, or quality of care provided, compared to inpatient care.

• Organizational compartmentalization of QM/QI activities by department or discipline is a weakness for quality improvement, not the most efficient or consistent with TQM philosophy, nor the best for preserving medical staff autonomy. Quality improvement is best done in a holistic and collaborative way.

• Monitoring service quality is more difficult than product quality because services are harder to measure and verify beforehand, are often more heterogeneous than an object, and can have more delays than products.

• To develop a quality culture, quality professionals should encourage leaders to be committed to a culture of excellence, not assess readiness, design long-range plans, or directly lead transformation efforts.

• Setting up an ambulatory care QM/QI program focusing on outcomes is difficult because patient care outcomes are often determined by the payer, not because patients are in control, records are not required, or outcomes are obvious.

• In evaluating physician care, a primary care clinic would select an indicator like newly diagnosed hypertensive patients being controlled within six months, not patient satisfaction, lab results, or staff compliance.

• The Quality Management Cycle, based on Juran's Quality Trilogy, incorporates information from strategic planning, not only non-clinical aspects, or use a departmentalized approach, nor excluding lab activities.

• A patient's perception of quality in an ambulatory healthcare center is most influenced by caring staff and physicians and the physical environment, not technology or physician technical competence.

• Total quality management (TQM) assumes that most service delivery problems stem from systems difficulties, not individual employee errors, frequent inspections, or a lack of top management involvement.

• Outside the U.S., most industrialized nations use universal healthcare coverage, not employer-based, managed care, or managed competition.

• The initial analysis of data is part of quality planning in Juran's quality management cycle. It’s an initial review and isn’t necessarily the only part of that phase, nor is it the part of the Juran quality cycle dedicated to quality control, or quality improvement.

• A potential conflict between TQM and quality improvement, according to Deming’s principles, is the use of numerical goals in management instead of focusing on breaking down barriers and always improving. Numerical goals can sometimes hinder the focus on improving every process.

• Managed care's core components include prepaid financing, comprehensive services across levels and settings, and controlled access to services, but NOT a broad choice of providers.

• The most important relationship between structure, process, and outcome in quality indicators is interdependent. A quality improvement initiative needs input from all levels in order to see if it is truly effective and implemented properly. Structure directly affects both process and outcome.

• Physicians working with HMOs in the US can use any model but not the broker model, of physician organization. Other models include staff and network, independent practice.

• Quality improvement teams try to find innovative solutions by researching successful ideas from other hospitals, previous lectures, and other industries like the automobile or hotel business, not just inside the hospital itself.

• The success of quality improvement relies on patient satisfaction, not just enhanced communication, employee empowerment, or improved statistical data. The primary goal of good quality improvement initiatives should be to help improve the impact on the customer base.

• While monitoring a medical record system is assessing the medical systems’ structure, it is often done in an attempt to evaluate medical necessity, not necessarily looking at the medical record outcomes or process of the healthcare record.

• Quality improvement (QI) focuses on improving performance measures and on systems and processes, unlike traditional quality assurance (QA) that primarily focuses on processes and systems and individual competencies.

• In monitoring cases of phlebitis with IVs, the focus is on the process of care, not the outcome, structure, or administrative procedures.

• The centerpiece of outcomes management is measuring patients’ functionality and quality of life, and not morbidity and mortality, data reliability, or financial impact.

• "Common causes" of problems refer to chronic or pervasive issues within a system, not one-time events, temporary issues or acute situations.

• Reviewing the timeliness of high-risk screenings addresses the process of care, not the outcome, structure, or administrative procedures.

• Risk management in the US healthcare emerged due to the increase in physician malpractice costs, not due solely to Medicare/Medicaid legislation, ignoring threats, or only improving physician malpractice liability.

• A quality improvement paradigm focuses on the efficiency, effectiveness of the processes, the patient's experience, and the performance outcomes and not on individual practitioner competency.

• Communication about quality is best led and managed by top management, not delegated to a department or considered exclusively an internal issue or independent of process budgets.

• The legal concept that replaces “charitable immunity” in regards to healthcare organization legal actions is corporate liability, not ostensible agency, the "borrowed servant" doctrine, or tort liability, which are all different aspects of the legal issues involved in business or organizational responsibility.

• In managed care, the common method of reimbursement for primary care physicians is capitation with withholds, and not straight salaries, discounted fees, or capitation without withholdings.

• The probability that a step in a process occurs as needed is reliability, not predictability, dependability, or consistency.

• The liability for the negligence of healthcare organization employees is respondeat superior, not res ipsa loquitur, ostensible agency, or quid pro quo, which are all different aspects of the legal issues involved in business or organizational responsibility.

• Organizational culture often reflects the underlying assumptions about people and how work is accomplished instead of the employees' cultural background, community relations, or organizational events.

• The liability of a healthcare organization for independent practitioners' negligence falls under the doctrine of ostensible agency, not respondeat superior, duty of care, or tort liability.

• Prospective payment systems reimburse providers before care is given. This is for predictability in costs, not based on actual costs, based on charges, nor determined by members served per year.

• Applying the pareto principle in quality improvement prioritizes addressing significant process issues, not tracking process effectiveness, providing data for strategic objectives, nor prioritizing patient outcome problems.

• Special cause variation in a process results from factors or issues that are assignable to a specific event and are not part of the normal process variation. These identified reasons include an error resulting in a bad outcome, an event or reason causing a malfunction, or something in the environment causing the malfunction. These are not just random things in the environment, but rather specific events.

• "Managed competition" in healthcare refers to healthcare providers competing within a geographic region using a method such as a network, not competing by specialty, or being administered by different management companies or being managed care organizations.

• The goal of reengineering is to improve care processes and not focus on pleasing patients, responding to change, or totally redesigning the organization.

• An integrated delivery system is a vertical system, not a subacute, horizontal, or acute system.

• The transitional care center will most likely help Stevens Strong with case management, home evaluation through occupational therapy, and continued physical therapy in the home. This will assist him in improving and returning to his previous level of self-sufficiency. It doesn't address diabetic disease or other specific treatment.

• Identifying and addressing common cause process variation leads to making procedures or protocols more stable and repeatable, not eliminating variation, improving practitioner competency, nor solely focusing on following procedures or protocols.

• A comorbidity is a pre-existing condition that affects a patient's treatment, length of stay, or overall experience, not something that occurs during their stay in the hospital, such as a complication within the medical facility during treatment.

• The success of a quality strategy in an integrated delivery system is best dependent on the QI team process as a functional whole, not necessarily on individual aspects like information systems, case management, or patient care. The team must work together in order to accomplish this.

• The key difference between a comorbidity and a complication is that a complication arises during the treatment period and requires treatment from the healthcare organization but does not necessarily pre-exist, or require treatment prior to admittance. A comorbidity does pre-exist and requires treatment prior to admittance.

• Evaluating a system’s structure requires considering the entire interplay and interrelationship of factors such as bylaws, organizational charts, community assessment, budgets, process flows, quality improvement plans, locations, budget, incentives and the interrelationships of decisions and attitudes.

• The best way to look at patterns of behavior over time is to create line graphs, and give context to the data with story telling, and not exclusively with brainstorming, creating gap hypotheses, or pareto charts.

• In statistical process control (SPC), assignable causes of variation should be eliminated first, not random or all causes. Assignable or special causes of variation are often a sign of a problem and should be addressed and eliminated, and sometimes eliminated or addressed.

• The philosophy that best supports a strategic initiative to redesign administrative processes from an efficiency perspective is lean thinking, not systems thinking, continuous quality improvement (CQI), or reengineering.

• In the transition from quality assurance to quality management/quality improvement, focusing on organization-wide processes rather than individual performance, and organizing activities around patient flow rather than department or discipline, led to the most significant benefit.

• Merging with a larger regional medical group requires a paradigm shift, not a profit structure, downsizing initiative, or financial gain. The organizational structure will change drastically in order to centralize areas such as quality, risk management and utilization.

• Attempts to align costs of healthcare with clinical outcomes can encourage overutilization of healthcare, not underutilization, community backlash or reengineering.

• To identify internal and external customers, asking "Who in your work day do you serve" produces the most helpful results. Other questions, like how does the employee know a supplier, are unnecessary in a large medical center in determining the master list of those who use the services.

• In lean thinking, the first tasks in the process improve patient outcomes by identifying and eliminating steps in the process that are wasteful. The first step is to identify and map the suppliers and their inputs.

• A process indicator measures significant events, such as events that require further investigation, activities that provide care and services, or negative variations from the expected, not the appropriateness of the treatment or procedure.

• Credentialing and privilege-delineation of a healthcare provider is determined from their compliance to federal and state regulations and standards, not including communication style or concerns for patients.

• Medical necessity is determined through a review of admission, DRG validation, and procedure reviews, and not solely from quality audits.

• The role of utilization management includes medical necessity and appropriate care and resource allocation, and does not include coordinating care after care planning.

• Availability is the aspect of the customer's care that is measured when considering how many people in a plan received the flu shot, not effectiveness or appropriateness.

• Appropriateness reviews for an appendectomy include considering the patient's testing, surgeon, diagnosis on admission, age, and pathology results.

• The most important patient safety issue a utilization reviewer should consider is the medical necessity for the treatment, not the correct procedure, timeliness of care or the specifics of the setting.

• A radiology department should include appropriateness review to determine the medical necessity of the x-rays ordered and performed and which aspects of the process should be reviewed or improved, not just considering timeliness, report dictation or patient waiting times.

• Zero waste means prioritizing efficiency, not effectiveness, appropriateness, or equity.

• Appropriateness of appendectomy frequently involves an assessment of pre-admission tests, pathology reports, and the patient’s clinical condition, including some consideration of age, not just clinical or pathology tests.

This quiz explores key concepts related to quality management in healthcare, focusing on the dimensions of care such as appropriateness, efficacy, and respect. Understand the intricacies of quality improvement activities and their impact on patient satisfaction and outcomes.