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Healthcare Quality Systems: Drivers & Examples

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  • 0:03 Quality Healthcare Systems
  • 2:06 Quality Drivers
  • 7:14 Lesson Summary
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Lesson Transcript
Instructor: Maya Shapland

Maya has worked in the clinical, education, and management sections of healthcare for over 25 years and holds bachelor's degree in Speech and associate degree in Nursing.

Quality in healthcare systems is driving the present and future of healthcare, improvements in healthcare, and cost of services delivered. This lesson gives a snapshot of drivers and examples in healthcare quality systems.

Quality Healthcare Systems

Grady is a registered nurse working in the quality services department at his hospital. He has received formal training in quality and patient safety. Grady leads his team in his facility to improve the patient experience and provide safe quality of care. Let's follow Grady as he tries to improve the healthcare quality at his hospital. But first, let's review some background.

Healthcare systems in the U.S. include hospitals, physician services, and other ancillary services such as lab and x-ray. Quality services for patients and families are the force behind written physician orders, policies and procedures for hands-on care, and payment for services. The overall goal of the quality service department is improved performance for better patient outcomes, or results of care. Desired outcomes of a quality service are better patient experience, improved safety of the patients, reduced cost of complications, and proper reimbursement.

Who's on the Team?

At Grady's hospital, the quality systems department could involve many members across the hospital. Grady notices that the surgical unit has a problem of missing the administration of medication to patients. So, he decides to build a team to conquer this problem. An example of the possible team members Grady might include are:

  • Clinical leaders, such as nursing managers and supervisors
  • Physicians and surgeons who bring knowledge and experience
  • Quality systems staff like patient safety nurses
  • Executive leaders who provide direction with experience
  • Representatives from other departments like the pharmacy department and physical therapy department
  • Clinical staff, such as nurses, nursing assistants, and technicians
  • Healthcare IT professionals who help gather and record data

For Grady's team, seven members will assist one another to find out what went wrong and how to correct the problem. In a culture of safety, it's not about blame but about correcting system failures.

Quality Drivers

Who is driving the quality bus for Grady and his team? Key drivers must be considered in every quality team and can provide education, experience, legal framework, resources, and standards for consideration. Let's look at the main drivers that will drive Grady's team to implementing quality services.

Patients and Families

The first driver of quality are patients and their families. For this reason, Grady has invited a patient representative to join the team. Priority in any quality decision and program, at any facility, is the patient and their families, which is known as patient-centered care. Patient satisfaction is paramount to building and sustaining quality healthcare. Patients want clear communication, to be active on the healthcare team, respect for their rights, information, comfort, and support.

Governmental Agencies

The second driver of quality are federal and state regulations. Federal and state regulations govern healthcare practitioners and facilities from billing to delivery of the care. Grady and his team must investigate the regulations and standards that apply to their situations before decisions are made.

Medicaid and Medicare

Medicaid and Medicare are the third driver of quality and are deeply involved in the oversight of healthcare in local hospitals, clinics, and physician practices. Complaints by patients to these regulatory bodies can unleash major fines and loss of Medicare acceptance as a payor, which could be disastrous for hospitals as Medicare and Medicaid provide revenue for healthcare services rendered.

State Regulations

The fourth driver of quality are state regulations, which are governing quality by legislation and required reporting of quality issues, such as infections and immunizations, in the interest of public health. Most states oversee healthcare under the Department of Health for that state. Inspections come regularly and in the event of a complaint by a patient.

Accreditation Organizations

The fifth quality driver of healthcare systems are the accreditation organizations. Being accredited is valuable as most payor sources, such as insurance, will partner with hospitals that are meeting standards set by the accrediting organization. Regular surveys are conducted to assess the quality of care delivered, and corrections must be made if problems have been identified.

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