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Competency 4: Health Care Quality Dede Carr, BS, LDA Karen Neu, MSN, CNE, CNP Slide 2 U.S. Department of Labor Grant This workforce solution was funded by a grant awarded by the U.S. Department of Labors Employment and Training Administration. The solution was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. This solution is copyrighted by the institution that created it. Internal use, by and organization and/or personal use by an individual or non-commercial purposes, is permissible. All other uses require the prior authorization of the copyright owner. 2 Slide 3 Quality of Health Care Competency Discuss quality issues in health care facilities and their impact on health care workers and delivery of care Indentify and list implications when not delivering quality health care ( consequences of inappropriate actions by employees) Discuss personal responsibility in achieving quality health care Identify self to evaluate areas for personal improvement Slide 4 What is Quality Health Care? Doing the right thing (getting the health care services you need) At the right time ( when you need them) In the right way ( using the appropriate test or procedure) To achieve the best possible results (Agency for Healthcare Research & Quality [AHRQ] n.d.) Slide 5 Quality of Care Quality of care speaks to excellence of health care received & is measured by patient satisfaction Easily accessible & available services Timely & safe delivery of care Coordination between services & continuity of care Effectiveness of services (delivery & outcomes of care) Slide 6 How do we provide quality of health care? Providing quality health care also means striking the right balance of services by: Avoiding underuse (for example, not screening a person for high blood pressure) Avoiding overuse (for example, performing tests that a patient doesnt need) Eliminating misuse (for example, providing medications that may have dangerous interactions) (AHRQ, n.d.) Slide 7 Be Active: Take Charge of Your Health Care Single, most important thing you can do to ensure you get high quality health care: Find & use health information & Take an active role in making decisions about your care Steps you can take to improve your care: Work together with your doctor & other members of the health care team to make decisions about your care Be sure to ask questions Ask your doctor what thee scientific evidence has to say about your condition Find & use quality information in making health care choices. (AHRQ, n.d.) Slide 8 Understanding Health Care Quality Health care quality varies where you live. Health care quality varies widely & for many reasons. Improving health care quality is a team effort, and it is ongoing on many levels. To succeed, every part of the health care system must become involved, including government and nongovernment organizations, Doctors, nurses, dentists, pharmacists, Hospitals, other providers, and YOU, the patient(AHRQ, n.d.) Slide 9 Organizational Impact on Quality Health Care Nurses shortage Staff Mix (increase in unlicensed assistive personnel)- Negative patient outcomes have resulted Increase in patient acuity (level, complexity, and intensity of care required) Costs associated with Poor Health Care Quality Cost of medical errors: lost in income, disability, death, higher health care costs Slide 10 Quality Health Care We all have a role and responsibility for improving the quality of health care. What can you do to improve your quality of care? See the following slides for choosing quality health care. Slide 11 Choosing Quality Health Care Look for a health plan that: Has been given high ratings by its members on the thing that are important to you Has doctors/dentists/chiropractors, etc. and hospitals you want or need Provides that benefits (covered services) you need Provides services where you need & when you need them Has documented history of doing a good job of preventing & treating illness (AHRQ, n.d.) Slide 12 Choosing Quality Health Care Look for a doctor who: Has received high ratings for quality of care Has the training & experience to meet your needs Will work with you to make decisions about your health care. (AHRQ, n.d.) Slide 13 Choosing Quality Health Care If you become ill, make sure you understand: Your diagnosis How soon you need to be treated Your treatment choices, including the benefits and risks of treatment How much experience your doctor has in treating your condition (AHRQ, n.d.) Slide 14 Choosing Quality Health Care Look for a hospital that: Is accredited by the Joint Commission on Accreditation of Healthcare Organization (JCAHO) Is rated highly by the State & by consumer groups or other organizations Has a lot of experience & success in treating your condition Monitors quality care & work to improve quality (AHRQ, n.d.) Slide 15 Choosing Quality Health Care In choosing a nursing home or other long term care facility, look for one that: Has been found by State agencies & other groups to provide quality care Provides a level of care, including staff & services, that will meet your needs (AHRQ, n.d.) Slide 16 Personal Responsibility in Achieving Quality Health Care 1. Maintain a healthy lifestyle. Approximately 40% of all premature deaths in the U.S. are due to healthy choices such as tobacco use, poor diet, sedentary lifestyle, misuse of drugs and alcohol, & failure to use safety equipment (University of MN, 2009) Healthy Lifestyle Checklist Maintain recommended body weight Eat a plant-based diet with moderate portions Engage in regular physical activity Dont smoke or use drugs Drink Alcohol in moderation Take steps to master your stress Nurture healthy relationships Find meaning & purpose in life(U of M) Slide 17 Personal Responsibility in Achieving Quality Health Care 2. Become an informed health care consumer Your provider options Do you know who is covered under your health plan? What is their philosophy? You want to find a provider you can communicate with & establish a relationship of mutual respect. Your treatment options If you have a specific condition or diagnosis, do you know all of your options? (see next slide) Slide 18 Personal Responsibility in Achieving Quality Health Care Your healthcare coverage Do you know which specialists & which hospitals are available to you? Do you know how many visits for services such as physical therapy are covered? Most important decisions regarding health benefits have been made by employers, health insurance companies, and the government, without our participation or input. (U of M) Slide 19 Personal Responsibility in Achieving Quality Health Care Costs. It is almost impossible to get information about the price & quality of healthcare providers & health plans. This is changing as insurers promote price & quality transparency, publishing the costs of visits & procedures on the web. You can use this information to find a hospital that offers the services & achieves the outcomes that are most important to you. Public policy. Public policy impacts your healthcare & that of others, Do you know what the laws in your state are around access to health care? Do you know how to access a consumer advocate when there are issues with insurance companies? (U of M) Slide 20 Personal Responsibility in Achieving Quality Health Care 3. Partner with your providers. It is important to recognize that this new partnership model of care requires a change in both you & your health care provider. If you have expectations of an equal relationship, you must communicate this to your provider. Open communication & collaboration with your provider requires you to participate fully in the process. (U of M) Slide 21 Personal Responsibility in Achieving Quality Health Care 4. Seek help when you need it. While you need to take charge, it doesnt mean you need to go at it alone. Take a trusted relative or friend to a doctors appointment to act as another set of ears & to write down what is said. Be sure they understand that they should listen & not speak for you. If you are admitted to a hospital, enlist the help of trusted relatives of friends to help prevent possible medical errors, such as incorrect medication. If you have a specific condition or diagnosis, you may find it helpful to join a support group in your community or online. These are often offered by hospitals, clinics, or associations, such as the American Cancer Society. (U of M) Slide 22 Health Care Workers (HCW)Impact on Health Care Costs Each health care worker contributes to the control of rising health care costs so must take a fiscal responsibility for his/her performance Efficiency & accountability on the part of everyone in the system is emphasized so one should ask: How can you as a HCW help reduce unnecessary costs? Each persons impact on costs may not seems to make a difference but when totaled over a period of time & multiplied by number of workers unconcerned with efficiency, costs are significant. (Juliar, p.91) Slide 23 Health Care Workers Impact on Costs Many ways HCW can contribute to costs of efficient & effective functioning of a facility. Personal Efficiency: Refers to HCWs performance & how it contributes to overall efficiency. Example: When a HCW arrives late, takes excessive breaks, frequent interruptions with personal phone calls or texting, Increase in coworkers case loads & their abilities to perform efficiently Results in decrease in patient satisfaction (Juliar, p.91) Slide 24 Costs of Poor Quality Health Care Related to the following problems: Duplicated work between departments Loss of time due to inefficient task performance Loss of staff due to job dissatisfaction Recruitment & training of new employees Expenditure & training of new employees Law suits & malpractice settlements Employees repeatedly making same errors, despite instructions Time wasted reporting & correcting errors Expenses related to over utilization of diagnostic tests to avoid malpractice (Juliar, p.91) Slide 25 Health Care Workers Impact on Costs Focus on Job: HCWs attention should be focused o 100% on duties with needs of patients & organization/employer a top priority Careful use of supplies/equipment: Damage or loss adds significantly to costs of operations Only use needed supplies & avoid waste Handle equipment carefully & follow manufacturers recommendations for use and care Billing & Coding: Do correctly without misplacing charges or can result inn not being reimbursed for care given & supplies needed (Juliar, p.91) Slide 26 Health Care Workers Impact on Costs Maintaining Inventory: Any item purchased by the healthcare facility belongs to the facility & cannot be used for personal use without authorization Even small items such as pen & paper should be for business purposes only Cost of items taken by employees is staggering and adds to overall costs for goods & services in the U.S. (Juliar p.91) Slide 27 Health Care Workers Impact on Costs Educating Patients: Promote the practice of healthy lifestyles to reduce need for medical services Encourage use of preventive measures such as immunizations & prenatal care to reduce the need for expensive care later Clearly explain patient self-care practices to prevent unnecessary office visits (Juliar, p.92) Slide 28 Health Care Workers Impact on Costs Being Willing to Cross-Train: Cross-training means learning skills outside traditionally expected of given occupation HCWs who have variety of skills & can perform many tasks are more cost-effective employees that those with limited skills Cross-training worker can fill in as needed, eliminate down-time & delays in patient care or completing departmental tasks Example: Respiratory therapists can learn to draw blood; transcriptions can perform insurance coding & billing Slide 29 Personal Efficiency To perform efficiently one must develop Strong organizational skills Prioritize according to importance Critically evaluate the situation to determine what is needed; make a timely decision Act (Juliar) Slide 30 Personal Efficiency To develop behaviors to improve personal effectiveness, use the following: Use problem-solving process to assist in determining what areas in your life, if improved, would create positive changes (Takes most effort & time) Assume responsibility for your life & your decisions Remember not doing anything or making a decision is a decision Dont let life pass you by as you passively look at the world Take action, make decisions, & initiate changes after a sound evaluation of what is needed (Juliar, p.92) Slide 31 Personal Efficiency Dont get sidetracked with minutiae (trivia) of life Focus on the big picture & indentify whats central to your wellbeing Expect setbacks in your progress, but dont use excuses not to continue If you feel you do not have enough time, monitor how you are using your time & evaluate & eliminate unimportant time wasters Communicate clearly & honestly with others when conflicts arise; Look for solutions that will satisfy all involved (Juliar, pp.92-93) Slide 32 Personal Efficiency If the healthcare worker is unable to find personal satisfaction, there is a greater likelihood of having a dissatisfying professional life. Achieving maximum personal effectiveness enables the healthcare worker to make contributions that lead to an efficient & high quality organization. In order to control costs, healthcare workers must pay attention to their actions!!! (Juliar, p.93) Slide 33 The Question How can I help to reduce unnecessary costs? To guide your work, ask yourself these questions: What are the facts? What is the best course of action? What is the right thing to do? What is the probable impact of my actions? So.Review the situation Gather necessary information Make sound decisions Slide 34 References Agency for Healthcare Research and Quality (n.d.). Guide to Health Quality. Retrieved from: http://www.ahrq.gov/consumer/guidetoq/ Juliar, K. (2003) Minnesota Healthcare Core Curriculum, 2e. Clifton Park, NY: Delmar Publishers, Inc. University of Minnesota. (August 6, 2009). Take Charge of Your Health: Whats My Role? Retrieved from: http://www.takingcharge.csh.umn.edu/navigate- healthcare-system/whats-my-role