Analysis of Quality Improvement Programs

The provided assignment involves analyzing several quality improvement programs in healthcare. These programs include the VA Clinical Assessment, Reporting, and Tracking System for Cath Labs (CART) program, medical team training, the implementation of a patient-centered medical home in the Veterans Health Administration, and interventions to reduce acute care transfers. The analysis also touches on the use of interrupted time series analysis in evaluating health care quality improvements and developing dashboards to help measure and achieve the triple aim. Furthermore, the assignment explores evidence-based quality improvement and its significance, as well as the phantom limb of the triple aim. A comparative effectiveness study of collaborative chronic care models for mental health conditions is also included. The assignment aims to provide a comprehensive understanding of various quality improvement programs in healthcare.

Health Care Quality Program
Implementation

Contents
INTRODUCTION...........................................................................................................................1
Data analysis against benchmarks and national standards..........................................................1
Observation about where quality improvements are needed.......................................................2
Goals for initiatives that address those deficiencies/opportunities in quality..............................3
Outcomes that are anticipated in order to accomplish the initiatives..........................................4
Appropriate time frames to re-evaluate data and providing a new analysis................................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7

INTRODUCTION
There are different types of requirements that a person has and these can be mental or
physical. For this purpose, there are hospitals that focus on delivering patients with all types of
services through which health related issues can be solved (Block, 2014). Present report is
focused on two hospitals which are Grand River Hospital & St. Mary’s General Hospital. Both
these firms make use of different type of strategies in order to provide proper services to their
patients. This report covers data analysis against benchmarks and national standards. Further, it
covers goals for initiatives that addresses opportunities in quality. Lastly, it also includes
appropriate time frames to re-evaluate data and to provide a new analysis.
Data analysis against benchmarks and national standards
Grand River hospital (GRH) is considered as one of the biggest community hospitals of
Ontario. All the employees work with a focus of being a successful and efficient leader in giving
support and care to the patients whenever required and necessary. As per the case study of
Patient safety at Grand River hospital and Mary's General hospital, it has been observed that in
2011, 23,391 people were being admitted in hospital and number of surgery visits also increased
to 12671. They have also observed a huge amount of emergency cases as the number went till
58596. The patients who were brought in hospital as emergency cases, that is, the number of
persons that were brought to the hospital by the ambulance was 58596. For this situation, GRH
has developed a quality framework which also involved a committee considering all the essential
patient’s safety measures (Woltmann and et.al., 2012). A senior team was also presented in it
along with specialised clinical practices that can be very beneficial for patients and also in
maintaining healthy lifestyle of patients. The whole analysis of data can be done by considering
the following factors of the hospitals i.e. assessment of care, appropriateness of it, safety
measures of the patient and the experience of patient remained with the centre.
The specific benchmark indicators were also used by the Grand river hospital in order to
evaluate and analyse data properly and also it can help in assessing the performance status of the
hospital committee as well. Specific health care has also been provided to Kitchener community
by the St MARY's general hospital (SMGH). It has been analysed that there were about 2000
members in staff of hospital and along with some volunteers as well. The hospital has been
observed to admit more than 100000 patients in which for about 47,000 people were admitted
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through emergency cases. About 20,000 people had surgeries and others were cases of the
emergency department. There have also been adjustments of various other arrangements that
have been made in the organizational structure for formalizing leadership positions. It has also
helped the organisation in accountability of quality metrics. It has also been recognized by IOM
that there was lack of training skills for which various sessions have been included in hospital
and it helped the hospital in gaining success at faster rate as well (Hammes, Rooney and
Gundrum, 2010). As per the research conducted in the Grand River hospital and St Mary's, it
has been observed that there were some factors because of which it contributes to patient safety
incidents. Active failures were considered as the lowest of all as it involves accidents like slips,
violations, mistakes etc. Workload of the staff can also be considered as one of the largest issues
as often, because of the workload situation in the hospitals, the hospital has to follow an
employee turnover in which a huge number of employees left the hospital. So, in resolving this
problem, various initiatives have been started by the hospital which helped these measures to be
resolved.
Observation about where quality improvements are needed
Both the firms have different type of requirements and from the study, it is identified that
there are certain set of areas in which improvement is requirement. When these areas are
focused, then it becomes favourable enough to make sure that business requirements can be
attained. In this context, below given are improvement that are to be made:
Lack of using improve or new Technology: With time, there are changes that have taken
place in relation with technology. It is important for health care providers to make sure that new
or updated technologies are used so that patients can be provided with proper services (Seow and
Sibley, 2014). When management do not make use of technology in effective manner, then it
affects the perception that are carried out by people for the services that are deliver by the
hospitals.
Lack of understanding for the roles and responsibilities: There are different type of skills
and capabilities that are carried out by individuals. It is important to make sure that all the care
providers make use of their skills and capabilities so that they are able to understand requirement
of patients and deliver them proper quality of services. It is being identified that care providers
are not able to perform with their full potential. In this context, it is important for care provider to
make sure that they provide them with proper training so that they are able to improve areas in
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which they lack. Further, it is also identified that employees are not able to perform due to lack
of understanding for that role and responsibilities that has to be played by them. For this purpose,
it is important that there is proper monitoring. This way, it becomes favourable enough to
provide training so that that care providers are able to clarify all their doubts in relation with the
roles and responsibilities that has to be played by them.
Cleanliness: Patient prefer to get proper services in which they feel free and confident
that the services delivered will enable to help them to overcome the issue.. It is important for
care providers to make sure that proper cleanliness is maintained in the hospitals and the rooms
in which the services are delivered (Starmer, Spector and Lipsitz, 2014). When these areas are
considered, then it becomes favourable enough to make sure that the rate of satisfaction level is
improved. As per the findings, it is identified that in the year 1997 there were about 98000
patients who died in America due to medical errors. There are many condition that are identified
in which patients may have been admitted to the hospital for particular health related issue but
after discharge many new issues related with health were identified. These are the conditions that
can be avoided when proper cleanliness is maintained by care providers (Shojania and
Grimshaw, 2017). It is also important that the equipment that are used are properly sterlised and
are cleaned from time to time.
Goals for initiatives that address those deficiencies/opportunities in quality
There are many aspect that are covered by the care providers in order to make sure that
they can support the health care operations in attaining the goals and objectives in effective
manner. There are requirement for the management to understand the set of problems that are
faced by each of the patients (Byrd, Vigen and Maddox, 2013). There are various types of
benefits and opportunities that both the hospitals (Grand River Hospital & St. Mary’s General
Hospital) will get when they work for improving quality of service. Below given are the steps
can be taken to attain the goals when improvement is make for the quality:
Monitoring: It is not possible for the care provider to know the performance level of
themselves. In this context, it is important to make sure that all the care providers are properly
monitored so that they are able to determine issues or areas in which improvement is required.
This is possible to list out care providers who are in need to training or support. From the
findings made, management of hospitals can set out training and development with the help of
which performance and skills that are required can be improved in effective manner. When
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patients are not able to get proper quality of services, then the main reasons for this can be
determined will be lack of effective performance from the side of care provided. However, when
proper monitoring take place, then it becomes favourable enough to perform the work in
effective manner.
Coordination: In health and social care it is required to have proper coordination so that
all the issues related with health that are faced by patients can be treated in effective manner.
There are conditions in which patient have multiple health related issues and it require nurses to
share the information to other professionals so that they can be treated properly. However, when
there is no proper interaction, then there are serious health related issues that can be identified for
the patient (Nelson, Helfrich and Sanders, 2014 ). In this context, management can improve their
quality by considering the interaction level that each of the care providers have with each other.
Strong relationship with patients: It is important to have healthy interaction with patients
so that they are able to identify issues or problems that are faced by them. When professionals
are not able to identify issues that are faced by them, there are negative impact over health
(Starmer, Spector and Lipsitz, 2014). In this context, developing strong relationship with patient
will enable to improve the quality of services and professional will deliver them services as per
their requirements.
Outcomes that are anticipated in order to accomplish the initiatives
There are positive impact on the hospitals when strategies provided above are
implemented.. In this context, below given are the few of the benefits that Grand River Hospital
& St. Mary’s General Hospital will get when they make use of the strategies that were discussed:
Satisfaction level of patients: When effective strategiesare applied, then it becomes
favourable enough to raise the satisfaction level of patients. There are certain set of expectations
that each of the patient have before they make use of the services of hospitals (Spinelli, 2013). In
this context, when they implement that strategies. The patients will be able to determine the trust
that they have formed with the professional. In this context, it becomes favourable for the
patients to develop trust and confidence that the health-related issue that they have will be solved
in effective manner.
Better interaction among care providers: It is important to have proper interaction with
all the care providers so that they all have proper understanding about the health issues that are
faced by the patients. it is important to make sure that all the have effective communication so
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that they are able to work together within aim to deliver high quality services to patients (Seow
and Sibley, 2014).
Reduction in medical error: When all the care providers are able to determine the type of
roles and responsibilities that are required to play , then they will be able focus more on their
work. This way, it is helpful enough to reduce the rate of errors in effective manner. It is
identified that because of medial error, there are many deaths that has caused in recent years
(Block, 2014). When there are proper set of planning and coordination and support from other
professional, then the rate of medical error is reduced. This way, it becomes favourable to make
sure that the rate of performance is improved and patients are delivered with high quality of
services in which they can overcome their health-related issues.
Appropriate time frames to re-evaluate data and providing a new analysis
There are various time frames that can be used re evaluation the data and also can help in
analysing a new one. Some factors are discussed as below:
 Specific time frames can prove very beneficial for both the hospitals and also can be used
for identifying and ensuring the number of patients and the details of the patients by the
practitioners (Don, 2012).
 A specific as well as sufficient time should be allotted to the clinical practitioners so that
they have enough time for completing their actual role. They should not have less time
that their research seems insufficient and it should not be that large duration also that the
practitioner after finishing the research, may have to waste the time (Grol and et.al.,
2013).
 These time frames can be considered on the shifts on a basis and that can be either on
daily, weekly or monthly basis.
 Then, these are compared cumulatively within the pre and post implementation groups.
 These involve structure of care, structure of care and the outcome of care which means
Grand river hospital and St Mary's hospital can focus on new policies in which they first
process that to which patient what care is being given and what are the alternatives to
that, which means if the person is allergic to that dose, what alternative can be provided
to the patient instead (Neily and et.al., 2010). The structure of care also includes the
various features that helps in maintaining the safety and health of the person. The bed
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sheets and the related stuff can be changed so that the patient can stay healthy enough and
did not have to face any new issue.
 After the structure, processing is important. It involves the fact that the processing of the
patient is necessary to maintain because it is the responsibility of the care centre to focus
on the health and safety of the patient by concerning all the needs of the patient along
with the safety features. It also involves the maintenance of the patient (Penfold and
Zhang, 2013).
After both the two factors, outcomes of the process are important as the Grand River
hospital and ST. MARY'S have to ensure the fact that the hard work and time they have
consumed in providing the treatment to the patient is worthy enough to be appreciated. The forte
of both the hospitals is to provide proper support and care to the patient so that the person can be
treated well as soon as possible. The results come as an evaluation of all the processes and
procedures of the hospitals, so evaluation of the outcomes is necessary as well.
CONCLUSION
From this report, it can be concluded that hospitals need to understand the issues or
problems that are faced by each of the patients and they should be delivered with services that
enable to raise the satisfaction level.. Further, it is important that management should make use
of new or updated technology so that they are able to deliver high quality services to patients.
Further, proper training and development should be provided so that they are able to make sure
that all the patients work with their full efficiency. There are certain doubts that care provider in
relation with their work. This can be solved with the help of training provided to them.
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REFERENCES
Books and Journals
Block, D. J. (2014). Revisiting the Triple Aim—Are we any closer to integrated health care?
Physician Executive, 40(1), 40–43.
Byrd, J. B., Vigen, R. & Maddox, T. M. (2013). Data quality of an electronic health record tool
to support VA cardiac catheterization laboratory quality improvement: the VA Clinical
Assessment, Reporting, and Tracking System for Cath Labs (CART) program. American
heart journal, 165(3), 434-440.
Grol, R. & et.al. (Eds.). (2013). Improving patient care: the implementation of change in health
care. John Wiley & Sons.
Hammes, B. J., Rooney, B. L. & Gundrum, J. D. (2010). A comparative, retrospective,
observational study of the prevalence, availability, and specificity of advance care plans
in a county that implemented an advance care planning microsystem. Journal of the
American Geriatrics Society. 58(7). 1249-1255.
Neily, J. & et.al. (2010). Association between implementation of a medical team training
program and surgical mortality. Jama. 304(15). 1693-1700.
Nelson, K. M., Helfrich, C. & Sanders, W. (2014). Implementation of the patient-centered
medical home in the Veterans Health Administration: associations with patient
satisfaction, quality of care, staff burnout, and hospital and emergency department
use. JAMA internal medicine, 174(8), 1350-1358.
Ouslander, J. G., Bonner, A. & Shutes, J. (2014). The Interventions to Reduce Acute Care
Transfers (INTERACT) quality improvement program: An overview for medical
directors and primary care clinicians in long term care. Journal of the American Medical
Directors Association, 15(3), 162-170.
Penfold, R. B. & Zhang, F. (2013). Use of interrupted time series analysis in evaluating health
care quality improvements. Academic pediatrics. 13(6). S38-S44.
Seow, H. Y. & Sibley, L. M. (2014). Developing a dashboard to help measure and achieve the
triple aim: A population-based cohort study. BMC Health Services Research, 14, 363.
Shojania, K. G. & Grimshaw, J. M. (2017). Evidence-based quality improvement: the state of the
science. Health affairs.
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Spinelli, W. M. (2013). The phantom limb of the triple aim. Mayo Clinic Proceedings, 88(12),
1356–1357.
Starmer, A. J., Spector, N. D. & Lipsitz, S. R. (2014). Changes in medical errors after
implementation of a handoff program. New England Journal of Medicine, 371(19), 1803-
1812.
Woltmann, E. & et.al. (2012). Comparative effectiveness of collaborative chronic care models
for mental health conditions across primary, specialty, and behavioral health care
settings: systematic review and meta-analysis. American Journal of Psychiatry. 169(8).
790-804.
Online
Don., H. 2012. [Online]. Available through: <https://link.springer.com/article/10.1007/s11628-
012-0141-2>.
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