TIP OF THE WEEK
Quality Improvement vs. Quality Assurance
In healthcare, we often use quality improvement (QI) and quality assurance (QA) synonymously, but they are not the same thing. QI and QA represent two very different schools of thought and knowing the difference is an important step to improving the quality of care and quality of life in your nursing home.
QA, FIXING WHAT’S BROKEN
The QA mindset stems from our efforts to meet federal and state regulations. When someone says, “We did what we needed to do to pass survey,” he or she is working in the QA mindset. The approach is typically reactive or defensive. QA assumes that we provide excellent care because we meet a certain minimum standard, so there is no need to change what is not broken.
The focus of traditional QA is on identifying outliers or “bad apples” so they can be fixed. People and departments with clinical responsibilities are the most heavily involved. In QA, managers are primarily concerned with taking steps to improve their staff performance so they meet a set standard. Traditional QA focuses on selected departments and elements of quality within those departments.
QI, WORKING TO ACHIEVE A VISION
In QI, prevention -- not inspection -- is the primary focus. Even when performance meets national and local norms, the organization strives to improve its performance, driven by a “good enough is never enough” mentality.
The QI approach is proactive and deliberate. It focuses organization-wide and it involves teams that cross functions and departments to create a seamless organization in which residents, information, supplies, and communication flow efficiently, without barriers, and across department lines.
In QI, attention is directed not only to circumstances of low performance by low-performing people and departments, but substantial energy and resources are invested in identifying underlying causes (or “root causes”) for patterns in performance or outcomes. The focus is on improving processes and reducing variation so that everyone’s performance improves together.
Healthcare organizations focusing on QI are motivated to meet regulatory expectations, but they are also driven to meet the expectations and requirements of all their customers, like their residents and families. Their goal is to advance quality because they want to provide high-quality care and compete/excel in the marketplace, not just to meet regulatory expectations.
QI is:
- A belief that the opinions and ideas of each person have great value for the institution
- A way of governing that allows for input from all interested parties
- A philosophy that no matter how good we are, there is always room for improvement
- A system that is only successful if people volunteer
QI is not:
- A gimmick, a separate team, or a passing trend
- A group of a chosen few who have power because they were appointed to a team
- A guarantee that decisions will always be unanimous or that all suggestions will be acted upon
- A movement necessitated by poor quality to begin with
- A mandate for forced participation
RESOURCE SPOTLIGHT
Institute for Healthcare Improvement (IHI) – Improvement Stories
We all learn from others' experiences testing and implementing changes in real settings — who should be on the team; what measures were tracked; which changes worked best or didn't work at all; and what lessons were learned. IHI’s collection of improvement stories is designed in the spirit of “all teach, all learn” in an effort to educate and inspire.
IN THE NEWS
CMS TO COLLECT "REVISIT FEES" THIS YEAR
September 20, 2007 -- McKnight’s -- The Centers for Medicare & Medicaid Services has established a system to charge healthcare facilities fees for follow-up inspections this year, according to a final rule published Thursday. Nursing homes have opposed such a system.
Under the rule, healthcare providers, including nursing homes, can request a reconsideration of the so-called revisit user fee in cases where they believe an error has been made. CMS extended the deadline for requesting reconsideration of a revisit user fee to 14 days from seven.
The agency also plans to issue a credit toward future revisit surveys if a reconsideration is found in a provider's favor. If CMS judges that a significant amount of time has elapsed before a credit is used, the agency said it will refund the assessed revisit user fee amount. CMS will collect fees for the remainder of fiscal year 2007. Read the final rule >>
PRESCRIPTION DRUG COVERAGE AND ELDERLY MEDICARE SPENDING
September 2007 -- National Bureau of Economic Research -- The introduction of Medicare Part D has generated interest in the cost of providing drug coverage to the elderly. Of paramount importance -- often unaccounted for in budget estimates -- are the salutary effects that increased prescription drug use might have on other Medicare spending. This paper uses longitudinal data from the Medicare Current Beneficiary Survey (MCBS) to estimate how prescription drug benefits affect Medicare spending. It compares spending and service use for Medigap enrollees with and without drug coverage. Read more >>
September 11, 2007 -- Washington Post -- In the past 10 years, despite resistance from primary care physicians and fears that the role of hospitalists could erode continuity of care, the ranks of hospitalists have exploded from a few hundred physicians in 1997 to 20,000 today -- about as many as there are gastroenterologists or neurologists. That's the fastest growth for any medical specialty in the country, according to the nonprofit Society of Hospital Medicine (SHM), the professional society for hospitalists.
Initially, hospitals and managed-care groups, seeking to cut costs and improve care quality, drove the trend. But with hospital reimbursement rates failing to keep up with costs, many primary care physicians are being won over and now find the hospitalist arrangement saves them time and money. And although many patients may resent not having their doctor at their bedside, just when they need him or her the most, the hospitalist movement, by most accounts, is here to stay.
Read more >>
September 16, 2007 -- Ohio.com -- Whether Muslim or Amish, Eastern European or African-American, patients want doctors who can communicate clearly, without rushing and without medical jargon. Yet more than 90 percent of doctors and nurses believe they already have the necessary skills and training to interact with patients from different cultures, as well as those who have little understanding of medical information. Whether both groups can be right will be an ongoing discussion of Summa Health System's Diversity Advisory Council. Read more >>
OHIO KEPRO EVENTS
Guidelines and Coding for Restraints Teleconference
Featuring Carla Brumby and Patsy Strouse, Ohio Department of Health
November 8, 2007 1:00 p.m. to 3:00 p.m.
Dial-in: 1.877.339.0018, Conf ID: *4477925*
Download the Flyer (PDF)
INDUSTRY EVENTS
Going the distance to reduce pressure ulcers on the next Campaign LIVE! IHI Teleconference
September 24, 2007, 4:00 to 5:00 p.m.
Dial: (800) 860-2442. No PIN code is required. Ask the operator to connect you to Campaign LIVE!
Preventing Pressure Ulcers IHI Teleconference
October 4, 2007, 1:00 to 2:00 p.m.
Dial: (800) 860-2442. No PIN code is required. Ask the operator to connect you to the Campaign Office.
Preventing Adverse Drug Events (Medication Reconciliation) IHI Teleconference
October 9, 2007, 1:00 to 2:00pm.
Dial: (800) 860-2442. No PIN code is required.
Ask the operator to connect you to the Campaign Office.
Improving AMI Care IHI Teleconference
October 18, 2007, 1:00 to 2:00pm.
Dial: (800) 860-2442. No PIN code is required. Ask the operator to connect you to the Campaign Office.
Together We Make a Difference: Solutions for Senior Care 2007
October 5-7, 2007, Columbus Ohio
The conference features plenary sessions and didactic sessions on medical direction, physician-nurse practitioner collaboration, urinary incontinence, atrial fibrillation, appropriate medication prescribing, and the latest diabetic medications (Registration ends Sept 28, 2007). Contact Catherine Austin at (216) 778-8087, Executive Assistant of OMDA, for more details.
The Many Facets of Pain Management: An Integrated Approach
November 7, 2007, 8:00 a.m. to 4:30 p.m., MetroHealth Medical Center, Cleveland. Call (216) 778-7707 for more information.
Medicare Learning Network:
Learning resources and products for the healthcare professional.
Alzheimer’s Association Training Events
Case Western Reserve University School of Medicine Courses
Ohio Department of Health, Technical Assistance Program – New Programs
Ohio Health Care Association Events
An archive of The Nursing Home Weekly Update is available on our Web site. Click here >>
