HCA 375 Comparative Performance

HCA 375 Comparative Performance ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON HCA 375 Comparative Performance HCA375 Discussions Week 2 – Discussion Comparative Performance For this discussion, you are tasked with comparing two hospitals, one that is considered a safety-net hospital (public hospitals who care for a large segment of the population who are uninsured or underinsured) and one hospital from a more affluent area in the state where you live. HCA 375 Comparative Performance Visit The Joint Commission: Quality Check (Links to an external site.) Links to an external site. . Take the following steps to find two hospitals: Enter a city and state, and then select Locate . A list of hospitals for that city and state will populate on the page. Select View Report . Select View Accreditation History . Next, select the most recent Quality Report , which will open as a PDF document. Scroll down to the pages that list the National Patient Safety Goals and then the National Quality Improvement Goals. Choose one from either list. If you choose a National Patient Safety Goal, State the goal and the procedure(s) indicated in the Organization Should Discuss the implications to the patient, staff (physicians, nurses, medical assistance, pharmacists, etc.) and hospital if the health care professional fails to follow the procedure indicated. If you choose a Quality Improvement Goal, State the measure and explanation of that goal. Discuss how the hospital can improve their performance to meet the target. Repeat the above steps for a second hospital. Reminder, one hospital should be a safety-net hospital and one should serve an affluent community. Next, compare and contrast the differences between the two facilities. After review of the two hospitals, discuss your opinion about the reasons these hospitals could have disparities. Your initial post should be 250 to 300 words and utilize at least one scholarly source from the Ashford University Library to justify your recommendations for improvement. Cite all sources in APA format as outlined in the Ashford Writing Center’s Introduction to APA (Links to an external site.) Links to an external site. . The Research, Keywords, Databases: An Overview (Links to an external site.) Links to an external site. video tutorial is available to help you become more familiar with the library database search features and how to generate keywords. HCA 375 Comparative Performance Guided Response: Choose two classmates, and respond as a patient who has experienced the issue identified in your classmates’ posts. Answer the questions listed below. Your guided response posts should be a minimum of five well-developed sentences. What role does customer satisfaction play in your decision to utilize the health care facility in the future based on the findings? What would you expect as the patient? Explain your answer. _03ch_moin_healthcare.pdf _04ch_moin_healthcare.pdf . 1 3 What is Special Education? The Healthcare Industry: Structure, History, and Continuous Quality Improvement Associated Press/J. Scott Applewhite iStockphoto/Thinkstock Learning Objectives Pre-Test After reading this you should behandicap able to dointerchangeably. the following: T/F 1. You can use thechapter, terms disability and 2. • The history special began in Medical Europe. Center T/F to better understand how continuous Analyze the of case studyeducation at Virginia Mason quality improvement works. 3. The first American legislation that protected students with disabilities was passed in the 1950s. T/F 4. • All students disabilities should be educated in special education Evaluate thewith structure of the U.S. healthcare system and how multipleclassrooms. players haveT/F a role in quality improvement. 5. Special education law is constantly reinterpreted. T/F • Relate major healthcare reforms U.S. history to the current state of quality improvement. Answers can be found at the end of theinchapter. • Describe quality management in managed care. • Examine quality improvement in hospitals and the effect on healthcare. HCA 375 Comparative Performance . • Show how physicians and physician practices implement quality improvement projects. 41 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.1 A Story of Continuous Quality Improvement Introduction In 2004, Virginia Mason Medical Center in Seattle admitted Mary McClinton for a complex but routine procedure to treat a brain aneurysm, which is an abnormal or weak spot on a blood vessel in the brain that causes an outward ballooning of the arterial wall. This can be lifethreatening, as a ruptured aneurysm with subsequent bleeding into the brain is lethal. Doctors intended to inject a contrast dye through a catheter in her leg as part of the procedure, but instead they injected her with antiseptic, which blocked the blood flow in her leg and caused her organs to fail, one by one. She died 19 days later as a result of this medical mistake because the antiseptic had been placed in an unlabeled container on the same tray as the dye. Virginia Mason has come a long way since 2004 and was named a top hospital of the decade in 2010 by The Leapfrog Group (http://www.leapfroggroup.org), a consortium of businesses that purchase health insurance for their employees and focus on improving the quality of healthcare. However, even before Ms. McClinton’s death, the hospital had begun to improve its safety procedures, developed checklists for surgeries and drug dispensations, established patient safety alerts, and encouraged all hospital employees to advocate for patient safety (AARP, 2013). Virginia Mason became one of the best hospitals in safety and quality standards within a few years of that tragic event. This was accomplished by the coordinated efforts of all hospital employees. 3.1 A Story of Continuous Quality Improvement The story of Virginia Mason Medical Center demonstrates how one healthcare system successfully used continuous quality improvement to improve the care of its patients. In 2001, Virginia Mason began to examine ways it could change its healthcare delivery to improve both quality and safety. During the search for a management method to achieve those goals, medical center leaders became aware of how the Boeing airplane manufacturer had used a system created by a Japanese car manufacturer to improve its processes. Called the Toyota Production System (TPS, sometimes also called lean production or lean theory), Boeing used the system to eliminate waste and improve quality in manufacturing its airplanes. You will find more on lean theory and how Virginia Mason put it into practice in Chapter 7. But what similarities do car and airplane manufacturing have with healthcare? Virginia Mason leaders found that the Toyota Production System principles—the customer comes first, Shizuo Kambayashi/Associated Press The Virginia Mason Medical Center used the principles of the Toyota Production System to improve the quality and safety of its healthcare delivery. 42 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.1 A Story of Continuous Quality Improvement Dedication to the highest quality, obsession with safety, the aim for high staff satisfaction, and a successful economic enterprise—translated very well to healthcare. While patients are certainly not cars, manufacturing and healthcare are both filled with complex production processes. In healthcare, those processes include admitting a patient, conducting a clinic visit, or performing surgery. As with manufacturing, these processes should embrace the concepts of quality, safety, customer satisfaction, staff satisfaction, and cost effectiveness—each of which Virginia Mason’s quality improvement system tries to optimize on behalf of its patients. Virginia Mason adopted the Toyota system and began to apply the tenets that worked successfully in car manufacturing through a number of quality improvement initiatives, naming its program the Virginia Mason Production System (VMPS). Its goal was to eliminate waste and improve quality and safety through tools and techniques adapted from the manufacturing world. . Early on in the quality improvement process, Virginia Mason used VMPS to develop a new Patient Safety Alert (PSA) system, which requires all staff members who encounter a situation likely to harm a patient to make an immediate report and stop any activity that could cause further harm. This is called “stopping the line,” or stopping the activity and correcting the problem, in the same way a worker at the Toyota plant could pull a cord to signal a problem and stop the production line rather than allowing a potential product defect. Senior leaders would respond to the most serious of these PSAs. If the safety of a patient is indeed at risk, an investigation is immediately launched to correct the problem. From the program’s inception in 2002 through 2009, more than 14,500 PSAs were reported and most were processed within 24 hours (Virginia Mason Medical Center, 2014, “VMPS Success Stories”). That contrasts sharply with the years prior to 2002, when reports took 3 to 18 months to resolve. Mary McClinton’s death occurred early in the VMPS implementation. The hospital had recently switched antiseptics (the solution used to clean skin before and after procedures) from a brown iodine-based solution to a colorless liquid (Perry & Ostrom, 2004). She was accidentally injected with an antiseptic, which was one of three clear liquids in bowls on the surgical tray; the other liquids were contrast solution, to make blood vessels visible on x-rays, and saline. This mistake caused Mary to suffer kidney failure, a sudden drop in blood pressure, and a stroke. The hospital publicly explained what had happened and apologized for the error. HCA 375 Comparative Performance . The case sparked sweeping changes in patient safety protocols at Virginia Mason. The hospital mistake-proofed the process by purchasing swabs with solution already on them to prevent future errors. As part of a legal settlement with Mary’s family, Virginia Mason used her case to teach medical staffers the importance of proper labeling of medications. She became the namesake of the hospital’s patient safety award, which is given annually to the team that develops and implements the most significant measures that enhance patient safety. Mary’s death was a watershed moment, further demonstrating the need to integrate the calling out of errors and defects in the organization’s culture. The problem also went beyond the walls of Virginia Mason and resulted in other hospitals changing their processes. Following Mary’s death, as well as several other high-profile cases, The Joint Commission (TJC) included the requirement that hospitals label all medication containers and solutions in procedure areas in its 2006 National Patient Safety Goals. 43 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.2 The United States Healthcare System The purpose of continuous quality improvement programs is to improve healthcare by identifying problems, implementing and monitoring corrective actions, and studying its effectiveness. . In this case, the problem at Virginia Mason was clearly identified by the preventable death of a patient and the hospital immediately began looking for ways to keep this situation from recurring. It is important to remember that CQI focuses on system issues. Beyond the mix-up that occurred during this specific procedure at Virginia Mason, it was important that the hospital look at the overall issue of properly labeling all medications and solutions to prevent errors throughout the system. By sharing its error, Virginia Mason also highlighted the problem so other healthcare organizations could make changes to their own systems. Questions to Consider 1. Discuss how, despite such major differences between manufacturing cars and caring for patients, the same quality improvement method can be used in healthcare and manufacturing. 2. When a patient death or major injury occurs, do you think a hospital should publicly explain what happened and offer an apology for the error? How can this benefit a hospital? How can such a public admission hurt the organization? 3. Can you think of an error that might occur at one hospital that could result in changes to other hospital systems? 3.2 The United States Healthcare System The U.S. healthcare system is a fiscally driven entity that spends more on healthcare than any other developed country in the world (Organization for Economic Co-operation and Development, 2013). Despite the limited access to basic healthcare by the millions of uninsured, healthcare costs continue to rise rapidly. In 2010, annual national health expenditures totaled $2.6 trillion, in comparison to $27.3 billion in 1960 (U.S. Census Bureau, 2012). HCA 375 Comparative Performance . By 2018, it is estimated that the United States will spend more than $4.3 trillion per year, or 20.3% of the gross domestic product (GDP), which is the monetary value of all finished goods and services produced within the United States in a year (Centers for Medicare and Medicaid Services, 2011a). In 2011, the United States spent 17% of its GDP on healthcare. This spending level far exceeds that of other Organization for Economic Co-operation and Development (OECD) nations: the next highest spender is France, which spent 11.2% of GDP in 2011 (OECD, 2013). In equal dollar terms, in 2011 the United States spent $8,175 per person, as compared to $3,970 per person in France. Despite spending more than double the amount of money on healthcare, health outcomes (such as life expectancy) are no better, and often worse, in the United States. Of course, there are many reasons for the high cost of healthcare in the United States, which must be balanced with the medical care the system provides. Take for instance, the fact that other countries place major restrictions on the amount of damages that can be awarded in malpractice lawsuits. That is the not the case in the United States, where a jury can decide 44 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. HCA 375 Comparative Performance Section 3.2 The United States Healthcare System to award millions of dollars to settle malpractice lawsuits brought against physicians and healthcare organizations. Malpractice reform, which has long been discussed, would help bring down healthcare costs in the United States. It’s also necessary to look at the care various countries are able to provide. Consider that technology is advanced in the United States and is far better than in many other countries. Access to medical services is also good in America compared to the wait times to see a doctor or schedule a surgery in many other countries. Costs would also go down if the healthcare system could address major health problems and create a healthier population of patients. For instance, obesity rates in America are among the highest in the world, leading to many health complications. The healthcare system has multiple players including employers, insurance companies, and managed care companies; health service professionals, which include physicians, nurses, and therapists; health service organizations such as hospitals, integrated delivery systems, and nursing homes; and the government. The players with substantial political and financial power try to influence decisions and maximize their interest in the largest industry in the nation. Each player has a different economic interest, but none can dominate the industry except the government. . Quality improvement efforts to reduce medical errors, such as injuries and deaths, are made by all parties involved in the healthcare delivery system. These efforts are ongoing and steady progress has been made to improve patient safety records and medical errors. While different players have their own interests in the healthcare system—an insurance company may look to keep costs under control while a physician may want to order many tests to diagnose a patient’s problem—all of the players benefit from quality improvement projects that reduce patient injuries. For example, a hospital may launch a quality improvement project to reduce patient falls. It is beneficial to the insurance companies who would have to cover a longer hospital stay if a patient fell and broke his or her hip, needing more days in the hospital as well as possible rehabilitation. Or hospitals that follow best practices, such as prescribing beta blockers to heart attack patients, can keep them healthier, allowing them to return to work and cutting future healthcare costs. Insurers, providers, employers, and healthcare professionals can all cooperate in creating a system that can reduce total healthcare costs and premiums while achieving better outcomes for patients. The Institute for Healthcare Improvement (IHI) calls this the “Triple Aim”: better care for individuals, better health for populations, and a lower per capita cost. The IHI supports initiatives to move the country to a system that achieves these goals. Web Field Trip For an overview of the healthcare system, visit the Kahn Academy website (http://www .khanacademy.org) and search for the video Healthcare System Overview. In the video, Professor Laurence C. Baker, Stanford University, considers some of the basic who, what, and how elements of the healthcare system. 45 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.2 The United States Healthcare System Employers and Insurance The United States has a fragmented healthcare delivery system in comparison to other developed countries such as England, Germany, and France. The system is described as fragmented because of the large number of insurers, health systems, and physicians that lack effective mechanisms to coordinate care. The system is unique because many working citizens receive their health insurance from their employer with a shared financial responsibility. Employers screen health insurance plans before offering a small number of these plans to employees. Screening is based on price, quality, and coverage, which is a layer of competition health insurance companies are required to successfully pass. F1 ONLINE/SuperStock The U.S. healthcare system includes about 1,000 insurance companies. Health Service Providers This system allows approximately 195 million Americans to obtain insurance through their employer, while another 105 million are covered by two major government programs: Medicare and Medicaid (Shi & Singh, 2013). This combination of employerand government-based insurance left approximately 47 million Americans without any health insurance in 2012 (Kaiser Family Foundation, 2013). The healthcare system includes about 1,000 insurance companies, 70 Blue Cross and Blue Shield plans, 452 health maintenance organizations (HMOs), and 925 preferred provider organizations (PPOs) (Shi & Singh, 2013). Individuals who provide healthcare are at the center of the delivery system, making crucial decisions to treat patients. HCA 375 Comparative Performance . The types of providers who drive care decisions include physicians, physician assistants, nurse practitioners, therapists, and others. These providers are also in a position to make decisions to improve financing, delivery, and quality of healthcare. Generally, the central point of healthcare delivery is the provider’s diagnosis and treatment plan. Quite often, quality improvement projects focus here because the patient’s journey typically begins with a visit to a primary care provider or specialist. Nurses are the largest group of healthcare professionals in the healthcare system, with approximately 2.8 million registered nurses (RNs), including advanced practice registered nurses, and about 690,000 licensed practical nurses (LPNs) (Health Resources and Services Administration, 2013). They are employed as caregivers in various settings to provide healthcare to patients alongside physicians and other providers. Nurses with advanced training and certification (such as nurse practitioners) are assuming an increasingly important role in care delivery. Therapists are health professionals whose role is to improve a patient’s functional movement (physical therapist) or to teach the patient how to carry out activities of daily living and to cope with working environments (occupational therapist) in the context of any 46 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.2 The United States Healthcare System limitations imposed by their health. Respiratory therapists and speech therapists are frequently employed in the healthcare system to help patients with breathing problems and speech impediments. While these healthcare professionals provide direct care to patients, they cannot do their jobs well without support from many other professionals who work in healthcare organizations. For instance, clinical safety and facility safety go hand in hand. Facility managers can make vital contributions to patient safety efforts. Patient safety, employee safety, and facility safety programs can work in conjunction to create a safe environment for everyone. HCA 375 Comparative Performance . Look at it this way: If a nurse gives out one wrong medication dose, it jeopardizes the safety of one patient. If a nursing home does not have a fire safety program, with a plan to evacuate all of its elderly residents in an emergency—some of whom are confined to bed and can’t get themselves out in case of a fire—everyone in that building can be put at risk. While physicians and nurses provide care to newborn babies in a hospital nursery, the facility’s security manager helps put in place the security system to protect those babies from abductions—a rare but frightening occurrence in hospitals. The hospital security guards will be the first to respond if someone tries to take a baby from that nursery without authorization. Patients count on having a secure and accurate medical record. That happens because of the work of health information management managers and staff who oversee a hospital’s medical records. HIPAA compliance officers put measures in place to ensure a patient’s protected health information—whether on paper or on a computer—is kept safe and isn’t accessed by unauthorized individuals. From housekeeping managers and staff to food services, it takes many people in different roles to keep healthcare organizations running. Health Service Organizations There are numerous organizations that provide health services, including hospitals, integrated delivery systems, and nursing homes. Hospitals are a central point to healthcare delivery, as they offer patient services (diagnostic and therapeutic) for med … HCA 375 Comparative Performance Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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HCA 375 Comparative Performance

HCA 375 Comparative Performance ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON HCA 375 Comparative Performance HCA375 Discussions Week 2 – Discussion Comparative Performance For this discussion, you are tasked with comparing two hospitals, one that is considered a safety-net hospital (public hospitals who care for a large segment of the population who are uninsured or underinsured) and one hospital from a more affluent area in the state where you live. HCA 375 Comparative Performance Visit The Joint Commission: Quality Check (Links to an external site.) Links to an external site. . Take the following steps to find two hospitals: Enter a city and state, and then select Locate . A list of hospitals for that city and state will populate on the page. Select View Report . Select View Accreditation History . Next, select the most recent Quality Report , which will open as a PDF document. Scroll down to the pages that list the National Patient Safety Goals and then the National Quality Improvement Goals. Choose one from either list. If you choose a National Patient Safety Goal, State the goal and the procedure(s) indicated in the Organization Should Discuss the implications to the patient, staff (physicians, nurses, medical assistance, pharmacists, etc.) and hospital if the health care professional fails to follow the procedure indicated. If you choose a Quality Improvement Goal, State the measure and explanation of that goal. Discuss how the hospital can improve their performance to meet the target. Repeat the above steps for a second hospital. Reminder, one hospital should be a safety-net hospital and one should serve an affluent community. Next, compare and contrast the differences between the two facilities. After review of the two hospitals, discuss your opinion about the reasons these hospitals could have disparities. Your initial post should be 250 to 300 words and utilize at least one scholarly source from the Ashford University Library to justify your recommendations for improvement. Cite all sources in APA format as outlined in the Ashford Writing Center’s Introduction to APA (Links to an external site.) Links to an external site. . The Research, Keywords, Databases: An Overview (Links to an external site.) Links to an external site. video tutorial is available to help you become more familiar with the library database search features and how to generate keywords. HCA 375 Comparative Performance Guided Response: Choose two classmates, and respond as a patient who has experienced the issue identified in your classmates’ posts. Answer the questions listed below. Your guided response posts should be a minimum of five well-developed sentences. What role does customer satisfaction play in your decision to utilize the health care facility in the future based on the findings? What would you expect as the patient? Explain your answer. _03ch_moin_healthcare.pdf _04ch_moin_healthcare.pdf . 1 3 What is Special Education? The Healthcare Industry: Structure, History, and Continuous Quality Improvement Associated Press/J. Scott Applewhite iStockphoto/Thinkstock Learning Objectives Pre-Test After reading this you should behandicap able to dointerchangeably. the following: T/F 1. You can use thechapter, terms disability and 2. • The history special began in Medical Europe. Center T/F to better understand how continuous Analyze the of case studyeducation at Virginia Mason quality improvement works. 3. The first American legislation that protected students with disabilities was passed in the 1950s. T/F 4. • All students disabilities should be educated in special education Evaluate thewith structure of the U.S. healthcare system and how multipleclassrooms. players haveT/F a role in quality improvement. 5. Special education law is constantly reinterpreted. T/F • Relate major healthcare reforms U.S. history to the current state of quality improvement. Answers can be found at the end of theinchapter. • Describe quality management in managed care. • Examine quality improvement in hospitals and the effect on healthcare. HCA 375 Comparative Performance . • Show how physicians and physician practices implement quality improvement projects. 41 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.1 A Story of Continuous Quality Improvement Introduction In 2004, Virginia Mason Medical Center in Seattle admitted Mary McClinton for a complex but routine procedure to treat a brain aneurysm, which is an abnormal or weak spot on a blood vessel in the brain that causes an outward ballooning of the arterial wall. This can be lifethreatening, as a ruptured aneurysm with subsequent bleeding into the brain is lethal. Doctors intended to inject a contrast dye through a catheter in her leg as part of the procedure, but instead they injected her with antiseptic, which blocked the blood flow in her leg and caused her organs to fail, one by one. She died 19 days later as a result of this medical mistake because the antiseptic had been placed in an unlabeled container on the same tray as the dye. Virginia Mason has come a long way since 2004 and was named a top hospital of the decade in 2010 by The Leapfrog Group (http://www.leapfroggroup.org), a consortium of businesses that purchase health insurance for their employees and focus on improving the quality of healthcare. However, even before Ms. McClinton’s death, the hospital had begun to improve its safety procedures, developed checklists for surgeries and drug dispensations, established patient safety alerts, and encouraged all hospital employees to advocate for patient safety (AARP, 2013). Virginia Mason became one of the best hospitals in safety and quality standards within a few years of that tragic event. This was accomplished by the coordinated efforts of all hospital employees. 3.1 A Story of Continuous Quality Improvement The story of Virginia Mason Medical Center demonstrates how one healthcare system successfully used continuous quality improvement to improve the care of its patients. In 2001, Virginia Mason began to examine ways it could change its healthcare delivery to improve both quality and safety. During the search for a management method to achieve those goals, medical center leaders became aware of how the Boeing airplane manufacturer had used a system created by a Japanese car manufacturer to improve its processes. Called the Toyota Production System (TPS, sometimes also called lean production or lean theory), Boeing used the system to eliminate waste and improve quality in manufacturing its airplanes. You will find more on lean theory and how Virginia Mason put it into practice in Chapter 7. But what similarities do car and airplane manufacturing have with healthcare? Virginia Mason leaders found that the Toyota Production System principles—the customer comes first, Shizuo Kambayashi/Associated Press The Virginia Mason Medical Center used the principles of the Toyota Production System to improve the quality and safety of its healthcare delivery. 42 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.1 A Story of Continuous Quality Improvement Dedication to the highest quality, obsession with safety, the aim for high staff satisfaction, and a successful economic enterprise—translated very well to healthcare. While patients are certainly not cars, manufacturing and healthcare are both filled with complex production processes. In healthcare, those processes include admitting a patient, conducting a clinic visit, or performing surgery. As with manufacturing, these processes should embrace the concepts of quality, safety, customer satisfaction, staff satisfaction, and cost effectiveness—each of which Virginia Mason’s quality improvement system tries to optimize on behalf of its patients. Virginia Mason adopted the Toyota system and began to apply the tenets that worked successfully in car manufacturing through a number of quality improvement initiatives, naming its program the Virginia Mason Production System (VMPS). Its goal was to eliminate waste and improve quality and safety through tools and techniques adapted from the manufacturing world. . Early on in the quality improvement process, Virginia Mason used VMPS to develop a new Patient Safety Alert (PSA) system, which requires all staff members who encounter a situation likely to harm a patient to make an immediate report and stop any activity that could cause further harm. This is called “stopping the line,” or stopping the activity and correcting the problem, in the same way a worker at the Toyota plant could pull a cord to signal a problem and stop the production line rather than allowing a potential product defect. Senior leaders would respond to the most serious of these PSAs. If the safety of a patient is indeed at risk, an investigation is immediately launched to correct the problem. From the program’s inception in 2002 through 2009, more than 14,500 PSAs were reported and most were processed within 24 hours (Virginia Mason Medical Center, 2014, “VMPS Success Stories”). That contrasts sharply with the years prior to 2002, when reports took 3 to 18 months to resolve. Mary McClinton’s death occurred early in the VMPS implementation. The hospital had recently switched antiseptics (the solution used to clean skin before and after procedures) from a brown iodine-based solution to a colorless liquid (Perry & Ostrom, 2004). She was accidentally injected with an antiseptic, which was one of three clear liquids in bowls on the surgical tray; the other liquids were contrast solution, to make blood vessels visible on x-rays, and saline. This mistake caused Mary to suffer kidney failure, a sudden drop in blood pressure, and a stroke. The hospital publicly explained what had happened and apologized for the error. HCA 375 Comparative Performance . The case sparked sweeping changes in patient safety protocols at Virginia Mason. The hospital mistake-proofed the process by purchasing swabs with solution already on them to prevent future errors. As part of a legal settlement with Mary’s family, Virginia Mason used her case to teach medical staffers the importance of proper labeling of medications. She became the namesake of the hospital’s patient safety award, which is given annually to the team that develops and implements the most significant measures that enhance patient safety. Mary’s death was a watershed moment, further demonstrating the need to integrate the calling out of errors and defects in the organization’s culture. The problem also went beyond the walls of Virginia Mason and resulted in other hospitals changing their processes. Following Mary’s death, as well as several other high-profile cases, The Joint Commission (TJC) included the requirement that hospitals label all medication containers and solutions in procedure areas in its 2006 National Patient Safety Goals. 43 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.2 The United States Healthcare System The purpose of continuous quality improvement programs is to improve healthcare by identifying problems, implementing and monitoring corrective actions, and studying its effectiveness. . In this case, the problem at Virginia Mason was clearly identified by the preventable death of a patient and the hospital immediately began looking for ways to keep this situation from recurring. It is important to remember that CQI focuses on system issues. Beyond the mix-up that occurred during this specific procedure at Virginia Mason, it was important that the hospital look at the overall issue of properly labeling all medications and solutions to prevent errors throughout the system. By sharing its error, Virginia Mason also highlighted the problem so other healthcare organizations could make changes to their own systems. Questions to Consider 1. Discuss how, despite such major differences between manufacturing cars and caring for patients, the same quality improvement method can be used in healthcare and manufacturing. 2. When a patient death or major injury occurs, do you think a hospital should publicly explain what happened and offer an apology for the error? How can this benefit a hospital? How can such a public admission hurt the organization? 3. Can you think of an error that might occur at one hospital that could result in changes to other hospital systems? 3.2 The United States Healthcare System The U.S. healthcare system is a fiscally driven entity that spends more on healthcare than any other developed country in the world (Organization for Economic Co-operation and Development, 2013). Despite the limited access to basic healthcare by the millions of uninsured, healthcare costs continue to rise rapidly. In 2010, annual national health expenditures totaled $2.6 trillion, in comparison to $27.3 billion in 1960 (U.S. Census Bureau, 2012). HCA 375 Comparative Performance . By 2018, it is estimated that the United States will spend more than $4.3 trillion per year, or 20.3% of the gross domestic product (GDP), which is the monetary value of all finished goods and services produced within the United States in a year (Centers for Medicare and Medicaid Services, 2011a). In 2011, the United States spent 17% of its GDP on healthcare. This spending level far exceeds that of other Organization for Economic Co-operation and Development (OECD) nations: the next highest spender is France, which spent 11.2% of GDP in 2011 (OECD, 2013). In equal dollar terms, in 2011 the United States spent $8,175 per person, as compared to $3,970 per person in France. Despite spending more than double the amount of money on healthcare, health outcomes (such as life expectancy) are no better, and often worse, in the United States. Of course, there are many reasons for the high cost of healthcare in the United States, which must be balanced with the medical care the system provides. Take for instance, the fact that other countries place major restrictions on the amount of damages that can be awarded in malpractice lawsuits. That is the not the case in the United States, where a jury can decide 44 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. HCA 375 Comparative Performance Section 3.2 The United States Healthcare System to award millions of dollars to settle malpractice lawsuits brought against physicians and healthcare organizations. Malpractice reform, which has long been discussed, would help bring down healthcare costs in the United States. It’s also necessary to look at the care various countries are able to provide. Consider that technology is advanced in the United States and is far better than in many other countries. Access to medical services is also good in America compared to the wait times to see a doctor or schedule a surgery in many other countries. Costs would also go down if the healthcare system could address major health problems and create a healthier population of patients. For instance, obesity rates in America are among the highest in the world, leading to many health complications. The healthcare system has multiple players including employers, insurance companies, and managed care companies; health service professionals, which include physicians, nurses, and therapists; health service organizations such as hospitals, integrated delivery systems, and nursing homes; and the government. The players with substantial political and financial power try to influence decisions and maximize their interest in the largest industry in the nation. Each player has a different economic interest, but none can dominate the industry except the government. . Quality improvement efforts to reduce medical errors, such as injuries and deaths, are made by all parties involved in the healthcare delivery system. These efforts are ongoing and steady progress has been made to improve patient safety records and medical errors. While different players have their own interests in the healthcare system—an insurance company may look to keep costs under control while a physician may want to order many tests to diagnose a patient’s problem—all of the players benefit from quality improvement projects that reduce patient injuries. For example, a hospital may launch a quality improvement project to reduce patient falls. It is beneficial to the insurance companies who would have to cover a longer hospital stay if a patient fell and broke his or her hip, needing more days in the hospital as well as possible rehabilitation. Or hospitals that follow best practices, such as prescribing beta blockers to heart attack patients, can keep them healthier, allowing them to return to work and cutting future healthcare costs. Insurers, providers, employers, and healthcare professionals can all cooperate in creating a system that can reduce total healthcare costs and premiums while achieving better outcomes for patients. The Institute for Healthcare Improvement (IHI) calls this the “Triple Aim”: better care for individuals, better health for populations, and a lower per capita cost. The IHI supports initiatives to move the country to a system that achieves these goals. Web Field Trip For an overview of the healthcare system, visit the Kahn Academy website (http://www .khanacademy.org) and search for the video Healthcare System Overview. In the video, Professor Laurence C. Baker, Stanford University, considers some of the basic who, what, and how elements of the healthcare system. 45 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.2 The United States Healthcare System Employers and Insurance The United States has a fragmented healthcare delivery system in comparison to other developed countries such as England, Germany, and France. The system is described as fragmented because of the large number of insurers, health systems, and physicians that lack effective mechanisms to coordinate care. The system is unique because many working citizens receive their health insurance from their employer with a shared financial responsibility. Employers screen health insurance plans before offering a small number of these plans to employees. Screening is based on price, quality, and coverage, which is a layer of competition health insurance companies are required to successfully pass. F1 ONLINE/SuperStock The U.S. healthcare system includes about 1,000 insurance companies. Health Service Providers This system allows approximately 195 million Americans to obtain insurance through their employer, while another 105 million are covered by two major government programs: Medicare and Medicaid (Shi & Singh, 2013). This combination of employerand government-based insurance left approximately 47 million Americans without any health insurance in 2012 (Kaiser Family Foundation, 2013). The healthcare system includes about 1,000 insurance companies, 70 Blue Cross and Blue Shield plans, 452 health maintenance organizations (HMOs), and 925 preferred provider organizations (PPOs) (Shi & Singh, 2013). Individuals who provide healthcare are at the center of the delivery system, making crucial decisions to treat patients. HCA 375 Comparative Performance . The types of providers who drive care decisions include physicians, physician assistants, nurse practitioners, therapists, and others. These providers are also in a position to make decisions to improve financing, delivery, and quality of healthcare. Generally, the central point of healthcare delivery is the provider’s diagnosis and treatment plan. Quite often, quality improvement projects focus here because the patient’s journey typically begins with a visit to a primary care provider or specialist. Nurses are the largest group of healthcare professionals in the healthcare system, with approximately 2.8 million registered nurses (RNs), including advanced practice registered nurses, and about 690,000 licensed practical nurses (LPNs) (Health Resources and Services Administration, 2013). They are employed as caregivers in various settings to provide healthcare to patients alongside physicians and other providers. Nurses with advanced training and certification (such as nurse practitioners) are assuming an increasingly important role in care delivery. Therapists are health professionals whose role is to improve a patient’s functional movement (physical therapist) or to teach the patient how to carry out activities of daily living and to cope with working environments (occupational therapist) in the context of any 46 © 2017 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.2 The United States Healthcare System limitations imposed by their health. Respiratory therapists and speech therapists are frequently employed in the healthcare system to help patients with breathing problems and speech impediments. While these healthcare professionals provide direct care to patients, they cannot do their jobs well without support from many other professionals who work in healthcare organizations. For instance, clinical safety and facility safety go hand in hand. Facility managers can make vital contributions to patient safety efforts. Patient safety, employee safety, and facility safety programs can work in conjunction to create a safe environment for everyone. HCA 375 Comparative Performance . Look at it this way: If a nurse gives out one wrong medication dose, it jeopardizes the safety of one patient. If a nursing home does not have a fire safety program, with a plan to evacuate all of its elderly residents in an emergency—some of whom are confined to bed and can’t get themselves out in case of a fire—everyone in that building can be put at risk. While physicians and nurses provide care to newborn babies in a hospital nursery, the facility’s security manager helps put in place the security system to protect those babies from abductions—a rare but frightening occurrence in hospitals. The hospital security guards will be the first to respond if someone tries to take a baby from that nursery without authorization. Patients count on having a secure and accurate medical record. That happens because of the work of health information management managers and staff who oversee a hospital’s medical records. HIPAA compliance officers put measures in place to ensure a patient’s protected health information—whether on paper or on a computer—is kept safe and isn’t accessed by unauthorized individuals. From housekeeping managers and staff to food services, it takes many people in different roles to keep healthcare organizations running. Health Service Organizations There are numerous organizations that provide health services, including hospitals, integrated delivery systems, and nursing homes. Hospitals are a central point to healthcare delivery, as they offer patient services (diagnostic and therapeutic) for med … HCA 375 Comparative Performance Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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