PhyCor Inc Case Study questions

PhyCor Inc Case Study questions ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON PhyCor Inc Case Study questions The word count distribution must include at least 350 words in response to each question. 1400 words total and 3 scholarly sources total. I wanted to address the “Real Time” requirement in the Case Summary section so that you don’t lose points unnecessarily. Here is a rule of thumb to work with: If the issue did not occur after January 2018, it should not feature in your case summary. This means your Case Summary essay should be an update of what has occurred over the past 12 months. PhyCor Inc Case Study questions In addition, don’t quote scholarly journal articles in the Case Summary. Typically, scholarly journal articles will not be “real time.” Moreover, quoting scholarly journals in the Case Summary tends to make students stray into analysis and application, rather than remaining focused on summary. The scholarly journal references should be reserved for your analysis and application essays. References for the Case Summary section should be current online sources. RESEARCH: You need to cite at least three Scholarly Journal articles in addition to citing the course textbook. Library research is required in the COMPLETE assignment of each unit. At least (2) of your citations must be from scholarly journal articles with references and must use citations from the downloaded book, Burns, L. R., Bradley, E. H., & Weiner, B. J. (2011). Shortell and Kaluzny’s Health Care Management: Organizational Design and Behavior (6th ed.). Wikipedia, Wiki Answers, About.com, Ask.com, Yahoo Answers, eHow, Personal blogs, and other sources of that ilk are not credible for academic work. Quoting such sources as credible is strictly forbidden. Finding Articles in EBSCO (Library Help) Here are 2 links that should help you in finding articles in the library: Ebsco-finding articles Ebsco-in a minute Read the Case Study on page 315 called PhyCor, Inc. and answer the following questions. 1.In a narrative format, discuss the key facts and critical issues presented in the case. 2.What was PhyCor’s initial strategy and business model? What do you think went wrong with this strategy and business model? 3.If you become the CEO of PhyCor, what steps would you take to develop a new strategy and business model? 4.What challenges will you be faced with as CEO in light of all of the changes in healthcare and pressures to provide more quality with less? PhyCor Inc Case Study questions https___dftj9wb4gc6c5.cloudfront.net_bethel_courses_hm_4551_unit_4_read.pdf hm_4551_unit_4_read.pdf Chapter 9 Improving Quality in Health Care Organizations S Ann Scheck McAlearney and AJeffrey A. Alexander CHAPTER OUTLINE U N D E R S • Quality Improvement in Health Care • Quality Measurement and Quality Improvement • Approaches to Quality Improvement • S Getting to Higher Quality and Quality Improvement • Applying Quality Improvement FrameworksR . LEARNING OBJECTIVES, After completing this chapter, the reader should be able to: 1. Explain the importance of quality improvement (QI) in health care 2. Define quality and performance measures for organizations 6. G A Differentiate the important issues in defining, measuring, and using quality and performance measures R QI implementation in HCOs Recognize the challenges of undertaking QI and R Distinguish among QI frameworks Describe opportunities to apply QI tactics andY strategies to support QI in HCOs 7. Assess conditions for QI change 8. Justify the need to manage for QI in health care 2 9. Explain the importance of people and focusing0on people issues in QI efforts 3. 4. 5. 10. Describe management roles to create high-performance, quality-focused organizations 9 0 T S Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 250 PART 2 • Micro Perspectives KEY TERMS Benchmarking Quality Improvement (QI) Clinical Practice Guidelines Quality Improvement (QI) Interventions Continuous Quality Improvement Quality Measures High-Performance Work Practices (HPWPs) Six Sigma Implementation Structural Measures of Quality Lean Transactional Leadership S Outcome Measures of Quality Transformational Leadership A Process Measures of Quality U N IN PRACTICE: Sharp HealthCare D and Their Quality Improvement Journey Sharp HealthCare is a large, not-for-profit health system E based in San Diego, California. With over 14,000 employees and 2,600 physician affiliates, the system is comprised of four acute-care hospitals, three specialty hospitals, and two medical R and services. Given its location in a highly regulated state, Sharp groups, and also includes a wide range of other facilities faces particular challenges associated with corporate S practice of medicine laws and the laws regulating nurse-staff ratios as they impact Sharp’s abilities to employ and deploy health care professionals throughout their organization. Yet despite these challenges, Sharp HealthCare has received increased attention over the past decade as it has received national recognition for Magnet designation for nursing excellence at two S of its acute-care hospitals, national designation as a Planetree hospital at another acute-care hospital, and the prestigious 2007 Malcolm Baldrige Award for Quality for the system as a whole. R Sharp’s self-described quality improvement “journey” has been multifaceted and has touched the entire health system. PhyCor Inc Case Study questions In the late 1990s, Sharp had a solid reputation .in the San Diego area, and patient satisfaction scores collected by the organization were high, indicating that there was not , much to worry about. A change in system leadership, however, created an opportunity to focus on quality and quality improvement in a new way. Curious about how they were doing, Sharp decided to convene some focus groups to find out how patients felt about Gand chagrin of health system leaders, Sharp’s patients told them the their health care experience. Much to the surprise experience was not all that good, and health care in Ageneral left much to be desired from a customer perspective. Instead of confirming their belief that Sharp was well regarded by satisfied patients, these focus groups indicated many opportunities for R data against other health systems and contracted with Press-Ganey for improvement. The health system began to benchmark patient satisfaction measurement. Patient satisfaction R scores as measured by the new scale were in the lowest quartile. Sharp’s leaders used these data to spark employee Y interest in quality and performance improvement, and to motivate employees to address needed changes. Over the course of the next decade, Sharp made a substantial investment in Lean and Six Sigma methods as its selected approach to performance improvement, and built a QI focus into the culture of the organization. In addition, as an organizing framework for the QI journey, 2 Sharp designed The Sharp Experience as a performance improvement initiative designed to help Sharp realize its mission-driven goal to be the best place to work, the best place to practice medicine, 0 coveted Baldrige Award for Quality in 2007 provided public recognition of and the best place to receive care. Sharp’s receipt of the Sharp’s success in their QI journey. Now beyond Baldrige, 9 Sharp continues to capitalize on opportunities for QI, and is currently driving improvements in patient safety, including “just culture,” transparency, Team Training, standardized communication processes, 0 handoff standardization, and design change to improve quality of care and patient safety throughout the health system. T S SOURCE: Nancy G. Pratt, RN, MS, Senior Vice President, Clinical Effectiveness, Sharp HealthCare; Sharp HealthCare Web site (http://www.sharp.com) Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. CHAPTER 9 • Improving Quality in Health Care Organizations CHAPTER PURPOSE With the release of the IOM’s report, To Err is Human: Building a Safer Health System (IOM, 1999), quality and patient safety reemerged as sentinel issues in health care delivery. The Institute’s report prompted renewed effort to identify and implement quality improvement inter ventions, inter ventions designed to decrease medical errors and enhance patient safety. It also rekindled attempts to hold HCOs accountable for quality. S Government agencies, accrediting bodies, employer groups, and other organizations have developed anA evergrowing number of quality indicators and patient safety U goals against which they intend to measure a health care N organization’s quality performance and improvement. Some states have implemented mandatory quality reporting D systems for hospitals (Morrissey, 2002). PhyCor Inc Case Study questions Thus, health E care organization quality is likely to remain under intense R scrutiny for some time. This chapter outlines how HCOs can improve quality and patient safety through QI efforts, S and describes the challenges and strategies for changing organizational systems to ensure that QI is an accepted part of organizational behavior. S R QUALITY IMPROVEMENT . IN HEALTH CARE , Most everyone agrees that high quality is an important characteristic of health care services. However, quality can be a difficult concept to define. Donabedian (2005) observed G that although quality can be very broadly defined, it usually A reflects the values and goals of the current medical system and of the larger society of which it is a part. According R to Donabedian (1988), there are three major elements of R quality: structure, process, and outcomes. Structure pertains to having the necessary resources to provide adequate health Y care; process focuses on how care is provided, delivered, and managed; and outcomes refers to changes in a patient’s health status as a result of medical care. 2 Another definition of quality that is commonly used 0 and widely accepted is contained in the influential report from 9 the Institute of Medicine (IOM), Crossing the Quality Chasm: A New Health System for the 21st Century. This report 0 defined quality as “the degree to which health services for T individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (IOM, 2001). The report also discussed the six major aims for improvement in health care, built around the need for care to be: safe, effective, patient-centered, timely, efficient, and equitable (IOM, 2001). Health care organizations (HCOs), then, are challenged to provide care, or support the micro-systems that deliver care, that achieves these aims (Berwick, 2002). Quality problems in the U.S. health care system are expressed in numerous ways, stem from different sources, and have different consequences for individuals and organizations. With respect to medical errors, for example, it is estimated that preventable medical errors cause between 44,000 and 98,000 deaths in hospitals each year (IOM, 1999). Further, although Americans receive only 55 percent of recommended treatments for preventive care, acute care, and care for chronic conditions (McGlynn et al., 2003), slightly more than 10 percent receive too much care; care that is not recommended or is potentially harmful (McGlynn et al., 2003). Additionally, poor quality can result in increased expenditures; research suggests that 20 to 30 percent of a typical organization’s expenses are due to issues such as redundancy of effort, rework, error, inefficiency, persistent problems, and untrained employees (Leebov and Ersoz, 2003). Quality Improvement (QI) Quality Improvement (QI) is an organized approach to planning and implementing continuous improvement in performance. QI emphasizes continuous examination and improvement of work processes by teams of organizational members trained in basic statistical techniques and problemsolving tools, and empowered to make decisions based on their analysis of the data. Typically, these QI efforts are strongly rooted in evidence-based procedures and rely extensively on data collected about the processes and outcomes experienced by patients in organizations. Although QI practices were originally developed in the manufacturing sector, quality experts contend that QI methods can be successfully applied to service delivery. Juran (1988), for example, argues that although service outcomes are difficult to measure, due to the intangibility of the product and the interactive nature of service delivery, it remains conceptually feasible to identify customer requirements, to translate these requirements into behavioral routines and standards for S Copyright 2011 Cengage Learning. PhyCor Inc Case Study questions All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 251 252 PART 2 • Micro Perspectives personnel, and to monitor these processes. Several HCOs report having measurable success in applying QI practices to clinical care processes (Gregor et al., 1996; Krein et al., 2004; Lynn, West, Hausmann, et al., 2007; Monteleoni and Clark, 2004; Pestotnik et al., 1996; Solberg et al., 2006; Ullman et al., 1996). Like other systems-based approaches, QI stresses that quality depends foremost on the processes by which services are designed and delivered. The systemic S in the focus of QI complements a growing recognition field that the quality of the care delivered by clinicians A depends substantially on the performance capability of U While the organizational systems in which they work. individual clinician competence remains important, N many increasingly see that the capability of organizational D systems to prevent errors, to coordinate care among settings and practitioners, and to ensure that E relevant, accurate information is available when needed is critical in R providing high-quality care. This systems-based perspective S and on QI emphasizes organization-wide commitment involvement because most, if not all, vital work processes span many individuals, disciplines, and departments in all S clinical settings. and patient registries and other information technology (IT). Registries, decision support, provider communication, and information exchange for care coordination are all important QI enablers. Registries, for example, track groups of patients with specific chronic diseases, helping medical teams to make the most of each office visit and to follow evidencebased care guidelines. Although the model provides general guidelines and identifies specific elements that should be included in a care delivery system, the way in which these elements are adapted by primary care practices will vary as a function of available resources, the types of patients treated by the practice, the size of the practice, and experience with similar forms of QI. In practice, QI interventions can also be described in organizational terms. Interventions can be described (1) by the levels of organization at which the intervention is targeted (e.g., individual level, microsystem level such as teams, work units or departments, or at the macrosystem level of the full organization); and (2) by the scale of the intervention (e.g., single medical center or clinics, multiple sites, or national rollout). Specifying the level and scale of QI interventions can help organizational members to better understand the nature of the QI goals, as well as the potential reach and impact of the QI intervention. R . QI interventions vary widely (Lucas et al., 2007). On QUALITY MEASUREMENT the one hand, externally developed QI involves, looking AND QUALITY QI Interventions outside the organization for new or redesigned practices— often evidence-based—to bring into the organization. The emphasis of the intervention is on the desired newG practice. Many efforts to bring research into practice, such asA guideline implementation, fall into this category.PhyCor Inc Case Study questions By contrast, in Rbegins locally developed QI, the improvement process with a problem, but participants do not know R what the improved practices will look like; solutions evolve through Y analysis and experimentation. In this case, the emphasis is on changing the process by which a service or product is produced. Still other QI initiatives are broadly predefined 2 but allow for considerable flexibility and local tailoring. 0 The chronic care model introduced through the Improving Chronic Illness Care Collaboratives is a good example of 9 such an approach. The Chronic Care Model consists of 0 care; six interrelated system components: effective team planned interactions among providers; self-management T support; community resources; integrated decision support; S IMPROVEMENT In order for organizations to focus on quality and QI in health care, they must understand how quality is measured and monitored. The following sections describe measures and measurement of quality and discuss some of the issues related to the definition and use of different quality and performance measures to drive QI efforts in HCOs. Quality Measures and Measurement Based on Donabedian’s (1966) definition of quality in health care, three basic classes of quality measures have been specified: structural, process, and outcome measures. First, structural measures of quality are defined as based on aspects of an organization or an individual’s actions that could impact overall quality or organizational performance. From a business operations standpoint, these structural measures are associated with Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. CHAPTER 9 • Improving Quality in Health Care Organizations the capacity of an organization to promote effective work. Examples of structural measures of quality in health care are numerous and include indicators such as the number and type of beds in a given organization, the presence of shared governance structures, and the existence of a computerized provider order entry (CPOE) system with decision support features. Even the presence of certain organizational certifications or accolades can be used as structural measures of performance, including accreditation by the S Joint Commission, or receipt of Magnet status in nursing. PhyCor Inc Case Study questions While structural measures of quality are often under the A control of a manager or an organization, they are often seen U as quite distal indicators of care quality. Next, process measures of quality refer to indicators N of the activities involved in carr ying out work in an D organization. Activities such as reviewing medical records E to ensure completion of patient education, monitoring physician and nurse compliance with organizational R standards for cleanliness, or evaluating the use of S central lines are all examples of process metrics. Process measures are often favored over structural measures because they are perceived to be more closely linked to S the clinical care quality, and because they are still within span of control managers have to influence and improve R work processes. . Third, outcome measures of quality are metrics based on the results of work performed. In many ,ways, outcome measures can be considered measures of work process outputs. Examples of outcome measures in health G care are numerous and include metrics such as health status, patient satisfaction, and mortality. Often outcome A measures are viewed as superior to other classes of quality R measures because clinical outcomes are of most concern and relevance to patients and the organizations in which R they receive care. Using Quality Measures Y A key foundation of any QI effort is the ability to accurately 2 measure quality and use those measures to identify problems, monitor progress, and formulate strategies 0 to improve quality of care. Although this seems intuitive, a variety of technical, organizational, and management 9 issues often impede the development and use of quality metrics 0 in HCOs. Perhaps the most fundamental problem is that T to many managers and boards simply do not know what do with quality measures even when they have access to them. Whereas measures of financial performance such as ROI (return on investment) and debt-to-asset ratio are immediately recognizable to most managers and board members, many quality measures remain strange and unfathomable to these same individuals. Often this reflects a lack of training in QI, which would enable managers to translate the measures into actionable changes in care processes. Instead, managers often delegate responsibility for quality performance shortfalls to individual clinicians or medical staff who are assumed to be either the source of knowledge about the problem or its cause, rather than linking the measures to failures in the systems that are the underlying root of the problem (Alexander and Young, 2010). For example, because of their lack of proximity to actual care delivery, managers may not understand the clinical processes and support infrastructure that affects quality indicators such as medication error … . 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