Week 7 Flashcards
Quality Improvement
-method to ensure that quality care is being provided
-self-monitoring, intra-institutional
-accrediting agencies review the pertinence and consistency of your review
-use evidence gained to effect change and provide better care
ACOTE Standards
-most recently updated in 2018
-the ACOTE standards represent the knowledge, skills and abilities required for clinical practice, these standards are not static
JCAHO
Joint Commission on the Accreditation of Hospitals Organization healthcare organizations
-These accreditation organizations are voluntary participation, however if your institution is JCAHO approved, then consumers can rest assured that someone is looking and checking routinely on the overall level of care provided at that facility
-they pick a patient case and follow their every move throughout the day/system
-JCAHO often speak to staff level workers
CARF
commission in the accreditation of rehabilitation hospitals
-ex. RUSK
Quantitative Monitors
-patient complaints
-documentation completeness and timeliness
-whether modalities are maintained for cleanliness
-whether clients are satisfied with the outcome of care
Qualitative Monitors
-case based outcomes of specific care delivery, looks at what is being done and how it’s being delivered (subjective)
-If the setting provides specialized care, like HSS that specializes in orthopedic care, do they have different outcomes for their orthopedic surgery than other facilities that are multi-specialty?
Single Case Study Design
-Some information that can be collected are functional outcome surveys Pre-treatment (like the DASH), then deliver specific treatment, then can do same checklist at discharge to check the effectiveness of the interventions.
-you can collect information from patients about how the intervention made quality of improvement change in their lifestyle. For example: how did the therapy affect their occupational profile and their personal sense of satisfaction. It is a subjective statement, but can help to reinforce what is being done well and what areas may need some attention.
Quality Improvement Studies
-quick and dirty administratice took used by OT managers or hospital admin to find out where care is not efficient; gives then quick goals to put in place on how to improve
-generally not refined or published research
- the measure should be sensitive enough to monitor change
- needs to be meaningful change and point to a direction that can help to solve a problem
Quality Improvement Monitors: Clinical Monitors
- rehab department seeing many patients with hemi shoulder pain after stroke, the department put a hemi-shoulder protocol in place for all incoming patients with flaccid UE, once the protocol was in place, there was a reduced # of shoulder subluxations & fewer patients with shoulder pain, may conclude that it is effective
-Clinical monitors document clinical outcomes, this can be looking at specific care plans or clinical pathways
Administration Monitors
Charting Complaince
-chart review
-peer review of documentation to see if it is complete and follows policies and procedures outlined by the facility
-Administrative monitors address things that aren’t specifically clinical like documentation issues, response to referral time, or maybe wait time for an appointment, they do not address the actual clinical care
Performance Measures
-Process Measures assess the steps that should be followed to provide good care
-Outcome Measures assess the results of healthcare that are experienced by patients (ability to perform ADLs)
-Patient Engagement & Patient Experience Measure uses direct feedback from patients and their caregivers about the experience of receiving care (surveys)
QA Program
The Physician Quality Reporting System (PQRS) federal program that uses medicare payment adjustments to promote quality measure reporting
-The government can then collect all of this data, with the ultimate goal of being able to see which providers are seeing improvement in their patients based on the quality data collected.
Five C’s of Valid Customer Requirements
Current: are consistent with today’s
competitors and benchmarks
Calculable: can be measured
Completable: can be reasonably and
realistically accomplished
Consensus-based: are identified and
supported by key stakeholders involved in
the process; includes consideration of
resources and resource limitations
Consistent with organizational goals: are
consistent with the organization’s mission
and vision
Continuous Quality Improvement as a Management Philosophy
-Awareness: create organizational awareness
-Knowledge: build foundation and skill
-Implementation: decentralize ownership
-Integration: establish ways of doing business
Stages of Team Development
Forming: team will need the leaders to provide clear aims and objectives
Storming: team leader’s authority may be challenged
Norming: team feels more comfortable sharing ideas, receiving constructive feedback, and offering commitment to the project goal
Performing: able to function as a unit, the team members’ motivation and confidence about the task at hand is secure, and their efforts demonstrate progress.
Plan-Do-Study-Act
-Plan: Identify and define the problem and aim, assess the current situation, develop solutions
-Do: implement pilot test/your solutions
-Study: study the results
-Act: revise or fully implement solutions
