Value Based Health Care E-Book

Yosef D. Dlugacz

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 376

Veröffentlichungsjahr: 2009

Beschreibung

Value-Based Health Care Linking Finance and Quality Yosef D. Dlugacz Value-Based Health Care? Value-Based Health Care?concisely explains the mandate to successfully link health care quality and finance and describes the tools to implement strategies for organizational success. Yosef Dlugacz provides many illustrative real-world examples of process and outcomes of the value-based approach, taken from a wide range of health care settings. Perfect for students preparing to enter health care management or for practicing health care leaders and professionals, this book is a vital guide to approaches that ensure the health of patients and health care organizations alike. Praise for Value-Based Health Care "Value-Based Health Care provides leaders and quality experts with the much needed roadmap for linking cost and quality. This book will help your organization thrive in today's ultra-competitive environment." --Patrice L. Spath, health care quality specialist and author of Leading Your Health Care Organization to Excellence and Error Reduction in Health Care: A Systems Approach to Improving Patient Safety "Yosef Dlugacz provides an essential overview of how staff, administrators, and clinicians can create not just a culture but a gestalt of quality health care delivery. . . .given the national debate over access, cost, and quality, the book could not be more timely." --Theodore J. Joyce, PhD, professor of economics and finance, academic director of the Baruch/Mt. Sinai MBA Program in Health Care Administration, and research associate, National Bureau of Economic Research "Dr. Dlugacz's?case studies and action plans provide great insights and workable solutions to provide safe and effective patient care. It is a welcome resource as we sit on the?advent of health reform." --Kathy Ciccone, executive director, Quality Institute of the Healthcare Association of New York State

Leseprobe

Table of Contents

Title Page

Copyright Page

Table of Figures

List of Tables

PREFACE

Acknowledgements

THE AUTHOR

Dedication

Introduction

PART 1 - BASIC PRINCIPLES OF QUALITY MANAGEMENT

CHAPTER 1 - DRIVERS OF CHANGE

LEARNING OBJECTIVES

EXTERNAL DRIVERS

INTERNAL DRIVERS

CHAPTER 2 - IMPROVING PATIENT SAFETY

LEARNING OBJECTIVES

UNDERSTANDING QUALITY MEASURES

WORKING WITH QUALITY INFORMATION

MEASURING VALUE

ASKING QUESTIONS VIA DATA

PRESENTING RESULTS

EFFECTIVE COMMUNICATION IMPROVES PATIENT SAFETY

CHAPTER 3 - FOCUS ON THE PATIENT

LEARNING OBJECTIVES

EFFECTIVE COMMUNICATION AND PATIENT FOCUSED CARE

HANDOFF INFORMATION TRANSFER

SBAR

BARRIERS TO EFFECTIVE COMMUNICATION

STRATEGIES TO REDUCE BARRIERS

CARE AND COMMUNICATION GUIDELINES

PATIENT EDUCATION

NEAR MISS REPORTING

CHRONIC DISEASE MANAGEMENT

TASK FORCES

PATIENT RIGHTS AND RESPONSIBILITIES

COMPASSIONATE CARING

CHAPTER 4 - UNDERSTANDING PROCESSES, OUTCOMES, AND COSTS

LEARNING OBJECTIVES

SOME EVENTS SHOULD NEVER OCCUR

LEADERS’ ROLE IN GOOD OUTCOMES

PHYSICIANS’ ROLE IN GOOD OUTCOMES

FINANCIAL VALUE OF GOOD OUTCOMES

CHANGING THE TRADITIONAL CULTURE

PART 2 - GETTING DOWN TO BUSINESS

CHAPTER 5 - THE VALUE OF PREVENTION

LEARNING OBJECTIVES

THE PROMOTION OF PREVENTION

THE PROBLEMS WITH PREVENTION

THE PATIENT’S ROLE

PREVENTION MEASURES

REGULATORY GROUPS’ ROLE IN PREVENTION

DATA’S ROLE IN PROMOTING PREVENTION

MANAGEMENT OF CHRONIC CONDITIONS

PREVENTION IN AMBULATORY CARE

PROACTIVE PREVENTION IN THE HOSPITAL

NATIONAL PATIENT SAFETY GOALS

TECHNOLOGY AND PREVENTION

CHAPTER 6 - THE COST OF SENTINEL EVENTS

LEARNING OBJECTIVES

CHANGING THE INCIDENT ANALYSIS FRAMEWORK

THE VALUE OF ROOT CAUSE ANALYSIS

MONITORING BEHAVIORAL HEALTH

ELIMINATING NEVER EVENTS

IMPROVING ERROR REPORTS

QUALITY MANAGEMENT’S ROLE IN CONTROLLING ADVERSE EVENTS

THE TRADITIONAL HIERARCHY LEADS TO ERRORS

THE ECONOMICS OF MALPRACTICE

CHAPTER 7 - MANAGING EXPENSES IN A HIGH RISK ENVIRONMENT

LEARNING OBJECTIVES

IMPROVING COST IN THE ICU

MATCH THE RESOURCES TO THE PATIENT

END OF LIFE CARE

SUSTAINING CHANGE

IMPROVING OPERATING ROOM EFFICIENCY

IMPROVING OVERSIGHT

MANAGING THROUGHPUT

CHAPTER 8 - IMPROVING COMMUNICATION AND ESTABLISHING TRUST

LEARNING OBJECTIVES

DEVELOPING TRUST

THE ROLE OF QUALITY MANAGEMENT IN INCREASING TRUST

TRANSPARENCY, TRACERS, AND TRUST

ESTABLISHING A COMMON LANGUAGE

SUSTAINING CHANGE

MONITORING CARE

ASSESSING COMPETENCY

THE ROLE OF REGULATORY REQUIREMENTS IN ENSURING COMPETENCY

MEDICAL STAFF CREDENTIALING

OBJECTIFYING COMPETENCY

STAFFING EFFECTIVENESS

PROMOTING COMPETENCY

CHAPTER 9 - PROMOTING A SAFE ENVIRONMENT OF CARE

LEARNING OBJECTIVES

COMMUNICATION ACROSS DISCIPLINES

WORKING TOGETHER TO IDENTIFY AND SOLVE PROBLEMS

IMPROVING PROCESSES

MONITORING SAFETY

ENSURING ACCOUNTABILITY

MAINTAINING A SAFE ENVIRONMENT

ESTABLISHING OVERSIGHT

COMMUNICATING ABOUT SAFETY

ASSESSING AND IMPROVING THE ENVIRONMENT

CHAPTER 10 - CONCLUSION

REFERENCES

USEFUL WEB SITES

INDEX

Table of Figures

FIGURE 1.1 Drivers of quality

FIGURE 1.2 Executive summary: Patient safety indicators

FIGURE 2.1 Quality measure

FIGURE 2.2 Example of a cause-and-effect diagram

FIGURE 2.3 Example of a run chart

FIGURE 2.4 Example of a bar graph

FIGURE 2.5 Example of a pie chart

FIGURE 2.6 Example of a control chart

FIGURE 2.7 Lines of communication

FIGURE 3.1 Risk points in communication

FIGURE 3.2 Pneumonia guideline, clinical version

FIGURE 3.3 Total hip replacement guideline, patient version

FIGURE 3.4 Pneumonia guideline, patient version

FIGURE 3.5 Distribution of near misses collected from OR nurses Hospital A

FIGURE 4.1 Insurers discount for quality

FIGURE 4.2 Traditional and quality management modes of analysis

FIGURE 5.1 Ambulatory services table of measures

FIGURE 6.1 Behavioral health table of measures

FIGURE 6.2 Emergency department table of measures

FIGURE 8.1 Using data to track brain aneurysm patients

FIGURE 8.2 Algorithm for physician credentialing

FIGURE 9.1 Safety and environment of care table of measures

FIGURE 9.2 Sharps injuries by activity

FIGURE 9.3 Clinical alarm effectiveness assessment tool

List of Tables

TABLE 2.1 HQA-CMS public reporting of surgical care infection prevention (SCIP)

TABLE 3.1 Methodology for error analysis

TABLE 3.2 Quality management and evidence-based task forces

TABLE 3.3 Heart failure clinical pathway

TABLE 8.1 Myocardial infarction table of measures

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Library of Congress Cataloging-in-Publication Data

Dlugacz, Yosef D., 1947-

p. cm.

Includes bibliographical references and index.

eISBN : 978-0-470-49812-5

1. Medical care—United States—Quality control. 2. Medical economics. I. Title.

RA399.A3D58 2010

362.1068’1—dc22

2009021529

PB Printing

PREFACE

As I travel around the country and internationally, speaking to health care professionals, policymakers, and administrative leaders about quality management, I have come to realize how many are unfamiliar with the new concepts of value and value based purchasing and the relationship between these concepts and quality care, organizational efficiency, and financial success. I am writing this book in order to explain these relationships, especially for those individuals who will be in a position to influence the future of the delivery of care in health care organizations.

In the past when I advocated for performance improvement processes, support came primarily from clinicians and the regulatory agencies. Today, as new processes for improvement are being designed, the C suite has become interested and involved. CEOs and CFOs are beginning to realize that concepts of waste and redundancy in care involve correlations between costs and expenses on the one hand and poor processes and outcomes on the other. Happily, I am beginning to be asked how quality management can help to transform organizations to meet the challenge of value and value based purchasing. Those who spend money on health care, whether individual patients or large organizations who purchase coverage for thousands of people, are insisting that they get value for their expenditures. Value means good outcomes. Good outcomes require quality management tools, techniques, and processes. Leaders realize that their organizations will fail if they do not provide their patients with value.

Attaching a financial benefit to compliance with quality indicators, as the Centers for Medicare and Medicaid Services and other national organizations are doing, will reinforce the importance of introducing quality oversight into the processes of care. Many administrators still regard compliance with quality indicators as an unnecessary expense and an annoying waste of time. As concepts of value evolve, these same administrators are learning how quality management can increase efficiency and reduce unnecessary expense. By improving care and minimizing errors, organizations receive positive media attention and increased market share. By learning to think about health care as a business, leaders are beginning to take quality management more seriously.

As the senior vice president and chief of clinical quality, education and research for the Krasnoff Quality Management Institute of the North Shore-LIJ Health System, I am in a position to design and implement processes that improve patient safety and reduce unnecessary expenses. Clients of the institute—hospitals and health care systems—ask us to help them develop a strong quality management infrastructure that will improve processes and reduce unnecessary expenses. They are impressed with improved processes that result in fewer excess days for length of stay, better turnaround time in the operating rooms, improved throughput from the emergency department through discharge, and more streamlined purchasing. That is, they see the advantage of planning, data collection, performance improvement, communication, and education about quality management. As organizational inefficiencies improve and the delivery of care results in improved outcomes, administrators and financial professionals realize the benefit to the organization. I hope this volume will illuminate the link between quality and finance for everyone invested in improving health care delivery, patients and professionals alike.

Great Neck, New York Yosef D. Dlugacz January 2009

ACKNOWLEDGMENTS

This book is a product of my many years in health care and my association with professionals who have generously shared with me their devotion to quality patient care and their belief that sustained improvements are possible.

I want to thank, in particular, Michael Dowling, president and CEO of the North Shore LIJ Health System (NS LIJHS); Mark Solazzo, senior vice president and chief operating officer (NS LIJHS); Gene Tangney, senior vice president and chief administrative officer (NS LIJHS); and Mark Claster, Trustee (NS LIJHS) for their support of the Krasnoff Quality Management Institute and their belief in the value of quality management.

The Krasnoff Institute owes its success to the many professionals who work tirelessly to improve the quality of care in the organizations with which we work. To Carolyn Sweetapple, Cathy Besthoff, Anne Marie Fried, Charles Cal, Jackie Kostic, and Mary Chaber, nurses whose expertise in business management, quality processes, regulatory requirements, utilization, nursing excellence, and education have proved invaluable, many thanks. Marcella De Geronimo and her outstanding staff of data analysts, Roshan Hussain, Nimmy Mathew, Peter Deng, Liz Ciampa, Christina Cheung, Carol Cross, and Ann Eichorn, have provided me with sophisticated information and reports that have enabled me to convince reluctant physicians and administrators about the value of quality data. Thanks also to Robert Silverman, MD, for his commitment to quality research and to his work with the Institute. My son, Hillel Dlugacz, contributed his time and his artistic talent to the cover. Working together is a pleasure and makes me proud.

Special thanks to Debi Baker, for her administrative ability and her graphic design talent, and to Quiana Binns for her clerical support. Joyce Guerriere has made it her business to assist me administratively with diligence and personalized attention. I could not manage without her.

I wish to express my gratitude to the publishing staff at Jossey-Bass, especially Andy Pasternack, who have been supportive of my efforts and generous with their professional advice throughout the years. Working with them has been a pleasure.

To Alice Greenwood, my friend and colleague, who has become my personal trainer of the mind, encouraging me to stretch myself intellectually and who challenges me to be my most productive, coherent and articulate self, I want to express my gratitude and my love.

My wonderful family, Doris, Adam, Stacey, Kylie, Stefanie, and Hillel, has put up with my travels, my long hours, and my many working weekends with understanding, support, and love. Every day I feel how lucky I am to have been so blessed.

THE AUTHOR

Yosef D. Dlugacz, PhD, is the senior vice president and chief of clinical quality, education, and research of the Krasnoff Quality Management Institute of the North Shore LIJ Health System. The goal of the Institute is to bridge the gap between theoretical knowledge learned in the academic setting and the realities of applying quality management methods in today’s health care environment. With decades of experience dealing with process variables and educating professionals and the community about the importance of integrating quality methods into the delivery of care to improve health outcomes, Dlugacz’s research focuses on developing models that link quality, safety, good clinical outcomes, and financial success for increased value and improved efficiencies. Dlugacz collaborates with other professionals and organizations to be at the forefront of the national agenda in improving health care services.

Dlugacz’s methodologies have been praised nationally and internationally. His academic appointments include Adjunct Associate Professor of Medicine of the New York Medical College; Adjunct Research Professor at New York University; Visiting Professor to Beijing University’s MBA Program; Executive in Residence, Hofstra University Frank G. Zarb School of Business; and Adjunct Professor of Management at Baruch/Mount Sinai MBA Program in Health Care Administration, City University of New York. He has appeared in numerous national audio and video teleconferences promoting quality and safety.

Dlugacz has published widely in health care and quality management journals on a variety of clinical care and quality topics. Recently, the Healthcare Financial Management Association published his article “High-Quality Care Reaps Financial Rewards” in their Strategic Financial Planning publication. His book, The Quality Handbook for Health Care Organizations: A Manager’s Guide to Tools and Programs (Jossey-Bass, 2004), has been praised as a valuable text for new quality professionals. His book, Measuring Health Care: Using Quality Data for Operational, Practical, and Clinical Improvement (Jossey Bass, 2006), helps to educate professionals about the relationship between quality care and financial success. He was invited to write the foreword for the Joint Commission Resources publication, Getting the Board on Board: What Your Board Needs to Know About Quality and Patient Safety (2007).

For Kylie Madeleine Dlugacz, my first grandchild, who enriches my life every day

INTRODUCTION

Unless you have just recently landed on this planet, you are aware that health care in the United States is undergoing dramatic changes. And you probably also realize that health care organizations are failing—clinically, organizationally, and financially—which is precisely why things have to change.

Shockingly, patient care has been defined as “unsafe,” with infections, for example, running rampant through hospitals, causing serious harm to patients, and costing organizations a great deal of money and time to rally the resources necessary to address these hospital acquired infections. Errors—that is, avoidable mistakes, such as giving the wrong dosage of medicine or operating on the wrong part of a patient’s body—are now being commonly recognized, again resulting in great harm and expense. As health care organizations have expanded and grown and also have become monsters of their own making, their financial situation has grown correspondingly grim. Furthermore, the population is sicker than ever before, with chronic diseases such as diabetes and heart disease on the increase, requiring constant and expensive interventions. The patient population is also aging, which means that patients come into hospitals with multiple problems and conditions and in somewhat vulnerable physical health. Today’s health care environment must address all of these issues. Everyone—health care leaders, governmental agencies, and private insurers—is looking to make a change to repair the clinical, financial, and public relations damage.