Introduction to healthcare management pdf free download

Introduction to healthcare management pdf free download

Introduction to health care management,Item Preview

17/03/ · READ (PDF) Introduction to Health Care Management by Sharon. Buchbinder full DOWNLOAD. PRODUCK DETAIL Author: Sharon Buchbinder. Pages: pages. Publisher The introduction to healthcare management 3rd edition pdf free download presents an introduction to acute and long-term care management, with emphasis on financial and Introduction to health care management: Free Download, Borrow, and Streaming: Internet Archive Loading viewer Introduction to health care management Publication date 11/03/ · Anthony Augustine Sandi Jia Bainga Kangbai Tulane University Abstract and Figures This chapter defines Health Management and takes a closer look at the different 13/10/ · About the author of Introduction To Healthcare Management pdf free download Amazon best-selling author Sharon Buchbinder’s broad range of writing includes ... read more

remove-circle Share or Embed This Item. EMBED for wordpress. com hosted blogs and archive. Want more? Advanced embedding details, examples, and help! Publication date Topics Health services administration Publisher Burlington, Mass. xxx, p. Thompson, Sharon B. Buchbinder, Nancy H. Williams, Grant T. Savage, Dennis G. Buchbinder, Jon M. Buchbinder, Donna M. Cox, Susan Judd Casciani. Full catalog record MARCXML. plus-circle Add Review. There are no reviews yet. Be the first one to write a review. Your doctor is practicing defensive medicine—diagnostic or therapeutic inDefensive medicine terventions conducted primarily to safeguard the provider against malpractice liability Diagnostic or thera Manner conducted primarily?

DId You Know? as a safeguard against malpractice liability Defining Healthcare Quality Institute of Medicine IOM A private, nonprofit organization created by the federal government to provide scienceÂ�based advice on matters of medicine and health The similar, yet competing priorities of the various healthcare stakeholders must be considered when defining healthcare quality. This task is not easy. In , Dr. The culmination of his remarkable body of work was a series of three volumes on explorations in quality assessment and monitoring. Before efforts to improve healthcare quality could begin in earnest, a common definition of quality was needed. This definition had to encompass the priorities of all stakeholder groups—consumers, purchasers, and providers. The Institute of Medicine IOM , a nonprofit organization that provides science-based advice on matters of medicine and health, championed efforts to bring the stakeholder groups together to create a workable definition of healthcare quality.

In , the IOM committee charged with designing a strategy for healthcare quality assurance published this definition: Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Chapter 1: Focus on Quality 7 This definition has stood the test of time. In , the IOM Committee on Quality of Health Care in America further clarified the concept of healthcare quality. In its report, Crossing the Quality Chasm: A New Health System for the 21st Century, the committee identified six dimensions of U.

healthcare needing improvement. These quality characteristics, listed in Critical Concept 1. Critical Concept 1. Care should not be provided to patients unlikely to benefit from it. In other words, underuse and overuse should be avoided. Source: IOM The IOM healthcare dimensions, together with the IOM quality of care definition, encompass what most people consider as attributes of healthcare quality. Quality involves understanding customer expectations and then creating a product or service that meets those expectations. Quality can be an elusive goal because customer needs and expectations are always changing. To keep up with the changes, quality must be constantly managed and continually improved.

Healthcare organizations are being challenged to improve the quality and value of services. Through a systematic quality management process, they can achieve this goal. Student Discussion Questions 1. In your opinion, which companies provide superior customer service? Which companies provide average or mediocre customer service? Think about your most recent healthcare encounter. What aspects of the care or service were you pleased with? What could have been done better? edu Chapter 1: Focus on Quality References Berwick, D. Dalrymple, J. Donabedian, A.

Explorations in Quality Assessment and Monitoring: The Definition of Quality and Approaches to Its Assessment, Vol. III: The Methods and Findings of Quality Assessment Measurement and Monitoring. Chicago: Health Administration Press. II: The Criteria and Standards of Quality. Institute of Medicine IOM. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press. Medicare: A Strategy for Quality Assurance: Volume I, edited by K. Kennedy, J. Manner, P. Walton, M. The Deming Management Method. New York: Putnam Publishing Group. For quality to be achieved, a systematic evaluation and improvement process must be implemented.

In the business world, this process is known as quality management. Quality management is a way of doing business that continuously improves products and services to achieve better performance. According to the American Society for Quality , the goal of quality management in any industry is to achieve maximum customer satisfaction at the lowest overall cost to the organization while continuing to improve the process. To achieve maximum customer satisfaction in healthcare, authors of the Institute of Medicine IOM report Crossing the Quality Chasm recommended eliminating overuse, underuse, and misuse of services Berwick Overuse occurs when a service is provided even though there is no evidence it will help the patient—for example, prescribing antibiotics for patients with viral infections. Underuse occurs when a service that would have been medically beneficial for the patient is not provided—for example, performing a necessary diagnostic test.

Not providing a health service that might have been medically beneficial Misuse Incorrect diagnoses, medical errors, and other sources of avoidable complications Measurement Collection of information for the purpose of understanding current performance and seeing how performance changes or improves over time Assessment Use of performance information to determine whether an acceptable level of quality has been achieved 2. While the terminology used to describe the process can be puzzling at first, the basic principles should be familiar to you. Quality management involves measurement, assessment, and improvement—things people do almost every day. Consider this example. Most people must manage their finances. You must measureÂ� —that is, keep track of your deposits and debits—to know where you stand financially. The purpose of improvement is just as the word implies—to make things better. The three primary quality management activities—measurement, assessment, and improvement—are parts of a closely linked cycle see Figure 2.

Healthcare organizations track performance through various measurement activities to gather information about the quality of patient care and support functions. Results are evaluated in the assessment step by comparing measurement data to performance expectations. If expectations are met, organizations continue to measure and assess performance. If expectations are not met, they proceed to the improvement phase to investigate reasons for the performance gap and implement changes based on their findings. Performance continues to be evaluated through measurement activities. Chapter 2: Quality Management Building Blocks 13 Figure 2. Cycle of Measurement, Assessment, and Improvement Measurement How are we doing?

Yes Assessment Are we meeting expectations? No Improvement How can we improve performance? Quality management activities in healthcare are complex, and the terminology can be confusing. The financial management example used earlier to explain quality management vocabulary also may help clarify basic quality management techniques. For instance, when you check your expenditures on leisure activities over the last six months, you are monitoring performance—looking for trends in your spending habits. If you decide to put 10 percent of your income into a savings account each month, you are setting a performance goal.

Application of these techniques to healthcare quality management is covered in later chapters. Improvement Planning and making changes to current practices to achieve better performance Data Numbers or facts that are interpreted for the purpose of drawing conclusions Performance 2. To stay in business, manufacturing and service industries have long sought better ways of meeting customer expectations. Healthcare professionals live by the motto primum non nocere—first, do no harm. To fulfill this promise, discovering new and better ways to care for patients has always been a priority. Although the goal—quality products and services—is the same regardless of the industry, Â�expectations Minimum acceptable levels of quality 14 Introduction to Healthcare Quality Management methods for achieving this goal in healthcare have evolved somewhat differently than in other industries.

Industrial Quality Evolution The contemporary quality movement in the manufacturing industry can be traced to work done by three men in the s at Western Electric Company in Cicero, Illinois. Walter Shewhart, W. Shewhart used statistical methods to measure variations in the telephone equipment manufacturing process. Waste was reduced and product quality was improved by controlling undesirable process variation. Shewhart is referred to as the father of statistical quality control, a method we will explore in Chapter 4. In the s, W. Edwards Deming, a professor and management consultant, transformed traditional industrial thinking Following World War II, Japanese manufacturing companies invited Deming to help them imperformance feedback, and measurement-based quality manprove the quality of their products. Over a period agement. The Deming model for continuous improvement is described in Chapter 5. Joseph Juran combined the science of quality with its practical application, providing a framework for linking finance and management.

and related resources needed to fulfill the objectives Chapter 2: Quality Management Building Blocks In the s, Juran, like Deming, helped jump-start product improvements at Japanese manufacturing companies. Whereas Deming focused on measuring and controlling process variation, Juran focused on developing the managerial aspects supporting quality. Another individual who had a significant impact on contemporary quality practices in industry was Kaoru Ishikawa, a Japanese engineer who incorporated the science of quality into Japanese culture. He was one of the first people to emphasize the importance of involvement of all members of the organization instead of only management-level employees.

Ishikawa believed that top-down quality goals could be accomplished only through bottom-up methods Best and Neuhauser To support his belief, he introduced the concept of quality circles—groups of 3 to 12 frontline employees that meet regularly to analyze production-related problems and propose solutions Ishikawa Ishikawa stressed that employees should be trained to use data to measure and improve processes that affect product quality. The science of industrial quality focuses on improving the quality of products by improving the production process. Improving the production process means removing wasteful practices, standardizing production steps, and controlling variation from expectations. These methods have been proven effective and remain fundamental to industrial quality improvement. The work of Shewhart, Deming, and Ishikawa laid the foundation for many of the modern quality philosophies that underlie the improvement models described in Chapter 5.

Following World War II, U. manufacturers were under considerable pressure to meet production schedules, and product quality became a secondary consideration. In the s, U. executives visited Japan to discover ways to improve product quality. During these visits, Americans learned about the quality philosophies of Deming, Juran, and Ishikawa; the science of industrial quality; and the concept of quality control as a management tool. As a result, many U. companies began to emulate the Japanese approach. Several quality gurus emerged, each with his own interpretation of quality management. During the s, Juran, Deming, Philip Crosby, Armand Feigenbaum, and others received widespread attention as philosophers of quality in the manufacturing and service industries. In , President Reagan signed into law the Malcolm Baldrige National Quality Improvement Act Spath , 23— This national quality program, managed by the U. Quality circles Small groups of employees organized to solve work-related problems Criteria Standards or principles by which something is judged or evaluated 16 Baldrige National Quality Award Recognition conferred annually by the Baldrige National Quality Program to U.

organizations demonstrating performance excellence, Introduction to Healthcare Quality Management quality. Many of these criteria originated from the quality philosophies and practices advanced by Shewhart, Deming, Juran, and Ishikawa. The annual Baldrige National Quality Award was also created to recognize U. For the first ten years, eligible companies were limited to three categories: manufacturing, service, and small business. In , two additional categories—education and healthcare—were added. The core values and concepts of the Baldrige Health Care Criteria are described in Critical Concept 2.

In , SSM Health Care, based in St. Louis, became the first healthcare organization to win the Baldrige National Quality Award. including healthcare organizations! Critical Concept 2. The directions, values, and expectations should balance the needs of all stakeholders. The leaders need to ensure the creation of strategies, systems, and methods for achieving excellence in healthcare, stimulating innovation, and building knowledge and capabilities. Patient Focus: The delivery of health care services must be patient focused. All attitudes of patient care delivery medical and nonmedical factor into the judgment of satisfaction and value. Satisfaction and value are key considerations for other customers, too. Learning is embedded in the operation of the organization. Valuing staff means committing to their satisfaction, development, and well being. Agility: A capacity for rapid change and flexibility are a necessity for success.

Health care providers face ever-shorter cycles for introductions of new and improved health care services. Faster and more flexible response to patients and other customers is critical. Focus on Future: A strong future orientation includes a willingness to make long-term commitments to key stakeholders—patients and families, staff, communities, employers, payers, and health profession students. Important for an organization in the strategic planning process is the anticipation of changes in health care delivery, resource avail- Chapter 2: Quality Management Building Blocks! Management by Fact: Measurement and analysis of performance are needed for an effective healthcare and administrative management system. Public Responsibility and Community Health: Leaders need to emphasize the responsibility the organization has to the public and need to foster improved community health.

Results should focus on creating and balancing value for all stakeholders—patients, their families, staff, the community, payers, businesses, health profession students, suppliers and partners, stockholders, and the public. Systems Perspective: Successful management of an organization requires synthesis and alignment. Synthesis means looking at the organization as a whole and focusing on what is important, while alignment means concentrating on key organizational linkages among the requirements in the Baldrige Criteria. Source: Spath H e a l t h c a r e Q u a l i t y E v ol u t i o n Until the s, the fundamental philosophy of healthcare quality management was based on the pre—Industrial Revolution craft model: Train the craftspeople physicians, nurses, technicians, etc. In , the American College of Surgeons ACS was founded to address variations in the quality 17 18 Accreditation Â�standards Levels of performance excellence that organizations must attain to become credentialed by a competent authority Quality assurance Evaluation activities aimed at ensuring compliance with minimum quality standards Introduction to Healthcare Quality Management of medical education.

A few years later, it developed the hospital standardization program to address the quality of facilities in which physicians worked. Training improvement efforts were also underway in nursing; the National League for Nursing Education released its first standard curriculum for schools of nursing in While the standards stressed the need for physicians and other professional staff to evaluate care provided to individual patients, none of the quality practices espoused by Deming and Juran was required of hospitals. The standards centered on structural requirements and eliminating incompetent people, not measuring and controlling variation in healthcare processes. The Joint Commission accreditation standards served as a model for provider quality requirements of the Medicare healthcare program for the elderly, passed by Congress in Through the s, quality requirements in healthcare—whether represented by accreditation standards, state licensing boards, or federal regulations—focused largely on structural details and on the discipline of defective hospitals and physicians Brennan and Berwick , The quality revolution affecting other industries in the s also affected healthcare services.

In , The Joint Commission added a quality assurance QA standard loosely based on the work of Deming and Juran Affeldt The QA standard required organizations to implement an organization-wide program to The Joint Commission Quality assurance and quality control may be used interchangeably to describe actions performed to ensure the quality of a product, service, or process. In the early s, following years of rapid increases in Medicare and other publicly funded healthcare expenditures, the government established external groups known as peer review organizations to monitor the costs and quality of care provided in hospitals and Chapter 2: Quality Management Building Blocks 19 outpatient settings IOM , 39— Throughout the s and s, healthcare quality management was increasingly influenced by the industrial concepts of continuous improvement and statistical quality control, largely in response to pressure from purchasers to slow the growth of healthcare expenditures.

Seeking alternative methods to improve healthcare quality and reduce costs, regulatory and accreditation groups turned to other industries for solutions. Soon the quality practices from other industries were being applied to health services. Today, many of the fundamental ideas behind quality improvement in the manufacturing and service industries shape healthcare quality management efforts. For example, The Joint Commission leadership standard incorporates concepts from the Baldrige National Quality Award Criteria, and the performance improvement standard requires use of statistical tools and techniques to analyze and display data. Professional groups such as the Medical Group Management Association teach members to apply statistical thinking to healthcare practices to understand and reduce inappropriate and unintended process variation Learning Point Balestracci and Barlow The Institute for Quality Evolution Healthcare Improvement sponsors improvement projects aimed at standardizing patient care practices and minimizing inappropriate The methods and principles guiding healthcare quality imvariation.

Case studies illustrating the adaptation provement efforts have evolved at a different pace than those of industrial quality science to health services imguiding quality improvement efforts in other industries. Sevprovement are found throughout this book. eral factors account for this difference. Gradually, healthcare is Some industrial quality improvement catching up by applying the best quality management practices techniques are not transferrable to healthcare. of the manufacturing and service industries. The manufacturing industry, for example, deals with machines and processes designed to be meticulously measured and controlled.

At the heart of healthcare are patients whose behaviors and conditions vary and change over time. These factors create a degree of unpredictability that presents healthcare providers with challenges not found in other industries Hines et al. In addition to adopting the quality practices of other industries focused on reducing waste and variation, healthcare organizations still use some components of the pre— Industrial Revolution craft model to manage quality. Adequate training and continuous monitoring are still essential to building and maintaining a competent provider staff. Structural details are also still important; considerable attention is given to maintaining adequate facilities and equipment. Many external forces influence business activities, including quality management. Government regulations, accreditation groups, and large purchasers of health services are major influences on the operation of healthcare organizations.

Regulations are issued by governments at the local, state, and national levels to protect the health and safety of the public. Regulation is often enforced through licensing. For instance, to maintain its license, a restaurant must comply with state health department rules and periodically undergo inspection. Just like the restaurant owner who must follow state health department rules or risk closure, organizations that provide healthcare services or offer health insurance must follow government regulations, usually at the state level. Regulations differ from state to state. If a healthcare organization receives money from the federal government for providing services to consumers, it must comply with federal regulations in addition to state regulations. Both state and federal regulations include quality management requirements. For example, licensing regulations in all states require that hospitals have a system for measuring, evaluating, and reducing patient infection rates.

Quality management requirements are also found in healthcare accreditation standards. Accreditation is a voluntary process by which the performance of an organization is measured against nationally accepted standards of performance. Accreditation standards are based on government regulations and input from individuals and groups in the healthcare industry. All other groups that accredit healthcare organizations and programs also require quality management activities. Table 2. Accreditation is an ongoing process, and visits are made to healthcare organizations at regularly scheduled or unannounced intervals to monitor their compliance with accreditation requirements. While accreditation is considered voluntary, an increasing number of purchasers and government entities are requiring it. Purchasers of healthcare services also influence healthcare quality management. The largest purchaser of healthcare services is the government. Healthcare organizations participating in these government-funded insurance programs must comply with the quality management requirements found in state and federal regulations.

Quality management requirements for each provider category are in federal regulations called Conditions of Participation. These regulations are a contract between the government purchaser and the provider. If a provider wants to participate in a federally funded insurance program, it must abide by the conditions spelled out in the regulations. Accreditation Group Organizations and Programs Accredited AABB formerly American Association of Blood Banks www. org Freestanding and provider-based blood banks, transfusion services, and blood donation centers Accreditation Association for Ambulatory Health Care www.

org Hospital-affiliated ambulatory care facilities and freestanding facilities, including university student health centers Accreditation Commission for Health Care www. org Home health care providers, including durable medical equipment companies American Accreditation HealthCare Commission, Inc. URAC www. org Health plans, credentials verification organizations, independent review organizations, and others; also accredits specific functions in healthcare organizations e. org Ambulatory surgery facilities Commission on Accreditation of Rehabilitation Facilities www. org Freestanding and provider-based medical rehabilitation and human service programs, such as behavioral health, child and youth services, and opioid treatment Commission on Cancer of the American College of Surgeons www. org Cancer programs at hospitals and freestanding treatment centers Commission on Laboratory Accreditation of the College of American Pathologists www. org Freestanding and provider-based laboratories Community Health Accreditation Program www.

org Community-based health services, including home health agencies, hospices, and home medical equipment providers Compliance Team, The www. com Providers e. Healthcare �Accreditation Groups 22 Introduction to Healthcare Quality Management Table 2. continued Healthcare � Accreditation Groups Health maintenance organization HMO Public or private organization providing comprehensive medical care to subscribers on the basis of a prepaid contract Accreditation Group Organizations and Programs Accredited Continuing Care Accreditation Commission www. org Continuing care retirement communities and aging services networks that are part of home, community, or hospital-based systems Diagnostic Modality Accreditation Program of the American College of Radiology www.

org Freestanding and provider-based imaging services, including radiology and nuclear medicine DNV HealthCare, Inc. org Durable medical equipment providers Intersocietal Commission for Accreditation of Nuclear Medicine Laboratories www. org Freestanding and provider-based nuclear medicine and nuclear cardiology laboratories Joint Commission, The www. org Healthcare services in jails, prisons, and juvenile confinement facilities National Committee for Quality Assurance www. org Managed care and preferred provider organizations, managed behavioral healthcare organizations, and disease management programs The quality management requirements found in accreditation standards and government regulations change often, and healthcare organizations must keep up to date on the latest rules. The websites listed in Table 2. Private insurance companies also pay a large amount of health service costs in the United States.

For Commission the most part, these Continuing plans relycare onretirement government regulations and www. org services networks that are part of home, accreditation standards to define basic quality management requirements for healthcare orcommunity, or hospital-based systems ganizations. However, some private companies additional quality Diagnostic Modality Accreditation Program insurance of the Freestandinghave and provider-based imagingmeasureservices, American of Radiology www. org for participating including radiology andFor nuclear medicine ment andCollege improvement requirements providers.

example, ou�tpatient �clinics that provide care for patients in a health maintenance organization HMO are Chapter 2: Quality Management Building Blocks often �required to report to the health plan the percentage of calls received by the clinic that are answered by a live voice within 30 seconds. The HMO uses this information to measure the quality of customer service in the clinic. The measurement, assessment, and improvement requirements of private insurance companies are detailed in provider contracts. If a provider wants to participate in a health plan, the provider must agree to abide by the rules in the contract. Some of these rules place quality management responsibilities on the provider. Conclusion Quality management activities in healthcare organizations are constantly evolving.

These changes often occur in reaction to external forces such as regulation or accreditation standard revisions and pressure to control costs. Healthcare quality management is also influenced by other industries. Improvement strategies used to enhance the quality of products and services are frequently updated as new learning emerges. Since their inception in , the Baldrige Quality Program Criteria have undergone several revisions. Healthcare quality management changed in when the Baldrige Criteria were adapted for use by healthcare organizations. In addition, the science of quality management, once reserved for the manufacturing industry, is now used in healthcare organizations. The rules and tools of healthcare quality management will continue to evolve, but the basic principles of measurement, assessment, and improvement will remain the same.

For instance, many people sort household garbage into two bins—one for recyclable materials and one for everything else. The tool has external stakeÂ�holders changed, but the basic principle—communicating—has not. include consumers, Why should healthcare organizations be involved in quality management activities? Foremost, quality management is the right thing to do. Providers have an ethical obliga- purchasers, regulatory agencies, and Â�accreditation groups. tion to patients to provide the best quality care possible. In addition, all stakeholders—Â� Key internal stakeÂ� consumers, purchasers, regulators, and accreditation groups—are requiring continuous holders include physi- improvement. Competition among healthcare organizations is growing more intense, and demand for high-quality services is increasing.

Healthcare organizations that study and cians and clinical and nonclinical employees. How do quality practices that originated in the manufacturing industry differ from the traditional quality practices of healthcare organizations? How would applying the core values and concepts of the Baldrige Health Care Criteria for Performance Excellence improve healthcare quality? See Critical Concept 2. Consider the healthcare encounter you described in Chapter 1 see student discussion question 2. If wasteful practices had been eliminated or steps in the process had been standardized, would you have had a different encounter? How would it have changed? org References Affeldt, J. American Society for Quality. Chapter 2: Quality Management Building Blocks Balestracci, D. Quality Improvement: Practical Applications for Medical Group Practice. Englewood, CO: Center for Research in Ambulatory Health Care Administration.

Berwick, D. Best, M. Brennan, T. New Rules: Regulation, Markets, and the Quality of American Health Care. San Francisco: Jossey-Bass, Inc. Butman, J. Juran: A Lifetime of Influence. New York: John Wiley and Sons. Catlin, A. Cowan, M. Hartman, S. Heffler, and the National Health Expenditure Accounts Team. Deming, W. The New Economics: For Industry, Government, Education, 2nd edition. Cambridge, MA: MIT Center for Advanced Educational Services. Hines, S. Luna, J. Lofthus, M. Marquard, and D. Becoming a High Reliability Organization: Operational Advice for Hospital Leaders. Rockville, MD: Agency for Healthcare Research and Quality. Institute for Healthcare Improvement. Ishikawa, K.

Introduction to Quality Control, translated by J. New York: Productivity Press. Joint Commission, The. Accreditation Manual for Hospitals, edition. Oakbrook Terrace, IL: The Joint Com� � mission. Kaiser Family Foundation. Trends and Indicators in the Changing Health Care �Marketplace. Menlo Park, CA: The Henry J. Merry, M. Spath, P. Leading Your Healthcare Organization to Excellence: A Guide to Using the Baldrige Criteria. Uselac, S. Zen Leadership: The Human Side of Total Quality Team Management. Loudonville, OH: Mohican. For example, the dashboard on my car displays lots of data. I can see how much gasoline is left in my tank, how fast I am traveling, and so on. These measures provide me with information about my car and my current driving situation. I decide how to use this information. Do I need to refill my gas tank soon, or can I wait a day or two? Do I need to slow down, or can I speed up a bit?

My reaction to the information is partially based on personal choices, such as my willingness to risk running out of gas or incurring a speeding ticket. My reaction to the information is also influenced by external factors, such as the distance to the nearest gas station and the speed limit. Information must be accurate to be useful. If the information is accurate and useful to me, I need to be able to interpret it. If I want to compare information, the metrics must be consistent. Companies measure costs, quality, productivity, efficiency, customer satisfaction, and so on because they want information. They use this information to understand current performance, identify where improvement is needed, and evaluate how changes in work processes affect performance. Like the information displayed on a car dashboard, the data must be accurate, useful, easy to interpret, and reported consistently.

The organization uses measurement information to determine how it is performing. In the next step, assessment, the organization judges whether its performance is acceptable. If its performance is not acceptable, the organization advances to the improvement step. In this step, process changes are made. After the changes are in 29 Measures Instruments or tools used for measuring Metrics Any type of measurement used to gauge a quantifiable component of performance Performance The way in which an individual, a group, or an organization carries out or accomplishes important functions and processes 30 Introduction to Healthcare Quality Management Figure 3. place for a while, the organization continues measuring to determine whether the changes are producing the desired result. Case Study The following case study illustrates the use of measurement information for quality management purposes.

The Redwood Health Center is a multispecialty clinic that employs ten care providersÂ�—nine physicians and one nurse practitioner. Quality customer service is a priority for everyone in the clinic. Measurement: How Are We Doing? A locked, ballot-style feedback box is located in the waiting area. Your feedback will help us make things better. There are six questions on the one-page feedback form: Chapter 3: Measuring Performance 31 1. Please circle one. At the end of each week, the clinic manager collects the feedback forms from the locked box. The results are tabulated and shared with clinic staff every month. At one monthly meeting, the clinic manager reports that many patients complain about the amount of time they must wait before they are seen by a care provider. The providers expect clinic staff to bring patients to the exam room within ten minutes of their arrival.

To determine whether this goal is being met, the clinic gathers data for three weeks on patient wait times. Patients are asked to sign in and indicate their arrival time on a sheet at the registration desk. The medical assistant then records the time patients are brought to an exam room. Assessment: Are We Meeting Expectations? Patient wait time data for the three weeks are tallied. On most days, patient wait times are ten minutes or less. However, the average wait times are longer than ten minutes on Monday afternoons and Thursdays. Further investigation shows that the clinic services a large number of walk-in patients on Monday afternoons. The wait time data help the clinic pinpoint where improvements are needed.

The clinic manager meets with the care providers to discuss ways of changing the current process to reduce bottlenecks and improve customer satisfaction. The physicians ask that fewer patients be scheduled for appointments on Monday afternoons to give them more time to see walk-in patients. The nurse practitioner agrees to work on Thursday mornings. Performance is measured to determine current levels of quality, identify improvement opportunities, and evaluate whether changes have improved outcomes. To test whether these changes have improved outcomes, the clinic continues to gather feedback on overall patient satisfaction and periodically collects and analyzes patient wait time data.

M e asur e me nt C h a ra cteri sti cs Performance measures 3. These numbers are called performance measures or quality indicators. There are many ways to communicate measurement data. Examples of measures and the most common numbers or statistics used to report data for healthcare quality management purposes are shown in Table 3. A measure expressed as a percentage is generally more useful than a measure expressed as an absolute number. For example, the percentage of nursing home residents who develop an infection is more meaningful than the number of nursing home residents who develop an infection. To provide even more information, both the percentage and number of residents who develop an infection can be reported. An average, sometimes called an arithmetic mean, is the sum of a set of quantities divided by the number of quantities in the set. In some situations, however, averages can be misleading.

For example, if a few of the numbers in the data set are unusually large or small called outliers , they are commonly excluded when calculating an average. The excluded outliers are examined separately to determine why they occurred. A ratio is used to compare two things. For instance, the nurse-to-patient ratio reports the number of hospital patients cared for by each nurse. In the same month, one hospital unit may report a ratio of 1 nurse for every 5. A consistently calculated ratio facilitates comparison between units. Regardless of how a measure is communicated, to be used effectively for quality management purposes it must be accurate, useful, easy to interpret, and consistently reported. Accuracy relates to the correctness of the numbers. For example, in the above case study, the time the patient entered the clinic must be precisely recorded on the registration sign-in sheet. Otherwise, the wait time calculation will be wrong.

Accuracy also relates to the validity of the measure. Because of these differences, the feedback is not a valid measure of just one aspect of clinic Â�performance—for example, just the patient registration process. Valid Relevant, meaningful, and correct; appropriate to the task at hand Usefulness Performance measures must be useful. Measurement information must tell people something they want to know. For instance, the computerized billing system of a health clinic contains patient demographic information e. The number or statistic used to report the data can influence the interpretation of the measurement information. For the measures to be used effectively, they must be accurate, useful, easy to interpret, and reported consistently. Line graph A graph in which trends are highlighted by lines connecting data points See figures 3. Ease of Interpretation Performance measures must be easy to interpret. Suppose the clinic manager in the case study reported the wait times for each patient on each day of the week.

An excerpt from the report for one day is shown in Table 3. The purpose of performance measurement is to provide information, not to make people sort through lots of data to find what they want to know. Having to read through several pages of wait time data to identify improvement opportunities would be tedious. A much better way to report the patient wait time data is illustrated in Figure 3. Using a line graph, the clinic manager displays the average wait times for the morning and afternoon of each day of the week. Consistent Reporting Performance measures must be uniformly reported to make meaningful comparisons between the results from one period and the results from another period.

For example, Table 3. Excerpt from Larger Report of Wait Time Data for Each Patient Monday Patient 1 12 minutes Patient 2 9 minutes Patient 3 17 minutes Patient 4 7 minutes Patient 5 9 minutes Patient 6 13 minutes Patient 7 21 minutes Patient 8 11 minutes Patient 9 7 minutes Patient 10 8 minutes Chapter 3: Measuring Performance 35 Figure 3. Line Graph �Showing Average Patient Wait Times 20 18 16 Minutes 14 12 10 8 6 4 2 0 Mon. Period suppose the clinic manager starts calculating patient wait time information differently. He changes the wait time end point from the time the patient leaves the reception area to the time the patient is seen by a care provider. This slight change in the way wait times are calculated could dramatically affect performance results.

The care providers would see an increase in average wait times and interpret it as a problem when in fact the increase was caused by the different measurement criteria, not a change in performance. This new measure can be used, but it should be reported separately, as shown in Figure 3. Line Graph �Showing Two �Measures of �Patient Wait Time 35 30 Average wait in reception area Average wait to see care provider Minutes 25 20 15 10 5 0 Mon. Period These measurement categories were first conceptualized in by Dr.

Avedis Donabedian His research in quality assessment resulted in a widely accepted healthcare measurement model that is still used today. Donabedian contended that the three measurement categories—structure, process, and outcome—represent different characteristics of healthcare service. To fully evaluate healthcare performance, Donabedian recommended that performance in each dimension be measured. The structure of healthcare is measured to judge the adequacy of the environment in which patient care is provided. The process of healthcare is measured to judge whether patient care and support functions are properly performed. Healthcare outcomes are measured to judge the results of patient care and support functions. Performance measures for most products and services would fall into these same categories.

Table 3. As such, measures of structure are indirect measures of performance. For example, although a restaurant maintains all food at proper storage temperatures, the possibility of serving spoiled food still exists. To ensure quality, measures of process and outcome also must be taken. Process Measurement Measures of process evaluate whether activities performed during the delivery of healthcare services are delivered satisfactorily. For instance, if an emergency department has a policy that all patients with confirmed pneumonia receive an antibiotic within two hours of arrival, we would measure caregiver compliance with the policy to determine whether their performance is acceptable. In healthcare quality management, process measures are most commonly used. Process measures provide important information about performance at all levels in the organization.

However, good performance does not automatically translate to good results. In the previous example, even if all patients with pneumonia receive antibiotics within two hours of arrival in the emergency department, some may not recover. For this reason, another dimension of healthcare quality—outcome—must be measured. O u t c om e M e a s u r e m e n t Measures of outcome evaluate the results of healthcare services—the effects of structure and process. A common outcome measure is patient satisfaction, an indicator of how well a healthcare facility is meeting customer expectations. Healthcare facilities also measure patient mortality death and complication rates to identify opportunities for improvement. Outcome measures are also used to evaluate the use of healthcare services. Average length of hospital stay and average cost of treatment are two examples of outcome measures that examine the use of services.

Process measures are used to assess whether services are delivered properly. Outcome measures are used to assess the final product or end results. For example, patient mortality rates at one hospital may be higher than rates at other hospitals because the hospital cares for more terminally ill cancer patients. This healthcare organization may do all the right things but appear to be an underperformer because of the population it serves. When evaluating measurement data, many factors affecting patient outcomes must be considered. Some measures evaluate tered physical �therapists? performance at the system level. the quality of customer services is an example of a system-level measure.

This measure is a snapOutcome: What is the rate of patient pain reduction following shot of overall clinic performance. Because many therapy? activities in a health clinic influence the quality of customer service, performance also needs to be evaluated at the activity level to assess patient satisfaction. The percentage of time reception staff telephones patients to remind them of upcoming clinic appointments is an example of an System-level measure activity-level measure. Data describing the Consider how the performance of an automobile is evaluated.

A common meaoverall performance of several interdependent sure of car performance is the number of miles it can travel per gallon of gasoline. Activity-level measures can be used to evaluate these actions. For example, average time between engine tune-ups is Activity-level measure Data describing the an activity-level measure of an action that affects car performance. By using a combination performance of one of system- and activity-level measures, the owner can judge not only overall fuel economy process or activity but also actions or lack thereof that might be adversely affecting it. A mix of system- and activity-level measures allows a healthcare organization to judge whether overall performance goals are being met and where frontline improvements may be needed.

On the external side, numerous government regulations, accreditation standards, and purchaser requirements directly affect measurement activities. The number and type of measures used to evaluate performance vary in proportion to the number of external requirements the organization must meet. Critical Concept 3. Performance Goals and Measures in Two Healthcare Settings 40 Introduction to Healthcare Quality Management! The performance measurement requirements of the federal government, the largest purchaser of healthcare services, continue to increase in response to quality improvement and cost-containment efforts. The measures of performance required of healthcare organizations help purchasers assess value in terms of the six Institute of Medicine IOM quality aims described in Chapter 1: Healthcare should be safe, effective, patient centered, timely, efficient, and equitable.

State licensing regulations often require healthcare organizations to evaluate structural issues, such as compliance with building safety and sanitation codes. Licensing regu- Chapter 3: Measuring Performance lations may also include specific requirements for process and outcome measures. A list of performance data that must be collected by ambulatory surgical treatment centers in Illinois is shown in Critical Concept 3. Source: Illinois General Assembly, Joint Committee on Administrative Rules Certain state and federal regulations apply only to specific healthcare units, such as radiology and laboratory departments. These regulations contain many quality control requirements with corresponding system- and activity-level performance measurement obligations. For instance, any facility that performs laboratory testing on human specimens must adhere to the quality standards of the Clinical Laboratory Improvement Amendments, passed by Congress in to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test is performed U.

Food and Drug Administration The standards of healthcare accreditation groups often contain system- and activity�level performance measurement requirements. Accreditation standards may duplicate those mandated by government regulations and purchasers. However, some measurement requirements found in accreditation standards are unique. They also must participate in the core measure project, which involves gathering and sharing measurement results with The Joint Commission. As much as possible, The Joint Commission coordinates its core measurement requirements with the measurement activities mandated by CMS to lighten the workload for organizations subject to both groups. Health plans accredited by the National Committee on Quality Assurance NCQA must participate in the Healthcare Effectiveness Data and Information Set HEDIS measurement project.

In , HEDIS comprised 71 measures across eight domains of patient care. Health plans accredited by NCQA are not required to gather information for all of the HEDIS measures. Learning Point A growing number of external groups are Choosing Measures mandating that healthcare organizations gather specific performance measures for quality manHealthcare organizations measure many aspects of perforagement purposes. When selecting performance measures, organizations must consider the most mance. Some of the measures are mandated by external current measurement directives of relevant govregulatory, licensing, and accreditation groups. Some of the ernment regulations, accreditation bodies, and measures are chosen to evaluate performance issues imporpurchasers.

tant to the organization. Consider a home health agency with a particularly large hospice patient population. Hospice patients have a limited life expectancy and require comprehensive clinical and psychosocial support as they enter the terminal stage of an illness or a condition. The measures required of Medicare-certified home health agencies do not address some of the performance issues unique to hospice patients and their families. Consequently, the home health agency will need to identify and gather its own performance measures of hospice services in addition to collecting the measures required to maintain Medicare certification. Clinic Measures of Performance and Their Purposes 44 Introduction to Healthcare Quality Management Table 3. These steps can be time consuming but are essential to ensuring the measures are useful for quality management purposes.

Identify Topic of Interest The first step to constructing a performance measure is to determine what you want to know. Consider just one function—for example, taking patient X-rays in the radiology department. This function involves several steps: Chapter 3: Measuring Performance 45 1. Answers to these questions can help the radiology department gauge its performance in each quality dimension. Quality Dimensions and Performance Questions for Â�Radiology Services 46 Introduction to Healthcare Quality Management Table 3. Factors to Â�Consider When Â�Selecting Â�Performance Â�Measures Factor Yes No Is the measure mandated by government regulations or accreditation standards?

Factors the radiology manager will take into consideration when selecting performance measures for the department are summarized in Table 3. Aspects of service that will be measured to answer performance questions must be stated explicitly. Without this knowledge, measures cannot be developed. D e v e lo p the Measure Once performance questions have been identified, the next step is to define the measures that will be used to answer the questions. To turn the question into a performance measure, the manager decides to use the percentage of results communicated to doctors within 48 hours of completion of an outpatient X-ray exam.

The top number in the fraction is the numerator, and the bottom number is the denominator.

edu no longer supports Internet Explorer. To browse Academia. edu and the wider internet faster and more securely, please take a few seconds to upgrade your browser. this is a book for management learning , there are principles of managment,i don't know the auther of this book if everyone of you know about this auther can give information. thank you anwar kakar. Log in with Facebook Log in with Google. Remember me on this computer. Enter the email address you signed up with and we'll email you a reset link. Need an account? Click here to sign up. Download Free PDF. pdf file : introduction to management. Anwar Kakar. Abstract this is a book for management learning , there are principles of managment,i don't know the auther of this book if everyone of you know about this auther can give information. Continue Reading Download Free PDF.

In this respect this chapter will Introduce and define management. Discuss the features, functions and importance of management. It is a very popular and widely used term. All organizations - business, political, cultural or social are involved in management because it is the management which helps and directs the various efforts towards a definite purpose. According to F. Management is a purposive activity. It is something that directs group efforts towards the attainment of certain pre — determined goals. It is the process of working with and through others to effectively achieve the goals of the organization, by efficiently using limited resources in the changing world. Of course, these goals may vary from one enterprise to another, e. Any branch of knowledge that fulfils following two requirements is known as discipline: 1. The knowledge should be formally imparted by education and training programmes.

Since management satisfies both these problems, therefore it qualifies to be a discipline. Though it is comparatively a new discipline but it is growing at a faster pace. It cannot be denied that management has a systematic body of knowledge but it is not as exact as that of other physical sciences like biology, physics, and chemistry etc. The main reason for the inexactness of science of management is that it deals with human beings and it is very difficult to predict their behavior accurately. Since it is a social process, therefore it falls in the area of social sciences.

Ernest Dale has called it as a Soft Science. Nature of management can be highlighted as: - i Management is Goal-Oriented: The success of any management activity is accessed by its achievement of the predetermined goals or objective. Management is a purposeful activity. For example, the goal of an enterprise is maximum consumer satisfaction by producing quality goods and at reasonable prices. This can be achieved by employing efficient persons and making better use of scarce resources. ii Management integrates Human, Physical and Financial Resources: In an organization, human beings work with non-human resources like machines. Materials, financial assets, buildings etc. Management integrates human efforts to those resources. It brings harmony among the human, physical and financial resources. iii Management is Continuous: Management is an ongoing process. It involves continuous handling of problems and issues. It is concerned with identifying the problem and taking appropriate steps to solve it, e.

the target of a company is maximum production. For achieving this target various policies have to be framed but this is not the end. Marketing and Advertising is also to be done. For this policies have to be again framed. Hence this is an ongoing process. iv Management is all Pervasive: Management is required in all types of organizations whether it is political, social, cultural or business because it helps and directs various efforts towards a definite purpose. Thus clubs, hospitals, political parties, colleges, hospitals, business firms all require management. Whenever more than one person is engaged in working for a common goal, management is necessary.

It is more concerned with groups. It involves the use of group effort to achieve predetermined goal of management of an organisation. This typically involves making a profit for the shareholders , creating valued products at a reasonable cost for customers , and providing rewarding employment opportunities for employees. This can be achieved only when management accomplishes its functions. A diagrammatic representation of the functions of management is as under: Figure 1 1. It is a systematic activity which determines when, how and who is going to perform a specific job. Planning bridges the gap between where we are to, where we want to go. Planning is important at all levels of management. However, its characteristics vary by level of management.

STEPS IN PLANNING FUNCTION: i Establishment of objectives: a. Setting of goals and objectives to be achieved. Stated in a clear, precise and unambiguous language. Stated in quantitative terms. Should be practical, acceptable, workable and achievable. ii Establishment of Planning Premises: a. Planning premises may be internal or external. Internal includes capital investment policy, management labour relations, philosophy of management, etc. Whereas external includes socio- economic, political and economical changes. Internal premises are controllable whereas external are non controllable.

iii Choice of alternative course of action: a. A number of alternative course of actions have to be considered. Evaluated each alternative in the light of resources available c. Chose the best alternative. iv Securing Co-operation: After the plans have been determined, it is necessary rather advisable to take subordinates or those who have to implement these plans into confidence. This motivates them, valuable suggestions can come and employees will be more interested in the execution of these plans. Planning is basically a decision making function which involves creative thinking and imagination that ultimately leads to innovation of methods and operations for growth and prosperity of the enterprise 2. It is a function in which the synchronization and combination of human, physical and financial resources takes place.

All the three resources are important to get results. Therefore, organizational function helps in achievement of results which in fact is important for the functioning of a concern. Hence, a manager always has to organize in order to get results. Identification of activities - All the activities which have to be performed in a concern have to be identified, grouped and classified into units. Departmentally organizing the activities - dividing the whole concern into independent units and departments is called departmentation. Co-ordination between authority and responsibility: Each individual is made aware of his authority and knows whom they have to take orders from and to whom they are accountable and to whom they have to report.

Thus an organization structure should be designed to clarify who is to do what tasks and who is responsible for what results and to furnish decision-making and communications networks reflecting. Staffing pertains to recruitment, selection, development and compensation of subordinates. NATURE OF STAFFING FUNCTION: i Staffing is an important managerial function ii Staffing is a continuous activity iii The basis of staffing function is efficient management of personals. iv Staffing helps in placing right men at the right job v Staffing is performed by all managers depending upon the nature of business, size of the company, qualifications and skills of managers, etc. DIRECTING: Directing is a process in which the managers instruct, guide and oversee the performance of the workers to achieve predetermined goals. Planning, organizing, staffing has got no importance if direction function does not take place. ii Continuous Activity - Direction is a continuous activity as it continuous throughout the life of organization.

iii Human Factor - Since human factor is complex and behavior is unpredictable, direction function becomes important. iv Creative Activity - Direction function helps in converting plans into performance v Executive Function - Direction function is carried out by all managers and executives at all levels throughout the working of an enterprise; To sum up, the plans may be the best feasible ones, the activities may be systematically organized, the staff may be highly efficient, but the organization will not succeed, if there is no proper direction. Mere planning, organizing and staffing are not sufficient to set the tasks in motion. Directing involves not only instructing people what to do, but also ensuring that they know what is expected from them. Management seeks to achieve co-ordination through its basic functions of planning, organizing, staffing, directing and controlling. Co-ordination is achieved through planning, organizing, staffing, directing and controlling.

Co-ordination is life-line of management. It is required in each and every function and at each and every stage and therefore it cannot be separated.

(PDF) Introduction to Health Care Management by Sharon B. Buchbinder,pdf file : introduction to management

22/02/ · Chapter 1: Introduction to Nursing Management Processes Chapter 2: External Factors Influencing Health Services Management Chapter 3: Managing Policy and First, healthcare management is at its core, a rela- tionship business. Your ability to build, grow, and maintain relationships will be the key determinant to your future success. These 17/03/ · READ (PDF) Introduction to Health Care Management by Sharon. Buchbinder full DOWNLOAD. PRODUCK DETAIL Author: Sharon Buchbinder. Pages: pages. Publisher Introduction to health care management: Free Download, Borrow, and Streaming: Internet Archive Loading viewer Introduction to health care management Publication date The introduction to healthcare management 3rd edition pdf free download presents an introduction to acute and long-term care management, with emphasis on financial and 11/03/ · Anthony Augustine Sandi Jia Bainga Kangbai Tulane University Abstract and Figures This chapter defines Health Management and takes a closer look at the different ... read more

Whereas Deming focused on measuring and controlling process variation, Juran focused on developing the managerial aspects supporting quality. It requires the manager to coach, assist, and problem solve with employees. For example, economic recessions can directly impact demand for a company's product. When forecasting efforts have short time horizons in small time periods, fewer data can be used. vi Company image and brand equity: The image of the company in the outside market has the impact on the internal environment of the company. Clinical decision making is the process by which physicians and other clinicians determine which patients need what and when. They are accountable for its use and misuse.

But managers tend to achieve only what has been planned. The task environment consists of introduction to healthcare management pdf free download specific individuals and organizations that interact directly with the organization and can affect goal achievement: customers, suppliers, competitors, producers of substitute products or services, labor unions, financial institutions, and so on. Dalrymple, J. The measurement results must be evaluated to determine whether performance is acceptable. Informal groups within the work plant exercise strong social controls over the work habits and attitudes of the individual worker.