1. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 23 Performance Improvement and Customer Service

2. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Quality of Care Major challenge –Balance between high-quality patient care and controlling costs Patient satisfaction not correlated to amount spent Difficult to measure

3. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Quality Improvement Role of Centers for Medicare & Medicaid Services (CMS) Decrease costs while maintaining quality Quality Assessment and Performance Improvement (QAPI)

4. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question True or False: –The U.S. ranks highest in quality of health care.

5. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer False U.S. ranks highest in health care costs –But not in quality of care

6. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Quality Quality of input resources Quality of process of delivery of services Quality of outcome of service

7. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Quality Programs Continuous quality improvement (CQI) –Quality assurance (QA) –Quality improvement (QI) –Performance improvement (PI) –Total quality management (TQM) Utilization review (UR) Quality improvement organization (QIO)

8. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Evaluation Areas Organizational structure Health care workers Patient outcomes

9. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question Which of the following refers to the evaluation of the necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities? A.QIO B.CQM C.UR

10. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer C. UR UR –Evaluation of necessity, appropriateness, and efficiency of use of health care services, procedures, and facilities

11. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer C. UR QIO –Organization contracted by CMS CQM –Approach to health care quality management

12. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Customer Service Essential to success Internal customers External customers

13. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Customer Service Customers evaluate entire experience Avoid slipping into automatic mode –Focus on patient Lawsuits most commonly related to whether patient likes health care workers Fewer long-term relationships in health care

14. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Lawsuits May be frivolous Time and money spent Stress Many can be avoided by working to ensure customer satisfaction

15. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question True or False: –Whether a lawsuit is filed or not is frequently based on whether the patient liked the health care professional.

16. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer True Lawsuits brought by patients more closely related to whether patient does or does not like health care professional than any other factor

17. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Customer Satisfaction Methods to assess: –Mail questionnaires –Call customers –Maintain log of complaints Satisfaction subjective

18. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Customer Satisfaction When working with unhappy customer: –Identify problem –Seek resolution –Verify satisfaction

19. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Internal Customers Those working in health care industry Areas of focus: –Good relationships with coworkers –Job satisfaction and pride in work –Constructive criticism –Destructive criticism

20. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question True or False: –Destructive criticism is never a positive event.

21. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer False Destructive criticism hard to receive, but looking for “kernel of truth” can be beneficial