Chapter 25 Management and Policy

25-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality in Healthcare: A Glimpse of the Past  Florence Nightingale Recognized that environmental considerations impact client recovery. Held nurses accountable for using assessment skills and sound clinical judgment.

25-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Initiatives through Accreditation  Accreditation Recognition or approval bestowed by an authorized organization or agency  Benchmark Standard of excellence

25-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Initiatives through Accreditation  Florence Nightingale provided a foundation for statistical measures in health care.  Ernest Codman, MD, developed a system to track clients to determine the effectiveness of care (1910).

25-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Initiatives through Accreditation  American College of Surgeons (ACS) began inspecting hospitals based on “The Minimum Standard” (1918).

25-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Initiatives through Accreditation  Joint Commission on Accreditation of Hospitals (JCAH) began hospital accreditation in  Began charging for accreditation survey services in 1964.

25-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Initiatives through Accreditation  JCAH accreditation recognized as a benchmark (standard of excellence) for hospital reimbursement for Medicare and Medicaid (1965).

25-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Initiatives through Accreditation  Donabedian published a framework for assessment of quality in health care (1966).  Accreditation focus shifted from minimum to optimal standards of quality (1970).

25-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Initiatives through Accreditation  Donabedian’s quality assurance framework changed the scope of the survey to include the entire organization.  Registered nurses and administrators joined the JCAH survey team.

25-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Donabedian’s Quality Assurance Framework  Structure  Process  Outcome

25-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Donabedian’s Quality Assurance Framework  Structure Health care settings Resources Payment and billing systems

25-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Donabedian’s Quality Assurance Framework  Process Examination of actual health care delivery activities to achieve “good medical care.” A variety of procedures are compared to published practice guidelines.

25-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Donabedian’s Traditional Quality Assurance Framework  Outcome Client or provider-focused. Defined in terms of recovery, restoration of function, and of survival. Involves peer review of physician or nursing practice.

25-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Improvement  Multidisciplinary Approach  All customers are treated with dignity. Client Staff Nurses Physicians

25-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. From Quality Assurance to Quality Improvement  FOCUS PDCA is a model for continuous quality improvement used in many health care organizations.

25-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The JCAHO Accreditation Survey Process  Performed every three years.  Evaluates every area of the organization.  An additional, unannounced random survey may occur.

25-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Role of the Nurse and other Caregivers in the Survey Process  Personal Interviews  Assessment of Clinical Competencies  Assessment of Organizational Competencies

25-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Role of Management in the Survey Process  Administrative and Human Resource Functions Policies Educational program Documentation of policies Credentialing process for medical staff Compliance with federal mandates

25-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Organizational Safety and the JCAHO  “Environment of Care” (EOC) Standards Accreditation standards intended to improve safety in the care environment.  All clinical personnel are involved.  Seven broad areas with a program manager assigned to each area

25-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Organizational Safety and the JCAHO  Partnership with the Occupational Safety and Health Administration (OSHA) Increased emphasis on employee safety and health

25-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. JCAHO Survey Outcomes  Eligibility for Medicare, Medicaid, and other third-party reimbursements is contingent upon JCAHO accreditation.  Several levels of JCAHO accreditation reflect full compliance or requirements for improvement with recommendations.

25-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. JCAHO Survey Outcomes  The most serious deficiencies are: Type 1 recommendation (most serious) Supplemental recommendations

25-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The 21st Century—A Quality Revolution  Health Policies Written decisions directing or influencing the actions or decisions of others Impact health of the affected population or individual by altering health determinants

25-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Types of Health Policies  Laws are enacted to achieve a specific objective. Title XVIII of the Social Security Act (Medicare)  Rules and regulations provide specific guidance for implementation of a law.  Judicial decisions are decisions made by a judge and based on the interpretation of laws.

25-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Health Policy Making, Implementation, and Analysis  An issue with a proposed solution is presented to a legislator.  The issue may be drafted and introduced in Congress.  A regulation is developed to guide implementation.  Modifications to the policy are made to achieve the desired result.

25-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Health Policy-Making Process  Can be impacted by politics.  Politics is the use of power to effect change.  Politics can either impede or propel the policy-making process.

25-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Nurse’s Role in Policy Making  Nurses are in a position to mobilize in response to legislation impacting client care through professional organizations or individually.

25-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Organizational Policy Making and Excellence in Nursing Practice  Health care policies at the organizational level define nursing practice.  Standard of Care Clinical practice guidelines, procedures, and algorithms are tools used to integrate health policy and “best practices” into nursing practice.

25-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Organizational Policy Making and Excellence in Nursing Practice  Professional Accountability The nurse is expected to remain knowledgeable about organizational and clinical policies, nursing practice guidelines, and additional information needed to deliver high-quality client care.