Quality management in healthcare: systems approach and organizational leadership

Healthcare Quality Measurement

Compare one measurement that you identified in the Week 2 Discussion with one measurement outlined by the CMS restricted reimbursements and explain how these two measures demonstrate evidence of compliance with their respective quality measurement standards.

In the Week 2 Discussion, we considered the importance of personnel-focused quality measures in rating healthcare performance. The Centers for Medicare and Medicaid Services (CMS) maintain a wide range of these measurement types. Accordingly, "of the quality measures currently in use by CMS, 153 address physician and other professional behavior as part of the 2009 PQRI measure set." (CMS, p. 6) This degree of attention suggests that there are many correlations between achieving positive treatment outcomes and providing meaningful frameworks, standards and oversight to healthcare providers. These system end-users will have a defining impact on treatment quality and, increasingly in the current regulatory climate, the impact of reimbursement penalties.

For instance, measuring nursing performance has a direct correlation to actual performance quality if executed properly. Rather than being perceived as a penalty-driven system, the effectively oriented performance measurement should raise morale and improve occupational commitment. The study by Albanese et al. (2010) indicates that nurses must be actively involved in the process of their own evaluation in order for this approach to have the desired impact on performance. According to the study, "when nurses are educated about performance and quality measures, are engaged in identifying outcomes and collecting meaningful data, are active participants in disseminating quality reports, and are able to recognize the value of these activities, data become one with practice." (Albanese et al., p. 226)

In spite of the value of such measures, the shift in regulatory focus has moved toward transitions measurements with an interest in reducing mortality and readmissions following hospitalization. These measures have been paired with heightening reimbursement penalties. As to these penalties, the CMS reports that "when combined with the proper incentives, whether financial or non-financial, the use of quality measures could foster better transitions and coordination of care in two ways. First, such "transition measures" may expand the unit of measurement, whether the timeframe or the number of actors. For instance, instead of measures that look only within a specific hospitalization, a transition measure looks at a specified period of time before and/or after that hospitalization such as hospital readmission or 30 day mortality, events taking place outside the timeframe of the actual hospitalization." (CMS, p. 8)

2. From a systems perspective, discuss how these different measures affect quality outcomes, support ethical principles, and influence patient care and nursing practice

The measures discussed above and the host of others now in use in the healthcare industry are collectively aimed at improving both treatment outcomes and accountability. The hope is that with greater accountability will come a greater ability to distill and eliminate costly and even deadly treatment errors. For instance, the study by Howie (2009) finds that "estimations of preventable adverse events as a result of medical errors range from at least 44,000 to as many as 98,000 American deaths annually." (p. 649)

The study asserts that many of these fatalities could be prevented through more thorough reporting of medical errors. The use of such reporting as a measure of performance quality could connect directly to a reduction in negative health outcomes owing to medication errors. Other examples are that cited in the article by Park et al., which evaluates the usefulness of nursing home report cards as a measurement tool. Park et al. confirm the idea expressed by the CMS that incentivizing measurement accountability can yield willing and constructive participation. According to their findings, "providers that improve their performance under public reporting may receive a return on their investment in quality improvement. This supports the business case for public reporting." (Park et al., p. 531)

Such healthcare quality measurements are especially important because, at present, the United States healthcare system is in a state of flux. If this change is to be for the better, data drawn from measurements must be used to bring about actionable improvement. For instance, the article by Wachter et al. (2009), asserts that "our failure to create real accountability for patient safety partly represents a fundamental misunderstanding regarding both how other, safer industries carry out their safety activities and the nature of errors." (Wachter et al., 1402)

Here, Wachter et al. make the argument that the use of a specific measurement of patient safety standards as manifested through procedures, practices and environmental conditions should be used to produce a lucid set of standards for healthcare providers. The assertion reinforces the overarching point of the present discussion, which is that the data gathered through a wide range of quality measurement indicators must be manifested as meaningful and pronounced standards in order to have real value.