NCQA Health Plan Accreditation: A Case Study

163 Words1 Page
bulb-icon

Recommended: Quality improvement in hospitals topic

THE NCQA health plan accreditation encompasses healthcare facilities to have written plan approved by the governing board and is required to be reviewed and updated periodically as if it was a policy or procedure document. Every department must have its own plan but not in any particular format. The plan must exhibit the essential aspects of the quality management system. This reading entails an example of a facility quality management plan. The board of trustees is responsible for the safety and quality care, treatment and services provided in the hospital. The board makes decisions with the medical staff and hospital management which include medical director, chief executive officer, nursing director, clinical services director, vice president

Show More
Related

  • Kaiser Permanente Case Study

    1708 Words  | 4 Pages

    Membership Services (MSD) at Kaiser Permanente used to be a modest department of sixty staff. However, over the past few years the department has doubled in size, creating minor departmental reorganization. In addition the increase of departmental staffing, several challenges became apparent. The changes included primary job function, as well as the introduction of new network system software which slowed down the processes of other departments. These departments included Claims (who pay the bills for service providers outside of the Kaiser Permanente network), and Patient Business Services (who send invoices to members for services received within Kaiser Permanente). Due to the unforeseen challenges created by the system upgrade, it was decided that MSD would process the calls for both of the affected departments. Unfortunately, this created a catastrophic event of MSD receiving numerous phone calls from upset members—who had received bills a year after the service had been provided. The average Monday call volume had risen from 1,800 to 2,600 calls per day. The average handling time for each phone call had risen as well—from an acceptable standard of 5.6 minutes to an unfavorable 7.2 minutes. The department continued to be kept inundated with these types of calls for the two years that these changes have been effect.

    Read More

  • Essay On Hospital Readmissions

    563 Words  | 2 Pages

    State and federal regulations, national accreditation standards, and clinical practice standards are created, and updated regularly. In addition, to these regulations, OIG publishes a compliance work plan annually that focuses on protecting the integrity of the program, and prevention of fraud and abuse. The Office of the Inspector General examines quality‐of‐care issues in nursing facilities, organizations, community‐based settings and occurrences in which the programs may have been billed for medically unnecessary services. The Office of the Inspector General’s work plan for the fiscal year 2011 highlights five areas of investigation for acute care hospitals. Reliability of hospital-reported quality measure data, hospital readmissions, hospital admissions with conditions

    Read More

  • Caris Healthcare Case Study

    1492 Words  | 3 Pages

    Leaders recognize improving clinical quality will have many benefits for both, residents and the organization. For example, it will benefit residents by improving satisfaction, reducing complications, and improving their quality of life. It will benefit NCH by reducing turnover, improving occupancy rates, attracting top talent, and enhance employee satisfaction (Advancing Excellence in America’s Nursing Homes, n.d.). Increasing professional development opportunities will be key for improving clinical quality. Professional development enhances the clinical staff’s competencies and will decrease turnover, which will enable NHC to experience a greater financial return on their development

    Read More

  • Case Study: Grady Memorial Hospital

    1044 Words  | 3 Pages

    If patients constantly have to wait an excessive amount of time they will either leave before they receive care or could end up becoming sicker as a result. Donabedian’s three-element model structure, process and outcome have become the gold standard for defining quality measurement (Varkey, 2010). Structure relates to the health care setting, which includes the hospital policies, procedures and design. Process evaluates if the right actions were taken for an intended outcome and how well the actions were executed to achieve the outcome. Outcome focuses on the patient, it measures the patient’s condition, behavior, and response to or satisfaction with care (Varkey, 2010). Although each of these measures focus on different areas, they indicate areas that need improvement. Also, the measurement from structure and process plays an important role in the patient’s outcome. If the hospital has the right staff, equipment and

    Read More

  • The Joint Commission

    800 Words  | 2 Pages

    The standards of the Joint Commission are a foundation for an objective evaluation process the may help healthcare organizations measure, assess and improve performance. These standards are focused on organizational functions that are key for providing safe high quality care services. The Joint Commission’s standards set goal expectations of reasonable, achievable and surveyable performance of an organization. Only new standards that are relative to patient safety or care quality, have positive impact on healthcare outcomes, and can be accurately measured are added. Input from healthcare professionals, providers, experts, consumers and government agencies develop these standards.

    Read More

  • Dashboard Analysis and Nursing Plan

    1319 Words  | 3 Pages

    The Centers for Medicare and Medicaid Services (CMS) have recently begun requiring hospitals to report to the public how they are doing on patient care. Brown, Donaldson and Storer Brown (2008) introduce and explain how facilities can use quartile dashboards to transform large amounts of data into easy to read and understandable tool to be used for reporting as well as to determine areas in need of improvement. By looking at a sample dashboard for an inpatient rehab unit a greater understanding of dashboards and their benefits can be seen. The sample dashboard includes four general areas, including nurse sensitive service line/unit specific indicators, general indicators, patient satisfaction survey indicators and NDNQI data. The overall performance was found to improve over time. There were areas with greater improvement such as length of stay, than others including RN care hours and pressure ulcers. The areas of pressure ulcers and falls did worse the final quarter and can be grouped under the general heading of patient centered nursing care. The area of patient satisfaction saw a steady improvement over the first three quarters only to report the worst numbers the final quarter. A facility then takes the data gathered and uses it to form nursing plan...

    Read More

  • Accreditations and Certifications in Nursing

    1986 Words  | 4 Pages

    To gain accreditation, TJC sets rigorous safety and quality of care standards and evaluates organizations to see whether or not they meet their standards. After the survey, TJC provid...

    Read More

  • Importance Of Resource Utilization In Nursing

    1514 Words  | 4 Pages

    It also proves that there should some retaining accountability in quality of care to individuals receiving healthcare. Aim is team work , planning, implementation , progress measuring of health care consumer within the organization.Promots continuous ongoing education of all healthcare providers.ANA provides some leadership qualities as nurses can act as a mentor to other colleagues for the improvement of nursing as a profession and quality of care. In leadership important personal qualities are communication and ability to resolve conflicts. So treat others with full of respect ,dignity and trust. Should consider the effectiveness of communication and ways to improve autonomy and accountability of nurses. Work under the influence of polcies and procedures and involve the patients and profession. Decision making bodies are taking the role for the sake of improve the healthcare outcomes and the professional practice improvement. In public health sectors there should be interprofessional team and that should be advance the nursing practice in interpreting the role for community as a whole. Also nureses can teach other staff members and patients. Pomoting good and healthy working atmosphere between local, national , international communities. Leaders are exhibiting the quality of flexible changing style and creativity according to the situation. They should be energetic in their action and also should accept the mistake by self and others . Other quality is co-ordination of care because in health sectors there is licensed and unlicensed nurses so there should co-ordination among staff members. Work as administrative team. Promote communication among staff members through written messages , publications and presentations. Promote direction to improve the effect of the multidisciplinary or interdisciplinary

    Read More

  • Health Care Quality Analysis

    1077 Words  | 3 Pages

    Quality care, safe practices and principles, and accountability constitute the foundation of any health care organization (Huber, 2014). Addressing patient safety issues and improving health care quality may include reorganizing operations to improve efficiency, coordinating care with interdisciplinary team members, and using information technologies (Wang, Cha, Sebek, McCullough, Parsons, Singer, & Shih, 2014). In this paper, I will review my organization’s quality program goals, objectives, and management structure, how quality improvement (QI) projects are selected, managed, and monitored, and how nursing staff are trained and supported in

    Read More

  • Accreditation Canadian Health Care System: A Case Study

    234 Words  | 1 Pages

    Accreditation Canada is important in improving patient safety in the Canadian health care system (Accreditation Canada, 2009, p. 3). This is accomplished through the Qmentum accreditation program, which began in 2008 (Accreditation Canada, 2009, p. 3). The components of the program include quality dimensions, national standards of excellence, required organizational practices, and performance measures (Accreditation Canada, 2009, p. 3). For example, through accreditation of required organizational practices (ROP), Accreditation Canada is able to pinpoint which ROPs organizations are compliant with and which ones are unmet (Accreditation Canada, 2009, p. 6). According to Accreditation Canada (2009), ROPs are “evidence based practices that mitigate

    Read More

  • Moldistribution Of Health Care Personnel

    1132 Words  | 3 Pages

    ... is an abstract model that proposes an exploratory plan for health services and evaluating quality of health care. In accordance with the model, information about quality of care can be obtained from three categories: structure, process, and outcomes. In addition, not long ago The Joint Commission include outcomes in its accreditation valuations (Sultz, & Young, 2011, p. 378).

    Read More

  • Importance Of Quality Improvement In Healthcare

    1233 Words  | 3 Pages

    In health care, Continuous Quality Improvement (CQI) is defined as a structured organizational process for involving personnel in planning and executing a continuous flow of improvement to provide quality health care that meets or exceeds expectations. CQI is helpful in facilitating medical errors as its main focus is the organization’s system. CQI‘s main emphasis is avoiding personal blame. Its main focus is on managerial and professional processes associated with specific outcomes, that is the entire production system. The primary goals of CQI is to guide quality operations, ensure safe environment & high quality of services, meet external standards and regulations, and assist agency programs and services to meet annual goals & objectives. All stakeholders such as patients, employees, and so forth are involved in CQI.

    Read More

  • Continuous Quality Improvement

    240 Words  | 1 Pages

    Continuous Quality Improvement is defined as, “a structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality healthcare that meets or exceeds expectations” (Sollecito & Johnson, 2013). CQI may be used by any health care organization for health care administrative and clinical processes. CQI is also considered to be an approach, perspective, or set of activities applied at various times. For instance, it is used in institutional improvement, societal learning, and professional responsibility (Sollecito & Johnson, 2013). CQI consists of various characteristics along with three main elements: philosophical, structural, and health care-specific, and three distinguishing

    Read More

  • Grading Scale And Definition Of Grading For Healthcare Institutions

    823 Words  | 2 Pages

    This results in accuracy and clarity in the grading process. A group of at least two appropriately trained and skilled analysts, is allocated to interact with the management of health care institution. The subjects discussed in the management meeting are all inclusive of topics like the, regulatory compliance, financial performance, medical specialties, , mission and policy, patient rights, nursing care and support services. From the preliminary management meeting to the final assignment of the grade it takes about three to four weeks for a multi-specialty hospital and around one to two weeks for a nursing

    Read More

  • Health Care Facility Planning

    631 Words  | 2 Pages

    The purpose of renovating a health care facility is to add new amenities and improve the existing ones. For successful renovation, one needs to plan on how the whole process is going to take place. “This process begins with the strategic direction for the organization and integrates facility planning with market demand and service line planning, operations improvement initiatives, and anticipated investments in new technology” (Hayward, 2006, Chapter 1). Successful facility planning should include a review how long the renovation will take, how much it will cost, and what changes the renovation will bring.

    Read More

More about NCQA Health Plan Accreditation: A Case Study

Open Document