Value Based Health Care: Linking Finance and Quality

Figures and Tables ix

Preface xi

Acknowledgments xiii

The Author xv

Introduction xvii

PART ONE BASIC PRINCIPLES OF QUALITY MANAGEMENT 1

1 DRIVERS OF CHANGE 3

Learning Objectives 3

External Drivers 5

Internal Drivers 11

Summary 20

Key Terms 20

Things to Think About 20

2 IMPROVING PATIENT SAFETY 21

Learning Objectives 21

Understanding Quality Measures 23

Working with Quality Information 24

Measuring Value 27

Asking Questions Via Data 30

Presenting Results 34

Effective Communication Improves Patient Safety 37

Summary 39

Key Terms 39

Things to Think About 39

3 FOCUS ON THE PATIENT 41

Learning Objectives 41

Effective Communication and Patient-Focused Care 43

Handoff Information Transfer 47

SBAR 47

Barriers to Effective Communication 48

Strategies to Reduce Barriers 50

Care and Communication Guidelines 51

Patient Education 52

Near-Miss Reporting 59

Chronic Disease Management 61

Task Forces 63

Patient Rights and Responsibilities 65

Compassionate Caring 65

Summary 67

Key Terms 68

Things to Think About 68

4 UNDERSTANDING PROCESSES, OUTCOMES, AND COSTS 69

Learning Objectives 69

Some Events Should Never Occur 70

Leaders’ Role in Good Outcomes 72

Physicians’ Role in Good Outcomes 74

Financial Value of Good Outcomes 76

Changing the Traditional Culture 77

Summary 86

Key Terms 86

Things to Think About 86

PART TWO GETTING DOWN TO BUSINESS 87

5 THE VALUE OF PREVENTION 89

Learning Objectives 89

The Promotion of Prevention 90

The Problems with Prevention 91

The Patient’s Role 92

Prevention Measures 93

Regulatory Groups’ Role in Prevention 94

Data’s Role in Promoting Prevention 95

Management of Chronic Conditions 99

Prevention in Ambulatory Care 101

Proactive Prevention in the Hospital 106

National Patient Safety Goals 107

Technology and Prevention 108

Summary 110

Key Terms 111

Things to Think About 111

6 THE COST OF SENTINEL EVENTS 113

Learning Objectives 113

Changing the Incident Analysis Framework 115

The Value of Root Cause Analysis 117

Monitoring Behavioral Health 121

Eliminating Never Events 124

Improving Error Reports 125

Quality Management’s Role in Controlling Adverse Events 126

The Traditional Hierarchy Leads to Errors 128

The Economics of Malpractice 129

Summary 130

Key Terms 131

Things to Think About 131

7 MANAGING EXPENSES IN A HIGH-RISK E NVIRONMENT 133

Learning Objectives 133

Improving Cost in the ICU 134

Match the Resources to the Patient 136

End-of-Life Care 137

Sustaining Change 138

Improving Operating Room Efficiency 141

Improving Oversight 142

Managing Throughput 143

Summary 146

Key Terms 147

Things to Think About 147

8 IMPROVING COMMUNICATION AND ESTABLISHING TRUST 149

Learning Objectives 149

Developing Trust 150

The Role of Quality Management in Increasing Trust 151

Transparency, Tracers, and Trust 151

Establishing a Common Language 157

Sustaining Change 159

Monitoring Care 160

Assessing Competency 163

The Role of Regulatory Requirements in Ensuring Competency 164

Medical Staff Credentialing 165

Objectifying Competency 165

Staffi ng Effectiveness 168

Promoting Competency 169

Summary 169

Key Terms 170

Things to Think About 170

9 PROMOTING A SAFE ENVIRONMENT OF CARE 171

Learning Objectives 171

Communication Across Disciplines 172

Working Together to Identify and Solve Problems 174

Improving Processes 175

Monitoring Safety 176

Ensuring Accountability 178

Maintaining a Safe Environment 180

Establishing Oversight 180

Communicating About Safety 181

Assessing and Improving the Environment 182

Summary 183

Key Terms 184

Things to Think About 184

10 CONCLUSION 185

REFERENCES 191

USEFUL WEB SITES 195

INDEX 197