“Barriers to an Effective QI Effort

For this Assignment, review Case 3, “Barriers to an Effective QI Effort,” in Chapter 11 of the text, Managing Health Services Organizations and Systems. Reflect on how you as a current or future health care administrator might address strategies to implement a quality improvement initiative. Consider the following questions: What considerations should you keep in mind to address quality? How does one measure quality and identify strategies to improve quality in an HSO? Then, review the Week 6 Case Questions document in this week’s Learning Resources to complete the Assignment.

The Assignment (2–4 pages):

  • Complete the case questions presented.
  • Be sure to provide support from the literature in completing the case questions.

Case Study 3 Barriers to an Effective QI Effort

District Hospital is a 260-bed, public, general acute care hospital owned by a special tax district . Its service area includes five communities with a total population of 180,000 in a southeastern coastal state in one of the nation’s fastest-growing counties. It is one of three hos- pitals owned by the special tax district. The seven other hospitals in District Hospital’s general service area make the environment highly competitive. District Hospital has a wide range of services and the active medical staff of 527 repre- sents most specialties. The emergency department (ED) is a major source of admissions. Last year, 26,153 patients visited the ED and 3,745, or 14.3%, were admitted. This was 42% of total hospital admissions. Some admissions were sent to the ED by private physicians and some came by ambulance, but most were self-referred. The hospital chief executive officer, W.G. Lester, noted that the number of visits to the ED was decreasing. Over a 3-year period, they had declined from a high of 29,345 to the current low of 26,153. Only part of this reduction seemed attributable to competition. Lester was also concerned about an increasing number of complaints concerning the quality of ED services. The complaints related to waiting time, poor attitudes of physicians, and questions about the quality of care. Investigation found that many complaints were justified, the causes of these problems were difficult to discern. Registered nurses (RN) employed in the ED want a larger role in triaging and treating patients, but the dominance of ED physicians limits the RNs’ duties and frustrates other staff, as well. This is manifested among RN staff by high turnover, low morale, and difficulty in re- cruitment and retention. Another factor is the emergency medical technician (EMT) program started in the county a few years ago. The EMTs are an important community medical resource and are very influ- ential in deciding the hospital to which patients in ambulances will be transported. It will be necessary for District Hospital, through the ED physicians, to participate actively in training and managing the EMT program if District Hospital is to receive its share of emergency pa- tients. ED physicians have refused to participate in teaching or directing the program, however. In fact, they often alienate the EMTs. Lester is concerned, too, that the position of full-time director of emergency medicine at District Hospital has been vacant for 4 years. Residency programs in emergency medicine are producing physicians who are seeking positions with higher salaries and better working condi- tions than those available at District Hospital. There has been little turnover among the six physicians who staff the ED; they include one general surgeon (retired from private practice), two internists, and three non-U.S.-trained medical graduates with specialties in family practice. The ED physicians seem to lack a clear commitment to District Hospital . All of them contract separately with the hospital to provide ED services. District Hospital bills ED patients and collects the physicians’ fees: moneys above the guaranteed minimum are paid to them pro rata. They participate in District Hospital’s fringe benefits and are covered by its professional liability insurance policy. One ED physician, Dr. Balck (the retired surgeon), recognizes the progress being made nationally in emergency medicine. She made several unsuccessful attempts to move District Hospital in the same direction. With great effort, she instituted programs on intradepartmental education and mandatory attendance at approved courses in emergency medicine. Quality related activities, however , are done perfunctorily. Also, she has tried to obtain full recognition The members of the PSO seem satisfied with the situation. Its executive committee does not understand the changing status of emergency medicine. As evidence of its unwillingness to grant full recognition to the department, the PSO has consistently denied the ED’s requests of the ED and its work by other members of the PSO. for full departmental status.

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