each question half page , one reference

Q1

 

As an administrator, I would move from analytics insight to healthcare improvement by following the five quality improvement phases. To begin I would first start by defining the problem. Analytics that come from raw data show the discrepancies in standards versus actual performance. By looking at the current state of the Health Care Organization (HCO) administrators can begin to define the specific problem so that they can identify opportunities for growth. This second step includes looking at the goals of the HCO so that potential growth is recognized. Next, it is important to execute improvement activities. This helps enforce that the problem is remedied and does not happen again. Mitigating errors or lapses in care can help HCOs reach their goals. The next step is evaluating outcomes. This step emphasizes ongoing evaluation and reporting of relevant information pertaining to patients to quantify the impact of implemented changes. Lastly, the changes need to be sustained. It is not a one-time deal. Positive change requires consistency and implementation so that it can have the intended impact (Strome, p. 130, 2013). 

A problem facing financials in an HCO would require administrators to look at the incoming and outgoing expenses to determine where the problem is coming from. It would rely on individuals who are experts in accounting to help quantify the financial data so that opportunities for financial growth can be identified. From there the group of administrators and accountants would need to evaluate the outcomes of increasing profits and sustain that level of income to reach improvements in financial positions. 

The three steps in identifying and selecting improvement opportunities are:

1. Determining likely root cause(s) of quality/performance problems.

2. Identifying possible countermeasures to address root causes.

3. Estimating countermeasure impact and effort to achieve goals.

The first step means identifying where, why, and how the problem is occurring and specifically how it is affecting the goals of the health care organization. The second step is the problem-solving step that requires solution management and effective leadership to come up with ideas to mitigate the problem. The last step is analyzing the overall effect that mitigating the problem can have on the organization. This step is all about determining if it is worth it to tackle the improvement opportunity.

Q2

 

a healthcare administrator, the transitional approach I would take from analytical insight to healthcare improvement is by following the five quality improvement phases. Phase one is to define the problem, data without context are just numbers, it up to us as administrators to put a story behind the numbers and break down what they mean to us in reference to the healthcare organization. Analytics give us a glimpse of the results of our organizational proccesses and what needs to be fixed. The second phase is to identify opportunities, from data analyzation and realizing the problem, it is best to identify the best areas to grow from. The third phase is to execute improvement activities, to put action to the plans that administrators put together to ensure that the problem is resolved and that it does not happen again. Evaluating outcomes is imperative for constant improvement and adjusting accordingly to how the organization reacts to change. Evaluating helps keep the HCO on track toward growth and sustainable change to identified problems. The final phase is to maintain these changes and find them as sustainable. 

A problem facing financial issues in my experience is in physicians ordering more expensive diagnostic imaging in MRIs or CT scans, for certain patients, especially Medicaid patients, their insurance may not fully cover it and results in a larger payment for the individual. In this case, it is smart for the payers and administrators to work together to formulate better “processes, guidelines, procedures, and even training to reduce these unnecessary diagnostic and associated costs” (Strom, 2013). 

3 steps to identifying and selecting improvement opportunities

1.) Determine which diagnostic imaging tactics can be interchangeable 

2.) Identify processes to address issue (guidelines & procedures)

3.) Evaluate patient outcomes

Obviously, physicians know what is best for the patient in terms of diagnosis and treatment. However, this may come at a premium cost, if there is a way to find less expensive diagnostic imaging to replace more expensive imaging for patients with medicaid or those who do not have insurance while maintaining similar integrity in imaging, then it should be done. It is important which imaging can be considered interchangable based on body part and speculated diagnosis. Next is implementation and identifying how physicians will sort this out on a patient-to-patient case basis. Next, evaluate patient outcomes to ensure that these images are interchangeable, or it is doing more good than bad.