DRIVE FALL 2016

PROGRAM Master of Business Administration in

Healthcare Services Management
MBA(HCS)
SEMESTER Semester 4
SUBJECT CODE & NAME MH0059 Quality Management in
Healthcare Services
Q. 1
Explain the requirements of quality patient care.

ANS:- Health care quality is a level of value provided by any health care resource, as
determined by some measurement. As with quality in other fields, it is an assessment of
whether something is good enough and whether it is suitable for its purpose. The goal of
health care is to provide medical resources of high quality to all who need them; that is, to
ensure good quality of life, to cure illnesses when possible, to extend life expectancy, and so
on. Researchers use a variety of quality measures to attempt to determine health care
quality, including counts of a therapy's reduction or lessening of diseases identified by
medical diagnosis, a decrease in the number of risk factors which people have following
preventive care, or a survey of health indicators in a population who are accessing certain
kinds of care.Health care quality is the degree to which health care services for individuals
and populations increase the likelihood of desired health outcomes. [1] Quality of care plays
an important role in describing the iron triangle of health care, which defines the intricate
relationships between quality, cost, and accessibility of health care within a community. [2]
Researchers measure health care quality to identify problems caused by overuse, underuse,
or misuse of health resources.[3] In 1999, the Institute of Medicine released six domains to
measure and describe quality of care in health:[4]

1. Safe - avoiding injuries to patients from care that is intended to help them.

2. Effective - avoiding overuse and misuse of care.

3. Patient-Centered - providing care that is unique to a patient's needs.

4. Timely - reducing wait times and harmful delays for patients and providers.

5. Efficient - avoiding waste of equipment, supplies, ideas and energy.

6. Equitable - providing care that does not vary across intrinsic personal characteristics.

While essential for determining the effect of health services research interventions,
measuring quality of care poses some challenges due to the limited number of outcomes
that are measurable.[5] Structural measures describe the providers ability to provide high
quality care, process measures describe the actions taken to maintain or improve
community health, and outcome measures describe the impact of a health care intervention.
[5]
Furthermore, due to strict regulations placed on health services research, data sources are
not always complete.Assessment of health care quality may occur on two different levels:
that of the individual patient and that of populations. At the level of the individual patient, or
micro-level, assessment focuses on services at the point of delivery and its subsequent
effects. At the population level, or macro-level, assessments of health care quality include
indicators such as life expectancy, infant mortality rates, incidence, and prevalence of
certain health conditions.[7]Quality assessments measure these indicators against an
established standard. The measures can be difficult to define in health care. [8] Quality
assurance is distinct from quality assessment and is based on the principles of total quality
management (TQM). It is a method of using quality assessment measures in a system-wide
manner to deliver high-quality care that is continually improving. [9]

The Donabedain model is a common framework for assessing health care quality and
identifies three domains in which health care quality can be assessed: structure, process,
and outcomes.[9] All three domains are tightly linked and build on each other. Improvements
in structure and process are often observed in outcomes. Some examples of improvements
in process are: clinical practice guidelines, analysis of cost efficiency, and risk management,
which consists of proactive steps to prevent medical errors.

Cost Efficiency Cost Efficiency, or cost effectiveness, determines whether the benefits of a
service exceed the cost incurred to provide the service. [7] A health care service is sometimes
not cost efficient due to either overutilization or underutilization. Overutilization, or overuse,
occurs when the value of health care is diluted with wasted resources. Consequently,
depriving someone else of the potential benefits from obtaining the service. Costs or risks of
treatment outweigh the benefits in overused health care. In contrast, underutilization, or
underuse, occurs when the benefits of a treatment outweigh the risks or costs, but it is not
used.[7] There are potential adverse health outcomes with underutilization. One example is
the lack of early cancer detection and treatment which leads to decreased cancer survival
rates.

Critical Pathways Critical Pathways are outcome-based and patient-centered case

management tools that take on an interdisciplinary approach by facilitating coordination of
care among multiple clinical departments and caregivers. [7] Health care managers utilize
critical pathways as a method to reduce variation in care, decrease resource utilization, and
improve quality of care.[10] Using critical pathways to reduce costs and errors improves
quality by providing a systematic approach to assessing health care outcomes. Reducing
variations in practice patterns promotes improved collaboration among interdisciplinary
players in the health care system.[7]

Health Professional Perspective

The quality of the health care given by a health professional can be judged by its outcome,
the technical performance of the care and by interpersonal relationships. [11]Outcome" is a
change in patients' health, such as reduction in pain, [12] relapses,[13] or death rates.[14] Large
differences in outcomes can be measured for individual medical providers, and smaller
differences can be measured by studying large groups, such as low- and high-volume
doctors.[15]Significant initiatives to improve healthcare quality outcomes have been
undertaken that include clinical practice guidelines, cost efficiency, critical pathways, and
risk management.[7]

Clinical Practice Guideline "Technical performance" is the extent to which a health

professional conformed to the best practices established by medical guidelines.[11] Clinical
practice guidelines, or medical practice guidelines, are scientifically based protocols to assist
providers in adopting a best practice approach in delivering care for a given health
condition.[7] Standardizing the practice of medicine improves quality of care by concurrently
promoting lower costs and better outcomes. The presumption is providers following medical
guidelines are giving the best care and give the most hope of a good outcome. [11] Technical
performance is judged from a quality perspective without regard to the actual outcome - so
for example, if a physician gives care according to the guidelines but a patient's health does
not improve, then by this measure, the quality of the "technical performance" is still high. [11]

Risk Management Risk management consists of proactive efforts to prevent adverse

events related to clinical care and is focused on avoiding medical malpractice. [7] Health care
professionals are not immune to lawsuits; therefore, health care organizations have taken
initiatives to establish protocols specifically to reduce malpractice litigation. [7] Malpractice
concerns can result in defensive medicine, or threat of malpractice litigation, which can
compromise patient safety and care by inducing additional testing or treatments. One widely
used form of defensive medicine is ordering costly imaging which can be wasteful. However,
other defensive behaviors may actually reduce access to care and pose risks of physical
harm.[16] Many specialty physicians report doing more for patients, such as using
unnecessary diagnostic tests, because of malpractice risks. [16] In turn, it is especially crucial
that risk management approaches employ principles of cost efficiency with standardized
practice guidelines and critical pathways

Q.2
Explain the implementation of QMS in
healthcare organisation.
ANS:- The top management of an organisation should be determined and committed to
implement a quality management system. No quality initiative within an organisation can
succeed without commitment from top management. Top management can demonstrate to
their clients that the organisation is committed to quality through the certification and
registration of the ISO 9000 standard. Top management should thus come to the realization
that overall business efficiency would be improved by means of a quality management
system

Establishing an Implementation Team

People are responsible for the implementation of ISO 9000. An implementation team,
headed by a Service Provider and a Management Representative (MR), is to be established.
The Service Provider and MR is the coordinator and is responsible for planning and
overseeing the implementation of the quality management system. He is thus the link
between top management and the ISO 9000 registrar. All departments within the
organisation should be represented on the implementation team.

Conducting ISO 9000 Awareness Programs

Conducting ISO 9000 awareness programs will inform all employees about the aim of a
quality management system. These include the advantages offered to customers and
employees, their respective responsibilities and roles within the system, and how the
quality management system operates.

Providing Training

All personnel and all areas in an organisation are affected by a quality management system.
Training regarding the quality management system should thus be provided for all
employees. The quality management system implementation plan should make provision for
this training. All basic concepts of quality management systems and its impact on the
organisation should be covered.

Conducting an Initial Status Survey

A quality management system conforming to the ISO 9000 standard should be created.
However, this does not preclude incorporating, adapting, or adding onto quality programs
that already exists. Thus, this step basically involves comparing an organizations existing
quality management system (if there is one) with the requirements of ISO
9001:2015.

Developing a Quality Management System Documentation

Documentation is an area where non-conformance regarding quality management systems

are very common. In order to avoid these non-conformities, documentation of a quality
management system should include the following:

Documented statements of a quality policy and quality objectives;

A quality manual;

Documented procedures and records required by the standard of ISO 9001:2015; and

Documents needed to ensure effective planning, operation and control of its

processes.

Control of Documents

In order to control quality management system documentation, a documented system

should be created. The creation, approval, distribution, revision, storage, and disposal of
various types of documentation are thus managed. Document control systems should be as
easy and simple to operate as possible. However, it should still be sufficient enough to meet
the requirements of ISO 9001:2015.

Implementation

In large organizations, it is best to implement the quality management system being

documented as the documentation is developed. This is in stark contrast to smaller
organizations, where the quality management system is implemented throughout the
organisation all at once. During phased implementation, however, an evaluation can take
place regarding the effectiveness of the system in different areas.
Through management review and an internal quality audit, the implementation progress is
monitored to ensure that the quality management system is effective and thus conforms to
the IS0 9000 standard.

Internal Quality Audit

The effectiveness of the installed system should be checked regularly by means of an

internal quality audit. Below are some reasons for conducting an internal quality audit into a
quality management system:

To ensure that the quality management system conforms to the quality management
system requirements established by your organization, as well as to the requirements
of the ISO 9001:2015 standard; and

To ensure that the quality management system is implemented and maintained in an

effective manner
Reviewing by Management

A management review should be conducted three to six months after quality management
system implementation took place. The reasons for conducting management reviews are to
ensure continuous effectiveness, adequacy, and suitability of the quality management
system.

Pre-assessment Audit

Before applying for certification, a pre-assessment audit usually takes place. Certification
bodies provide a qualified but independent auditor to conduct this service. Some degree of
confidence is gained before application for certification if the pre-assessment audit goes
well.

Certification and Registration

A formal application for certification is made at a certification body as soon as the quality
management system has been operating for a few months and has stabilized. An audit of
the documents (known as an adequacy audit) is first carried out, and if it conforms to the
requirements of the quality standard, it is followed by an on-site audit. A certificate is only
awarded to the organisation if the certification body is satisfied with the workings of the
system. However, the certificate is valid for a period of three years only, after which the
certification body will carry out periodic surveillance audits.

Continual Improvement

Although an organisation gained certification, it is important to note that it has to try and
improve the suitability and effectiveness of the quality management system on a continuous
basis.

Q.3 Explain the implementation of QMS in healthcare organisation.

ANS:- Successful organizations have figured out that customer satisfaction has a direct

impact on the bottom line. Creating an environment which supports a quality culture

requires a structured, systematic process. Following are steps to implementing a quality

management system that will help to bring the process full circle.

Lets begin by defining the word quality.

Quality Defined:

A subjective term for which each person has his or her own definition. In technical usage,

quality can have two meanings: (1) the characteristics of a product or service that bear on
its ability to satisfy stated or implied needs and (2) a product or service free of

deficiencies. American Society for Quality (ASQ)

A Quality Management System is The organizational structure, processes, procedures and

resources needed to implement, maintain and continually improve the management of

quality. American Society for Quality (ASQ)

Total Quality Management (TQM) is a management approach to long-term success

through customer satisfaction. TQM focuses on the development of products and services

that meet the needs andexceed the expectations of key customer groups.

This is accomplished by creating an integrated system that isprocess centered,

has total employee involvement and iscompletely customer focused. Creating a

culture that is customer focused and collecting and studying data that supports efforts for

the customer are critical components to the system.

Steps to Creating a Total Quality Management System

1. Clarify Vision, Mission and Values

Employees need to know how what they do is tied to organizational strategy and objectives.

All employees need to understand where the organization is headed (its vision), what it

hopes to accomplish (mission) and the operational principles (values) that will steer its

priorities and decision making.

Develop a process to educate employees during new employee orientation and

communicate the mission, vision and values as a first step.

2. Identify Critical Success Factors (CSF)

Critical success factors help an organization focus on those things that help it meet

objectives and move a little closer to achieving its mission. These performance based

measures provide a gauge for determining how well the organization is meeting objectives.
3. Develop Measures and Metrics to Track CSF Data

Once critical success factors are identified, there needs to be measurements put in place to

monitor and track progress. This can be done through a reporting process that is used to

collect specified data and share information with senior leaders. For example, if a goal is to

increase customer satisfaction survey scores, there should be a goal and a measure to

demonstrate achievement of the goal.

4. Identify Key Customer Group

Every organization has customers and understanding who the key customer groups are is

important so that products and services can be developed based on customer requirements.

The mistake a lot of organizations make is not acknowledging employees as a key customer

group.

Example Key Customer Groups:

Employees

Customers

Suppliers

Vendors

Volunteers

5. Solicit Customer Feedback

The only way for an organization to know how well they are meeting customer requirements

is by simply asking the question. There should be a structured process to solicit feedback

from each customer group in an effort to identify what is important to them. Organizations

often make the mistake of thinking they know what is important to customers and ask the

wrong survey questions. This this type of feedback is obtained through customer focus

groups.
6. Develop Survey Tool

Next develop a customer satisfaction survey tool that is based on finding out what is

important to customers. For example, customers might care more about quality than cost

but if you are developing a product and trying to keep the cost down and skimping on the

quality, you are creating a product that might not meet the needs of the customer.

There are lots of survey software available. One I like is SurveyGizmo which is an easy to use

online survey tool. You can play with it and try it for free to see if its something that would

benefit your organization.

7. Survey Each Customer Group

Each customer group should have a survey customized to their particular requirements and

they should be surveyed to establish baseline data on the customers perception of current

practice. This provides a starting point for improvements and demonstrates progress as

improvement plans are implemented.

8. Develop Improvement Plan

Once the baseline is established you should develop an improvement plan based on

customer feedback from each group. Improvement plans should be written in SMART

goals format with assignments to specific staff for follow through.

Goals May Include Some of the Following:

Process improvement initiatives, such as: customer call hold times

Leadership Development: Walk-the-Talk

Management Training/Development: How to manage employees in a quality

environment

Staff Training/Development: Customer Service

 Performance Management: Setting expectations, creating job descriptions that

support the vision and holding staff accountable.

9. Resurvey

After a period of time (12-18 months), resurvey key customers to see if scores have

improved. Customer needs and expectations change over time so being in-tune to changing

needs and expectations is critical to long-term success.

10. Monitor CSF

It is important to monitor CSF monthly to ensure there is consistent progress toward goals.

This also allows for course correction should priorities and objectives change during the

review period.

11. Incorporate Satisfaction Data into Marketing Plans

Once youve achieved some positive results with your satisfaction data, use it as a

marketing tool! A lot of successful organizations miss the boat by not letting others know

what they do well. Customers want to know how an organizations internal processes

work especially if those process help to deliver an outstanding product or service!

12. Technology

Make sure technology is user-friendly and supports targeted improvements. For example, a

website should be easy to navigate as well as easy to find (SEO) and the content should be

easy to understand.

Final Thoughts

Make sure employees understand the vision as well as their role in supporting it. Look for

ways to ensure that all internal processes are standardized and that employees receive the

training to understand the standardization.

Q.4 Define accreditation and certification. List the benefits of
accreditation and certification of hospitals.
ANS:- Certification is a comprehensive evaluation of a process, system, product, event, or
skill typically measured against some existing norm or standard. Industry and/or trade
associations will often create certification programs to test and evaluate the skills of those
performing services within the interest area of that association. But testing laboratories may
also certify that certain products meet pre-established standards, or governmental agencies
may certify that a company is meeting existing regulations (such as emission
limits).Accreditation is the formal declaration by a neutral third party that the certification
program is administered in a way that meets the relevant norms or standards of certification
program (such as ISO/IEC 17024). Many nations have established specific bodies. In the
United Kingdom, for example, an organization known as United Kingdom Accreditation
Service (UKAS) has been established as the nation's official accreditation body. Most
European nations have similar organizations established to provide accreditation services
within their borders.There is no such "approved" accreditation body within the United States,
however. As a result, over the years multiple accreditation bodies have become established
to address the accreditation needs of specific industries or market segments. Some of these
accreditation services are for profit entities, however the majority are not-for-profit bodies
that provide accreditation services as part of their mission.Certification and Accreditation
(C&A) in Information Secu Certification and Accreditation is a two-step process that ensures
security of information systems.[1] Certification is the process of evaluating, testing, and
examining security controls that have been pre-determined based on the data type in an
information system. The evaluation compares the current systems security posture with
specific standards. The certification process ensures that security weaknesses are identified
and plans for mitigation strategies are in place. On the other hand, accreditation is the
process of accepting the residual risks associated with the continued operation of a system
and granting approval to operate for a specified period of time.

The process of accreditation helps in realizing a number of benefits, such as:

Helps the Institution to know its strengths, weaknesses and opportunities.

Initiates Institutions into innovative and modern methods of pedagogy

Gives Institutions a new sense of direction and identity.

Provides society with reliable information on quality of education offered.

Promotes intra and inter-Institutional interactions.

Accreditation signifies different things to different stakeholders. These are:

Benefits to Institutions:

Accreditation is market-driven and has an international focus. It assesses the characteristics

of an Institution and its programmes against a set of criteria established by National Board
of Accreditation.

NBAs key objective is to contribute to the significant improvement of the Institutions

involved in the accreditation process. Accreditation process quantifies the strengths,
weaknesses in the processes adopted by the Institution and provides directions and
opportunities for future growth.

NBA accredited Institutions may be preferred by funding agencies for releasing grants for
research as well as expansion etc.

It signifies that the Institutional performance is based on assessment carried out through a
independent competent body of quality assessors, with strengths and weaknesses
emanating as a feedback for policy-making.

Is it worth putting in all of the work? Consider these benefits of earning a certification, and if
you see the benefits for your situation, go for it!

1. A differentiator against the competition. When employers are interviewing, the

competition is often stiff. If you have the certification, and the other person does not,
you are at a definite advantage.

2. Plugs you into two new communities: one that is earning the certification, and one
that has the certification. For example, if you are going for your PMP certification, you
will immediately have something in common with other hopefuls, and this can
provide networking opportunities through classes, the web, and meetings. The same
holds true when you have earn the certification; you are a member of the "club."
While these are benefits of PMP certification, the same would hold true of most
certifications.

3. Gives you confidence that you have "passed through the chairs." When you have set
your sights on a goal, put together a plan, work hard, and you reach it, you gain
confidence, which spills over into all aspects of your life.

4. Gives you tools to draw upon when needed. Having gone through all of the study and
hard work, you have mastered a new body of knowledge. Put it to use as soon as you
can!

5. While it is said that "experience is the greatest teacher," a certification "rounds you
out." Often, experience is strong in some areas, but not in others. Like education,
experience rounds you out, giving exposure to ideas and approaches outside your
comfort zone. In addition, being able to think outside your experience is an ingredient
of leadership.

6. You can be a better mentor. The ability to mentor is based greatly on experience, but
the best mentors can reach beyond their experience. They are able to extrapolate
from their experience, and relate it to someone else's entirely different experience.

7. Establishes you as a continuous learner. Employers are always looking for people who
never want to stop learning. Learning is a value unto itself, and those around you will
respect and admire you for it, and sometimes even be a little jealous!
 8. Will enable you to make more money. Often, earning a certification, such as the PMP,
can quickly lead to compensation increases of 20% and more.

9. Enables you to better evaluate the talents and skills of others. With the discipline to
master the material for the certification, you are in a better position to evaluate the
skills of others. You have had the opportunity to evaluate your own strengths and
weaknesses in the process of earning the certification, and have a broader
understanding of the skills and toolsets that can be effective.

10. Gets your foot in the door in the new area. Many career changers turn to
certifications to get themselves into a new area. For example, many technical people
who want to advance will earn the PMP certification in order to move into a position
of greater responsibility.

Q.5
Define total quality management. Describe the importance of
TQM in healthcare.
ANS:- Total Quality Management (TQM) may have been the first quality oriented philosophy
to transition into healthcare. TQM is based on three principles: continuous quality
improvement (CQI), customer focus, and teamwork. To date, limited research attention has
been given to challenges involved in adopting such practices to healthcare. Despite the
enthusiasm raised by the potential benefits, many initiatives have not fully delivered the
promised results. Some of the reasons for failure can be traced to the insufficient support of
health professionals, the lack of leadership commitment and the tendency to look at TQM in
isolation rather than putting it at core of the institutions strategy. Moreover, there exist
various powerful subcultures (e.g. managers subculture, physicians subculture, etc), each
one of whom has their own perspective of what quality should be and how the work should
be done

Continuous Quality Improvement (CQI)

Continuous quality improvement is a concept based on a Japanese philosophy of kaizen,

the principle of which is based on continually seeking improvement on a process or system.
The underlying belief on continuous improvement is that any aspect of a process or system
can be improved. The focus is not to wait for a big problem to occur before acting CQI
involves simplifying a process or a task and a lot of it was due to the computer application,
automation, and processes that have exploded in the late 1980s. Medical has been slow in
adapting to it. Healthcare is notorious for its enormous knowledge base, the vast array of
data that are devoted to patient care, and the complexity of those data. Yet many clinicians
and hospitals still rely on paper and pen to record data, on charts and files to store data, and
on their reliance to cognitive memory or searching abilities to findin stacks of charts, files,
books, journals, and literature summariesdata and information to support decisions.

An example of this is a clinical laboratory in Southern California that still believes in

manually inputting their timecard and the breakdown of their daily workload. Anecdotal
accounts indicates that many workers at this particular department complained at the end
of the day that after looking at hundreds if not thousands of cells in a microscope, manually
inputting numbers is just an enormous task. The matter was brought up to the managers
attention and some workers in the department even made an effort to simplify the process
through use of Excel spreadsheet, but the managers of the place called it cheating. The
Excel program was discarded. This is a classic example of an archaic manager subculture at
workplace of which each has their perspective of how the work should be done.

Customer Service

emphasized the responsibility of managers in instilling a customer focused environment and

direction for employees, including adherence to the dual nature of medical quality.
Continuous quality improvement (CQI) in health care espouses customer service and
stakeholders define it based on their expectations and needs. For instance, in an effort to
provide better customer focused environment, a big clinical lab in San Diego has rebranded
their initiative as Vision for the Future and Beyond. The goal: to find ways to work better,
what the organization could do differently to improve the way they serviced customers,
improve what they offered customers, improve the way they operate, and improve their
overall service to patients, customers and our employees. The renaming was embraced by
everyone and hundreds of initiatives and projects sprang up, and were prioritized.

Teamwork

Teamwork means employee involvement in quality. As such, the people involved have a
common goal and purpose. The members of the team work together, rather than delegating
to subordinates, their performance is judged not only by individual contributions but also by
group contributions, and the members have an overarching purpose that transcends
individual priorities.

Conclusion

For total quality to be implemented, one strategy is to have the leaders of the organization
steer the workforce in the right direction. In this authors introductory paragraph, it was
emphasized that some of the reasons for failure of continuous quality improvement can be
traced to the insufficient support of health professionals, the lack of leadership commitment
and the tendency to look at TQM in isolation rather than putting it at core of the institutions
strategy. Moreover, there exist various powerful subcultures (e.g. managers subculture,
physicians subculture, etc), each one of whom has their own perspective of what quality
should be and how the work should be done . Leaders of an organization have a major role in
the development of an organizational culture that is supportive of organizational
improvement. The leader of the organization must foster total employee involvement in the
quest for excellent service quality.

Q.6
Explain the methods of performance evaluation in
healthcare services.
ANS:- In the case of healthcare, communities must be able to identify opportunities for
reducing costs and improving quality, and monitor whether those opportunities are being
successfully addressed. RHICs can serve as a trusted source of actionable information about
the cost and quality of healthcare services, the health of the population, and/or the extent to
which innovative methods of delivery, payment, and health promotion are being used in
their community.
RHICs across the country are publishing reports on many aspects of quality and cost that are
unavailable to the public and healthcare providers through any other source. These
measurement and reporting initiatives are developed and operated with the active
involvement of the physicians and hospitals whose performance is being measured, who
ensure that the measures are meaningful and the data are accurate. This involvement
increases the willingness of providers to change care processes in order to improve their
performance.

Types of Performance Measurement: quality of physician services, quality of hospital

services, quality of health plans, patient experience of care, cost of healthcare services,
disparities in performanceost Regional Health Improvement Collaboratives collect and
publicly report data on the quality of care delivered by physician practices. The types of
measures reported include both clinical processes of care (e.g., did all diabetic patients
receive a test to measure their level of blood sugar?) and care outcomes (e.g., how many
diabetic patients had well-controlled blood sugar levels?), as well as patient experience of
care.

Most of these measurement systems rely on health plan claims data, but some include
clinical data. The Wisconsin Collaborative for Healthcare Quality has pioneered a
methodology to obtain clinical data directly from physicians, thus enabling more
comprehensive quality measurement. This methodology does not depend on physicians
having electronic health record systems, thereby allowing broad-based participation. Similar
approaches are now being used by other RHICs, such as Minnesota Community
Measurement and the Health Improvement Collaborative of Greater Cincinnati. While RHICs
typically use nationally-endorsed measures where they exist, they have also pioneered the
development of new and improved measures where needed.

Pioneering New Measures to Determine the Quality and Cost of Care

The California Cooperative Healthcare Reporting Initiative conducts a telephone

survey of primary care physician offices to assess after-hours physician availability
and access to appropriate emergency and urgent care information.

Minnesota Community Measurement has developed MN Healthscores, a website

produced by Minnesota Community Measurement to report information about the he

Quality of Hospital Services

A number of Regional Health Improvement Collaboratives also report on the quality of

care delivered in the hospitals in their community. Here again, the measures range
from processes (e.g., how quickly heart attack patients were treated) to outcomes
(e.g., infection rates and mortality rates). For example: The Iowa Healthcare
Collaborative issues a detailed report with extensive measures of the quality and
safety of patient care in hospitals in Iowa.

The Greater Detroit Area Health Council issues reports on a wide range of measures
of the quality and safety of patient care in hospitals in southeastern Michigan.

The Maine Health Management Coalition recognizes hospitals and physician practices
with the highest performance on the quality of patient care.
RHIC reports on the quality of hospital services: Albuquerque, Cincinnati, Cleveland,
Detroit, Iowa, Kansas City, Maine, Memphis, Minnesota, Nevada, Oregon, Seattle, South
Central PA, Utah, West Michigan, Western New York, Wisconsin

Quality of Health Plans

Many RHICs also report on the quality of care delivered to patients who have health
insurance from a specific health plan. For example:

The Washington Health Alliance issues an extensive analysis of health plan quality
and services, rating health plans on over three dozen different itemsSome RHICs also
are developing and producing health plan performance measures for the state-level
Health Insurance Exchanges.

Regional Health Improvement Collaborative reports on the quality of health plan

services: California, Seattle, Utah, West Michigan, Wisconsin

The Oregon Health Care Quality Corporation (Q Corp)

As an independent non-profit organization, the Oregon Health Care Quality Corporation (Q

Corp) brings stakeholders together to produce transparent information measuring the
quality, utilization and costs of health care in the state. Information for more than 20
measures are available to consumers, employers, providers, policymakers, health insurers
and others. Q Corps annual report, Information for a Healthy Oregon, provides a statewide
snapshot of those measures to highlight opportunities for improvements in health care.
Many of the measures are publicly reported on the website www.PartnerforQualityCare.org.
Q Corp has also built a provider portal with clinic, provider and patient-level detail for the
measures to help primary care practices improve care. For more information about Q Corps
reports, visit www.Q-Corp.org/reports.

Patient Experience of Care

A growing number of RHICs are also collecting and reporting information that focuses on
consumers experience with healthcare services. For example:

In 2013, Minnesota Community Measurement released the results of the nations first
and largest statewide patient experience survey. It included more than 230,000
patient-completed surveys on patient experience of care from 651 clinics around
Minnesota.