Quality Initiatives & Standards in a Community Services Program - Case Study Example

Improving Quality Initiatives & Standards in a Community Services Program Introduction Walton Community Services, Inc., a reliable community healthcare provider faces a great dilemma. It is concerned with the continued provision of a high quality of service to the majority of its clientele. This organization mostly provides geriatric care. At present, there is a lack of professionals specializing in this area, which means that the competency of those left to care for older patients is not as credible. This suggests a decrease in the quality of care for these older patients. To make matters worse, cost of healthcare for this specific population has increased (Hinshaw, 2006). Currently, senior citizens account for 12.4% of the population. It is predicted that by the year 2030, this statistic will increase to 20%, which amounts to about 70 million (Mion, 2003). According to Bennett and Flaherty-Robb (2003), this trend will have a profound impact on healthcare. For instance, how will a community healthcare provider address the needs of its growing clientele with the high quality of service it deserves? It brings healthcare providers like Walton the difficult task of keeping healthcare costs low and service quality high. Senator R. J. Durbin (2006) admonishes that it is important to “…tackle the issue[s that] will negatively impact the health care system, the nation’s financial health, and the quality of life for senior citizens” (p. 3). To solicit enough funding from the state, Walton Community Services, Inc. must justify their cause with evidence that they provide the highest quality of service it can offer its patients. Mick and Wyttenbach (2003) recommend that that the improvement of service quality will rely on the ability of an organization to effect and manage change as well as on the use of proven data collection methods. Problem Focus Walton Community Services, Inc. did not receive a three-year accreditation from the Commission on Accreditation of Rehabilitative Facilities (CARF). CARF is an international, non-profit organization which provides accreditation for organizations working in the human services field. Walton only garnered an 80% quality compliance rating which is low for a healthcare standard (CARF, 2008). Obtaining accreditation from CARF leads to many benefits which includes an improved reputation within the community as well as the “fulfillment of licensure laws and third party payments” (Viable Solutions, 2008, p.5). Most of all, the company needs CARF Accreditation to qualify for government funding. Clearly, Walton Community Services, Inc. needs to be more vigilant in upholding its service quality to be able to achieve at least 90% compliance rating from CARF and thus gain the accreditation it desires. This is a challenge, considering healthcare facilities are in the midst of budget cuts such as lowering nurse staffing-member ratios. The problem at hand is how Walton Community Services, Inc. can improve its service quality standards to meet CARF’s requirements for accreditation while in the midst of a financial crisis? Proposed Solution and Rationale The Institute for Clinical Evaluative Services in Toronto (2004) states that the Balanced Score Card (BSC) is suitable for use by organizations seeking to make policy, procedure, or related company-wide changes. Its criteria being consistent with CARF standards, the BSC is a useful tool that can provide a snapshot of the company’s management, functions, and outcomes of the internal Quality Assessment and Performance Improvement (QAPI) program to policy makers, payers, and other interested parties (Santiago, 1999). Recent studies, most notably one by Hashmi (2003), have laid the foundation for the proposed project in terms of relevance, feasibility, and likelihood of expected outcome. Hashmi (2003) stated that, in order to accomplish its goals of obtaining a three-year certification through CARF and maintaining this status through upholding the proposed QAPI program, fostering use of the BSC to identify the tasks to be done will be naturally followed by several systemic changes: creating the necessary management structure; developing the strategies for the changes to take place; designing the mechanisms to incorporate the change; and assigning the resources. The objective of the project is to implement an information-driven decision making cycle using measurements of quality for the programs of care offered by Walton Community Services, Inc. The main goal is to hold the company to a new standard of a minimum of 90% quality compliance using a set of standardized QAPI measures using the BSC. Thus, the proposed solution is, in order to achieve the goal, everyone involved in the provision of healthcare services at Walton Community Services needs to be trained and monitored in providing high quality service to comply to the standards of the proposed QAPI program using the BSC. Section A: Problem Description Problem Identification Walton Community Services, Inc. did not receive the three-year accreditation through the Commission on Accreditation of Rehabilitative Facilities (CARF) standards. The fact of this problem is felt elsewhere in the company as well and can be seen most plainly in the fact that the company’s present quality goal of quality compliance is 80%. This low benchmark is lenient by today’s competitive healthcare standards (CARF, 2008). Walton Community Services, Inc. would benefit from systemic changes that will shift its quality performance upward. Importance of the Problem Since it mostly serves the senior-aged population, the failure to obtain accreditation from CARF affects Walton Community Services, Inc. greatly, as it is unable to solicit government funding without the necessary accreditation. Elderly patients themselves are less able than ever to cover their medical costs. In addition, service needs have expanded as the elderly population has grown more diverse, creating needs that vary among cultural groups. According to Bennett and Flaherty-Robb (2003), “…as the population of the elderly increases, the growing proportion and numbers of older adults in the American population will have a profound impact on all sectors of society, including health care.” Often this translates to impact on federal and state government expenditures and policymaking. In light of these all-angled squeezing forces, healthcare providers are finding it increasingly difficult to keep healthcare costs low and service quality high. In particular, community providers such as Walton Community Services, Inc. are affected most heavily by such problems when they take the form of organizational budget cuts. Project Objectives In the midst of budget cuts and commensurate lowered nurse staffing member ratios, the proposed project aims to increase the overall quality of patient and community relations within Walton Community Services, Inc. programs. The project’s method will be, basically, to implement an information-driven decision-making cycle on measurements of quality within the programs of care offered by Walton Community Services, Inc. The main goal will be to hold the company to a new standard of a minimum of 90% quality compliance using a set of standardized Quality Assessment and Performance Improvement (QAPI) measures, operationalized as the Balanced Score Card (BSC) and Commission on Accreditation of Rehabilitation Facilities’ (CARF) standards. Brief Solution Description and Rationale The BSC is a useful tool that can provide a snapshot of the company’s management, functions, and outcomes of QAPI services to policy makers, payers, and other interested parties (Santiago, 1999). Using the BSC as a framework, the nursing models will be evaluated according to the five requisites of the BSC strategy: learning and growth, internal processes, outcomes, customer measure, and financial measure. However, its effectiveness will depend on how clearly and accurately the objectives have been outlined and how well the indicators to be measured have been established (Santiago, 1999). In order to ensure a high level of effectiveness for the project, a team of six professionals will be formed into a QAPI committee. This group will include the company’s Compliance Officer and will be charged with assessing, evaluating, and analyzing the performance of model nurses according to the BSC and CARF standards. Their findings will ultimately be useful in ascertaining effective and efficient delivery systems for the company’s elderly community programs; providing a higher rating within the QAPI program while enduring State budget cuts; and managing the company’s budgetary constraints within the area of nurse-to-member staffing ratios while maintaining quality member community services. Section B: Solution Description Description of Solution and Rationale At the time of this writing, Walton Community Services Inc. has undertaken only required measures aimed at quality sustenance. As the company’s budget has tightened and resources continue to dwindle, the need for quality management has increased dramatically. With the implementation of this project, the existing services will continue as before, but a cycle of data collection and information-driven decision-making will be incorporated into the delivery of these services. The overall goal of quality for all services provided is at least 90% compliance to set standards of CARF. By accomplishing this goal, using the BSC and QAPI initiatives, Walton Community Services, Inc. will become worthy to receive the three year maximum accreditation through the Commission of Accreditation on Rehabilitative Facilities (CARF), giving them endorsement as a high quality service organization. Aside from attracting more clients due to this stamp of quality approval, they are eligible for government support, which would help ease the company with its every-increasing expenditure. The Balanced Score Card (BSC) will function as the framework for quality management in that its measures represent the company’s goals for quality services. As such, it will operationalize the company’s mission and strategy into a comprehensive set of performance measures, thereby enabling true strategic measurement and management of the company’s functions as a system (Radnor & Lovell, 2003). The BSC is expected to help the company in achieving its goals of increased referrals through the continued management of services. In preparation for rolling out the project, the QAPI committee members will prepare a written plan to outline QAPI activities. The Board of Directors will have to approve this plan before the project can commence. As a way of maintaining the course of the project, this proposal shall be reviewed by the QAPI committee every 30 days. The QAPI committee will receive information reports from all departments of the company and report a summary of its findings to the Board of Directors and applicable personnel, according to a predetermined schedule. To validate the findings, the committee will also conduct an analysis of services-related documentation. All aspects of the project will be overseen by the company’s Compliance Officer who will be the project director. The project will involve staff members who provide direct care to members, the Case Managers, Nursing Director, Executive Director, the company’s Compliance Officer, and its Board of Directors. Additionally, administrative staff will be needed for communication purposes. Company employees involved in the project do not need to be compensated in additional pay for their efforts and participation in the project, as project activities are considered a normal part of their daily duties. The project will require different members of the staff to fill various roles. Generally, however, except for staff involved in the QAPI Committee, work for the project will entail collecting data and reporting it using the provided instruments to the QAPI Committee and/or the Project Director. The six-member QAPI committee will be selected from among the company’s staff. The Nursing Director will lead this committee that will also consist of two Case Managers, one Nursing Supervisor, the Executive Director, and the Compliance Officer. The group will meet monthly to compile data reports and related suggestions for new initiatives, referencing established QAPI protocols, in preparation for submission to the Board of Directors. External evaluations of the project QAPI data also will be done by State Reviewers, as this is a normal part of their QAPI program. State surveyors welcome the opportunity to evaluate member service outcomes. There will be no cost to the company for this service. Notice must be provided 30 days in advance to have a surveyor come out to evaluate customer service satisfaction. Such notice will be given upon the Board of Directors’ initial approval of the project. Hopefully, this gives the staff enough time to make progress in the rendition of their service to the members. In order to lend validity to the quality measures reviewed by the QAPI committee, this committee will also run a monthly check of compliance in terms of collected data accuracy and reliability. The company’s Compliance Officer will be responsible for this aspect of data analysis and review. Information collected will be supplemented by both financial and non-financial measures of performance. A status report is furnished to the Board of Directors after a thorough review of the information collected is summarized. The reporting cycle for the Board will be 90 days long. The Board of Directors is scheduled to meet for two sessions in the six-month duration of this project. At the end of this period, they re-evaluate the proposal using the quality indicators identified in the BSC and CARF. Should the whole project merit the approval for continuation by the Board, project meeting dates will then be set, including annual evaluations of this QAPI project. Adjustments in policy or procedure may be the direct result of the ongoing operation of the project. Such changes cannot be detailed herein as they will occur in real time as the project continues and develops. Such changes also have the potential to affect any or all staff in the company. These decisions will come solely from the company’s Board of Directors. During the data collection and data-driven improvement stage of the project, it is hoped that the delivery of quality service to patients will not be affected. On the other hand, it is likely that patients may detect positive changes resulting from the project initiatives. Consistency of Solution with Research Recent research studies have laid the foundation for the current project in terms of relevance, feasibility, likelihood of expected outcome, and the need for change within Walton Community Services. For example, a study conducted by Rabbani et al. (2007) assessed the feasibility of using the BSC within a low-income health setting and resulted in improvements in patient, staff, clinical, and financial outcomes alike within their health care settings. Another study by Hashmi (2003) used a QAPI program similar to the one proposed herein. This author stated that, in order to accomplish its goals of obtaining a three year certification through CARF and maintaining this status through upholding the QAPI program, fostering use of the BSC to identify the tasks to be done will be naturally be followed by several systemic changes: creating the necessary management structure, developing the strategies for the changes to take place, designing the mechanisms to incorporate the change, and assigning the resources. Feasibility of the Project With the BSC as the basis of measurement for the current project, its focus on whole-organization functionality is what necessitates participation by a large portion of the company’s staff. With most company employees involved, the efforts to fulfill the change of the current project will be distributed lightly across many shoulders. It will be through an organized and collaborative effort that the project will attain its objective. Further, because the elements of the project will be distributed across many staff members, the burden of the changes brought about by the implementation of this project can be expected to be more manageable for all employees. Consistency of Solution with Resources While the company presently has a QAPI program in place, the proposed project will heighten the quality indicators within this project while incurring a very minimal expense considering all aspects of the proposal. The general expectation is that the project’s benefits will far outweigh its costs. References Bennett, J., & Flaherty-Robb, M. (2003). Issues Affecting the Health of Older Citizens: Meeting the Challenge. ANA. The Online Journal of Issues in Nursing, 8(2) Commission on Accreditation of Rehabilitative Facilities (2008). Retrieved September 9, 2009 from http://www.carf.org Hashmi, K. (2003, October 8). Introduction and Implementation of Total Quality Management (TQM). ISixSigma.com. Retrieved September 5, 2009, from http://www.isixsigma.com/library/content/c031008a.asp Hinshaw, S. (2001). A Continuing Challenge: The Shortage of Educationally Prepared Nursing Faculty". Online Journal of Issues in Nursing, Vol.6 (No.1). Retrieved September 17, 2009, from Ovid database. Institute for Clinical Evaluative Services (ICES) Toronto (2004). Developing a Balanced scorecard for public health. Retrieved September 5, 2009 from http://www.ices.on.ca/file/Scorecard_report_ final.pdf Libeowitz, S. ( June 23, 1994 ) Policy Analysis, . Why Health Care Cost So Much. Cato Policy Analysis No. 211.Cato Institute Mick S., &Wyttenbach, M. (2003). Advances in Health Care Organization Theory. San Francisco: Jossey- Bass Mion, L. (2003). "Care Provision for Older Adults: Who Will Provide?" Online Journal of Issues in Nursing. Vol. 8 No. 2, Manuscript 3. Rabbani F, Jafri SM, Abbas F. Pappas G. Brommels M. Tomson G. ( 2007). Journal for healthcare quality : official publication of the National Association for Healthcare Quality. 2007 Sep-Oct;29(5):21-34. Radnor & Lovell (2003). Santiago (1999, Dec). “Use of balanced scorecard to improve the quality of behavioral healthcare.” Psychiatry Services. 50, 1571-1576. Retrieved September 16, 2009 from: http://www.psychservices.psychiatryonline.org/cgi/content/full/50/12/1571 United States Senator Richard J. Durbin and Health Care and Community Leaders Meet to Develop Plan of Action for Geriatric Care. May 16, 2006 pNABusiness Wire, p.NA. Retrieved September 04, 2009, from General One File via Gale: http://find.galegroup.com/itx/start.do?prodId=ITOF Walton Community Services, Inc. (2009, September). Quarterly Staff Evaluations. 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