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Healthcare is ever-evolving, and it is of utmost importance for clinicians to put their best foot forward when providing care to patients. As advances in healthcare arise, the standards in which practices are held tend to grow, as well. Standards of care are continuously being analyzed and improved upon, to maintain the validity of a well-functioning system. Establishment of a multitude of quality assurance measures and organizations help guide facilities in the right direction to achieve optimal functioning, while providing the greatest level of quality care to patients. Healthcare systems should always be up-to-date on the standards set in place by said organizations to uphold a reputation of high quality care, which in turn will guide patients to seek medical attention from such accredited facilities, creating more business for the organization.
Current Quality Outcomes Measures
Quality care can be achieved in various ways, from the smallest acts of kindness toward a patient, to exceeding benchmarks set by quality measurement systems, such as, the Hospital Inpatient Quality Reporting (IQR) Program and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The IQR was created in order for the Centers for Medicare & Medicaid Services (CMS) to collect data from facilities involved in the program, and display said data publicly for consumers to review when making a conscious decision about where to seek medical attention (Centers for Medicare & Medicaid Services, 2017). Hospitals are incentivized to achieve the standards set by the IQR and can also be penalized with a reduction in payout for not meeting said standards; the goal of this program is “…to encourage hospitals and clinicians to improve the quality and cost of inpatient care provided to all patients” (Centers for Medicare & Medicaid Services, 2017).
Along with the IQR, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was created in order for the consumer to have a say in his or her own care. The purpose of this survey is to “…produce data about patients’ perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers” (Centers for Medicare & Medicaid Services, 2017). Like the IQR, data collected from HCAHPS are available for public viewing to incentivize facilities to improve the quality of their care, establish accountability, and create a form of transparency for patients to make informed decisions regarding where to seek healthcare (Centers for Medicare & Medicaid Services, 2017). Development of the HCAHPS survey began in 2002, and was implemented for the first time in 2008; this created standards in which hospitals from all across the nation would now be compared to equally (Centers for Medicare & Medicaid Services, 2017).
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Significance of the Mandates for Improving Quality Care
“Most healthcare organizations today have complete QI [quality improvement] programs and are actively working to improve patient outcomes and promote patient safety” (Marquis & Huston, 2015, p. 556). Coinciding with the implementation of quality assurance measures, organizational accountability for quality has, indeed, improved. Not only are hospitals rewarded with incentives when accomplishing mandates set by such programs, they also have their reputation to uphold as credible and patient-friendly facilities. “Organizational accountability for the internal monitoring of quality and patient safety has increased exponentially the last 30 years” (Marquis & Huston, 2015, p. 556).
In a healthcare setting, managers tend to be active leaders in regard to quality patient care. As mentioned previously, healthcare is ever-evolving, and along with improvements in medical practice come new regulations and standards of care. It is expected of a manager to be knowledgeable of the evolutionary change occurring in the clinical, legal, and quality assurance aspects of healthcare, and to ensure his or her subordinates are educated in regard to any said changes and follow up-to-date guidelines (Marquis & Huston, 2015, p. 33).
“…Change is a primary feature of contemporary healthcare environments, managers must be able to shift from a traditional focus on operational task completion to the leadership skills of visioning, motivating, and inspiring other before desired outcomes can be achieved” (Marquis & Huston, 2015, p. 33).
The nurse’s role for meeting organizational outcomes for quality care may be the most pivotal patient interaction. Nurses are at the forefront of patient care, and are tasked with the responsibly of providing patient education regarding their care and medications, therapeutic communication, attentiveness to patient needs, recognition of clinical manifestations and/or signs and symptoms that are reportable to providers, and a multitude of other bedside duties. As a result of these responsibilities, nurses spend the most time with their patients compared to any other member of a patient’s care team; meaning, their interaction with a patient is essentially what is representative of the facility as a whole. When nurses have ample time to attend to their patients, there is an “…increase in HCAHPS related to effective nursing communication…” (Schuelke, et al., 2014). It is also proven that patient outcome and satisfaction is positively impacted when nurse staffing is at or above recommended level in order to adequately attend to the duties reported above (Stimpfel, 2016).
Statistics of FSRMC Compared to Tennessee
According to the “survey of patients’ experiences” data displayed for Fort Sanders Regional Medical Center on the CMS website, “79% of patients reported their nurses ‘always’ communicated well”, whereas the Tennessee state average is 81% (Centers for Medicare & Medicaid Services, 2018). “81% of patients reported that their doctors ‘always’ communicated well”, compared the state’s average of 83% (Centers for Medicare & Medicaid Services, 2018). “67% of patients reported they ‘always’ received help as soon as they wanted”, whereas the state’s average is 71% (Centers for Medicare & Medicaid Services, 2018). “65% of patients reported that staff ‘always’ explained about medicines before giving them”, which came close to the state average of 66% (Centers for Medicare & Medicaid Services, 2018). “68% of patients reported that their bathrooms were ‘always’ clean”, which is comparably lower than the state’s average of 74% (Centers for Medicare & Medicaid Services, 2018).
“61% of patients reported that the area around their room was ‘always’ kept quiet”, whereas the state’s average is 66% (Centers for Medicare & Medicaid Services, 2018). “89% of patients reported that YES they were given information about what to do during recovery at home”, compared to the Tennessee state average of 87% (Centers for Medicare & Medicaid Services, 2018). “54% of patients reported they ‘strongly agree’ that they understood their care when they left the hospital”, which exceeded the state’s average of 51% (Centers for Medicare & Medicaid Services, 2018). “73% of patients reported they gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)”, matching the state’s average of 73% (Centers for Medicare & Medicaid Services, 2018). “76% of patients reported YES, they would definitely recommend the hospital”, which is comparably higher than the Tennessee state average of 71% (Centers for Medicare & Medicaid Services, 2018).
Role of Organizations in Establishing Standards for Quality Healthcare
“Patient satisfaction often has little to do with whether a patient’s health improved during a hospital stay” (Marquis & Huston, 2015, p. 556). To ensure patients are receiving the best quality care, organizations such as the Joint Commission (JC), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid Services (CMS), and American Nurses Association (ANA), have created standards that facilities are expected to uphold when providing care to consumers. For example, JC has required that all hospitals implement quality assurance programs that evaluate all aspects of a healthcare team, and to create specific plans to target “known or suspected patient problems” (Marquis & Huston, 2015, p. 558). In order to improve upon quality of care, JC collects data on outcome measures, readmission rates, and hospital-acquired infection rates, and has also implemented a “core measures program” that includes six major areas intended to “better standardize its valid, reliable, and evidence-based data sets” (Marquis & Huston, 2015, p. 558).
The CMS also plays an active role in setting standards and measuring quality healthcare, and is widely known for incentivizing facilities through its “quality-based purchasing” program (Marquis & Huston, 2015. P 559). In combination with AHRQ, CMS created the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to accurately depict patients’ perspectives about their care, and publicly report the data as one of the first nationally held standards for healthcare (Marquis & Huston, 2015, p. 561). In addition, the ANA is responsible for the publication of the Scope and Standards of Practice which “provides a foundation for all registered nurses in practice” and exemplifies “optimal performance expectations for the nursing profession” (Marquis & Huston, 2015, p. 549). A hallmark of the ANA is the establishment of clinical practice guidelines as a reflection of evidence-based practice in order to ensure patients are receiving the most up-to-date care that will lead to the best possible outcome (Marquis & Huston, 2015, p. 550).
Steps Taken to Improve HCAHPS and Reduce Readmission
Fort Sanders Regional Medical Center (FSRMC) prides their reputation “as a Joint Commission Comprehensive Stroke Center, [who] offers state-of-the art care that maximizes recovery from stroke” (FSRMC, 2018). In the emergency department, it is imperative to take advantage of every patient encounter and provide the highest quality care in a timely manner. Identifying and treating the source of a patient’s chief complaint in the shortest amount of time is a priority of all staff in the emergency department at FSRMC, along with being attentive to patient needs and establishing a trusting relationship. Dennis Downhour, a registered nurse in the emergency department at FSRMC, states “communication is the biggest factor in providing quality care, and we find that patients tend to be increasingly satisfied with their care if we [the staff] convey a clear message”; he continues to explain that educating patients about their care in conjunction with clear communication can lead to reduced readmission rates (Downhour, 2018).
Summary
As healthcare continues to evolve, it is imperative to continuously analyze clinical practice in order to provide the highest quality of care for patients. There has been a multitude of quality assurance measures and organizations established to help guide facilities in the right direction to achieve optimal functioning, while providing the greatest level of quality care to patients. Nurses are at the forefront of patient care, and reflect the facility they are employed at with every encounter. All members of a clinical team should be up-to-date on the most recent guidelines of practice, and should be aware of hospital policy. The establishment of national quality control guidelines and standards have revolutionized healthcare for consumers by allowing them to have a say in their care and being able to choose what they believe is best for themselves.
