Texas Health performance strategies were: hospitals within a health system can turn to each other as partners in quality improvement efforts and resources to help solve shared problems, preprinted order sets help standardize practices and improve core measure performance, even prior to implementation of an electronic health record system, report cards can be used to provide individual feedback and quality improvement staff should be willing to provide one-on-one coaching to physicians in need of improvement. Organizational Theory is as defined as an attempt to explain something one observes or believes.
There are many theories in this case study. By improving the quality of care, Texas Health Resources implemented a system-wide electronic health record system. This system provides real time access to patient records, medication alerts and clinical decision support. Texas Health Harris Methodist also relies on concurrent chart review to improve performance and provide ongoing education and strengthening the core measures of the staff. This chart outlines if any case meet the criteria for core measures which is the hospital’s main focus.
Another theory was that Texas Health organized a Surgical Care Improvement Project workup that consisted of many different professions. This workshop’s goal was to provide recommendations or improving performance in surgical improvement measures. In order for the workup to have a complete understanding of their position within the workup, they created a flowchart outlining the process of antibiotic administration and discussed each step accordingly. One of the improvement measures was administrating antibiotics within one hour before surgery, and discontinue of antibiotics 24 hours after surgery.
This is where the flow chart helps the workup to make an informed decision. Texas Health depends on preprinted order sets to simplify treatment processes and help guarantee implicate with the core measures. Some surgeons didn’t agree with the antibiotic selections on the preprinted order sets. In order to get them to agree to it, Cindy Steep- Gang, contacted the Quality Improvement Organization to obtain evidence-based literature supporting the selected drugs on the preprinted order sets. Gang believed it was necessary that the information case from the surgeons’ peers so it would be more of an influence on the surgeon’s decision.
Texas Health Methodist was a learning organization because they organize an annual quality conference. This conference would recognize peers and their efforts in improving quality and safety of care. Texas Health Methodist also participated in projects where there would be demonstrations on how to improve the safety of hospitals and also the quality of the hospital. They also brought together workups to resolve problems and implement new processes within the hospital. The health system would also host a monthly Performance Improvement and Patient Safety Council.
The council established system-wide educational and training materials to help hospital staff discontinue antibiotics within 24 hours. For the staff, to gain more knowledge, one-on-one coaching was offered and report cards were offered to let staff know what improvements and suggestions could be made. In every organization, there should be some type of structure. Organizational structure is something that is best decided upon internally, through a process of critical thinking and discussion by members of the group. Without organizational structure, there would not be any set rules, obligations, or stature.
In this case study, organizational structure was shown. For example, Texas Health Resources employed a chief clinical and quality officer to lead quality and patient safety initiatives across the system. It also has a performance improvement department and data management department that provide support for quality improvement activities at a hospital level. Texas Health Resources approached quality improvement by measuring success as an all-or- nothing achievement. In order to maintain structure, a patient must have received all recommended surgical care to be counted as a compliant with the Surgical Care Improvement Project core measures.
In an organization, in order to have structure, there needs to be someone there to instruct. This is where the leaders come in the organization. Beverly Barton, R. N. , the clinical outcome specialist, was responsible for focusing on daily management of core measurement performance. She committed 80% of her time to core measures and spends the rest helping with physician credentialing activities. She teaches new staff about the core measures and their relationship to improving patient care and speaks with other quality improvement staff at monthly staff meetings. Another leader in this case study is Cindy Steep-Hahn, M.
S. , C. C. C. ; she is the director of quality. She believes that communication and feedback from staff are important. This is an important factor when trying to improve core measures. It is better to get feedback from the person who was working directly in the hospital. Hahn also believes it is important to look at the facts, the facts are what sets the manner for what changes needs to be made and what improvements are being made. Texas Health Harris Methodist- Cocklebur continues to grow as an organization. It has a 71 % satisfactory rate. They strive to grow as an organization and continue to focus on core measures.
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