1. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.1

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3. 3 Quality of Care Major Challenge –Balance between high-quality patient care and controlling costs Patient satisfaction not correlated to amount spent Difficult to measure

4. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.4 Quality Improvement Role of CMS Process to preserve or improve quality of care while decreasing costs

5. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Quality Quality of input resources Quality of process of delivery of services Quality of outcome of service

6. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Quality Programs Continuous Quality Improvement (CQI) Quality Assurance (QA) Quality Improvement (QI) Total quality management (TQM) Utilization Review (UR)

7. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Evaluation Areas Organizational structure Health care workers Patient outcomes

8. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Customer Service Essential to success Internal customers External customers

9. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Customer Service Customers evaluate entire experience Don’t slip into automatic mode –Focus on patient Lawsuits most commonly related to whether patient likes health care workers Fewer long-term relationships in health care

10. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Lawsuits May be frivolous Time and money spent Stress Many can be avoided by working to ensure customer satisfaction

11. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Customer Satisfaction Mailing out questionnaires Calling customers Maintaining a log of complaints Satisfaction is subjective

12. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Internal Customers Those working in the health care industry Maintain good relationships with coworkers Promote job satisfaction and pride in work Constructive criticism Destructive criticism