Scenario
You are being considered for a health care manager position at a local health care facility. The job description for this position emphasizes the need for quality assurance and improvement through tracking outcomes and analyzing the data. The first step in the interview process is to provide written answers for a series of questions sent to you by the facility’s HR department. The questions focus primarily on describing the process of tracking outcomes and improving quality and safety.
Preparation
Continuous quality improvement (CQI) is the idea of constantly improving performance and outcomes. CQI is a foundational principle to the delivery of health care. Having high quality and safety ratings is important to a health care organization for these reasons:
- The organization’s success can be advertised to the public to gain the trust of the community.
- Delivering consistent, high-quality care keeps the organization in compliance with regulations, which are Conditions for Coverage and Participation set forth by the Centers for Medicare/Medicaid (CMS) and state health departments.
- Having high quality ratings helps in negotiations with payers to secure higher payments. Payers are increasingly tying payments to how the provider has performed with quality metrics, which are standards set forth by various agencies, including the National Council for Quality Assurance (NCQA) and the Agency for Healthcare Research & Quality (AHRQ).
Do the following as you prepare to answer the interview questions:
- Review the Conditions for Coverage (CFCs) & Conditions of Participation (CoPs), a list of federal CMS regulations for health care facilities (e.g., nursing homes, surgical centers, etc.) and operations (e.g., home health agencies, hospice agencies, etc.).
- Review “QI: Getting Inside Quality Improvement Mindset” from NCQA, which provides tips on how to gain a continuous quality improvement mindset.
- Visit The Joint Commission, which accredits and certifies hospitals and health facilities, and read about their accreditation process and quality standards.
- Many businesspeople use Microsoft Excel to plan, track, filter, and analyze data in their work environment. For an introduction or refresher on using Excel at work, consider watching the LinkedIn Learning videos located in this week’s Learning Activities folder: “Excel Essential Training” and “Excel Quick Tips.”
Assessment Deliverable
Write a response for the hiring department that addresses the following questions in 175+ words each:
- Describe some of the regulations and quality standards (e.g., CMS, NCQA, AHRQ, The Joint Commission) that you must maintain as a health care manager. Why is CQI/process improvement so important in a health care workplace?
- What are the impacts on a health care facility (e.g., hospital, doctor’s office) of external regulations and quality standards (e.g., CMS regulations, state regulations, The Joint Commission)? As a manager, how would you ensure that your department is compliant with external regulations and quality standards?
- Why is CQI process so important for quality of direct patient care? What are the outcomes on patient care if the health care organization does or does not have a good CQI process in place? As a health care manager, how would you ensure that continual improvements in quality are being made?
- What are approaches that health facilities and agencies take to ensure the aptitude and competency of their clinical and non-clinical staff members? As a manager, what are some things you can do to ensure that your team has the proper resources to consistently deliver high quality care?
- What is the role of technology in direct patient care quality and safety? As a manager, how could you use technology (e.g., Microsoft Excel, Tableu) to help your department stay on track?
