Quality Management In Health Care Delivery HCA 550- Course Syllabus

COLLEGE OF HEALTH AND HUMAN SERVICES

CaliforniaStateUniversity, Long Beach

Health Care Administration Program

HCA 550-01 - Quality Management/Improvement in Health Care Delivery

Semester Spring 2016

Instructor: Rus Billimoria, MD, MPH, CPHQ
E-mail:
Office Hours: Tuesdays6-7 pm
(Please call for appointments or pre- arranged telephonic appointments also available as requested by students)
Cell: (310) 508 1472 / Class Number:4697 (HCA 550,Section 01)
Class Location: SPA, Room-106
Class Meets: January 19–May6, 2016
Mondays from 7 PM to 9:45 PM
Additional Contact Information:
HCA Program Administrative Coordinator: Deby McGill,
Tel. 562/985-5694; fax 562/985-5886

Catalog Description

Prerequisites: HCA 502 – Health Care System, (Please refer to details below)

Basic elements of quality improvement and organizational responsibilities related to quality improvement in health care delivery. Data analysis for quality improvement, clinical practice guidelines, and future of healthcare quality improvement strategies.

Letter grade only (A-F). (Lecture)

ADA Accommodation will be provided to any student who requests such, as defined by the ADA act and CSU-LB. Please contact Dr. Billimoria or refer to your student handbook for further information.

Note: This syllabus is subject to change. Should there be any changes; students will be notified in class of the amendments.

COURSE PREREQUISITES:

For HCA 550 students: Prior to attending this course students are required to complete the following courses:

  • HCA 502 – Health Care System

Exemptions for the prerequisites are generally not entertained. However, these may be considered on a case-by-case basis.

COURSE OBJECTIVES

The purpose of this course is to familiarize the student with the concept of Quality and the process of Quality Improvement across the Health Care continuum. This course focuses on the history and evolution of quality, its terms, principles, theories, and practices. The student is introduced to a diverse collection of methods of improving quality, including but not limited to continuous Quality Improvement and Total Quality Management, and to the guidelines for implementing quality management and the continuous quality improvement processes. Additionally , the students will be asked to review the changes that a selected number of health care systems from across America have implemented in order to achieve the Institute of Medicine’s goals to make quality health care more safe, timely, effective, equitable, efficient, and patient-centered. Students will also be exposed to new cutting edge technologies that impact the quality improvement efforts/interventions in health care delivery.

Learning Objectives, Domain and Competency Table

Learning Objective / Domain / Competency / Activity (A1), Assignment (A2) or Assessment (A3)
Understand and evaluate the implications and effects of regulation, legislation and accreditation to Health Care Quality Improvement / Knowledge of the Healthcare Environment / Regulatory and administrative environment in which the organization functions (e.g., antitrust; Stark I and II; accreditation; organized labor) / Lecture, Short Essay
And Class Discussion
Understand and discuss Quality, Efficiency, Return on Investment, Access to health care and Quality implications / Knowledge of the Healthcare Environment / The interrelationships among access, quality, cost, resource allocation, accountability, and community / Lecture, Discussions, Project & Paper
Discuss, Understand Customer Satisfaction- Six Sigma, Lean Sigma, Taguchi Loss function theories / Knowledge of the Healthcare Environment / The patient perspective / Lecture, Discussions, Project and Case studies
Understand, discuss Incentive payments for Quality Health Care / Knowledge of the Healthcare Environment / Funding and payment mechanisms of the healthcare system / Lecture, Discussions, Paper or classroom projects
Understand the need for Accreditation, accreditation standards, and impact of Accreditation to Quality / Knowledge of the Healthcare Environment / Governmental, regulatory, professional, and accreditation agencies (e.g., CMS; JCAHO; NCQA) related to healthcare delivery / Lecture, Discussion
Understand and analyze New Technologies and Quality Implications / Knowledge of the Healthcare Environment / Healthcare technological research and advancements / Lecture, Discussion
Understand and Discuss Quality Improvement in various delivery systems / Knowledge of the Healthcare Environment / Organization and delivery of healthcare (e.g., acute care, ambulatory care, medical practice, ancillary services) / Lecture, Discussion, Project
Use Statistical Tools and Analysis for Quality Improvement / Business Knowledge and Skills / Basic statistical analysis / Lecture, Classroom project
Use Clinical Guidelines, Benchmarks in Quality Improvement / Business Knowledge and Skills / Evidence-based practice / Lecture and Discussion
Use Predictive Modeling for Decision Support / Business Knowledge and Skills: D. Strategic Planning and Marketing / Characteristics of strategic decision support (e.g., planning; marketing; modeling; forecasting) / Lecture, Discussion
Developing a Quality Imrovement Program-Mission,Vision,Goals, Objectives. Aligning Quality Improvement with organizational strategic plan / Business Knowledge and Skills: D. Strategic Planning and Marketing / Organizational mission, vision, objectives and priorities / Lecture, Discussion and Project
Evaluate the benefits of Electronic Health Records, E-Prescribing and improvement of safety and quality-Regional Extension Centers and the Federal Stimulus for HIT / Business Knowledge and Skills: E. Information Management / Physician practice management IT systems (e.g., billing; referral/authorization; claims processing; electronic medical records; prescription writing; productivity; transcription) / Guest Lecture, Discussions, Position Paper Optional
Discuss Credentialing Requirements as a structural component for Quality Improvement / Business Knowledge and Skills: F. Risk Management / Credentialing, medical malpractice, and professional liability / Lecture, Discussion
Discuss and Analyze Detailed Theories, Principles of TQM, CQI, Deming, Juran etc- / Business Knowledge and Skills: G. Quality Improvement / Quality improvement theories and frameworks / Lecture, Discussion, Paper, Project
Develop strategy for Quality Planning and management / Business Knowledge and Skills: G. Quality Improvement / Quality planning and management / Lecture and Classroom Project
Calculate Utilization Metrics and Relative Resource Use. Understand Quality Implications of Under Over Utilization and Medical Loss Ratio (MLR) / Business Knowledge and Skills: G. Quality Improvement / Utilization review and management regulations / Lecture, Discussion, Classroom Project

EXPECTED STUDENT LEARNING OUTCOMES

Upon completion of this course, the student will be able to:

  1. Describe the evolution of the health care systems and Quality Management/Improvement Programs and reflect on its future.
  1. Understand the reasoning and the importance of the requirements for Health Care Quality

Management/Improvement Programs.

  1. Describe the most current Quality Management/Improvement Program principles and techniques for health care in general. This includes the principles of Continuous Quality Improvement, Total Quality Management, and proactive versus reactive Quality Management programs.
  1. Understand the impact of federal and state legislation on Quality Management/Improvement Programs in Health care.
  1. Understand the need for and development of standards for accreditation of health care entities.
  1. Describe the recent impact of consumers on health care Quality Management/Improvement Programs and the development of health plan Report Cards (HEDIS etc.).
  1. Understand the use of data and statistics for an effective Quality Management/Improvement Program.
  1. Understand basic elements of provider credentialing, physician profiling and report cards, risk management and liability issues as they relate to Quality Management/Improvement Programs.
  1. Understand the effect of Patient Safety issues on Quality Management/Improvement systems.
  1. Understand the recent trends in Quality Management/Improvement and Continuous Quality and Continuity of Care issues in Assisted Living, Skilled Nursing, and Long Term Care.
  1. Health Care Report Cards, Pay For Performance and other strategies used for improving the quality of health care
  1. Demonstrate understanding of the principles in the development of a Quality Management/Improvement Program and Strategies for a health care entity via successful completion of class project.

REQUIRED TEXTS AND ANY OTHER REQUIRED MATERIALS AND INFORMATION.

This course does not prescribe a specific text, since no single text would cover the broad scope of this course. However, the following books and materials are strongly recommended for review:

This course does not prescribe a specific text, since no single text would cover the broad scope of this course. However, the following books and materials are strongly recommended for review:

  1. Continuous Quality Improvement in Healthcare, Solecito, William A and Johnson Julie, K, 4th Edition, Copyright 2013, Jones and Bartlett Publication, Massachusetts; ISBN 13: 978-0-7637-8154-5
  1. Lecture notes and handout materials
  1. Supplementary Text: The HealthCare Quality Handbook- Elizabeth Ransom, Maulik Joshi, David Nash and Scott Ransom, 2nd Edition 2008, Health Administration Press, Chicago Illinois
  1. Supplementary Text: Conducting Health Outcomes Research-Robert L.Kane, David M. Radosevich, 2011, Jones and Bartlett Learning, LLC, Sudbury, MA 101776
  1. A list of References is presented at the end of the syllabus. Students are encouraged to use this reference material for enhancing the information discussed in class. In addition, generous use of the information may be made for class papers and project assignments

Lecture notes and handout materials. All lecture notes will be posted on Beach Board. Students need to print these. Very few copies may be available for distribution by the instructor.

TYPES OF ASSIGNMENTS

IShort Essays (10% of overall class Grade for each one of 2essays over the course of the semester. Total Percentage of Grade for 2 essays is 20)

To understand the latest trends around Quality Management/Improvement Programs it is necessary to review articles related to health care quality from various sources including professional medical or health care journals. Students will be expected to write short essays on specific prescribed topics (a maximum of two, doubled spaced and typed pages). The students will be provided with a relevant topic for each essay. Students will then research and select one or more published articles pertaining to the topic and complete the short essay as follows:

1)Introduction – Introduce the topic with a brief overview of sources used for the essay. Students must make special mention in support of selecting their articles

2)Summary-Summarize the contents of the article(s) as they relate to the topic.

3)Discussion-Provide your analysis and discussion pertaining the topic being discussed.

4)Conclusions – Conclusion regarding the topic derived from the article(s).

The essays will be graded on a scale of (0 – 20 points). Grading will be based on the contents of sections addressed above.

Examples of Journals that may be used for writing your essays are as follows:

a)Journal of the American Medical Association (JAMA) -

b)New England Journal of Medicine -

c)Annals of Internal Medicine -

d)Journal of Health Politics, Policy and Law -

e)Journal of HealthCare Quality -

f)Med Bio World - Hospital & Healthcare Management Journals -

The twoshort essayswill be due in the weeks assigned. Please see agenda on the following pages for due dates.

On the due date, submit one copy to the instructor. The essay will be returned after review and scoring.

IIClass Participation (20% of Overall Class Grade)

Active classroom participation is encouraged. Each student will have adequate opportunities to participate in classroom discussions. Students will be provided the opportunity to participate in small projects and pop quizzes to assess participation.The small projects will be scored. Level of participation will contribute towards the overall course grade. Graduate Students will also participate in special projects and journal article reviews.

IIIMid Term Exam for HCA 550 (Constitutes 30% of the Overall Class Grade)

Position Paper (HCA 550):

Students may select their own topic related to Health Care Quality Improvement with presentation of information as highlighted in the example below:

Example Only: Development of a Quality Management/Improvement Program/Projects may present organizational and process problems or issues that need to be reviewed and resolved if possible. Develop your view of an idea or a problem related to program development using professional literature and other resources from within andoutside the course materials. This position paper must have four major components.

  • Description of the problem or idea. (20% of the Mid Term Exam Grade)
  • Description of the significance of the problem or issue arising out of the Quality Management/Improvement Program development. (30% of the Mid Term Exam Grade)
  • Your position, analysis and proposed solution if applicable. (40% of the Mid Term Exam Grade)
  • Literature support for your position and analysis. (10% of the Mid Term Exam Grade)

The position paper will need to be written on a minimum of 10 double spaced pages. Your position paper may be presented to the class. Oral presentations are optional. Arrangements for your presentation are to be made at least a week prior to the desired date. The oral class presentation of your position paper should be 15 minutes in length, followed by a question & answer session. Grading will be based mainly on the written paper, however, oral presentations will only help enhance the overall final class grade.

IVPROJECT: Quality Management/Improvement Program Development (30% of the overall Grade)

A major classroom project will be the development of a Quality Management/Improvement Program or Quality Improvement Process/strategypertaining to a health care entity. This project will be assigned during the course and will be completed as the Final Exam.

Students will form teams and develop a Quality Management/Improvement Program or Process for improvement of selected care and services for their assigned entity. The project will make use of quality improvement principles and information presented during the course. Each student within a team must make specific contributions to the program or project development and discussions.

The projects developed will be presented to the class by all members of each team. Each team member presents their specific contributions to the project. Please see course agenda below for day of presentation. Guest speakers may be present during presentations and will contribute to the discussions.

Grading For “The Quality Management/Improvement Program Development Project": (Constitutes 30% of the overall class grade)

IShort Paper: Each student’s contribution towards the team project will be presented in form of a paper not less than two double-spaced type written pages. The paper shall comprise of the following elements:

a)Introduction to the portion being contributed by the student. (10% of Final Grade)

b)Presentation of the ideas and components the student is responsible for developing as part of the team effort (10% of Finals Grade)

c)Discussionand the importance of the student’s contribution towards the team project using the principles and theories discussed in class as well as pertinent literature reviewed by the student. (30% of Finals Grade)

IIClass Presentation by Team (50% of the Finals Grade)

The Finals Grade will be a combination of the individual paper and team presentation scores.

Instructor will be available to all students for guidance during development of the project.

Presentation Scoring Rubric will consider the following:

All 7 Elements listed below must be covered in your Presentation

  1. Outline the research documenting need for healthcare improvement (Background)
  2. Define the system in which you are making improvements (Hospital, HMO,SNF or other entity)
  3. Identify key themes for improvement efforts (Which areas or items of the issue were selected for improvement and why)
  4. Use the improvement processes best suited for your project. (Six Sigma, Lean, PDSA etc)
  5. Develop and describe the team meeting management skills used to accomplish your project. (Includes Team Dynamics)
  6. Describe basic steps used in managing change as you implemented your improvement plan
  7. Describe the value and context for the tools your team used and implemented in settings you used:
  • Fishbones
  • Process mapping
  • Flow charting
  • Run/control charts

AGENDA AND SEQUENCE OF ASSIGNMENTS (The agenda is subject to change.)

WeekObjective

Week 1 – January 19a) Introduction to the course.

b)Literature Review Guidelines.

c)Introduction to Terminologies.

d)Introduction to Health Care Systems

a)Selection of Teams & Team Leaders for projects.

Week 2 –January 26a)Evolution of Health Care Quality Management with a

historical perspective.

b)Basic Elements of Quality Improvement

Readings: Review Chapters 1 & 2 McLaughlin

Business Case for Quality – Reading for project

Essay # 1 – Topic to be announced in class

Week 3 – February 2a)Quality Improvement Thoughts and Basic Elements of Quality.

b)The Deming approach to Quality Improvement.

c)Principles of Continuous Quality Improvement (CQI) and

Total Quality Management (TQM).

d)Fishbone Diagram

e) Classroom Project-Business case for Quality

Readings: Chapter 1 (McLaughlin), Lecture Notes and Literature

Essay # 1 to be submitted in class

Week 4 – February9 a)Beyond Ishikawa

b)Use of Data for Quality Improvement and Health Systems

c)FOCUS and Classroom QI Project

Review: Chapter 11 (McLaughlin), Lecture Notes