Quality Management In Health Care Delivery HCA 450- Course Syllabus

COLLEGE OF HEALTH AND HUMAN SERVICES

CaliforniaStateUniversity, Long Beach

Health Care Administration Program

HCA 450-04 - 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.
Telephonic appointments also available
at other prearranged days and times)
Cell: (310) 508 1472 / Class Number:Section 04, 7510 (HCA 450)
Class Location: HHS 1, Room-101
Class Meets: –January 25, 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 300. (Please refer to details below) and HCA 465 (Preferred)

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 450 students: Prior to attending this course students are required to complete the following courses:

  • HCA 300 (Health Care System) and
  • HCA 465 (Analysis and Evaluation)

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; JC; 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, Crosby etc- / Business Knowledge and Skills: G. Quality Improvement / Quality improvement theories and frameworks / Lecture, Discussion, Paper, Project
Discuss, analyze concepts and applications of Six Sigma and Lean (Industry Model and Relevance to Healthcare) / 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 use of Quality Improvement Tools and Strategies including Kaizen, Lean and Six Sigma.
  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/Project 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:

  1. Introduction to Quality Health Care Management, Patrice Spath, 2013, 2nd Edition, AUPHA, Health Administration Press, Chicago, Illinois

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

TYPES OF ASSIGNMENTS

IShort Essays (Approx. 10% of overall class Grade for each one of 2essays over the course of the semester. Total Percentage of overall class grade for these 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 typed pages with a reasonable font size 11 or 12 ). 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 reason for selecting the article(s) or sources used for the essay. Students must make special mention in support for 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 (Approx. 10% 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. Level of participation will contribute towards the overall course grade.

IIIMidTerm Exam for HCA 450 (Constitutes approx. 30% of the Overall Class Grade)

HCA 450 students will be administered a midterm exam worth approximately30% of the overall class grade. The exam will comprise of multiple questions. Questions will be a mix of essay type discussions and short problemsbased on case studies using the knowledge from topics discussed in class and the prescribed text book during the semester and a series of short case studies or notes on specific issues or topics.

For each essay question, the student will be required to use the following format:

a)An Introductionto address the case or problem presented

b)Presentation of the ideas in addressing the issue or case using information from the course.

c)Brief Discussion of the interventions or direction suggested by the student for addressing the case or issue

d)Conclusion- Summary of thoughts

Length of the written answer is left to the discretion of the student. It is important to ensure that the above four points be taken into consideration for a complete answer. In general two type written pages with a reasonable font size (11 or 12) would be adequate.

IV PROJECT: Quality Management/Improvement Project or Program Development (Approx. 30% of the overall Grade)[1]

A major classroom project will be the development of a Quality Management/Improvement Program or Quality Improvement Project or Process/strategypertaining to a health care entity. This project will be assigned during the course and will be completed as part of your final exam. Students will select a topic for the project and discuss with instructor before starting.

Students will form teams and develop a Quality Management/Improvement Program or ProcessImprovement strategy based topicpertaining to improvement of care and/or services for their selected entity. The project will make use of quality improvement principles and informationpresented 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 and grading.

Grading Components For “The Quality Management/Improvement Program Strategy Project" (Constitutes approximately30% of the overall class grade):

IClass Presentation by Team (The score achieved by the team will be applied to each team member)

IIShort Project Paper by Each Student: In addition to the presentation, 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: The importance of portion being contributed by the student.

b)Presentation of the ideas and components the student is responsible for developing as part of the team effort

c)Discussionon 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.

IIIPresentation 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. Examples include but are not limited to:
  • Fishbones
  • Process mapping
  • Flow charting
  • Run/control charts

The Final Exam Grade for each student includes a combination of the individual student contribution paper and team presentation scores.

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

VComprehensive QUIZ (Approx. 10 % of overall grade):One Comprehensive Quiz will be offered during the semester. This will be announced a week prior to each quiz giving adequate preparation time to the students.

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

WeekObjective

Week 1 –January 25a) Introduction to the course.

b)Literature Review Guidelines.

c)Introduction to Terminologies.

d)Introduction to Health Care Systems

e)Selection of Teams (8) & Team Leaders for projects.

Week 2 –February 1a)Evolution of Health Care Quality Management with a

historic perspective.

b)Introduction to Quality Improvement (Lecture Notes)

c)Discuss Quality Improvement Project

Readings: Review Chapters1 (Prescribed Text Book)- Defining Quality, What is Quality?

Business Case for Quality – Reading for class project

Week 3 –February 8a)Basic Elements of Quality Improvement (Lecture Notes)

b)The Deming approach to Quality Improvement.

c)Continuous Quality Improvement (CQI) and

Total Quality Management (TQM) (Thoughts, Lecture notes)

d) Classroom Project-Business case for Quality

Readings: Chapter 2 (Prescribed),Quality Building Blocks

Week 4 –February 15Topic for Essay # 1 to be announced in class

a)Continuous Quality Improvement –Thoughts (Lecture Notes)

b)Beyond Ishikawa (Lecture Notes)

c)Data and Measuring Performance

Review: Chapter 3 (Measuring Performance)

Essay # 1 to be submitted in class

Week 5 –February 22a) Performance Improvement Tools for Quality- Introduction with Fishbone Diagram (Lecture Notes)

b) Discuss FOCUS and Pareto Charts (Lecture notes)

c) Leadership and Quality Improvement Teams (Lecture notes)

d) Draw Fishbone- in class exercise

Review:Chapter 6 (Performance Improvement Tools) and Chapter 7 (Improvement Project Teams)

Week 6 –February 29a) Progress Report and Updates on the Quality Improvement

project by each team.

b) Variations(Lecture Notes)

c) Plan Do Study Act (Using more Tools)

Review: Chapters 4 (Page 100) and Chapter 5 (Continuous improvement)

:

Topic for Essay # 2 to be announced in class

Week 7 –March 7

a)Principles and Tools for Quality Part I (Lecture Notes)

b)Control Charts

c) Using Quality Improvement Tools- Small Classroom Project

Review: Chapter 6 (Performance improvement Tools)