MHA-FP5014 -Assessment1: Regulatory Environment – Executive Summary

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Assessment 1: Regulatory Environment – Executive Summary

Overview

Create a 3–4-page executive summary of tools and best practices for quality improvement, risk management, and learning guidelines. Include a summary table that describes the status of an organization’s compliance with regulatory requirements.

Note: The assessments in this course build upon each other, so you are strongly encouraged to complete them in a sequence.

The scope of the regulatory environment and its requirements are ever-changing. Health care leaders need to know where they can find information about the requirements (within the subsector of the industry) to respond appropriately to issues. In addition, health care leaders need to proactively set strategies in place to mitigate future risks to their patients and organizations.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 1: Conduct an environmental assessment to identify quality- and risk-management priorities for a health care organization.
    • Conduct a proactive assessment based on the existing regulations and requirements.
    • Describe strategies to influence, impact, and monitor the needed changes for quality improvement.
    • Develop a value proposition for change management that incorporates quality- and risk-management concepts.
    • Create an executive summary of a risk-management issue that describes an organization’s compliance with a regulatory requirement.
  • Competency 4: Analyze applicable legal and ethical institution-based values as they relate to quality assessment.
    • Integrate legal and ethical principles and also organizational mission, vision, and values into the decision-making process.
  • Competency 5: Communicate in a manner that is scholarly, professional, and consistent with expectations for professionals in health care administration.
    • Write clearly and concisely, with well-organized communication that is supported by relevant evidence.
    • Use correct grammar, punctuation, and mechanics as expected of a graduate learner.

Context

It is an exciting time in health care as all of us experience the implementation of the Patient Protection and Affordable Care Act of 2010. The change will likely affect your current or future health care job. Leaders in our industry are rethinking how business is to be conducted.

Understanding relevant terminology is an important step in addressing the topics of health care quality, risk management, and regulatory environment.

Read further in the Assessment 1 Context [PDF] document, which contains important information related to the following topics within the regulatory environment:

  • Quality of Services.
  • Potential Risks.
  • Regulatory Requirements.
  • Regulatory Bodies.
  • Benchmarking as a Condition of Participation.

Questions to Consider

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as a part of your assessment.

The Regulatory Environment:

  • Which regulatory bodies oversee the subsector of the health care industry in which you currently work or would like to work?
  • How would you figure out which organizations oversee the subsector?
  • How would you determine which laws apply to your setting and what type of data you need to collect and examine?
  • What are the standards of care?
  • How would you locate these standards?
  • How would you know if your organization exceeded those standards and might be in a position to apply for accreditation?

Establishing a Culture of Patient Safety:

  • What is an example of a best practice for establishing a systems-based culture of patient safety?
  • How will you know if your organization was identified as an example of success when best practices are used?

Benchmarking:

  • What types of processes exist for collecting and analyzing data to identify trends in the performance of your health care setting?
  • Who are some of the health care industry’s best performers in terms of risk management?
  • What types of benchmarking data are important to consider?
  • What roles within your own organization need to be involved in a proactive risk-management program?
  • What are some critical success factors for the establishment of a systems-based risk-management program?
  • What types of considerations or cautions are important to keep in mind when interpreting internal and external benchmarking data?

Required Resources

The following resource is required to complete this assessment.

Suggested Resources

The resources provided here are optional and support the assessment. They provide helpful information about the topics. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MHA-FP5014 – Health Care Quality, Risk, and Regulatory Compliance Library Guide can help direct your research. The Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.

Accountable Care Organizations

This article discusses how a health care facility transitioned into an Accountable Care Organization successfully.

This article discusses how ACOs have achieved cost savings while improving care for their patients.

Quality Improvement Strategies

This article examines the revised nursing home quality measures endorsed by the National Quality Forum which could best represent the improving quality of care in nursing homes.

This article examines the various domains associated with quality improvement in healthcare organizations.

This article explains the key role that leadership plays in supporting and aligning staff for patient care using the Malcom Baldrige criteria as a path to quality excellence.

This article explores how hospital managers perceive lean in the context of quality improvement.

This article discusses methods for auditing cost and quality tailored to a hospital’s specific population.

This article focuses on the factors affecting the adoption of innovative assurance technologies in nursing care.

Regulatory and Compliance

This article discusses a new regulation establishing and new safety-reporting for drugs under the investigational new drug applications.

Additional Resources for Further Exploration

You may use the following optional resources to further explore topics related to competencies.

Process and Performance Improvement

This is the home page of the American Productivity and Quality Center that provides best practices and benchmarking tools for designing effective methods for process and performance improvement.

Quality Improvement

This is a blog page on how to improve care for patients with Medicare.

This is the home page of Medicare that summarizes measures of quality shown on Hospital Compare.

This article discusses the Affordable Care Act funding for health providers to improve patient care.

Patient Safety

This article discusses various principles for creating a culture of safety in hospitals.

This is the home page of the National Quality Forum. It focusses on reducing preventable admission and readmissions, reducing adverse health care associated conditions, and reducing harm or unnecessary care.

This is the home page of the Joint Commission on patient safety goals and standards.

Regulatory and Compliance

This is the home page of the Healthcare Compliance Association for compliance professionals in the healthcare provider field.

This is the home page of the OIG U.S. Department of Health and Human Services. It discusses legal issues regarding ACOs participation in Medicare.

This is the home page of the U.S. Department of Health and Human Services laws and regulations.

Risk-Management Text Books

  • Kavaler, F., & Alexander, R. S. (2014). Risk management in health care institutions: Limiting liability and enhancing care (3rd ed). Burlington, MA: Jones and Bartlett. Available from the bookstore.
    • Chapter 4, “Communications to Reduce Risk,” read the section, “Grading and Ranking Health Care,” pages 111–114.
    • Chapter 5, “Financing Risk,” pages 123–125.
  • Youngberg, B. J. (2011). Principles of risk management and patient safety. Sudbury, MA: Jones and Bartlett. Available from the bookstore.
    • Chapter 1, “Risk Management and Patient Safety: The Synergy and the Tension,” pages 3–12.
    • Chapter 2, “Integrating Risk Management, Quality Management and Patient Safety into the Organization,” pages 13–22.
    • Chapter 3, “Benchmarking in Risk Management,” pages 23–30.
    • Chapter 6, “Patient Safety: The Last Decade,” pages 63–68.
    • Chapter 16, “Principles for Strategic Discovery,” pages 203–214.
    • Chapter 17, “Full Disclosure as a Risk Management Imperative,” pages 215–224.
    • Chapter 24, “Improving Risk Manager Performance and Promoting Patient Safety with High-Reliability Principles,” pages 343–350.
    • Chapter 29, “The Impact of Fatigue on Error and Patient Safety,” pages 423–430.




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