Value Based Health Care: Linking Finance and Quality

Value-Based Health Care Linking Finance and Quality Yosef D. Dlugacz Value-Based Health Care? Value-Based Health Care?concisely explains the mandate to successfully link health care quality and finance and describes the tools to implement strategies for organizational success. Yosef Dlugacz provides many illustrative real-world examples of process and outcomes of the value-based approach, taken from a wide range of health care settings. Perfect for students preparing to enter health care management or for practicing health care leaders and professionals, this book is a vital guide to approaches that ensure the health of patients and health care organizations alike. Praise for Value-Based Health Care "Value-Based Health Care provides leaders and quality experts with the much needed roadmap for linking cost and quality. This book will help your organization thrive in today's ultra-competitive environment." —Patrice L. Spath, health care quality specialist and author of Leading Your Health Care Organization to Excellence and Error Reduction in Health Care: A Systems Approach to Improving Patient Safety "Yosef Dlugacz provides an essential overview of how staff, administrators, and clinicians can create not just a culture but a gestalt of quality health care delivery. . . .given the national debate over access, cost, and quality, the book could not be more timely." —Theodore J. Joyce, PhD, professor of economics and finance, academic director of the Baruch/Mt. Sinai MBA Program in Health Care Administration, and research associate, National Bureau of Economic Research "Dr. Dlugacz's?case studies and action plans provide great insights and workable solutions to provide safe and effective patient care. It is a welcome resource as we sit on the?advent of health reform." —Kathy Ciccone, executive director, Quality Institute of the Healthcare Association of New York State

Table of Contents:
Figures and Tables ix Preface xi Acknowledgments xiii The Author xv Introduction xvii PART ONE BASIC PRINCIPLES OF QUALITY MANAGEMENT 1 1 DRIVERS OF CHANGE 3 Learning Objectives 3 External Drivers 5 Internal Drivers 11 Summary 20 Key Terms 20 Things to Think About 20 2 IMPROVING PATIENT SAFETY 21 Learning Objectives 21 Understanding Quality Measures 23 Working with Quality Information 24 Measuring Value 27 Asking Questions Via Data 30 Presenting Results 34 Effective Communication Improves Patient Safety 37 Summary 39 Key Terms 39 Things to Think About 39 3 FOCUS ON THE PATIENT 41 Learning Objectives 41 Effective Communication and Patient-Focused Care 43 Handoff Information Transfer 47 SBAR 47 Barriers to Effective Communication 48 Strategies to Reduce Barriers 50 Care and Communication Guidelines 51 Patient Education 52 Near-Miss Reporting 59 Chronic Disease Management 61 Task Forces 63 Patient Rights and Responsibilities 65 Compassionate Caring 65 Summary 67 Key Terms 68 Things to Think About 68 4 UNDERSTANDING PROCESSES, OUTCOMES, AND COSTS 69 Learning Objectives 69 Some Events Should Never Occur 70 Leaders’ Role in Good Outcomes 72 Physicians’ Role in Good Outcomes 74 Financial Value of Good Outcomes 76 Changing the Traditional Culture 77 Summary 86 Key Terms 86 Things to Think About 86 PART TWO GETTING DOWN TO BUSINESS 87 5 THE VALUE OF PREVENTION 89 Learning Objectives 89 The Promotion of Prevention 90 The Problems with Prevention 91 The Patient’s Role 92 Prevention Measures 93 Regulatory Groups’ Role in Prevention 94 Data’s Role in Promoting Prevention 95 Management of Chronic Conditions 99 Prevention in Ambulatory Care 101 Proactive Prevention in the Hospital 106 National Patient Safety Goals 107 Technology and Prevention 108 Summary 110 Key Terms 111 Things to Think About 111 6 THE COST OF SENTINEL EVENTS 113 Learning Objectives 113 Changing the Incident Analysis Framework 115 The Value of Root Cause Analysis 117 Monitoring Behavioral Health 121 Eliminating Never Events 124 Improving Error Reports 125 Quality Management’s Role in Controlling Adverse Events 126 The Traditional Hierarchy Leads to Errors 128 The Economics of Malpractice 129 Summary 130 Key Terms 131 Things to Think About 131 7 MANAGING EXPENSES IN A HIGH-RISK E NVIRONMENT 133 Learning Objectives 133 Improving Cost in the ICU 134 Match the Resources to the Patient 136 End-of-Life Care 137 Sustaining Change 138 Improving Operating Room Efficiency 141 Improving Oversight 142 Managing Throughput 143 Summary 146 Key Terms 147 Things to Think About 147 8 IMPROVING COMMUNICATION AND ESTABLISHING TRUST 149 Learning Objectives 149 Developing Trust 150 The Role of Quality Management in Increasing Trust 151 Transparency, Tracers, and Trust 151 Establishing a Common Language 157 Sustaining Change 159 Monitoring Care 160 Assessing Competency 163 The Role of Regulatory Requirements in Ensuring Competency 164 Medical Staff Credentialing 165 Objectifying Competency 165 Staffi ng Effectiveness 168 Promoting Competency 169 Summary 169 Key Terms 170 Things to Think About 170 9 PROMOTING A SAFE ENVIRONMENT OF CARE 171 Learning Objectives 171 Communication Across Disciplines 172 Working Together to Identify and Solve Problems 174 Improving Processes 175 Monitoring Safety 176 Ensuring Accountability 178 Maintaining a Safe Environment 180 Establishing Oversight 180 Communicating About Safety 181 Assessing and Improving the Environment 182 Summary 183 Key Terms 184 Things to Think About 184 10 CONCLUSION 185 REFERENCES 191 USEFUL WEB SITES 195 INDEX 197

About the Author :
The Author Yosef D. Dlugacz, PhD, is senior vice president and chief of Clinical Quality, Education, and Research, Krasnoff Quality Management Institute, a division of the North Shore–Long Island Jewish Health System.