Term Paper on "Improving Patient Care Through Training"

Term Paper 6 pages (1501 words) Sources: 5

[EXCERPT] . . . .

Improving Patient Care through Training at the Department of Veterans Affairs

One of the requirements of a well-managed integrated quality assurance program in a tertiary healthcare setting is the publication and distribution of minutes from meetings of committees, boards, agencies and healthcare services or divisions. These minutes are required to be audited by other committees, boards, agencies and services to determine their impact, if any, on their operations and to identify opportunities for improving patient care. Unfortunately, many such groups fail to provide comprehensive minutes of their meetings in a timely fashion and in some cases, such minutes are not provided at all, an issue that directly relates to the needs assessment which is discussed further below.

Needs assessment:

The Department of Veterans Affairs (VA) is the nation's largest healthcare provider, delivering a complete range of services to veteran patients in a national system of tertiary healthcare facilities that are organized into 22 semiautonomous, geographically defined service networks (Landrum, Normand & Rosenheck, 2003). According to the VA's Web site, "The VA healthcare system has grown from 54 hospitals in 1930, to include 171 medical centers; more than 350 outpatient, community, and outreach clinics; 126 nursing home care units; and 35 domiciliaries. VA health care facilities provide a broad spectrum of medical, surgical, and rehabilitative care" (VA history, 2012, para. 2).

The VA is tasked with the overarching mandate, taken from Lincoln's second inaugural address, "To care for him who shall have borne the battle and for his widow and orphan." To achieve this vital mandate, the VA needs an integrated quality assurance program that operates efficiently by using the most current information available. One of the most important but underutilized components of an efficient quality assurance program is the timely circulation of minutes throughout the healthcare organization for audit by interested and affected groups and services. According to Parajon (2010), the general purpose of such quality assurance programs at the VA is to "assure the quality of agency action through the development of standards, the evaluation of performance against those standards, and action to upgrade substandard performance" (p. 1339).

The auditing of meeting minutes by other committees and medical center services is part of an overall push to integrate all aspects of patient care into a comprehensive framework that can be used to assess current performance and identify opportunities for improving patient care at the VA (Kuhn, 1999). In this regard, Landrum and her associates emphasize that, "Evaluating the use of hospital services and outpatient services [at the VA] is a central activity of performance monitoring" (p. 7). Besides committee meeting minutes, the sources of information for the integrated quality assurance approach also include:

1. Morbidity-mortality studies;

2. Monitoring activities (medical and other professional staffs);

3. Review of prescriptions;

4. Hospital profile data;

5. Process and outcome studies;

6. Incident reports (safety and clinical care);

7. Review of laboratory, radiological and other diagnostic reports;

8. Utilization review findings;

9. Staff interviews; and,

10. Patient surveys and comments (Affeldt, 1980).

The auditing process is also a requirement of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), but many healthcare practitioners have either been unwilling or unable to comply with this need. In this regard, Affeldt (1980) emphasized early on that, "Although the objectives are desirable and many hospital staffs have successfully completed audits that have been useful in analyzing patterns of care and in educating practitioners, audit has often been regarded by physicians as tedious, costly and nonproductive" (p. 166).

Performed efficiently and routinely, though, the integrated quality assurance approach can be highly effective. The JCAHO currently requires the following general elements for such a quality assurance initiative:

1. The integration or coordination of all quality assurance activities into a comprehensive program;

2. A written plan for the program;

3. A problem-focused approach to review;

4. Annual reassessment of the program, and,

5. Measurable improvement in patient care or clinical performance (Affeldt, 1980).

Since its adoption during the early 1990s, though, the audit process that underlies the integrated quality assurance approach has improved the quality of care at the VA across the board. Although the entire system continues to struggle to satisfy the growing demand for veterans' healthcare services, the VA medical system is currently ranked equal to or exceeding comparable healthcare services in the private sector according to the JCAHO and others. For example, a letter to the editor from a former VA employee notes that, "When I worked for the Veterans Administration in the 1970s, it was a dismal operation. Morale was poor, management was worse. That model is now totally outdated. The National Committee for Quality Assurance, a health care watchdog organization, ranked the VA system, by a variety of criteria, as better not only than the sort of care offered by Medicare but even the best civilian health care plans" (Cummins, 2007).

The minutes of meetings that are conducted by various VA groups must include several basic items in order for them to be useful, including the date and time of the meeting, who was in attendance (and who was not), what was discussed and by whom (old business and new business), and so forth, all the while ensuring that physician-patient confidentiality is maintained (Zinski, 2006). In addition, many VA medical centers have adopted their own meeting-minutes template to help standardize the minute-taking process as well as their audit by others within the organization that might be affected by their content.

Design:

The materials required for the training needed for improved minute-taking at VA meetings will consist of the following:

1. A locally developed "minute-taking guide" (this would be a short pamphlet describing the recommended format, a description of an agenda, and the contents of typical meeting minutes as well as note-taking tips and suggestions for recording, transcription and secure handling of meeting content);

2. A 15-minute PowerPoint presentation including a description of an agenda, Robert's Rules of Order, an overview of the minute-taking process, as well as an organizational schematic illustrating the dissemination of the information contained in the minutes and how it is used in the VA's integrated quality assurance process.

These training materials will be designed by the respective office of quality assurance in collaboration with the facility's graphic arts department.

Development:

The training medium for this initiative will be a series of in-services that will be conducted by office of quality assurance personnel as described further below.

Implementation:

The minute-taking training initiative will be implemented by placing notices in the medical center's weekly bulletin and through a series of daily announcements on the medical center's public address system preparatory to the first in-service. Posters will also be placed in the medical center's hallways, cafeteria area, library and other prominent locations the week prior to the in-service. Emphasis will be placed on the fact that all personnel responsible for minute-taking will be required to complete the in-service. In addition, emphasis will also be placed on the fact that refreshments will be served and a door-prize awarded to promote attendance.

The in-service will be delivered by a program specialist from the office of quality assurance who will distribute the minute-taking pamphlet described above to all attendees, followed by an introductory orientation and the 15-minute PowerPoint presentation. A question-and-answer session will conclude the minute-taking in-service.

Evaluation:

The evaluation of the effectiveness of the minute-taking in-service will be based on a benchmark of how many medical center services and committees submitted their minutes to the office of quality assurance in a timely fashion (defined as within the prescribed time limits of the medical center, typically within 30 days of the meeting) averaged over the past 6-month period that contain all requisite minute elements. This benchmark data will be placed in an Excel spreadsheet and each medical center service and committee's minutes will be… READ MORE

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