Reference no: EM13830367

Quality Improvement Plan

Health Maintenance Organization (HMO) is focused on ensuring effective and efficient healthcare is provided to people by qualified healthcare professionals. Their approach is based on collaboration. The organization has integrated its functions to include health insurers, healthcare providing organizations, and the community at large. The main mission is to foster qualified healthcare to employees from qualified health professionals, a replacement of the traditional system (Hazinski & American Heart Association, 2011). Quality improvement goals are three main here; to reduce the procedure required for one to access services within the organization; to minimize the charges that are presently as a result of the long process through which patients need to go through for them to receive services; and to improve the mode of service delivery within the organization.

The role of patients, community and other stakeholders in quality improvement in HMO is definite. Patients are the recipients of services offered by the organization. For QI to be effected, responses from patients are crucial. Since information will be collected through distribution of questionnaires and interview method, patients in this case will be the center of focus of information collection. In other words, they are the main source of information that will later be analyzed and changes effected. Friends surrounding the organization may aid in implementation of the QI. Consider the long process through which patients have to go through to access HMO services. Friends who have a better way and suggestion of how the entire process can be simplified, by development of automated systems for instance (Sollecito and Johnson, 2013), are of importance to HMO.

External indicator in this case is by simplifying the process required to access HMO services. Additionally, reduction in the total costs and flexibility of the HMO rules and policies are indicators available to consumers. Presently, as described earlier, the process is long as the patient should get consent from a medical Doctor before presenting the same to HMO. Consequently, costs incurred in effecting these add up, making the entire process costly, contrary to initial organization's aim. Policies should be flexed in a way that the patient need not get consent from a primary care physician alone.

Feedback from stakeholders is important for quality improvement, it is the main aspect for change to be effected. Doctors are the professional healthcare providers. Their feedback might give HMO an insight of how they can be easily accessed by HMO organization. For example, HMO can create a portal where each Doctor fills their profile and provides contacts. This might not only be easy for patients to access them in case they need consent but will hasten the process in general. Insurers on the other hand are an important collaborator to HMO. Their feedback might help restructure the mode of operation of HMO. For example, each health insurer might provide an automated list of patients which have insured their health risks with them (Pilzer, 2013). These might then be integrated into one, easily retrievable file, further simplifying the process.

References:

Hazinski, M. F., & American Heart Association. (2011). BLS for healthcare providers. Dallas, TX: American Heart Association.

Pilzer, P. Z. (2005). The new health insurance solution: How to get cheaper, better coverage without a traditional employer plan. Hoboken, NJ: John Wiley.

Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's Continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning.

Required:

Create a presentation summarizing your final Quality Improvement Plan., original work, cite references, references 7 slides not including title and reference slide