Essay Grade

Assessment 1 Context
The Regulatory Environment
Quality of Services
Following the Institute of Medicine (IOM) initial reports on patient safety and medical errors,
an increased attention and accountability has been placed on providers to improve the quality
of services (2000, 2001). Within the industry, the IOM of the National Academies released a
report in 2011 regarding systematic reviews for the promotion of patient safety and related
standards.
Potential Risks
Implicit within the quality care delivery process is the identification of potential risks, which
may ultimately affect patient care. As the delivery of care standards are increasingly refined,
cost-related metrics also must be monitored. The U.S. government, insurance companies,
and other private payers are carefully watching the evolution of care standards and cost
metrics. Health care leaders must be up to speed with quality care standards, identification of
potential risks, and compliance with relevant regulations.
An example of the integration of these concepts can be found in the launch of the accountable
care organization (ACO) concept by the Department of Health and Human Services Center for
Medicare and Medicaid Services (CMS). Secretary of Health and Human Services Kathleen
Sibelius (2011) conveyed that the HHS “team carefully weighed the interests of hospitals,
doctors, patients, and other stakeholders” when formulating the ACO roles and
responsibilities. Risk assessment, quality care, and cost considerations are incorporated into
the ACO concept (Lee, Casalino, Fisher, & Wilensky, 2011).
Regulatory Requirements
It is important to consider the National Center for Healthcare Leadership Competencies
(NHCL). Think of what types of skills will be needed to lead your organizations toward the
goal of demonstrating quality and balancing costs. You may even wish to assess your own
current competency levels relative to the health care industry’s movement toward
performance measurement and increased accountability (NHCL, n.d.).
Dr. Donald Berwick, who headed the HHS ACO efforts, discusses ACO concepts in his 2011
White House blog entitled Improving Care for People With Medicare. Dr. Berwick relates that:
Thanks to the Affordable Care Act, the Department of Health and Human Services
(HHS) today released proposed new rules to help doctors, hospitals, and other health
care providers better coordinate care for Medicare patients through Accountable Care
Organizations (ACOs). ACOs are designed to create and support a team of health
care providers who treat individual patients by working together across care settings.
Dr. Berwick (2011) adds that “ACOs would have to meet high-quality standards in five key
areas:
1. Patient/Caregiver Experience of Care.
2. Care Coordination.
3. Patient Safety.
4. Preventive Health.
5. At Risk Population/Frail Elderly Health.”
MHA-FP5014 Assessment 1 Context
1
Assessment 1 Context
Regulatory Bodies
In health care settings, there are various levels of oversight for organizations. Health care
managers must be aware of the standards required to successfully provide quality care.
Health care organizations need to comply with both regulatory standards as well as quality
indicators set by accrediting bodies. For example, the Joint Commission is an accrediting
body that sets standards for hospitals and other health care organizations. Organizations that
are accredited by the Joint Commission are held to a higher standard. Voluntary accreditation
allows health care organizations to benchmark themselves to ensure they are in line with
national standards.
Benchmarking as a Condition of Participation
Most of us have heard about benchmarking and are somewhat familiar with the concept. But,
if your supervisor walked into your work setting today and asked you to provide some internal
benchmarking data and compare it against national best practices, would you know what
action or steps to take? Furthermore, would you know what organizations develop
benchmarking standards and provide guidance for quality improvement?
Youngberg (2011), a health care patient safety and risk management expert, describes
benchmarking as the process of collecting and analyzing data to identify trends in
performance and, when compared with other collectors of the same data, identifying best
performers and determining if interventions that were introduced to address identified
problems yielded the desired results. (p. 24)
Benchmarking is not only a quality improvement tool but a condition of participation for some
government and other payer sources. An example of this can be found in the requirements for
accountable care organizations. Health care leaders must be familiar with the standards
provided by both licensing bodies and accrediting organizations. It is important for health care
leaders to understand how their organization stands in comparison to its peers as well as what
standards it needs to meet for licensure, accreditation, and other regulatory compliance.
References
Berwick, D. (2011). Improving care for people with Medicare [Blog post]. Retrieved from
http://www.whitehouse.gov/blog/2011/03/31/improving-care-people-medicare
Institute of Medicine. (2000). To Err Is Human: Building a Safer Health System. Washington, DC: The
National Academies.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century.
Washington, DC: The National Academies.
Lee, T. H., Casalino, L. P., Fisher, E. S., & Wilensky, G. R. (2010). Perspective roundtable: Creating
accountable care organizations [Web video]. Retrieved from http://www.nejm.org/doi/
full/10.1056/NEJMp1009040
National Center for Healthcare Leadership. (n.d.). NCHL Health Leadership
Competency Model. Retrieved from http://www.nchl.org/static.asp?path=2852,3238
U.S. Department of Health & Human Services. (n.d.). Accountable care organizations.
Retrieved from http://oig.hhs.gov/compliance/accountable-care-organizations/index.asp
Youngberg, B. J. (2011). Principles of risk management and patient safety. Sudbury, MA: Jones &
Bartlett.
MHA-FP5014 Assessment 1 Context
2
Executive Summary Table
Action Step
Relevant Data
Resource Information
1. Issue.
2. Regulatory Requirements.
*Cite sources.
3. Risk Management
Implications.
4. Environmental Assessment.
* Cite tools used for analysis.
5. Resources to Address
Issue.
6. Philosophy or Culture
Statement.
*Cite source: some
possibilities are IOM
concepts, joint commission,
MAGNET, Baldrige criteria,
mission statement, or others.
7. Measurement and
Monitoring.
*Cite sources.
8. Organizational
Improvement.
*Cite sources.
9. Ethics Considerations.
*Cite sources. One option is
ACHE code of ethics.
1
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 riskmanagement 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.
Content
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 systemsbased risk-management program?
What types of considerations or cautions are important to keep in mind when
interpreting internal and external benchmarking data?
Assignment Instruction
Note: This assessment should be completed first.
Preparation
Scenario
Assume you have taken on a new role as the chief operating officer. You are
charged with leading system-wide risk-management efforts to identify risk and
minimize HACs. Your organization’s financial viability depends on receiving
proper reimbursement for services delivered. As the chief operating officer, you
must create an executive summary that describes your organization’s compliance
with the regulatory requirement, to promptly identify conditions that are POAs
and proactively assess and manage risk.
Instructions
Step One: Executive Summary Table
Select a risk-management issue within a specific health care setting or
organization. You will use this issue as a starting point for your work on this
assessment. Use the Executive Summary Table from the Required Resources to
complete this step.
1. Issue: Write a brief description of the risk-management issue you selected. Explain
why this risk-management issue is important to your organization.
2. Regulatory Requirements: Compile a list of the applicable regulatory requirements
and an explanation of what they mean to your chosen risk-management issue.
3. Risk-Management Implications: Identify the associated risk-management
implications. For example, HACs result in no reimbursement, and poor quality
ratings. Also, there is a risk of losing repeat admissions, a risk of losing Joint
Commission and Magnet accreditation or excellence, or other negative implications.
4. Environmental Assessment: Assess the internal versus external environment
relative to the risks associated with your chosen risk-management issue. You may
use strengths, weaknesses, opportunities, and threats (SWOT) analysis or another
suitable tool. Be sure to cite the source.
5. Resources to Address Issue: Describe any resources or strengths your
organization possesses that could aid in addressing the risk-management issue.
6. Philosophy or Culture Statement: Summarize your organization’s philosophy or
culture as it relates to patient safety and error reporting.
7. Measuring and Monitoring:
o Identify metrics for measuring or monitoring the risk-management issue.
o
Propose how you will make use of the outcome data for organizational
improvement.
8. Organizational Improvement: State how you will encourage voluntary reporting.
9. Ethics Considerations: Describe legal and ethical implications related to the
handling of this risk-management issue.
Utilize established sources of information. Some sources that may be useful to
you include the federal register, statutes, discipline-specific peer-reviewed
journals, and government agency references.
Step Two: Executive Summary
Using the information assembled in Step One, prepare a 3–4-page executive
summary for a written presentation to the management team. Select a format for
your summary based on your chosen organization’s standards for executive
summaries. (Examples of these types of documents can also be found using an
Internet search.) Include the following:
•
•
•
A proactive assessment of your organization’s compliance with the regulatory
requirement to promptly identify POAs and proactively assess and manage risk
based on existing regulations and requirements.
Your identification of tools and best practices for monitoring parameters and
reducing risk, including organizational structure needed for risk reeducation, as
supported by the literature.
Your recommendations for quality improvement and organization-specific risk
management and learning guidelines.
You must include the completed table from Step One as an appendix to this
executive summary.
Additional Requirements
•
Written communication: Written communication should be free from errors that
detract from the overall message. (You must include the Executive Summary Table
as an appendix to your report.)
•
•
•
•
Length of paper: 3–4 double-spaced pages for the written portion of the
assessment.
Number of resources: A minimum of three resources.
APA Format: Use appropriate APA format for clear, concise presentation of
information. Communicate information and ideas accurately, utilizing peerreviewed sources, including proper APA reference citations.
Font and font size: Times New Roman, 12 point.
Assessment 1 Context
The Regulatory Environment
Quality of Services
Following the Institute of Medicine (IOM) initial reports on patient safety and medical errors,
an increased attention and accountability has been placed on providers to improve the quality
of services (2000, 2001). Within the industry, the IOM of the National Academies released a
report in 2011 regarding systematic reviews for the promotion of patient safety and related
standards.
Potential Risks
Implicit within the quality care delivery process is the identification of potential risks, which
may ultimately affect patient care. As the delivery of care standards are increasingly refined,
cost-related metrics also must be monitored. The U.S. government, insurance companies,
and other private payers are carefully watching the evolution of care standards and cost
metrics. Health care leaders must be up to speed with quality care standards, identification of
potential risks, and compliance with relevant regulations.
An example of the integration of these concepts can be found in the launch of the accountable
care organization (ACO) concept by the Department of Health and Human Services Center for
Medicare and Medicaid Services (CMS). Secretary of Health and Human Services Kathleen
Sibelius (2011) conveyed that the HHS “team carefully weighed the interests of hospitals,
doctors, patients, and other stakeholders” when formulating the ACO roles and
responsibilities. Risk assessment, quality care, and cost considerations are incorporated into
the ACO concept (Lee, Casalino, Fisher, & Wilensky, 2011).
Regulatory Requirements
It is important to consider the National Center for Healthcare Leadership Competencies
(NHCL). Think of what types of skills will be needed to lead your organizations toward the
goal of demonstrating quality and balancing costs. You may even wish to assess your own
current competency levels relative to the health care industry’s movement toward
performance measurement and increased accountability (NHCL, n.d.).
Dr. Donald Berwick, who headed the HHS ACO efforts, discusses ACO concepts in his 2011
White House blog entitled Improving Care for People With Medicare. Dr. Berwick relates that:
Thanks to the Affordable Care Act, the Department of Health and Human Services
(HHS) today released proposed new rules to help doctors, hospitals, and other health
care providers better coordinate care for Medicare patients through Accountable Care
Organizations (ACOs). ACOs are designed to create and support a team of health
care providers who treat individual patients by working together across care settings.
Dr. Berwick (2011) adds that “ACOs would have to meet high-quality standards in five key
areas:
1. Patient/Caregiver Experience of Care.
2. Care Coordination.
3. Patient Safety.
4. Preventive Health.
5. At Risk Population/Frail Elderly Health.”
MHA-FP5014 Assessment 1 Context
1
Assessment 1 Context
Regulatory Bodies
In health care settings, there are various levels of oversight for organizations. Health care
managers must be aware of the standards required to successfully provide quality care.
Health care organizations need to comply with both regulatory standards as well as quality
indicators set by accrediting bodies. For example, the Joint Commission is an accrediting
body that sets standards for hospitals and other health care organizations. Organizations that
are accredited by the Joint Commission are held to a higher standard. Voluntary accreditation
allows health care organizations to benchmark themselves to ensure they are in line with
national standards.
Benchmarking as a Condition of Participation
Most of us have heard about benchmarking and are somewhat familiar with the concept. But,
if your supervisor walked into your work setting today and asked you to provide some internal
benchmarking data and compare it against national best practices, would you know what
action or steps to take? Furthermore, would you know what organizations develop
benchmarking standards and provide guidance for quality improvement?
Youngberg (2011), a health care patient safety and risk management expert, describes
benchmarking as the process of collecting and analyzing data to identify trends in
performance and, when compared with other collectors of the same data, identifying best
performers and determining if interventions that were introduced to address identified
problems yielded the desired results. (p. 24)
Benchmarking is not only a quality improvement tool but a condition of participation for some
government and other payer sources. An example of this can be found in the requirements for
accountable care organizations. Health care leaders must be familiar with the standards
provided by both licensing bodies and accrediting organizations. It is important for health care
leaders to understand how their organization stands in comparison to its peers as well as what
standards it needs to meet for licensure, accreditation, and other regulatory compliance.
References
Berwick, D. (2011). Improving care for people with Medicare [Blog post]. Retrieved from
http://www.whitehouse.gov/blog/2011/03/31/improving-care-people-medicare
Institute of Medicine. (2000). To Err Is Human: Building a Safer Health System. Washington, DC: The
National Academies.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century.
Washington, DC: The National Academies.
Lee, T. H., Casalino, L. P., Fisher, E. S., & Wilensky, G. R. (2010). Perspective roundtable: Creating
accountable care organizations [Web video]. Retrieved from http://www.nejm.org/doi/
full/10.1056/NEJMp1009040
National Center for Healthcare Leadership. (n.d.). NCHL Health Leadership
Competency Model. Retrieved from http://www.nchl.org/static.asp?path=2852,3238
U.S. Department of Health & Human Services. (n.d.). Accountable care organizations.
Retrieved from http://oig.hhs.gov/compliance/accountable-care-organizations/index.asp
Youngberg, B. J. (2011). Principles of risk management and patient safety. Sudbury, MA: Jones &
Bartlett.
MHA-FP5014 Assessment 1 Context
2
Executive Summary Table
Action Step
Relevant Data
Resource Information
1. Issue.
2. Regulatory Requirements.
*Cite sources.
3. Risk Management
Implications.
4. Environmental Assessment.
* Cite tools used for analysis.
5. Resources to Address
Issue.
6. Philosophy or Culture
Statement.
*Cite source: some
possibilities are IOM
concepts, joint commission,
MAGNET, Baldrige criteria,
mission statement, or others.
7. Measurement and
Monitoring.
*Cite sources.
8. Organizational
Improvement.
*Cite sources.
9. Ethics Considerations.
*Cite sources. One option is
ACHE code of ethics.
1
7/8/2019
Regulatory Environment – Executive Summary Scoring Guide
Regulatory Environment – Executive Summary Scoring Guide
CRITERIA
NON-PERFORMANCE
BASIC
PROFICIENT
DISTINGUISHED
Conduct a proactive
assessment based
on the existing
regulations and
requirements.
Does not conduct a
proactive
assessment based
on the existing
regulations and
requirements.
Conducts a proactive
assessment based on the
existing regulations and
requirements, but the
assessment is either
incomplete or flawed.
Conducts a
proactive
assessment
based on the
existing
regulations and
requirements.
Conducts a proactive
assessment based on the
existing regulations and
requirements and indicates
how regulations and
requirements are likely to
change, going forward.
Describe strategies
to influence, impact,
and monitor the
needed changes for
quality improvement.
Does not describe
strategies to
influence, impact,
and monitor the
needed changes
for quality
improvement.
Describes strategies to
influence, impact, and
monitor the needed
changes for quality
improvement, but the
description is either
incomplete or flawed.
Describes
strategies to
influence, impact,
and monitor the
needed changes
for quality
improvement.
Describes strategies to
influence, impact, and
monitor the needed
changes for quality
improvement, and outlines
challenges to implement
those strategies.
Develop a value
proposition for
change management
that incorporates
quality- and riskmanagement
concepts.
Does not develop a
value proposition
for change
management that
incorporates
quality- and riskmanagement
concepts.
Develops a value
proposition for change
management that
incorporates quality- and
risk-management
concepts, but the
proposition is either
incomplete or flawed.
Develops a value
proposition for
change
management that
incorporates
quality- and riskmanagement
concepts.
Develops a value
proposition for change
management that
incorporates quality and risk
management concepts, and
supports the proposition
with citations from the
literature.
Create an executive
summary of a riskmanagement issue
that describes an
organization’s
compliance with a
regulatory
requirement.
Does not create an
executive summary
of a risk
management issue
that describes an
organization’s
compliance with a
regulatory
requirement.
Creates an executive
summary of a risk
management issue that
describes an
organization’s
compliance with a
regulatory requirement,
but the summary is either
unclear or incomplete.
Creates an
executive
summary of a risk
management
issue that
describes an
organization’s
compliance with a
regulatory
requirement.
Creates an executive
summary of a risk
management issue that
describes an organization’s
compliance with a
regulatory requirement and
the executive summary is
concise, complete, and
convincing.
Integrate legal and
ethical principles
and also
organizational
mission, vision, and
values into the
decision-making
process.
Does not integrate
legal and ethical
principles and also
organizational
mission, vision,
and values into the
decision-making
process.
Integrates legal and
ethical principles and
also organizational
mission, vision, and
values into the decisionmaking process, but the
integration is either
incomplete or flawed.
Integrates legal
and ethical
principles and
also
organizational
mission, vision,
and values into
the decisionmaking process.
Integrates legal and ethical
principles and
organizational mission,
vision, and values into the
decision-making process
and describes the internal
and external contexts for
decision-making.
Write clearly and
concisely, with wellorganized
communication that
is supported by
relevant evidence.
Does not write
clearly and
concisely, with
well-organized
communication
that is supported
with relevant
evidence.
Writes clearly and
concisely, with wellorganized communication
that is supported with
relevant evidence, but
with some errors or
lapses.
Writes clearly and
concisely, with
well-organized
communication
that is supported
with relevant
evidence.
Writes clearly and concisely,
with well-organized
communication that is
supported with relevant
evidence from appropriate
peer-reviewed journals.
https://courserooma.capella.edu/bbcswebdav/institution/MHA-FP/MHA-FP5014/190700/Scoring_Guides/a01_scoring_guide.html
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7/8/2019
Regulatory Environment – Executive Summary Scoring Guide
CRITERIA
NON-PERFORMANCE
BASIC
PROFICIENT
DISTINGUISHED
Use correct
grammar,
punctuation, and
mechanics as
expected of a
graduate learner.
Does not use
correct grammar,
punctuation, and
mechanics as
expected of a
graduate learner.
Uses correct grammar,
punctuation, and
mechanics as expected
of a graduate learner, but
with some errors or
lapses.
Uses correct
grammar,
punctuation, and
mechanics as
expected of a
graduate learner.
Uses correct grammar,
punctuation, and mechanics
as expected of a graduate
learner, conforming to all
APA standards and
guidelines.
https://courserooma.capella.edu/bbcswebdav/institution/MHA-FP/MHA-FP5014/190700/Scoring_Guides/a01_scoring_guide.html
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