Discuss how quality improvement plays an important role in today’s healthcare industry

Discuss how quality improvement plays an important role in today’s healthcare industry.

Quality improvement is a process that healthcare organizations use to identify problems and then implement solutions that aim to improve patient care. Quality improvement initiatives can be small-scale, such as improving hand hygiene compliance among staff, or large-scale, such as redesigning the way care is delivered for a specific disease.There are many reasons why quality improvement is important in healthcare. First, improving the quality of care can lead to better outcomes for patients. For example, when hospitals implement evidence-based practices for managing heart failure, they see fewer patient deaths and readmissions.

Second, quality improvement can help reduce healthcare costs. For example, by preventing hospital-acquired infections, hospitals can avoid the costs associated with treating these infections. Finally, quality improvement can help increase patient satisfaction. When patients receive high-quality care, they are more likely to be satisfied with their experience and recommend the hospital to others.Healthcare organizations have been working on quality improvement initiatives for many years. However, the focus on quality has become even more important in recent years as the healthcare industry has come under greater scrutiny. With the passage of the Affordable Care Act, hospitals are now being held accountable for the quality of care they provide. This means that they must continuously

Include the following in your discussion: EHR, external government  agency influences, internal organization influences, continuous improvement, performance improvement and assessment, patient safety, utilization management, reliability sciences, the purpose of a quality management plan, and  how an improvement project team can assist with continuous improvement.

Prepare this assignment using the following guidelines:     2,000 – 2,500 words     APA-compliant formatting, including title and reference pages     Include biblical foundations application section (500 – 750 words)     Minimum of five scholarly references (Discuss how quality improvement plays an important role in today’s healthcare industry.)

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

  1. Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse\’s role and responsibility.
  2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
  3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
  4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.
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You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.  

Prepare this assignment according to the guidelines found in the APA Style Guide, (Discuss how quality improvement plays an important role in today’s healthcare industry.) (Discuss how quality improvement plays an important role in today’s healthcare industry.)

The Effect of Affordable Care Act of 2010 on Nursing Practice, Nurses’ Role and Responsibility

From the early 1900s, US presidents had envisioned an all-inclusive health care coverage that would ensure universal access to high–quality healthcare in this country. A principal component of this healthcare system is to go past ensuring coverage, a delivery system that is efficient and affordable. According to Erickson et al. (2020), basic restructuring of both payment policies and delivery systems is needed to realize a system of healthcare that gives prominence to patients’ interests first. However, the providers and their care teams need support to deliver patient and family- focused care of high-quality value that is also affordable. Come March 2010, and then-president Barrack Obama appended his signature of the Affordable Care Act of 2010. The act demands most US citizens apply for health insurance coverage and levies penalties for individuals who do not comply while simultaneously making exceptions for a few protected groups. Among other elements, the ACA provides healthcare professionals with a chance to shape patient services delivery. Nurses who comprise the single largest healthcare profession as current and future decision-makers in healthcare have to reflect on actualizing these results in their places of work. Consequently, this paper purposes of outlining ACA of 2010 with a bias towards the sections that reform the healthcare delivery and payment system. It further describes the impact of ACA on nursing practice amongst other salient factors that affect the US healthcare system today. 

Outline of ACA of 2010 and How It Reforms Healthcare Delivery and Payment of Services

The ACA of 2010, popularly referred to as Obamacare, mandates that more than 200 workers must provide health insurance coverage and establish the American Health Benefits Exchange, where citizens can review and compare insurance plans. Obama (2016) notes that healthcare costs impact the economy, the federal budget, and almost every American’s well-being. Health insurance helps children gain academic excellence at school, grownups to be more productive at work, and Americans of all ages t to enjoy longer, healthier lives. Studies indicate that the US spends more on health care than other first-world countries but has lower insurance coverage rates and produces health outcomes that are both variable and uneven (Erikson et al., 2020). A case in point is that the fee-for-service (FFS) payment system pegs reimbursement for providers and other healthcare professionals on the number of appoints, tests, or procedures availed to the patient instead of the quality or appropriateness of the given services. This payment has seen the introduction of Value-based payment (VBP), alternative payment models (APMs). (Discuss how quality improvement plays an important role in today’s healthcare industry.) (Discuss how quality improvement plays an important role in today’s healthcare industry.

Moreover, delivery systems interventions were formulated to shift payment premised on the number of services to payment models that encourage high-quality, cost-effective care. Lasater et al. (2016) note that the ACA 2010 VBP program has positively impacted nursing practice in that it has led to improved, high quality, and effective patient experience and safety of care. The Magnate concept further incentivizes hospitals to foster a culture where nurses have a role and responsibility to prioritize clinical and administrative contributions that improve patient care.

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How Quality Measures and Pay for Performance Impact on Patient Outcomes

Pay for performance, synonymously referred to as performance-related pay, and refers to company programs that pay workers based on how they perform on their job. From a theoretical point of view, P4P programs would help support the behavior of healthcare professionals to improve the quality of care delivered, decrease unwarranted use of costly health care services, and improve a patient’s health outcomes (Mendelson et al., 2017). Most importantly, quality measures in the P4P initiatives allow healthcare facilities to benchmark performance against peers and offer consumers and insurers a common metric value to assess and evaluate hospital quality. Subsequently, nurses have a responsibility to ensure that the more than 1000 quality measures defined by the National Quality Forum, the measures that matter to nursing professionals are realized. Under outcome measures provide an insightful look at how hospital performance changes over time and how their organization compares with peers. Nurses have a critical role to play in uncovering the causes that lead to different outcomes. For example, the nurse is responsible for ensuring a patient gets all the recommended and prescribed medications. In surgical patients, the nurse has to ensure all best practices for wound care have been strictly adhered to. Similarly, the purview of process measures means the concerned nurse can address a recommendation for antiplatelet therapy after stent implantation is followed. In a nutshell, utilizing nursing-sensitive quality measures is bound to help the healthcare industry move towards evidence-based practice where payment is pegged on value (WHO, 2016).

Emerging Professional Nursing Leadership and Management Roles

A nurse leader is defined as an individual nurse interested in excelling in a career path to practice at the top of their licensure. As Ens et al. (2018) observe, Key Message #3 of the IOM Report states that nurses should be full partners with physicians and other healthcare professionals redesigning the US healthcare system. Whether taking the role of a nurse leader at the organizational level or managerial role, the nurse of the 21st century must increasingly be aware that there exists a strong correlation between a cohesive healthcare team and singular achievements in inpatient quality and safety. This correlation is true in acute care and long-term care settings implying that the nurse leader or nurse manager must have a thorough understanding of how to integrate strategic steps to ensure long-term success in day-to-day activities. Additionally, the nurse leader/manager is expected to solve issues connected to bedside care and patient safety against a backdrop of financial constraints and staffing shortages. Be that as it may, nursing leadership and management manifest their best when the entire healthcare team is also successful.

Prediction of Two Ways in Which Nursing Practice and Nursing Roles Will Transform between 2022 and 2026

Trends in the current US healthcare system consist of several polarizing issues like the rise of collaboration, the emergence of cutting-edge technology and its roles and impact on healthcare, the shift towards value-based care, and the inexorable move towards a single-payer system. Due to the limited scope of this essay, only two predictions w namely the rise of interprofessional collaboration and the move towards single-payer, will be elaborated. The next five years will increase interprofessional collaboration as doctors continue to leave their consultant offices and work in hospitals. This collaboration will lead to more centralized healthcare that focuses on the strengths and specialties of both nurses and doctors, thus achieving higher value (Vogenberg & Santilli, 2019). The US is the only country in the developed nations without a national healthcare system. A careful examination of the current changes in healthcare, like the shift towards value-based payment and the shift towards collaboration instead of competition, helps one identify that single-payer healthcare is on the horizon (Glied et al., 2019). A single paper system offers the promise of universal coverage, ensures equity and affordability at the point of service, amongst other benefits. 

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Conclusion

To sum up, this paper has established that trends in the US healthcare system continue to emerge or grow into maturation under the ACA of 2010. Additionally, federal policy proposals and regulatory changes continue to reshape commercial insurance. Finally, reforms in US healthcare payments have seen the numbers of individuals under VBP continue to increase and appear headed towards a single-payer system in the next five years. (Discuss how quality improvement plays an important role in today’s healthcare industry.

References

Ens, B., Bazylewski, S., & Duchscher, J. B. (2018). Emerging Nursing Leadership Issues. Leadership and Influencing Change in Nursing.

Erickson, S. M., Outland, B., Joy, S., Rockwern, B., Serchen, J., Mire, R. D., & Goldman, J. M. (2020). Envisioning a better US health care system for all: health care delivery and payment system reforms. Annals of internal medicine172(2_Supplement), S33-S49.

Glied, S., Black, M., Lauerman, W., & Snowden, S. (2019). Considering “single payer” proposals in the US: lessons from abroad. Issue Brief (Commonw Fund)2019, 1-10.

Lasater, K. B., Germack, H. D., Small, D. S., & McHugh, M. D. (2016). Hospitals known for nursing excellence perform better on value based purchasing measures. Policy, Politics, & Nursing Practice17(4), 177-186.

Mendelson, A., Kondo, K., Damberg, C., Low, A., MotĂşapuaka, M., Freeman, M., … & Kansagara, D. (2017). The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review. Annals of internal medicine166(5), 341-353. (Discuss how quality improvement plays an important role in today’s healthcare industry)

Obama, B. (2016). United States health care reform: progress to date and next steps. Jama316(5), 525-532.

Vogenberg, F. R., & Santilli, J. (2019). Key trends in healthcare for 2020 and beyond. American health & drug benefits, 12(7), 348.

World Health Organization. (2016). Strategizing national health in the 21st century: a handbook.

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