Quality assurance in managed care organizations and hospitals is evaluated using a number of mechanisms. The first mechanism is the employment of quality programs. Quality programs include all programs and activities put in place by organizations and the government to ensure that quality in maintained (Berger, 2011). The major activities of this program include assessment of quality assurance plan, assessment of the work plan, assessment of quality activities and studies, assessment of an organization’s staffing and organization, assessment of the effectiveness of the credentialing program, assessment of the effectiveness of medical records management system, assessment of the effectiveness of the quality of care complaints, and assessment of delegated activities. Apart from that, another mechanism through which quality assurance can be implemented is through conduction of internal complain and appeal program. This program assesses the effectiveness of the complaints program and how it is helping to improve quality in health institutions (Iglehart, 2011). It takes into account the number of quality related complains over a predetermined period and assesses the effectiveness of the corrective measure undertaken by the organization. This helps in ascertaining the effectiveness of the program in restoring quality and managed health care. This program also helps in assessment of the reliability of the record keeping system for complains and appeals. In addition to that, this program enables for conduction of on-site reviews with the aim of ensuring that all complains are addressed in the right manner for the restoration of quality (Steele and Merrick, 2013).
Assessment of the availability and accessibility of medical services is another important way through which quality assurance can be conducted (Iglehart, 2011). This mechanism looks into the geographic location of health service providers, ways of conducting referrals, ease of access to emergency care section, continuation of care after first treatment, coordination and cooperation of health personnel during health care activities, effectiveness of the appointment scheduling, and access to chiropractic and ob-gyn health care services. This program enables for site visits of the health care providers to ensure that they comply with the set health care guidelines, laws, and rules.
In addition to the above mechanisms, health care assurance can also be conducted through utilization review program. This program helps in the reviewing of an organizations staffing needs, application of industry standards, qualifications of the quality assurance personnel, and effectiveness of the procedure used during appeals and complains (Lovaglio, 2011). This program assesses the utilization of assets, time, and other resources at health organization to ensure that there is effective management and use of resources. According to Berger (2011), underuse, misuse, and overuse of resources is one of the major sources of poor quality health care. Organizations need to ensure that they maintaining an up to date schedule of the use of resources and assets to ensure that all resources are optimally used in delivery of health care services.
Quality ratings for health care services can be formulated through a number of mechanisms. The first way of formulating the quality rating of health care services is through evaluation of the process of health care delivery (Steele and Merrick, 2013). This mechanism assesses if patients follow the required procedures when getting medication. It assesses the procedures followed for outpatient, inpatient and emergency services and evaluates whether these procedures are effective in delivering quality services. It assesses the procedures followed in administering medicines and continuation of medication after the first treatment of a patient. This mechanism also assesses if patients are given the right medicines, procedures used in examining patients, medical advice and counselling given to patients, and accessibility of health care in an organization. Consideration of all these elements and functionalities helps in the rating of the quality of a health care institution.
Another major approach used in formulating quality ratings of health care services is through evaluation of health care outcomes. This approach assesses the impact of treatment on a patient and its effectiveness in alleviating suffering and pain (Felland, Ginsburg and Kischbauch, 2011). It assesses the outcomes of a predetermined number of patients after treatment at a health facility. It looks into the total time taken for one to receive full medication, the time taken for one to heal after treatment, the time taken for a medical condition to re-emerge after treatment, complications arising after medication, and the side effects encountered by a patient after medication. Assessing these factors helps one to determine the level of quality of medical services offered by a health institution. It also helps in determining the effectiveness of medications offered at a health institution and highlights the major areas that need improvement (Lovaglio, 2011).
Apart from the above strategies, another method used in formulating quality ratings of a hospital is through assessment of the experience of patients and their relatives. This helps in getting the different opinions on the efficiency and quality of services offered at a hospital (Felland, Ginsburg and Kischbauch, 2011). Getting patients feedback and opinions also helps in getting firsthand information on patient handling procedures, effectiveness of treatment and efficiency of service delivery at a health facility hence enabling for easy rating. Getting patient’s feedback also gives the overall satisfaction level of patients hence enabling for easy rating of services offered. Apart from that, patient’s feedback also helps assessors to know if the after service procedures and processes are effective in ensuring that a patient gets healed or not. This gives a better position to know the rating of health care services (Lovaglio, 2011).
Apart from the above methods of measuring health care quality, one can also use a number of programs and tools to asses and verify the quality of health care. The first tool that can be used is the health plan employer data and information set (HEDIS). This program examines if a health care provider follows all the set standards and rules and rates a hospital after the assessment. Another program that is very useful in quality assurance is the consumer assessment of healthcare providers and systems (CAHPS) (Iglehart, 2011). This program uses patient feedbacks and surveys to report experiences and level of service quality of a hospital. Apart from that, another major program used in evaluation and assessment of health care quality is ORYX. This program assesses the performance of hospitals and nursing homes hence giving a rating for the quality of services delivered. The Medicare health outcome survey is also another important tool in quality assurance and assessment. It helps in assessing the sanity and mental well-being of health care givers hence ascertaining their level of accuracy and efficiency in service delivery (Iglehart, 2011). The nursing home compare is another important tool in health care assessment and management. It compares the efficiency and quality of service delivery in many hospitals hence giving a rating of the level of service delivery.
In conclusion, it is evident that measuring and assessing a hospital’s quality of service delivery is essential in maintaining high quality health care (Steele and Merrick, 2013). Quality assurance helps in restoring the quality of service delivery in health care institutions hence ensuring that there is delivery of quality services. It helps in assessing and discovery of underused, overused, and misused assets in a health care setting hence enabling for efficient allocation and use of resources. Quality assurance also helps in the discovery of poor patient handling strategies, poor health care procedures, and poor management of time hence enabling for restoration of efficiency and service quality (Felland, Ginsburg and Kischbauch, 2011).