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Learn about the major challenge of balancing high-quality patient care and controlling costs in healthcare, and why patient satisfaction is not always correlated to the amount spent. Discover various quality improvement programs and the role of Centers for Medicare & Medicaid Services (CMS) in decreasing costs while maintaining quality. Understand the importance of customer service, both internal and external, and how it impacts patient satisfaction and potential lawsuits. Explore methods to assess customer satisfaction and strategies for resolving issues with unhappy customers and constructive criticism.
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Chapter 23 Performance Improvement and Customer Service
Quality of Care • Major challenge • Balance between high-quality patient care and controlling costs • Patient satisfaction not correlated to amount spent • Difficult to measure
Quality Improvement • Role of Centers for Medicare & Medicaid Services (CMS) • Decrease costs while maintaining quality • Quality Assessment and Performance Improvement (QAPI)
Question • True or False: • The U.S. ranks highest in quality of health care.
Answer • False • U.S. ranks highest in health care costs • But not in quality of care
Quality • Quality of input resources • Quality of process of delivery of services • Quality of outcome of service
Quality Programs • Continuous quality improvement (CQI) • Quality assurance (QA) • Quality improvement (QI) • Performance improvement (PI) • Total quality management (TQM) • Utilization review (UR) • Quality improvement organization (QIO)
Evaluation Areas • Organizational structure • Health care workers • Patient outcomes
Question • Which of the following refers to the evaluation of the necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities? • QIO • CQM • UR
Answer • C. UR • UR • Evaluation of necessity, appropriateness, and efficiency of use of health care services, procedures, and facilities
Answer • C. UR • QIO • Organization contracted by CMS • CQM • Approach to health care quality management
Customer Service • Essential to success • Internal customers • External customers
Customer Service • Customers evaluate entire experience • Avoid slipping into automatic mode • Focus on patient • Lawsuits most commonly related to whether patient likes health care workers • Fewer long-term relationships in health care
Lawsuits • May be frivolous • Time and money spent • Stress • Many can be avoided by working to ensure customer satisfaction
Question • True or False: • Whether a lawsuit is filed or not is frequently based on whether the patient liked the health care professional.
Answer • True • Lawsuits brought by patients more closely related to whether patient does or does not like health care professional than any other factor
Customer Satisfaction • Methods to assess: • Mail questionnaires • Call customers • Maintain log of complaints • Satisfaction subjective
Customer Satisfaction • When working with unhappy customer: • Identify problem • Seek resolution • Verify satisfaction
Internal Customers • Those working in health care industry • Areas of focus: • Good relationships with coworkers • Job satisfaction and pride in work • Constructive criticism • Destructive criticism
Question • True or False: • Destructive criticism is never a positive event.
Answer • False • Destructive criticism hard to receive, but looking for “kernel of truth” can be beneficial
