MHA-FPX5014 Health Care Quality, Risk, and Regulatory Compliance
Assessment 1 Instructions: Regulatory Environment – Executive Summary
This assessment is 2 parts. 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.
Introduction
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.
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.
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 systems-based risk-management program?
• What types of considerations or cautions are important to keep in mind when interpreting internal and external benchmarking data?
Overview and Preparation
The following resource is required to complete this assessment. You will fill out the Executive Summary Table and turn in the completed form separately.
Executive Summary Table [DOCX].n (attached)
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 linked above to complete this step.
Issue: Write a brief descriiption of the risk-management issue you selected. Explain why this risk-management issue is important to your organization.
Regulatory Requirements: Compile a list of the applicable regulatory requirements and an explanation of what they mean to your chosen risk-management issue.
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.
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.
Resources to Address Issue: Describe any resources or strengths your organization possesses that could aid in addressing the risk-management issue.
Philosophy or Culture Statement: Summarize your organization’s philosophy or culture as it relates to patient safety and error reporting.
Measuring and Monitoring:
Identify metrics for measuring or monitoring the risk-management issue.
Propose how you will make use of the outcome data for organizational improvement.
Organizational Improvement: State how you will encourage voluntary reporting.
Ethics Considerations: Describe legal and ethical implications related to the handling of this risk-management issue.
Utilize established sources of information. 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. Must be relevant, scholarly, current (within 5 years)
APA Format: Use appropriate APA format for clear, concise presentation of information. Communicate information and ideas accurately, utilizing peer-reviewed sources, including proper APA reference citations.
Font and font size: Times New Roman, 12 point.
Competencies Measured
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 risk-management 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.
