Care Management Model Essay

3680 words - 15 pages

Care Management Mode PAGE \* MERGEFORMAT 21
CARE MANAGEMENT MODELAbstractOrganizational directions are influenced by many factors. This paper will explore four factors that share influence in health delivery organizations and characterize effective systems designs. Most of these have been integral parts of healthcare for some time, but until the latter part of the twentieth had not held as prominent a place in the organizational structure. Quality improvement, change, care management, values and outcomes in an hypothesized dialysis unit are presented to show the integration and possible implementation of the philosophies, tools and strategies learned in this managed care methodologies course.Quality ManagementHealthcare at one time considered itself insulated from market forces until the early nineties. Changes in the form of Medicare reimbursements and a move towards managed care drove healthcare to analyze and adapt quality control efforts in a quantitative method rather than descriptive and prescriptive modalities. Integration and implementation of quality control and management theories have resulted in a less than homogeneous consensus on a single quality system. Rather, a succession of philosophies, systems, and tools have been embraced and subsequently discarded. Due in large part to the diverse nature of the healthcare services rendered, codification of a single, total quality management entity is a virtual impossibility.Quality improvement and assurance programs are imperative for healthcare facilities to maintain standards of care. The complexity of treatment and equipment has increased dramatically in the last several decades necessitating continuous education and retraining for healthcare professionals. Quality management works on both prevention and improvement of existing systems. The capability to determine and meet the needs of the patient also impacts the resources allotted and required. The American Nurses Association's Scope and Standards for Nurse Administrators cites the need for quality assurance and improvement programs to be in place in any setting served by organized nursing services (ANA, 2004)No single philosophy can be generalized to fit all healthcare systems; however Deming built a firm foundation when he established a quality management framework for post war Japan. Deming enumerated fourteen points that help promote quality. These points emphasized using teamwork and education with worker input to improve quality and increase production (Stratton, 2000).Division of labor is the basic concept of Deming; the workers do the work and the managers improve systems (Swansburg, 1998). Deming devised the concept of total quality management in a model called the PDCA or Shewhart cycle. This model calls for P-plan, D-do, C-check and A-act (Kelly, 2007).Deming stressed that collaboration of multidisciplinary teams improves the channels of communication. Solutions to potential and ongoing problems are consequently more...

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