Risk and Quality Management Introductory Guide

Risk and Quality Management Introductory Guide

Overview

Quality risk management in healthcare is a systematic approach to quality improvement and management that involves improving quality through managing risks. This means that risk and quality managers must assess, control, communicate, and review risks to quality products and services in healthcare settings. Through risk and quality management, the healthcare industry guarantees that products and services do not harm the health and safety of patients and other consumers within the industry. This is an introductory guide to risk and quality management in which the principles of quality improvement and risk management in the healthcare industry, decision-making processes, risk-management tools and strategies, and quality-management tools and strategies are presented.

Overview of Risk and Quality Management

Basic Concepts of Quality Improvement in the Health Care Industry

The concept of quality in the healthcare industry differs from other industries. The World Health Organization (2022) defines quality health care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes.” The main domains of quality in the healthcare industry include safety of care, effectiveness, patient-centeredness of care, timeliness of care services and products, efficiency, and equitability of healthcare services Agency for Healthcare Research and Quality (AHRQ) (2022). Therefore, the basic concepts of quality improvement in the healthcare industry are the continuous improvement of these basic healthcare quality domains with the aim of achieving higher efficiency in healthcare delivery, reduction of cost of care, ensuring equitable and timely access to effective healthcare services and products, and providing safe care services and products to achieve high-quality patient outcomes.

Basic Concepts of Risk Management in the Health Care Industry

The healthcare industry is vulnerable to various threats and risks. As the major aspect of all domains of human existence, from economic to social domains, therefore requires absolute protection from existing threats and risks. The concepts of risk management are obviously critical to the management of quality in the healthcare industry. Experiences from the COVID-19 pandemic management process have proven the significant relationship between risk management and accreditation standards to ensure adherence to safety standards and achievement of quality outcomes (Gökmen Kavak et al., 2020). The basic concepts of risk management in the healthcare industry include using the right risk assessment methodologies, calculating risks, and safeguarding the selection criteria and objectives. Additionally, other concepts of effective risk management include incorporating risks into their decision-making processes to establish an effective risk management culture and share the risk information with critical stakeholders to support continuous improvement of the risk management process.

Decision-Making Processes

Risk management decisions are made based on the outcomes of a risk analysis (Wright & Wright, 2019). This includes obtaining quantitative analysis results of the impact of the risk on the health system or ability of the health care system, including hospitals, health care products, and services to support the delivery of safe and quality health care services. On the other hand, quality management decisions in the healthcare industry are based on how the impact of the risks can be minimized or prevented in order to guarantee the safety of delivered care and ensure high-quality health and patient outcomes.

Areas of concern during the making of risk and quality management decisions can be identified based on fluctuations within the industry, as well as internal and external factors, whether in operations, financing, product safety, or prevailing policies. These fluctuations can help identify the potential areas of concern where risks can occur, how they can occur, and their impact on the healthcare industry. It is also important to consider risk factors that exist within the industry or at the organizational level, such as human and other technical threats such as failures in either human, organizational, or technological systems (Mardani et al., 2019).

Risk and quality management decisions need to be made based on validated concerns. The areas of concern can be validated by determining the probability of the risks occurring in these areas or the factors concerned leading to the occurrence of the risks. Additionally, the concerns can be validated by considering the nature of services and products, which are related to the potential for risk occurrence and the nature and probability of the risks occurring. The concerns can also be validated based on the degree of damage the risk can cause to the organization and the health care if it occurs.

The consistency of making evidence-based decisions determines the effectiveness of risk and quality management in the healthcare industry. The best process to use is the evidence-based logic model. According to the Centers for Disease Control and Prevention (CDC) (2020), the use of the logic model helps associate an organization’s program, its resources, activities, and the intended outcomes. The logic model ensures consistency in making evidence-based decisions, assisting in setting up quality outcome goals, evaluating the risks and available resources, and identifying the potential challenges to effective risk and quality management.

Risk-Management Tools and Strategies

Two common risk management tools and strategies used in the healthcare industry are the Root Cause Analysis (RCA) and the probability and impact matrix. The RCA technique can help identify the potential risk within an area of concern, the related factors of the risks, and why such factors are more likely to cause the risks. It can also help identify how the medical, clinical, and other staff will respond to the risk. Although the RCA can help answer the questions of what, when, why, who, and why of risk and provide a logical approach to risk management, it can only be utilized after the risks have occurred.

The probability and impact matrix identifies the probability of a risk occurring and its impact on the healthcare organization. The tool uses probability and impact scores to prioritize risks. It can also help plan risk management approaches based on the context of the risk. The probability and impact matrix is simple to use as it does not require complex risk analyses. However, it fails to make use of quantifiable data, which may lead to incomplete risk management and the development of a false sense of safety.

Quality-Management Tools and Strategies

Two major quality-management tools or strategies used in the healthcare industry include Total Quality Management (TQM) and the Lean methodology. The TQM approach is used to plan and control the operations of the healthcare industry to meet patient and community expectations. Although the TQM approach helps improve employee engagement and productivity while reducing wastage by improving the efficiency of processes, it can be complicated and costly to implement.

Lean methodology focuses on centering the healthcare industry operations on the patient. Therefore, it helps create for the patient by continuously improving the efficiency of health care operations. Lean methodologies help achieve value-based care by reducing waste and motivating the staff. However, Lean methodologies may fail due to the lack of a specific implementation strategy. Lean methods are also not applicable in low-resource healthcare settings.

Summary

Risks and quality management are essential processes in the healthcare industry, as risks that define safe and quality care within the industry are inevitable. Applying risk- and quality-management decisions in the healthcare industry faces various challenges related to the unpredictable nature of the healthcare industry, hence unpredictable risk, the lack of uniform economic capacities among consumers and providers, economic instability and unpredictability, and the diversity of risk knowledge among the industry’s consumers.

 References

Agency for Healthcare Research and Quality (AHRQ). (2022, December). Six Domains of Healthcare Quality | . https://www.ahrq.gov/talkingquality/measures/six-domains.html

Centers for Disease Control and Prevention (CDC). (2020, November 17). Logic Model. CDC. https://www.cdc.gov/tb/programs/evaluation/Logic_Model.html

Gökmen Kavak, D., Öksüz, A. S., Cengiz, C., Kayral, İ. H., & Çizmeci Şenel, F. (2020). The importance of quality and accreditation in health care services in the process of struggle against COVID-19. Turkish Journal of Medical Sciences, 50(8), 1760–1770. https://doi.org/10.3906/sag-2007-279

Mardani, A., Hooker, R. E., Ozkul, S., Yifan, S., Nilashi, M., Sabzi, H. Z., & Fei, G. C. (2019). Application of decision making and fuzzy sets theory to evaluate the healthcare and medical problems: A review of three decades of research with recent developments. Expert Systems with Applications, 137, 202–231. https://doi.org/10.1016/J.ESWA.2019.07.002

World Health Organization. (2022). Quality of care. WHO. https://www.who.int/health-topics/quality-of-care#tab=tab_1

Wright, J. F., & Wright, J. F. (2019). Decision-making in Risk Management. Perspectives on Risk, Assessment and Management Paradigms. https://doi.org/10.5772/

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Risk and quality management are the responsibility of all employees. As a healthcare manager, it is important that you are able to communicate the importance of these topics to your team members.

In this assignment, you will demonstrate the skill of risk management by evaluating appropriate decision-making processes in risk and quality management as you prepare an introductory guide on the basic concepts of risk and quality management. You will apply the risk- and quality-management concepts you’ve learned to the healthcare industry.

Risk and Quality Management Introductory Guide

Assignment Directions
Create a 3- to 4-page quality- and risk-management introductory guide. Include the following sections in your guide:

Overview
Explain the basic concepts of quality improvement in the healthcare industry.
Explain the basic concepts of risk management in the healthcare industry.
Decision-Making Processes
Explain the information needed for making risk-management and quality-management decisions in the healthcare industry. Consider the following in your explanation:
How do you identify your areas of concern?
What data do you need to validate your concerns?
What process or methods do you use to ensure consistency in making evidence-based decisions?
Risk-Management Tools and Strategies
Evaluate 2 risk-management tools or strategies used in the healthcare industry. Include the following:
Explain the purpose of each tool or strategy.
Explain the advantages and disadvantages of each of the tools or strategies you selected.
Quality-Management Tools and Strategies
Evaluate 2 quality-management tools or strategies used in the healthcare industry. Include the following:
Explain the purpose of each tool or strategy.
Explain the advantages and disadvantages of each of the tools or strategies you selected.
Summary
Explain challenges in applying risk- and quality-management decisions in the healthcare industry.

Cite 3 references to support your assignment.