Analysis of how the CQI process is different from TQI.

Ante- OBAMA era and post- OBAMA era, healthcare organizations in the U.S., will continue to face some serious health care challenges. Medicare, OBAMA care, Long-term care (LTC) and Insurance are some of the issues that are currently on the brinks of change. However, despite all the down play and rhetoric, OBAMA care, has offered relief to countless individuals and families. The U.S. health care industry, has continually improved their services to provide the highest quality at the best cost over the past few years. Continuous Quality Improvements (CQI) is an approach to quality management that builds upon traditional quality assurance methods by emphasizing the organization and systems: it focuses on "process" rather than the individual; it recognizes both internal and external "customers"; it promotes the need for objective data to analyze and improve processes. CQI has been used more in the manufacturing world as compared to the healthcare industry. In addition, CQI is an analytical decision making tool which allows you to see when a process is working predictably and when it is not. The core concepts of the CQI are as follows: Core Concepts of CQI Quality is defined as meeting and/or exceeding the expectations of our customers. Success is achieved through meeting the needs of those we serve. Most problems are found in processes, not in people. CQI does not seek to blame, but rather to improve processes. Unintended variation in processes can lead to unwanted variation in outcomes, and therefore we seek to reduce or eliminate unwanted variation. It is possible to achieve continual improvement through small, incremental changes using the scientific method. Continuous improvement is most effective when it becomes a natural part of the way everyday work is done. The CQI is managed and led by the individuals or members who are able to analyze and interpret the data and then translate those interpretations into action. The traditional approach to strategic planning processes starts with an analysis based on SWOT (strengths, weaknesses, opportunities, threats) or its reframed counterpart TOWS (threats, opportunities, weaknesses, strengths). Secondly, in 1987, the Joint Commission for Accreditation of Health care Organization (JCAHO) , launched the “agenda for change” , which were initiatives that were designed to base accreditation of health care organizations such as hospitals , clinics, and long-term health care facilities on implementation of a quality improvement model of management . Just here of late, quality health care is well sought after. Consequently, leaders in every field especially the health care industry are constantly striving for quantifiable evidence , evidence that validates the data that substantiates improvements initiatives or strategic methods of improvements in production of services and delivery. Hospital leaders are responsible for indoctrinating healthcare workers a strong quality driven work environment. Every professional should continue to strive to provide the best affordable quality service or health care with zero defects. For example, this Pareto chart reflects trending patterns cited during production processes. This Pareto chart tool, lean or other six sigma methodologies can be used to engage the medical providers, by providing illustrations of data that is representative of some of the varied defects, which occurred or were cited during quality inspections of production of services. The CQI system was all part of the bigger vision which is the total quality of management (TQM) system or Quality Management System (QMS). “Increased emphasis is being placed on the continuous quality improvement (CQI) education of residents of all specialties.” (Jones, K. B., Gren, L. H., & Backman, R. (2014)) Total Quality Management (TQM) is a comprehensive and structured approach to organizational management that seeks to improve the quality of products and services through ongoing refinements in response to continuous feedback. Fourthly, leaders are able to use these important pieces of information, when urgent business decision making is necessary and gage the resources needed to perform general job duties. This advantage gives the managers insight of what areas have higher risk probability, and how to address and more important create a contingency plan, in any event. Taking precautions on the front end, and addressing the issues before they happen is always good sound management. Return on Investment (ROI) provides a figure for the ratio of savings to the cost of the investment. Businesses benefit from implementing strategic goals that aim total Quality Improvements (TQI). TQI address the upstream or preventive management. The results of a TQI are most beneficial when planning for long-term business goals and quality and applicable when making assessments and gauging. It is imperative; we properly take into account the information that is possible in these reports. According to Farruggia, to accomplish the necessary transformation in TQI , the infrastructure of the organization must change. In conclusion, “in the current market economy, companies are constantly struggling to achieve a sustained competitive advantage that will enable them to improve performance, which results in increased competitiveness, and of course, profit.” (Cătălin, S. H., Bogdan, B., & Dimitrie, G. R. (2014)). Improved quality inherently lowers costs as it provides better service. The benefits of using a CQI include higher quality of service delivered, happier patients and customers, and lower costs. According to , Mayer, Jones, Dowling-Lacey, Nehchiri, Muasher, Gibbons, & Oehninger TQI is sometimes confused with quality control (QC) and quality assurance (QA), there are major differences between the three quality plans: (i) QC is an activity designed to ensure that a specific element within the laboratory is functioning correctly; (ii) QA is a comprehensive program designed to look at a laboratory as a whole and to identify problems or errors that exist in an attempt to improve the entire process; (iii) TQI is also a comprehensive monitoring process designed not only to detect and eliminate problems, but also to enhance a laboratory's performance by exploring innovation and developing flexibility and effectiveness in all processes. Quality improvement requires five essential elements for success: fostering and sustaining a culture of change and safety, developing and clarifying an understanding of the problem, involving key stakeholders, testing change strategies, and continuous monitoring of performance and reporting of findings to sustain the change. References 1. Cătălin, S. H., Bogdan, B., & Dimitrie, G. R. (2014). THE EXISTING BARRIERS IN IMPLEMENTING TOTAL QUALITY MANAGEMENT. Annals Of The University Of Oradea, Economic Science Series, 23(1), 1234-1240. 2. Jones, K. B., Gren, L. H., & Backman, R. (2014). Improving Pediatric Immunization Rates: Description of a Resident-Led Clinical Continuous Quality Improvement Project. Family Medicine, 46(8), 631. 3. Farruggia, M. J., & Farruggia, M. H. (1995). TQI: BLENDING THE OLD WITH THE NEW. Nursing Management, 26(4), 67-68. 4. Mayer, J. F., Jones, E. L., Dowling-Lacey, D., Nehchiri, F., Muasher, S. J., Gibbons, W. E., & Oehninger, S. C. (2003). Total quality improvement in the IVF laboratory: choosing indicators of quality. Reproductive Biomedicine Online (Reproductive Healthcare Limited), 7(6), 695-699.

Analyze how Health Care Providers Address Issues of Quality

Leaders in health care and providers of health care services are all striving to improve the cost and quality of services being provided to their customers. However, understanding disparities in health care access is imperative; when attempting to identify a solution. For many health service providers, the primary business organizational goal is, to always look for ways to improve the quality of life or service, life expectancy, overall physical, social, and mental health status, disease prevention by detection and disability and easy entrance into the health care system for customers. To fully address these concerns, it is necessary that everyone has equal low- cost access, to an affordable comprehensive plans and quality health care services. By addressing, some of the most chronic illnesses before-hand, will make a whole lot of financial difference in the bottom line long-term. These financial savings makes possible, funding for other critical the long –term strategic planning. Access to all sorts of information and services, is paramount in efforts to prevent and improve social, economic, mental and physical levels of accomplishments individually and as a community. Therefore, great communication, information systems (IIS) and Public Relations (PR) skills, will help to deliver pertinent information to the right audience and in timely manner. Social, economic and health equity, concerns continues plague the U.S. until this day. Equitable access to health services assures timely use of personal health services to achieve the best health care results individually. Firstly, access to health care services in the U.S., undeniably for many years has had the most negative and devastating consequence in minority communities. Fortunately, OBAMA care has been the panacea to some individuals and families when dealing with their health care woes. The "Universal healthcare" or "universal coverage" is an ideal concept that refers to a situation where everyone is covered for basic healthcare services, and no one is denied care as long as they are legal residents of the U.S. And of course with the recent illegal massive immigration influx, this too has added more complexity to an out of control situation, as it were with policies, rules and regulations. In certain countries, like Russia, and throughout the world countries offer healthcare universally, to all their citizens, in public and private sectors, and not through single-payer systems. Nevertheless, there are a few steps that can be taken to alleviate access problems and are as follows: a. provide efficient and coordinated care for patients and extend the reach of each provider b. Ensuring that all staff members are professionally trained and educated c. Removing barriers to practice, which exist at the state and federal levels, for established professions Secondly, Quality of services in health care is most important, when it applies to that individual, more so than in any other sector. “The need to improve quality of care represents a major goal of all health care systems.” (Montgomery, A., Todorova, I., Baban, A., & Panagopoulou, E. (2013) However, overall else, improving health care services depends on the patient’s ability to gain and maintain some level of consistent coverage so that they are in position to be monitored , assessed and tracked. Beyond everything, the quality concept is based on zero defects. There are several methods used for improving the quality of services and are as follows: a. Setting goals and investing in whatever catalyst will help you to reach your business goals b. Tracking and measuring your goals at increments c. Conducting interviews and surveys regularly Lastly, customer satisfaction is the most important feedback that any business manager seeks. “In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives.” (Wu, Z., Robson, S., & Hollis, B. (2013) Customer satisfaction is based purely on the experience that clients have had with your organization. The level of satisfaction determines rather or not the customer will return to your place of business or not. There are multiple ways to keep your customer coming back and are as follows: a. Thank all your customers for their business b. Try to impress your customers as if you want a pay raise c. Think about your paycheck every time you talk to a customer In conclusion, “despite decades of progress globally there is still an unacceptable level of preventable illness and death, and millions of people are denied their basic right to health.” (Grgić, M., Bilas, V., & Franc, S. (2014) Additionally, health care professionals should be informed and trained with providing information to patients in hospitals and nursing homes or any facility that are places of public accommodation covered by Title III of the ADA. In addition, all governmental organizations and other places with public accommodation, such as hotels, retail establishments, restaurants, and museums are all good starting places for reaching out to the right potential customer. Furthermore, adequately staffing the health workforce with those professionals that daily meet or exceed the needs of the people in the community in many ways, is your ideal candidate. References 1. Grgić, M., Bilas, V., & Franc, S. (2014). IMPROVEMENT OF HEALTH CARE SYSTEMS FUNCTIONING AS AN ELEMENT OF ALLIVIETING POVERTY. Global Conference On Business & Finance Proceedings, 9(1), 407-412. 2. Montgomery, A., Todorova, I., Baban, A., & Panagopoulou, E. (2013). Improving quality and safety in the hospital: The link between organizational culture, burnout, and quality of care. British Journal Of Health Psychology,18(3), 656-662. 3. Wu, Z., Robson, S., & Hollis, B. (2013). The application of hospitality elements in hospitals. Journal Of Healthcare Management / American College Of Healthcare Executives, 58(1), 47-62.

Implement a TQM System

The Health care system in the U.S. in 2014 customarily scrambles to characterize better methods for delivering cost cutting solutions. Continuous Quality Improvement (CQI), sometimes referred to as Performance and Quality Improvement (PQI), is a process of creating an environment in which management and workers strive to create constantly improving quality. Implementing a fully functional total quality management (TQM) system can be time consuming and cost your organization massive funding. Reports, with findings based on improvement efforts, are issued periodically to personnel throughout the agency and provide information useful for improving programs and practice. CONTINUOUS QUALITY IMPROVEMENT TEAM ROLES ARE AS FOLLOWS: • Chair/Facilitator - facilitates Continuous Quality Improvement meetings, champions the Continuous Quality Improvement process and coordinates input and feedback to staff. • Scribe - takes detailed meeting minutes, schedules meeting room. • Member - participates in review of issues referred to the Continuous Quality Improvement team; provides feedback to peers, stakeholders and consumers. Planning and implementing a total quality management system requires dedication from the entire team and levelheadedness enough to acknowledge that there isn’t a cure all for every type of situation. “The strategy of building performance quality policy is based on the commitment and involvement of management, identifying legislative requirements, customer requirements (stakeholders), as well as increased staff empowerment and involvement.” (PARASCHIVESCU, A. O., & CĂPRIOARĂ, F. M. (2014) Realistically, a truly functional (TQM) system is not exactly a cookie cutter situation and remains a work in progress (WIP). Some familiarity may exist between organizations when being compared; however each organization posses its own DNA, as it were, make-up, culture, business ethic and practices, thus creating unique opportunities for vast improvements individually. “Recent research shows that about 90% of buyers in the international market consider quality as having at least equal importance with price in making the decision to purchase.” (Cătălin, S. H., Bogdan, B., & Dimitrie, G. R. (2014) There are many advantages to implementing a TQM than disadvantages and are as follows: a. Process improvement b. Defect prevention c. Priority of effort d. Developing cause-effect relationships e. Measuring system capacity F. Developing improvement checklist and check forms G. Helping teams make better decisions H. Developing operational definitions I. Separating trivial from significant needs J. Observing behavior changes over a period of time Secondly, total quality management (TQM) works by measurement: finding the right criteria to assess and track quality levels. “However, recent quality researchers have found contradictory performance evidence highlighting that the success of TQM might depend on various contextual factors.” Wiengarten, F., Fynes, B., Cheng, E. T., & Chavez, R. (2013). In addition, quality in health care is often measured by health outcomes and patient satisfaction that are found in surveys and other feedback from patients. There are three basic concepts to TQM: a focus on customers, continuous improvement and learning, and participation and teamwork by all employees. Implementing a TQM is a step-by-step process and is as follows: a. Top management learns about and decides to commit to TQM. TQM is identified as one of the organization’s strategies. b. The organization assesses current culture, customer satisfaction, and quality management systems. c. Top management identifies core values and principles to be used, and communicates them. d. A TQM master plan is developed on the basis of steps 1, 2, and 3. e. The organization identifies and prioritizes customer demands and aligns product and services to meet those demands. f. Management maps the critical processes through which the organization meets its customer’s needs. g. Management oversees the formation of teams for process improvement efforts. h. The momentum of the TQM effort is managed by the steering committee. i. Managers contribute individually to the effort through providing planning, training, coaching, or other method. j. Daily process management and standardization take place. k. Progress is evaluated and the plan is revised as needed. l. Constant employee awareness and feedback on status are provided and a reward/recognition process is established. Health care organizations in the U.S. are anxiously implementing quality improvement programs to further meet and attempt to exceed patient demands of improving service and clinical quality in health care. “TQM practices have been principally studied in organizations of larger size, but little has been investigated in relation to Small and Medium-sized Enterprises (SMEs), as they present inimitable challenges to quality management due to their diverse features.” (Kaur, P., & Sharma, S. K. (2014) The implementation process requires spending substantial time, effort, and money in order to master and appreciate a TQM. There are five strategies in developing a TQM and are as follows: 1. The TQM element approach a. The TQM element approach takes key business processes and/or organizational units and uses the tools of TQM to foster improvements. This method was widely used in the early 1980s as companies tried to implement parts of TQM as they learned them. b. Examples of this approach include quality circles, statistical process control, Taguchi methods, and quality function deployment. 2. The guru approach a. The guru approach uses the teachings and writings of one or more of the leading quality thinkers as a guide against which to determine where the organization has deficiencies. Then, the organization makes appropriate changes to remedy those deficiencies. b. For example, managers might study Deming’s 14 point or attend the Crosby College. They would then work on implementing the approach learned. 3. The organization model approach a. In this approach, individuals or teams visit organization that have taken a leadership role in TQM and determine their processes and reasons for success. They then integrate these ideas with their on ideas to develop an organization model adapted for their specific organization. b. This method was used widely in the late 1980s and is exemplified by the initial recipients of the Malcolm Baldrige Quality Award. 4. The Japanese total quality approach a. Organizations using the Japanese total quality approach examine the detailed implementation techniques and strategies employed by Deming Prize –winning companies and use this experience to develop a long-range master plan for in-house use. b. This approach was used by Florida Power and Light – among others – to implement TQM and to compete for and win the Deming Prize. 5. The award criteria approach a. When using this model, an organization uses the criteria of a quality award, for example, the Deming Prize, the European Quality Award, or the Malcolm Baldrige National Quality Award, to identify areas for improvement. Under this approach, TQM implementation focuses on meeting specific award criteria. b. Although some argue that his is not an appropriate use fo award criteria, some organizations do use this approach and it can result in improvement. In conclusion, according to the Journal of Transnational Management, “TQM primarily focuses on the production of quality goods and services and the delivery of excellent customer service; however, its success increases when it is extended to the entire company.” TQM has a quantitative character; it emphasizes measuring outcomes to gauge quality levels. Implementing a TQM involves embracing change and revolves around the following: a. Commitment by Senior Management and all employees b. Effective strategy, vision, mission and goals c. Customer/ Supplier relationships d. Communication e. Tools and techniques for improvement f. Team work g. Systems to facilitate improvement h. and most of all TRUST The future of Continuous Quality Improvement (CQI) in health care seems very tentative, on the grounds, that it only started receiving recognition here of late, and went on for decades or even generations being totally ignored, as it were. I would hope that just due attention and focus will bring direct resources to those broken deficiencies in the system. The lack of communicating impedes; point number one which is commitment by management. This causes the urgency and seriousness of CQI or TQM in health care to be dismissed somehow. This is problematic and directly opposes business strategic initiatives in quality and across the board. Recent attention of system fallacies and scandals has sown seeds in the U.S. population, causing even more skeptics. Again, in my opinion CQI is a work in progress like everything else in this world, imperfection is constant. Improvements have been accounted for and the relief to some I’m sure is stupendous, but the problem is colossal and will require many years of research and development. Proper implementation of TQM has significant positive potential in quality, customer service and internal and external customers’ satisfaction. Skillful leadership is manifested by improving the bottom line. Leadership and TQM, succors funds for future projects in quality service improvement initiatives and other strategic projects, as well. Meeting or exceeding customer and company projections and expectations is a result of control mechanisms in effect. There are a host of those involved in CONTINUOUS QUALITY IMPROVEMENT AND ARE AS FOLLOWS: • Persons & families served • Employees, volunteers & consultants • Members of advisory boards • Consumer advocates • All levels of agency staff References 1. Cătălin, S. H., Bogdan, B., & Dimitrie, G. R. (2014). THE EXISTING BARRIERS IN IMPLEMENTING TOTAL QUALITY MANAGEMENT. Annals Of The University Of Oradea, Economic Science Series, 23(1), 1234-1240. 2. Kaur, P., & Sharma, S. K. (2014). Evaluating the Relationship and Influence of Critical Success Factors of TQM on Business Performance: Evidence from SMEs of Manufacturing Sector. IUP Journal Of Operations Management, 13(4), 17-30. 3. PARASCHIVESCU, A. O., & CĂPRIOARĂ, F. M. (2014). Strategic Quality Management. Economy Transdisciplinarity Cognition, 17(1), 19-27. 4. Selim Zaim, Nizamettin Bayyurt, Ali Turkyilmaz, Nihat Solakoglu & Halil Zaim (2008): Measuring and Evaluating Efficiency of Hospitals Through Total Quality Management, Journal of Transnational Management, 12:4, 77-97 5. Wiengarten, F., Fynes, B., Cheng, E. T., & Chavez, R. (2013). Taking an innovative approach to quality practices: exploring the importance of a company’s innovativeness on the success of TQM practices. International Journal Of Production Research, 51(10), 3055-3074. doi:10.1080/00207543.2012.752609

Several ways quality circles and feedback loops can be used within health care organizations to strengthen quality management initiatives and activities.

Quality circles are groups of employees that meet regularly to consider ways of resolving problems and improving production in their organization. According to online encyclopedia, “A quality circle is a participatory management technique that enlists the help of employees in solving problems related to their own jobs.” The mass majority of these circles consist of employees working together in an operation, who meet at regular intervals to discuss problems of quality and to devise solutions for improvements. In my opinion, quality circles work best if led by an on-site supervisor or a senior worker independent of production and production management. Secondly, quality staff or quality circles and feedback groups are normally small in number and often transfer information to upper or senior management by way of Pareto charts and graphs and other data, which is the greatest expose of trending quality patterns. Exhibit 1 Thirdly, according to an online blog, “Quality circles and feedback loops are curriculums that are composed of employees or consumers that aid companies and healthcare organizations in arbitrating, analyzing, and solving work-related issues, presenting the solution to supervisors, and implementing the solutions themselves to improve performance in health care organizations.” Feedback loops are often described as people, this particular feedback group is an automated interactive voice response system (IVRS) that initiates a phone conversation with a patient with their permission, and then asks questions about their visit with the healthcare organization they visited. There are many pros and cons as it relates to this type of response system. There aren’t any Information Technology systems that are obsolete, when it comes to technical or system issues and breakdowns. Fourthly, online sources, noted that quality circles and feedback loops are programs made up of employees and or consumers that assist companies and healthcare organizations in determining problematical issues, communicating what they believe problems are, and finding potential resolutions to repair the problem. Members of these groups must be prepared to work as a collectively and objectively, as a unit to improve outcomes and to promote efficiency while reducing errors .There are a few ways quality circles and feedback loops can be used within health care organizations to strengthen quality management initiatives and activities and are as follows: Quality Circle is a form of participation management. Quality Circle is a human resource development technique. Quality Circle is a problem solving technique. The sessions can be used as a brain storming session. This process provides the healthcare organization needed information to compile and provide a better value for patient satisfaction. In conclusion, with regard to quality, quality control circle (QCC) members must be able to perform their inspections in an environment of trust and empowerment and without fear of retaliation or obstruction of power by upper management. The reported results must remain unbiased and neutral. “Introduction Quality circles, as a participatory management technique, offer one alternative for dealing with frustration and discontent of today’s workers.” (Hosseinabadi, R., Karampourian, A., Beiranvand, S., & Pournia, Y. (2013). Furthermore, it is encouraged that upper management appoint a manager as the mentor of the team, charged with helping members of the circle achieve their objectives. Production managers, in no way should not have direct influence or say over the independent quality circles, as this is conflict of interest. Likewise, if properly implemented, quality circles and feedback loops can be utilized to improve these certain functions within your organization and are as follows: a. Problem identification b. Problem selection c. Problem analysis d. Generate alternative solutions e. Select the most appropriate solution f. Prepare plan of action g. Present solution to management h. Implement a solution References 1. Cahil, S. (2013). Thoughtful feedback loop: A nurse’s approach to personal and organizational improvement. American Nurse Today, 8(6). 2. Hosseinabadi, R., Karampourian, A., Beiranvand, S., & Pournia, Y. (2013). The effect of quality circles on job satisfaction and quality of work-life of staff in emergency medical services. International Emergency Nursing,21264-270. doi:10.1016/j.ienj.2012.10.002 3. McLaughlin, C. P., & Kaluzny, A. D. (2013). Continuous quality improvement in health care. Sudbury, MA Jones and Bartlett, ISBN:9780763781545 Enter the Holiday Sweepstakes for a chance to win a Generous Minims Gift Set. A $56 Value. Valid 12/2-12/29

How definitions of quality have changed in the health care arena.

The U.S.’s current health care infrastructure is under some heavy pressure and is facing immediate and severe challenges, here of late. These issues that surrounds the industry, comprises not only cost and quality of service , as it relates to patients, but caregivers are also burdened with the cost of equipment, regulations and varied list of liabilities. In addition, there are bigger growing problems with issues like policies, laws, or regulations that govern the larger health care system. “The current health care environment with a myriad of policies, laws, and regulations imposed by government agencies, private sector insurers, and institutions, challenges both nurses and patients who are often caught between the cross currents of cost constraints and access to appropriate quality care.” (Abood, S. (January 31, 2007) However, one of the most important and significant issues that we are faced with is the rising cost of health care service to patients. These health care woes that we are experiencing have always been latent, but continuously ignored. The health care industries in the U.S. have reached its climatic point. The lack of good sound leadership is evident, in the fact that we can feel and witness the devastation and impact of a failed strategic approach. The need for control mechanisms as it were, has propelled the U.S. health care industry into a new path or direction. As a result, of such an array of problems we have significant increase in demand for a dynamic leadership with the ability and skill set to create a systematic process that will allow them to design and implement effective interventions to promote quality in health systems. Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. What has changed and is of great magnitude, is that quality is more centered around the patient, whereas not so long ago it was primarily centered around the caretakers’ wallet, if you will. Secondly, the World Health Organization (WHO) states, Quality of care: a process for making strategic choices in health systems. The latest technologies used in health care, for example less invasive techniques or informatics has advanced our methods of quality healthcare. In addition, research and development teams are on a constant mission looking for solutions and for ways to improve the quality of services being offered. The latest advancements or innovations in health care do possess the ability to lower the cost and also increasing access to quality health care. Thirdly, there are several “quality gurus” that have made a significant impact and contributions to our communities and our society as well as abroad. Dr. Deming, according to references for business in an online article noted that he is most renowned for reminding management that most problems are systemic and that it is management's responsibility to improve the systems so that workers (management and non-management) can do their jobs more effectively. According to online business reference, one of Deming's essential theories is his System of Profound Knowledge, which includes appreciation for a system, knowledge about variation (statistics), theory of knowledge, and psychology (of individuals, groups, society, and change). Fourthly, on the other hand, according to business reference, Crosby makes the point that it costs money to achieve quality, but it costs more money when quality is not achieved. Crosby espoused his basic theories about quality in four Absolutes of Quality Management and are as follows: 1. Quality means conformance to requirements, not goodness. 2. The system for causing quality is prevention, not appraisal. 3. The performance standard must be zero defects, not "that's close enough." 4. The measurement of quality is the price of nonconformance, not indexes. There are three major three basic strategies that are used to improve quality: A. Inform - Making sure that high quality is available on which clinical and management decisions can be based. B. Change - Realigning services so that they are based on sound evidence of results and cost effectiveness. C. Monitor - Constantly assessing and reassessing services to ensure that change results in improvements. These three basic strategies that can not only can be beneficial in the medical arena, but also has some form of leverage in many other business models as well. By taking the initiative and informing the people of important business matters demonstrates your desire for transparency, thus creating a more trusting atmosphere. This is the most prominent selling point. Furthermore, promoting your idea or your plan of change to improve quality requires a bit of skill to encourage the members of your team to buy-in, as it were. Although, it is not the most important, change is difficult in most situations. Most people are somewhat reluctant because they fear the unknown. In addition, during this very fragile phase, either the people will support your cause or throw it to the wind. Lastly, your skill to plan, design and implement control mechanisms that are fit to monitor the progress of your strategic plan, is paramount. Monitoring your changes, to determine whether or not things are good or needs improvements will help you to be able to gage more efficiently the needs of your organization. In conclusion, although quality and quality management does not have a formal definition, most agree that it is an integration of all functions of a business to achieve high quality of products through continuous improvement efforts of all employees. Quality revolves around the concept of meeting or exceeding customer expectation applied to the product and service. It is possible, to improve the quality of the health care system by fostering change in the process of care and in the performance of nurses and other medical staff members. Besides, if we take into account some of the more profound usages of the terms quality health care which consists of such characteristics as efficiency, efficacy, effectiveness, equity, accessibility, comprehensiveness, acceptability, timeliness, problems in quality can relate to the structure, process or outcomes of care appropriateness, continuity, privacy and confidentiality we would be able to see the thing clearer , that we have a long way to go as far as trying to meet the highest quality standard. “It is pivotal to medical staff efforts to improve quality and safety, yet the quality assurance process model that has prevailed for the past 30 years evokes fear and is fundamentally antithetical to a culture of safety.” (Edwards, M. T. (2013) References 1. Abood, S. (January 31, 2007). "Influencing Health Care in the Legislative Arena". OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 1, Manuscript 2. DOI: 10.3912/OJIN.Vol12No01Man02 2. Barnett, K. (2011). Quality Improvement Strategy. 3. Edwards, M. T. (2013). A Longitudinal Study of Clinical Peer Review's Impact on Quality and Safety in U.S. Hospitals. Journal Of Healthcare Management, 58(5), 369-384. 4. McLaughlin, C. P., & Kaluzny, A. D. (2013). Continuous quality improvement in health care. Sudbury, MA Jones and Bartlett. 5. Kern, L. M., Edwards, A., & Kaushal, R. (2014). The Patient-Centered Medical Home, Electronic Health Records, and Quality of Care. Annals Of Internal Medicine, 160(11), 741.

Friends with Benefits

Friends with Benefits Is everyone hooking up? Having sex with someone is a complicated act and the participates "SHOULD" be fully prepared to handle the consequences. Your life will never be the same if your sexual act results in having a baby. Not only is it younger people that are finding themselves in precarious situations, but there are some older folk that go into these sexual relationships just as ill-prepared, if you will. Undoubtedly, not everyone is responsible and sometimes people engage in activities that soon thereafter they regret even happened. For example, many times friends have a night out on the town drinking and partying , but sometimes they take it a bit to far and find themselves together in bed the next morning. Makes you wonder, why didn't the control-mechanism ever kick in in this instance? Subsequently,the friend relationship is now on some more ish..... Sex can take a relationships to places never imagined and can be either positive or negative. Nonetheless, it is more justifiable in the eyesight of Elohim, if you are a married couple as compared to having sex out of wedlock. Yes, I said "WEDLOCK". Seeing that, so many people are taking part in multiple sexual relationships does not necessarily make it Okay in the eyesight of GOD if you will. Plainly speaking, so many people around the world are commit suicide, but does that make it okay? Of course not, you do not have the right to take your life. Elohim still treasures the idea of family, which consist of a man his wife and his children. It is of no consequence to the King, your individual or personal appreciation of what makes up a family. Fact of the matter is, he established the pattern when he himself took on a bride and we all know her by the name of "EVE". It is comical, that all of sudden in 2014, the world wants to pretend like we were never taught the difference between what is right and wrong. But, nevertheless, that is another days blog. Having sex is more of a spiritual act, although it is physically carried out. During these relations Oxytocin, which is the hormone that is made in the brain, in the hypothalamus, and it is transported to, and secreted by, the pituitary gland, which is located at the base of the brain. Oxytocin, has been called the "Love" hormone and it either causes you to want more from your sexual partner or not. Many people drift and engage in sex with numerous other sexual partners for multiple reasons and can be a harmful lifestyle. Chemically it is known as a nonapeptide (a peptide containing nine amino acids), and biologically, as a neuropeptide. It acts both as a hormone and as a brain neurotransmitter. In the sexual secretions there are hormones that are transferred to your partners, that creates the sexual desires for one another. There are so many sexual risk involved, yet we are still willing to have sex unprotected in some instances. What is that a man or woman can say to another person that would cause him/her put it all on the line? Is it really love? For the most part this is absolutely not just LUST!

Management constitutes a variety of tasks including the activities where people, technology, job tasks, and other resources are combined and effectively coordinated to achieve your organizational goals and objectives.

Management constitutes a variety of tasks including the activities where people, technology, job tasks, and other resources are combined and effectively coordinated to achieve your organizational goals and objectives. “Capital budgeting allows managers to perform cost benefit analysis on proposed long-term investment projects.” (Kocher, C. (2007). This process or function is a set of activities dedicated to the larger picture. Management functions are based on a common philosophy and approach. They centre around the following: 1. Developing and clarifying mission, policies, and objectives of the agency or organization 2. Establishing formal and informal organizational structures as a means of delegating authority and sharing responsibilities 3. Setting priorities and reviewing and revising objectives in terms of changing demands 4. Maintaining effective communications within the working group, with other groups, and with the larger community 5. Selecting, motivating, training, and appraising staff 6. Securing funds and managing budgets; evaluating accomplishments and 7. Being accountable to staff, the larger enterprise, and to the community at large (Waldron, 1994b). • Planning: outlining philosophy, policy, objectives, and resultant things to be accomplished, and the techniques for accomplishment • Organizing: establishing structures and systems through which activities are arranged, defined, and coordinated in terms of some specific objectives • Staffing: fulfilling the personnel function, which includes selecting and training staff and maintaining favorable work conditions • Directing: making decisions, embodying decisions in instructions, and serving as the leader of the enterprise • Coordinating: interrelating the various parts of the work • Reporting: keeping those to whom you are responsible, including both staff and public, informed • Budgeting: making financial plans, maintaining accounting and management control of revenue, and keeping costs in line with objectives Every facility manager (FM) needs to be concerned with the cost of business. “Most healthcare systems used a blend of board and department-initiated input into budget development, usually with interaction between the two.” (Smith, D. G., & Wynne, J. (2005) Your goal as FM is to improve the net revenue and cash flow of your organization through numerous strategies. In your tool kit should be ways to maximize the total cost of ownership of all the assets you maintain, namely, buildings and equipment. If at all possible avoiding cuts to personnel and those with specialty assets that are complementary to our services and programs. Secondly, budgeting is everything when it comes to determining the success of your healthcare division.” (Wernz, C., Zhang, H., & Phusavat, K. (2014) Healthcare costs have increased considerably over the past decades around the world”. It is unfortunate that some managers have yet to make it primary and the most important business function. All departments have some associations that must be cleared through the finance department which requires the full consensus between administration and hospital operations. Therefore, full communication and required and expected from all parties involves in the daily activities of running a hospital. Thirdly, budgeting and preparing financial budgets is all part of the daily business operations in the hospital and we must learn from the past so we won’t repeat the failures or yesterday. Some major budget considerations for healthcare facility managers are as follows: 1.) Do Not Budget in a Silo 2.) History and Predictive Maintenance 3.) Use the Buzzwords 4.) Benchmarking 5.) Investment in Expense Reduction Strategies Equals Revenue “The benchmarking approach is adapted, by using interview techniques along with non-participant observations in which the results have been unified.” (International Journal of Healthcare Management, 7(3), )The FM needs to be listening to the buzzwords because they are important indicators of how to capture their attention and meet business goals. Tailor your budget with information to help you understand how supporting your budget needs will help them meet challenges. In conclusion, “Health care leaders and policy makers have tried countless incremental fixes-attacking fraud, reducing errors, enforcing practice guidelines, making patients better "consumers," implementing electronic medical records-but none have had much impact.”( PORTER, M. E., & LEE, T. H. (2013). However, healthcare has become routine in the way they operate. As a result, millions of dollars worth of expenses have been removed in order to accommodate recent governmental budget cuts to healthcare programs. We must also rebuild our new healthcare infrastructure in a way that is robust and more cost-efficient in the services we offer. Though, there have some growth in the market share over the last several years there is still much needed research and development in the U.S. health care systems. References 1. Improving efficiency and community-wide practices: benchmarking through integrated pastoral care. (2014). International Journal of Healthcare Management, 7(3), 214-220. doi:10.1179/2047971913Y.0000000068 2. Kocher, C. (2007). Hospital Capital Budgeting Practices and Their Relation to Key Hospital Characteristics: A Survey of U.S. Manager Practices. Journal Of Global Business Issues, 1(2), 21-29. 3. PORTER, M. E., & LEE, T. H. (2013). THE STRATEGY THAT WILL FIX HEALTH CARE. Harvard Business Review, 91(10), 50-70. 4. Smith, D. G., & Wynne, J. (2005). Capital budgeting practices in hospitals. International Journal Of Healthcare Technology & Management, 7(1/2), 1. 5. Wernz, C., Zhang, H., & Phusavat, K. (2014). International study of technology investment decisions at hospitals. Industrial Management & Data Systems, 114(4), 568. doi:10.1108/IMDS-10-2013-0422 50% Off the Gifts Category with any purchase of $25 or more, Plus get a $10 Gift Card! Enter code GIFTS at checkout. Offer valid 12/10 - 12/17/14. Free 39 Piece Set with any purchase of $20 or more. Enter code GIFT39 at checkout. Offer valid 12/13/14 only. Make the right call with InterCall! Get audio unlimited conference line for $19/month! Order now! Get 50% off per minute audio conferencing for up to 125 participants with code ICA5 at InterCall.com! Order Now!

There are macro and micro-economic factors that could directly or indirectly influence your business operations.

There are macro and micro-economic factors that could directly or indirectly influence your business operations. The social science that studies the choices that individuals, businesses, governments, and entire societies make as they cope with scarcity, the incentives that influence those choices, and the arrangements that coordinate them is called economics. (Edition 931) The economic subject matter is broad and can be very complex; nevertheless there are major questions that economist must consider when that wanting to provide clarity for defining the economic scope of a business organization. Fundamentally, there are two major questions and are listed below:  How do choices end up determining what, how, and for whom goods and services get produced?  When do choices made in the pursuit of self-interest also promote the social interest? “Micro-ethical questions arise primarily for subordinates in an organization and concern what should be done when the demands of conscience conflict with perceived occupational requirements.” (Brummer, J. 81-91) “Macro-ethical questions arise principally for superiors and concern the setting of policy for the organization in general.” (Brummer, J. 81-91) International ethical quandaries are a significant challenge to those businesses that opt to engage in globalized business operations. Although, the law may vary from country to country, it is one of the most important aspects of globalized business. Needless to say, although however, is that traditional cross-cultural ethics are superseding major factor that tends to plunder. The application of a moral code of conduct to the strategic and operational management of a business is called business ethics. Even though ethics can be debatable, there have been many years spent in corporate governance trying to determine or define these business related ethics or codes of conduct. Nevertheless, there are three major levels of business ethics. To classify these elements they have been categorized into the following categories:  the macro level  the corporate level  the individual level The international relationships and the role of business on an international scale characterizes the macro level. At the macro level the role of business in the national and international organization of society and the relative morality of different political/social systems, free enterprises and centrally planned economies. The social responsibility of ethical issues facing individual corporate entities (private and public sector) when developing and implementing strategies is at the corporate level. Lastly, behavior and actions of individuals within organizations can be allocated at the individual level. The concept of morality is that it is "proper behavior" and "knowing the difference between “right and wrong". (et al) Therefore, morality provides the underlying foundations and establishes the tone, in which businesses should conduct itself professionally. Unfortunately, in the more recent years, complications with business ethics and morality abroad, has been on a constant rise. Many of the ethical issues arise as a result of poor human management. More concisely, some of the ethical issues are in relation to the hiring, management and dismissal of the people who work in your business. It is unfortunate, that some organizations don’t realize that the people who work in your business also have certain rights that are bound to ethics. On the other hand, microeconomics is the study of financial issues from the perspective of individual economic units, such as a single household, small business or individual. The minimum wage has a number of positive and negative effects on businesses, families and individual workers, from a microeconomics perspective. For clarity purposes, minimum wage is a prescribed wage level that must be met or exceeded by employers in all employment contracts, as set forth in the Fair Labor Standards Act. Likewise, the issue of minimum wage, has been contested time and time again and remains a very highly sensitive and debatable topic. Notwithstanding, one of the main arguments in opposition to raising the minimum wage is that higher wages increase operating costs for small business. Furthermore, the traditional high Global Competitive Reports (GCR), which has raised issues on multiple levels according to the US, is largely attributable to fallacies poor science and ideology. “The GCR purports to be an objective scientific instrument, but is in fact based on ideology that (mis)leads governments, corporations and individuals to make decisions that are unethical in their application and effects”. (Bergsteiner, H., & Avery, G, 392) Immense differences between Eastern and Western cultures and business environments, that once meet in theory in national and regional organizations are now failing. . “Differences in style and culture that may once have appeared to be trivial are having major impacts on the ability of global organizations to maintain uniform standards of practice and operating procedures.” (Finfleman, J., & Lopez, O.) Lastly, the issues with the environmental sustainability which involves making decisions and taking action that are in the interests of protecting the planet. Currently, environmental sustainability is a topical issue that receives plenty of attention from the media and from different governmental departments. This is a result of the amount of research going into assessing the impact that human activity can have on the environment. References Brummer, J. (1985). Business Ethics: Micro and Macro. Journal of Business Ethics, 4(2), 81-91. Edition, Custom. SKS 5000-Business Strategies for Organizational Effectiveness within the Global Perspective VitalSource eBook for Northcentral University. Pearson Learning Solutions. VitalBook file. Strubler, D., Park, S., Agarwal, A., & Cayo, K. (2012). DEVELOPMENT OF A MACRO-MODEL OF CROSS CULTURAL ETHICS. Journal Of Legal, Ethical & Regulatory Issues, 15(2), 25-34. Bergsteiner, H., & Avery, G (2012). When Ethics are Compromised by ideology: The Global Competitiveness Report. Journal Of Business Ethics, 109(4), 391-410 Finfleman, J., & Lopez, O. (2012). Global consulting in a culturally diverse world; Ethical and legal implications. Consulting Psychology Journal: Practice And Research, 64(4), 307-324. Doi:10.1037/a0031675

Non-Adherence, Whether Intentional or Not

Non-Adherence, Whether Intentional or Not Often times patients being prescribed medication that will discontinue use, more than likely making this decision themselves and without informing their health care provider or health professional. As a result, there are major costs and even the possibility of death associated with its discontinuation. The most common is partial non- adherence. This partial non-adherence is much more prevalent than that of full discontinuation in which it to can also be detrimental. More frequently, patients are adjusting their medication regimen without properly being informed. There are many reasons for failure to comply with medical advice and some of them we will be discussing throughout this paper. We will examine the data from those patients who take their regime as prescribed, those who do not take their prescribed regime and those who don’t do not have a proposed regular regime. The extent to which an individual follows medical advice is a major concern in every medical specialty (Osterberg & Blaschke, 2005). There has been much awareness put forth in an attempt to encourage patients to follow the doctor’s recommendations as prescribed. In addition, the lack of influence in the communication between patients and healthcare professionals is also overwhelming. Particularly, if no clear agreement is formed with the patient at the beginning of the treatment process, then surely in the end should be of no consequence. A doctor has a duty to explain, in terms understandable to the patient, what he or she intends to do before a patient begins a course of treatment. To adhere with the ideology of informed permission, physicians must equip patients with the necessary information for them to make a educated and informed decision. This includes the intended benefits of, alternatives to, and the possible risks and complications of that treatment or procedure. Recent studies, have shown that untimely discontinuation was found to be less than half in patients who recalled being told to take the medication for at least 6 months compared with those not given this information (Bull et al, 2002b). It has proven even more difficult when patients lack insight into their condition. A lesser-known coequal to the doctrine of informed consent is informed refusal. Informed refusal cases occurs when patients claim that they were not made aware that refusing the proposed medical or surgical treatment or consultation would be a risky idea. Patients argue that their physician did not inform them of the potential harm that could result from not undergoing the recommended treatment or consultation; and, that if their physician had appropriately informed them of the consequence of refusal, they would have discerened that the benefits outweighed those risks and would have consented to having the recommended treatment/procedure. Patient adherence to a medication regimen is central to good patient outcomes. In addition, adherence is the quality of the provider/patient relationship. Effective provider/patient communication is empirically linked to positive outcomes of care including patient satisfaction, health status, recall of information, and adherence . Provider discussions help patients understand their illness and weigh the risks and benefits of treatment. Healthcare providers are an essential part of the five interacting dimensions of medication adherence identified by the World Health Organization (WHO) (See Figure 1 and Table 1), which include social/economic factors, medical condition-related factors, therapy-related factors, and patient behaviors. Identifying strategies for improving medication adherence are the responsibility of all involved, but the focus of this Time Tool is on the provider’s role in medication adherence. Figure 1. Five Interacting Dimensions of Adherence Appendix A Table 1. Factors Reported to Affect Adherence Appendix B Poor adherence to prescribed medication is associated with reduced treatment benefits and can obscure the clinician’s assessment of therapeutic effectiveness. Non-Adherence is thought to account for 30% to 50% of treatment failures . Non-Adherence leads to worse medical treatment outcomes; higher, avoidable hospitalization rates; institutionalization for the frail elderly; and increased healthcare costs . Attention to adherence is especially important in the current economic climate where we are seeing an uptick in patients foregoing medications by not filling or refilling prescriptions and hoarding medications due to high costs. Considering all of the factors listed in Table 1 that contribute to poor adherence, on the surface, it would appear that the provider role is very small. Yet this is not the case. Physicians play an essential role in medication adherence. Patients who trust their physicians have better two-way communication with their physician. Trust and communication are two elements critical in adherence advantages. Numerous studies show that physician trust is more important than treatment satisfaction in predicting adherence to prescribed therapy and overall satisfaction with care. Physician trust correlates positively with acceptance of new medications, intention to follow physician instructions, perceived effectiveness of care, and improvements in self-reported health status. A recent meta-analysis of physician communication and patient adherence to treatment found that there is a 19% higher risk of no adherence among patients whose physician communicates poorly than among patients whose physician communicates well . Statistically, the odds of patient adherence are 2.26 times higher if a physician communicates well. This translates into more than 183 million medical visits that need not take place if strong interpersonal physician/patient communication occurs. Communication contributes to a patient’s understanding of illness and the risks and benefits of treatment. Hence, the major challenge is to improve: • Verbal and nonverbal communication (patient-centered care) • Interviewing skills (improved competency) • Discussions and provide greater transmission of information (task-oriented behavior) • Continuous expressions of empathy and concern (psychosocial behavior) • Partnerships and participatory decision-making (patient-centered care) Poor adherence to medical treatment is widespread and well recognized, as are its consequences of poor health outcomes and increased healthcare costs (See Figure 2) . Non-Adherence to medications is estimated to cause 125,000 deaths annually. Consider these other statistics: • Overall, about 20% to 50% of patients are non-adherent to medical therapy • People with chronic conditions only take about half of their prescribed medicine • Adherence to treatment regimens for high blood pressures is estimated to be between 50 and 70 percent • 1 in 5 patients started on warfarin therapy for atrial fibrillation discontinue therapy within 1 year o Underuse of anticoagulant therapy for prevention of thromboembolism is attributed to the risk factors of younger age, male gender, low overall stroke risk, poor cognitive function, homelessness, higher educational attainment, employment and reluctant receptivity of medical information • Rates of adherence have not changed much in the last 3 decades, despite WHO and Institute of Medicine (IOM) improvement goals • Overall satisfaction of care is not typically a determining factor in medication adherence • Adherence drops when there are long waiting times at clinics or long time lapses between appointments • Patients with psychiatric disabilities are less likely to be compliant • Non-Adherence results in an economic burden of $100 to $300 billion per year.  Annually, Non-Adherence costs $2,000 per patient in physician visits  The rate of Non-Adherence is expected to increase as the burden of chronic disease increases • Non-Adherence accounts for 10% to 25% of hospital and nursing home admissions (Figure 3). Recent research has found medication Non-Adherence to result in:  5.4 times increased risk of hospitalization, re-hospitalization, or premature death for patients with high blood pressure  2.5 times increased risk of hospitalization for patients with diabetes  More than 40 percent of nursing home admissions Cross tabulation of reasons for not taking medications as prescribed and the rate of taking medications as prescribed . Appendix C If No, Why? Did you take your drugs as prescribed? Total No Yes No response 2 48 50 1.30% 75.7% 77.00% Cost of medications 6 0 6 6 0 6 3.90% 0.00% 3.90% The nature/busy schedule of work 4 0 4 2.60% 0.00% 2.60% Don't like taking medications 4 0 4 2.60% 0.00% 2.60% Too much medications 1 0 1 0.70% 0.00% 0.70% Side effects(When I feel worse) 10 0 10 6.60% 0.00% 6.60% Forgetfulness 2 0 2 1.30% 0.00% 1.30% When I feel better 8 0 8 5.30% 0.00% 5.30% Total 37 48 50 24.30% 75.70% 100% Majority of the respondents 50 (75.7%) take their medications as prescribed, while 37 (24.3%) do not. In Table 6, the reasons for not taking their medications as prescribed were attributed to cost of the medications 6(3.9%), the nature and busy work schedules 4(2.6%), dislikes for medications 4(2.6%), too much medications 1(0.7%), side effects of medications-when feeling worse 10(6.6%), forgetfulness 2 (1.3%), when feeling better 8(5.3%). However, discontinuing medications when feeling worse, and well were the most common causes of medication non- adherence. Studies revealed some of these factors: cost of the medications. Cost is a crucial issue in patient’s adherence especially for patients with chronic diseases as the treatment period could be life-long. A number of studies found that patients who had no insurance cover, were more likely to be non-adherent to treatment. Side effects of the medications feeling worse, feeling better. Patient’s knowledge about their disease and treatment is not always adequate. Some patients lack understanding of the role their therapies play in the treatment others lack knowledge about the disease and consequences of poor adherence from the study. The statistical (chi square) analysis showed a significant association with P < 0.01. In conclusions, interventions that will address these problems of non-adherence are imperative in order to improve adherence the more. Some of alternative interventions include the healthcare providers improving on the areas of patient education and counseling, communication between them and patients, medication selection with cost consideration and intolerable side effects of the medications, shorter wait time and accessibility of the clinics to the patients. References Smith DH, Kramer JM, Perrin N, et al. A randomized trial of direct-to-patient communication to enhance adherence to beta-blocker therapy following myocardial infarction. Arch Intern Med. 2008; 168(5): 477-483. BENNETT, BRIGGS, TRIOLA (2013). Statistical Reasoning for Everyday Life. ,, 1-77. Osterberg, L. & Blaschke, T. (2005) Adherence to medication. New England Journal of Medicine, 353, 487–497. Mitchell, A. J., & Selmes, T. (2007). Why don't Patients take their medicine? Reasons and Solutions in Psychiatry. Advances in Psychiatric Treatment, 13:336-346. Retrieved from http://apt.rcpsych.org/content/13/5/336.full.pdf+html Bull, S. A., Hu, X. H., Hunkeler, E. M., et al (2002a) Discontinuation of use and switching of antidepressants: influence of patient–physician communication. JAMA, 288, 1403–1409. Bultman, D. C. & Svarstad, B. L. (2000) Effects of physician communication style on client medication beliefs and adherence with antidepressant treatment. Patient Education and Counseling, 40, 173–185. DiMatteo MR. Variation in patients’ adherence to medical recommendations. Medical Care. 2004; 42(3); 200-209.