Leading for Quality in Healthcare: Development and Validation of a Competency Model
Andrew Garman and Linda Scribner
Increased attention to healthcare quality and impending changes due to health
reform are calling for healthcare leaders at all levels to strengthen their skills in
leading quality improvement initiatives. To address this need, the National Association
for Healthcare Quality spearheaded the development and validation of a
competency model to support healthcare leaders in assessing their strengths and
planning appropriate steps for development. Initial development took place over
the course of several days of meetings by an advisory panel of quality professionals.
The draft model was then validated via electronic survey of a national sample
of 883 quality professionals. Follow-up analyses indicated that the model was
content valid for each of the target samples and also distinguished differing levels
of job scope and experience. The resulting model contains six domains spanning
three organizational levels.
A Roadmap for Improving Healthcare Service Quality
Denise M. Kennedy, Richard J. Caselli, and Leonard L. Berr
A data-driven, comprehensive model for improving service and creating longterm
value was developed and implemented at Mayo Clinic Arizona (MCA).
Healthcare organizations can use this model to prepare for value-based purchasing,
a payment system in which quality and patient experience measures will
influence reimbursement. Surviving and thriving in such a system will require a
comprehensive approach to sustaining excellent service performance from physicians
and allied health staff (e.g., nurses, technicians, nonclinical staff). The
seven prongs in MCA's service quality improvement model are (1) multiple data
sources to drive improvement, (2) accountability for service quality, (3) service
consultation and improvement tools, (4) service values and behaviors, (5) education
and training, (6) ongoing monitoring and control, and (7) recognition
and reward. The model was fully implemented and tested in five departments
in which patient perception of provider-specific service attributes and/or overall
quality of care were below the 90th percentile for patient satisfaction in the
vendor's database. Extent of the implementation was at the discretion of department
leadership. Perception data rating various service attributes were collected
from randomly selected patients and monitored over a 24-month period. The
largest increases in patient perception of excellence over the pilot period were
realized when all seven prongs of the model were implemented as a comprehensive
improvement approach. The results of this pilot may help other healthcare
organizations prepare for value-based purchasing.
Language Services in Hospitals: Discordance in Availability and Staff Use
Brette A. Tschurtz, Richard G. Koss, Nancy J. Kupka, and Scott C. Williams
Despite efforts to advance effective patient–provider communication, many patients'
language needs continue to be unmet or inappropriately addressed by healthcare
providers (Wielawski 2010; Patek et al. 2009; Wilson-Stronks and Galvez 2007). This
study presents a picture of the language resources currently provided by hospitals
and those resources practitioners actually use. Questionnaire data were collected
from 14 hospitals in Florida's Palm Beach, St. Lucie, and Martin counties on availability,
staff awareness, and staff use of linguistic resources and services.
Inconsistencies were identified between the language tools, services, and
resources hospitals provide and those staff use. In addition, a large majority of staff
respondents still rely upon someone accompanying the patient for communication
with patients who have limited English proficiency, despite evidence that this practice
contributes to miscommunication and serious medical errors (Flores et al. 2003;
Flores 2005; HHS OMH 2001; Patek et al. 2009). Hospitals that use bilingual staff
as interpreters often do not test the competency of these staff, nor do they assess the
utilization or effectiveness of the tools and resources they provide.
Hospitals can improve the cultural and linguistic care they provide if they
(1) address the practice of using ad hoc interpreters, (2) effectively disseminate
to hospital staff regarding how and when to access available resources,
and (3) collect patient population data and use it to plan for and evaluate the language
services they provide to their patients.