Riskand Quality Management Assessment Summary
Riskand Quality Management Assessment Summary
Descriptionof the organization and purpose of risk and quality management
TheNational Infertility Association, Resolve, is an organization thathas played a significant role in helping out people that suffer frominfertility since the year 1974. The organization’s risk andquality management improvements give priority to the safety of allpatients, while at the same time diverging new and modern methods offorming an effective and efficient team (Varkey, Reller, & Resar,2007). This, in turn, aims at ensuring that the organization provideshealthcare services that are of high quality to all patients. In therecent past, patients have faced issues when it comes to proceduresthat lack insurance coverage as well as with cost of visits. As aresult, some patients have been forced to cater for some servicesthat range from hundreds to thousands of dollars. The sole aim of theorganization is to offer financial assistances for any individuals inneed as well as find such individuals suitable and affordable healthcare coverage. Varkey et al (2007) findings indicate that many statesthat need insurance coverage have not incorporated or mandatedinfertility coverage as a health issue in fact, it is only fifteenstates that have the mandate to cover some forms of fertility.
Thechief problem was to determine an insurance provider that would offersome kind of infertility coverage in order to assist patients andhelp them avoid out of pocket expenses. In this analysis, necessaryinformation that plays a significant role in helping risk managersalign several activities associated with improvement and quality carewill be put down in a strategic manner (Bento, 2006). Thisinformation include a brief overview of quality improvement and riskmanagement evolution, samples of several approaches employed towardsquality and risk management in an integrated manner, brief summary ofhow quality improvement and risk management have been integrated,review on current functions that are carried out by risk and qualitydepartment, and suggestions on how healthcare coverage can beimproved for all patients.
Resolve,for instance, would take part in the implementation, establishment,and in the coordination of ongoing risk assurance and qualityimprovement compliance with various accredited healthcareorganizations. If the organization adopt and embrace the need toanalyze and trend data, then it will be able to handle and tacklevarious health issues whenever they arise. Resolve’s chief conceptaims at providing qualitative and continuous healthcare to staff,patients, and consumers. It is vital that the organization educateits members on all requirements, state laws, cost, and competitionfrom payers and staff if is to accomplish its primary goal ininfertility knowledge. However, the organization should not forgetits accreditation requirements when indulging in all theseactivities.
Riskof failed premium payments or services constitutes the current issue.Patients may be forced to pay extremely high out of pocket expensesif they lack insurance that offers them infertility coverage. This isbecause it is only 15 states that have the mandate to viewinfertility coverage as a major medical issue while the rest coverwhat they deem necessary (Varkey et al., 2007). This, in turn, cangive rise to other risks that include limited visits, limitedprocedures, and loss of employees that result to provision of poorhealthcare, and negative impact on the finances of organization ifservices are not paid in time. Since most people consider theorganization as a center for education, resource, and knowledge forconsumers, it may be associated with other risks. These types ofrisks include lack of education, patient privacy, and patient,visitor, and employee safety. These risks may have detrimentaleffects on the organization if they fail to be implemented in aproper manner. Patients’ safety may also be put at a risk thusforcing the organization to pay fines for poor safety ethics. As aresult, the morale of patients, staff, and the entire organization aswell as health care services provided may be enormously affected in anegative manner.
Internaland external factors effect on quality outcomes
Anorganization’s internal and negative factors may have eitherpositive or negative immense impact on the quality outcomes. Thesefactors include but not limited to technological capabilities, healthinsurance providers, and competitors (Kraus, 2010). Infertilitycoverage can be affected in a negative manner by health insuranceproviders. This is because only a few health care providers offerinfertility coverage hence, forcing patients to part away with outof pocket expenses. In connection to this, the organization maysuffer severe stress and incur several challenges if patients fail topay for the provided services. In fact, according to Kraus (2006),approximately 20 percent of Americans suffer from unexplainableinfertility thus, opting for treatment, while only 2 percent havesome form of infertility coverage through employee or private paidinsurance. Again, failure to update the organization’s technologyand systems can have detrimental effects on the organization dailyactivities.
Thereare several short and long term goals that the organization canprovide. These goals include: Provision of banks that offer fundingsources for infertility to all patients, discussing payment options,assist all patients in the financial planning, helping patients inthe preparation and submission of grant requests, ensuring that allpatients access education course for financial planning in order forthem to have sufficient knowledge in various areas of organizationthat deal with finances, and involvement of patients in the planningof finances.
CME(Continuing Medical Education): These constitute most courses thatoffer web-based resources and information as well as electronicnewsletters that play a significant role in giving assistance tocenters and clinics that offer healthcare and reduce risks (Varkey etal., 2007).
HRSA(Health Resource and Services Administrations): This policy aim atproviding detailed and comprehensive approaches towards qualityimprovement, assurance, and risk management. It also offers onlineeducation programs on risk management and other resources.
Publichealth: This refers to a process that prevents diseases, prolong aperson’s life, as well as promote health of individuals throughchoices and efforts of the health care organization. They help anorganization in influencing patents’ health outcomes (Kraus, 2010).It also provides various interventions on methods on management andtreatment of disease as well as other health conditions.
Relationshipbetween risk and quality management
Thechief aim of both risk and quality management in any organization isto offer continuous health care services that satisfy all consumers.Both risk and quality management work hand-in-hand towards theimprovement of staffs’ performance. Such staffs are trained inorder to create a positive environment that offers qualitativepatient care and assurance.
Anyhealth organization incorporates risk and quality management in itsdaily activities since it aims at maintaining as well as establishingpatients’ insurance and safety. Resolve’s risk and qualitymanagement aim at helping individuals, families, and couples solvetheir infertility issues in order to build a future with theirchildren.
Bento,A. (2006). Factors Effecting Performance Management SystemOutcomes. Baltimore, MS: University of Baltimore.
Kraus,G.P. (2010). Health Care Risk Management: Organization and ClaimsAdministration. Cambridge: Cambridge University Press.
Varkey,P., Reller, K., & Resar, R. K. (2007). Basics of QualityImprovement in Health Care. Mayo Clinic Proceedings, 82(6),735-739.