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Southside HMO Case Essay

The case is about Southside HMO, which serves 495,000 members throughout the eastern region of the United States. It has come to your attention that several members or patients who participate in your plan have filed a complaint that your HMO plan does not provide quality healthcare delivery. Several patients have been denied healthcare services to see specialists to whom they were referred by their primary care providers.so the board of directors has asked to provide a report detailing the strategies and recommendations to investigate the complaints and to identify strategies to ensure that quality management initiatives are in place to make sure that quality healthcare services are provided to all members. So if I am the chief executive officer of Southside HMO the strategies and recommendations that I collect to solve the problem is as follows normally Southside HMO should over all the patients so the provider reminder system should be implemented like reminders in charts, computer based reminders for providers and computer based decision support.

They also should assess current activities in quality improvement to evaluate effectiveness in addressing overlap, they should establish a structure for example through policy, regular meetings or realignment of the organizational hierarchy which ensures the patient care activities are addressed in a coordinated manner involving the risk management and quality improvement functions, they should seek guidance from legal counsel to structure of quality improvement activities maximizes legal protections granted by state and federal status while allowing for the flow of information across both functions they also should ensure quality improvement plans and efforts and see that aligned with the strategic goals of the organization, they should educate stakeholders like executive staff, boards of trustees, physicians, caregivers and other differences between and similarities of quality improvement and on how the functions are addressed in the organization and they should design systems to coordinate and streamline processes of data collection, data analysis, monitoring and evaluation.

As the chief executive officer of Southside HMO I think first we should collect the compliments from patients who had given the complaints and according to that he should solve the problem and the chief executive should focus mainly on customers because the organization mainly depend on customers, they should understand current and future customer needs, should meet customer requirements and should try to exceed the expectations of customers. An organization attains customer focus when all people in the organization know both the internal and external customers and also what customer requirements must be met to ensure that both the internal and external customers are satisfied. Leaders of an organization establish unity of purpose and direction of it. They should go for creation and maintenance of such an internal environment, in which people can become fully involved in achieving the organization’s quality objectives.

People at all levels of an organization are the essence of it. Their complete involvement enables their abilities to be used for the benefit of the organizations. The desired result can be achieved when activities and related resources are managed in an organization as a process. An organization’s effectiveness and efficiency in achieving its quality objectives are contributed by identifying, understanding and managing all interrelated processes as a system. Quality Control involves checking transformed and transforming resources in all stages of production process. One of the permanent quality objectives of an organization should be the continual improvement of its overall performance, leveraging clear and concise Process Performance Measures.

Effective decisions are always based on the data analysis and information. Since an organization and its suppliers are interdependent, therefore a mutually beneficial relationship between them increases the ability of both to add value by following the above principles we can follow ensure that quality management initiatives are in place to make sure that quality healthcare services are provided to all members.

Reference

American Society for Healthcare Risk Management (ASHRM): Data for safety: turning lessons learned into actionable knowledge [online]. 2008 [cited 2009 Mar 4]. Available from Internet: http://www.ashrm.org/ashrm/education/ development/monographs/Mono_ActionKnowledge.pdf. Reichheld, Fredrick F., and W. Earl Sasser Jr., “Zero Deflections: Quality Comes to Services,” Harvard Business Review (September– October 2009). Plura, J., Nstroje a metody managementu jakosti. In: Riadenie kvality v energetike, CastÆ – Papiernicka, SlovenskÆ spolocnos pre kvalitu a j., p.1 8


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