This report is written for the Board of Directors of the Nazarene Community Health Clinic (NCHC). It outlines the importance and necessity of quality management as it pertains to the health care reform’s mandate that all Americans have access to quality, affordable health care.

1. Running head: QUALITY MANAGEMENT REPORT 1
Health Quality Program
Cynthia Brown
March 20, 2012

2. QUALITY MANAGEMENT REPORT 2
Abstract
This report is written for the Board of Directors of the Nazarene Community Health Clinic
(NCHC). It outlines the importance and necessity of quality management as it pertains to the
health care reform’s mandate that all Americans have access to quality, affordable health care.
To meet the requirement of quality health care, the Nazarene must implement and sustain a
Quality Improvement Program which effectively measures and improve the health care outcomes
in the clinic. The Institute of Medicine’s (IOM) definition of quality is given in this report. The
report will discuss in detail the role of a Quality Improvement Program as a tool for quality
management within the clinic by covering the following topics:
• The Patient Protection and Affordable Care Act (PPACA)
• Two Top-level Principles and Related Concepts for Measuring and Managing Quality in
the Clinic
• Comparison and Contrast of Two Statistical Tools and Methods that can be used to
Measure and Improve Health Care Outcomes in the Clinic.
• Description of How These Tools and Methods will Assure Safety of the Clinic’s Patients
Keywords: community living assistance services and support (CLASS), Continuous Quality
Improvement (CQI), Department of Health and Human Services (DHHS), electronic health
record (EHR)

3. QUALITY MANAGEMENT REPORT 3
Health Quality Program
It has always been the mission of the Nazarene Community Health Clinic (NCHC) to
provide quality health care to its patients. The Board of Directors and all other stakeholders are
in agreement that high quality is essential to the organizational goals and/or objectives in serving
our community. In the health care arena, quality is a very difficult concept to measure, manage,
and even define. The Institute of Medicine (2001) has tried to defined quality as the extent that
health services increase the probability that expected health outcomes are met while being
consistent with present day professional expertise. The IOM (2001) further implies that efforts
to improve health care should focus on six major components: safety, effectiveness, patient-
centeredness, timeliness, efficiency, and equitability. These components are in alignment with
the goals and/or objectives set forth in the NCHC mission statement which we believe ensure
that the health care provided by our clinic is of high quality. We however lack a program which
will assist the clinic in measuring, managing, and improving quality throughout the organization.
This report will discuss particular topics that will justify the need to develop, finance, and
implement a health quality program for the Nazarene Community Health Clinic.
Topics
The Patient Protection and Affordable Care Act
The government has become the leader in developing quality indicators and patient safety
goals which will measure a health care organization’s quality and quality improvement efforts;
thereby linking reimbursement payments to quality outcomes. The mandate to link
reimbursement payments to quality outcomes can be found in the Patient Protection and
Affordable Care Act (PPACA). The PPACA is comprised of nine titles which deal with health
care reform (Democrats, 2011):

4. QUALITY MANAGEMENT REPORT 4
Quality, affordable health care for all Americans. Under this title, the focus is making
health insurance affordable through shared responsibility. The idea is to create a total
reformation of the insurance market through the elimination of discriminatory practices; ensuring
that all Americans are covered under some type of health insurance; and by offering tax credits
for individuals and families.
The role of public programs. Under this title, PPACA expands the eligibility for
Medicaid for lower income individuals for which the federal government will pay the majority of
the cost.
Improving the quality and efficiency of health care. Of particular interest to NCHC is
this title, because payment for services will be linked to better quality outcomes. Although the
goal of this title is to improve the medical services for everyone, particular attention will be paid
to patients under the Medicare and Medicaid programs. The patient base at NCHC is comprised
mostly of members in these two programs. Under the PPACA, a new program will be created
which will result in community health teams whose goal is to increase access to community-
based, coordinated care. A health delivery system center will be used to research health delivery
system improvement and best practices that contribute to the improvement, quality management,
and safety of health care delivery. Also under this title, the Department of Human Health
Services Secretary will launch a national strategy to improve health care service delivery, patient
outcomes, and population health. NCHC must have a quality program in place to meet the
quality standards set forth by the federal government in order to ensure optimal reimbursement
for services rendered.
Prevention of chronic disease and improving public health. Under this title, a new
Prevention and Public Health Investment Fund will be created. All barriers to accessing

5. QUALITY MANAGEMENT REPORT 5
preventive services will be eradicated. The ultimate goal of this title is that of creating healthy
communities through the development of a modern 21st
century public health infrastructure.
Health care workforce. Under this title, PPACA’s goal is to strengthen the American
workforce in health care professions by supporting institutions in training and education. Grants
for workforce planning and development in health care; grants for states and medical schools in
the area of emergency services; student loan program modification; scholarships for
disadvantaged students; strengthening of primary care training; and additional support for the
existing health care workforce are some of the benefits of this title.
Transparency and program integrity. Under this title, new requirements have been
implemented that call for public health system information to be made available. There are also
new requirements designed to eliminate fraud and abuse in public and private programs.
Improving access to innovative medical therapies. Under this title, biological product
licensing will be approved through a process established by the Federal Drug Administration.
Also drug discounts will be given to make drugs more affordable to certain children’s hospitals,
cancer hospitals, critical access and sole community hospitals, and rural referral centers.
Community living assistance services and supports. Under this title, a national
voluntary insurance program for purchasing community living assistance services and support
(CLASS) will be created. The program is designed to assist those persons with functional
limitations and has a five-year vesting period for eligibility of benefits. It is important to note
that no taxpayer funds will be used to pay the benefits.
Revenue provisions. The important item to note under this title is an excise tax of 40
percent will be placed on insurance companies and plan administrators on any annual premiums
over $8,500 for single coverage and $23,000 for family coverage.

6. QUALITY MANAGEMENT REPORT 6
Two Top-level Principles and Related Concepts for Measuring and Managing Quality in
the Clinic
Title III of the PPACA, proposes to link payment to quality outcomes. Therefore, I
believe one of the top-level principles and related concepts for measuring and managing quality
in the clinic should be to have a Quality Improvement Program whose responsibility would be to
examine and improve processes in the clinic. The Quality Improvement Program objective
should be that of evaluating actions taken for an intended health care outcome and the evaluation
of how well these actions were performed in the achievement of the health care outcome
(Varkey, 2010). The Quality Improvement Program would be comprised of members trained in
basic statistical techniques, clinical practices, and the use of problem-solving tools (Bradley,
Burns & Weiner, 2012). Team members of the Quality Improvement Program should also have
the authority to make decisions based on data analysis (Bradley et al., 2012).
The second top-level principle and related concept for measuring and managing quality in
the clinic is to continuously evaluate and improve on the three basic classes of quality measures;
structure, process, and outcome. Structural measures of quality in the clinic can include
measures taken to meet JCAHO accreditation for clinics; the use of electronic health records; and
in-service training for medical staff.
Process measures for quality can include activities such as reviewing the medical records
to ensure physician and nurse signatures on orders, monitoring physician and nurse compliance
with clinical standards for medication distribution, and evaluating the wait time upon arrival for
clinical appointments. The use of a Run Chart as a measurement tool can depict the wait time of
patients (see chart below). The clinical standard for wait time for a scheduled appointment is 15

7. QUALITY MANAGEMENT REPORT 7
minutes with a 98% compliance rate. The Run Chart will show that the clinic deviated from the
standard in 1st
quarter of the year.
Run Chart
0
20
40
60
80
100
Jan
FebM
arch
April
Months
Patients
15-20 min
25-30
over 30 min
Lastly, the clinic should be evaluating outcomes following health care treatment and the
costs of providing the treatment (Varkey, 2010). Outcomes can be measured using patient
satisfaction forms and by capturing the status of the patient after treatment in the health record.
The clinic can use a Patient Satisfaction Survey to find out if the patient was satisfied with the
care received, the providers, costs of treatment, and whether or not they would refer
friends/relatives for the care. The clinic can also follow the results of certain treatments for
chronic illnesses along with the cost of providing the treatment. For example, the number of
times dietary consultations and exercise classes were suggested for non-insulin dependent
diabetic patients.
Comparison and Contrast of Two Statistical Tools and Methods that can be used to
Measure and Improve Health care Outcomes in the Clinic
Two statistical tools and methods that can be used in the measurement and improvement
of outcomes in the NCHC are Continuous Quality Improvement (CQI) and Six Sigma. In

8. QUALITY MANAGEMENT REPORT 8
comparison, both methodologies measure the result of work performed using such health care
outcomes as patient satisfaction, mortality rates, and safety. Both CQI and Six Sigma focus on
the processes that are in place and their effectiveness. Both methodologies can be used by the
Quality Improvement Team as tools of empowerment, education, and leadership. Organization-
wide acceptance and participation is imperative for the success of both CQI and Six Sigma.
Both require the involvement of key personnel, such as physicians, at the onset. The clinic must
also be willing to support the efforts of CQI and Six Sigma financially. This financial
commitment would involve the resources needed to collect and interpret data; trained team
members on the effective use of methodologies, and the costs of implementing necessary
changes to processes.
In contrast, CQI is used when the problem is minor in nature while Six Sigma is used
when there is a need for major changes (Benedetto, 2003). Also, Six Sigma uses more advanced
data analysis tools, integrates clearer financial data into its process, and is performed under rigid
time constraints (Anabari & Kwak, (2006). The goal of Six Sigma is to minimize variations to
the process by improving on the process; whereas CQI’s approach is to plan and implement
continuous organizational improvement to the process (Bradley et al., 2012).
Description of how These Tools and Methods will Assure Safety of the Clinic’s Patients
Efforts to strengthen the infrastructure of NCHC can be achieved by using the tools of
CQI and Six Sigma to address the issue of patient safety. One of the areas of concern when it
comes to patient safety is the process of health record availability at the time of patient visits and
complete, accurate documentation in the health record. It is the policy of the clinic to ensure that
all health information pertinent to the continual care of its patients is made available and is a part
of the organization’s best practices. Government funding for the electronic health record (EHR)

9. QUALITY MANAGEMENT REPORT 9
and the clinic’s policy to ensure patient safety in all of its processes should be main motivators in
the creating of an EHR system. The Department of Health and Human Services (DHHS) sought
the help of the Institute of Medicine (IOM) to research the EHR system’s impact on patient
safety and quality care (IOM, 2003). One of the recommendations of the IOM was that all health
care organizations should establish a comprehensive patient safety system in the form of an EHR
which would allow access to complete patient information and decision support tools (IOM,
2003). It was also recommended at the end of IOM’s study that the Federal government provide
financial support for implementation of EHRs throughout the health care system (IOM).
Using CQI and the Six Sigma methodologies to analyze the use of the clinic’s current
health record information availability and completeness, accuracy documentation can help to
decide whether an investment in an EHR is both cost-effective and can improve patient safety.
The CQI methodology can be used to identify instances when health record availability did not
meet the clinic’s standards and when documentation errors could have posed potential harm in
the treatment of patients. The Six Sigma methodology can be used to measure the process of
installation, use, and costs of an EHR system.
In conclusion, a Quality Improvement Program should definitely be a part of the
Nazarene Community Health Clinic’s best practices in an effort to measure and manage quality
care. The importance of quality management as it pertains to safety, quality measures, and
quality management are evident in this report. The Board of Directors should pay particular
attention to the nine titles outlined in the Patient Protection and Affordable Care Act as a
guideline for developing a health quality program. The financial justification can be seen in the
new health care reform’s proposal to link repayment to quality outcomes. Therefore, it would
benefit the clinic both financially and competitively to create a Quality Improvement Program

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that focuses on quality measurement, improvement, and management. Today’s health care
consumer expects safety and quality to be key components of their medical experience at
Nazarene Community Health Center. As health care providers it is our duty to provide safe,
quality health care to each of our patients.
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http://www.nap.edu.
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