Quality Improvement Organizations (Q.I.O.s)

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1.   What is the role and function of the Quality Improvement Organization program?

2.    In your opinion, has the quality of health care received by
Medicare beneficiaries improved or declined over time as a result of the
QIO program? 

This is the reading for the week: With a presence in every state and most federal
territories, QIOs have been called “the nation’s main infrastructure for
quality improvement” (Hsia, 2003). In
this chapter, we describe the history and evolution of QIOs, provide
examples of how QIOs apply CQI in the Medicare program, and examine
potential future roles for QIOs. The methods described provide an
overview of CQI techniques that are applicable on a national level.

There are several major professional certification
organizations that allow individuals to get national certifications. Two
that I am member of include Regulatory Affairs Professionals Society
(RAPS) and the American Society for Quality (ASQ). The Regulatory
Affairs Professionals Society (RAPS) is the largest global organization
that offers Regulatory Affairs Certification (RAC), the only
post-academic professional credential to recognize regulatory
excellence. This site can be found at http://www.raps.org/.

Role of the Change Agent

Although people resist change, change is important to
innovation, competitiveness, and growth. “The rate of change in your
organization must exceed the rate of change on the outside”, said Jack
Welsh, Six Sigma advocate and former CEO of General Electric in
summarizing the importance of change in the context of being successful
and remaining competitive. Frequently, Six Sigma improvements lead to
process change. One of your roles as the project’s leader is to help
others work through change and understand the importance of change.
Cultural Resistance By their very nature, improvement efforts create
change in the organization. The intended effect of change is to offer
something better to internal and external customers – an enhanced
product or service, a more efficient work process, reduced waste and so
forth. The actual effect, even though technologically sound and
appealing, has a social consequence. Any change might be viewed by those
affected as a threat, and until the threat is neutralized, change will
be difficult to achieve. This objection to change on the part of those
affected is defined as “cultural resistance”.

Cultural resistance is a natural consequence of
change, particularly any abrupt change that alters established habits,
traditions, beliefs, status, or practices. Cultural resistance to change
can occur even among those who would benefit from the proposed change.
Hence the organization must allow time for changes in its culture and
its structure to take hold. Restructuring business processes for
improvement takes time, both for acceptance of the new system and for
retraining employees in their new roles within the system. The future of
health care is tied directly to improvements in quality and safety and
our ability to meet the challenges of adapting new ideas to everyday
practices in health care. In much the same way that continuous quality
improvement (CQI) in health care has evolved over the last 60 years, we
are now experiencing an acceleration in ideas, technology, and research
that affects both health care and CQI. The gap from data to decisions is
closing. This trend is further fueled by vast amounts of easily
available information that leads to greater awareness of choices and
expectations on the part of internal and external customers, including
payers, providers, and patients, as well as their families and
communities. These trends lay the foundation for the next wave of CQI
ideas and initiatives. As the field of quality improvement in health
care is rapidly evolving, the organization and delivery of health care
are becoming more complex, and health care professionals are continuing
to grapple with the best ways to improve quality of care and add value
to the patient experience. The aim of this chapter is to create a road
map for those who will be leading the transformation of health care.
(Sollecito, 2012)


McLaughlin, C. P., Johnson, J. K., and Sollecito, W. A. [Eds.]. 2012. Implementing Continuous Quality Improvement in Health Care: A Global Casebook. Sudbury, MA: Jones & Bartlett Learning.)

Hsia, D. C. 2003. Medicare quality improvement: Bad apples or bad systems? JAMA, 289(20): 2648.

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