Quality Improvement Tools, Case Study Example

The list of problems described in the case study are profoundly disturbing. While some of them are of a more urgent nature (e.g., the issue involving urine and feces on the bathroom floors and immunizations), they could all potentially lead to punitive measures against the skilled nursing facility. CMS, at the least, would likely sanction the home leading to a lowering of the home’s CMS quality rating; this would hurt business over the long-term. The TJC could undertake more serious sanctions: Since TJC is in charge of certification, they could place the home’s operations at jeopardy; that is, threaten not to renew certification that would lead the home to ultimately close. The state health department could also undertake a serious of sanctions that would lead to a loss of public reputation (at best), at worst the very livelihood of the home could be at stake- not to mention that of the home’s inhabitants as a low immunization rate and discarded medication patches could threaten their health.

Quality improvement tools could play a crucial role in turning around the current state of the skilled nursing facility. In particular, there seems to be little overall supervision of whether basic quality standards are being adhered to- these standards serve as a key benchmark so that potential sanctions cannot be levied against the organization. Underneath the surface issues of compliance, however, likely lies a deeper issue: an organizational culture problem. That is, while there are numerous issues that need to be addressed, the main barrier is likely a culture that has grown out of control and no longer responds to egregious violations. Thus, the rebuilding of the organization’s culture must be the foremost goal of the organization. The upper ranks of management must identify the most urgent issues to address; once those are addressed it must be then taken to other levels to make sure that quality standards are adhered to.

References

Center for Medicare and Medicaid Services. Guidelines for penalty and sanctions. Available at: cms.org.

The Joint Commission. The Joint Commission web site available at: http: jointcommission.org.