Quality Assurance in Managed Mental and Behavioral Health

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Table of Contents

Introduction
Summary of Quality Ratings
Organizational Rating
Conclusion
Reference List

Introduction

The health delivery system aims at increasing the access of health care to the people, improving the quality of such care while reducing the costs involved. This is compromised by the fact that the managed care system is based on profit making and because of insurance, the cost of health care has soared thus becoming a significant issue in the economy. Further, the aspect of mental care in managed care has been of concern to the health care sector stakeholders since it requires high costs to manage mental illnesses. In addition, mental illnesses have increased among the population and it requires urgent medical intervention. This paper provides the summary of the quality ratings that are applied in the quality assessment of health organizations. Additionally, it outlines the ratings of organizations as either low or high based on the quality assurance results. This summary is based on the San Francisco General Hospital, California pacific medical ctr-pacific campus hospital, New York Downtown Hospital and North Bay Medical Center in New York.

Summary of Quality Ratings

Quality assurance as Donabedian and Bashshur (2003) assert involves the actions taken for the establishment, protection, promotion and improvement of the quality of health care provided. This mainly encompasses the categories of performance monitoring and readjustments, and system design and resources. System design and resources look at the professional recruitment, education, training and certification according to the set standards in the sector. The issue of resources also examines the machinery in place and the general functional structure of the organization with new developments (Donabedian & Bashshur, 2003). Performance monitoring and readjustments on the other hand examine the use of information on the actions of a health care organization to form the basis of its quality levels. This involves the examination and evaluation of the actions of the organization in the promotion of health care such as involvement in research work (Shi & Singh, 2008).

The quality assurance is also based on standards especially those set in managed care (Noble & Klein, 2000). Since the health organizations are service based, the quality is founded on their human and health services. The quality aspects examines the process of measurement of care, the results or outcomes of such measurements, the experiences of patients in the health care and the modes of payment and volume for the care provided (Shi & Singh, 2008). The ratings of quality in the health services are based on the standards of health already established, the legal requirements, process care measures such as the surgical care improvement project process of care measures, the outcomes of such measures such as the mortality rates, and other functional structures and the involvement in health research. The quality of human services are based on the experiences of the patients in the organization with concerns for evaluation of communication, nursing care, the general condition of the hospital, the urgency of services and the recommendations offered (Noble & Klein, 2000).

Organizational Rating

North Bay Medical Center in New York ranked the highest in terms of well developed and functional structure in handling patients, emergencies and its involvement in research work, being equipped with the necessary machinery, modified system of dealing with the inpatient causalities with a highly advanced rehabilitation facility and a highly-improved survival and chemotherapy response system for patients suffering from terminal diseases with the problem of laxity which is common among health organizations (Noble & Klein, 2000).

The comparison analysis based on the San Francisco General Hospital, California pacific medical ctr-pacific campus hospital and New York Downtown Hospital ranks California pacific medical ctr-pacific campus hospital as the highest and New York Downtown Hospital as the lowest in terms of quality among the three. San Francisco Hospital ranks as the middle between the two. California pacific medical ctr-pacific campus ranks highest since in comparison with San Francisco, it had a higher performance in patient experiences achieved through: better communication between the hospital staff, quality nursing care, general condition of the hospital and recommendation of patients in the heath care facility as well as high general performances in the use of medical imaging tests like mammograms, MRIs, and CT scans. On the other hand, San Francisco scored higher in the areas of antibiotic administration, urgency of service and methods of hair removal on surgical areas. The New York Downtown Hospital ranked lowest due to the low performance in the experiences of patients and the similar ranking with San Francisco Hospital in surgical process and the unnecessary follow-ups in medical imaging.

Conclusion

The quality assessments ascertain the level of care provided in order to improve the overall quality of health. This paper has summarized the quality rating used by stakeholders and policy makers in health and ranked the organizations in terms of the results of their quality levels. This shows New York Downtown Hospital as the lowest; California pacific medical ctr-pacific campus hospital as the highest with only three hospitals in comparisons while North Bay Medical Center ranks the highest overall.

Reference List

Donabedian, A., & Bashshur, R. (2003). An introduction to assurance in health care. New York, NY: Oxford University Press US.

Noble, E., & Klein, L. (2000). Quality assurance: the measure of quality culture in a managed care setting. Total Quality Management and Business Excellence, 11(2), 199-205.

Shi, L., & Singh, D. (2008). Delivering health care in America: A systems approach. New Jersey, NJ: Jones & Bartlett Learning.

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Quality Assurance in Managed Mental and Behavioral Health

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