Kaiser Permanente: Quality Improvement Analysis

Improving the quality of discharge planning in acute care include addressing the lack of appropriate staff and patient education about appropriate planning for discharge (4). This includes implementing proper discharge teaching regarding signs and symptoms to seek medical attention, management and care of medical equipment, and access to community resources (4, 5). Other challenges are patients with complex comorbidities too difficult to discharge as well as lack of community supports and equipment for newly discharge patients and lack of rehabilitation and nursing home beds (4). Consequently, acute care units are pressured to vacate hospital beds in response to the growing elderly population. Hospital professionals tend to focus discharge teaching and preparation on medical areas such as diet, activity, treatments, and medications (5). Community referrals to appropriate services at the time of hospital discharge does not often happen contributing to poorer patient outcomes and re-hospitalizations

Discharge planning is used to create a plan of care for a patient who is leaving a care setting. An evaluation is done to determine the patient’s continuing care needs once they have left the care facility. When patients are send back home or to a facility that does not require full time nursing care assistance, programs need to be put into place to ensure that the patient is receiving the proper continuation of care post discharge. Proper discharge planning can decrease the chances of a hospital readmit, help in recovery, ensure medications are prescribed and given correctly, and adequately prepare family or caregivers to assume proper post discharge care. According to the Family Caregiver Alliance, “It is important, not only for patients, but family

Reinvest current net income into interest accounts for future variable health care costs for years to come

1. Kaiser Permanente starting in 1945 when Sydney Garfield and Henry Kaiser came together to form the healthcare system still used today. During the Industrial Revolution, many workers were found to have healthcare needs and not all were insured. In collaboration to help these members, Kaiser and Garfield created a system in which employers paid a set monthly premium and physicians joined a prepaid group practice in efforts to ensure care for all employees. This evolved Kaiser Permanente into the healthcare giant it is now.

Healthcare is in a constant state of change with movements that impact rates, access and quality of care. Hospitals have become more competitive due to the rising cost of care delivery and the reduction in reimbursement from payers. This causes difficulty in delivering quality care to all patients, which is being measured by mandated patient perception surveys, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS scores are part of value

The first SMART goal is regarding the elevated re-hospitalization rates, and how as a team we can reduce these numbers by 10% within the next six months. I chose this goal because the Medicare requirements are changing for reimbursement rates and we are a non-for profit organization where cutting down on any costs are important for not only our organization but also for our patients.

The fact that there are broad spectrums of services available within the Kaiser Permanente network makes it easier to coordinate patient care. For example the Northern California site has implemented programs that focus on five “imperatives of personal care”, which are: patients have to have a primary care doctor, they need to be able to see that physician, patients that call have a short telephone wait, patients should receive timely appointments and have a great care experience (Commonwealth fund June 2009). Care management definitely plays a crucial role in health care. When the patients needs are met and quality care is received the result is patient satisfaction and potentially cost saving for the organization. Patients not only have to deal with health issues, many experience challenges within their environment and certain limitations depending on socioeconomic status. Therefore , coordination of patient care is key to the success of any health care delivery system.

This paper will propose how TriCity Medical Center will monitor performance, achieve regulatory and accreditation compliance, and improve overall organizational performance. It will describe ways TCMC will communicate with leadership to ensure alignment of organizational goals and gain buy-in from staff to achieve compliance with the standards and requirements issued by regulatory and accreditation bodies. Also it will determine how compliance with the regulations and development of risk- and quality-management systems for the organization contributes to the organization’s overall performance-management system.

The third part of the action plan will be to assess the progress of changes. This requires measuring current and future performance against past performance, which will need to be assessed more in depth than the initial tracer patient audit. The last portion of the corrective action plan not only assesses the change, but might also include further revisions to the change in policy and procedures if it is found that performance is inconsistent with the standards set forth by the Joint Commission. The part of the plan has four parts that consist of:

Ineffective discharge teaching often leads to unnecessary admissions to the hospital resulting in negative patient outcomes and decreased patient satisfaction. This negatively impacts the well-being of the patient and creates a financial burden on institutions. As a result, this universal practice issue requires a call to action on the part of the nursing profession. Nurses can proactively assist in assuring incidents of readmission do not occur. Nurses as educators play a critical role in the successful transition of patients from hospital to home. The overall goal of discharge education is to ensure there is an exchange of critical information between the patient and nurse in which plans of care are understood and followed. The research

Standard 16 of the American Nurses Association (ANA) Scope and Standards Practice, directs nurse leaders to advocate not only for patients but for all members of our healthcare community. As a discharge planner, I am in a unique position to advocate not only for patients but for caregivers as well. As part of my responsibilities, I participate in daily multi-disciplinary team rounds. The meetings take place so that all disciplines can openly discuss patient care needs. They provide the perfect opportunity for anyone to bring to light problems or concerns.

The problem in this scenario is the challenges faced with trying to implement a new clinical pathway. This particular clinical pathway trying to be implemented is concerning ventilator-dependent patients who are discharged to home with home health care needs. These patients tend to have multiple health care needs beyond the ventilator and the new clinical pathway will establish a smooth transition from hospital to home, allowing for all the patient’s needs to be met. The challenges arise when trying to get all areas of the health care team to get involved. This especially includes the physicians that seem reluctant to follow a nurse’s guidelines. Not only are the physicians reluctant, the home health care representative will not be available to attend team meetings for a while. The new clinical pathway is due to be started in one month, so there is little time to get all parties on board.

Established in the 1930s by Henry J. Kaiser and Dr. Sidney as a health care program for construction, shipyard, and steel mill employees, in 1945 Kaiser Permanente (KP) opened enrollment to the public (Our History, 2016). Despite many challenges and setbacks, KP has grown to become one of the largest leading healthcare providers (SPEC Associates, 2011; "Labor Management," n.d.). However, is KP ready to meet the health care needs of citizens in the next decade? This paper will delve into KP to assess their readiness as well as their strategic plans regarding network growth, adequately staffing nurses, managing resources, and maintaining patient satisfaction.

Providing quality delivery care is the cornerstone of Kaiser operation and addressing language needs of the diverse communities it serves is receiving attention from the National Diversity and Inclusion Office. Kaiser’s National Diversity and Inclusion was established with the objective to promote, support, and assist the regions in implementing the Kaiser Permanente Board of Directors agenda in providing culturally competent medical care and culturally appropriate services to improve the health and satisfaction of its members.

Examining planning for and effectively measuring the health care quality indicators make healthcare quality more transparent and provide information for quality improvement programs and initiatives in the healthcare system.