This course focuses on concepts of facility wide performance improvement/quality assurance, usability and human factors and professionalism/customer service in the healthcare environment.

In this course, you will receive an introduction to the broad topic of Quality Management in the healthcare environment. Special emphasis is placed on developing analytical skills for quality assessment/performance improvement and credentialing/utilization/risk management activities.

You will learn by Lectures with matching Power Point slides, discussion of "hot topics," 8 quizzes and two examinations.

If you complete this course and do well, you will be able to:

• Quality infrastructure                                                                                                                 

  • Describe the evolution of healthcare quality management from its inception to the           present day      
  • Demonstrate knowledge of contributions of healthcare pioneers                                                 
  • Identify basic infrastructure and systems necessary to support quality management activities      
  • Understand peer review immunity, principles of confidentiality in peer review activities and federal            regulations requiring reporting of peer review activity (National Practitioner Data Bank)                      
  • Understand development of an organizational mission, vision and values            statement                     
  • Determine educational/training strategies for introducing and refining quality management           

  knowledge throughout an organization   

  • Recognize key components of an organization’s quality infrastructure:  Quality Council, quality advisor and quality improvement teams                                                                  
  • Understand stages of team growth                                                                                
  • Describe issues in quality costs and program financial considerations                
  • Demonstrate important role of the customer in quality assessment
  • Identify the basics of Joint Commission requirements for medical staff credentialing, re- credentialing and delineation of clinical privileges                                          
  • Demonstrate competence in designing a physician profile

                                                      
  Planning and implementing an improvement strategy                                                                 

  • Understand Governing Board’s role in quality management
  • Describe Joint Commission requirements for leadership process                                    
  • Demonstrate key points in strategic planning process                                                    
  • Differentiate between quality policies, procedures and standards of care

  Measurement, assessment and improvement                                                                             

  • Understand development and components of an organizational              
  • Quality Management Plan                                                                                 
  • Describe major focuses of quality measurement                                                            
  • Demonstrate ability to write objective, measurable, valid and reliable indicators   
  • Define different types of indicators:  sentinel event, rate based indicators, outcome indicators, process indicators and structure indicators                                                            
  • Demonstrate competence in using tools of quality analysis and display                                      
  • Discuss Joint Commission indicator monitoring system and current efforts to access quality of services rendered in an organization                                                             
  • Demonstrate knowledge in information summarization, coordination, dissemination and presentation                                                                                                                   
  • Discuss basics of successful meeting preparation and coordination                               
  • Demonstrate ability to prepare a summary report for the Governing Board          
  • Define steps in performing annual evaluation of quality program performance                 

  Performance information and reference databases                                                                                 

  • Define benchmarking and its uses in healthcare environment
  • Understand assessment process and methods of determining variance              
  • Describe various systematic approaches to improvement currently used in USA 

  Utilization and risk management                                                                                                            

  • Define case management         
  • Understand development and use of critical/clinical pathways                            
  • Describe utilization management program concepts                                                       
  • Discuss medical necessity appropriateness review, discharge planning monitoring, and over/under utilization surveillance                                                                  
  • Describe content requirements for a utilization review plan                                              
  • Identify role of administration, medical staff and physician advisers                               
  • Discuss various methods of performing utilization review                                               
  • Understand impact of Medicare regulations in utilization management                             
  • Discuss methods of external agency review and impact of managed care                       
  • Identify various groups active in utilization management                                     
  • Describe structure and purpose of HEDIS (Health Employer Data and Information Set)   
  • Identify barriers to a successful utilization management program                                                
  • Define risk management                                                                                               
  • Describe incident reporting program, occurrence screening, claims management and professional liability                                                                                                           
  • Understand defenses to a professional liability claim                                                     
  • Discuss administrative responsibility in risk management                                               
  • Identify key components of an effective safety management program                
  • Describe key legal cases establishing risk precedents                                                                

  External regulators and reviewers and standard setters                                                               

  • Identify Joint Commission standards supporting data collection and performance            improvement
  • Define structure and operation of AHRQ (Agency for Healthcare Research and Quality)               
  • Describe standards of care and standards of practice, how they are developed and how they are integrated with policies and procedures                                                                                   
  • Discuss various JCAHO survey types and use of standards manuals                 
  • Describe how to prepare for a Joint Commission survey                                                            
  • Identify other accreditation organizations (AOA, NCQA, NCQA, AAAHC, URAC)  
  • Describe CMS and Medicare Conditions of Participation and its impact on quality                                   management                                                                                                                
  • Identify key federal regulations affecting quality, risk and utilization management

Your course grade will be determined according to the following percentages.

All HIM students are expected to complete this course with a 70% or better.  Successful completion of the course work will result in the following grade:
 

There are 2 exams in this course. You are expected to take your examinations at one of the NVCC campus Testing Centers. Be sure to allow enough time to complete your exam before the Testing Center closes; Testing Centers have specific policies relating to the administration of ELI exams. You will need to take a photo ID, your NovaConnect empl ID number, and the appropriate Exam Pass when you go to the Testing Center.  

For Testing Center locations, hours of operation and policies, click here.

For information on taking exams outside of the metropolitan area, click here.

I am here to help you succeed in this course. Occasionally questions or problems may arise. Here is how to contact me::

E-mail : llovelace@nvcc.edu

You may also call me to schedule a meeting in person.

1. Use your web browser to connect to http://www.nvcc.edu/bbstart. Follow the directions to determine your email, Blackboard and VIVA account user names and passwords.
2. Access your email account and make sure you know how to use it; you will be required to use this account for all course-related email.
3. Log on to Blackboard at http://learn.vccs.edu.
4. Click on this course under "My Courses." Review the entire course to make sure you understand what will be required of you. Then start completing the assignments.

Please note that account generation takes approximately one week from the time of your paid registration. If you cannot log on after one week, contact the IT Help Desk. If you can log on to Blackboard, but your course isn't listed, please contact ELI or your instructor.