Running Header: Continuing Improvement for the National Service Quality and Outcome Framework 1 Continuing Improvements for the National Health Service Quality and Outcomes Framework Michele Kratter Keiser University Professor Denton HSM 691/Quality Management in Healthcare 2/13/2016 Management Healthcareuyanagement Healthcare Running Header: Continuing Improvements for the National Service Quality and Outcome Framework 2 1. What do you consider to be the key issues for quality improvements in the NHS qualityimprovement program as it goes forward? Established in 2013, NHS is the driving force for improvement working to improve health outcomes for people and also change expertise. Its primary theme is collecting and reviewing data, so as to improve business operations in healthcare and also recognize opportunities (McLaughlin, Johnson, & Sollecito, 2011). There are critical issues that need to be considered for NHS quality improvement program, including the necessity of the funds for quality improvement, clients' needs, expectations of the community, and the needs of service providers. 2. What do you consider to be the strengths and weaknesses of the effort to improve the development of QOF indicators over the next couple of years? One of the strengths of the attempt to improve the development of QOF is that it is designed to give incentive to the best practice for the care of patients with long- term ailments; its compliance generates significant extra incomes for practices. However, it has limitations due to the bureaucracy involved in reporting and validating data. To make the system reliable, there is the need to enhance improvements in the next few years to simplify and eliminate the number of indicators. 3. The program appears to be using QALY metrics to justify the choices of future quality and outcome indicators. What are the strengths and weaknesses of such an approach to valuing quality? The strengths of QALY metrics includes helping reduce the burden of diseases of patients, Running Header: Continuing Improvements for the National Service Quality and Outcome Framework 3 valuing quality, and increasing the quality to the people. However, it has weaknesses in that it lacks sensitivity, it also doesn't clearly measure the impact of the disease and impact on the family (McLaughlin, Johnson, & Sollecito, 2011). Moreover, it is not easy to apply to chronic illnesses and life expectancy figures and facts may be inaccurate. 4. Some researchers have expressed doubts about the improvement effectiveness of indicators in the high 90% range. What is your evaluation of this concern and what alternatives do recommend? Some of the records and values of clinics as determined by the NHS computerized system were not collected from the best adequate sampling data available. There was also a misrepresentation of a presence of a registry, since it is measured on the amount of time scheduled per clinical visit. These variables were determined by surveys on the number of patients who visited a site annually. 5. Most U.S. P4P efforts do not allow for exclusion of a significant number patients. What the pro and cons of this approach and the one used by NHS? The NHS to Pay-for-performance allows for certain exclusions in the U.K, in that it changes the nature of the office visit. Both of them are based on performance against targets where physicians are paid on targets which incredibly, are much greater in the U.K. (Buetow & Roland, 1999). Pay-for-performance programs might have unintended effects on other aspects of care, Running Header: Continuing Improvements for the National Service Quality and Outcome Framework 4 especially on physician motivations where they might be tempted to avoid sicker patients, exacerbating disparities, and avoiding certain types of care for which quality is not measured. 6. NHS is a single payer system. How does this affect its design of the QOF system and its efforts to implement it? How do the much more complex U.S. payment systems affect its utilization of the P4P systems? The QOF systems of NHS single payer system has many complications. Firstly, there is insufficient funding for the programs, and there is constant pressures to contain spending and only infrequent and indirect pressure to increase (Ferlie & Shortell, 2001). Empirical evidence shows that nationalized health care systems have undesirable consequences. The extensive implicit rationing is severe and intentionally conceals life and death decisions from patients. Other problems are outdated facilities and medical equipment, personnel shortages, politically driven inequalities, waiting times, significant variations in patient care, financial waste and loss of personal liberty. The U.S system is more complex and has its own difficulties in its implementations of the P4P systems including clinical effectiveness, coordination and continuity and access and equity (Buetow & Roland, 1999). 7. The NHS QOF effort is obviously full of very specific point systems for evaluation. What are the strengths and weaknesses of such quantification of decision rules in a healthcare environment? The NHS QOF point systems are not consistent due to the greater association between the outcomes and deprivation more than in any of the QOF scores. The relationship between socio- Running Header: Continuing Improvements for the National Service Quality and Outcome Framework 5 economic deprivation and health is much higher. In spite of some setbacks, the results highlight the point that the clinical value of the QOF is dependent on the selected indicators. The system did not seem to have generated as a set of indicators as intended. The main limitation is the short lag time between the implementation and cost-effective, which may not be efficient to assess the full impact of the QOF (Ferlie & Shortell, 2001). Running Header: Continuing Improvements for the National Service Quality and Outcome Framework 6 References Buetow, S. A., & Roland, M. (1999). Clinical governance: bridging the gap between managerial and clinical approaches to quality of care. Quality in Health Care, 8(3), 184-190. Ferlie, E. B., & Shortell, S. M. (2001). Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Quarterly, 79(2), 281315. McLaughlin, C. P., Johnson, J. K., & Sollecito, W. A. (2011). Implementing continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Publishers