week 2 you decide

Topics: Management, Quality assurance, Quality management system Pages: 3 (709 words) Published: October 16, 2014


The case is about Southside HMO, which serves 495,000 members throughout the eastern region of the United States. It has come to your attention that several members or patients who participate in your plan have filed a complaint that your HMO plan does not provide quality healthcare delivery. Several patients have been denied healthcare services to see specialists to whom they were referred by their primary care providers.so the board of directors has asked to provide a report detailing the strategies and recommendations to investigate the complaints and to identify strategies to ensure that quality management initiatives are in place to make sure that quality healthcare services are provided to all members. So if I am the chief executive officer of Southside HMO the strategies and recommendations that I collect to solve the problem is as follows normally Southside HMO should over all the patients so the provider reminder system should be implemented like reminders in charts, computer based reminders for providers and computer based decision support. They also should assess current activities in quality improvement to evaluate effectiveness in addressing overlap, they should establish a structure for example through policy, regular meetings or realignment of the organizational hierarchy which ensures the patient care activities are addressed in a coordinated manner involving the risk management and quality improvement functions, they should seek guidance from legal counsel to structure of quality improvement activities maximizes legal protections granted by state and federal status while allowing for the flow of information across both functions they also should ensure quality improvement plans and efforts and see that aligned with the strategic goals of the organization, they should educate stakeholders like executive staff, boards of trustees, physicians, caregivers and other differences between and similarities of quality improvement...
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