Healthcare Quality Management

Healthcare Quality Management

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Healthcare Quality Management

Mcleod Medical Centre is an acute centre hospital located in Florida. The hospital is ranked higher among the others which provide acute care. The hospital provides emergency treatment, receives its tests electronically, can track the patient’s progress electronically and provides both outpatient and inpatient services (“Medicare Hospital Comparison”, 2016). As shown above, the hospital has invested in both resources and professionals. The ratio of nurses to patients is high meaning that more patients can receive more attention.

Additionally, the hospital has an internal quality control system the monitors the quality levels of different practices. Examples of some of the practices monitored include the wait time and response level of the medical practitioners (“Medicare Hospital Comparison”, 2016).  The second hospital should introduce a quality management section that will introduce standards for different practices. Additionally, it should invest more in resources and medical professionals to reduce the nurse to patient ratio.

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The value of services in the different hospitals can be increased by focusing on both medical and non-medical aspects of quality (Hibbard & Greene, 2013). Access to medical care and physicians should be increased in the different hospitals. Additionally, the waiting time should be reduced to minimal levels. Responses should be collected from different patients on the effects of waiting times. 

Additionally, the hospital should invest in providing patients with enough information regarding different conditions (Taylor et al., 2014). Well, trained counsellors will be used to create a link between the hospital and the patients. Check-in and check-out procedures should also be friendly to patients (Aiken et al., 2013).  The hospital should also provide ancillary services to all patients (Dixon-Woods, McNicol & Martin, 2012). Medical aspects include having trained professionals, use of modern equipment and new technologies as well as proper medications and instruments.


Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M., … &          Tishelman, C. (2012). Patient safety, satisfaction, and quality of hospital care: cross     sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344, e1717.

Dixon-Woods, M., McNicol, S., & Martin, G. (2012). Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant  literature. BMJ quality & safety, bmjqs-2011.

Hibbard, J. H., & Greene, J. (2013). What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2), 207       214.

Medicare Hospital Comparison. (2016). Retrieved 9 June 2016, from FLORENCE%2C%20SC&lat=34.1954331&lng=-79.7625625\

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality inhealthcare. BMJ quality & safety, 23(4), 290-298.

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Mayo Clinic’s Utilization Management Program

Utilization Management Program
Utilization Management Program

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An Overview of Mayo Clinic’s Facility Utilization Management Program

Mayo clinic is a sophisticated health care organization, which runs a variety of health care facilities, medical schools, and health science schools in the United States (Kashyap et al, 2016). This organization has developed an elaborate healthcare facility management program, which is aimed at enhancing the functionality of its facilities and personnel by integrating the most qualified health specialists and staff with a well-designed and equipped environment. Mayo clinic provides health care services to millions of patients from within the country and outside at a reduced cost (Miller et al., 2014).

The health care provider has facilities that are located in some of the following areas; Rochester, Jacksonville, Minnesota, Phoenix, Arizona, Scottsdale and Florida. In fact, its clinical campuses in Rochester are regarded as the world’s most integrated clinical facilities (Kashyap et al, 2016). In Mayo clinic, facility utilization and management program is based on empirical and evidence based strategies, which are aimed at providing the clinicians and other health care service providers with a conducive work environment, and the clients with high quality services, depending on urgency, and in the most appropriate and efficient manner (Kashyap et al, 2016).

Facility utilization management is also regarded as a venture that assists the management to reduce the overall costs of running the facility. It is therefore implemented in a prospective, concurrent, and retrospective approach (Kashyap et al, 2016). The health care provider has also developed the ‘at-risk care delivery program’, which is meant to increase the effectiveness of health care provision to its clients, as well as an enabling environment for the physicians and other staff members.

For instance, the at-risk care delivery program is designed to provide clients with; a well-planned discharge schedule for inpatients; provision of services with minimum variation for all clients; and a continuum of high quality care services to both inpatients and outpatients in the clinic, and all these being designed to result in minimization of any unnecessary care that could be provided to patients, and as such, an overall reduction of costs incurred in service delivery to patients is achieved (Kashyap et al, 2016).

Critique of the Facility’s Utilization Program In Light Of the Standard Utilization Management Programs

Facility Utilization Management (FUM) in this organization is evident in the systems and procedures that it has adopted as an effort to achieve health care savings. In particular, FUM is achieved through effective management of patients’ care as well as minimizing unnecessary care that is given to the patients (Kashyap et al, 2016). Physicians and other medical staff in Mayo clinic have been sensitized to the need to adhere to FUM guidelines as health service providers, as an effort to increase the accountability of medical service provision to patients who are regarded as payers in the system.

As such, they are required to provide health care services in accordance with the patient’s needs and the medical necessity that arises from the need, which in this case should be provided to the patient in the most efficient and appropriate manner at all times (Massimino et al., 2015). To achieve this, Mayo clinic has adopted the necessary technology to oversee efficient and economical service provision to patients including hospital admission programs, length of stay management, and precertification programs (Julianna et al., 2013).

All these programs are designed to provide patients with services in the most economical manner, where costs are aligned with the type of service provided. These programs have been adopted in all areas within Mayo clinic’s health facilities including medical, substance abuse, laboratory, and surgical sectors.

FUM within Mayo clinic is performed retrospectively and concurrently as deemed necessary. The specific objectives include maintaining the average number of patients who receive services, but at a reduced cost; establishing a DRG-guided inpatient health care facility; and to effect free for service outpatient services as a containment strategy to cut down on costs (Kashyap et al, 2016).

In its prospective review programs, Mayo clinic evaluates patients’ perceived medical or care need before admission, and assesses its appropriateness in terms of the proposed service requirement against any available medical information about the patient’s condition. This is followed by conducting an extensive consultation to determine the necessity for the required services or procedure (Julianna et al., 2013). If positive outcomes are obtained, then the patient is admitted for services or provided with outpatient services, if negative, alternative treatment options are discussed with the patient (Kashyap et al, 2016).

The prospective review program may be seen as a cost effective measure since it prevents the patient from being given unnecessary treatment services, and the health facility from incurring costs from the services provided, medicine and consultancy fees for physicians. The likely disadvantage in the program is that prospective reviews are bound to take lots of time if they are to be effective and meaningful (Massimino et al., 2015). In addition, the type of review may not be effective in cases where patients require emergency services, and this is because unnecessary costs would still be incurred during the diagnosis.

In its retrospective review programs, Mayo clinic conducts a detailed analysis of the duration of stay among other metrics in all its institutions and health facilities, including an analysis of the length of stay at the physician(s) level. Retrospective review is aimed at identifying any gaps in care provision, and whether there exist anomalous utilization patterns in the system (Kashyap et al, 2016). The information provided is used to make updates on clinical guidelines and registries according to care outcomes, after which necessary adjustments are made.

The retrospective review may be seen as an important venture because it helps management to optimize the health service outcomes, and at the same time achieve a reduction in the overall costs of operating the clinics. In addition, gaps in the utilization of medical staff and facilities may also be identified through the review, which would allow the appropriate adjustments to be effected. If effectively done, this would be reflected as reduced operation costs.

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In its concurrent review programs, Mayo clinic emphasizes that its physicians and the medical staff screen patient’s conditions or health service requirements before admission, which is a means of determining the medical necessity of the patient’s need requirements (Kashyap et al, 2016). Information from the screening procedure is also used to determine the appropriateness of the patients’ perceived requirement. As an effective care management program, the screening procedure helps determine the appropriate duration required in giving the patient the required service care, and this information is used to schedule the period of stay from admission to when the patient is discharged.

The concurrent review program may be seen as an effective venture in as far as cost reduction in care provision is concerned. This is so because; information obtained from the screening procedure may be used by physicians to prescribe the correct treatment. Specifically, it allows the nurses and medical staff to provide health care services in an efficient manner while focusing on the anticipated outcomes (Kashyap et al, 2016). In this case, wastage of time and medication is minimized; the clinic is also able to anticipate the appropriate bed days for scheduling.

On the other hand, the clinic is able to cut down on costs incurred through bed stays and admission services, which is because the applicability of the provision of home support services may be evaluated during the screening procedures. In addition, the patients are also able to receive high quality services and the needed attention, since the nurses and physicians would need to monitor the patient’s progress in an effort to adhere to the schedule and discharge plans.


Kashyap, R., Farmer, J. C., O’Horo, J. C., & Farmer, C. (Eds.). (2016). Mayo Clinic Critical Care Case Review. Oxford University Press.            q=mayo+clinic++&ots=PwF_auNEbd&sig=Bj5vKP_jdmz1YhiYaEc4U9IBTBI

Massimino, P. M., Joseph, M. L., & Kopelman, R. E. (2015). Hospital Performance and    Customer-, Employee-and Enterprise-Directed Practices: Is the Mayo Clinic Reputation Deserved?. Journal of Management Cases, 28.

Merten, Julianna A., et al. “Utilization of collaborative practice agreements between physicians     and pharmacists as a mechanism to increase capacity to care for hematopoietic stem cell transplant recipients.” Biology of Blood and Marrow Transplantation 19.4 (2013): 509-518.

Miller, R. C., de los Santos, L. E. F., Schild, S. E., & Foote, R. L. (2014). Organizational Culture and Proton Therapy Facility Design at the Mayo Clinic. International Journal of Particle Therapy, 1(3), 671-681.

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