Appraisals: Evaluating Procedures

The objective of an appraisal is to provide a detailed, written description of the procedure. This document can be used for future treatment planning and decision-making. Most organizations will also use an appraisal in setting up their service or care standards.

Appraisals take the form of a 'processes' document and not a 'product'-based document. For example, if a service wishes to appraise the outcome(s) of their service for all new service users, they need to carry out this process for each and every new service user. This will provide an accurate description from the consumer's viewpoint and help identify strengths, weaknesses and ways in which services can be improved.

When writing an appraisal you should consider:

As a minimum, documentation of the following is required:

The World Health Organization has published "Assessing Quality in Mental Health Care".

This publication provides guidance on the quality of mental health care and describes several models for assessing quality. This can be used as a basis for developing an appraisal.

The International Classification of Functioning, Disability and Health has published a publication that describes quality of care in terms similar to those used by the World Health Organization. It provides an approach that combines elements from Disability Scope of Practice (DoP) and medical model of disability (MMOD).

SMART techniques are used in various aspects of healthcare including:

One example is AIS (Australian Institute of Sport) in Australia who are using this process to assess their athletes and coaches, who then use the information to improve their coaching skills.

Other examples are shown below:

The company Bell Health uses an extensive and structured approach to quality assurance.

To ensure the quality of their healthcare (including pharmacy) service, Bell Health has developed Model-based Management/Assurance (MBMA) which includes a wide range of management processes and an effective quality assurance system. MBMA is regularly tested by external agents and audited by the internal auditor for evidence of its effectiveness. The audit report published in 2011 shows that it was very effective at ensuring appropriate management of its health service, including that it was 'clearly compliant' with applicable legislation and regulatory requirements.

Blair Doyle's model is similar to the MBMA model. He uses the acronym M-O-R-S to describe its components – the different ways of working that are necessary for high quality care.

In the UK, The National Institute for Health and Care Excellence (NICE) is a non-governmental organisation that provides national guidance and advice to improve health and social care in England and Wales. NICE develops guidance in three areas: public health, improving effectiveness of healthcare (clinical practice) and public health.

In 2008 they developed an assessment tool called Quality of Life Prognosis (QOLP) which looks at the following: 

The internationally recognized CCTM is committed to assuring quality care across the continuum of healthcare.

Its quality management model is built on a foundation of seven Quality Assurance Assessment Processes and 9 Quality Assurance Criteria. 

The CCTM constructs Quality Standards with the following objectives: 

The United States Department of Veterans Affairs conducts annual inspections of Veterans Health Administration facilities across the US. The inspections cover eight areas that relate to quality and safety:

A VHA chapter will develop an Action Plan to address any issue found in its inspection from each action item listed above. During the development stage, a QS is issued by VHA, which requires all Facilities to update their Action Plans as part of their Continuous Improvement Program (CIP) within 18 months.

The table below summarizes what the VA expects to be in each Action Plan based on each inspection team's findings:

In addition to the VHA's annual inspection, each chapter has its own local facility or regional quality programs to assess facility risk management and improvement efforts. Some examples include:

Many health organizations desire accreditation from an external agency. One of the most well known voluntary accrediting organizations is The Joint Commission (TJC). For example, hospitals accredited by TJC have been found to have lower rates of hospital-acquired infections than unaccredited hospitals. 

Hospital accreditation requirements are similar across the board and are targeted at improving hospitals' processes, systems, and services as well as reducing barriers to optimal practice. The Joint Commission has a list of standards that should be met by each hospital. These standards are broken down into three categories: 

In order to obtain accreditation, health organizations must meet set specifications. A survey is developed by the organization during its application process and sent to the organization's facilities for evaluation from the accrediting agency. Facilities must meet all required qualifications in order for accreditation approval for a year after application approval is granted.

In addition to the standards listed above, other requirements define how a facility should be operated. If a health organization is turning over more than $1 billion in annual revenue, they are required to have four mandatory components of their QS:

If an organization expects to have more than 100 beds in its hospital, it must also have four additional requirements:

The U.S. Department of Health and Human Services (HHS) has issued regulations for quality management systems that hospitals and other health facilities must follow when offering Medicare, Medicaid, or private insurance services. These regulations are currently administered by the Centers for Medicare & Medicaid Services (CMS). CMS is responsible for "ensuring quality care by accrediting hospitals and other institutional providers, reviewing the performance of those providers and making payment based on that performance."

The Quality Management System Requirements states that all Medicare, Medicaid, and private insurance providers must:

1. Create a valid patient assessment process and document it in their medical records. This is to ensure that proper assessments are performed for all patients.

2. Implement a valid medical necessity determination process and document it in their medical records. This has to be done for every service provided which includes diagnostic tests and procedures as well as administration of drugs, biologics, or devices used to treat or diagnose a condition or disease.

3. Create and maintain documentation for providing a complete, accurate and timely disclosure of information needed to support quality assessment, outcomes research and improvement efforts.

The Centers for Medicare & Medicaid Services (CMS) strives to improve the quality of care provided to Medicare beneficiaries. Quality Management System Requirements that facilities must follow in order to receive payments from CMS are:

If a provider is found not to meet these requirements they may be suspended or terminated from further participation with federal programs. 

Federal law sets the expectation that CMS will use information derived from its inspection process as an opportunity "to promote continuous quality improvement" and "identify causes of patient safety events.

Conclusion

While quality management systems are generally used for hospital and health care services, the concept can be applied to a wide range of businesses. From product quality to services, many components of QMS are becoming applicable across industries and companies. The challenge facing organizations today is not whether or not to implement a quality management system, but how to implement one properly.

In recent years the importance of customer satisfaction in business has been acknowledged as very significant. Methods for improving customer satisfaction are widely researched, however there remains much debate as to what constitutes effective customer satisfaction management.