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Quality Assurance

The principles of quality as they relate to healthcare services and documentation can be defined as comprehensive codes of conduct that ensure the accuracy, accessibility, and overall ethical value of client services.

Quality assurance involves all those planned and systematic actions necessary to provide confidence that the facility will perform satisfactorily and above minimum standards. Most health care organizations establish standards, or guiding principles, that measure their service expectations. Quality management plays a big role in establishing guiding principles.

Quality Improvements/ Process Improvement protocols should be incorporated  within your infra structure. After compliance audits are performed by the quality assurance program, process improvement plans are generated by the quality assurance team and issued to departments that had deficiencies on their audits. The quality assurance program is responsible for ensuring that identified deficiencies are improved. Deficiencies left unattended may result in future liability issues. Did I say Liability issues (Ok good!) Corrective action plans and being proactive maintains best practice facilities. Always maintain patient safety and satisfaction.

Mental health agencies have been increasingly required by their accrediting bodies to specify and implement plans to continuously monitor and improve the quality of the services they provide (Commission on Accreditation of Rehabilitation Facilities, 2008Council on Accreditation, 2008; Joint Commission, 2008).

The DCF 65D30 website highlights the performance management and planning unit  and supports the development of a comprehensive substance abuse service delivery system that is based on the principles of continuous quality improvement. You may explore the following web site for ideas:  

"Managing Managed Care" has placed many restraints within our industry it requires providers to evaluate evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections and maintaining quality improvements. Our Team can assist you addressing any system problems.

Your  quality assurance should incorporate a systematic process of checking to see whether a product or service being developed is meeting specified requirements. A system for evaluating performance, as in the delivery of services or the quality of products provided to consumers, customers, or patients. Many companies have a separate department devoted to quality assurance. A quality assurance system is said to increase customer confidence and a company's credibility, to improve work processes and efficiency, and to enable a company to better compete with others.

Quality planning enables programs to evaluate their effectiveness and to develop additional services based on community and client needs. Goals are established and measurement indicators are utilized. An indicator measurement may be the results of your clients satisfactory surveys. Quality control evaluates current procedures and compares to existing standards and best practice recommendations. Implementation of effective changes are evaluated by team (your QA Team) . Your team will also analyze the process, identify corrective actions and defined a method for improvement. The quality committee continues to work together with the clinic members to ensure implementation of the quality assurance plans for both current and new projects.

Many agencies will hire a Quality Assurance Director/coordinator to ensure the agency meets accountability factors and maintains best practice approaches. The quality assurance director or coordinator would be responsible but not limited to some of the following tasks:

  • Record management
  • Chart auditing and maintaining clinical documentation adherents
  • Auditing and contract compliance's
  • Monitoring utilization review teams  (UR)
  • Works with other department in preparing pertinent reports and submits quarterly reports to appropriate Administrator. organizes and coordinates Quality Council.
  • Performing federally mandated quality-control reviews of the Medicaid and Insurance and contract/ grant  programs;
  • Audit and maintain infectious control policies/procedures
  • Assuring agency maintains client privacy and HIPAA regulations
  • Providing internal and independent audits for all programs;Provides significant data/trends to the medical staff and other hospital personnel for their use in correcting problems
  • and meeting requirements of all regulatory agencies in a timely manner.
  • Conducting retrospective reviews of human resources . Responsible for the management and oversight of Quality Risk Management Department functions and personnel.
  • Assists with staff development
  • Determining medical necessity for prior authorization of medical services and requests
  • Providing independent fair hearings for clients and employees (adherence to patient , client and employee grievance procedures)
  • Client safety and environmental safety
  • Ensuring department compliance with the federal Health Information Portability and Accountability Act (HIPAA).
  • Establishes, implements, and communicates goals, objectives, policies and procedures in accordance with strategic plan.
  • Maintains professional and technical knowledge by conducting research; attending seminars, educational workshops, classes and conferences; reviewing professional publications; establishing networks; participating in professional societies; conferring with representatives of contracting agencies and related organizations.

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