Imagine you are a quality leader for a health care organization, and you have been asked to create a document for new employees to introduce the basic concepts of risk and quality management.
Write a 1,050- to 1,400-word paper in which you address the following:
Explain basic concepts of quality improvement in the health care industry.
Explain the concepts of risk management in the health care industry.
Analyze the information needed for decision-making processes in risk and quality management in the health care industry.
Analyze 4 risk-and quality-management tools used in the health care industry by considering the following:
What are the risk- and quality-management tools used in health care?

What is the purpose of each tool?

What are the advantages and disadvantages of the tools selected?
Explain challenges in making risk- and quality-management decisions in the health care industry.
Running head: QUALITY IMPROVEMENT
Risk and Quality Management Manual
Rhonda Harris
HCS/451
William Johnson
April 26, 2020
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Introduction
The health care sector is quite complex, which means that implementing some of the
improvements might take some work. Improving the quality of service offered by this industry
allows patients to receive better care, and health care facilities utilize their resources efficiently
(Allen-Duck et al., 2017). One of the hindrances of quality improvement is that the provision
of patient care as a whole usually is not a process that can get improved. Medical personnel
mostly depend on their skills to treat patients by providing personalized care. Caregivers have
accepted that quality improvements can get made on the procedures they follow and, at the
same time, allow them to provide personalized patient care.
Basic Concepts of Quality Improvement in The Health Care Industry
There are a couple of basic concepts whose adoption leads to quality improvement in
the health care sector. The first concept revolves around having a hands-on approach in cases
where improvements are getting implemented within a health care facility (Allen-Duck et al.,
2017). Engaging in discussions and theoretical applicability of the refinements will not raise
the quality of service offered. The best way is to have all medical personnel participate in the
implementation of the improvements. By doing this, they better understand how to adjust and
align their work to conform to the dictates of the new system.
The second concept requires the existence of a standardized definition of quality within
the health care facility (Allen-Duck et al., 2017). It will act as the gauge for the type of services
offered by medical personnel. Most facilities have adopted the quality framework developed
by the IOM. The definition put forward revolves around the provision of individualized care to
every person that visits care facilities. Quality is what the patient considers as such and is
important to them. After setting out what quality entails, then comes measuring the services
offered to determine if they adhere to the quality standards and what improvements should get
adopted (Allen-Duck et al., 2017).
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When it gets revealed that quality improvements are getting instituted, most caregivers
start to panic. They believe such measures seek to hold them accountable for the performance
of their duties. However, measurement centered on quality improvement is not focussed on the
personnel but rather the system they use to offer care to patients (Allen-Duck et al., 2017).
Doing this allows for the identification of systems that need improvements in the process,
raising the quality of care according to patients. Adherence to all these concepts gets
accompanied by improved quality of care, characterized by limited time wastage and efficient
resource utilization.
Concept of Risk Management in the Health Care Industry
Risk management in the health care industry encompasses all measures and procedures
deployed within a health care facility to minimize the exposure of those seeking treatment to
risks (Alam, 2016). Traditionally risk management in this field revolved around the elimination
of errors from caregivers that might harm patients. However, with the entry of technology,
many avenues have gotten incorporated into the arena of risk management. Hospitals and other
care facilities are instituting measures centered on monitoring, detection, and evaluation of the
systems running within their facilities, to determine which pose a risk to patients and then get
rid of them.
Information Needed for The Decision-Making Process in Risk Quality Management in
The Health Care Industry
Incorporation of RMIS in the health care industry has helped decision-makers get their
hands on vital information they can use to evaluate risks within care facilities. One type of
information held with such a system is data regarding the number of casualties within a given
hospital (Alam, 2016). Such information points out the areas posing the greatest risk to patients
according administrators with an opportunity to eliminate them. The system also holds
information regarding insurance policies signed by hospitals and other care facilities. Such
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information allows these facilities to know how much liability they will incur, stemming from
claims from patients treated as their facilities. Generally, the information required by decisionmakers revolves around three parameters. Information regarding risk exposure, risk protection,
and finally, risk management (Alam, 2016).
Risk and Quality Management Tools Used in The Health Care Industry
Purpose of the Tools
The lean production system is one of the risks and quality management tools used in
the health care sector (Hughes, 2008). It mostly helps to determine the wastages taking place
within the systems adopted by care facilities. The tool seeks to help administrators comprehend
what their patients require from them and then make improvements to ensure patient
satisfaction. The second tool used is the root cause analysis (RCA) (Hughes, 2008). It involves
looking at what caused a particular event to take place and how to avoid it occurring once
again. Within the health care industry, it helps decision-makers understand events that might
pose risks to patients. With such information, they can then make improvements to prevent the
reoccurrence of such risks.
FMEA is another risk and quality management tool incorporated within hospitals and
care facilities (Hughes, 2008). It involves evaluating a system before it gets adopted to
determine the flaws and levels of risk it would pose to those who use it. The tool helps
administrators to anticipate errors within a system and deal with them before they get deployed.
Finally, there is PDSA, which seeks to ensure that all changes made to a system are improving
the quality of care rendered by the system (Hughes, 2008). Mostly it points out whether the
changes are necessary or just a waste of time.
Advantages and Disadvantages
Using a lean management system has an upside and a downside. One benefit stemming
from its use is the elimination of wastages within the system (Hughes, 2008). It then allows the
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system to function effectively, thereby improving the quality of services offered and
minimizing exposure to risks. On the downside, using this tool requires an evaluation of the
entire system, which means that at times the quality of services rendered will get affected. The
upside of using the RCA is that it allows for the identification of causes to an event, making it
possible to eliminate them (Hughes, 2008). However, the downside is that this tool only comes
into play when something happens. It is not a preventative tool; rather, it is a reactionary tool.
FMEA, just like other tools, has both advantages and disadvantages. One advantage is
that using it makes it possible to prevent adoption if systems with flaws that might harm patients
or staff (Hughes, 2008). On the downside, testing a system to determine its flaws is a timeconsuming process that might affect the operating timeline of the system. PDSA, on the other
hand, allows for the evaluation of changes to a system before their incorporation (Hughes,
2008). By doing this, hospitals can know which changes are beneficial and which serve no
purpose and as should get eliminated.
Challenges in Making Risk and Quality Management Decisions In The Health Care
Industry
The first challenge revolves around the lack of sufficient structures supporting the
decision-makers (Alterson, 2014). Some of the structures include a lack of pertinent
information that would guide their procedures. Without information regarding the risks
associated with a particular system or the improvements required, decision-makers cannot do
their jobs appropriately. The second challenge stems from a lack of a culture centered on risk
awareness (Alterson, 2014). People within the health care field rarely recognize that the
systems they use pose certain risks not only to them but also to patients. Therefore such a
culture impedes adherence to the sensitization measures or improvements made by decisionmakers.
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Conclusion
Every patient that approaches a care facility expects to receive the highest standard of
care possible. Such a level only gets attained if health care facilities come to terms with the fact
that improvements have to take place. When the quality of care accorded to patients improves,
so does the health status of Americans. Risks are part of the medical field, and as such, hospitals
and other care facilities should always strive to find a way to recognize them before they present
themselves and deal with them. Therefore, an efficient health care industry always seeks to
improve the quality of care it offers its patients, and the best way to do this is to eliminate all
risks associated with the systems they use.
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References
Alam, A.Y. (2016). Steps in the Process of Risk Management in Healthcare. Journal of
Epidemiology and Preventative Medicine, 2(2).
Allen-Duck, A., Robinson, J.C., & Stewart, M.W. (2017). Healthcare Quality: A Concept
Analysis. Nursing Forum, 52(4), 377-386.
Alterson, G. (2014, May 28). Risk management issues, challenges, and tips. Retrieved from
https://www.helpnetsecurity.com/2014/05/28/risk-management-issues-challengesand-tips/
Hughes, R.G. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Rockville (MD): Agency for Healthcare Research and Quality.

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