You have been appointed as Director Quality Improvement in a large Health Maintenance Organization?

You have been appointed as Director Quality Improvement in a large Health Maintenance Organization?


You have been appointed as Director Quality Improvement in a large Health Maintenance Organization. Your 2004 customer satisfaction survey (CAHPS) shown members being dissatisfied with accessibility and quality of care provided. In addition the (HEDIS) Preventive studies have shown results are below the benchmark in Annual Eye exam screening for Diabetes patients (members). It is now your responsibility to proceed with improving the Quality within your organization. How will you proceed?

You have been appointed as Director Quality Improvement in a large Health Maintenance Organization?
by improving the problem areas. See why the Annual Eye exams are not up to standards and find a way to fix it. I would contact the customers with diabetes and do a poll. Also, see how you can improve the accessibiltiy and quality of care. Why is it a problem... You need to get some good people that care to work for you that can help you find the answers and are willing to help turn things around.
Reply:Statrt teaching your people better excuses to why people aren't going to get the coverage.





Pretending to want to fix health insurance, spend more money...you must not be in the states......





Maybe when we called we didn't get the stupid voicemail hell that takes us everywhere but the place we want. Or the even dumber voice recognition stuff that takes you out of the country if you sneeze at the wrong decible. Or people who don't even speak our language making it impossible to understand and translate exactly what our problem is. Yeah..it happens ALL THE TIME.





Maybe sending out reminders to the insured who need the eye exams (age range/coverage needs). Ya'll have all the other info on file so I know ya'll have that too.





Don't deny healthcare payments or tests when people really need it. You aren't a Dr, atleast not one that you indicated so what qualifies you to decide what I need? Stay out of my medical decision making and just pay the d@mn bill since I have payed you faitfully for over 12 yrs.





Sorry it's not technical but the technical people don't know what we are pissed about. They aren't docs either.





You can't change the quality of care unless you come down on the docs but you can change YOUR quality.
Reply:I'd start with an independent assessment by a consultant which should define the problems, measure the scale of them and suggest ways to address the problems and how to measure their success.





I'd consider getting in touch with Alan Clarke, head of the UK Deming quality group at the CQI in London to kick off with.





Once you have a report and action points then prioritise them for the quickest gains (from the customers point of view)... quick gains are important when you are changing a culture.