Faculty of Medicine University of Jaffna Sri Lanka completed

1 Quality Assessment and Management in Healthcare Name Institution Course Professor Date 2 Quality Assessment and Management in Healthcare Introduction Healthcare organizations are complex due to the nature of service outcomes and a blend of diverse medical practitioners. Quality assessment and management in healthcare are integral to the principles of quality related to physical attribute services. The textbook increases the understanding of quality management in healthcare. For instance, chapter fourteen discusses how program evaluation, performance management, and continuous quality improvement could enhance organizational performance. Performance management is a framework for organizational improvement and evaluation. Performance management is used in the private and public sectors. Healthcare organizations have different performance management systems that enhance quality using performance standards and employee performance measures. Chapter fifteen discusses managing finance and budgets (Fallon, 2013). Business plans are part of financial management and budgets since they are outlines for launching, maintaining, or expanding organizational activities. The primary components of business plans are executive summaries, market analysis, necessary funding, ownership and management, prospective financial data, organizational descriptions, marketing and sale strategies, and product description. Financial statements are integral to finance management and budgets since they convey an organization’s financial position. Income statements are profit and loss statements comprising details of expenses, sales, and net incomes the organization generates. Chapter sixteen discusses information management in healthcare. The textbook defines health information and data as information providing immediate access to diagnosis, laboratory tests, allergies, and medications that healthcare practitioners use to enhance abilities or services for making timely clinical decisions. Result management is another part of information management that provides access to 3 new and past test results to allow healthcare practitioners to make informed decisions about patient safety and effective treatment (Fallon, 2013). Order management ensures that medical practitioners can enter and store orders for tests, prescriptions, and other care services. Order management reduces duplication, improves legibility, and allows the timely completion of orders. Electronic communication and connectivity are electronic devices that promote open, secure, and readily accessible communication channels among patients and providers to increase diagnosis and treatment timeliness, enhance care continuity, and reduce adverse events’ frequency. Case Study Critique The presented case study is about analyzing the audit at Mercy Hospital. Mercy Hospital is significant in the region’s healthcare since it is the leading care provider. The audit revealed significant challenges from the auditor and how hospital management covered the purchase of a scanner that cost more than the initial budget. For instance, Jack’s interviewing techniques showed his weaknesses. Jack’s interviewing techniques showed those of an individual who lacked preparation. Auditors should be prepared for interviews to minimize the risks of failing and enhance success opportunities. Jack had audited the hospital a year ago and had an unpleasant experience. The unpleasant experience should have increased his determination to prepare and have appropriate facts to enhance the interview. Porter and Crumbley (2012) stipulate that increased preparedness and development of interview skills among auditors increase their positioning to obtain evidence and solve cases. Another evident flaw in Jack’s interviewing techniques is the lack of appropriate evaluation of responses. The best auditors should distinguish opinions from facts and become conscious of bias in an interview. For instance, Jack failed to control his interview and 4 distinguish opinions from facts. Jack mentioned that he failed to realize the scheduled BOD meeting in the organization, which could affect the interview. Auditors should be prepared to identify appropriate representations to get documentary evidence for supporting essential representations from an interview. The significance of the flaws in Jack’s interview shows that Jack could have approached the interview differently to get better results. The first approach Jack should have taken is planning for the interview. Enhanced planning and preparation are integral to successful audits and interviews. Jack should have prepared a written agenda covering the discussions in the interview since it consists of the important questions to recall the interview questions. Jack should have used his previous experience with Mary Hospital to understand that challenges might arise and find appropriate opportunities to navigate them. Jack’s lack of preparation is evident from his lack of contact to resolve an issue with the checks he was concerned about regarding the scanner’s price. Even though Jack had questions about the abnormally large invoices, he lacked follow-up questions that could enhance transitioning and overseeing the project. Jack forgot to identify the director offering a bribe to avoid other questions about the inflated invoices regarding purchasing the 64-Slice CT Scanner. The director’s statement of Jack working as an internal editor on payroll audit for the rest of his career if he fails to change his attitude and reconsider options. Another thing Jack forgot to do was read the basic internal audit text on proper specifications since the director requested him to read it to comprehend the total cost of acquiring the scanner. According to Abdelrahim and Al-Malkawi (2022), internal auditors should remember all audit aspects to enhance internal audit effectiveness to achieve predefined objectives. Internal audit effectiveness entails stating the objectives clearly and 5 adding value to organizations to improve their operations. Therefore, auditors should develop appropriate measures to cover all auditing aspects and improve governance processes and effective risk management. Conclusion Quality assessment and management in healthcare are integral to the principles of quality to enhance patient care. Program evaluation and performance management are integral to healthcare since the private and public sectors use them to enhance patient outcomes. Information from the case study has been central to understanding the significant challenges auditors face in hospitals. For instance, Jack struggled with the audit at Mercy Hospital since he failed to prepare for the interview. Another flaw in Jack’s interviewing techniques is the lack of appropriate evaluation of responses. The study enhanced my understanding of financial departments and the complex nature of how healthcare management could monitor spending in healthcare facilities. Besides, the chapters influenced my opinions on managing finance and budgets since they provided broad definitions of various factors affecting financial management and budgets. For instance, the clarity of critiquing the case study and the depth of the paper benefited from the chapters since they provided further insights on conducting financial audits in healthcare. The descriptions in the case study could affect healthcare setting organizations and management by providing better ways of dealing with healthcare challenges. 6 References Abdelrahim, A., & Al-Malkawi, H. A. (2022). The Influential Factors of Internal Audit Effectiveness: A Conceptual Model. International Journal of Financial Studies, 10(3), 71. doi:https://doi.org/10.3390/ijfs10030071 Fallon, L. F. (2013). Managing health organizations for quality and performance. Jones & Bartlett Publishers. Porter, S. F., & Crumbley, D. L. (2012). Teaching interviewing techniques to forensic accountants is critical. Journal of Forensic & Investigative Accounting, 4(1), 122-146. Florida National University HSA-6752 Statistic in Health Care Management Week 6 Nonparametric Test: Chapter 10 Objective: To critically reflect your understanding of the readings and your ability to apply them to your Health care Setting. ASSIGNMENT GUIDELINES (10%): Nonparametric Tests: Analysis, description and applying techniques. For this assignment, you will critically evaluate, compare and contrast parametric and nonparametric tests, identify multiple applications where nonparametric tests approaches are appropriate and identify the appropriate nonparametric hypothesis testing procedures base on type of outcome variable and number of samples. You are invigorated to choose a specific Nonparametric test as a reference to do this assignment. The paper will be 4-5 pages long. Each paper must be typewritten with 12point font and double-spaced with standard margins. Follow APA style 7th edition format when referring to the selected articles and include a reference page. EACH PAPER SHOULD INCLUDE THE FOLLOWING: 1. Introduction (25%) Distribute a short-lived summary of the meaning (not a description) of the Chapter and articles you read, in your own words. 2. Nonparametric Test (50%) Compare and contrast parametric and nonparametric tests. Identify multiple applications where nonparametric tests approaches are appropriate. Identify the appropriate nonparametric hypothesis testing procedures base on type of outcome variable and number of samples Did these Chapter and articles change your thoughts about Nonparametric Test? If so, how? If not, what remained the same? 3. Conclusion (15%) Briefly recapitulate your thoughts & conclusion to your analysis of the articles and Chapter you read. Evaluation will be based on how clearly you respond to the above, in particular: a) The clarity with which you critique the chapter. b) The depth, scope, and organization of your paper; and, c) Your conclusions, including a description of the impact of this Chapter on any Health Care Setting. ASSIGNMENT RUBRICS Assignments Guidelines Introduction Nonparametric Test Conclusion Total 10 Points 25 Points 50 Points 15 Points 100 points ASSIGNMENT GRADING SYSTEM A B+ B C+ C D F Dr. Gisela LLamas 90% – 100% 85% – 89% 80% – 84% 75% – 79% 70% – 74% 60% – 69% 50% – 59% Or less. 10% 25% 50% 15% 100% Chapter 10 Nonparametric Tests Learning Objectives (1 of 2) • Compare and contrast parametric and nonparametric tests • Identify multiple applications where nonparametric approaches are appropriate • Perform and interpret the Mann–Whitney U test • Perform and interpret the Sign test and Wilcoxon Signed Rank test Learning Objectives (2 of 2) • Compare and contrast the Sign test and Wilcoxon Signed Rank test • Perform and interpret the Kruskal–Wallis test • Identify the appropriate nonparametric hypothesis testing procedure based on type of outcome variable and number of samples Nonparametric Tests • Appropriate when outcome is continuous but not normally distributed – Rank scores (e.g., disease stage) – Continuous but subject to extremes – Continuous but there are limits of detection (on high or low end of scale) General Approach • Rank data • Perform analysis on ranks • Follow same 5-step procedure for hypothesis testing Ranking Data • Raw data 7 5 • Ordered data 0 2 9 3 0 2 3 5 7 9 3 4 5 6 • Ranked data 1 2 Ranking Data with Ties • Raw data 7 7 • Ordered data 0 2 9 3 0 2 3 7 7 9 • Ranked data 1 2 3 4.5 4.5 Assign mean rank to ties, Sum of ranks = n(n + 1)/2 6 Tests with Two Independent Samples: Mann–Whitney U Test (1 of 2) • Continuous outcome that is not assumed to follow a normal distribution • Two independent samples H0: Two populations are equal H1: Two populations are not equal Tests with Two Independent Samples: Mann–Whitney U Test (2 of 2) • Test statistic is U = min(U1, U2), n 2 (n 2 + 1) n1 (n 1 + 1) U1 = n1n 2 − − R2 − R 1 U 2 = n1n 2 − 2 2 where R1 and R2 are the sums of the ranks in groups 1 and 2. • Reject H0 if U ≤ critical value in Table 5. Example 10.1. Mann–Whitney U Test (1 of 4) • A Phase II clinical trial is run to investigate efficacy of a new drug for asthma in children. • Outcome is number of episodes of shortness of breath over a 1-week period. Placebo Drug 7 3 5 6 6 4 4 2 12 1 Example 10.1. Mann–Whitney U Test (2 of 4) H0: The two populations are equal H1: The two populations are not equal a = 0.05 • Test statistic is U. • Rank data in pooled sample (n = 10), and compute R1 and R2. Example 10.1. Mann–Whitney U Test (3 of 4) Example 10.1. Mann–Whitney U Test (4 of 4) n1 (n1 + 1) 5(6) U1 = n1n 2 − − R1 = 5(5) − − 37 = 3 2 2 n 2 (n 2 + 1) 5(6) U 2 = n 1n 2 − − R 2 = 5(5) − − 18 = 22 2 2 • Test statistic is U = 3. • Reject H0 if U ≤ 2 (Table 5). • Do not reject H0 because 3 > 2. We do not have significant evidence to show that the two populations are not equal. Tests with Matched Samples: Sign Test (1 of 2) • Continuous outcome measured in matched or paired samples; differences are not assumed to follow a normal distribution. • Matched or paired samples H0: Median difference is zero H1: Median difference >, 2. We do not have significant evidence to show that there is a difference in QOL measured before versus after chemotherapy treatment. Tests with Matched Samples: Wilcoxon Signed Rank Test (1 of 2) • Continuous outcome measured in matched or paired samples, differences are not assumed to follow a normal distribution. • Matched or paired samples H0: Median difference is zero H1: Median difference >, 25. We do not have significant evidence to show that the median difference in SBP is not zero. Tests with More Than Two Independent Samples: Kruskal–Wallis Test (1 of 2) • Continuous outcome that is not assumed to follow a normal distribution • k (k > 2) independent samples H0: k population medians are equal H1: k population medians are not all equal Tests with More Than Two Independent Samples: Kruskal–Wallis Test (2 of 2) • Test statistic is H, k R2   12 j  − 3(N + 1) H=   N(N + 1) j=1 n  j   where k = number of groups, N = total sample size, nj = sample size in jth group, Rj = sum of the ranks in jth group. • Reject H0 if H ≥ critical value in Table 8. Example 10.8. Kruskal–Wallis Test (1 of 4) • A clinical study is run to assess differences in albumin levels in patients following 5%, 10%, and 15% protein diets. Example 10.8. Kruskal–Wallis Test (2 of 4) H0: The three population medians are equal H1: The three population medians are not equal a = 0.05 • Test statistic is H. • Rank data in pooled sample (n = 12), and compute R1, R2, and R3. Example 10.8. Kruskal–Wallis Test (3 of 4) Example 10.8. Kruskal–Wallis Test (4 of 4) • R1 = 7.5, R2 = 30.5, R3 = 40. • Test statistic is H. k R2   12 j  − 3(N + 1) H=   N(N + 1) j=1 n  j   12  7.52 30.52 40 2    − 3(13) = 7.52 = + + 12(13)  3 5 4  • Reject H0 if H ≥ 5.656 (Table 8). Tests with More Than Two Independent Samples: Kruskal Wallis Test • Reject H0 because 7.52 > 5.656. • We have statistically significant evidence to show that there is a difference in median albumin levels among the three diets.