Emerging Healthcare Quality Model

In the conditions of the market economy, when care provided by the practitioners and clinics is perceived as a commodity, the quality of the latter becomes especially important. In turn, the governmental structures implement measures that focus on its improvement, which results in the emergence of the new trends in healthcare. As a result, the quality model itself becomes subjected to changes, often being transformed completely. The following work focuses on the discussion of the emerging healthcare quality model, as well as the analysis of the concept of a high-performance organization and its application to one of the health agencies.

The implementation of the Affordable Care Act (ACA) as a result of the reform has resulted in the emergence of the two major quality-related trends in healthcare. First of all, there is the control over the providers of medical services that is carried out by the newly established Accountable Care Organizations (Marjoua & Bozic, 2012). As a result, currently, the facilities and practitioners receive guidance to ensure the care they provide is coordinated and patient-centered, as well as of high quality. Moreover, such trend has provided for the unification of services, namely through the introduction of a single payment system, i.e. only one entity is responsible for reimbursement and compensation (Jacobs & Skocpol, 2016). As a result, the new healthcare quality model is becoming more centralized, which is likely to result in the reduction of expenditures due to the lack of fragmentation.

The second major trend is related to the introduction of the value-based payments. In general, it is an approach that focuses on the provision of financial incentives to healthcare facilities and practitioners for meeting certain performance standards. It should be noted that some of the factors, namely the clinical outcomes, cannot be measured precisely, which means that the quality and efficiency of work becomes the primary focus of the assessment process. At the same time, the providers that do not meet the requirements (i.e. make a significant amount of medical errors or overprice their services) are penalized (Ross, 2013). Thus, it is possible to say that the new model makes the quality of health services a cornerstone of the American healthcare as a whole and combines several approaches to it, including uniformity, constant control, and motivation. Moreover, given its mandatory nature (i.e. the presence of penalties and fines for low-quality work), it is possible to assume that the transformation of the industry will be rather swift.

At the same time, it becomes clear that in order to cope with the newly presented requirements, healthcare facilities and agencies must improve efficiency of their internal processes – in other words, become high-performance organizations. In such entities, the leaders tend to maintain the efficient relationship that is based on trust rather than on authority with the employees working at all organizational levels. This goal is achieved through valuing loyalty of the workers, treating them with respect, creating as well as maintaining individual relationships with employees, encouraging trust and belief in others, and treating all people fairly (Huber, 2013). Despite the diversity of such organizations, all of them have common features. The first of them is high quality of management, which is manifested in the trustworthiness of managerial techniques used by the leaders, who serve as role models for other members of the company. Moreover, the management of such firms is characterized by its integrity (Holbeche, 2011) and, therefore, the ability to provide conditions for the fast decision making and action taking.

The next important feature of a high-performance organization is its openness, as well as action-oriented nature. In particular, there is a frequent engagement of managers in dialogues with the personnel, as well as communication and knowledge exchange become a significant part of daily routine. Moreover, all of the members are involved in the important processes while being allowed to make mistakes. Finally, the managerial staff perceives change as a positive event (Katzenbach & Smith, 2015). Another characteristic of a high-performance organization is its long-term orientation, with its managers maintaining and planning the relationships with stakeholders strategically. The customer service (i.e. the quality of products) is among the primary goals of the enterprise. Moreover, there is little to no turnover of the leaders, with them being promoted from within the company rather than hired. Finally, there is an atmosphere of security and stability in the firm. In addition, continuous improvement is also a feature inherent in the high-performance organizations, which helps them differ from other entities. All the processes within it are being improved, simplified, and aligned on the constant basis. In turn, relevant indicators are constantly monitored and reported (Huber, 2013). Finally, a high-performance organization is characterized by the outstanding quality of its personnel, with the people being inspired to achieve their goals, as well as trained to be flexible and resilient (Shepherd & Smyth, 2012). In turn, the workforce becomes diverse, and the partnership is the primary way of its growth.

By obtaining the general portrait of a high-performance organization, it is possible to apply this information to one of the health agencies in the U.S., namely the Center for Medicare and Medicaid Services, to define its efficiency. In particular, under the conditions of the healthcare reform, the entity has demonstrated the ability to make decisions and take actions quickly, which is a sign of a quality management. By taking into account its active participation in the process of reformation of the health system (Kronenfeld & Kronenfeld, 2015), it is possible to make an assumption regarding the high level of openness of the agency, as well as positive attitude of its leaders towards the change. The strategic focus of organization (e.g. the participation in the healthcare reform that is to be completed in the 2020s) demonstrates its long-term orientation, meaning that the agency plans its activities thoroughly (Kronenfeld & Kronenfeld, 2015). Additionally, it maintains the partnership with a wide array of organizations both on the local and federal levels (e.g. healthcare facilities, funds, state authorities, etc.) while also makes attempts to improve the quality of services it provides to its stakeholders without increasing their costs. Finally, the diversity of workforce is among its distinctive features, with people of different races, ethnicities, and religions working there (Jacobs & Skocpol, 2016). As a result, such an approach helps to better understand the needs of the beneficiaries. Therefore, the Center for Medicare and Medicaid Services can be perceived as a high-performance organization. However, there is still room for improvement, especially in the field of involvement of the workers in the important processes, the maintenance of a trust-based relationship between the leaders and employees, the creation of atmosphere of stability after the reform, etc.

In conclusion, it is possible to say that the healthcare reform has resulted in the quality of provided care becoming the primary focus of government and the healthcare facilities. The emergence of new trends in the industry, as well as the presentation of new requirements to the providers, have resulted in the formation of new quality system, which forces the companies engaged in healthcare to change, improving their performance. At the same time, despite the fact that many of health organizations and agencies can be considered high-performance entities, the principle of continuous improvement dictates the need for their further development, which will raise the quality of care to a new level.