The Role of Providers in Quality Assurance and Health Maintenance and Prevention

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TheRole of Providers in Quality Assurance and Health Maintenance andPrevention

The Role of Providers in Quality Assurance and Health Maintenance andPrevention

The providers are often expected to comply with the quality assurancewhile delivering health care to their patients. A slight mistake inthe giving the medical care might result in severe consequences thatwill undermine the likelihood of the patient recovering. Hence, thequality assurance oversees the processes taken while administeringthe managed care or even the acute intervention. In this case, theproviders are supposed to gain enough knowledge on theirresponsibilities and focus on improving their skills. The approachwill assist them in understanding how to deal with dilemmas in theirrespective units. This essay reveals how the providers strive ingiving the high-quality care that considers the health maintenance aswell as the prevention of certain diseases.


The process of providing the quality care often requires thephysicians to get enough education on the specific steps that theywill take in dealing with various challenges in their units. As aresult, most of the providers have been forced to seek enoughawareness that will assist them in understanding what they aredealing with. First, they have been compelled to undertake theprofessional training that will ensure that they have acknowledgedthe essence of quality assurance. The sessions provide enoughknowledge where they can identify the specific aspects that arecrucial in giving quality care. The education provides an opportunityfor greater networking where the physicians get a chance to revealtheir experiences with different dilemmas (Pawlson, 2014). Theinformation-sharing process often ends up being essential inillustrating the measures they should take while complying withquality assurance in the clinical setting. The collaborativepartnership also gives a platform where the providers can get achance to acknowledge their mistakes and get better ways of handlingtheir challenges and suggest better ways of health maintenance.

Various measures are crucial in facilitating the provider awarenessand ensuring that they comply with the quality assurance process aswell. First, frequent training is appropriate in increasing theeducation and making sure that they have the knowledge needed in thesystem (Pawlson, 2014). A supportive environment also motivates thephysicians to work based on the guidelines in the medical setting. Italso makes sure that they use teamwork as a way of exchanging ideasand understanding how they can improve the care delivery (Pawlson,2014). However, the collaboration will occur among different units sothat they can master a way of enhancing the overall processes andcoordination needed.

Analysis of the physician education, it is clear that the trainingmight be inefficient if it is not applied frequently. In some cases,the providers need to undergo the difficult and regular sessions tomaster the knowledge and get enough experience required in handlingthe challenges that might arise in the clinical setting (Pawlson,2014). However, networking seems to work, and it has provided anopportunity to share information on the quality assurance andexperiences that capture the dilemmas that most of them face. Thecollaboration also enhances the likelihood of the providers gettingthe solutions needed in handling most of the problems they face inthe hospital.

Lastly, the physicians will be expected to implement certainrecommendations to avoid the likelihood of facing challenges in thefuture. Inter-disciplinary collaboration can expose the providers tovarious measures and guidelines needed to prioritize the qualityassurance (Pawlson, 2014). The feedback from the patients and otherstakeholders can assist them in identifying any flaws in theirmeasures. Improved communication also facilitates the movement ofinformation in the various departments and make sure that everyphysician can access the standards that they should comply with(Pawlson, 2014). Lastly, the providers also do need adequate medicalresources that will enhance the care delivery and give the propermedical intervention that they should implement to minimize furthercomplications.

Part 2

The Health Maintenance Organizations (HMO), the Point of Service(POS), as well as the Preferred Provider Organizations (PPO) are someof the managed care plans that have been quite efficient inmaintaining the health of the patients. They have focused on managingthe finances and delivering high-quality services (Landon, Zaslavsky,Saunders, Pawlson, Newhouse &amp Ayanian, 2012). The managed carephilosophy often differs based on the type of intervention that isapplied to that particular condition. For instance, the HMO focuseson maintaining health as opposed to undertaking the acute approachesneeded in reducing the severity of the diseases. The philosophy alsobelieves that individual incentives and measures such as nutrition,exercises, proper counseling as well as screening often reduces thetreatment costs that might be needed to deal with the particularpatients (Landon et al., 2012). In fact, the theory shows thatmanaged care plan is often cheaper compared to the acute interventionthat is more expensive and risky too. It focuses on the widerperspective of the world while delivering the health care and itasserts on preventing and improving the clinical challenges thatpeople might experience.

An individual that has registered with the HMO is more likely toreceive the preventive clinical care that includes the vaccines.However, a few patients might be disadvantaged and fail to access thenecessary quality health care such as the vaccines (Shenson,Anderson, Slonim &amp Benson, 2012). The disadvantaged groupincludes the African Americans, poor and less educated individuals(Shenson et al., 2012). For instance, the HMO members might be morewilling and have the ability to access the vaccinations needed. Aneducated non-HMO member might even end up getting advanced healthcare compared to a less-educated HMO member instead. Hence, theprevention problem clearly refers to the unfair distribution of thehealth benefits that is evident in the society, and it mightinterfere with the vaccination process as well (Wong &amp Do, 2012).Some parents have even focused on ignoring the school vaccinationpolicies, and such individuals are more likely to encourage thespread of communicable diseases in the community.

Raising awareness among the disadvantaged group is one way ofensuring that the non-HMO members also can access the vaccinationservices. First, the situation shows that they are more likely tosuffer in the long-run since vaccination is an important part oftheir recovery process (Hibbard et al., 2012). They can still accessthe medical management intervention through other programs, andenough education clarifies what they need to do so that they canaccess the necessary services that align with the quality assurance.

The managed care plans are clearly working, and the low costs alsomake healthcare much affordable. In fact, the early interventionemployed helps the patients in checking their health and ensuringthat they are not suffering from any severe complications. Forinstance, the regular exercises ensure that the body is physicallyfit and the screening identifies any serious infection that a personmight have (Hibbard, Greene, Sofaer, Firminger &amp Hirsh, 2012).However, the disadvantaged group is unable to get the medicalservices because the HMO seems to ignore their interests. The lack ofvaccination means that they can keep suffering from diseases that canbe prevented, and they can spread such infections to other peopleinstead.

Various measures suggested will be critical in reaching the requiredsolutions needed. First, HMO should collaborate with CDC and otherpublic health agencies and ensure that everyone can access thenecessary medication (Andrade, Raebel, Boudreau, Davis, Haffenreffer,Pawloski, &amp Platt, 2012). The managed care organizations shouldfocus on being the active leaders since they are supposed to play anintegral role. The public health agencies can even arrange theawareness programs where they enlighten the communities on the needto engage in physical exercises, regular clinical examinations, andother preventive mechanisms to reduce the severity of their diseases.


In conclusion, the physicians are supposed to understand the qualityassurance and engage in activities that will minimize the likelihoodof errors occurring in their activities. Failure to comply with suchguidelines often creates mistakes that will interfere with thepatient’s health. Regular education and training ensure that theproviders have acquired enough knowledge on what they shouldundertake while dealing with patients. The collaborative partnershipalso provides an opportunity for the providers to share informationon their experiences and how to handle particular challenges. Themanaged care plan is also convenient and cheaper compared to theacute intervention that is expensive. In fact, its philosophy statesthat early initiatives such as the physical exercises and the regularexaminations identify and provide measures to stop any seriousinfections. In this case, the managed care has resulted in the unfairdelivery of medical care since some people such as the AfricanAmericans, poor and less educated individuals are often considered asa part of the disadvantaged group. Perhaps, educating the ones thatthe disadvantaged group helps in reducing the unfairness and focus ondelivering high-quality care to everyone in the society.


Andrade, S. E., Raebel, M. A., Boudreau, D., Davis, R. L.,Haffenreffer, K., Pawloski, P. A., … &amp Platt, R. (2012). Healthmaintenance organizations/health plans. Pharmacoepidemiology,5, 163-188.

Hibbard, J. H., Greene, J., Sofaer, S., Firminger, K., &amp Hirsh,J. (2012). An experiment shows that a well-designed report on costsand quality can help consumers choose high-value health care. Healthaffairs, 31(3), 560-568.

Landon, B. E., Zaslavsky, A. M., Saunders, R. C., Pawlson, L. G.,Newhouse, J. P., &amp Ayanian, J. Z. (2012). Analysis of MedicareAdvantage HMOs compared with traditional Medicare shows lower use ofmany services during 2003–09. Health Affairs, 31(12),2609-2617.

Pawlson, L. G. (2014). The evolving role of physician organizationsin quality related activities. Israel journal of health policyresearch, 3(1), 18.

Shenson, D., Anderson, L., Slonim, A., &amp Benson, W. (2012).Vaccinations and preventive screening services for older adults:opportunities and challenges in the USA. Perspectives in publichealth, 132(4), 165-170.

Wong, K. Y., &amp Do, Y. K. (2012). Are there socioeconomicdisparities in women having discussions on human papillomavirusvaccine with health care providers?. BMC women`s health,12(1), 33.

The Role of Providers in Quality Assurance and Health Maintenance and Prevention

  • Uncategorized

TheRole of Providers in Quality Assurance and Health Maintenance andPrevention

TheRole of Providers in Quality Assurance and Health Maintenance andPrevention

Thequality of health care is the degree in which health care servicesfor populations and individuals increase the possibility of desiredtreatment outcomes. The quality of services plays a significant rolein illustrating the triangle of health care that classifies theassociated connections between cost, accessibility, and quality ofhealth care within a community. It is vital to note that assessmentof health care can occur at two different stages that of thepopulation and the individual patient (Mitra, 2016). The stage ofindividual patient centers on services at the point of delivery andits later outcomes. At the population`s stage, evaluation of qualityhealth care comprises of indicators like the prevalence of particularhealth conditions, life expectancy, incidences, and infant mortalityrates.

Researchhas revealed that the quality of health care in the United States ispatchy, which has called for attention to quality improvement,particularly in the public hospitals. Although physicians arefundamental to the development efforts of quality health care,subjecting them to focus on these programs is challenging due toreimbursement pressures and competing time. For hospitals to overcomethese challenges, they need to implement various strategies. Thehospital plans comprise of employing physicians who will assist inidentifying areas in health care that need improvement (Abdelhak,Grostick, &amp Hanken, 2014). Another strategy that the hospitalsneed to implement is offering visible support through leadership torecognize and nurture physician champions who will assist in engagingwith other peers for the achievement of the best care. Lastly,hospitals need to communicate the significance of physician effortsand contributions. It is evident that more progress and success canbe made through a greater coalition of doctors and hospitals workingtogether in quality assurance, health maintenance, prevention, andimprovement of the quality of health care.

Conversely,hospitals in the United States face increasing demands to take partin an extensive range of quality improvement programs and activities.Research shows that the influence and role of health practitionerssuch as nurses in these efforts have significantly increased. Theorganizational cultures of hospitals have considerably set the stagefor nurses` functions and quality improvement in those programs(Pawlson, 2014). For instance, hospitals endowed with soundleadership embrace the idea of quality as every person`sresponsibility. It allows the provision of adequate feedback andaccountability on the part of service providers for strong staffcommitment in quality assurance, health maintenance, prevention, andimprovement of services.

Nevertheless,hospitals deal with challenges concerning the participation of nursesat different levels of service provision and lack of adequateresources. Other problems comprise of increasing demands to take partin more quality improvement programs. For instance, the problems makeit difficult to report and collect data aimed at improving thequality of services to patients. The inadequacy of traditionalnursing education in preparing nurses to take their role in themodern hospital setups equally impedes quality service provision.Since nurses are an essential caregivers in hospitals, they influencethe quality of health care offered, patient and treatment outcomes(Song, Rose, Safran, Landon, Day, &amp Chernew, 2014). Therefore,the pursuit of hospitals to quality assurance, health maintenance,prevention, and improvement is dependent on the ability of hospitalsto participate and utilize nursing resources efficiently.

Forthis assignment, I will compare the ratings of two hospitals in Miamiand Ohio. Apparently, hospital ratings assist patients in makingwell-informed decisions about health care (McBride, &amp Tietze,2015). Further, hospital comparison provides patients with legitimateand valid information regarding the hospitals being compared. Inaddition, hospital rating allows patients to select various hospitalsand compare their performance concerning the treatment of variousdiseases such as diabetes, heart attack, pneumonia, and surgery.

Hospitalsin Miami

Universityof Miami Hospital

TheUniversity of Miami Hospital is a general medical and surgicalhospital with 514 beds and is located in Miami FL that providesemergency services to patients. In addition, the hospital hasconsiderably benefited from the advanced technology as it receiveslaboratory results electronically (McBride, &amp Tietze, 2015). Thehospital electronically tracks tests, and referrals for the patients.The hospital uses safe surgery checklists for out and in patients.Records reveal that the University of Miami Hospital has attained thehighest ratings in two operations and procedures.

AnneBates Leach Eye Hospital

Itis an acute hospital located in Miami Florida with one hundred beds.The Anne Bates Leach Eye Hospital has a very high rating of patientsatisfaction, and most patients always say that they will referothers to this hospital (Steele, 2013). It uses technology to trackresults, referrals, and laboratory reports. It provides emergencyservices and uses surgery checklists for out and in patients.

Hospitalsin Ohio

MontroseMemorial Hospital

MontroseMemorial Hospital is a general surgical and medical hospital locatedin Montrose with sixty-nine beds. It provides emergency services, andit can receive patient`s lab results electronically. Further, thehospital tracks referrals, tests, and lab results electronicallybetween visits. Both the in and outpatients use surgery checklists.Records show more than sixteen thousand people have visited theemergency room, and have had more than two thousand admissions. TheMontrose Memorial Hospital legally attained the Joint Commission`sGold Seal for its certification (Steele, 2013). Apparently, theapproval is a sign of excellence and quality, which reflects thededication and commitment of the hospital to providing quality healthcare.

GunnisonValley Hospital

GunnisonValley Hospital is a critical access hospital located in Utah.Gunnison Valley Hospital has a record of providing its patients withquality health care and assurance. In addition, the hospital providesemergency services to its patients. The hospital also tracks thetests, lab results, and referrals electronically between visits(McBride, &amp Tietze, 2015). The hospital is a Joint Commissionaccredited and award-winning health system. The iVantage healthanalytics has named the Gunnison Valley Hospital five times as one ofthe top hundred critical access hospitals in the United States.Lastly, the Gunnison Valley Hospital has been called a “Stronghealthhospital”.


Physiciansplay a significant role in provident quality assurance, healthmaintenance, and prevention of our health care systems. It isimportant for the government and the hospitals to work in closecollaboration with the physicians in providing quality health care tothe patients. Conversely, it is vital for patients to considerquality health care since some hospitals offer excellent servicesthan others. For instance, hospitals performing numerous surgeries ofthe same kind provide exceptional results to their patients. It isessential to consider how the state and the patients have rated thehospital. Also, it is critical to determine whether the hospital iscovered by your insurance cover plan and if it has handled thecondition one is suffering from. It is prudent to consider whetherthe physician has rights in the hospital of your choice. All of thefour hospitals discussed above have the best ratings and qualify asthe top hospitals that meet their patients’ needs.


Abdelhak,M., Grostick, S., &amp Hanken, M. A. (2014). Healthinformation: management of a strategic resource.Elsevier Health Sciences.

McBride,S., &amp Tietze, M. (2015). Nursinginformatics for the advanced practice nurse: Patient safety, quality,outcomes, and interprofessional.Springer Publishing Company.

Mitra,A. (2016). Fundamentalsof quality control and improvement.John Wiley &amp Sons.

Pawlson,G. (2014). Theevolving role of physician organizations in quality relatedactivities.Retrieved on March 16, 2017, from

Song,Z., Rose, S., Safran, D. G., Landon, B. E., Day, M. P., &ampChernew, M. E. (2014). Changesin health care spending and quality four years into global payment.Retrieved on March 16, 2017, from

Steele,R. E. (2013). Managed care in a public setting. Guidelinesfor planning, organizing, implementing and evaluating comprehensivehealth care (CHC).Retrieved on March 16, 2017, from