Assessment 1 Regulatory Environment – Executive Summary Table Instructions: Create a 3-4 page executive summary table of tools and best practices and a SWOT

Assessment 1
Regulatory Environment – Executive Summary Table

Instructions: Create a 3-4 page executive summary table of tools and best practices and a SWOT analysis for quality improvement, risk management, and learning guidelines that describes the status of an organization's compliance with regulatory requirements.

Introduction

Note: The assessments in this course build upon each other, so you are required to complete them in sequence.

The scope of the regulatory environment and its requirements are ever-changing. Healthcare leaders need to know where they can find information about the requirements (within the subsector of the industry) to respond appropriately to issues. In addition, healthcare leaders need to proactively set strategies in place to mitigate future risks to their patients and organizations.

It is an exciting time in healthcare as all of us experience the implementation of the Patient Protection and Affordable Care Act of 2010. The change will likely affect your current or future healthcare job. Leaders in our industry are rethinking how business is to be conducted.

Understanding relevant terminology is an important step in addressing the topics of healthcare quality, risk management, and regulatory environment.

Read further in the Assessment 1 Context [PDF] Download Assessment 1 Context [PDF]document, which contains important information related to the following topics within the regulatory environment:

• Quality of Services.
• Potential Risks.
• Regulatory Requirements.
• Regulatory Bodies.
• Benchmarking as a Condition of Participation.

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as a part of your assessment.

The Regulatory Environment:

• Which regulatory bodies oversee the subsector of the healthcare industry in which you currently work or would like to work?
• How would you figure out which organizations oversee the subsector?
• How would you determine which laws apply to your setting and what type of data you need to collect and examine?
• What are the standards of care?
• How would you locate these standards?
• How would you know if your organization exceeded those standards and might be in a position to apply for accreditation?

Establishing a Culture of Patient Safety:

• What is an example of a best practice for establishing a systems-based culture of patient safety?
• How will you know if your organization was identified as an example of success when best practices are used?

Benchmarking:

• What types of processes exist for collecting and analyzing data to identify trends in the performance of your healthcare setting?
• Who are some of the healthcare industry's best performers in terms of risk management?
• What types of benchmarking data are important to consider?
• What roles within your own organization need to be involved in a proactive risk-management program?
• What are some critical success factors for the establishment of a systems-based risk-management program?
• What types of considerations or cautions are important to keep in mind when interpreting internal and external benchmarking data?

Overview

Note: The assessments in this course build upon each other, so you are required to complete them in sequence.

In this assessment, you will create a SWOT analysis and a comprehensive executive summary table of tools and best practices for quality improvement, risk management, and learning guidelines. Include an executive summary table that describes the status of an organization's compliance with regulatory requirements.

The healthcare industry is continually evolving with the advancements of technology, science, and regulation. The consistent evolution of the industry has created an unprecedented environment for healthcare leaders to be operating within. The evolution of change has therefore transitioned the industry into a value-based delivery model.

Regulatory compliance in healthcare is in place to ensure patient safety and that healthcare facilities are operating under a legal and ethical umbrella to which standardized best practices are being utilized.

As an entity within the healthcare industry, the goal for all organizations is to aim for regulatory compliance, but to be consistently assessing and reevaluating your operations with an aim toward achieving the mentality and behaviors of a high-reliability organization (HRO). A key example of the endeavor to transition healthcare toward becoming HROs is the development of affordable care organizations (ACO).

Read further in the Assessment 1 Context [PDF] Download Assessment 1 Context [PDF]document, which contains additional resources.

Preparation

For this assessment, select your organization, Path 1, or one of the organizations from the list in Path 2, on which to base your work.

Path 1

You are highly encouraged to select your current employer on which to base your work, and if you choose this path, make sure the Learner and Employer Acknowledgement and Release Form [PDF] from your workplace is completed.

See the Workplace Integrated Learning resource for more information about selecting the healthcare organization you will use for the assessments in this course.

Be sure the organization has readily available data for the four categories from Kaplan and Norton's 1996 model. Those categories are:

• Financial performance measures.
• Internal business processes.
• Learning and growth.
• Customer satisfaction.

Path 2

Select one of the following cases from one of the organizations listed below as the basis for each of your assessments. Note: The assessments in this course build upon each other, so you are required to use the same case and organization throughout.

1. UPMC Children's Hospital of Pittsburgh: Hospital-Acquired Conditions. Imagine you are the director of risk management.
2. CVS Pharmacy: US Labor Department’s OSHA Proposes $89,000 in Fines to CVS Pharmacy for Exit, Storage and Other Hazards at Orange, Conn., Store. Imagine you are the new safety officer for CVS Health.
3. Anthem Blue Cross Blue Shield: Anthem Pays $16 million in Record HIPAA Settlement for Data Breach. Imagine you are the risk officer for Anthem Blue Cross Blue Shield.

Note: These are the same cases from the Regulatory Environment Cases reading list.

Instructions

Select a risk management issue within a specific healthcare setting or organization. You will use this issue as a starting point for your work on this assessment. Use the Executive Summary Table [DOCX] Download Executive Summary Table [DOCX]to complete this step.

1. Current organization and background. Present your organization and background.
2. Present the organization's philosophy or culture statement: Include mission, vision, and values.
3. Prepare a SWOT analysis for your organization. Assess the internal versus external environment relative to the risks associated with your chosen risk management issue.
4. Regulatory requirements: Compile a list of the applicable regulatory requirements and an explanation of what they mean to your organization. How do you anticipate these regulations to change in the future? Is your organization prepared?
5. Risk management implications: Identify the associated risk management implications. For example, HACs result in no reimbursement and poor quality ratings. Where is your selected organization experiencing risk by not meeting a regulation or not providing services as efficiently as they could?
6. DMAIC lens: Assess your risk management concern. What is causing this problem to occur?
7. Recommendations: What recommendations do you have for this scenario? What challenges will you face when implementing this change?
8. Measuring and monitoring:
   • Identify metrics for measuring or monitoring the risk management issue and your recommendations.
   • Propose how you will make use of the outcome data for organizational improvement.
9. Ethics considerations: Describe legal and ethical implications related to the handling of this risk management issue.

In your executive summary table and SWOT analysis, be sure you:

• Conduct a proactive assessment based on the existing regulations and requirements.
• Describe strategies to influence, impact, and monitor the needed changes for quality improvement.
• Develop a value proposition for change management that incorporates quality and risk management concepts.
• Prepare a SWOT analysis for your organization assessing the internal versus external environment relative to the risks associated with your chosen risk management issue.
• Integrate legal and ethical principles and also organizational mission, vision, and values into the decision-making process.

Utilize established sources of information. Some sources that may be useful to you include the federal register, statutes, discipline-specific peer-reviewed journals, and government agency references.

• APA Format: Use appropriate APA format for a clear, concise presentation of information. Communicate information and ideas accurately, utilizing peer-reviewed sources, including proper APA reference citations.

Additional Requirements

• Written communication: Written communication should be free from errors that detract from the overall message.
• Length: 3–4 pages for the table.
• Number of resources: A minimum of three resources.
• APA Format: Use appropriate APA format for a clear, concise presentation of information. Communicate information and ideas accurately, utilizing peer-reviewed sources, including proper APA reference citations. Refer to the APA Module to help with APA style guidelines.
• Font and font size: Times New Roman, 12 point.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Conduct an environmental assessment to identify quality and risk management priorities for a healthcare organization.
  • Conduct a proactive assessment based on the existing regulations and requirements.
  • Describe strategies to influence, impact, and monitor the needed changes for quality improvement.
  • Develop a value proposition for change management that incorporates quality and risk management concepts.
  • Prepare a SWOT analysis for your organization assessing the internal versus external environment relative to the risks associated with your chosen risk management issue.
• Competency 4: Analyze applicable legal and ethical institution-based values as they relate to quality assessment.
  • Integrate legal and ethical principles and also organizational mission, vision, and values into the decision-making process.
• Competency 5: Communicate effectively using professional standards embracing diversity, equity, and inclusion.
  • Write clearly and concisely, with well-organized communication that is supported by relevant evidence.
  • Use correct grammar, punctuation, and mechanics as expected of a graduate learner.

Preparation

For this assessment, select your organization, Path 1, or one of the organizations from the list in Path 2, on which to base your work.

Path 1

You are highly encouraged to select your current employer on which to base your work, and if you choose this path, make sure the Learner and Employer Acknowledgement and Release Form [PDF] from your workplace is completed.

See the Workplace Integrated Learning resource for more information about selecting the healthcare organization you will use for the assessments in this course.

Be sure the organization has readily available data for the four categories from Kaplan and Norton's 1996 model. Those categories are:

• Financial performance measures.
• Internal business processes.
• Learning and growth.
• Customer satisfaction.

Path 2

Select one of the following cases from one of the organizations listed below as the basis for each of your assessments. Note: The assessments in this course build upon each other, so you are required to use the same case and organization throughout.

1. UPMC Children's Hospital of Pittsburgh: Hospital-Acquired Conditions. Imagine you are the director of risk management.
2. CVS Pharmacy: US Labor Department’s OSHA Proposes $89,000 in Fines to CVS Pharmacy for Exit, Storage and Other Hazards at Orange, Conn., Store. Imagine you are the new safety officer for CVS Health.
3. Anthem Blue Cross Blue Shield: Anthem Pays $16 million in Record HIPAA Settlement for Data Breach. Imagine you are the risk officer for Anthem Blue Cross Blue Shield.

Note: These are the same cases from the Regulatory Environment Cases reading list.

Instructions

Select a risk management issue within a specific healthcare setting or organization. You will use this issue as a starting point for your work on this assessment. Use the Executive Summary Table [DOCX] Download Executive Summary Table [DOCX]to complete this step.

1. Current organization and background. Present your organization and background.
2. Present the organization's philosophy or culture statement: Include mission, vision, and values.
3. Prepare a SWOT analysis for your organization. Assess the internal versus external environment relative to the risks associated with your chosen risk management issue.
4. Regulatory requirements: Compile a list of the applicable regulatory requirements and an explanation of what they mean to your organization. How do you anticipate these regulations to change in the future? Is your organization prepared?
5. Risk management implications: Identify the associated risk management implications. For example, HACs result in no reimbursement and poor quality ratings. Where is your selected organization experiencing risk by not meeting a regulation or not providing services as efficiently as they could?
6. DMAIC lens: Assess your risk management concern. What is causing this problem to occur?
7. Recommendations: What recommendations do you have for this scenario? What challenges will you face when implementing this change?
8. Measuring and monitoring:
   • Identify metrics for measuring or monitoring the risk management issue and your recommendations.
   • Propose how you will make use of the outcome data for organizational improvement.
9. Ethics considerations: Describe legal and ethical implications related to the handling of this risk management issue.

In your executive summary table and SWOT analysis, be sure you:

• Conduct a proactive assessment based on the existing regulations and requirements.
• Describe strategies to influence, impact, and monitor the needed changes for quality improvement.
• Develop a value proposition for change management that incorporates quality and risk management concepts.
• Prepare a SWOT analysis for your organization assessing the internal versus external environment relative to the risks associated with your chosen risk management issue.
• Integrate legal and ethical principles and also organizational mission, vision, and values into the decision-making process.

Utilize established sources of information. Some sources that may be useful to you include the federal register, statutes, discipline-specific peer-reviewed journals, and government agency references.

• APA Format: Use appropriate APA format for a clear, concise presentation of information. Communicate information and ideas accurately, utilizing peer-reviewed sources, including proper APA reference citations.

Additional Requirements

• Written communication: Written communication should be free from errors that detract from the overall message.
• Length: 3–4 pages for the table.
• Number of resources: A minimum of three resources.
• APA Format: Use appropriate APA format for a clear, concise presentation of information. Communicate information and ideas accurately, utilizing peer-reviewed sources, including proper APA reference citations. Refer to the APA Module to help with APA style guidelines.
• Font and font size: Times New Roman, 12 point.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Conduct an environmental assessment to identify quality and risk management priorities for a healthcare organization.
  • Conduct a proactive assessment based on the existing regulations and requirements.
  • Describe strategies to influence, impact, and monitor the needed changes for quality improvement.
  • Develop a value proposition for change management that incorporates quality and risk management concepts.
  • Prepare a SWOT analysis for your organization assessing the internal versus external environment relative to the risks associated with your chosen risk management issue.
• Competency 4: Analyze applicable legal and ethical institution-based values as they relate to quality assessment.
  • Integrate legal and ethical principles and also organizational mission, vision, and values into the decision-making process.
• Competency 5: Communicate effectively using professional standards embracing diversity, equity, and inclusion.
  • Write clearly and concisely, with well-organized communication that is supported by relevant evidence.
  • Use correct grammar, punctuation, and mechanics as expected of a graduate learner.