COLLEGE OF HEALTH AND HUMAN SERVICES
California State University, Long Beach
Health Care Administration Program
HCA 450-01 Quality Management/Improvement in Health Care Delivery
Semester SPRING 2014
Instructor: Rus Billimoria, MD, MPH, CPHQ
E-mail: rbillimo@csulb.edu
Office Hours: Mondays 6 - 7 pm
(Please call for appointments)
Phone: (213) 694 1250 ext. 4274
Cell: (310) 508 1472
Class Number: 10876 (HCA 450, Section 01)
Class Location: VEC, Room-115
Class Meets: January 27 – MAY 12, 2014
Mondays from 7 PM to 9:45 PM
Additional Contact Information:
HCA Program Administrative Coordinator:
Deby McGill, dmcgill@csulb.edu
Tel. 562/985-5694; fax 562/985-5886
Catalog Description
Prerequisites: HCA 300, and 465. (Please refer to details below)
Basic elements of quality improvement and organizational responsibilities related to quality
improvement in health care delivery. Data analysis for quality improvement, clinical practice
guidelines, and future of healthcare quality improvement strategies.
Letter grade only (A-F). (Lecture)
ADA Accommodation will be provided to any student who requests such, as defined by the ADA act
and CSU-LB. Please contact Dr. Billimoria or refer to your student handbook for further information.
Note: This syllabus is subject to change. Should there be any changes; students will be notified in
class of the amendments.
COURSE PREREQUISITES:
For HCA 450 students: Prior to attending this course students are required to complete the following courses:
 HCA 300 (Health Care System) and
 HCA 465 (Analysis and Evaluation , preferred)
Exemptions for the prerequisites are generally not entertained. However, these may be considered on a caseby-case basis.
COURSE OBJECTIVES
The purpose of this course is to familiarize the student with the concept of Quality and the process of Quality
Improvement across the Health Care continuum. This course focuses on the history and evolution of quality,
its terms, principles, theories, and practices. The student is introduced to a diverse collection of methods of
improving quality, including but not limited to continuous Quality Improvement and Total Quality
Quality Management In Health Care Delivery HCA 450- Course Syllabus
Management, and to the guidelines for implementing quality management and the continuous quality
improvement processes. Additionally , the students will be asked to review the changes that a selected
number of health care systems from across America have implemented in order to achieve the Institute of
Medicine’s goals to make quality health care more safe, timely, effective, equitable, efficient, and patientcentered. Students will also be exposed to new cutting edge technologies that impact the quality
improvement efforts/interventions in health care delivery.
EXPECTED STUDENT LEARNING OUTCOMES
Upon completion of this course, the student will be able to:
1.
Describe the evolution of the health care systems and Quality Management/Improvement
Programs and reflect on its future.
2. Understand the reasoning and the importance of the requirements for Health Care Quality
Management/Improvement Programs.
3. Describe the most current Quality Management/Improvement Program principles and techniques for
health care in general. This includes the principles of Continuous Quality Improvement, Total Quality
Management, and proactive versus reactive Quality Management programs.
4. Understand the impact of federal and state legislation on Quality Management/Improvement
Programs in Health care.
5. Understand the need for and development of standards for accreditation of health care entities.
6. Describe the recent impact of consumers on health care Quality Management/Improvement
Programs and the development of health plan Report Cards (HEDIS etc.).
7. Understand the use of data and statistics for an effective Quality Management/Improvement
Program.
8. Understand basic elements of provider credentialing, physician profiling and report cards, risk
management and liability issues as they relate to Quality Management/Improvement Programs.
9. Understand the effect of Patient Safety issues on Quality Management/Improvement systems.
10. Understand the recent trends in Quality Management/Improvement and Continuous Quality and
Continuity of Care issues in Assisted Living, Skilled Nursing, and Long Term Care.
11. Health Care Report Cards, Pay For Performance and other strategies used for improving the quality
of health care
12. Demonstrate understanding of the principles in the development of a Quality
Management/Improvement Program and Strategies for a health care entity via successful completion
of class project.
REQUIRED TEXTS AND ANY OTHER REQUIRED MATERIALS AND INFORMATION.
This course does not prescribe a specific text, since no single text would cover the broad scope of this
course. However, the following books and materials are strongly recommended for review:
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
1. Introduction to Quality Health Care Management, Patrice Spath, 2013, 2nd Edition, AUPHA, Health
Administration Press, Chicago, Illinois
2. Continuous Quality Improvement in Healthcare, William A. Solecito and Julie K. Johnson, 4th
Edition, 2013, Jones and Bartlett Publishers, Inc. Sudbury, Massachusetts (Optional for
reference).
Lecture notes and handout materials. All lecture notes will be posted on Beach Board. Students need to print
these. Very few copies may be available for distribution by the instructor.
TYPES OF ASSIGNMENTS
I
Short Essays (10% of overall class Grade for each one of 2 essays over the course of the
semester. Total Percentage of overall class grade for 2 essays is 20)
To understand the latest trends around Quality Management/Improvement Programs it is necessary to
review articles related to health care quality from various sources including professional medical or health
care journals. Students will be expected to write short essays on specific prescribed topics (a maximum of
two, doubled spaced and typed pages). The students will be provided with a relevant topic for each essay.
Students will then research and select one or more published articles pertaining to the topic and complete
the short essay as follows:
1)
2)
3)
4)
Introduction – Introduce the topic with a brief overview of sources used for the essay.
Students must make special mention in support of selecting their articles
Summary-Summarize the contents of the article(s) as they relate to the topic.
Discussion-Provide your analysis and discussion pertaining the topic being discussed.
Conclusions – Conclusion regarding the topic derived from the article(s).
The essays will be graded on a scale of (0 – 20 points). Grading will be based on the contents of
sections addressed above.
Examples of Journals that may be used for writing your essays are as follows:
a)
b)
c)
d)
e)
f)
Journal of the American Medical Association (JAMA) - http://jama.ama-assn.org/
New England Journal of Medicine - http://content.nejm.org/
Annals of Internal Medicine - http://www.annals.org/
Journal of Health Politics, Policy and Law - http://www.jhppl.org/
Journal of HealthCare Quality - http://www.allenpress.com/jhq/
Med Bio World - Hospital & Healthcare Management Journals - http://www.medbioworld.com/
The two short essays will be due in the weeks assigned. Please see agenda on the following pages for due
dates.
On the due date, submit one copy to the instructor. The essay will be returned after review and scoring.
II
Class Participation (10% of Overall Class Grade)
Active classroom participation is encouraged. Each student will have adequate opportunities to participate in
classroom discussions. Students will be provided the opportunity to participate in small projects and pop
quizzes to assess participation. Level of participation will contribute towards the overall course grade.
HCA 450 SPRING SYLLABUS
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
III
Mid Term Exam for HCA 450 (Constitutes 30% of the Overall Class Grade)
HCA 450 students will be administered a mid term exam worth 30% of the overall class grade. The exam will
comprise of multiple questions. Questions will be a mix of essay type discussions based on case studies
using the knowledge from topics discussed in class during the semester and a series of short case studies or
notes on specific issues or topics.
For each essay question, the student will be required to use the following format:
a) An Introduction to address the case or problem presented(20% of the question grade)
b) Presentation of the ideas in addressing the issue or case using information from the course.(40% of
the question grade)
c) Brief Discussion of the interventions or direction suggested by the student for addressing the case
or issue (30% of the question grade)
d) Conclusion- Summary of thoughts (10% of the question grade)
Length of the written answer is left to the discretion of the student. It is important to ensure that the above
four points be taken into consideration for a complete answer.
For the short notes topic the student will be expected to write a short paragraph on each of the topics.
IV
FINALS PROJECT: Quality Management/Improvement Program Development (30% of the
overall Grade)
A major classroom project will be the development of a Quality Management/Improvement Program or
Quality Improvement Process/strategy pertaining to a health care entity. This project will be assigned during
the course and will be completed as part of your final exam.
Students will form teams and develop a Quality Management/Improvement Program or Process for
improvement of selected care and services for their assigned entity. The project will make use of quality
improvement principles and information presented during the course. Each student within a team must
make specific contributions to the program or project development and discussions.
The projects developed will be presented to the class by all members of each team. Each team member
presents their specific contributions to the project. Please see course agenda below for day of presentation.
Guest speakers may be present during presentations and will contribute to the discussions.
Grading For “The Quality Management/Improvement Program Development Project": (Constitutes
30% of the overall class grade)
I
Each student’s contribution towards the team project will be presented in form of a paper not less than
three double-spaced type written pages. The paper shall comprise of the following elements:
a) Introduction to the portion being contributed by the student. (10% of Mid term Grade)
b) Presentation of the ideas and components the student is responsible for developing as part of the
team effort (10% of Mid term Grade)
c) Discussion and the importance of the student’s contribution towards the team project using the
principles and theories discussed in class as well as pertinent literature reviewed by the student.
(30% of Mid Term Grade)
II
Class Presentation by Team (50% of the Mid Term Grade)
III
Presentation Scoring Rubric will consider the following:
All 7 Elements listed below must be covered in your Presentation
1. Outline the research documenting need for healthcare improvement (Background)
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
2. Define the system in which you are making improvements (Hospital, HMO,SNF or other
entity)
3. Identify key themes for improvement efforts (Which areas or items of the issue were
selected for improvement and why)
4. Use the improvement processes best suited for your project. (Six Sigma, Lean, PDSA etc)
5. Develop and Describe the team meeting management skills used to accomplish your
project. (Includes Team Dynamics)
6. Describe basic steps used in managing change as you implemented your improvement
plan
7. Describe the value and context for the tools your team used and implemented in settings
you used:




Fishbones
Process mapping
Flow charting
Run/control charts
The Final Exam Grade will be a combination of the individual paper and team presentation scores.
Instructor will be available to all students for guidance during development of the project.
V
QUIZZES (5 % of grade each quiz): Two Quizzes will be offered during the semester. This will be
announced a week prior to each quiz giving adequate preparation time to the students.
AGENDA AND SEQUENCE OF ASSIGNMENTS (The agenda is subject to change.)
Week
Objective
Week 1 – January 27
a)
b)
c)
d)
e)
Week 2 – February 3
a)
Week 3 – February 10
HCA 450 SPRING SYLLABUS
Introduction to the course.
Literature Review Guidelines.
Introduction to Terminologies.
Introduction to Health Care Systems
Selection of Teams & Team Leaders for projects.
The evolution of Health Care Quality Management with a
historic perspective.
b)
Basic Elements of Quality Improvement
Readings:
Review Chapters 1 (Prescribed Text Book)
Chapters 1 & 2 McLaughlin (Optional for 450)
Business Case for Quality – Reading for project
Essay # 1 – Topic to be announced in class
a)
Basic Elements of Quality Improvement continued.
b)
The Deming approach to Quality Improvement.
c)
Principles of Continuous Quality Improvement (CQI) and
Total Quality Management (TQM).
d)
Outcomes needed of Quality
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
e)
Classroom Project-Business case for Quality
Readings:
Chapter 2 (Prescribed ) ,
Chapter 1 (McLaughlin), Lecture Notes and Literature
Week 4 – February 17
Essay # 1 to be submitted in class
a)
Principles in developing a Quality Improvement Program
in health care .
b)
Use of Data for Quality Improvement and Health Systems
c)
Data Mining
Review:
Week 5 – February 24
Week 6 – March 3
a)
b)
c)
d)
Review:
Chapters 1 & 3 (Prescribed Text Book)
Chapter 11 (McLaughlin, Optional), Lecture Notes
Process capability and variations (Chapter 4 both books)
Tools for Quality- Introduction
Project on Quality Improvement .
Leadership and Quality Improvement Teams
Chapter 7 (Prescribed)
Chapter 6 (McLaughlin), Lecture Notes & Literature
Essay # 2 --- Topic will be announced in class
a) Progress Report and Updates on the Quality Improvement
project by each team.
b) Tools for Quality
c) Data Analysis in Quality Management
Review: Chapters 3,4 & 5 (Prescribed Text Book) & Lecture Notes
:
Chapters 4 & 5 (McLaughlin)
Essay # 2 to be submitted in class
Week 7 – March 10
Week 8 – March 17
a)
Six Sigma and Lean Theories
b)
Using Quality Improvement Tools- Small Classroom Project
Health Plan Report Cards.
b)
Health Employer Data Information Set -2007 (HEDIS).
c)
ORYX systems (JC)
d)
Disease Management Programs.
e)
Understanding Accreditation
Review:
Chapter 3 (Prescribed)
Chapter 2 (McLaughlin)
Lecture Notes & Literature
Week 9 - March 29
a) Introduction To Government Legislation in Health Care &
b) Understanding Regulatory Requirements (Guest Lecturer)
c) Health care Quality and Long Term care (Guest Lecturer)
Review: Chapter 8 (Prescribed Text Book),
Lecture Notes
HCA 450 SPRING SYLLABUS
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
Week 10 – March 31
Week 11 – April 7
SPRING BREAK
Students to turn in Mid Term Exam Papers in Class
Small Classroom project- (With Guest Lecturer)
Long Term Care other Issues
Week 12 – April 14
a) Accreditation
b) Relative Resource Use and Utilization Management
Week 13 – April 21
Guest lecture- Obama care and Quality
Week 14 – April 28
a) Leap Frog
b) Medicare Star Program
i. Health Information Technology, Information Management
and quality of health care
c) Incentive Programs and Quality
d) Disease Management Programs
e) Chronic Care Improvement Programs/Care Management
Week 15 – May 5
FINAL EXAM / PRESENTATIONS: Group Presentations of Quality
Improvement Projects
Week 16 – May 12
a) Group Presentations of Quality Improvement Projects
b) Students to submit their individual written project reports
c) Course Summary and wrap up
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
BASIS FOR ASSIGNING THE COURSE GRADE
This being a double numbered course, university policy requires greater expectations, additional work and
different grading scales for graduate students. Due importance will be given to student participation in
projects, papers, class work and exams. Letter Grades are assigned from A-F for level of achievement in the
course. For final computation of the letter grades, following weights for each course component will be used:
Component HCA 450
Short Essays:
#1
#2
Percent of Grade
QUIZ 1
QUIZ 2
Mid Term Exam Paper
Final Exam
Development of a Quality
Management Program
Project
Class Participation (Including
Attendance and in class
projects)
5%
5%
30%
30%
TOTAL
100%
10%
10%
10%
STUDENT RESPONSIBILITIES AND EVALUATION
Attendance
Students are required to attend and to be prepared for each session by reading any assigned or referenced
materials. Attendance is expected at each class session. However, if there are compelling circumstances,
an absence may be excused. It then becomes the responsibility of the student to bring her/himself up to
date with the class material. Please notify the lecturer of any absenteeism either in advance if preplanned or
after the fact if due to emergent situations.
Drops
It is the responsibility of the student to file for a drop status if he or she desires. No drops will be signed by
the instructor after the third week.
Exams
A traditional grading system is required for evaluation of student performance in this course. There will be
one mid-term and one final exam. Exam formats will be developed and announced by the Instructor. No
make-up exams will be offered unless the student has made specific arrangements with the instructor prior
to the exam.
ADDITIONAL INTERNET RESOURCES:
America’s Health Insurance Plans
HCA 450 SPRING SYLLABUS
www.ahip.org
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
American College of Medical Quality
American Health Information Management Association
American Health Information Management Association
American Healthcare Association
American Society for Healthcare Risk Management
American Society For Healthcare Risk Management
Association for Quality
association for quality
California Association for Healthcare Quality
California Code of Regulations
California Department of Corporations
California Medical Association
Joint Commission on Accreditation of Healthcare Organizations
Medicare
National Guideline Clearinghouse
National Library of Medicine
National Network of Libraries of Medicine
Quality Indicator Project
www.acmq.org
www.ahima.org
http://www.ahima.org/
www.aha.org
www.ashrm.org
http://www.ashrm.org/ashrm/index.jsp
www.asq.org
http://www.asq.org/
www.cahq.org
http://ccr.oal.ca.gov/
www.corp.ca.gov
www.cmanet.org
www.jcaho.org
www.cms.hhs.gov
www.guideline.gov
www.nlm.nih.gov
www.nnlm.gov
www.qiproject.org
CHEATING AND PLAGIARISM:
The following is excerpted from the California State University, Long Beach Policy Statement 85-19,
dated December 13, 1985.
It is the policy of the faculty and administration to deal effectively with the student who practices cheating or
plagiarism. These acts are fundamentally destructive of the process of education and the confident
evaluation of a student's mastery over a subject. A University maintains respect and functions successfully
within the larger community when its reputation is built on honesty. Similarly, each student benefits in
helping to maintain the integrity of the University. This policy, therefore, provides for a variety of faculty
actions including those, which may lead to the assignment of a failing grade for a course and for
administrative actions, which may lead to dismissal from the University. It is the intent to support the
traditional values that students are on their honor to perform their academic duties in an ethical manner.
GENERAL:
The following definitions of cheating and plagiarism shall apply to all work submitted by a student.
DEFINITION OF PLAGIARISM:
Plagiarism is defined as the act of using the ideas or work of another person or persons as if they were ones
own, without giving credit to the source. Such an act is not plagiarism if it is ascertained that the ideas were
arrived at through independent reasoning or logic or where the thought or idea is common knowledge.
Acknowledge of an original author or source must be made through appropriate references, i.e., quotation
marks, footnotes, or commentary. Examples of plagiarism include, but are not limited to, the following: the
submission of a work, either in part or in whole, completed by another; failure to give credit for ideas,
statements, facts or conclusions with rightfully belong to another; in written work, failure to use quotation
marks when quoting directly from another, whether it be a paragraph, a sentence, or even a part thereof;
close and lengthy paraphrasing of another writing or paraphrasing should consult the instructor.
HCA 450 SPRING SYLLABUS
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
Students are cautioned that, in conducting their research, they should prepare their notes by (a) either
quoting material exactly (using quotation marks) at the time they take notes from a source; or (b) departing
completely from the language used in the source, putting the material into their own words. In this way,
when the material is used in the paper or project, the student can avoid plagiarism resulting from verbatim
use of notes. Both quoted and paraphrased materials must be given proper citations.
DEFINITION OF CHEATING:
Cheating is defined as the act of obtaining or attempting to obtain or aiding another to obtain academic credit
for work by the use of any dishonest, deceptive or fraudulent means.
Examples of cheating during an examination would include, but not be limited to the following: copying,
either in part or in wholes, from another test or examination; discussion of answers or ideas relating to the
answers on an examination or test unless such discussion is specifically authorized by the instructor; giving
or receiving copies of an exam without the permission of the instructor; using or displaying notes; "cheat
sheets," or other information or devices inappropriate to the prescribed test conditions, as when the test of
competence includes a test of unassisted recall of information, skill, or procedure; allowing someone other
than the officially enrolled student to represent the same. Also included is plagiarism, which is defined as
altering or interfering with the grading procedures.
It is often appropriate for students to study together or to work in teams on projects. However, such students
should be careful to avoid use of unauthorized assistance, and to avoid any implication of cheating, by such
means as sitting apart from one another in examinations, presenting the work in a manner which clearly
indicates the effort of each individual, or such other method as is appropriate to the particular course.
ACADEMIC ACTION:
One or more of the following academic actions are available to the faculty member who finds a student has
been cheating or plagiarizing.
a) Review -- no action.
b) An oral reprimand with emphasis on counseling toward prevention of further occurrences;
c) A requirement that the work be repeated;
d) Assignment of a score of zero (0) for the specific demonstration of competence, resulting in the
proportional reduction of final course grade;
e) Assignment of a failing final grade;
f) Referral to the Office of Judicial Affairs for possible probation, suspension, or expulsion
COURSE BIBLIOGRAPHY
1. Adams, Karen, Greiner, Ann C., Corrigan, Janet M., Committee on the Crossing the Quality Chasm:
Next Steps Toward a New Health Care System, 2004, 176 pages.
2. Aspden, Philip, Corrigan, Janet M., Wolcott, Julie, Erickson, Shari M., Editors, Committee on Data
Standards for Patient Safety; Patient Safety: Achieving a New Standard for Care, 2004, 550 pages
3. Berwick Donald, Payment by Capitation and the Quality of Care- Part 5 (1996) The New England
Journal of Medicine, 335,16,1227-1231
4. Blumenthal David, Quality of Care – What is it? – Part I, (1996) The New England Journal of
Medicine, 335, 12, 891-894
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
5. Blumenthal David, The Origins of Quality of Care Debate- Part 4 ( 1996) The New England Journal of
Medicine, 335, 15, 1146-1149
6. Brook Robert, McGlynn Elizabeth, Measuring Quality of Care – Part 2, (1996) The New England
Journal of Medicine, 335, 13, 966-970
7. Brown, RN, CPHQ, Janet A., The Healthcare Quality Handbook: A Professional Resource and Study
Guide, 2004/2005 Edition (20th edition available after 7/31/05)
8. Budetti, PP; 10 Years Beyond the Health Security Act Failure: Subsequent Developments and
Persistent Problems. 2004, JAMA; 292: 2000-2006
9. Bush, GW, Ensuring Access to Health Care: The Bush Plan. JAMA, 2004; 292: 2010-2011
10. Chassin Mark, Improving the Quality of Care- Part 3, (1996) The New England Journal of Medicine,
335, 14, 1060-1063
11. Chassin Mark, Hannan Edward and DeBuono Barbara , Benefits and Hazards of Reporting Medical
Outcomes Publicly ( 1996) The New England Journal of Medicine, 334,6, 394-398
12. Couch James (Editor), Health Care Quality Management/Improvement Program for the 21st Century,
1991, American College of Physician Executives and American College of Medical Quality.
13. Davies, H. O., Washington, A. Eugene, Health Care Report Cards: Implications for vulnerable
patient groups and the organizations providing them care (2002), Journal of Health Politics, Policy
and Law, Vol. 27, 379- 399
14. Dlugacz, Yosef D., Alice Greenwood, Andrea Restifo The Quality Handbook for Health Care
Organizations: A Manager's Guide to Tools and Programs ISBN: 0787969214 Pub. Date: March
2004 Series: J-B AHA Press, #131
15. Ellen Nolte and C Martin McKee, Measuring the health of nations: Updating an earlier analysis,
Health Affairs, Volume 27, 58-71, 2008.
16. Golub, Robert M, Beyond Mental Mediocrity, JAMA, 2006, 296, 1139-1140
17. Gruen, RL, Pearson, SD, Brennan, TA, Physicians-Citizens-Public Roles and Professional
Obligations. JAMA, 2004; 291: 94-98
18. Hagland, Mark, Transformative Quality, 2009, CRC Press, ISBN: 13: 978-1-4200-8492-4
19. Health Employer Data Information Set –HEDIS 2005/2006, Published by NCQA
20. Hersh, W, Health Care Information Technology: Progress and Barriers. JAMA 2004; 292: 2273-2274
21. Iezzoni Lisa, Assessing Quality Using Administrative Data, (1997) Annals of Internal Medicine , 127,
8 (Part 2), 666-674
22. Kerry, J., Ensuring Access to Health Care: The Kerry Plan. JAMA, 2004; 292: 2010-2011
23. Landrum, Mary Beth et al, Is spending more always wasteful? The appropriateness of care and
outcomes among colorectal cancer patients. Health Affairs, Volume 27, 159-168, 2008
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
24. Leach, David C, Philibert, Ingrid, High Quality Learning for High Quality Health Care-Getting it Right,
JAMA, 2006, 296: 1132-1134
25.
26. Lighter Donald, E., Advanced Performance Improvement in Health Care-Principles and Methods,
2011, Jones and Bartlett Publishers, ISBN: 13: 978-0-7637-6449-4
27. Mclaughlin Curtis and Kaluzny Arnold, Continuous Quality Improvement in Health Care, 3rd Edition,
2006, Aspen Publication
28. Prevalence of Overweight and Obesity Among US Children, Adolescents and Adults, 1999-2002.
JAMA, 2004; 291 2847-2850
29. Quality First: Better Healthcare for All Americans, Advisory Commission on Consumer Protection
and Quality in the Healthcare Industry (Call 800/732-8200 for your free copy)
30. Ransom, Elizabeth, Joshi, Maulik, S., Nash, David, B., Ransom, Scott, B., The Healthcare Quality
Handbook, Second Edition, 2008, ISBN: 978-1-56793-301-7
31. Reschovsky, J, D., Hargraves, J. Lee., and Smith, A. F., Consumer beliefs and health plan
performance: It’s not whether you are in an HMO but whether you think you are. ( 2002), Journal of
Health Politics, Policy and Law, Vol 27, 353-377
32. Robinson, JC, Reinvention of Health Insurance in the Consumer Era. JAMA, 2004; 291: 1880-1886
33. Robinson, J.C., Slouching towards value based health care. Health Affairs, Volume 27, 11-12, 2008
34. Spath , Patrice: Introduction to HealthCare Quality Management, 2009, AUPHA, Health
Administration Press, Chicago, Illinois, ISBN: 978-1-56793-323-9
35. Spath , Patrice: Introduction to HealthCare Quality Management, 2013, 2nd Edition, AUPHA, Health
Administration Press, Chicago, Illinois, ISBN: 978-1-56793-593-6
36. Solecito, William A and Johnson Julie, K, 2013, McLaughlin and Kaluzny’s Continuous Quality
Improvement in Healthcare, 4th Edition, Copyright 2013, Jones and Bartlett Publication, Massachusetts;
ISBN 13: 978-0-7637-8154-5
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