COLLEGE OF HEALTH AND HUMAN SERVICES
California State University, Long Beach
Health Care Administration Program
HCA 450 - Quality Management/Improvement in Health Care Delivery
Semester SPRING 2014
Instructor: Thomas McCabe, J.D., MBA
E-mail: Thomas.McCabe@csulb.edu
Office Hours: M-W 12-12:30 pm
Cell: (562) 708-0955
Class Number: 25377-04
Class Location: SPA Room-106
Class Meets: January 21– May 9, 2014
M-W from 12:30 PM to 1:45 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. (Please refer to details below) and HCA 465 (Preferred)
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)
Note: This syllabus is subject to change. Should there be any changes; students will be notified in class & on
BeachBoard 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 case-by-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 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 patient-centered. Students will also be exposed to new cutting edge technologies that impact the quality
improvement efforts/interventions in health care delivery.
Quality Management In Health Care Delivery HCA 450- Course Syllabus
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 now prescribes a specific text, though no single text would cover the broad scope of this course. The
following books and materials are either prescribed or strongly recommended for review:
1. Introduction to Quality Health Care Management, Patrice Spath, 2009, AUPHA, Health Administration Press,
Chicago, Illinois (PRESCRIBED TEXT BOOK)
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 ONLY).
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.
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
TYPES OF ASSIGNMENTS
I
Quizzes (four (4) quizzes at 15 pts. each, total 60 pts. or 13.3% of grade)
Students will be required to bring a Scantron for the four quizzes administered throughout the semester. See class dates
and assignments graphic for dates and chapters/material to be covered.
II
Class Participation & Attendance (40 pts. or 8.9% of 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.
III
Midterm Exam (100 pts. or 22.2% of grade)
Students will be administered a midterm exam worth 22.2% of the overall class grade. The exam will be comprised of
multiple questions. Questions will be True/False and/or Multiple Choice, with a set of essays based on case studies
using the knowledge from topics discussed in class and the prescribed textbook. A Scantron and a Green/Blue Book
are required.
For each essay question, the student will be required to use the following format:
a)
b)
c)
d)
An Introduction to address the case or problem presented.
Presentation of the ideas in addressing the issue or case using information from the course.
Brief Discussion of the interventions or direction suggested by the student for addressing the case or issue
Conclusion- Summary of thoughts
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.
IV
Term Project: Quality Management/Improvement Project or Program Development (100 pts. or 22.2% of
grade)
A major classroom project will be the development of a Quality Management/Improvement Program or Quality
Improvement Project or Process/strategy pertaining to a health care entity. This project will be assigned during
the course.
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.
I
In addition to the presentation, 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 be comprised of the
following elements:
a) Introduction to the portion being contributed by the student.
b) Presentation of the ideas and components the student is responsible for developing as part of the team
effort
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
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.
II
Class Presentation by Team
The score achieved by the team will be applied to each team member.
III
Presentation Scoring 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)
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:




IV
Fishbone diagrams
Process mapping
Flow charting
Run/control charts
Final Exam (150 pts. or 33.3% % of grade)
The Final will be similar to the Midterm Exam, and is NOT cumulative. There will be T/F and Multiple Choice
questions, along with short essays. A Scantron and a Green/Blue Book are required.
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
AGENDA AND SEQUENCE OF ASSIGNMENTS (The agenda is subject to change.)
Week
Objective
Week 1 – Jan. 21
a)
b)
c)
d)
e)
Week 2 – Jan. 28
CHAPTER 1 FOUCS ON QUALITY
Chapters 1 & 2 Solecito (Optional for 450)
Week 3 – Feb. 4
CHAPTER 2 QUALITY MANAGEMENT BUILDING BLOCKS
Chapter 1 (Solecito, Optional), Lecture Notes and Literature
Week 4 – Feb. 11
CHAPTER 3 MEASURING PERFORMANCE
Chapter 11 (Solecito, Optional), Lecture Notes
Week 5 – Feb. 18
QUIZ 1 Chapters 1 through 3
CHAPTER 7 IMPROVEMENT PROJECT TEAMS
Chapter 6 (Solecito Optional), Lecture Notes & Literature
Week 6 – Feb. 25
CHAPTER 4 EVALUATING PERFORMACE
Chapters 4 & 5 (Solecito Optional)
Week 7 – Mar. 4
QUIZ II Chapters 4 & 7
CHAPTER 5 CONTINUOUS IMPROVEMENT
Week 8 – Mar. 11
CHAPTER 6 PERFORMANCE IMPROVEMENT TOOLS
Week 9 – Mar. 18
Week 10 – Mar. 25
Week 11 – April 1
Introduction to the course.
Literature Review Guidelines.
Introduction to Terminologies.
Introduction to Health Care Systems
Selection of Teams for projects.
MIDTERM EXAM (CHAPTERS 1 THROUGH 7)
CHAPTER 8 IMPROVING PATIENT SAFETY
SPRING RECESS- NO CLASSES
Week 12- April 8
CHAPTER 9 ACHIEVING RELIABLE QUALITYAND SAFETY
Week 13 – April 15
QUIZ III Chapters 8 & 9
CHAPTER 10 MANAGING THE USE OF HEALTHCARE RESOURCES
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
Week 13 – April 22
CHAPTER 11 ORGANIZING F0R QUALITY
Week 14 – April 29
QUIZ IV Chapters 10 & 11
PRESENTATIONS
a) Group Presentations of Quality Improvement Projects
b) Students to submit their individual written project reports
Week 15 – May 6
PRESENTATIONS
a) Group Presentations of Quality Improvement Projects
b) Students to submit their individual written project reports
Week 16 – May 13 (5-7 pm)
FINAL EXAM
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
QUIZZES (4)
MIDTERM EXAM
TERM PROJECT
FINAL EXAM
CLASS PART. & ATTEND.
TOTAL
Points
60
100
100
150
40
450
% of Grade
13.3%
22.2%
22.2%
33.3%
8.9%
100%
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.
More than two absences during the semester will impact the class participation score adversely.
Drops
It is the responsibility of the student to file for a drop status if he or she desires. The instructor will sign no drops after
the third week.
Exams
A traditional grading system is required for evaluation of student performance in this course. There will be four (4)
quizzes, one mid-term, one term project and one final exam. Exam formats will be developed and announced by the
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
Instructor. No make-up exams will be offered unless the student has made specific arrangements with the instructor
prior to the exam. . A Scantron and a Green/Blue Book are required.
Student Course Evaluation
Students will have an opportunity to evaluate this course. Feedback from students is very important and is considered
critical to improving this course.
ADDITIONAL INTERNET RESOURCES:
America’s Health Insurance Plans
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.ahip.org
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.
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
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.
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
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
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
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
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Quality Management In Health Care Delivery HCA 450- Course Syllabus
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
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. 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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