SELF EVALUATION , PEER EVALUATION, PATIENT

SATISFACTION , UTILIZATION REVIEW

INTRODUCTION

• The realization of goals and objectives is based on the accuracy of the judgements and inferences made by decision-makers at every stage. To arrive at a good decision the test, measurements and evaluation are being used in all situations. Thus evaluation has become a part and parcel of every system to determine the achievement of goals in a given period.

TERMINOLOGIES

• Evaluation: Evaluation is an act or process that allows one to make a judgement about the desirability or value of a measure.

• self evaluation: Self evaluation is an evaluation of one's own abilities and failings

• Peer evaluation: Peer evaluation is a process by which one's colleagues assess his quality and accuracy.

• Patient satisfaction: Patient satisfaction is defined as the extent of the resemblance between the expected quality of care and the actual received care.

MEANING OF EVALUATION

• The term evaluation is derived from the word valoir which means “to be worth”. Thus evaluation is the process of judging the value or worth of an individual’s achievements or characteristics.

• It is an act or process that involves the assignment of a numerical index to whatever is being assessed.

• Evaluation is an act or process that allows one to make a judgement about the desirability or value of a measure.

SELF EVALUATION

DEFINITION• Self evaluation is defined as judging

the quality of one’s work, based on evidence and explicit criteria, for the purpose of doing better work in the future.

• Self evaluation is defined as looking at progress, development and learning to determine what has improved and what areas still need improvement. Usually involves comparing a "before" situation with a current situation.

-Riley guide

• Self evaluation is an evaluation of one's own abilities and failings

- Reverse dictionary

PURPOSES OF SELF EVALUATION

• To encourage continuing self-evaluation and reflection and to promote an ongoing, innovative approach.

• To encourage individual professional growth in areas of interest to the employee

• To improve morale and motivation by treating the employee as a professional in charge of his or her own professional growth.

• To encourage collegiality and discussion about practices among peers in an organization

• To support employees as they experiment with approaches that will move them to higher levels of performance

BENEFITS OF SELF EVALUATION

 

• Increased confidence in their own learning, in trying out new ideas, in changing their practice and in their power to make a difference.

• Enthusiasm for collaborative working, despite initial anxieties about being observed and receiving feedback

• Improved team-work and greater flexibility in their use of their skills

• Increased awareness of new techniques and greater insight into thinking

• Enhanced planning skills to ensure more effective task management.

TOOLS FOR SELF EVALUATION

• Staff annual professional review procedures

• Observation can involve experts; can be informal or formal procedures. Feedback from such observation is very valuable, but must be handled sensitively

• Checklist: provides guidance for collection of relevant evidence used to determine the merits, worth or significance of a self

QUESTIONS FOR SELF APPRAISAL

HAND OUTS

PEER EVALUATION

INTRODUCTION

• In response to the public‘s clamor for improved care quality, some nursing organizations instituted peer review as one method for increasing nurses accountability for effective decision- making and interventions

DEFINITION

• Peer evaluation is a process by which one's colleagues assess his quality and accuracy.

• Peer review is a process by which employees of the same rank, profession, and setting evaluate one another’s job performance against accepted standards.

- O’ Loughlin and Kaulbach

• An organized effort whereby practicing professionals review the quality and appropriateness of services ordered or performed by their professional peers.

- American Nurses Association

THE SUCCESS OF PEER EVALUATION DEPENDS ON

• Short but objective method• Trained observers• Constructive feedback for faulty

development• Open communication and trust

METHODS OF PEER EVALUATION

• Direct observation

Observation is the most frequent method used. The peer-observer may be only passively present, or may be actively engaged in the class while still serving the observation process. Selecting a peer observer can be difficult.

• Evaluation of course materials

PROCESS OF PEER REVIEW

PHASES OF PEER EVALUATION

• The peer evaluation process may be developed using three phases of establishing a peer review programme:

I. Familiarization

II. Utilization

III. Internalization

Peer Evaluation Form for Nursing Faculty

HAND OUTS

ADVANTAGES:

• Improves team work• Encourage group members

involvement and responsibilities • Encourage peers to reflects on their

role and contribution to the process of group work.

• Focuses on the development of judgement skills

• Provides more relevant feed back to the students as it is generated by their peers.

• Give opportunities for the hidden leaders to be selected

DISADVANTAGES

• Threats to friendship bias • Time consuming• Artificially inflated.• Peers feels ill equipped to undertake the

assessment.• Reluctance to make judgement regarding

their peers

PATIENT SATISFACTION

INTRODUCTION• Consumers of health care services demand

quality care. Patient satisfaction has been used as an indicator of quality services provided by health care personnel. The most important predictor of patients overall satisfaction with hospital care is particularly related to their satisfaction with nursing care. In recent years, the focus on consumerism in a highly competitive environment has led to increased interest in measuring patient satisfaction with health care

DEFINITION

• Patient satisfaction is defined as a health care recipients reaction to salient aspects of the context, process, and result of their service experience.

- Pascoe (1983) • Patient satisfaction is defined as the extent

of the resemblance between the expected quality of care and the actual received care.

- Scarding (1994)

NEED FOR EVALUATING PATIENT SATISFACTION

• Data about patient satisfaction equips nurses with useful information about the structure, process and outcome of nursing care.

• It is a requirement for therapeutic treatment and is equivalent to self therapy.

TOOLS FOR MONITORING PATIENT SATISFACTION

• Postal Surveys – Questionnaires

Questions must be carefully designed so that they are clear concise and relevant

Strengths / Advantages

• Cost effective.• Specific segments can be easily

targeted.• Wider sample distribution possible.• Encourages high response rate.• Visuals may be used.• Little bias.

• Patient/client anonymity.• Respondents given time to complete.• Can use validated survey

instruments.• Qualitative comments can be

included.• Can be administered by independent

external agencies.

Weaknesses/Disadvantages

• Difficulties associated with procuring an accurate list of client/patient details.

• No opportunity for explanation or follow up questions.

• Potential to excludes sections of the population.

• Provides limited opportunities for large numbers of community members to participate in the process.

• Does not allow for the exchange of ideas and discussion.

• Reliability dependent on timing.

Questionnaires

• A structured document, using closed or open ended questions that can be self administered or interviewer administered.

• Designed to elicit Patient/client feedback on certain dimension of quality / aspects of care.

Strengths / Advantages

• Agenda can be set by Organisation.• Allows for collation of both qualitative

and quantitative data.• Relatively inexpensive.• Qualitative comments can be

included.

Weaknesses/Disadvantages

• Questions must be carefully designed so that they are clear concise and relevant.

• The choice of response options can affect how people think and respond to questions.

• Generally require software support to record results.

• Potential to excludes sections of the population.

  COMPONENTS OF EVALUATION OF PATIENT SATISFACTION

• Evaluation of the programs and activities of various departments including outpatient care, inpatient care, overall health education activities of the hospital

• Evaluation of the various resources available in the hospital for effective health care

• Evaluation of effectiveness of hospital personnel including medical, paramedical, nursing as well as non-medical employees of the hospital.

• Services are relevant to the needs of the population it serves.

Patient satisfaction with nursing care is important for any health care agency because nurses comprise the majority of health care providers and they provide care for patients 24 hours a day.

ULITILIZATION REVIEW

• The utilization review program includes determining appropriate hospital length of stay and necessary treatments for various illnesses and conditions and reviewing patient medical records on admission and at intervals during hospitalization to ensure that the patient receives appropriate care.

• Utilization review is an assessment of the appropriateness and economy of an admission to a health care facility or a continued hospitalization. The length of the hospital stay also is compared with the average length of stay for similar diagnoses.

- Mosby's Medical Dictionary, 8th ed.

AIMS AND OBJECTIVES: • The main aim is to curb the exploding

health care costs with conservative use of hospitalization and expensive diagnostic and treatment procedures.

• They work in liason with a business organization to provide healthcare services to the organization’s employees at discounted rates.

• Cost containment to limit each patient‘s diagnostic and treatment measures to the fewest, least expensive procedures that will relieve patient symptoms, avert costly complications, and return the patient to fullest possible function in the shortest time possible.

UTILIZATION REVIEW NURSE

• A utilization review nurse is a registered nurse who reviews individual medical cases to confirm that they are getting the most appropriate care. These nursing professionals can work for insurance companies, determining whether or not care should be approved in specific situations, and they can also work in hospitals

MINIMUM QUALIFICATIONS

• A Bachelor’s Degree in Nursing; five (5) years of clinical care or nursing experience; OR an equivalent combination of education and experience AND (2) two years experience Utilization Review. Certification in Utilization Review or Utilization Management is preferred

Essential Functions of utilization review nurse

• Obtains and evaluates medical records for in-patient admissions to determine if required documentation is present.

• Obtains appropriate records as required and initiates Physician Advisories as necessary for unwarranted admissions.

• Conducts on-going reviews and discusses care changes with attending physicians and others.

• Formulates and documents discharge plans.• Provides on-going consultation and

coordination with multiple services within the hospital to ensure efficient use of hospital resources

• Identifies pay source problems and provides intervention for appropriate referrals

• Coordinates with admitting office to avoid inappropriate admissions.

• Coordinates with clinic areas in scheduling specialized tests with other health care providers, assessing pay source and authorizing payment under Medically Indigent Adult program as necessary.

• Reviews and approves surgery schedule to ensure elective procedures are authorized.

• Coordinates with correctional facilities to determine appropriate use of elective procedures, durable medical goods and other services.

REPRESENTATIVE DUTIES

• Performs utilization review in accordance with all state mandated regulations. Maintains compliancy with regulation changes affecting utilization management. Reviews patients’ records and evaluates patient progress. Performs continuing review on medical records and identification and need of on-going hospitalization.

• Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct review Reviews and validates physician’s orders, reports progress and unusual occurrences on patients. Ensures appropriate and cost-effective healthcare services to patients.

• Documents review information in computer. Communicates results to claims adjusters. Enters billing information for services. Prepares information for notification letters for providers and employees.

• Records and reports all information within scope of authority Performs administrative duties; receives, logs in and files a variety of reports, client charts, client interactions and other documents. Performs other duties as assigned or required.

BIBLIOGRAPHY