Improving Quality in Outpatient Services: 1st Edition (Hardback) book cover

Improving Quality in Outpatient Services

1st Edition

By Carole Guinane, Noreen Davis

Productivity Press

300 pages | 29 B/W Illus.

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Hardback: 9781439850602
pub: 2011-06-22
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A valuable reference for those involved in the field of ambulatory patient care, Improving Quality in Outpatient Services offers time-tested instruction on how to create a world-class outpatient program. It supplies a high-level overview of current opportunities, national quality programs, and challenges—outlining the policies, procedures, and plans required for success.

Stimulating readers with a wealth of practical applications, stories, and examples, the book details the governance, medical staff, and quality structures required to create, implement, and maintain a safe and efficient outpatient program. It introduces powerful techniques for infection control, medication management, risk prevention, and the elimination of medication errors. It also:

  • Lists mandatory policies and procedures
  • Contains practice drills to prepare you for real-world scenarios
  • Explains how to create a report card to measure quality at all levels
  • Includes a sample curriculum that outlines the courseware required by OSHA and other licensing and regulatory agencies

The authors address documentation and human resources factors and supply an abundance of information and resources in the appendices, including how and where to apply for certification, medical record review tools, policy and procedure checklists, and a state-by-state listing of resources available for outpatient and ambulatory programs. Explaining how to involve patients in the decision making process, the text details a proven system for evaluating quality at all levels of your organization.


… hits the mark as both a roadmap and practical guide. … Carole Guinane and Noreen Davis bring a wealth of practical experience to the table … . Their nursing backgrounds coupled with their strong business and public health experiences in ambulatory care provide a foundation for understanding critical segments of the industry where change is sweeping through the care delivery model. …provides both a broad visionary direction for where we need to go in outpatient care management but also provides the details which must be considered as part of our efforts to lead the future of healthcare delivery.

—Kevin Fickenscher, MD

Table of Contents

Defining Outpatient Healthcare

Outpatient Quality

National Health Statistics Reports

Outpatient Quality Initiatives (HOP QDRP)

Clinical Performance Measures for Ambulatory Care

ASC Quality Collaboration

American Medical Association (AMA)

Safe Injection Practices Coalition

Safe Practices for Better Healthcare

Creating a Structure for Quality and Safety

Simplicity Is Best

Tie Your Quality Strategy to Your Mission, Vision, and Values

Appoint a Governing Body

Leader Selection

The Medical Staff, Nurses, and Allied Health Professionals

Meetings, Minutes, and Keeping a Calendar

Quality Program Topics

Engineering the Customer Connection

Quality Function Deployment


Plan, Do, Check, and Act (PDCA), and Six Sigma

Three Types of Waste

CSP Number 1: Keep Wait Times to a Minimum

CSP Number 2: Make a Good Impression

CSP Number 3: Be Open and Honest

CSP Number 4: Don’t Blame the Customer

CSP Number 5: Ask Questions

CSP Number 6: It’s Not a Meat Market

CSP Number 7: Follow Through

CSP Number 8: No Medical Mumbo Jumbo

CSP Number 9: Work as a Team

CSP Number 10: Relate to the Person

Policies, Procedures, and Plans

Staying True to Your Mission, Vision, and Value

Creating Lean and Useful Documents

Regulatory Requirements for Documents

The Users of Policies, Procedures, and Plans

Use Reference Manuals and Association Books

Document Format

Documents to Create and Have on Hand

Reviewing and Revising Your Documents

The Human Resource Factor


Quality and the HR Factor

Creating Complete HR Files

Health Care Quality Improvement Act (HCQIA) of 1986

Vendor and Contract Files

Clinical Contract Employee Requirement and Files

Monitoring, Collecting, and Analyzing Data

HR Training to Promote Safety and Quality

Audits and Auditors

Measuring Quality and SafetyMeasurement

Induction, Deduction, and the Scientific Method

Case Study

Scorecards for Outpatient Services

Rewarding Based on Performance

Medication Safety

Safety Overview

Formulary, Consulting Pharmacist, and Tools

High-Alert Medications

Look-Alike Sound-Alike Medications (LASAs)

Contrast Media




Injection Safety and Multiuse Medication Vials

Labeling Medications and Containers

Medication Reconciliation

Sample Medications

Storing and Securing Medications

Medication Safety Reporting

Adverse Drug Reaction Reporting

Infection Prevention in the Ambulatory Setting

Infection Prevention and Control

Infection Control and Prevention Structure

Disaster Planning and Outbreak Investigation

Infection Control and Prevention Committee

Infection Control and Prevention Plan


Bloodborne Pathogens

Sharps: Engineering Safety Mechanisms

Multiuse Vials and Single-Use Vials

Environmental Cleaning and Disinfection

Sterilization, Disinfection, and Cleaning

Recommended Sterilization Resources


Mandatory Staff Training in Infection Prevention

Infection Prevention Resources

Clinical Documentation


Meaningful Use

Electronic Health Records (EHRs)

Meaningful Use Quality Implications

The Purpose of Clinical Documentation

Authentication and Completion of Medical Records

Problem Lists

Allergy and Sensitivity Documentation

Ambulatory Surgery Center Documentation


Security and Retention of Medical Records

Regulatory Requirements

Risk Management and Safety


Challenges and Opportunity in the Ambulatory Setting

Common Causes of Errors in the Ambulatory Setting

Building Your Safety Program

Patient Safety Culture

National Patient Safety Goals

Universal Protocol

Surgical and Anesthesia Safety

Airway Maintenance

Malignant Hyperthermia

Postanesthesia Monitoring

Environmental Safety

MRI Safety

Radiation Safety

Surgical Fires

Work Flow Analysis and Redesign

Safety Program Training

What to Do If You Experience a Safety Event

Use of RCA and FMEA Tools

Licensing, Deemed Status, Accreditation, and Certification

Defining Licensing, Deemed Status, Accreditation, and Certification

Why Become Accredited?

Certification of Programs

Ambulatory Accreditation and Certification Programs

Survey Preparation

Accreditation Listing

Practice Makes Perfect

Why Practice?


5 Whys

Using Checklists to Improve Safety and Quality

Codes and Drills

Scenario Training

Scenario Example for Endoscopy


Checklist on Policies, Procedures, and Plans for an Outpatient Setting

Quality Glossary

Quality Reporting Measures

Infection Prevention Plan Example

Risk Assessment

Medical Record Review Criteria Audit

Safety Management Program

Root Cause Analysis and Corrective Action Plan

State Contacts for Ambulatory Licensing and Standards

Patient Education Pathway Example


Each chapter concludes with a Summary, Key Points, and Sources

About the Authors

Carole Guinane is a healthcare executive with extensive experience in all aspects of clinical operations, risk management, quality, compliance, regulations, accreditations, medical staff affairs, and insurance in the acute care inpatient and outpatient setting.

Ms. Guinane has over 30 years of experience helping organizations with people and process issues. She has published widely and is nationally recognized as a writer, speaker, consultant and change agent and trainer on topics such as clinical improvement and innovation, leadership, systems thinking, strategic planning, customer-mindedness, Six Sigma, creating a corporate culture, working through change and clinical pathways. Ms. Guinane is a licensed RN and a Six Sigma Black Belt. She also serves on the editorial board for the Heart Hospital Journal and the Journal for Healthcare Quality.

Noreen Davis, RN, MPH is currently the Directory of Quality Outcomes Management for CMC-Union where she has fiscal and supervisory responsibility for Performance Improvement, patient safety, case management and infection prevention and control. She is also responsible for all National Quality Measure data collection and reporting and is the liaison with the medical staff for evidence based order sets.

Ms. Davis is a published author and has completed her black belt in Six Sigma. She is a member of the NAHQ (National Association for Healthcare Quality) and holds a Masters of Public Health from UNC-Chapel Hill.

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Industries / Service Industries
MEDICAL / Administration