Official websites use .gov
Secure .gov websites use HTTPS
Organizational challenges to improving quality of care in Indian Health Service hospitals
Organizational challenges to improving quality of care in Indian Health Service hospitals
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Reports-in-brief (Promoting Women in Development (Project))
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
- Publication:
- [Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, August 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Hospitals, Public -- organization & administration
Quality of Health Care
United States
United States. Indian Health Service - Genre(s):
- Technical Report
- Abstract:
- Why OIG Did This Review. This study identifies underlying organizational challenges that may hamper IHS's ability to address critical longstanding problems at its hospitals. At times, these problems have had serious consequences, including difficulty maintaining compliance with Federal quality-of-care requirements. OIG and others have previously analyzed these problems and recommended corrective actions. IHS has made important new plans for improving the quality of care that it provides in its hospitals. However, if underlying organizational challenges are not addressed, they may prevent IHS from bringing its full organizational strength to these efforts. How OIG Did This Review. We based our findings on interviews with IHS officials and other stakeholders, and our observations of agency practices while we were conducting this and other OIG studies. Interview topics included challenges to the operations of IHS HQ, Area Offices, and hospitals, and suggestions for accelerated progress. We did not independently verify the substance of the statements provided to us in interviews. We also reviewed agency documents, including the Strategic Plan that IHS released in 2019. We conducted qualitative analysis to identify challenges to IHS agency management of its hospitals, and to develop strategies for improvement. What OIG Found. OIG identified underlying issues that are hindering the Indian Health Service (IHS) from improving its management of its hospitals, and recommends strategies for IHS as it implements new improvement plans. The issues represent core organizational challenges that, if not addressed, could continue to limit IHS's ability to improve hospital operations and quality of care: (1) Lack of Formal Structure, Policies, and Roles: IHS officials reported that they were often uncertain about their roles and those of other officials, including the authority to act in correcting problems. Consequences included lack of accountability and undermining of quality of care. This absence of clear roles was especially problematic with regard to the roles and responsibilities of IHS headquarters (HQ) and Area Offices. (2) Lack of a Clear View of Hospital Performance and Problems: We found that IHS HQ lacked awareness and insight about Area Office activities and hospital performance. In addition, IHS's organizational culture did not always encourage candid communication, with what one official called a "culture of niceness" that sometimes impeded useful discussion of problems. (3) Lack of Confidence in IHS's Ability to Succeed: IHS officials consistently expressed a deep commitment to and passion for the agency's mission and beneficiaries. However, officials also expressed doubt in the agency's ability to make sustained improvements. Addressing Organizational Challenges. To address these underlying organizational challenges, IHS should incorporate the strategies we outline in this report as it implements its new plans to improve operations: establish strong agency structures; ensure that leaders have a clear view of problems and champion "continuous learning" in their work; and leverage the deep commitment of officials and staff to foster a greater confidence in the agency moving forward. In other evaluations, OIG has recommended specific actions for improving quality in IHS hospitals, such as establishing a comprehensive compliance program focused on quality of care. We continue to urge IHS to implement those recommendations.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (26 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101757639 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101757639