Donna Lee Gardner
Quality – three dimensions of health service quality
Client – patient quality concerns the ability to provide a service giving clients/patients what they want.
Professional quality – Professionals’ views of whether the service meets clients’/patients’ needs as assessed by professionals (outcome being one measure) and whether staff correctly selects and carries out procedures that are believed to be necessary to meet such needs. Management quality – The most efficient and productive use of resources to meet client/patient needs, within limits and directives set by higher authority, person, or body carrying executive responsibility.
The evaluation of occupational health services should be guided by the analysis of the work processes and their objectives. At the professional level, the results of the evaluation should contribute to the improvement of the quality of our services, and at the scientific level, evaluation research should provide the best evidence for occupational health practice.
- What outcomes are used for provider competency?
- General Responsibilities
- Act professionally at all times
- Arrive at the office punctually
- Act as gatekeeper for all patients presenting to the office for treatment and/or referral
- Be responsible for all medical aspects of care in the office
- Maintain patient satisfaction survey scores at or above the threshold
- Attend and contribute to provider meetings
- Demonstrate willingness to treat urgent/emergency cases whenever they occur
- Assume a leadership role in the office
- Communicate effectively with clients and staff
- Communicate with subspecialists and case managers to promote resolution of a case • Assign duty status of worker that is concordant with findings on physical examination
- Keep cases heading toward cure or maximum improvement
- Computer Skills
- Demonstrate ability to use EMR, enter results of history, physical examination, diagnosis, treatment plan, and work restrictions for all patients evaluated. Demonstrate ability to navigate in systoc through medical records and chart box. Build and maintain injury and illness templates
- Document findings of physical examinations in the EMR
- Review and complete all forms related to injuries and exams in the EMR
- Demonstrate competency with Outlook to send/receive email and view provider schedule
- Marketing
- Maintain familiarity with employer contacts
- Maintain telephonic contact with the employer
- Perform walk-throughs
- Attend sales calls
- Maintain familiarity with payers, insurers, and TPAs
- Identify potential new clients for marketing staff
- Quality Assurance
- Participate in the QA program
- Maintain quality standards at or above the threshold level
- Assist in the development of new QA standards
- Physical Examinations
- Perform and interpret history and physical examination results and document appropriately in the EMR
- Be familiar with the regulatory guidelines for all physicals
- Demonstrate expertise in evaluating drivers and other safety-sensitive employees undergoing DOT examinations
- Know the components of physical examinations requested by specific clients
- Advise clients of what components are required for requested physical exams and laboratory tests based on the type of work employees perform
- Soft Tissue Injury Treatment
- Demonstrate knowledge of anatomy and physiology of the musculoskeletal system
- Perform skillful, directed physical examinations of the body part injured and arrive at an appropriate working diagnosis
- Analyze the mechanism of injury and its causal relationship to the patient’s complaints and physical findings
- Establish a treatment plan and then reevaluate the treatment plan and make appropriate adjustments when improvement does not occur as expected • Appropriate use of home exercises and physical therapy
- Order appropriate testing
- Make appropriate and timely referrals
- Perform aspirations and injections of joints and tendons
- Have a working knowledge of durable medical equipment available and demonstrate an ability to use these devices appropriately in the treatment and rehabilitation of injuries
- Pulmonary Evaluations
- Perform complete examinations of the respiratory system and apply the clinical findings to situations in the workplace
- Treat acute and subacute inhalation injuries
- Have working knowledge of respiratory medications and their application to work-related conditions
- Be familiar with OSHA respiratory guidelines/questionnaire
- Perform respiratory clearances
- Interpret PFTs and apply findings to workplace situations
- Cardiovascular Evaluations
- Perform a complete cardiovascular examination
- Interpret EKG tracings
- Familiarity with the indications for GETT and thallium stress tests
- Interpret reports of cardiac tests and reports from cardiologists and apply the findings to workplace situations
- Neurological Evaluations
- Evaluate, diagnose, and treat injuries resulting in neurological symptoms
- Diagnose and treat concussions and post-concussive syndromes
- Order appropriate neurological diagnostic testing
- Make referrals to specialists when indicated
- Radiology
- Order appropriate radiology tests for the evaluation and treatment of work-related injuries and illnesses
- Perform preliminary review of the radiographs ordered and document in EMR
- Order special diagnostic testing (MRI, CT, bone scans, etc.) when indicated
- Review reports of radiographs and special diagnostic tests, document in EMR, and make appropriate changes in treatment plan and referrals, if needed, based on those results
- Audiology
- Review audiograms and apply findings to workplace noise levels
- Be familiar with OSHA guidelines for hearing conservation
- Be able to determine if significant threshold shifts have occurred when reviewing serial audiograms
- Know DOT regulations regarding hearing thresholds
- Make recommendations to employees regarding hearing conservation based on audiogram results
- Visual Acuity and Eye Injuries
- Evaluate and diagnose workplace eye injuries
- Demonstrate ability to use Wood’s Lamp and Slit Lamp in the evaluation of eye injuries • Ability to treat corneal abrasions and superficial foreign bodies in the eye
- Make appropriate ophthalmologic referrals when indicated
- Know DOT guidelines for visual acuity
- Have a working knowledge of ophthalmic medications for the treatment of work-related eye injuries
- Lacerations
- Evaluate lacerations to determine the extent of the laceration
- Identify lacerations that require referral to specialist
- Demonstrate ability to repair simple and moderately complex lacerations with sterile technique and with appropriate techniques and suture material
- Apply dressings to lacerations
- Administer local anesthesia and digital blocks for the repair of lacerations
- Use tissue adhesive for laceration repair when indicated
- Remove sutures/staples
- Appropriate prescription of antibiotics for wounds
- Schedule follow-ups for wound checks and suture removal
- Review wound care with injured worker
- Blood Borne Pathogen Exposure (BBPE)
- Evaluate workers with potential BBPE and determine if exposure has occurred
- Have a working knowledge of Meridian’s BBPE protocol
- Order appropriate testing and prescribe medication according to the BBPE protocol
- Assist in determining the donor’s serological status
- Provide counseling to the exposed worker
- Medical Review Officer
- Obtain and maintain valid MRO certification
- Complete all recommended CMEs for MRO
- Perform duties of MRO for validation of drug screen results
- General Responsibilities
- How do we monitor competency after employee orientation? Monitor ongoing employee activities for the process of all patient care for the program.
- Who defines the standards for operations? Administrative personnel
- What is the best approach for sales monitors? Relationship building
- What outcomes are used for onsite services? This depends on the client. Many look at decreased medical claims, costs, monitoring of health claims, and early disease identification.
- What is the best approach to client company satisfaction monitoring, yearly or monthly? There are several approaches to client satisfaction monitoring: Quarterly monitoring of safety supervisors for injury management outcomes and quarterly monitoring of HR staff for access to appointments and scheduling with feedback for exams and tests.
