Lisa Anderson is a 74-year-old female with a history of osteoporosis. She is a widow and lives alone in a two-story home. Mrs. Anderson is retired and depends on her Social Security income. She takes pride in making all her own food from scratch. While she is walking at the hospital today, Mrs. Anderson falls and fractures her left hip. She is transported to the OR for immediate surgery.
Patient falls are a serious problem in hospitals, resulting in substantial morbidity, mortality, increased length of stay, and higher costs. It is estimated that high hospitalization rates in healthcare organizations result from patient falls. Fall rates in acute-care hospitals have been measured between 2.2 and 7 falls per 1,000 admissions. Injuries occur in approximately 30% of falls, and severe injuries occur in 4% to 6% of falls. Patient falls increase the cost of patient care. It was found that patients who fell and were injured as a result of a fall had $4,233 higher charges and a length of stay (LOS) of 12.3 days.
Provide an example of something in your current facility that is increasing the cost of care in your organization. How is it being controlled, or how could it be controlled? Make sure to provide some ideas of what could be done better to improve care and outcomes.
The Prevention + Appraisal + Failure (P-A-F) Model
CoQ has been studied in a variety of literature. The costs associated with quality are divided into four categories: (1) prevention, (2) appraisal, (3) internal failure, and (4) external failure. The cost of prevention includes items such as training and preventive maintenance. These expenses are used to avoid losses in the future. Cost of appraisal includes items that are used to assess the current process, such as audits and inspections. Internal failure cost includes expenses used on areas that need additional resources prior to the delivery of products. These costs would include items such as rework needed because of inadequate processes, or an additional task not originally accounted for. The last category is external failure, which is the cost incurred in areas such as recall, customer warranty, etc. (Evans & Lindsay, 2017; Porter & Rayner, 1992).
Failure cost, cost of appraisal plus prevention, and cost of quality are the three lines of the PAF model. This model suggests that with the increase of cost of appraisal plus prevention, there will be a decrease in failure cost. Once the product reaches 100% conformance, the failure cost will be 0%. Because this is not always possible and very difficult to achieve, there should be a balance between failure cost and quality. This can be used to justify the scale of quality and control efforts. There is a huge amount of CoQ data collected and available, but rarely is the data analyzed and distributed back to the appropriate people (Burgess, 1996).
Crosby’s Model
According to Schiffauerova and Thomson (2006), the Crosby model is similar to the PAF model in that the cost categories are similar. Crosby defines CoQ as the sum of the price of conformance and price of non-conformance. Conformance includes a cost for prevention efforts. This will assure that processes are in place so that things are done right the first time. The cost of non-conformance is used when processes fail and the work is not accomplished. This is wasted money that is used to try and correct issues and requires increased efforts to make up for customer dissatisfaction (Evans & Lindsay, 2017).
Process Cost Model
This model focuses on processes and not products. Process cost is the total cost of conformance and non-conformance for a particular process. Conformance is the process cost. Here, the main focus is process and making sure the process is correct so that the end goal is the high-quality product that was intended. The cost of non-conformance is the failure cost that incurs because of incorrect or unstable processes that caused the end product to be other than what was actually intended. Incorporating the cost of non-conformance can actually help in the decision-making process for conformance (Pekanov, Mijoc, & Mijoc, 2015; Schiffauerova & Thomson, 2006).
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