PEER EVALUATION

DEFINITION

“Employees of the same rank, profession, and setting evaluate one anothers job performance
against accepted standards.” -O’Loughlin and Kaulbach

The Success of Peer Evaluation Depends on:

 Depend upon the objective

 Supervision
 Evaluation for fault development
 Open or good communication.

METHODS OF PEER EVALUATION

 By direct observation
 Watching videotaping
 Evaluation of course materials by checklist/rating scale
 Analysis of portfolios.

PROCESS OF PEER REVIEW

(i) Establish a policy requiring peer reviews.

(ii) Establish criteria for peer evaluations.

Establish policy

Make the criteria for evaluation

Conducting the procedure

Written evaluation

Keep in record

Compare the other final result

 PATIENT SATISFACTION

INTRODUCTION

Clients demand quality care. When we provide quality care to patient, so patient satisfied. The
most important predictor of patients overall satisfaction with hospital care is particularly related
to their satisfaction with nursing care. In recent years, know competitive environment has led
to increased interest in measuring patient satisfaction with health care.

DEFINITION

''It is defined as the patient satisfaction 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 SAISFACTION

 Progressive of the patient with useful information by evaluation checklist.

 Need therapeutic treatment and evaluation to self-therapy. Patients helps themselves
get healed faster because they are more willing to comply with treatment and adhere to
instructions of health care providers, and thus have a shorter recovery time.

METHODS OF MONITORING PATIENT SATISFACTION

 Medical Audit/medical evaluation

 Quality assurance committee reviews
 Observed nursing performances
 Judgemental method/supervise in method

COMPONENTS OF EVALUATION OF PATIENT SATISFACTION

1. Evaluation of the programmes and activities of various department including outpatient

care, inpatient care, discharge patient.
2. Various resources available in the hospital for effective health care after that we can
evaluate.
3. Evaluate the whole health team.
4. Services are relevant to the needs of the population it serves.
UTILISATION REVIEW

In this programme includes determining appropriate hospital length of stay and necessary
treatments for various illnesses and reviewing patient medical records on admission at intervals
during hospitalisation to ensure that the patient receives appropriate care or not if received the
appropriate care patient was satisfied.

AIMS AND OBJECTIVES

1. Cost effective services provide to patient.

2. Business organisation to provide health care services to the organisations employees at
low cost.
3. Cost containment to limit each patient diagnostic and treatment measure to the fewest,
least expensive procedure that will relieve patient symptoms, avert costly
complications, and return the patient to fullest possible function in the shortest time
possible.

UTILISATION REVIEW NURSE

 Registered nurse review the client setting the appropriate care.

 They worked for insurance companies, so health services improved.
 Need to be review situations dispassionately to make decisions which are fair, even if
they may be uncomfortable.
 At a hospital, a utilization review nurse examines patient cases if the hospital feels that
a patient may not be receiving the appropriate treatment.
 Insurance company the utilization review nurse inspects claims.
 The nurse see the patient's situation against the policy held by the patient, the standards
of the insurance company, and the costs which may be involved in treatment.
 To have experience in the field working with the patient that condition.

PURPOSES OF UTILISATION REVIEW

 Utilisation review is to ensure and document that care is necessary and its provided at
the appropriate level.
 The utilisation review activities with which will come into contact involve prior
authorisation for elective hospitalisation and concurrent review during hospitalisation.
GOVERNMENT INSURANCE PROGRAMME IN UTILISATION REVIEW

 Prior authorisation: When a patient is to be admitted to a hospital for elective medical

or surgical care, permission must be obtained in advance.
 A review co-coordinator or physician associated with the PSRO will based on the
information provided, determine the necessity of hospitalisation.
 It services can be safety provided in outpatient setting, the request for hospitalisation.
 Outpatient cost much less than in-patient care and therefore encouraged.

HEALTH MAINTENANCE ORGANISATION

Utilisation review is built into the health maintenance organisation concept from the
perspective of centralized control. Many HMOs conduct patient care through a certain type of
services be reviewed by utilisation review organisation prior to authorisation being i given to
proceed with the planned treatment. Some insurance carriers are trying to educate patients
regarding proper utilisation by putting on emphasis on primary care physicians to direct patient
care, referrals to specialists, hospitalisation, and length of stay.

Second Opinion for Elective Surgery

 Some insurance companies are requiring a second opinion, when elective surgery is
recommended. Patient is seen by another surgeon selected by insurance company.
 If the surgeon disagree, company may not pay for the procedure or may request third
opinion.

THE MEDICAL ASSISTANTS ROLE IN UTILISATION REVIEW

 Role in utilisation review is to know the restrictions.

 Insurance restrictions for cost containment will vary from one area to another in
government and private concentration of primary care. Each patient select or assigned
a primary care physician who manages patients needs.
 Refers patients to specialists or for hospitalisation as needed.
 This helps monitor activity.
 Other services not paid without primary physician referral
 Avoid unnecessary services or self -referral by patient to specialists.
EMPHASIS OF CARE

 Care through medical unit stressed maintain and preventive care.

 It is based on the principle, that patients should seek care before problem begin or
require major care.
 Through early intervention care can be provided at a reduced cost.

INSURANCE COMPANIES

 Employees pay a majority portion of the health premiums for the employees.
 Employers encourage insurance carriers to assist cost containment.
 Rules and regulations that apply in the area to be learnt and to be alert to the changes
that take place.
 System of arrangement with employers to be made to ensure programme changes
announcement are shared with all employees.

NECESSARY PERMISSIONS

 If advance permission is needed for certain referrals or hospitalisations to be obtained

by filling a proper forms and notifying the appropriate agencies or facilities.

HOSPITAL REVIEWERS

Hospital utilisation review co-ordinate works with physicians to see the patient does not stay
in the hospital any longer than medically necessary.

FILLING CLAIM FORMS

Claim forms for medical to be done to file claims to insurance carriers. It is easier and faster to
older claim form through local supply houses than insurance carriers our forms.