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How to Plan a Site Visit for Your Policy Makers

  • March 12, 2016

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Use this advocacy tool to help plan and implement a site visit with your local, state and federal policymakers.

Some say that a picture is worth a thousand words, but showing someone your work firsthand can be worth many more. One of the most effective ways to Be a Big Voice for Little Kids TM  is to invite policymakers to experience your work with infants and toddlers for themselves. A site visit gives policymakers the opportunity to connect the decisions they make to the faces of infants, toddlers, and families in their community, and is a great strategy that can create a lasting impression. Use the guidance below to plan and implement a site visit with your local, state and federal policymakers.

If you are a planning to invite your federal policymakers for a site visit, feel free to use our Sample Invitation to Member of Congress for Site  Visit.

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Coordinate The Service For A Site Visit

Post by sadna » Wed Sep 28, 2016 12:26 am

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Re: Coordinate The Service For A Site Visit

Post by Lorina » Wed Sep 28, 2016 9:48 am

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Risk Management Plan for Childcare Centers

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Risk Management Plan for Childcare Centers

Running a childcare business is a rewarding venture that requires a great deal of commitment, passion, and responsibility. Childcare providers have the crucial task of caring for children while ensuring their safety and protection from potential risks. Understanding how to manage these risks is crucial to maintaining a successful and sustainable business.

Risk management refers to the process of identifying, assessing, and controlling risks that businesses face. Many businesses have some sort of risk management plan in place to minimize potential risks and protect their business. In the case of childcare businesses, risks can range from accidents, injuries, and illnesses to legal liability and reputational damage. The risks can seem daunting, but taking the time to develop a comprehensive plan can help ensure the safety and well-being of the children in your care. 

Continue reading to learn more about what risk management is in relation to child care, its importance, and how you can create a plan to protect your children, staff, and business.

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What is risk management in child care?

Risk management is the process of identifying, assessing, controlling, and treating potential risks or threats by finding ways to minimize, transfer, or eliminate them and their impact. In child care, the most apparent risk is to the health and safety of the children in your care; however, the risks don’t end there. In addition to the health and safety risks, which also pose a threat to your entire staff, there are various sources that risks can stem from.

Additional risks to consider include financial, operational, and compliance risks. For example, financial risks stemming from fraud and property liability exposure may lead to financial losses for your childcare center. While compliance risks related to record keeping and hiring, for example, impact compliance on the local, state, and federal levels.

To properly anticipate risks, there are several factors to consider as you work toward building and executing your risk management plan.

Health and safety risks

Health and safety risks can cause a person to suffer harm or adverse health effects—physical, mental, or social—when exposed to hazards. Some of the most common safety hazards in childcare centers and schools come from slips, trips, and falls on things like stairs, wet floors, and elevated surfaces.

Additional risks that children may face during child care include life-threatening allergies and bullying. It is important that you identify any possible security, environmental, or public health risks that your children and staff might be exposed to at your center.

In the event of any accident or injury occurring at your program, it's a good idea to have an incident reporting procedure in place. With brightwheel's childcare incident reports , you can create digital incident report templates that your staff can easily use in the event of an incident and share instantly with families, keeping everyone informed and protecting your business.

Operational risks

Operational risks can affect how your business runs its day-to-day activities. Four factors usually cause operational risk : people, processes, systems, or external events. 

At your childcare center, an operational risk caused by people can stem from staff shortages. A process-based operational risk might look like a breakdown in your meal program after placing a late order. If your center relies on manually entering customer information, this creates another operational risk that might affect billing, tracking attendance, and more. Lastly, external events can also pose issues to your daily operations. For example, a storm could cause a power outage or damage to your building, preventing your center from functioning fully.

Strategic risks

Strategic risks include the possible losses your childcare business may face based on decisions made at a strategic level. This can negatively affect your ability to meet your company goals. Similar to operational risks, strategic risks can include both internal and external factors that will affect how you strategize. 

Within your childcare business, strategic risks can come from important decisions regarding location, management, and cash flow. External events, such as new technology and consumer demand changes, can also pose a risk to your childcare center and the ability to meet your goals and objectives.

Compliance risks

Depending on the location of your childcare center, there are specific local, state, and federal laws that your business must comply with to maintain proper licensing. Compliance risks are risks that affect your ability to comply with these regulations. Examples of compliance risks include maintaining the proper staff-to-child ratios, hiring employees with the appropriate education and experience, and following the minimum requirements for zoning and fire codes.

Financial risks

Financial risks refer to the liabilities that may cause your childcare center to lose money. These risks can also affect your ability to fulfill your financial obligations. The most obvious financial risk comes from cash flow. Is your business generating enough money to pay your employees? Are you able to pay for your daily operations? Additional financial risks can come from insurance liability, employee misconduct, and financial mismanagement.

Reputational risks

Reputational risks are any risk that impacts your business reputation. While this may seem less tangible than the other risks your childcare center is facing, it’s necessary to keep a positive reputation in the eyes of your stakeholders: your children, their families, your employees, and any investors. Your business image can boost or damage your public perception, which greatly impacts the success of your business.

There are many risks to consider when building a risk management plan; however, it is an irreplaceable step in operating an effective, profitable childcare center.

Why is risk management important?

The most efficient way for your childcare center to deal with potential risks is to know that they exist. Risk management is important because it equips you, your staff, and your business with the tools to identify and eliminate risks. Child care is an unpredictable industry. If the COVID-19 pandemic acts as any indication, it’s impossible to prepare for every situation. However, risk management puts your business in a better position to survive and thrive through perilous circumstances.

Other various benefits come with creating a plan. Risk management:

  • Forecasts potential issues
  • Increases risk awareness
  • Improves operational efficiency
  • Improves childcare and workplace safety and security
  • Minimizes loss
  • Reduces negative risk impact

Risk is a natural part of running any childcare business. Use the steps outlined below to create your risk management plan and enjoy the benefits of preparing your center for potential risks.

How to create a risk management plan

It’s important to create a risk management plan that will protect the children in your care, your staff, and your business. While the process may seem challenging, the benefits far outweigh the time spent creating the plan or the difficulties you’d face without one. To create a risk management plan, you will need to:

  • Identify the risks
  • Assess the risks
  • Develop a risk response
  • Develop contingency plans
  • Document and communicate your plans

1. Identify risks

The first step to creating your risk management plan is to brainstorm. Ask yourself, “ What are the risks to my childcare center? ” You might find it beneficial to consult with multiple groups of people at this stage. While your teachers might be a greater source of information on the day-to-day risks posed on the children, other staff and administration can help broaden the list to incorporate all potential risks for operating the center.

2. Assess the risks

After you identify the risks, assess them. Evaluate their probability and impact. It is impossible to eliminate all risks; however, prioritizing them can ensure that you create the proper plans and responses for the most critical ones. During your assessment, use this time to determine the cause of the risks, which will help in the next step—developing a risk response.

3. Develop a risk response

How do you plan to deal with the risks that occur in your childcare center? There are four common responses to risk:

  • Risk avoidance: The elimination of hazards or activities that can negatively impact your business. An example of risk avoidance in child care would be the removal of all elevated playground equipment to prevent children from falling.
  • Risk reduction: The process of minimizing the loss associated with risk rather than eliminating it. Having a plan in place for reducing the spread of infectious diseases is an example of risk reduction in childcare settings. While you can’t eliminate the spread of the flu, you can have measures in place to reduce it.
  • Risk transfer: The process of contractually shifting the responsibility of risk from one party to another. Purchasing insurance and acquiring liability waivers from parents are examples of risk transfer.
  • Risk acceptance: The acknowledgment of potential loss from risk. Also known as residual risk, it is the risk that remains after risk reduction and risk transfer measures have been implemented.

4. Develop contingency plans

Your risk response can cover most situations or events; however, you will need to develop contingency plans when risks can’t be avoided or transferred. Create a plan for how you will continue or resume business operations in the face of a crisis or emergency. 

5. Document and communicate your plans

The final step in creating a risk management plan is documenting it and communicating it to the appropriate parties. The people connected to your childcare center—the children, teachers, families, and staff—should be aware of your plans and their role in risk management.

A tool like brightwheel’s childcare management software can help streamline administrative tasks and easily scale your childcare program, allowing you to share documents—risk management plan, handbooks, and menus—with staff and families. In addition, brightwheel is the most secure all-in-one childcare and preschool software with the highest financial data security and compliance levels for payments, offering two-factor authentication, data privacy with data encryption, and 24x7 fraud monitoring.

You might find it beneficial to keep both physical and digital copies that your staff can access. Once all relevant people have been informed, make sure you train your staff in the procedures and regularly review and practice any drills.

Risk management plan template

The format you use for your risk management plan is up to you; however, you might find it useful to start building yours with a template as a reference. 

The following templates are great tools to use as a guide.

Centers for Disease Control and Prevention (CDC)

The CDC provides a straightforward 10-page risk management template that walks you through the steps to create your own. It is divided into three sections: the purpose, procedure, and tools and practices. After describing your purpose for creating your risk management plan, the template guides you through risk identification, risk analysis (qualitative and quantitative), response planning, and monitoring and reporting. The CDC also includes a risk management plan approval sheet for acquiring necessary signatures from relevant parties acknowledging their review of the plan.

Smartsheet offers an extensive collection of  risk management plan templates . In addition to the risk assessment matrix template seen above, they offer:

Risk management plan template:  Includes typical sections such as risk identification, analysis and monitoring, and roles and responsibilities

Risk register template:  Includes a register to create a detailed log of who owns a risk, the level of impact and probabilities, planned actions, and response status

Risk management matrix: Includes a risk assessment matrix for getting an overview of risk ratings and a management matrix for identifying and assessing risks, describing mitigation strategies, and monitoring control efforts

Smartsheet Risk Assessment Matrix Template

Connecticut Department of Social Services

The risk management plan template from the Connecticut Department of Social Services is ideal for your childcare center if you’re new to creating a risk management plan. It not only provides instructions for the author of the plan, but it also provides the definition and purpose of risk management, along with additional tools and resources for developing a plan. This document will help you assign roles and responsibilities, outline procedures, and decide how to escalate high-exposure risks.

Less risk, greater reward

It is impossible to eliminate all the risks associated with operating your childcare center; however, it is possible to reduce them and strengthen your business practices. Risk management plans allow you to identify possible risks, eliminate or reduce them, and plan for the future.

Whether you are looking to create a risk management plan or update an existing one, be sure to use the information in this article to protect you, your business, and all those you serve. It is your strongest tool in preventing and handling crises and emergencies.

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An Evaluator’s Guide to Performing Successful Site Visit Observations

For external evaluators, site visits (e.g. visiting schools) provide an opportunity to experience the activity, program, or product first-hand while also offering a chance to connect in-person with participants from a study. As these observations provide an important addition to report findings, Magnolia Consulting follows several steps for successfully navigating site visit observations. Based on our experience, here are five key guidelines for successful site visit observations:

  • Conduct an in-person study orientation. Conducting an in-person study orientation before site visits offers the opportunity to meet and interact with participants, which helps to establish a trusting relationship. Having a positive rapport with participants is important as it allows for open communication and can help reduce any participant concerns associated with site visit observations. During the study orientation, inform participants of details about the purpose of the site visits, expectations for participation, and how site visits will be scheduled to minimize disruption in the classroom. During the orientation, explain how the data will be used and how evaluators will maintain participant confidentiality. If the budget does not allow for an in-person orientation, webinars with video access are also a helpful tool to introduce yourself to the participants.
  • Create an observation protocol.  Using an observation checklist or protocol helps to reduce bias associated with observations and assures that preestablished guidelines are followed. These protocols typically focus on the quality and extent to which an activity, program, or product is implemented and/or aligned to best instructional practices in the field (i.e., reading instruction, STEM). If multiple evaluators perform observations across participants or sites, the measure should be checked across observers for agreement and accuracy.
  • Enlist a site coordinator . If budget allows, plan for having an on-site coordinator who knows the site’s participants and inner workings. This individual can communicate with the evaluation team’s program coordinator on details throughout the study such as scheduling observations across multiple participants at the site. Furthermore, the site coordinator can communicate details with participants before the observation and answer any questions that arise. In addition to coordinating site visit observations, the site coordinator might be responsible for other helpful tasks such as managing consent forms and ensuring assessments are distributed and returned in an organized manner.
  • Be flexible with scheduling.  Allowing flexibility and accommodating a site’s scheduling needs supports understanding and recognition of “real world” complications. If possible, create a schedule that follows the site’s established routines. This may require conducting observations across several days rather than consolidating multiple sessions into a shorter timeframe. If the evaluation budget is limited and requires observations to be performed within a brief period, work with the site coordinator to determine another mindful, yet suitable schedule. If appropriate, send participants a direct email one week prior to the visit restating the purpose of the observation and confirming the schedule. This can help avoid an observation from being unannounced.

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The Site Visit

Learn the key activities you should take before, during, and after the site visit.

A site visit is essential for gathering relevant site information. It helps you to:

  • Meet site representatives, local officials, tribal organizations, community members, and other stakeholders.
  • Establish contacts to facilitate the collection of relevant information.
  • Tour the site to determine activities and possible ways that community members might be exposed to contaminants.
  • Obtain first-hand knowledge of current site conditions.
  • Confirm previously obtained site information.

See the key activities to take before, after, and during the site visit in the diagram below.

Key Activities Before, During, and After the Site Visit

Cycle of Key Activities Before, During, and After the Site Visit

Work with Community Members and Other Stakeholders

ATSDR broadly defines the community associated with a site as the entire population living on and around the site. Community members and community-based organizations are excellent sources of information about the site and community health concerns, including:

  • Site-specific issues.
  • Nature of the concerns.
  • Local behavioral patterns that may influence exposures.
  • Degree to which the community is involved.

Tip: Conduct the site tour before meeting with the community so that you can better understand community references and locations they may mention.

Remember: Before reaching out to any community members directly, you need to have a firm understanding of ATSDR’s process for engaging the community . While initial contact with community members and others could happen during the site visit, working with stakeholders is a process that will likely continue throughout the PHA process.

Community Contacts

Working with the community engagement specialist, health educator, and regional representative, you can typically identify a few key community contacts (individuals and organizations) by reading through government site files or talking with staff from different government agencies. Some of the individuals and community groups that you might want to contact include:

  • Individual site petitioners (if any) and local residents, particularly community leaders
  • Site-specific advisory boards
  • Tribal organizations/leaders
  • Faith-based organizations
  • Local medical society and other healthcare providers
  • Fishing, hunting, agricultural, conservation, and industrial organizations
  • Media outlets and social media influencers
  • Community organizations
  • Local community environmental groups
  • Staff at universities or other area academic institutions
  • School principals and school nurses
  • Labor unions
  • Staff of local institutions and facilities near the site (e.g., childcare centers, prisons)

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The use of on-site visits to assess compliance and implementation of quality management at hospital level

1 NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands

2 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

3 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK

M. Dersarkissian

4 Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA

C.A. Thompson

5 Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA

N.S. Klazinga

6 Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

7 UCLA Center for Health Policy Research, Los Angeles, CA, USA

R. Suñol

8 Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain

9 Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain

Stakeholders of hospitals often lack standardized tools to assess compliance with quality management strategies and the implementation of clinical quality activities in hospitals. Such assessment tools, if easy to use, could be helpful to hospitals, health-care purchasers and health-care inspectorates. The aim of our study was to determine the psychometric properties of two newly developed tools for measuring compliance with process-oriented quality management strategies and the extent of implementation of clinical quality strategies at the hospital level.

We developed and tested two measurement instruments that could be used during on-site visits by trained external surveyors to calculate a Quality Management Compliance Index (QMCI) and a Clinical Quality Implementation Index (CQII). We used psychometric methods and the cross-sectional data to explore the factor structure, reliability and validity of each of these instruments.

Setting and Participants

The sample consisted of 74 acute care hospitals selected at random from each of 7 European countries.

Main Outcome Measures

The psychometric properties of the two indices (QMCI and CQII).

Overall, the indices demonstrated favourable psychometric performance based on factor analysis, item correlations, internal consistency and hypothesis testing. Cronbach's alpha was acceptable for the scales of the QMCI ( α : 0.74–0.78) and the CQII ( α : 0.82–0.93). Inter-scale correlations revealed that the scales were positively correlated, but distinct. All scales added sufficient new information to each main index to be retained.

This study has produced two reliable instruments that can be used during on-site visits to assess compliance with quality management strategies and implementation of quality management activities by hospitals in Europe and perhaps other jurisdictions.

Introduction

In a more and more market-oriented health-care delivery system it may be increasingly important to evaluate the quality of care delivered. To this end, health-care purchasers are gathering and using performance information on patient experiences as well as organizational and clinical performance indicators. Despite years of efforts to improve the reliability and validity of performance indicators, there are still differences in outcomes related to registration and measurement error in the administrative databases used to calculate outcome indicators. Additional information about quality management and clinical quality strategies could be a valuable adjunct to hospital assessment, especially since accreditation/certification instruments that can be used to assess quality management systems already exist [ 1 ].

An alternative to administrative data and surveys is the on-site visit (or audit). Visits involving independent auditors can verify compliance with activities, methods and procedures used to plan, control, monitor and improve the quality of care. On-site visits are mainly used by accreditation and certification organizations who visit an organization for a few days, reviewing documents and meeting with front-line staff. To date, easy-to-use survey instruments have not been developed for use by health-care purchasers or health-care inspectorates. Such instruments could be used to reveal whether a hospital has appropriate quality management strategies in place, whether they are used and whether they are stimulating continuous learning and improvement. The latter is based on the Deming or Nolan Quality Improvement Cycle, which describes the steps: Plan–Do–Check/study–Act. On-site visits offer an opportunity to discuss achievement of more complex steps like ‘Check and Act’. In addition, widely used quality indicators can rarely be used to measure the improvement structures and culture of hospital units, which can be explored in conversation during an on-site-visit.

In this article we describe the development of two novel quality management indices for purchasers and other stakeholders of European hospitals. Both are developed within the DUQuE project (Deepening our understanding of Quality Improvement in Europe). One (the Quality Management Compliance Index or QMCI) focuses on compliance with existing quality management procedures at the hospital level and the other (the Clinical Quality Implementation Index or CQII) on activities that support continuous improvement of clinical indicators. This paper describes testing of the psychometric properties of the two newly developed measurement instruments (QMCI and CQII).

Setting and participants

The study took place in the context of the DUQuE project which ran from 2009 to 2013 [ 2 ]. Hospitals were sampled at random from all acute care hospitals in seven European countries: Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Data for the QMCI and CQII were collected in the hospitals that participated in the in-depth study of the DUQuE project. In total, 74 hospitals (response rate 88%) were visited by experienced surveyors and these responses were used for the psychometric analyses.

Development of the instruments

Quality management compliance index.

The aim of the QMCI was to identify and verify the compliance to a set of closely related methods and procedures used to plan, monitor and improve the quality of care. By design, three scales of the index were defined a priori as quality planning, monitoring opinions of professionals and patients, and improvement of quality of care based on the notion that if a hospital would like to base its quality management on a limited number of activities, then it would need to have a plan based on the opinions of front-line staff and the users of hospital services, patients. Furthermore, strategies are necessary to solve possible shortcomings mentioned by professionals and patients.

The choice of questionnaire items was based on expert opinion of experts with years of experience in hospital performance evaluation during accreditation and certification audits. The main criteria for including an item were its assumed influence on quality and safety of care, and the feasibility of verifying an answer to the item. Face validity was established based on the review by 10 experts of the DUQuE project, and a pilot test in two hospitals. All items of the QMCI ( n = 15) were rated on a five-point Likert scale, varying from ‘no or negligible compliance’ (0) to ‘full compliance’ (4).

Clinical Quality Implementation Index

The purpose of the CQII is to test clinical quality systems and seek evidence of their implementation at the hospital level. The CQII has been designed to measure to what extent efforts regarding key clinical quality areas are implemented across the hospital. Following Bate and Mendel [ 3 ], each quality effort is assessed with regard to three levels of development: (i) Do quality efforts regarding the key areas exist (i.e. is there a responsible group and hospital protocol)? (ii) To what extent are these efforts monitored (i.e. with regard to compliance and improvement measurements)? (iii) To what extent is the sustainability of these efforts monitored?

The key clinical areas included stem from the different quality functions described in most accreditation systems, as well as the recommendations of the WHO Patient Safety Alliance covering most of the key hospital clinical and safety areas. In total, seven areas were selected: (i) preventing hospital infection, (ii) medication management, (iii) preventing patient falls, (iv) preventing pressure ulcers, (v) routine assessment and diagnostic testing of patients in elective surgery, (vi) safe surgery that includes an approved checklist and (vii) preventing deterioration and advance life support (i.e. rapid response teams, resuscitation programmes). As a whole, the audit instrument comprised items from seven clinical areas, which could be rated on a five-point Likert scale, varying for example from ‘no compliance’ to ‘full compliance’. Additionally, when no information was available ‘not applicable’ could be selected. However, to get more meaning groups, the answer categories were recoded to a scale of 1–3, where responses of no, negligible or low compliance were coded as 1, medium compliance was coded as 2 and high, extensive or full compliance were coded as 3. The choice for the seven clinical areas was based on the fact that evidence exists on how to prevent the unsafe practices and related adverse outcomes. By following the existing guidelines patient harm might be prevented and patient safety improved.

Data collection

The QMCI and the CQII were designed as data collection tools for use during on-site visits by experienced surveyors who had previous experience in hospital accreditation, but had no relationship with the hospitals. Data were collected in the 74 hospitals between May 2011 and February 2012. In total, 14 external surveyors (2 in each country) collected data. The surveyors were trained on the main aspects to be assessed, and the scoring system. A data collection manual was developed to provide guidance and ensure homogeneity of data collection. Data were first gathered on paper and then entered into an online database system and checked by the country coordinator for missing data. Every hospital was visited by two surveyors for 1 day. No hospital professionals were made aware of the contents of the visit beforehand.

Data analysis

We began the analysis by describing the sample of hospitals that provided data from external visits. Then, we investigated the factor structure, reliability and construct validity of QMCI and CQII using standard psychometric methods. We conducted principal components, confirmatory factor, reliability coefficient, item-scale total correlation and inter-scale correlation analyses separately for QMCI and CQII. There were no missing values for any of the items, as data collected from hospitals participating in external visits were complete. Since we had external visit data from only 74 hospitals and factor analysis required 5–10 observations per variable, we did not split the data into two parts to perform factor analysis. We explored factor structure using principal component analysis with oblique (promax) rotation with a factor extraction criterion of eigenvalues >1 and three or more item loadings. Items were assigned to the factor where they had the highest factor loading, and only items with loadings ≥0.3 were retained. However, only one item was used to assess the ‘quality planning’ domain for QMCI, and this was considered to be theoretically important for assessing quality compliance. We then used confirmatory factor analysis to examine whether the data supported the final factor structure, where root mean square residual <0.05 and a non-normed fit index >0.9 indicated good fit. We also used Cronbach's alpha to assess internal consistency reliability of each factor, where a value of 0.7 was acceptable. Item-total correlations corrected for item overlap were used to examine the homogeneity of each scale. Item-total correlation coefficients of 0.4 or greater suggested adequate scale homogeneity. Lastly, we assessed the degree of redundancy between scales using inter-scale correlation coefficients, where a Pearson's correlation coefficient <0.7 was indicative of non-redundancy. Once psychometric evaluations of QMCI and CQII were completed and a final factor structure was established, we computed scores for each of the scales comprising these indices by taking the mean of items retained for each scale from the factor analysis. These sub-scales were then summed to build each final index. We subtracted the number of scales from the final CQII in order to bring the lower bound of the index down to 0. In order to assess construct validity, we used Pearson's correlation coefficients to examine the relationship between CQII and QMCI. We also provide descriptive statistics on the final index, sub-scales aggregated to build the index and items that comprise the sub-scales. All statistical analyses were carried out in SAS (version 9.3, SAS Institute, Inc., NC, 2012).

Hospital characteristics

Across the 7 countries, 74 hospitals participated in this in-depth part of the DUQuE project. The teaching status was evenly balanced between non-teaching (55%) and teaching (45%). Most hospitals were publicly owned (80%) and comprised 501–1000 beds (42%) (Table  1 ).

Table 1

Characteristics of hospitals participating in the analysis

The QMCI was designed to measure compliance in 3 domains: quality planning (1 item); quality control and monitoring (12 items) and improving quality by Staff development (5 items), but factor analysis revealed 4 factors instead of the proposed three, as can be seen in Table  2 . The quality planning factor comprised one item as this domain was only assessed with one question in our questionnaire. The other three QMCI sub-scales were monitoring of patient/professional opinions, monitoring of quality systems and improving quality by staff development. Factor analysis revealed that the items initially included in the quality control and monitoring domain actually clustered on two distinct factors: the monitoring of the opinions of patients and professional and that of quality systems. This distinction is meaningful and was retained. Three items from the questionnaire did not load on any of the factors and these were excluded.

Table 2

Factor loadings, Cronbach's alpha and corrected item-total correlations of QMCI ( n = 74)

The factors of the QMCI yielded acceptable results with regard to internal consistency (Cronbach's alpha ranges between 0.74 and 0.78). None of the corrected item-total correlations were <0.4, except in the case of one item in the improving quality by staff development sub-scale, indicating that all items contribute to the distinction between high and low scores on the factor. The inter-scale correlations, presented in Table  3 , had a maximum of 0.52, which is below the maximum threshold of 0.70. This indicates that the QMCI is indeed a multi-dimensional construct with sub-scales addressing independent aspects of quality management. All sub-scales had notable correlations with the overall index, meaning that they contribute to the QMCI.

Table 3

Inter-scale correlation coefficients of QMCI and scales with overall construct ( n = 74)

Note. The numbers in the first row correspond to the scales in the first column.

Descriptive statistics for QMCI, the sub-scales and items that comprise the sub-scales are presented in Table  4 . QMCI had a final scale range of 0–16. Six out of 15 items had a median score of 4 (range 0–4). This is also reflected in a high ceiling ratio of these items. In contrast to most other items, the third item (improving quality by staff development) was an exception. It had a low average (zero) and a high floor ratio.

Table 4

Distribution of item and scale scores of QMCI ( n = 74)

a Median (IQR) presented for individual question items.

b QMCI is the sum of all 4 sub-scales, range: 0–16.

Clinical quality implementation index

The CQII aimed to assess three levels of implementation, such as existence of protocol, monitoring of compliance and sustainability by measuring and using indicators to keep an improvement focus. Factor analysis revealed, however, that the items did not group into these dimensions. Instead, the factors appear to be grouped according to different clinical areas (Table  5 ) suggesting that the levels of clinical implementation are not consistent on the same level across different clinical areas. Rather, the levels of development coexist and reflect the implementation of a certain area. Therefore, we used the items to describe clinical implementation as a single score for each area. The seven sub-scales retained by factor analysis were preventing hospital infection, medication management, preventing patient falls, preventing patient ulcers, routine testing of elective surgery patients, safe surgery practices and preventing deterioration. The resulting seven-factor structure showed high factor loadings, Cronbach's alphas ranging from 0.82 to 0.93 and corrected item-total correlations. The inter-scale correlations, presented in Table  6 , had a maximum of 0.59, which is below the maximum threshold of 0.70. This indicates that the CQII is a multi-dimensional construct.

Table 5

Factor loadings, Cronbach's alpha and corrected item-total correlations of CQII ( n = 74)

Table 6

Inter-scale correlation coefficients ( n = 74)

CQII had a final scale range of 0–14. The distribution of the scores (Table  7 ) showed that the prevention of hospital infection stands out with a very high average score and a ceiling ratio of over 80% for all of its items. For other items it seems that quite a number of hospitals have the highest or lowest score (ceiling effects). Around two-thirds of the hospitals have a low score on the sub-scale routine testing of elective surgery patients.

Table 7

Distribution of item, scale and index scores ( n = 74)

a Median (IQR) presented for individual question items

b CQII is the sum of all 7 sub-scales (minus 7), range: 0–14.

Construct validity: hypothesis testing

The inter-index correlation between QMCI and the CQII was 0.565. This was in line with our expectations that both are distinct, but related constructs.

Main findings

The results suggest that at the hospital level the QMCI and CQII are reliable and valid to assess compliance with quality management procedures as well as the extent of several activities related to continuous improvement of clinical quality. The latter activities included having a group of professionals responsible for the clinical area as well as a formally approved protocol and performance indicators. The initially proposed factor structure of both indices had to be adjusted based on the results of the factor analysis, but these minor adjustments did not change the theoretical constructs, instead refining the fit of the sub-scales to the concepts of interest. Both QMCI and CQII showed a high internal consistency and appeared to be multi-dimensional constructs. The descriptive results showed that some items included in the indices may be subject to ceiling effects with a large proportion of respondents having a positive score. Despite that, we kept the items and clinical areas in the instrument in case subsequent testing in across a broader range of hospitals in other European countries reveals more variation than those investigated in our study.

Strength and limitations

On-site audits have the advantage that they provide more objective and independent outcomes based on factual information derived for instance from an annual report. In contrast to self-administered questionnaires, audit can avoid potential social desirability bias in responses. The time burden for the audited organization is relatively low compared with an all staff survey. The downside is that documents on which the audit is based have to be reliable. Furthermore, trained surveyors are needed to conduct the audit to minimize variation due to inter-observer differences.

Relation with other studies

Using audit as a measurement strategy is relatively rare, although it may grow as it is proving useful in other study designs [ 4 , 5 ]. More often audit instruments are used as a tool to improve quality, especially in the form of an accreditation programme. As a recent review suggests, audits seem to lead to improved structure and process of care and even clinical outcomes [ 6 ].

The two indices we developed and evaluated have the potential for use in research and in routine practice to help hospitals focus on quality and safety issues as well as follow the quality improvement P-D-C/S-A cycle. The instruments can also be used by purchasers, policy-makers or health-care inspectorates, if they want to assess the implementation of quality management at hospitals level in a more standardized way. The QMCI focuses on the core elements of a quality system, while the CQII has its focus on clinical areas that are directly related to patient care at ward level. Future research is needed to investigate the relationship between these novel quality measurement tools and other indicators including patient outcomes.

Deepening our Understanding of Quality Improvement in Europe (DUQuE) has received funding from the European Community's Seventh Framework Programme (FP7/2007–2013) under grant agreement number 241822. Funding to pay the Open Access publication charges for this article was provided by European Community's Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 241822.

Acknowledgements

We thank the experts, country coordinators and participating hospitals of the DUQuE project for their valuable advice on the measurement instrument, and the respondents for their effort and time to fill in the questionnaire.

Patients struggle to get lifesaving medication after cyberattack on a major health care company

Desperate patients around the country have been forced to choose between paying out of pocket for essential medications or forgoing them entirely as the aftermath of a cyberattack on a major health care company stretches into its third week. 

Change Healthcare, a little-known but critical subsidiary of UnitedHealth Group, detected the attack on Feb. 21. Since then, pharmacies, doctors offices and patients say their lives and work have been upended by widespread outages in systems commonly used for medical billing and insurance claims. 

Disruptions to copay assistance and coupon card processing at pharmacies, in particular, have highlighted key vulnerabilities in a system on which people’s lives depend.

Ronda Miller, 54, said she and her husband rely on a discount card to afford his insulin — he has Type 2 diabetes and congestive heart failure. But when she tried to pick up his medication at her pharmacy in Deadwood, South Dakota, on Feb. 22, the card could not be processed. Without it, the medications would cost hundreds of dollars.

“When you are diabetic, whether it’s Type 1 or Type 2, without insulin they’re going to die,” Miller said.

Ronda Miller and her husband John Paul Miller.

Change Healthcare’s technology is involved in transactions throughout the industry — beyond those involving United Healthcare insurance. The company says it completes 15 billion transactions a year, amounting to $1.5 trillion in health claims. On its website, Change said the hack affected 21 parts of its business, including many that providers use to receive payments, get reimbursed by insurers and process patients’ insurance eligibility.

“Anything that requires interaction between health plans, a pharmacy, a facility, an office has been disrupted,” said Dr. Jesse Ehrenfeld, the president of the American Medical Association. “That has far-reaching implications, whether you’re on routine, standard medications, whether you rely on a rebate program from a pharmaceutical company, whether you’re just trying to get clearance to have routine elective surgery.” 

UnitedHealth Group said in a statement that it took “immediate action to disconnect Change Healthcare’s systems to prevent further impact” and that the services would “remain offline until we are certain we can turn them back on safely.”

The company said Tuesday that a new network connecting pharmacies to benefit managers could come online as soon as Thursday.

Laura Lester, who owns Marion Family Pharmacy in Marion, Virginia, said the biggest effect in her community has been on patients who can’t afford their medications without copay assistance cards.

“We’ve got people walking away from diabetes medicines, antipsychotics, ADHD medications,” she said. 

“We had one woman yesterday who had to pay $1,100 out of pocket because the copay card wasn’t working,” she added. The patient needed the medication for her irritable bowel syndrome, she said.

Even patients who don’t use copay assistance have faced immense challenges. Donna Hamlet, 73, a breast cancer patient at Florida Cancer Specialists & Research Institute, takes a medication called IBRANCE that would cost her around $16,000 a month without insurance. But on Feb. 23, she said, a pharmacy told her it couldn’t process her refill through insurance because of the cyberattack.

Donna Hamlet, a 16-year breast cancer survivor.

Without the drug, Hamlet said, “the cancer would fill up my body, and I guess I would die.”

After four or five days of phone calls, she got her prescription filled via OptumRx, a UnitedHealth Group pharmacy benefit manager. 

Nathan Walcker, the CEO of the Florida institute treating Hamlet, estimates that $350 million worth of the practice’s charges have been affected by billing delays due to the cyberattack.

But Walcker said he worries most about patients who can’t get prior authorizations processed — many insurance companies require them for cancer treatments, which can cost up to $100,000 per course. 

“We have no ability today to even know if we have a prior authorization in hand for a new patient,” he said. 

The Centers for Medicare and Medicaid Services on Tuesday encouraged Medicare and Medicaid programs to remove or relax prior authorizations during the outage and to consider giving health care providers advance funding. Hospitals can submit accelerated payment requests, CMS said, and Medicare providers struggling to submit claims can send paper versions and may be eligible for exceptions or extensions.

UnitedHealth Group said that as of Tuesday, around 90% of claims were “flowing uninterrupted,” with pharmacy claims “flowing at near-normal levels,” thanks to temporary fixes or systems’ coming back online.

The company has encouraged health care providers to switch to an Optum system to expedite submitting claims and receiving payments. Meanwhile, the new network connection that the company expects Thursday should address “the majority of the coupon volume” managed by Change Healthcare, it said.

Optum is also offering temporary loans to medical practices, but providers say they’re insufficient.

Dr. Christine Meyer, who owns an internal medicine practice in Exton, Pennsylvania, said her office submits up to $600,000 a month in claims but was offered only a monthly loan of $4,000.

Amid the sudden halt in revenue, Meyer said, the small offer was “an emotional slap in the face.”

Her practice is manually submitting some claims to insurance websites, she said, and her staff printed around 1,000 paper claims and FedExed them to Medicare. 

“The next thing I have to do is start to cut expenses, stop buying supplies and vaccines, then reduce our staff, then reduce our hours and then, God forbid, the unthinkable: just shut our doors,” Meyer said.

Doctors, pharmacists and industry experts say the hack has exposed major vulnerabilities in the health sector, particularly given Change Healthcare’s dominance. 

“How do you have a system where it has this big of a leak and almost two weeks later, you’re leaving the small pharmacy owners to try to figure out a solution?” asked Dr. Mayank Amin, the owner of Skippack Pharmacy in Skippack, Pennsylvania.

Amin said he and his staff have spent hours calling insurance companies to find out patients’ eligibility manually, one at a time. The work has kept him up until 2 a.m every night, he said. He even plans to pick up free samples of a blood-thinner medication from a local doctor’s office to distribute to a patient.

“What do I get out of this? Zero profit but the feeling that you’re able to help somebody who relies on you,” he said.

Ronda Miller said that her pharmacy in South Dakota gave her husband a free box of his diabetes medication for now and that his doctor also provided a sample. But for families like hers, she said, the disruption has meant “playing with people’s lives.”

Change Healthcare said the perpetrator of the cyberattack “represented itself to us as ALPHV/Blackcat.” Alphv was involved in the attack on MGM Resorts last year, costing the company $100 million. It is developed and maintained by a group of Russian-speaking cybercriminals.

In total last year, victims of cybercrime sent a record $1 billion in extortion payments to ransomware criminals, according to Chainalysis , a company that tracks cryptocurrency payments.

UnitedHealthcare didn’t answer questions about whether it paid a ransom. But experts at the cybersecurity companies Recorded Future and Tenable pointed to a bitcoin wallet that received a payment of more than $22 million Friday. The companies say the wallet, which was viewed by NBC News, belonged to Alphv. Wired first reported the news.

The sum has since been doled out, mostly in $3.2 million portions that the two companies haven’t been able to trace fully. Alphv’s site on the dark web claims it is no longer operational.

Cybersecurity expert Eric Noonan, the CEO of CyberSheath, said that if UnitedHealth did pay a ransom, “it’s a terrible precedent, because what it now does is say this is a viable market.”

Change Healthcare was “a very attractive target,” Noonan said, because it runs critical infrastructure and the attack has had visible consequences.

Noonan said UnitedHealth needs to address whether patients’ personal information has been compromised. Thus far, the company has said only that its teams are “actively engaged and working to understand the impact.” 

Noonan also called for the federal government to require mandatory minimum cybersecurity for all critical infrastructure sectors, including health care.

“Americans, I think, are somewhat defenseless in this regard, because they’re relying on the companies to implement the right levels of cybersecurity, and that’s largely not happening,” he said.

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Daniella Silva is a reporter for NBC News, focusing on education and how laws, policies and practices affect students and teachers. She also writes about immigration.

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Aria Bendix is the breaking health reporter for NBC News Digital.

Where is customer care in 2024?

Customer care leaders are facing their greatest challenge in decades. They must prepare their organizations for an AI-enabled future while simultaneously meeting tough commercial targets and rising customer expectations. Our latest global survey suggests that many companies are struggling on all these fronts.

About the authors

This article is a collaborative effort by Eric Buesing , Maximilian Haug, Paul Hurst, Vivian Lai, Subhrajyoti Mukhopadhyay, and Julian Raabe , representing views from McKinsey’s Operations Practice.

Major disruptions are always painful, and the transition from a care paradigm dominated by human agents to one steered by AI technologies may be the biggest disruption in the history of customer service. Can organizations find a route to hyperefficient, digitized customer care while retaining the personal contact and responsiveness that customers require?

Right now, many customer care leaders feel trapped in no-man’s-land. Technology has enabled them to evolve their operations significantly, and the traditional call center environment is rapidly becoming a thing of the past. Yet when these digitally enabled models underperform—and they often do—companies need to master entirely new approaches to performance improvement alongside their traditional tool kits.

Customer care in the spotlight

The key findings in this article are based on McKinsey’s fourth global survey of customer care executives. This survey was our largest yet, gathering the views of more than 340 leaders at the director, senior director, vice president, and C-suite levels. Respondents came from companies with annual revenues of $100 million to $10 billion-plus, representing every major industry segment.

The majority of respondents said that the companies they worked for were headquartered in North America (just over 50 percent) or Western Europe (almost 25 percent), with 10 percent headquartered in India and 4 percent in China. Most respondents said their organizations operated in multiple regions: 75 percent reported operating in North America, 58 percent in Europe, 57 percent in Asia–Pacifc, 39 percent in the Middle East and Africa, and 37 percent in Latin America. We plan to expand future research to include more organizations headquartered outside North America and Western Europe.

To make matters worse, executives say that most of the challenges highlighted in our last survey  are still present today (see sidebar, “Customer care in the spotlight”). Those challenges include rising call volumes, high levels of employee attrition, and persistent talent shortages. Meanwhile, some of the largest consumer-facing technology organizations in the world have become exceptional at digitally enabled customer care, which is lifting customer expectations everywhere, piling further pressure onto customer care staff and leadership at other companies.

Our survey reveals three major themes that are top of mind for customer care leaders. First, their priorities are shifting, from an overwhelming focus on customer experience to a multidimensional approach that also emphasizes revenue goals and technology transformation. Second, they are working hard to build future-ready AI-enabled ecosystems for their operations. Finally, they are boosting their capabilities by investing in employee upskilling programs and building stronger outsourcing relationships.

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Reprioritizing core operations.

When we began monitoring the sentiment of customer care leaders in 2016, their priorities were clear. Customer experience came first, followed at a distance by operational improvement, technology transformation, and revenue generation—in that order.

Over the past seven years, those priorities have converged (Exhibit 1). Revenue generation, which was mentioned by about one in 20 customer care leaders in our first survey, has been rising steadily in importance ever since. It is now a priority for a third of customer care leaders. But over the past two years, technology enhancements and operational improvements have seen the fastest increases. The expectation that customer care functions can do it all and do it well has never been higher.

Leaders also understand that they need to engage with their customers to delight them. Currently, only 11 percent of respondents say reducing contact volume is important to them, a 20-percentage-point drop over 12 months. Indeed, 57 percent of leaders expect call volumes to increase by as much as one-fifth over the next one or two years.

Separate research suggests that these leaders are right to stay focused on direct personal interaction, even when many of their customers are young digital natives. In a recent McKinsey survey of 3,500 consumers, respondents of all ages said that live phone conversations were among their most preferred methods of contacting companies for help and support. That finding held true even among 18- to 28-year-old Gen Z consumers, a cohort that favors text and social messaging for interpersonal communications.

There’s also evidence that younger consumers are getting tired of the digital self-service paradigm. One financial-services company reports that its Gen Z customers are 30 to 40 percent more likely to call than millennials, and they use the phone as often as baby boomers. Premium-segment customers of all ages also prefer the phone, with many saying that live phone support is part of the premium service they are paying for.

These findings don’t point to a future of phone-only customers, however. While customers of all generations prioritize support from a real person, they also want the flexibility to use different channels according to their needs. Digital-chat services have achieved a high level of acceptance across generations, and email remains important, especially for older consumers (Exhibit 2).

The need to excel in service across multiple channels creates extra challenges for customer care leaders, especially when budgets are tight. And 37 percent of respondents in our survey say that cost is still a key priority. This tension is driving companies to look for ways to control the customer care costs that go beyond call volume reduction, with automation and outsourcing the most frequently cited levers.

Creating a future-ready AI ecosystem

The tensions in modern customer care are clearly seen in companies’ approaches to advanced digital technologies. Our survey demonstrates that digital has already become a decisive differentiator. Among respondents who report that their operations are delivering better-than-expected performance, more than half have high levels of digital integration. Banking, telecommunications, and travel and logistics are among the leading industries in this regard.

Those high performers are in the minority, however. Only 8 percent of respondents from North America report greater-than-expected satisfaction with their customer performance. In Africa, Europe, and the Middle East, the figure is 5 percent. Among organizations reporting that performance was in line with or lower than expected, more than 80 percent also say their levels of digital integration are partial or low.

Leaders agree that they need to get digital right. More than half of the respondents to our survey expect the share of inbound contacts that take place through digital channels to exceed 40 percent in the next three years.

Artificial intelligence will play a decisive role in future customer care ecosystems. Respondents to our survey are already deploying AI tools in a variety of applications, including chatbots and automated email response systems, training and support for call center agents, back-office analytics, and decision making.

Over the past 12 months, the availability of powerful generative AI (gen AI) tools, especially large language models (LLMs) that can parse and respond to unstructured text or speech, has opened new possibilities for technology in customer care. More than 80 percent of respondents are already investing in gen AI, or expect to do so in the coming months, with leaders highlighting a wide range of potential applications.

One European subsidiary of a global bank replaced its well-established rules-based customer chatbot with a new system based on gen AI technology. Seven weeks after launch, the AI chatbot was 20 percent more effective at successfully answering customer queries than the old tool. The bank has already identified a road map of improvements that could double its performance in the coming months.

Early adopters are extremely ambitious about the potential of gen AI. The executive in charge of customer care at one major global organization told us that they expect 100 percent of customer interactions to be AI-enabled in the coming years, using a combination of technologies including new virtual assistants, agent-assist tools, and AI-powered voice analytics.

For most companies, however, the gen AI customer care revolution is still in its early stages. Leaders highlight multiple issues that are making it hard for them to integrate these technologies into their existing processes and workflows. The issues include technical challenges regarding deployment and scaling; concerns about safety, security, and governance; and difficulties in defining the desired outcomes from, or business case for, gen AI investments (Exhibit 3).

Learn more about Customer Care

Rethinking skills.

Today, customer care organizations lack many of the critical skills they need to deliver excellent service and navigate the transition to a digitally mediated, AI-enabled world. In part, that’s because customer care leaders have been running to stand still. Record levels of staff attrition following the COVID-19 pandemic meant that supervisors spent much of their time interviewing and bringing new staff up to speed. They spent less time mentoring their established teams, a problem exacerbated by the introduction of hybrid and remote working arrangements. Some agents and team leaders have spent years working with little interaction or coaching from their managers.

Staff turnover has now slowed, and two in three leaders in our latest survey say upskilling and reskilling are critical priorities. Companies highlight a range of benefits that accrue from effective upskilling and reskilling programs, including improvements to employee morale, increased productivity, and faster adoption of new technologies and working methods. Meanwhile, technology is changing upskilling programs. Twenty-one percent of leaders tell us that they are already using AI-based tools to train and support their customer care staff.

AI-based agent support systems are already becoming a key tool for companies seeking to offer extremely effective personal service to demanding customers. These systems can help agents resolve complex queries the first time, simultaneously reducing care costs and boosting customer experience.

One global construction equipment company, for example, uses a gen AI system to help its call center staff navigate thousands of pages of technical-support documentation. The system selects the appropriate steps to resolve a customer’s problem in seconds, based on free text questions entered by the agent and background information such as the serial numbers of vehicles and parts. The tool has cut average call resolution times from around 125 minutes to a few seconds, and it is currently saving customers €150,000 to €300,000 per day in reduced asset downtime.

Elsewhere, companies are using AI to transform the way they manage and support their customer care agents. New AI-based tools can optimize call volume forecasting, for example. This approach helped one company improve forecast accuracy by seven percentage points, while halving the work required to manage team capacities and schedules. The change improved customer service levels by more than 10 percent, while cutting staffing and overtime costs by more than 5 percent.

Companies are also looking outside their organizations for innovative ways to fill capability gaps. Outsourcing, once viewed primarily as a way to reduce costs, is increasingly seen as an effective source of additional skilled capacity and innovation capabilities. Fifty-five percent of the companies in our survey currently outsource part of their customer care operations, and 47 percent of those organizations expect to increase their outsourcing over the next two years.

Outsourcing relationships are becoming deeper too, with respondents telling us that they are now using their business process outsourcing for a range of activities that extends far beyond traditional call and email handling. They include content management and digital-marketing services, payments handling, and the development of AI-based customer care tools. Following the blueprint established by major players in the industrial products, medical device, software, and e-commerce sectors, some companies are now working with outsourcing partners to set up global innovation hubs that will drive the development of next-generation customer care technologies.

Our survey suggests that customer care organizations are running at two different speeds. In the fast lane, top performers have seized the opportunities presented by advances in digital technologies. With ruthless prioritization, they are investing capital to drive efficiency and service excellence across the customer journey. The best have already reshaped their organizations around highly integrated digital platforms. One high-performing company with more than 5,000 service agents is on track to deliver 75 digital-experience improvements this year, for example.

Other companies are still in the slow lane, struggling to fit a patchwork of digital point solutions into legacy care ecosystems. Unsure where to put their dollars, they are trapped in a cycle of continual system adaptation with no clear destination or road map.

In 2024, both types of organizations may need to shift their positions on the road. Gen AI is raising the bar for performance, productivity, and personalization in customer care, and tomorrow’s fully AI-enabled care organizations will operate very differently from those of today. It’s time for companies to look at their care ecosystems with fresh eyes. They should formulate an independent perspective on the changing expectations of their customers and the role of advanced AI in their organization. The future of customer care is calling. Leaders should answer with a bold vision and an aggressive time line for change.

Eric Buesing is a partner in McKinsey’s Charlotte office, where Paul Hurst is an associate partner; Maximilian Haug is an associate partner in the Boston office; Vivian Lai is a consultant in the New York office; Subhrajyoti Mukhopadhyay is an expert in the Chicago office; and Julian Raabe  is a partner in the Munich office.

The authors wish to thank Jorge Amar, Brian Blackader, Marcela Guaqueta, Suryansha Gupta, and Josh Wolff for their contributions to this article.

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  • Supplement to Health Center Program Site Visit Protocol: Guidelines and Logistics for Virtual HRSA/BPHC Look-Alike Initial Designation Visits

Health Center Program Compliance Manual

HRSA’s Bureau of Primary Health Care (BPHC) is responsible for effective and efficient oversight of the Health Center Program. This includes ensuring that health centers are compliant with statutory and regulatory requirements for the Health Center Program. The Health Center Program Compliance Manual is the principal resource to assist health centers in understanding and demonstrating compliance with Health Center Program requirements. View the Health Center Program Compliance Manual .

Progressive Action Conditions Library

Health centers that fail to demonstrate compliance as described in the Health Center Program Compliance Manual will receive a condition of award/designation. The Health Center Program uses a standard set of conditions outlined in the Progressive Action Conditions Library that describes how health centers can demonstrate compliance with health center program requirements. View the Progressive Action Conditions Library .

Archived Site Visit Protocol

Need to access an archive copy of the Site Visit Protocol that was effective May 2022 to April 2023? Submit a request through the BPHC Contact Form , and select: “Site Visit Protocol General Inquiry.”

IMAGES

  1. Daycare Floor Plan Design

    site visit coordination plan childcare

  2. 9+ Child Care Plan Templates

    site visit coordination plan childcare

  3. Ontario Canada Child Care Centre

    site visit coordination plan childcare

  4. Care Coordination Using a Shared Plan of Care Approach: From Model to

    site visit coordination plan childcare

  5. Case Management and Care Coordination

    site visit coordination plan childcare

  6. Child Daycare Business Plan

    site visit coordination plan childcare

COMMENTS

  1. How to Plan a Site Visit for Your Policy Makers

    A site visit gives policymakers the opportunity to connect the decisions they make to the faces of infants, toddlers, and families in their community, and is a great strategy that can create a lasting impression. Use the guidance below to plan and implement a site visit with your local, state and federal policymakers. If you are a planning to ...

  2. PDF Sample Site Visit Plan

    Sample Plan for a Head Start Site Visit 1 . Welcome by the Director and/or Board Chair outside of the facility or inside the entrance. ... Family Engagement Coordinator — Explain how Head Start is so much more than child care or pre-k because of its comprehensive, two-generational model that can focus on children's

  3. Forum

    Step 1: to email all the staff and parents of the upcoming visit by the regulatory authorities for an assessment and rating of the service. To develop a letter to hand out to all the families about the visit and to display on the staff and parent's notice board. Step 2: to arrange meetings with all the staff to discuss about the process and ...

  4. Site visit coordination plan.docx

    Site visit coordination plan Student name Akriti Upreti Assessment Task AT2 - Part D Supervisor Miss Shirin Date 22/04/2021 Workplace Twinkle Star Early Learning Centre Communication plan 1. Discuss the topic with your colleague. 2. Explain the different way of method, time frames and staff briefing. 3. To provide the feedback. 4.

  5. PDF HTN-Planning and Conducting Site Visits

    How-To Note: Planning and Conducting Site Visits. This resource describes practical steps and effective practices for planning and conducting a site visit. How-To Notes provide guidelines and practical advice to USAID staff and partners related to the Program Cycle. This note was produced by the Bureau for Policy, Planning and Learning (PPL).

  6. Chcece019chcpol002at2partd sitevisitcoordinationplan0719.docx

    Part D: Develop a Site Visit Plan You will need to imagine that your workplace is going to have an upcoming site visit and assessment, where you are responsible for coordinating the workplace to ensure it is ready for audit. Discuss site visits with your supervisor if you need help to get an understanding of the process involved. Once you have an understanding of this process, develop ...

  7. Visit Coordination Plan

    Form File. DCYF is a cabinet-level agency focused on the well-being of children. Our vision is to ensure that Washington state's children and youth grow up safe and healthy—thriving physically, emotionally and academically, nurtured by family and community.

  8. Coordinating a Site Visit

    Explorers will visit a company or organization to learn more about their career. AGE APPROPRIATENESS • Exploring Posts (14-20 years old) • Exploring Clubs (10-14 years old)

  9. Risk Management Plan for Childcare Centers

    A tool like brightwheel's childcare management software can help streamline administrative tasks and easily scale your childcare program, allowing you to share documents—risk management plan, handbooks, and menus—with staff and families. In addition, brightwheel is the most secure all-in-one childcare and preschool software with the ...

  10. Health Center Program Site Visit Protocol

    The Health Resources and Services Administration (HRSA) designed the Site Visit Protocol (SVP) to gather necessary information to perform its oversight responsibilities. The SVP includes a standard and transparent methodology that aligns with the Health Center Program Compliance Manual. In 2023, HRSA updated the SVP to increase consistency ...

  11. Washington State Early Learning Coordination Plan

    The Washington State Early Learning Coordination Plan (ELCP) is designed to meet that challenge. There are more than 826,000 children in Washington State, ages birth through 8 years.1. A Washington State plan co-created by parents, caregivers, and professionals with aims to support families, eliminate systemic racism, elevate early care and ...

  12. 2021 and 2022 Site Visit Protocol: Summary of Updates

    The Health Resources and Services Administration (HRSA) implemented the Health Center Program Site Visit Protocol (SVP) for all Operational Site Visits (OSVs) and look-alike (LAL) initial designation (ID) site visits in January 2018. The SVP is the tool used to assess compliance with Health Center Program requirements. The SVP provides HRSA with information necessary to perform its oversight ...

  13. Preparing for an Assessment and Rating Visit

    Assessment and Rating Timelines. Timeline. Step. Process. Week 1*. A: Notice of visit. The approved provider receives a letter from the regulatory authority requesting a copy of the service Quality Improvement Plan within three weeks and notifying of the four week period in which the assessment and rating visit will occur. Week 3.

  14. PDF Site Visit Guide 2023

    The Health Center Controlled Network (HCCN) Site Visit Guide defines the purpose, requirements, and processes the Health Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC) undertakes to conduct on-site or virtual site visits. This guide is intended to be used by HCCN Project Officers (POs), HCCNs, and consultants ...

  15. An Evaluator's Guide to Performing Successful Site Visit Observations

    Enlist a site coordinator. If budget allows, plan for having an on-site coordinator who knows the site's participants and inner workings. This individual can communicate with the evaluation team's program coordinator on details throughout the study such as scheduling observations across multiple participants at the site.

  16. The Site Visit

    A site visit is essential for gathering relevant site information. It helps you to: Meet site representatives, local officials, tribal organizations, community members, and other stakeholders. Establish contacts to facilitate the collection of relevant information. Tour the site to determine activities and possible ways that community members ...

  17. PDF Developmental Screenings, Collaboration, and Coordination for

    45 CFR Part 98.33(c)(1) The state/territory is to make information available on existing resources and services in conducting developmental screenings and providing referrals when appropriate. 45 CFR Part 98.33(c)(2) Provide a description of how a family or child care provider may utilize resources and services to obtain developmental ...

  18. PDF Supplement to Manual 4

    planning the option to participate in a virtual site visit (VSV) in lieu an in-person visit (IPV). Purpose of This Guide This guide is a supplement to CACREP Mini-Manual 4 - Preparing for the On-Site Visit. It serves to highlight those areas of the site visit process unique to Virtual Site Visits. All programs are expected to

  19. PDF 2020-2023 Site Visit Guide for Primary Care Associations

    PCAs funded in fiscal year (FY) 2020 are required to support health centers to improve the health of individuals and communities by providing training and technical assistance (T/TA) to meet five goals. Increase access to comprehensive primary care. Accelerate value-based care delivery.

  20. How-To Note: Planning and Conducting Site Visits

    This How-To Note supplements USAID's Automated Directives System (ADS) 201.3.4.10.B. It lists Agency requirements for programmatic site visits, identifies practical steps and effective practices for planning and conducting a site visit, and recommends follow-up actions once a site visit has taken place. This How-To Note is intended as a resource for Missions and Washington Operating Units (OUs).

  21. The use of on-site visits to assess compliance and implementation of

    Visits involving independent auditors can verify compliance with activities, methods and procedures used to plan, control, monitor and improve the quality of care. On-site visits are mainly used by accreditation and certification organizations who visit an organization for a few days, reviewing documents and meeting with front-line staff.

  22. Patients struggle to get medication after cyberattack on Change Healthcare

    After a cyberattack on Change Healthcare, patients are struggling to access and afford essential medication. Outages persist in systems used for medical billing and insurance claims.

  23. Site Visit Protocols and Guides

    March 2023. Health Center Program Site Visit Protocol (SVP) The Site Visit Protocol is a tool to assist the Health Resources and Services Administration (HRSA) perform its oversight of health centers. The SVP includes a standard and transparent methodology that aligns with the Health Center Program Compliance Manual.

  24. What do customers want from contact centers

    This tension is driving companies to look for ways to control the customer care costs that go beyond call volume reduction, with automation and outsourcing the most frequently cited levers. Creating a future-ready AI ecosystem. The tensions in modern customer care are clearly seen in companies' approaches to advanced digital technologies.

  25. Site Visit Resources

    HRSA's Bureau of Primary Health Care (BPHC) is responsible for effective and efficient oversight of the Health Center Program. This includes ensuring that health centers are compliant with statutory and regulatory requirements for the Health Center Program. The Health Center Program Compliance Manual is the principal resource to assist health ...