Healthcare Quality Management

Answer ANY EIGHT of the questions below. All questions carry equal points: Note: Please cite your sources using APA style. All homework needs to be typed and submitted on the blackboard as a word document. Please include the questions that you are answering within your responses1) Define the following: Quality, Accuracy, Reliability and Value. Briefly identify the stakeholders that are interested in quality health care and their preferences (hint: think about the Ps).2) What does IOM stand for? What three key issues did they identify in their book “Crossing the Quality Chasm” in 2001? What is their definition of health care quality?3) How does the reliability of healthcare services affect the quality of care you receive? What type of healthcare service do you find to be the least reliable in delivering a quality product. What type do you find most reliable?4) Name the three Quality Pioneers (Gurus) and briefly discuss the contribution of any one pioneer to the field of quality. 5) Who is Avedis Donabedian? What was his contribution to health care quality? (hint: SPO)6) Identify and briefly describe the three primary quality management activities7) Discuss the different types of standards. How do standards help improve quality in health care. Provide an example of each.8) Describe how you use the cycle of measurement, assessment, and improvement (see exhibit 2.1) to evaluate and make changes in your personal life?9) What is accreditation? Identify one health care accrediting organization, the type of HCOs it accredit
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Introduction to Healthcare
Quality Management
2nd edition
Chapter 1: Focus on Quality
Course Overview
â?¢ Two broad content areas â?? Quality & IT
â?¢ Module 1 â?? Quality Management & Patient Safety
â?¢ Module 2 â?? Health Information Management
â?¢ Syllabus and required readings on blackboard
â?¢ Assessments â?? quizzes, homework, case analysis, attendance
participation, pop quizzes and extra credit (usually).
Copyright 2013 Health Administration Press
Course overview
â?¢ Quality & patient safety â?? Definitions, rationale, tools, approaches,
measurement, assessment and improvement methodologies.
â?¢ Health Information Systems Management â?? Definitions, laws and
their implications, nomenclatures, rationale â?? benefits and
challenges, trends
Copyright 2013 Health Administration Press
What you need to know for SUCCESS
â?¢ Not Rocket Science â?? If you need an A then here is what you NEED
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Attendance â?? if you havenâ??t signed the sheet, you are absent in class
If you are absent, understand what was covered in class â?? discuss with colleague
Lateness â?? come to class on time and do not leave early
Planning work â?? review syllabus thoroughly and understand the assignments
Keep up with reading (chapters additional reading),
Make notes and refer to slides and class discussions
Reflect on class activities and discussions
Understand grading criteria and weights of assignments
Discuss and participate in class
Contribute to discussions
Use office hours to clarify doubts
Submit work in a timely manner
Effective group work matters
Be professional in your communication
Do NOT use phones, tablets for non-class work (Be Attentive)
Read articles â?? additional readings assigned
Do NOT plagiarize
5
Best photo contest!
6
What Is Quality?
â?¢ An attribute of a product or service
â?¢ Conformance to customer
specifications and expectations
â?¢ Quality is defined by customer
â?¢ Perceived quality is correlated with
VALUE
Copyright 2013 Health Administration Press
Defining Quality
â??The totality of features and characteristics of a
product or service that bear upon its ability to
satisfy the stated or implied needs of a customer�
ISO 9000
â??Meeting customer expectationsâ?
What quality isnâ??t
Demystifying quality jargon
â?¢ Quality Control
â?¢ Quality Assurance
â?¢ Quality Improvement
â?¢ Quality Management
â?¢ Total Quality Management
Demystifying quality jargon
â?¢ Quality Control – Quality control is a set of activities
intended to ensure that quality requirements are
actually being met. (failure detection system â?? relies
on testing and observations; product oriented)
â?¢ Quality Assurance â??Quality assurance is a set of
activities intended to establish confidence that quality
requirements will be met. ( a failure prevention
system â?? planned and systematic activities; process
oriented )
Demystifying quality jargon contd..
â?¢ Quality Improvementâ?? Quality improvement refers to
anything that enhances an organization’s ability to meet
quality requirements.
â?¢ Quality Management – Quality management includes all
the activities that organizations use to direct, control, and
coordinate quality. These activities include formulating a
quality policy and setting quality objectives. They also include
quality planning, quality control, quality assurance, and quality
improvement.
Key terms – quiz
â?¢
â?¢
â?¢
â?¢
â?¢
â?¢
â?¢
â?¢
â?¢
Accuracy
Precision
Reliability
Value
Features
Specifications
Durability
Responsiveness
Quality Control, Quality Assurance, Quality Improvement, Total Quality
Management, ISO9000, Six Sigma, Lean Sigma���..
Copyright 2013 Health Administration Press
Accuracy and Precision
Copyright 2013 Health Administration Press
Accuracy & Precision
â?¢ Accuracy
â?¢ Precision
Copyright 2013 Health Administration Press
One last time â?? Accuracy and Precision
â?¢ Accuracy – the accuracy of a measurement system is
the degree of closeness of measurements of a
quantity to that quantity’s actual (true) value.
â?¢ Precision – The precision of a measurement system,
also called reproducibility or repeatability, is the
degree to which repeated measurements under
unchanged conditions show the same results.
JCGM 200:2008 International vocabulary of metrology â?? Basic and general concepts and associated terms (VIM)
John Robert Taylor (1999). An Introduction to Error Analysis: The
Study of Uncertainties
in Physical
Measurements.
University Science Books. pp. 128â??129.
Copyright
2013 Health
Administration
Press
Reliability = Precision
â?¢ An important ingredient of quality
â?¢ The probability that a system will perform properly over a defined
time span
â?¢ Many healthcare processes fall into the unreliable category.
â?¢ Class discussion â?? which health care services are unreliable?
Copyright 2013 Health Administration Press
Uniqueness of Healthcare â?? Can patients
determine value?
â?¢ Value =( Features/Costs)
â?¢ The costâ??quality connection (value) is hard for consumers to judge.
Why?
â?¢ Demand induced supply
â?¢ Most consumers are shielded from the actual costs, making the value
judgment more difficult.
â?¢ How does this affect demand for health care services?
Copyright 2013 Health Administration Press
What Is Healthcare Quality?
â?¢ Quality attribute similarities and differences for
stakeholder groups:
Consumers
Right treatments
Good outcomes
Good interactions with caregivers
Clean and pleasant environment
Best technology
Purchasers
Same as consumers, with more emphasis on costs and cost-effectiveness
Providers
Same as consumers and purchasers, with additional emphasis on
avoiding litigation
Copyright 2013 Health Administration Press
1990 Institute of Medicine Definition
â??Quality of care is the degree to which health
services for individuals and populations increase the
likelihood of desired health outcomes and are
consistent with current professional knowledge.�
Source: Institute of Medicine. 1990. Medicare: A Strategy for Quality Assurance:
Volume I, edited by K. N. Lohr. Washington, DC: National Academies Press.
Copyright 2013 Health Administration Press
Six Key Quality Dimensions
1. Safe
2. Effective
3. Patient centered
4. Timely
5. Efficient
6. Equitable
Source: Institute of Medicine. 2001. Crossing the Quality Chasm: A New Health
System for the 21st Century. Washington, DC: National Academies Press.
Copyright 2013 Health Administration Press
Consumersâ?? Quality Expectations:
Which Are Most Important to You?
â?¢
â?¢
â?¢
â?¢
â?¢
Donâ??t kill me
Do help me and donâ??t hurt me
Donâ??t make me feel helpless
Donâ??t keep me waiting
Donâ??t waste resourcesâ??mine or anyone elseâ??s
Source: Berwick, D. M. 2005. â??My Right Knee.â? Annals of Internal Medicine 142 (2):
121â??25.
Copyright 2013 Health Administration Press
Achieving Quality Priorities
â?¢ Healthcare organizations must have a planned and systematic
approach for meeting the quality expectations of stakeholders.
Copyright 2013 Health Administration Press
Introduction to Healthcare
Quality Management
2nd edition
Chapter 2: Quality Management
Building Blocks
Quality Management
â?¢ A way of doing business that continuously improves products and
services to achieve better performance
â?¢ Goal: Achieve maximum customer satisfaction at the lowest overall cost to
the organization while continuing to improve the process.
Copyright 2013 Health Administration Press
Quality Management Activities
Measurement
How are we
doing?
Yes
Assessment
Are we meeting
expectations?
The three primary quality
management activities are
parts of a closely linked
cycle.
No
Improvement
How can we improve
performance?
Copyright 2013 Health Administration Press
Brief History of Industrial Quality Evolution
â?¢ 1920s: Shewhart introduced statistical quality control.
â?¢ 1950s: Deming and Juran introduced quality control and quality
management philosophies to Japan.

â?¢ 1960s: Ishikawa introduced the importance of a â??bottom-upâ?
approach to quality improvement.
â?¢ 1970s: Many US companies started losing market share to global
competitors.
â?¢ Donabedian â?? Quality Guru in Healtcare
â?¢ Home work
Copyright 2013 Health Administration Press
A Brief History of Quality Management
â?¢ Shewhart
â?¢ Developed the use of statistical process control charts, which provide
an opportunity to control the variability of processes
â?¢ Juran
â?¢ Believed quality problems could be traced to ineffective
management.
â?¢ Created a framework for managing quality that consisted of three
elements: quality planning, quality control, and quality improvement.
6-28
Walter A. Shewhart
6-29
Joseph M. Juran
6-30
Dr. W. Edwards Deming (1900-1993)
6-31
A Brief History of Quality Management
â?¢ Deming:
Stressed that
significant quality
improvement only
comes from
changing the
organization, and
that responsibility
rests with upper
management.
Demingâ??s 14
Points
6-32
Healthcare Organizations as Systems
Inputs
â?¢Patients
â?¢Personnel
â?¢Supplies
â?¢Equipment
â?¢Facilities
â?¢Capital
Conversion
Process
â?¢Diagnostic
â?¢Treatment
â?¢Operations
â?¢Business
â?¢Management
â?¢Support
Outputs
â?¢Clinical status
â?¢Functional status
â?¢Satisfaction
â?¢Cost-effectiveness
â?¢Culture
WORK = PROCESS
â?¢ All WORK/TASKS = PROCESSES
â?¢ VARIATION inherent in all PROCESSES
â?¢ Normal and Abnormal variation
â?¢ Common cause and special cause
â?¢ Variation in care can be associated with excess morbidity, mortality
and cost
â?¢ Reducing variability improves outcomes
How do we improve Quality
â?¢ Internal ( from within the HCO)
â?¢ Quality Improvement Programs
â?¢ TQM, CQI, LEAN, Six Sigma
â?¢ External â?? Accreditation, Licensure, Registration
â?¢ Question â?? Which comes first?
35
The Quality Spiral
Step-by-Step Calculation
Cpl, Cpu, Cpk: Indices of Process Variation
LSL
USL
Target
X â?? LSL
USL â?? X
Actual Spread, 3 
C pl
Actual Spread, 3 
X
C pu
Standards-Based Approach to Quality Evaluation
â?¢ Definition of Standard â?? Explicit, predetermined expectation set by a
competent authority that describes an organizationâ??s acceptable
performance level
â?¢ Sources of standards
â?¢
â?¢
â?¢
â?¢
â?¢
Professional Societies
Panel of experts
Research studies
Regulations
Consensus on what are the â??best practicesâ?
38
Standards – Types
â?¢ Structure Standards: Look at inputs such as human
resources, design of a building, availability of resources to
perform activities
â?¢ Process Standards: look at activities or interventions
carried out for patient care e.g. clinical
pathways/guidelines
â?¢ Outcome Standards: look at the effect of the
interventions on a specific health problem and whether
the expected purpose of the activity was achieved e.g.
patient mortality, infection rate
39
Push for Business Excellence
â?¢ 1987: US business and quality leaders studied
what high-performing businesses were doing
better or differently.
â?¢ â??Strategic planning for quality and quality improvement programs,
through a commitment to excellence in manufacturing and services, are
becoming more and more essential to the well-being of our Nation’s
economy.� (Excerpt from the Malcolm Baldrige National Quality Improvement
Act)
â?¢ This resulted in the development of criteria to
support the Baldrige National Quality Program.
Copyright 2013 Health Administration Press
Baldrige Health Care Criteria for
Performance Excellence Framework
A Systems Perspective
Organizational Profile:
Environment, Relationships and Challenges
2
Strategic
Planning
5
Workforce
Focus
7
Results
1
Leadership
3
Customer Focus
6
Process
Management
4
Measurement, Analysis, and Knowledge Management
Baldrige National Quality Program, 2009-10
Healthcare Performance Excellence: Baldrige
Core Values
â?¢ Visionary leadership
â?¢ Managing for innovation
â?¢ Patient-focused excellence
â?¢ Management by fact
â?¢ Organizational and personal
learning
â?¢ Social responsibility and
community health
â?¢ Valuing staff and partners
â?¢ Focus on results and creating
value
â?¢ Agility
â?¢ Focus on the future
â?¢ Systems perspective
Copyright 2013 Health Administration Press
Where We Are Today?
â?¢ Regulations and accreditation standards affecting
healthcare quality management are incorporating Baldrige
core values and statistical thinking originated by Shewhart,
Deming, and others.
â?¢ Science of quality improvement and high reliability used in
industrial and service industries is being increasingly
applied to healthcare delivery.
Copyright 2013 Health Administration Press
External Forces Affecting Healthcare
Quality Management
â?¢ State and federal regulations
â?¢ Voluntary accreditation standards
â?¢ Large purchasers
Copyright 2013 Health Administration Press
Cost of Quality
â?¢
All of the costs associated with maintaining the quality of goods and services.
â?¢
Those costs are reduced as failures are moved closer to the firm and ultimately prevented.
6-45
Healthcare Quality Management
â?¢ The rules and tools continue to evolve.
â?¢ The goalâ??continuous improvementâ??remains the
same.
Copyright 2013 Health Administration Press
Readings
â?¢ Berwick: My Right Knee; Annals of Internal Medicine
â?¢ Chassin: The ongoing quality improvement journey; Health Affairs
Copyright 2013 Health Administration Press

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