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Healthcare organizations must have a planned and systematic approach
Effective Based on consistent scientific knowledge & provided to patients who could benefit
Efficient Waste & overuse should be avoided
STEEEP Safe, Timely, Effective, Equitable, Efficient, Patient Centered
Reliability The probability that a system will perform properly & consistently over a defined time span
Quality is about Meeting customers’ needs and expectations Managing and continuously improving services
Quality An attribute of a product or service
Quality Management A way of doing business that continuously improves products and services to achieve better performance
Shewhart introduced statistical quality control 1920s
Deming and Juran introduced quality control and quality management philosophies to Japan. 1950s
Ishikawa introduced the importance of a “bottom-up” approach to quality improvement 1960s
This resulted in the development of criteria to support the Baldrige National Quality Program Push for business excellence
American College of Surgeons (ACS) hospital standardization program, 1st sponsored program to improve quality 1913
The Joint Commission adopted quality assurance standard. 1980
A contract that hospitals must sign with the government, a huge series of rules & regulations a facility must abide by in order to treat Medicare patients including quality management regulations Conditions of Participation (COP)
a status conferred on a hospital by a professional standards review organization (TJC) in formal recognition indicating that they meet quality effectiveness criteria Deemed Status
Science of quality improvement and high reliability used in industrial and service industries is being increasingly applied to healthcare delivery. Previously inhibited by the conditions & behaviors of patients
Effective Measurement Accurate Useful Easy to interpret Consistently reported
A measure is usually expressed in some sort of percentage or ratio because a percentage more clearly communicates a measure’s prevalence in a population
Discharged Not Final Billed (DNFB) Clean Claim Rate Chart Delinquency Rate H&Ps completed 24 hours prior to a procedure or surgery Common HIM Measurements
Structure Process Outcome Patient experience Measurement Categories
Assess the adequacy of the environment in which medical care takes place Structure Measures
Assess what is being done and whether the system is working as it should Process Measures
Assess discrete, patient-focused endpoints. Outcome Measures
Patient’s perception of processes and outcomes Patient Experience
System level and activity level Measurement Levels
External & Internal Influence Measurement Topics
Make care safer Strengthen personal & family engagements with their healthcare providers Promote effective communication Promote effective care & prevention of chronic diseases Promote Best Practices Make care affordable National Quality Strategy Priorities
Health plans that are accredited by the National Committee for Quality Assurance (NCQA) must participate in the HEDIS measurement project which measures a broad range of health & consumer issues
– probability that the measurement is free of random errors & yields consistent results Interrater Reliability
utilized to enable data conversions are mapped to useful information results Check Sheets
Quality stakeholder group formed in 1999 for the purpose of creating national standards for measurement and public reporting of healthcare performance data. Uniquely they do not require performance measurement requirements. National Quality Forum (NQF)
Seal of approval” for healthcare quality measures. NQF Endorsement
Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances Clinical Measures
framework that helps organizations put strategy at the center of the organization by translating strategy into operational objectives that drive behavior and performance. Balanced Scorecard
Judging or evaluating measurement data for the purpose of reaching a conclusion Assessment
The science of examining raw data with the purpose of drawing conclusions about the information Data Analytics
The difference between actual and expected performance. Performance Gaps
uses the level of performance achieved by an exemplary or world-class organization Benchmarking
Snapshot Reports Tabular report Pie chart Scatter diagrams Bar graph Histogram Pareto chart Radar chart
Tabular Report aka Data Tables Gathers numeric data from different periods
Pie chart –contributions of parts to a whole
Scatter diagrams – for analyzing relationships or correlations between 2 variables
Bar graph – easily compares data
Histogram – a.k.a Frequency distribution, shows a distribution of values as rankings
Pareto chart – similar to bar charts, but in decreasing or lowest frequency
States that for many events, 80% of the results come from 20% of the inputs. Organizations should resolve these problems to have the greatest impact on performance improvement Pareto Principle
Radar chart plotting 5-10 performance measures, showing strengths & weaknesses
Trend Reports Display data from several periods
One of the best displays uses symbols or colors to draw attention to performance concerns Dashboard
Trend Reports Line graph Bar graph
Line graph a.k.a Run Charts, used to show measurement over time
Bar graph can be used to show data for different periods
Application of statistical methods to assess and control performance Statistical Process Control (SPC)
championed the use of statistical methods to evaluate the causes of variation in performance results. Improvement strategies are different depending on the cause of variation. He is considered the father of statistical quality control. Walter Schewart
Special causes are identified and eliminated. Process itself is not changed (special causes are extrinsic to the process). Process is unstable
SPC Tools Line graphs Control charts
Reacting to performance measurements without recognizing the natural variances that occurs in a process Tampering
Analyzing performance of various processes and improving them repeatedly to achieve quality objectives Continuous Improvement
Define the improvement goal. Analyze current practices. Design and implement improvements. Measure success Steps of performance improvement
Used in Rapid Cycle Improvement (RCI) Involves small process changes and careful measurements of those changes to achieve an improvement goal FOCUS-PDCA
PDCA Plan Do Check Act Schewart
FOCUS Find a process that needs change Organize a team of people Clarify the current process Understand the causes of the variation Select action needed to improve process
FADE Focus Analyze Develop Execute
Eliminate wasteful inefficiencies. Lean project goal
Lean Project Steps Identify performance problem. Evaluate current work processes. Identify areas of opportunity. Find root causes of problems.
Lean Project Steps 2 Design a better way of working. Create an implementation plan. Identify expected improvements, Make process changes and measure results
Reduce performance variability. Six Sigma
analysis, implementation, and review common thread shared by different models