“Quality Improvement – Who Cares?” Julietta Fiscella, MD, CPE, FCAP Chief, Department of Pathology, Cytopathology & Laboratory Medicine Clinical Associate Professor, Pathology & Laboratory Medicine Quality and Compliance Department

Quality Improvement - Who Cares? Institute of Medicine (IOM) definition: “Quality of care is the degree to which health service for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

Quality Improvement - Who Cares? “Quality healthcare consists of necessary medical professional processes that result in cure, significant measured improvement in the patient’s condition, alleviation of pain or other desired outcomes, and provides real value for the dollars spent.”

Quality Improvement - Who Cares? Quality “Doing the right thing for the right people at the right time and doing it right the first time”

Quality Improvement - Who Cares? OBJECTIVES: Briefly discuss why the need for quality in healthcare is of growing importance Discuss our Laboratory Quality Program Brief discussion of cost and its relation to quality in a value based healthcare system The future of quality improvement and reporting

Quality Improvement - Who Cares? “To Err is Human: Building a Safer Health System” - 1999 “Crossing the Quality Chasm” - 2001

Quality Improvement - Who Cares? IOM Action Plan: Safety – avoiding injury Effectiveness – implementing scientific knowledge Patient centeredness – preferences, needs and values Timeliness – reducing delays and wait times Efficiency – avoiding waste Equity – reducing disparity

Quality Improvement - Who Cares? In 2007, the Institute for Healthcare Improvement launched the Triple Aim framework of healthcare; this initiative focused on three themes: Improve the health of the defined population Enhance the patient care experience (including access and reliability) Reduce or at least control the per capita costs of care

Quality Improvement - Who Cares? QMS – A formalized quality management system modeled after (CLSI): QMS for Healthcare - HS1-A2A CLSI published document (GP35-A), describing the use of quality indicators for process improvement and to monitor lab quality CLSI’s 12 Quality Systems Essentials (QSEs)

Quality Improvement - Who Cares? Quality System Essentials (QSEs) Documents & Records: QSE 1 Organization: QSE 2 Assessments - Internal & External: QSE 3 Customer Service & Satisfaction: QSE 4 Corrective Action & Preventive Action: QSE 5

Quality Improvement - Who Cares? Quality System Essentials (con’t): Personnel: QSE 6 Equipment: QSE 7 Purchasing and Inventory: QSE 8 Process Improvement: QSE 9 Facility & Safety: QSE 10 Information Management: QSE 11

Quality Improvement - Who Cares? Audits / Inspections Internal Tracer audits (NYSDOH requirement) General audits CAP (self-audits) External CAP, AABB, NYSDOH, FDA, TJC, vendors and/or reference labs

Quality Improvement - Who Cares? OCCURRENCE MANAGEMENT

Quality Improvement - Who Cares? RL Solutions Hospital reporting system Many levels of severity for reporting

Quality Improvement - Who Cares? Medical Error Risk Management (MERM) Representatives from MCIC, nursing, legal, quality, pharmacy, patient relations and the Chief Quality Officer determine whether an event should be documented as: RCA NYSDOH PSRM Hospital Quality Board

Quality Improvement- Who Cares? Common Laboratory Metrics: Lost samples Corrected reports Failed proficiency testing Customer complaints Turnaround times Division-specific Metrics: Identify and monitor indicators that measure critical aspects of service, high risk or problem- prone areas

Quality Improvement - Who Cares? VALUE = QUALITY / COST

Quality Improvement - Who Cares? COSTS OF MISLABELED SPECIMENS Consider the efforts of all staff involved: Discover error and notify SMS Check for erroneous results reported and remove Check for other patient / tube involvement Notify floor of error and ask for redraw Redraw and send new specimen SMS processing Analysis / report time

Quality Improvement - Who Cares? COSTS OF MISLABELED SPECIMENS (con’t) Consider the efforts of all staff involved: Average hourly wage = $20.00 (RN = $30, PCT = $15, SMS Tech = $15, Lab Tech = $20) Estimated Test Cost = $10 40 x 20 x 10 = $8000.00

QUALITY CONTINUUM Analytical Phase CLIA/CAP AQ QA AQ - Lack of Awareness - Oblivious CLIA/CAP QA Checklist Mentality Aim to Meet Minimum Requirement AQ Focus on Analytical quality Reactive not proactive

QUALITY CONTINUUM Organization Excellence QM Performance Excellence TQM QM QM Formalized QMS Operational Transparency Metrics Track Cost of Quality Organization Honesty TQM Benchmarking Feedback Loops Employee Involvement Fact-based Decision Making Systems Thinking Aim to Meet Customer Requirements Reporting Culture Proactive Performance Excellence Include Entire Organization and all Management Systems Innovation Long-Term Success Aim for Best Practices Achieving Benchmarks Learning Organization

Quality Improvement - Who Cares? Future Tracking the cost of quality Quarterly dashboards for all units Total employee engagement