QUALITY IMPROVEMENT BASICS Chapter 7 QUALITY IMPROVEMENT BASICS

Definition of Quality Institute of Medicine “degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge” Donabedian conception of quality as: Structure – quality personnel and facilities Process – quality processes both in management and production of health care Outcomes – quality resulting from the application of structural and process variables

Definition of Quality (cont’d) Donabedian’s four parts Technical management Interpersonal relationships Amenities of care Ethical principles guiding care Two Quality Questions Are the right things done? (effectiveness) Are things done right? (efficiency)

Why is Quality Important? Underuse – failure to provide a service whose benefit is greater than its risk Underuse of Beta Blocker prescription after first heart attack Overuse – use of service when risk outweighs its benefits Uncritical use of antibiotics, especially in consumer products Misuse – risk service is provided badly reducing benefit to patient Medical errors, medication errors

Baldrige Award Criteria Strategic Framework Structure Leadership Strategic planning Focus on patient, other customers, and markets Process Staff focus Process Improvement Outcomes Organizational performance outcomes or results Supported by measurement, analysis, and knowledge management Source: Baldrige National Quality Program Criteria for Performance Excellence, http://www.baldrige.nist.gov/PDF_files/2009_2010_Business_Nonprofit_Criteria.pdf   

Common Elements Measurement Definition Reliability Validity Process Variation and Statistical Process Control Special Cause Variation Common Cause Variation

Continuous Process Improvement “A structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations” Based on process part of Donabedian’s definition TQM/CQI’s five dimensions Process focus Customer focus Data-based decision making Employee empowerment Organization-wide scope FOCUS-PDCA

FOCUS/PCDA Find – identify process problem Organize – put together a team to work on process Clarify – use techniques to clarify the problem Geographic mapping Flowcharting Understand – measure and collect data to Select – identify process improvements for implementation

FOCUS/PDCA (cont’d) Plan – create an implementation plan for taking the process to the next level Do – implement and test the new process Check – evaluate the measures used and assess outcomes Act – assure continuation of newly implemented process, if successful ,or redo the process, if not successful

Six Sigma “Data-driven quality methodology that seeks to eliminate variation from a process” Large HR component Quality training and personnel Leadership DMAIC

DMAIC Define –delimit scope of work and time frames for completion Measure – create and apply measures and metrics Analyze – assess and flowchart the process Improve – specify the steps to be taken to meet goals Control – assure permanence of the improvements

Quality Improvement Tools Data collection Checksheet Chart abstractions or chart audits Workflow diagram Process mapping Flowchart Process analysis Cause-and-effect (fishbone) diagram Pareto Chart