INTRODUCTION TO QUALITY MANAGEMENT
DIAGNOSTIC IMAGING IS THE MULTI-STEP PROCESS
THERE ARE NUMEROUS SOURCES OF VARIABILITY IN BOTH HUMAN FACTORS AND EQUIPMENT THAT CAN PRODUCE SUBQUALITY IMAGES
THE PURPOSE OF QUALITY MANAGEMENT PROGRAM IS TO CONTROL OR MINIMIZE THOSE VARIABLES
VARIABLES IN DIAGNOSTIC IMAGING EQUIPMENT IMAGE RECEPTOR PROCESSING VIEWING CONDITIONS COMPETENCY OF THE TECHNOLOGIST, INTERPRETER, AND SUPPORT STAFF.
LEVELS OF QUALITY OF GOODS EXPECTED QUALITY PERCEIVED QUALITY ACTUAL QUALITY
SINCE 1980 HEALTHCARE DELIVERY IS UNDERGOING DRAMATIC CHANGES!! THESE CHANGES ARE GREATLY AFFECTING DIAGNOSTIC IMAGING DEPARTMENTS
HEALTHCARE CHANGES
CHANGES IN HEALTH CARE THAT AFFECT IMAGING DEPARTMENTS ADVANCES IN TECHNOLOGY LEGISLATION AND GOVERNMENT REGULATIONS JCAHO PROCEDURES CORPORATE BUYOUTS AND MERGERS METHODS OF REIMBURSEMENT FOR SERVICES
ADVANCES IN TECHNOLOGY COST OF INSTALLATION & MAINTENANCE
LEGISLATION AND GOVERNMENT REGULATIONS SAFE MEDICAL ACT 1990 MAMMOGRAPHY QUALITY STANDARDS ACT OF 1992 INCREASED RESPONSIBILITY OF DIAGNOSTIC DEPARTMENT MANAGERS AND STAFF TO DOCUMENT PROPER EQUIPMENT OPERATION AND PROCEDURES.
CORPORATE BUYOUTS AND MERGERS
CORPORATE BUYOUTS AND MERGERS SINCE 1980 1,000 HOSPITALS CLOSED
JCAHO PROCEDURES TQM QA
METHODS OF REIMBURSEMENT FOR SERVICES HMO’S LOWER REIMBURSMENT RATE!!!
CONCEPT OF SCIENTIFIC MANAGEMENT UNTIL 1980 HISTORY OF Q.M. 1900 FREDERICK WINSLOW – FATHER OF SCIENTIFIC MANAGEMENT CONCEPT OF SCIENTIFIC MANAGEMENT UNTIL 1980
HISTORY OF Q.M. 1980 W. EDWARDS DEMING & JOSEPH JURAN CONCEPT OF QUALITY IMPROVEMENT
SOME IMAGING DEPT. SINCE 1930s SYSTEMATICALLY MONITOR THEIR EQUIPMENT TO SAVE MONEY AND INCREASE EFFICIENCY
GOVERNMENTAL ACTIONS 1968 RADIATION CONTROL FOR HEALTH AND SAFETY ACT 1980 OSHA 1981 CONSUMER PATIENT RADIATION HEALTH AND SAFETY ACT SMDA OF 1991 1992 MQSA 1996 HIPPA 2000 CARE ACT
1968 RADIATION CONTROL FOR HEALTH AND SAFETY ACT REQUIRED US DEPT. OF HEALTH TO DEVELOP AND ADMINISTER STANDARDS THAT WOULD REDUCE HUMAN EXPOSURE FROM ELECTRONIC DEVICES. BRH – REG. ACTION IN 1974 TO CONTROL THE MANUFACTURE AND INSTALLATION OF MEDICAL AND DENTAL DIAGNOSTIC EQUIPMENT JACHO ADOPTED THESE RECOMMENDATIONS
1980 OSHA IN RESPONSE TO OUTBREAK OF HIV AND HEPATITIS B VIRUSES, MANDATED THE POLICY ON BLOOD-BORNE PATHOGENS. OSHA ALSO MONITORS WORKPLACE FOR OCCUPATIONAL EXPOSURE TO RADIATION AND CHEMICALS.
1981 CONSUMER PATIENT RADIATION HEALTH AND SAFETY ACT ADDRESSED ISSUES OF UNNECESSARY REPEAT EXAMS IT ESTABLISHED MINIMUM STANDARD FOR ACCREDITATION OF EDUC. PROGRAMS IN RADIOLOGIC SCIENCEAND FOR THE CERTIFICATION OF EQUIPMENT OPERATORS!!!!!!
SMDA OF 1991 REQUIRES MEDICAL FACILITY TO REPORT TO FDA ANY MEDICAL DEVICE THAT CAUSED INJURY OR DEATH OF A PATIENT!
1992 MQSA MANDATED Q.A. PROGRAMS FOR ALL FACILITIES PERFORMING MAMMOGRAPHY STUDIES – FDA APPROVAL. IT ALSO SPECIFIED STANDARD AND REQUIREMENTS FOR EQUIPMENT, TECHNOLOGISTS, DOCTORS INTERPRETING THE RADIOGRAPHS, AND MEDICAL PHYSICISTS.
HIPAA OF 1996 SIMPLIFICATION OF H.C. STANDARDS TO ESTABLISH NATIONAL STANDARDS FOR HEALTHCARE E-COMMERCE CONFIDENTIALITY OF PATIENT RECORDS!!!!!!
ACCREDITATION IS VOLUNTARY!!! JCAHO INCE 1970 REQUIRES HOSPITALS AND OTHER HEALTHCARE PROVIDERS TO PERFORM AND DOCUMENT Q.M. PROCEDURES FOR THE FACILITIES TO GET ACCREDITATION ACCREDITATION IS VOLUNTARY!!!
LACK OF ACCREDITATION HOSPITALS MAY NOT BE ABLE TO HAVE RESIDENCY PROGRAMS HOLD CERTAIN LICENSES HAVE MEDICAID CERTIFICATION RECEIVE MALPRACTICE INSURANCE
ENHANCEMENT OF PATIENT CARE QUALITY ASSURANCE IS AN ALL-ENCOMPASING MANAGEMENT PROGRAM USED TO ENSURE EXCELLENCE IN HEALTHCARE THROUGH THE SYSTEMATIC COLLECTION AND EVALUATION OF DATA. PRIMARY OBJECTIVE: ENHANCEMENT OF PATIENT CARE
QUALITY MANAGEMENT PART OF THE QA ASSURANCE PROGRAM THAT DEALS WITH TECHNIQUES USED IN MONITORING AND MAINTENANCE OF THE TECHNICAL ELEMENTS OF THE SYSTEMTHAT AFFECT THE QUALITY OF THE IMAGE
Q.M. DELAS WITH EQUIPMENT AND INSTRUMENTATION
QUALITY CONTROL LEVELS OF TESTING NONINVASIVE- SIMPLE NONINVASIVE AND COMPLEX INVASIVE AND COMPLEX
CONTINUOUS QUALITY IMPROVEMENT INCORPORATED BY JCAHO IN 1991
C.Q.I.
KAIZEN
CQI SYNONYMS TQM- TOTAL QUALITY MANAGEMENT TQC - TOTAL QUALITY CONTROL TQI – TOTAL QUALITY IMPROVEMENT SQC – STATISTICAL QUALITY CONTROL
FOCUS IS ON THE ORGANIZATION AS C.Q.I DOES NOT REPLACE QA INSTEAD OF JUST ENSURING & MAINTAINING QUALITY IT CONTINUALLY IMPROVES QUALITY BY FOCUSING ON IMPROVING THE SYSTEM FOCUS IS ON THE ORGANIZATION AS THE WHOLE
C.Q.I INTERNALLY MOTIVATED EVERY EMPLOYEE CONTRIBUTES TO THE SUCCESS OF THE ORGANIZATION
C.Q.I. PROCEES IMPROVEMENT PREMISES 85/15 RULE 80/20 RULE WORKERS KNOW THEIR WORK BETTER THAN OUTSIDER STRUCTURED PROBLEM SOLVING SUCCESSFUL IN PROBLEM SOLVING QUALITY IMPROVEMENT – JOB OF EVERYONE IN THE ORGANIZATION
PROCESS ORDERED SERIES OF STEPS THAT HELP ACHIEVE A DESIRED OUTCOME.
PARTS OF THE PROCESS SUPPLIER INPUT ACTION OUTPUT CUSTOMER : INTERNAL EXTERNAL
PROBLEM IDENTIFICATION AND ANALYSIS: TEAMS – 2 PEOPLE OR MORE! IDEAL: 6 – 12 PEOPLE
GROUP DYNAMICS TOOLS BRAINSTORMING FOCUS GROUPS QUALITY IMPROVEMENT TEAM QUALITY CIRCLES MULTI-VOTING CONSENSUS WORK TEAMS PROBLEM SOLVING TEAMS
1985- JCAHO 10- STEP MONITORING AND EVALUATION PROCESS ASSIGN RESPONSIBILITY DELINEATE THE SCOPE OF CARE SERVICE IDENTIFY THE IMPORTANT ASPECTS OF CARE AND SERVICES IDENTIFY INDICATORS ESTABLISH MEANS TO TRIGGER EVALUATION COLLECT AND ORGANIZE DATA INITIATE EVALUATION TAKE ACTION TO IMPROVE CARE AND SERVICES ASSESS EFFECTIVENESS OF ACTIONS AND MAINTAIN IMPROVEMENTS COMMUNICATE RESULTS TO AFFECTED INDIVIDUALS
ASSIGN RESPONSIBILITY
DELINEATE THE SCOPE OF CARE SERVICE
IDENTIFY THE IMPORTANT ASPECTS OF CARE AND SERVICES
IDENTIFY INDICATORS SENTINEL EVENT – INDIVIDUAL EVENT SIGNIFICAN EVENT TO TRIGGER FURTHER REVIEW. AGGREGATE DATA – RELATES TO QUANTIFICATION OF PROCESS RELATED TO MANY CASES.
INDICATORS: APPROPRIATNESS OF CARE – IS IT NECESSARY? CONTINUITY OF CARE – DEGREE OF COORDINATION AMONG PRACTITIONERS. EFFECTIVENESS OF CARE – THE LEVEL OF BENEFIT. EFFICACY – THE LEVEL OF BENEFIT UNDER IDEAL CONDITIONS EFFICIENCY – OUTCOME OBTAINED WHEN THE HIGHEST QUALITY CARE IS DELIVERED. RESPECT & CARING SAFETY IN THE CARE ENVIRONMENT TIMELINESS OF CARE COST OF CARE AVAILABILITY OF CARE
ESTABLISH MEANS TO TRIGGER EVALUATION
COLLECT AND ORGANIZE DATA
INITIATE EVALUATION
TAKE ACTION TO IMPROVE CARE AND SERVICES
ASSESS EFFECTIVENESS OF ACTIONS AND MAINTAIN IMPROVEMENTS
COMMUNICATE RESULTS TO AFFECTED INDIVIDUALS
JACHO CYCLE FOR IMPROVEMENT DESIGN. MEASURE ASSESS IMPROVE
DESIGN. SYSTEMATIC PLANNING AND IMPLEMENTATION
MEASURE COLLECTION OF VALID AND RELIABLE DATA
ASSESS HISTORICAL DATA DESIRED PERFORMANCE LIMITS PRACTICE GUIDELINES EXTERNAL REFERENCE DATABASE BENCHMARKING
IMPROVE DATA IMPROVE ANALYSIS