BUS 285 Total Quality Management Dr. Connolly June 9, 2004 IRC Office Hours WebCT Faculty Chat Office Tuesdays 4:00 – 5:00PM Wednesday 3:30PM IRC

Expected Outcomes Recognize course requirements Recognize course requirements Select presentation topic Select presentation topic Assign readings Assign readings Orientation to webcasting and use of webCT shell Orientation to webcasting and use of webCT shell Orientation to quality in health care Orientation to quality in health care

Course Requirements Meeting course objectives Meeting course objectives Class participation 30 pts; including reading assignments Class participation 30 pts; including reading assignments Presentation of a quality management tool 30 pts Presentation of a quality management tool 30 pts Evaluation of a quality management program 40 pts Evaluation of a quality management program 40 pts Optional final take home exam, 10 pts Optional final take home exam, 10 pts

Learning Environment On campus, IRC 302 On campus, IRC 302 Webcasting live or archives Webcasting live or archives WebCT WebCT Discussion Board (post all responses to classes) Discussion Board (post all responses to classes) Chat Room Office hours & Student Chat Chat Room Office hours & Student Chat Assignment information Assignment information Modules Modules Grading sheets Grading sheets

Webcasting Environment Watching live and questions Watching live and questions Questions will be answered during the first 10 minutes of class again 5 minutes before break time and again before end of class Questions will be answered during the first 10 minutes of class again 5 minutes before break time and again before end of class Telephone in classroom Telephone in classroom Emergency only desk top Emergency only desk top Archive: watch and respond to each reading presented within 1 week; post to Discussion Board on WebCT for that class Archive: watch and respond to each reading presented within 1 week; post to Discussion Board on WebCT for that class

Learning Environment Videostreaming & webcast: live or archived Videostreaming & webcast: live or archived

Reading Assignments Prepare as outlined in syllabus Prepare as outlined in syllabus Post on Discussion Board for class designated Post on Discussion Board for class designated Briefly present in class on campus Briefly present in class on campus Students webcasting must respond, at least one sentence to each reading presented; post on Discussion Board within 1 week of class Students webcasting must respond, at least one sentence to each reading presented; post on Discussion Board within 1 week of class

Presentation Topics 30 Pts Benchmarking Benchmarking Run Chart Diagram Run Chart Diagram Evaluation Grid Evaluation Grid Flow Chart Matrix Check List Flow Chart Matrix Check List Force Field Analysis Force Field Analysis Pareto Chart Pareto Chart Root cause analysis/Sentinel Events Root cause analysis/Sentinel Events Scatter Diagram Scatter Diagram Focus groups Focus groups Quality Improvement Story Boarding Quality Improvement Story Boarding Report Cards Report Cards Consumer Satisfaction Consumer Satisfaction Fishbone chart/cause & effect diagram Fishbone chart/cause & effect diagram Control charts Control charts

Presentation Requirements minutes on campus One week before, Power Point file to label, BUS285, class date, your name; no animations, transitions or audio One week before, Power Point file to label, BUS285, class date, your name; no animations, transitions or audio Two readings, one research on tool presented posted one week before for students on Discussion Board for presentation date Two readings, one research on tool presented posted one week before for students on Discussion Board for presentation date Post Power Pt file on Discussion Board WebCT Post Power Pt file on Discussion Board WebCT Collect Peer Evaluations on campus and your e- mail within WebCT Collect Peer Evaluations on campus and your e- mail within WebCT Post teaching objectives Post teaching objectives Evaluate teaching; measure stated objectives Evaluate teaching; measure stated objectives

Evaluation of Quality Management Program 40 pts Due July 28, 2004 See syllabus for details See syllabus for details Prepare using Criteria provided Prepare using Criteria provided Must have Executive Summary Must have Executive Summary Must be congruent with APA format Must be congruent with APA format Maximum 10 pages Maximum 10 pages Upload to Assignment area in WebCT or provide 2 copies turn in on campus Upload to Assignment area in WebCT or provide 2 copies turn in on campus Your recommendations are critical; based on your evaluation and literature Your recommendations are critical; based on your evaluation and literature

Optional Final Examination Due August 2, extra points can be gained if the optional final take home essay examination is selected 10 extra points can be gained if the optional final take home essay examination is selected 2 essay questions will be prepared from 6 choices 2 essay questions will be prepared from 6 choices

Total Quality Management Improving quality is an ethical imperative (Wurzbach, 1997) What is it? What is it? TQM, coined 1985 Naval Air Systems Command TQM, coined 1985 Naval Air Systems Command What are the driving forces? What are the driving forces? How do we know if we have it? How do we know if we have it? What is your responsibility as a manager and or administrator? What is your responsibility as a manager and or administrator?

Are we doing the right thing right? (Fitzpatrick,1994)

Macro Forces Medicare Medicare Consumer movement Consumer movement American industry, Deming’s TQM American industry, Deming’s TQM Financial constraints Financial constraints JCAH JCAH Managed care Managed care Employee benefit programs Employee benefit programs Third-party payors Third-party payors Demands for access & quality Demands for access & quality Integrated health care systems Integrated health care systems

Defining Health Care Quality Effectiveness of the organization Effectiveness of the organization Value-laden attribute meeting expected standards Value-laden attribute meeting expected standards Excellence and quality Excellence and quality Ethical concepts beneficence, prudence & justice Ethical concepts beneficence, prudence & justice Cannot be measured directly Cannot be measured directly Culturally competent care Culturally competent care

ANA, Nursing’s Safety & Quality Initiative 1994 Educate RNs about quality measurement Educate RNs about quality measurement Inform public & purchasing/regulating consituencies about safe, quality health care Inform public & purchasing/regulating consituencies about safe, quality health care Investigating research methods and data sources for empirical evaluation of safety and quality Investigating research methods and data sources for empirical evaluation of safety and quality

IOM Rules for Redesign (2001) Care is based on continuous healing relationships Care is based on continuous healing relationships Care is customized according to patient needs & values Care is customized according to patient needs & values The patient is the source of control The patient is the source of control Knowledge is shared & information flows freely Knowledge is shared & information flows freely Decision making is evidence-based Decision making is evidence-based

IOM Redesign Rules Safety is a system property Safety is a system property Transparence is necessary Transparence is necessary Needs are anticipated Needs are anticipated Waste is continuously decreased Waste is continuously decreased Cooperation among clinicians is a priority Cooperation among clinicians is a priority

Managed Care Environment Focus on outcomes Focus on outcomes Research based practice Research based practice High quality care High quality care Cost-effective interventions Cost-effective interventions Responsible for widespread application of information technology Responsible for widespread application of information technology

Report Card: Managed Care Access Access Quality/Appropriateness Quality/Appropriateness Promotion/Prevention Promotion/Prevention Outcomes Outcomes General health improved General health improved Quality of life improved Quality of life improved Treatment reduces psychological stress Treatment reduces psychological stress More productive & independent More productive & independent

IOM Crossing The Quality Chasm: Changes Needed (2001) Safe Safe Effective Effective Patient-centered Patient-centered Timely Timely Efficient Efficient equitable equitable

IOM Environment Changes (2003) Applying evidence to health care delivery Applying evidence to health care delivery Using information technology Using information technology Aligning payment policies with quality improvement Aligning payment policies with quality improvement Preparing the workforce Preparing the workforce

AACN: Role New Clinical Nurse Leader (2004) Leadership in care of sick across all environments Leadership in care of sick across all environments Design and provision of health promotion and risk reduction services for diverse populations Design and provision of health promotion and risk reduction services for diverse populations Provision of evidence-based practice Provision of evidence-based practice Population-based health care to individuals, clinical populations & communities Population-based health care to individuals, clinical populations & communities

Clinical Nurse Leader Role Cont. Clinical decision-making Clinical decision-making Design and implementation of plans of care Design and implementation of plans of care Risk anticipation Risk anticipation Participation in identification and collection of care outcomes Participation in identification and collection of care outcomes Accountability for evaluation and improvement of point of care outcomes Accountability for evaluation and improvement of point of care outcomes

Clinical Nurse Leader Role Cont. Mass customization Mass customization Client and Community advocacy Client and Community advocacy Education & information management Education & information management Delegation & oversight of care delivery & outcomes Delegation & oversight of care delivery & outcomes

Clinical Nurse Leader Role Cont. Team management & collaboration with other health professional team members Team management & collaboration with other health professional team members Development & leveraging of human, environmental & material resources Development & leveraging of human, environmental & material resources Management & use of client –care & information technology Management & use of client –care & information technology

Theoretical Frameworks for Evaluation Total Quality Management Total Quality Management Continuous Improvement Continuous Improvement Donabedian’s Model Donabedian’s Model

Donabedian’s Model Structure Structure Process Process Outcomes Outcomes

Structural Components Organizational structure Organizational structure Education of nurses & workforce Education of nurses & workforce Nursing standards of care Nursing standards of care Ratio of total nursing staff to patients Ratio of total nursing staff to patients Changes in market place Changes in market place Political influences Political influences Technology Technology Management philosophies Management philosophies

Process Components Interpersonal relationships between nurses and patients, among staff & supervisors Interpersonal relationships between nurses and patients, among staff & supervisors Nursing knowledge and competencies Nursing knowledge and competencies Change of shift report Change of shift report Practice environment Practice environment

Outcomes Sensitive to Nursing Functional health Functional health Physiologic health Physiologic health Psychological health Psychological health Health knowledge and behavior Health knowledge and behavior Perceived health Perceived health Family health Family health

Patient Outcome Components Mortality rates Mortality rates Length of stay Length of stay Adverse incidents Adverse incidents Pain management Pain management Skin integrity Skin integrity Falls Falls Complications Complications Patient and family satisfaction Patient and family satisfaction Ability to cope with illness Ability to cope with illness Growth & development of patient Growth & development of patient Adherence to a discharge plan Adherence to a discharge plan

Nurse Outcomes Satisfaction Satisfaction Retention Retention Autonomy Autonomy Sickness Sickness Absenteeism Absenteeism Work pressure Work pressure Involvement Involvement Peer cohesion Peer cohesion Supervisor support Supervisor support Innovation Innovation QOL QOL Burn out Burn out

Deming’s Points 13. Institute a vigorous program of education and self improvement for everyone. 13. Institute a vigorous program of education and self improvement for everyone. 8. Drive out fear. Create Trust. Create a climate for innovation. 8. Drive out fear. Create Trust. Create a climate for innovation. 5. Improve constantly and forever the system of production and service. 5. Improve constantly and forever the system of production and service. Walton, M. (1990). Deming management at work. New York: Perigee.

Summary TQM Leadership must support the process Leadership must support the process Organization must be customer oriented Organization must be customer oriented Quality improvement is linked to customer judgments Quality improvement is linked to customer judgments Employees must be empowered to be creative, to contribute develop & learn Employees must be empowered to be creative, to contribute develop & learn Organization is process focused Organization is process focused Organization uses visionary management Organization uses visionary management

Failing to meet the customer’s expectation of quality will result in customer dissatisfaction and is usually an indicator of poor quality (Ludwig-Beymet et al. 1993)

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