QUALITY ASSURANCE & CHANGE STRATEGIC MANAGEMENT IN HEALTHCARE 3 MARCH, 2009

QUALITY DOING THE RIGHT THINGS RIGHT, THE FIRST TIME & EVERY TIME –Quality of conformance – absence of defects –Quality of design – customer satisfaction

CUSTOMERS PAYORS PATIENTS ANY DOWNSTREAM USER OF OUTPUT VIRTUALLY EVERYONE IN YOUR ORGANIZATION

HEALTHCARE QUALITY MEDICAL OUTCOMES PATIENT SATISFACTION CLIENT SATISFACTION

EVALUATION OF QUALITY ACCURATE DIAGNOSES IMPROVEMENT AT DISCHARGE MORBIDITY & MORTALITY EFFICACY OF TREATMENT TOTALITY OF A PRODUCT THAT BEARS ON ABILITY TO SATISFY NEEDS OR WANTS

CQI CONTINUOUS QUALITY IMPROVEMENT IF IT AIN’T BROKE IT CAN STILL BE IMPROVED IF IT ISN’T PERFECT MAKE IT BETTER

CONTINUOUS QUALITY IMPROVEMENT PROACTIVE APPROACH THAT ASSUMES ALL PROCESSES CAN BE IMPROVED ASSUMES A REASONABLE LEVEL OF QUALITY TO BEGIN WITH ASSUMES YOU ARE DOING THE RIGHT THINGS ALREADY

ELEMENTS OF CQI ORGANIZATION WIDE PROCESS FOCUSED TEAM-BASED PROSPECTIVE AND ONGOING USES OUTPUT OR INSPECTION MEASURES CUSTOMER DRIVEN

GOAL OF PROCESS IMPROVEMENT DO IT RIGHT THE FIRST TIME –CORRECTIONS ARE EXPENSIVE 99% IS NOT GOOD ENOUGH –6000 STEPS TO BUILDING A CAR –60 THINGS WRONG WITH YOUR CAR –SOME WILL BE FATAL FLAWS

DEMING POOR QUALITY –IS THE RESULT OF BADLY DESIGNED OR MALFUNCTIONING PROCESSES –CAN BE PREVENTED –PREVENTED BY REDUCTION OF VARIABILITY

JURAN QUALITY IS FITNESS FOR USE - FREE FROM DEFICIENCIES AND MEETING CUSTOMER NEEDS QUALITY TRILOGY –PLANNING –CONTROL –IMPROVEMENT

CROSBY QUALITY IS FREE – WHAT COSTS IS NONQUALITY PRODUCTION COST OF QUALITY –NONCONFORMANCE – COST TO FIX IT –CONFORMANCE – COST TO EVALUATE AND IMPROVE

OUTLIERS UNDESIRABLE –PREVENT FUTURE OCCURRENCES DESIRABLE –CAN IT BE DUPLICATED?

HEALTHCARE QUALITY YOUR BODY IS NOT A CAR ALL TREATMENTS HAVE RISKS ALL TREATMENTS HAVE FAILURES EVERYONE IS GOING TO DIE

ORGANIZATIONAL CHANGE

Organizational Change Any discernable modification in any aspect of an organization’s purpose or objectives. culture, strategies, tasks, technologies, people, or structures.

Managing Change Four stage model –Identification –Planning –Implementation –Evaluation

Why Change Organizations, like people, are always growing or dying. Changes carry a variety of costs and should never be undertaken unless reasons are compelling.

Resistance to Change When people are part of the status quo, even minor changes are disruptive. Individuals pay selective attention to the environment according to their interests and selectively interpret the information they receive. All change is personal and personnel.

Reasons for Resistance Insecurity or uncertainty Inconvenience Implies the current situation is bad Relationships change Individual and group status changes Economic losses Resentment of exercise of power Union opposition

Personal & Personnel RIF & pay cuts Hiring freeze Downsizing means more work for fewer people. New jobs go to new people Survivor guilt

Reducing Resistance Education and communication Participation Support adjustment Negotiate agreement Manipulate or co-opt the opposition Coercion – inappropriate?

Platitudes/Truths Diapers and politicians should be changed regularly and for the same reason. No one likes to be changed but a baby. All change is stressful.