1. Quality Improvement Timothy L. Ricks, D.M.D., M.P.H.
Nashville Area Dental Officer
Kristina Rogers, B.S.
Nashville Area Statistician/Improvement Advisor
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2. Quality Components Risk Management Patient Safety Peer Review
Quality Assurance
Strategic Planning
Quality Improvement
11/11/2018

3. What is Quality? It depends on the stakeholders’ perspectives
From a provider view:
Did the treatment I provided work?
Are we using the best available equipment and procedures?
From a health administrator’s view:
Were the patients satisfied with the care they received?
Was there a good cost-benefit ratio?
From a patient’s view:
Did my provider listen to my concerns?
Did my provider spend enough time with me?
From a tribal council’s view:
Were all patients in need treated adequately?
Is the clinic financially independent?
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4. Quality Components Risk Management Patient Safety Peer Review
Quality Assurance
Strategic Planning
Quality Improvement
11/11/2018

5. Risk Management Risk management is all about mitigation of risk.
Risk to Patients
Patient Safety Activities
Risk to Providers
Malpractice - FTCA
Risk to the Organization
CMS
Accreditation Organizations – AAAHC, JCAHO
DEA
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6. Risk Management Read the IHS Risk Management Manual:
The manual:
Provides an overview of who is covered under FTCA & under what conditions
Provides guidance on how to avoid malpractice issues (how to work with patients)
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7. Quality Components Risk Management Patient Safety Peer Review
Quality Assurance
Strategic Planning
Quality Improvement
11/11/2018

8. Patient Safety
“Patient safety is indistinguishable from the delivery of quality care.” IOM, 2004
To Err is Human - a landmark report by the Institute of Medicine in
National Patient Safety Goals
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9. Patient Safety Some possible dental patient safety issues:
Sterilization
Dental waterlines
Disinfection of equipment/chairs
Physical hazards
Radiation
Rubber dam use
Medications/anesthesia
Others?
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10. Quality Components Risk Management Patient Safety Peer Review
Quality Assurance
Strategic Planning
Quality Improvement
11/11/2018

11. Peer Review Two types: How often should it be done?
Ongoing Peer Review (routine)
Focused Peer Review (for cause)
How often should it be done?
Ongoing – quarterly
At least annually by external reviewer
Who can do peer reviews?
Dentists-dentists; DDS or RDH-RDH
ADO can do them, but don’t just count on that.
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12. Peer Reviews in our Area
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13. Quality Components Risk Management Patient Safety Peer Review
Quality Assurance
Quality Improvement
Strategic Planning
11/11/2018

14. What is Quality Assurance?
Quality Assurance – evaluation of performance/quality of care that is reactive, retrospective, policing, and sometimes punitive.
Quality Improvement – a formal approach at evaluating performance and systems that is proactive, both prospective and retrospective, non-punitive, and focused on improving care to patients.
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15. Which of the following has a QA focus?
Which staff member failed to transfer the call to the correct extension?
Are we creating an environment encouraging clinicians to report errors?
How do we reduce production errors on the widget line?
Patient had a bad outcome; were the doctors or nurses at fault?
What could we do to increase the efficiency of chart filing?
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16. Quality Components Risk Management Patient Safety Peer Review
Quality Assurance
Strategic Planning
Quality Improvement
11/11/2018

17. Strategic Planning Where are you going? What are your priorities?
How are you going to get where you are going?
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18. Strategic Planning in Dental
Written Quality Improvement/Performance Improvement Plan
Written HP/DP Plan
Written overall Strategic Plan (short-term and long-term goals)
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19. Quality Components Risk Management Patient Safety Peer Review
Quality Assurance
Strategic Planning
Quality Improvement
11/11/2018

20. Quality Improvement Plan-Do-Study-Act (PDSA) Cycle
Small scale tests and multiple cycles of testing should be used to build knowledge about needed changes. There is no wrong or right aspect to test. Initial testing sparks ideas that can lead to other tests. You should brainstorm ideas for change that might lead to an improvement with other clinic staff. Changes are tested by using Plan-Do-Study-Act (PDSA) cycles. This is essentially the scientific method. Each PDSA cycle will create information that can be used to determine how close you are to meeting your objectives. Rapid cycle PDSAs will allow you to obtain quick feedback and the opportunity to change testing components along the way. The Model for Improvement (shown below) is used to construct PDSA cycles.
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21. Quality Improvement What are we trying to accomplish?
How will we know that a change is an improvement?
What change can we make that will result in improvement?
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22. The “PDSA” Model PLAN: Plan a change or test of how something works.
DO: Carry out the plan.
STUDY: Look at the results.
What did you find out?
ACT: Decide what actions should be taken to improve.
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23. QI - PLAN State objective of the test Make predictions
Develop plan to carry out the test… (who, what, where, when)
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24. QI - DO Carry out the test
Document problems and unexpected observations
Begin analysis of data
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25. QI - STUDY Complete the analysis of the data
Compare test data to predictions
Summarize what was learned
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26. QI - ACT What changes are to be made?
What will be the objective of the next cycle?
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27. Important Aspects of the PDSA
These are inherently done all of the time. Can you think of an example?
Short-cycle (rapid) PDSAs allow for quick evaluations of minor changes made.
A single QI project might involve multiple PDSAs.
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28. Quality Improvement is not a one-time process!
The PDSA Cycle requires that the process be continued – the “Act” part of the cycle
Continuous Quality Improvement helps:
Maintain the positive steps you’ve already taken
Continuously improve quality of care
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