2. QUALITY IMPROVEMENT BASICS
Chapter 7
QUALITY IMPROVEMENT BASICS

3. 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

4. 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)

5. 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

6. 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,   

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

9. 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

10. 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

11. 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

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

13. 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

14. 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