1. Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA

2. Learning Objectives Define Quality Identify Approaches to Quality Identify Types of Measures for Quality

3. Defining Quality Quality Philosophies & Definitions Approaches to Quality Picking Appropriate Quality Measures

4. Activity Draw An Image Of Quality – First Thing That Comes To Mind 5 Minutes Total To Complete This Exercise

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10. What Is Quality? Quality Philosophies Definitions of Quality

11. Quality Philosophies Quality Guru 1.W.E. Deming 2.Joseph Juran 3.Philip Crosby View of Quality 1.It’s Up To Management 2.It’s Not Accidental 3.Quality Vaccine

12. Common Definitions

13. I’ll Know It When I See It

15. Fitness For Use

19. Conformance to Requirements

21. What Is Quality? Know It When I See It Fitness for Use Conformance to Requirements Meeting Customer Expectations Exceeding Customer Expectations Superiority to Competitors Safe Effective Patient-Centered Timely Efficient Equitable

22. Approaches To Quality IHI/PDSA Lean Six Sigma Accreditation

23. IHI/Model for Improvement

25. PDSA Cycles Increase Belief Change Will Result in Improvement Small Tests = Small Risk Rapid Cycle Testing = Quick Feedback Multiple Cycles = Iterative Learning List of Changes & Outcomes for an Improvement Process

26. Lean Eliminating Waste & The Pursuit of Perfection

27. What Is Lean? Toyota Production System Reduce Waste (muda) Change for the Better (kaizen) More Customer Value Pursue Perfection

28. Six Sigma Eliminating Errors & Improving The Bottom-Line

29. What Is Six Sigma? Motorola Fact-Based, Data Driven Defect Reduction/Prevention Customer Centered Bottom-Line Results Project Based

30. Accreditation Joint Commission Patient-Centered Medical Home

31. Accreditation to Drive Quality Systems Approach Set of Standards Provides Direction Helps Build Capacity

32. Summary of Approaches

33. Approaches & Tools * Additional tools are available for each approach. The primary references used for this toolkit include the Institute for Healthcare Improvement (IHI) and the American Society for Quality (ASQ). Lean Sigma uses a combination of tools from both the lean and six sigma.

34. Picking Quality Measures Uses of Measures Types of Measures Developing Measures

35. Uses of Quality Measures Quality Measures Improvement Research Accountability

36. Uses of Quality Measures

40. Types of Measures Measure Type 1.Structural 2.Process 3.Outcome 4.Balancing Focus 1.Infrastructure & Capacity 2.Delivery of Care 3.Ultimate Goal 4.Different Perspectives

41. A Good Measure Is… Aligned With The Mission Important to Customers Actionable Accessible to People

42. More Tips… Plot Data Over Time Use Sampling Make It Routine Use Qualitative & Quantitative Data

43. The Details

44. Questions?

45. References Associates in Process Improvement (August, 2007). The improvement handbook: models, methods & tools for improvement. Version for : IHI Improvement Advisor Development Program. Bauer, J.E., Duffy, G.L., Westcott, R.T. (2006). The quality improvement handbook (2 nd ed.). Milwaukee, WI: American Society for Quality Bialek, R., Duffy, G.L., Moran, J.W. (2009). The public health quality improvement handbook. Milwaukee, WI: American Society for Quality. Duke, O. (Sept, 2008). Driven by metrics. Quality Progress. Milwaukee, WI: American Society for Quality. National Quality Measures Clearinghouse. Tutorials on quality measure. Available at: www.qualitymeasures.ahrq.gov/tutorial/index.aspx