2. HEALTHCARE QUALITY CONCEPTS Chapter 1

3. Changing Perspectives in Quality Participants can identify 3 types of disruptive behavior. Participants can identify 2 types of difficult conversations in healthcare that if avoided can jeopardize patient safety. Participants can identify 2 skills that are essential to effective communication. “Quality in a product or service is not what the supplier puts in. It is what the customer gets out and is willing to pay for.” Peter F. Drucker 2

4. QUALITY, COST, AND RISK INTEGRATION 3 = Quality of Care/Services + Outcomes Cost Value

5. NON-INTEGRATED PERSPECTIVE 4 Mgmt Governance Clinical Support

6. Integrated Perspective Governance Management Support Clinical 5

7. QUALITY MANAGEMENT: BASIC PRINCIPLES Productive Work is Accomplished Through Processes. Sound Customer-Supplier Relationships are Absolutely Necessary for Sound Quality Management. The Main Source of Quality Defects is Problems in the Process. Poor Quality is Costly. 6

8. QUALITY MANAGEMENT: BASIC PRINCIPLES Understanding the Variability of Processes is Key to Improving Quality. Quality Control Should Focus on the Most Vital Processes. The Modern Approach to Quality is Thoroughly Grounded in Scientific and Statistical Thinking. 7

9. QUALITY MANAGEMENT: BASIC PRINCIPLES Total Employee Involvement is Critical. New Organizational Structures Can Help Achieve Quality Improvement. Quality Management Employs: – Quality planning – Quality control (measurement) – Quality Improvement 8

10. TOTAL QUALITY MANAGEMENT An Organizational Management Philosophy and Top-Level Commitment to Foster a Belief in the Value of:  Customers  Employees/staff  Management  Teamwork  Deming’s 14 points 9

11. CONTINUOUS QUALITY IMPROVEMENT  CQI is a Management Approach of Study and Improving Processes  It is a Management Method for Creating TQM  At CQI’s Core is a Quality Culture/Patient Safety Culture  CQI is a Management Approach of Study and Improving Processes  It is a Management Method for Creating TQM  At CQI’s Core is a Quality Culture/Patient Safety Culture 10

12. CONTINUOUS QUALITY IMPROVEMENT  Organizational Commitment  Quality Culture  Customer Focus  Team Emphasis on Improving Systems and Processes  Constant Learning and Improving  Organizational Commitment  Quality Culture  Customer Focus  Team Emphasis on Improving Systems and Processes  Constant Learning and Improving 11

13. RESPONSIBILITIES OF THE QUALITY PROFESSIONAL 12  Understand Principles of TQM and CQI  Develop a Healthcare Quality Strategy  Participate in Preparation for External Awards  Articulate to Leadership How to Use  TQM and CQI  Data Measurement  Assessment  Improvement  Lead and facilitate change within the organization  Understand Principles of TQM and CQI  Develop a Healthcare Quality Strategy  Participate in Preparation for External Awards  Articulate to Leadership How to Use  TQM and CQI  Data Measurement  Assessment  Improvement  Lead and facilitate change within the organization

14. SYSTEMS THINKING System: Perceived whole whose elements hang together effecting each other Systems Thinking: A body of principles, methods, and tools focused on the interrelatedness of forces in a system 13

15. PROCESSES IN SYSTEMS THINKING 14 Systemic Structure Key Components:  Process flows,  Attitudes & perceptions,  Ways decisions are made,  Hierarchy  The system working with all its parts

16. PROCESSES IN SYSTEMS THINKING 15 Four Levels in Systems:  Events (occurrences)  Patterns of Behavior (trends over time)  System Structure (decisions, relationships, efforts, targets, incentives, etc.)  Mental Models (beliefs, assumptions, mind sets about ways work gets done)

17. SYSTEMS THINKING -PROCESS TOOLS Cause and Effect Relationships Process Diagrams Show a Flow or Sequence of Activities 16 AaffectsB C A thenB C

18. Who are the various owners of the process? What group of people have some stake or ownership of different parts of the process? You can address the symptoms, but until you address the problem you can not resolve it Addressing the symptoms is call the Band-Aid approach Systems Thinking 17

19. MD writes order Sent to Pharmacy by Nursing Pharmacy fills the order Pharmacy sends the medication up to the Nursing Unit Nurses give the medication Nurses & MD monitors the patient’s condition Medication Process 18

20. What if the doctor’s handwriting can not be read and doctor is not available? What if the Pharmacy decides not to fill it until later? Or if the Pharmacy has no medication What if it does not get to the unit until after the time it was needed? What if the nurses are too busy to be able to give the medication on time? Medication Process 19

21. What if Nursing decides to change the times they administer the medications and does not tell the Pharmacy? What if the Pharmacy does not have a medication and does not contact the doctor until after clinic hours and the MD is not on call? What if Pharmacy decides to send the medication in 2 pouches instead of just one? Medication Process 20

22. You need to examine the players and determine who will be affected by any actions that you take You want to expand your clinic? – How many more practitioners ? – Nursing staff to run the clinic & move patients around? – Lab work increase of workload? – Radiology increase of workload? – Pharmacy have needed medications? CAN NOT DO IT BY YOURSELF when you want to do something like this Systems Thinking 21

23. THE CONCEPT OF CUSTOMER “Customer” – One Who Receives Goods or Services External Customer – Those Outside the Organization Receiving Services Internal Customer – Those Performing Work, but Dependent On Others Within the Organization Performing Work Customer Supplier Relationships 22

24. CUSTOMER FOCUS Listen To & Communicate With Customers; Identify and Address True Needs; Optimize Treatment Patterns and Outcomes: Enhance Performance of Internal Processes; Respond to Requests For Information; Build Trust, Respect, and Loyalty in Relationships Patient Centered Care Coordination of Care 23

25. Keeping the Customer in Mind Dissemination of cultural transformation and performance improvement information  within the organization and  to our customers! 24

26. IDENTIFYING CUSTOMERS AND THEIR NEEDS Identifying Customer Needs & expectations:  Surveys and interviews  Focus groups  Research  Brainstorming  Teams 25

27. ORGANIZATIONAL CULTURE Culture – Basic Set of Assumptions About People, How People Work Together and How Work Gets Done. 26

28. IMPACT OF ORGANIZATIONAL CULTURE 27  Organizational Ethics  Patient Safety  Corporate Compliance  Organizational Change  Performance and Productivity  Internal and External Customers  Organizational Ethics  Patient Safety  Corporate Compliance  Organizational Change  Performance and Productivity  Internal and External Customers

29. Quality & Patient Safety Culture Most organizations have different organizational cultures, including different healthcare organizations Healthcare must change into a Quality and Patient Safety culture if we are to survive There must be a Patient Centered culture Care must be Evidence-Based Teamwork is essential 28

30. CULTURAL TRANSFORMATION 29  Just Culture – Blame Free  Adoption of “Quality / Patient Safety Culture”  Commitment to Excellence  Long-range Strategic Planning  Flexible Management Styles  Systems Thinking  Delegation and Empowerment  Team Building  Increase Communication  Just Culture – Blame Free  Adoption of “Quality / Patient Safety Culture”  Commitment to Excellence  Long-range Strategic Planning  Flexible Management Styles  Systems Thinking  Delegation and Empowerment  Team Building  Increase Communication

31. CULTURAL TRANSFORMATION 30 Visionary Leadership Systems Thinking Inspiration Management’s Commitment Team Building Calculated Risk Taking Implementation Employee Involvement Engagement Innovation

32. So, How Do We Get There? Need to start with defining quality at an organization Assess where the organization is in terms of the organizational culture Develop and design what the new Quality / Patient Safety Culture will look like and how to get there 31

33. REDESIGNING THE ORGANIZATION  Sustained Approach  Downsizing  Restructuring/Rightsizing  Organizational Structure  Reengineering 32

34. REEINGINEERING 33 Work Redesign Customer Focus Service Integration Management Restructuring Cross Training

35. INTEGRATED DELIVERY SYSTEMS Types: – Horizontal – Vertical Degrees of Integration 34 Hospital A Hospital B Hospital C Hospital D Hospital Clinic LTC Rehab

36. EVALUATING CLINICAL INTEGRATION 35 Coordination of Clinical Processes and Services Cost Effective Care Appropriate Sharing of Facilities and Services Avoid Unnecessary Duplication

37. Other Leadership Topics Awareness of Statutory & Regulatory Requirements – OSHA – HIPAA – PPACA Quality & Reimbursement – Capitation – Pay for Performance