Ch.1 Intro to quality management

Action
the activity to achieve the desired outcome
Aggregate data indicator
quantifies a process or outcome related to many cases
Appropriateness of Care
whether the type of care is necessary
Benchmarking
involves comparing one organization’s performance with that of another
brainstorming
a group process used to develop a large collection of ideas without regard to their merit or validity
concurrent data
data collected during the time of care
Continuity of care
the degree to which the care is coordinated among practitioners and/or organizations
critical path
documents the basic treatment or action sequence in an effort to eliminate unnecessary variation
customer
a person, department, or organization that needs or wants the desired outcome
effectiveness of care
the level of benefit when services are rendered under ordinary circumstances by average practitioners for typical patients
Efficacy of care
the level of benefit expected when healthcare services are applied under ideal conditions
Efficiency of care
the highest quality of care delivered n the shortest amount of time with the least amount of expense & a positive outcome
expectation
a preestablished level of performance applied to a specific indicator
focus group
group dynamic tool for problem identification & analysis
FOCUS-PDCA
a quality management method developed by the Hospital Corporation of America
Indicator
a valid & reliable quantitative process or outcome measure related to 1 or more dimensions of performance
Input
info or knowledge necessary to achieve the desired outcome
Mammography Quality Standards Act (MSQA
federal legislation mandating quality standards for all mammographic procedures
Process
an ordered series of steps that help achieve a desired outcome
Quality Assurance
an all-encompassing management program used to ensure excellence
Quality control
the part of the quality assurance program that deals with techniques used in monitoring & maintenance of technical systems
Quality improvement team
a group of individuals who are responsible for implementing the solutions that were derived by a focus group
Safe Medical Devices Act (SMDA
legislation of 1991 that requires a medical facility to report to the Food & Drug Administration any medical devices that have caused a serious injury or death of a patient or employee
Safe Medical Devices Act (SMDA):
it also authorizes civil penalties to be imposed on healthcare workers or facilities that do not report defects & failures in medical devices
Sentinel event indicator
an individual event or phenomenon that is significant enough to trigger further review each time it occurs
Supplier
one who provides goods or services
Expected quality
is based on customer expectations & may be influenced by outside factors
perceived quality
is highly subjective & difficult to quantify
actual quality
uses statistical data & considers all factors that can influence the final outcome
Radiation Control for Health & Safety Act (1968)
Feds 1st attempt to require imaging departments to implement quality management programs. US dept. of health, education, & welfare (nka: health & human services) was required to develop & administer standards aimed at reducing human exposure to radiation from electronic products
Bureau of Radiologic Health (BRH)

A.K.A National Center for Devices and Radiologic Health

They were given responsibility for implementing the Radiation Control for Health & Safety Act. Beginning in 1974, manufacture & instillation of medical & dental x-ray equipment was regulated to reduce production of useless radiation
Consumer-Patient Radiation Health & Safety Act (1981)
Addressed issues like: unnecessary repeats, QA techniques, referral criteria, radiation exposure, & unnecessary mass screening programs. Also accreditation of educational programs.
CARE act
consumer assurance of radiographic excellence: if passed, it would mandate educational & training requirements for all technologists performing imaging studies (mandating the standards contained in the consumer-patient radiation health & safety act of 1981)
Safe Medical Devices Act of 1991
Requires medical facilities to report any medical devices that have caused a serious injury or death of a patient or employee to the Food & Drug Administration
Continuous Quality Improvement (CQI)
Incorporates QA/QC models
Focuses on not only ensuring & maintaining quality, but also improving quality

Based on the 14 points for management

85/15 rule
Focus on process
Process or system in place is the cause of problems 85% of the time & people in the process are the cause 15% of the time
80/20 rule
80% of the problems are the result of 20% of the causes
process
an ordered series of steps that help achieve a desired outcome
system
a group of related processes
-supplier, input, actin, output, and the customer
supplier
one who provides goods or services
input
info or knowledge necessary to achieve the desired outcome
action
the activity to achieve the desired
Output
the desired outcome, product, or characteristics that satisfy the customer
customer
a person, department, or organization that needs or wants the desired outcome
Key Quality Characteristics
qualities or aspects identified as being the most important to customers
Focus groups
is a small group that focuses on a particular problem and then hopefully derives a solution
Quality improvement team
A group of individuals who implement solutions derived from the focus groups
Quality circles
Supervisors & employees from the same or similar departments who meet regularly to identify departmental problems & recommend solutions.
Multi-voting
Method used after brainstorming to rank validity of ideas/concerns
Consensus
Groups discuss ideas & agree on what needs to be addressed 1st
Work teams
Focus on solving a complete problem or completing an entire task
TJC
10-step process
Sentinel Event Indicator
an individual event or phenomenon that is significant enough to trigger further review each time it occurs
Aggregate Data Indicator
quantifies a process or outcome related to many cases
Appropriateness of care
whether the type of care is necessary
Systematic planning & implementation
A collection of valid & reliable data to demonstrate effectiveness & efficiency
TMP plan
5 steps
define, list, ask, sequence, identify
SWOT
Strengths, weaknesses, opportunities & threats
FADE
focus, analyze, develop, execute,
FMEA
procedure for analysis of potential failure within a system, classifying the severity or determining the failures effect upon the system and helping determine remedial actions to overcome these failures.
Six Sigma
5 step process that seeks to identify & remove causes of error in business processes
1. Define process improvement goals
2. Measure key aspects of current process & collect data
3. Analyze data for cause & effect
4. Improve process based on data analysis

5. Control process so deviations are corrected BEFORE errors occur