Intro to Healthcare Quality Managment

What is Quality?
An Attribute of a product or service

Cost is indirectly related to its perceived quality

What is Healthcare Quality?
Quality attribute similatities and differences are different for each stakeholder grp: Consumers, Purchasers, Providers
Quality is about?
Meeting Customers’ needs and expectations

Managing and coninuosly Improving Services

Who are the Stakeholders
Consumers, Purchasers, Providers
What do Consumers expect?
Satisfactory [rpvoder interactions
clean facilities
best available technology
recieve the right treatments/good outcomes
What do Purchasers expect?
Cost and Quality
Cost-effectiveness (value)
Admits prevented
What do Providers expect?
Legal liability protection
ie defensive medicine
Improved Patient outcomes
Define Quality
IOM 1990
Quality of care is “the degree to which health services for individuals and populations increase the liklihood of desired health outcomes and are consistent with current professional knowledge.”
Six Key Quality Dimensions
1 safe
2 Effective
3 Patient Centered
4 Timely
5 Efficient
6 Equitable
Comsumers’ quality expectations
Don’t kill me
do help me and dont hurt me
dont make me feel helpless
dont keep me waiting
dont waste resources-mine or anyone elses
Quality Management
A way of doing busness that continuosuly improves products and servixes to achieve better performance
Goal- achieve maximum customer satisfactin at the lowest overall cost to the oranization while continuing to improve the process.
Institute of Medicine-
Recomendations to achieve maximum customer healthcare satisfaction in quality:eliminate ….
No medical evidence it will help
Ex- Use of antibiotics to treat viral infections
Medically beneficial but not provided
Ex- Not performing a diagnostic test
Not carried out properly
Ex- Wrong site surgery
Quality Managment Activities
The 2 main primary quality management activities are parts of a closely linker cycle.
-Collect performance info
-Close gaps in deficient outcomes
-Achieve better performance
-Use performance info
-Identify quality levels achieved
-Determine quality success/failure
-Pan/make changes to current model
-Close gaps in deficient outcomes
-Achieve better performance
Shewhart 1920’s
Introduces statistical quality control
Deming & Juran 1950’s
Introduce controal and quality managemtn philosophies to Japan
Ishikawa 1960’s
Intoriduce the importance of a “bottom up” approach to quality improvement.
Know that 1970’s- Many US comapnies start losing market shar to global competitors.
External Forces Affecting Quality Management
State and Federal Government
Voluntary accreditation standards
Dawn of 21st Century
Regulations and accreditation standards affecting healthcare quality management began to incorporate Baldrege core values and statistical thinking orignated by SHEWART, DEMING and others

Science of qual improvement used in industiral and service indust being applied to hlth care delivery

Joint Commision adopts quality assurance standards 1980
-Identify important or potential problems or concerns with pt care
-Objectively assess the cause and scope of the prob or concern
-Implement decisions or actions designed to elminate the problems
-Monitor activities to ensure that desired results are achieved and sustained
-Document the effectiveness of the overall prog to enhance pt care and ensure sounds clinical performance
1920’s increasingly stringent licensing and standardization programs
1913 American College of Surgeons (ACS) hospital standardizaiton program
1957 ACS program transition to the joint commission on Accreditation of Hospitals
Mimimum requirements (structural and inidividual competence)
3 measurement categories?
Structure Measures
Assess the adequacy of the environment in which medical care takes place
ie-# of registered nurse hrs workder per nursing home resdent each day
-often used for licensing & accreditation
Effective Measurement
Easy to interpret
Consistently reported
Process Measures
-Asses what is being done and whether the system is working as it should
ie-% of women age 42-69 who had a mammogram during the previous 12 mnths
-THE MOST COMMON type of Hlth Care performance measure
Outcome Measure
-Assess discrete, pt-focused endpoints
ie- % of home health care pts who were admitted to a hospital for 24 hrs or more while a in home hlth
-Results can be influenced by factors out of the provider’s control
Selecting Measurement Topics
-External influences
-Priorities of national grps (regulatory, accreditation, and purchasers
-Internal influences
-Strategic priorities of the organization
How to Construct a measure
-Identify topic of interest
-Develop measure
-Design data collection System
IOM key dimensions of quality
patient centered
Design data collection strategy
Identify the best sources of accurate data

Identify what, who , when and how

what and who
-study population
-sample or not?
-Data collectors
– Provide oversight of data collectors
– Provide sufficient training and supervision
When and How
-Frequency of data collection
-Frequency of data reporting
-Data collection instruments
-Electronic data query
(NGF) what does it stand for?
National Quality Forum
Quality Stakeholder grp formed in 1999
Goal- to create national standards for measurement and public reporting of hlth care performance data
NQF endorsement is a “seal of approval” for health care quality measures
Scientific acceptability
Clinical Measures
-Clinical decision making
-Process by which physicians and staff determine which pt’s need what and when
-Measures of clinical decision making
-Often derived from clinical practice guidelines
Measures of clinical decision making
Primarily evidence-based process measures
What is a Balanced Scoreboard?
A framework that helps organizations by translating strategy into operational objectives that drive behavior and performance
Scorecard Categories & Measures
Internal business
Learning & Growth
Statistical Process Control (SPC)
Application of statistical methods to assess and control performance
-Used to identify performance variations that would benefit from further investigation
-Understanding variation is the first step toward improvement
Walter Shewhart Every process displays variation, but:
-Some have only common-cause variation
-Stable, consistent and predictable
– Inherent in the process being measured
-Seome exhibit special-cause variation:
-Unstable inconsistent, unpredictable
– Not inherent in the process being measured
SPC tools
Used to identify the type of variation ehibited by performance data
-line graphs
-Control charts
2 ways to improve a process
If a process is unstable (special-cause variation is prestent)
-elminate special-cause don’t change process
If process is stable (common-cause variation present)
-changes must be made. Common caused are inherent in the process.
Dr. Walter Shewhart developed control limits
-The limts:
-The average +3 or -3
-The rationale for contorl limits
– Do not want to undue # of false alarms
– Do not want to detect each little change is the process
Control Chart
Dr Walter Shewhart developed the control chart to identify types of variation
-Control charts have statistically calculated upper & Lower control limits.
-Usually set at +3 or -3 standard deviations from the mean