Healthcare Customer Service Quiz

Healthcare Quality Concepts

• Healthcare quality is defined as the balance of health benefits and harm.

• Quality in healthcare practice is doing the right things right the first time, every time, for every person.

•  A healthcare quality framework, based on Total Quality Management (TQM) philosophy, includes continuous improvement.

• TQM is a management approach emphasizing quality, leadership responsiveness rather than directness, and decreased emphasis on inspection, focusing on systems and investment in learning and education.

Chapter Outlines

• Definitions of Healthcare Quality (HCQ)
• History of Healthcare Quality
• Aspects of HCQ
• Concepts and principles of HCQ
• Quality dimensions
• Total Quality Management (TQM)
• Concept of value
• The quality chasm
• Error is human
• Role of HCQ professional
• Quality Trilogy

Two Broad Definitions of Quality in Healthcare

• Classic Definition: Quality refers to the ability of a product or service to consistently meet or exceed customer expectations. The issue of defining who is the customer is important.
• Institute of Medicine (1990) Definition: Quality is the extent to which health services for individuals and populations increases the likelihood of desired health outcomes and is consistent with current professional knowledge.

Definitions of HCQ

• Doing the right things right, each time.
• Compliance to standard.
• Freedom from defects.
• Meeting customer expectations.
• Increasing likelihood of desired outcomes.
• Consistent with current professional knowledge.
• Healthcare accessibility, effectiveness, safety, accountability, and fairness.

JCI Defined Quality

• Optimal achievement of therapeutic benefit and avoidance of risk, with minimal harm. (free from harm)

History of Healthcare Quality

• The historical development of healthcare quality concepts is discussed in this chapter

Total Quality Management

• Total Quality Management (TQM) covers encompassing concepts, including Quality Assurance, Quality Control, and Inspection
• Quality control implemented on short notice, focusing on output, and emphasizing the standards.
• Quality Assurance is long-term and focused on processes while emphasizing on customer-oriented activities.

Continuous Quality Improvement

• Continuous Quality Improvement (CQI) is about improving the whole process, not just isolated parts
• CQI encompasses the process elements as an interrelated loop with no starting or ending point

Juran Trilogy

• Juran’s Trilogy encompassing planning, control, and improvement of quality

Quality Gurus

• Quality experts and theories are referenced in this topic

Deming's 14 Points

• Principles that are applied to management are discussed in detail here.

Codman

• The emphasis is on the end results/outcomes.
• Output is something tangible and can be measured.
• Outcome is subjective and cannot be measured

Deming's Philosophy

• The problems with a production process arise from defects in the system's processes.

Key Dimensions of Quality Care

• Safe care
• Timely care
• Effective care
• Efficient care
• Equitable care
• Patient-centered care

Timeliness

• The degree to which care is provided at the most appropriate time.

Availability

• The degree to which appropriate care and services are accessible.

Competency

• The degree to which a practitioner adheres to professional and/or organizational standards of care and practice.

Continuity

• Coordination and delivery of healthcare services consistently over time.

Effectiveness

• Doing something correctly in light of existing knowledge to reach a desired outcome.

Efficacy

• Ensuring the desired effect is achieved based on scientific research/evidence.

Efficiency

• The relationship of outputs of services to inputs of resources used, and how cost-effective the care delivery is.

Prevention/Early Detection

• A process of identifying risk factors and interventions that prevent and treat disease.

Respect and Caring

• Providing care with sensitivity for the individual's needs and expectations, while respecting individual's differences and getting their participation in decisions related to their care.

Safety

• Interventions that minimize adverse outcomes for the patients and healthcare providers.

Key Dimensions of Quality and their Explanations

• Appropriateness: The care and services provided are relevant to the individuals' needs
• Availability: The healthcare services are accessible in case of a need
• Competency: The practitioner’s proficiency in accordance to professional and/or organizational standards
• Continuity: Services are delivered as a coherent unbroken succession across healthcare delivery settings and practitioners.

Quality Management (QM)

• Organizational system assessment
• Clinical performance monitoring (meeting standards)
• Patient outcomes and care process measurement, analysis, and reporting
• Patient safety planning, process implementation and Measurement
• Organization performance improvement process
• Review medical necessity and appropriateness
• Resource allocation, timeliness, appropriateness, efficiency, and cost

Important Roles and Quality Functions

• Quality Management (QM)
• Patient Safety Management (PS)
• Utilization Management (UM)
• Risk Management (RM)

Infection Control (IC)

• Surveillance and prevention
• Medical staff's appointment and reappointment procedure
• Orientation of quality standards, policies, procedures, and documentation
• Data collection, summarization, aggregation of data
• Analysis, display, presentation, and use
• Ongoing organizational communications
• Effectiveness oversight

System Thinking

• Systems analysis that includes seeing overall patterns, structures and cycles

Measurement of Outcomes

• Clinical, functional, and perceived outcomes are assessed.

Factors that affect outcomes

• Disease process and severity
• Care process
• Patient compliance
• Random and unidentified variables

Basic concepts of total quality management

• Productive work is accomplished through specified processes
• Sound customer relationships are critical for quality
• Poor quality is costly and must be prevented.
• Focus on the vital processes with full employee involvement
• Quality management activities

###TQM philosophy

• Emphasis on Quality, responsive leadership
• Decrease emphasis on inspection, focus on systems, not individual
• Investment in learning and education, long-term vision
• Cautious use of minimum standards, ongoing quality improvement

Quality Management Principles and related dimensions

• Quality Management principles and processes
• ISO 9000:2005 Quality Management Principles

Healthcare Quality Strategy (NQS)

• National Quality Strategy (NQS) priorities and leverages to achieve better care, healthy people, and affordable care

Cost of Quality (COPQ)

• Cost of quality refers to the cost of doing well or the cost of prevention

Cost of poor quality (COPQ)

• Cost of poor quality (COPQ) includes cost of scrap, rework, warranty costs, expediting costs, lost sales, and costs due to late delivery, excess inventory, and costly changes to engineering.

Integrated Healthcare

• Interprofessional, characterized by collaboration and communication
• Data is tracked and analyzed to identify improvement opportunities