QI Team Process Using Deming Cycle in Nursing Care

Quality Improvement

• Achieves deserved and feasible quality of nursing care using the Deming Cycle (FOCUS-PDCA)
• FOCUS-PDCA involves:
  • Find a process to improve
  • Organize a team that knows the process
  • Clarify current knowledge of the process
  • Understand causes of process variation
  • Select the process improvement
  • Plan the improvement
  • Do data collection, data analysis, and improvement
  • Check data from process improvement and customer outcome
  • Act to maintain and continue improvement

Utilization Review

• Opportunity for health insurance companies to review a request for medical treatment
• Purpose: confirms that the plan provides coverage for medical services, minimizes cost, and determines if recommended treatment is appropriate

Sample of Quality Improvement Activities

• Example: Providing good care for people with chronic illness through timely and clinically relevant information

Complaint Analysis

• A customer complaint is a blessing in disguise
• Prompt resolution of a complaint often generates more customer loyalty than trouble-free service
• Facts about complaints:
  • Average customer tells ten people or more about the problem
  • A complaint identifies an area of business that might need improvement
• Effective questions to analyze complaints:
  • How could we have prevented this service problem?
  • How would you have handled it differently?
  • Could we have responded better to the customer?

Morbidity and Mortality Review Meetings

• Requirements of all medical departments within a hospital
• Guidelines assist departments in conducting effective meetings and setting minimum standards
• Decide what measurement is appropriate (e.g., frequency, quantity, cost, and time)
• Determine the period of time for the Pareto chart
• Collect and record data, and subtotal the measurements for each category

Credentialing

• Process of obtaining, verifying, and assessing the qualifications of a healthcare practitioner
• Simplify the task by focusing on tasks considered to be at risk or where the impact of failure would be felt

Juran

• Focused on quality control with the "trilogy": quality planning, quality control, and quality improvement
• An SPC representation of the trilogy is used in the figure
• A spec is developed usually with a ± tolerance
• A control chart is used to get the process under control

Quality-Based Problem-Solving/Process Improvement

• Quality improvement tools:
  • Control charts (Statistical Quality Control or Statistical Process Control)
  • Lot sampling
  • Process capability
  • Value analysis
• The Deming / Shewhart cycle is useful in solving quality problems
• The PDCA circle denotes continuous improvement by repeating the basic cycle of:
  • Plan
  • Do
  • Check
  • Act

Quality Improvement

• Achieves deserved and feasible quality of nursing care
• Uses Deming Cycle (FOCUS-PDCA) to improve quality
  • F: Find a process to improve
  • O: Organize a team that knows the process
  • C: Clarify current knowledge of the process
  • U: Understand causes of process variation
  • S: Select the process improvement
  • P: Plan the improvement
  • D: Do data collection, data analysis, and improvement
  • C: Check data from process improvement and customer outcome
  • A: Act to maintain and continue improvement

Utilization Review

• Is a health insurance company’s opportunity to review a request for medical treatment
• Purpose: confirms that the plan provides coverage for medical services, minimizes cost, and determines if the recommended treatment is appropriate

Quality Improvement Activities

• Ideas for Change: Clinical Information Systems
  • Example: Provide good care for people with chronic illness by giving clinicians access to timely and clinically relevant information
• Complaint Analysis
  • Identifies areas of business that need improvement
  • Uses three primary tools: customer survey, policy technicians, and customer complaint form
  • Analyzes complaints to improve customer service

Complaints

• A customer complaint is a blessing in disguise, as it can generate more customer loyalty than trouble-free service
• A complaint identifies an area of business that might need improvement
• If multiple customers have the same complaint, it indicates a functional problem that needs analysis, discussion, and correction

Sentinel Events Monitoring

• Defined as serious adverse events that cause death or severe injury to patients and result in loss of trust in the healthcare system
• Surveillance of sentinel events is an important role of public health
• Used to prevent such events and promote patient safety

Ishikawa Diagrams

• Also known as Fishbone or Cause-and-Effect diagrams
• Non-qualitative tools (qualitative)
• Sometimes called 5M Diagram
• Includes:
  • Men
  • Machine
  • Materials
  • Measurements
  • Methods

Pareto Chart

• Used to analyze data about the frequency of problems or causes in a process
• Used to focus on the most significant problems or causes
• Used to analyze broad causes by looking at their specific components

Total Quality Management (TQM)

• Emphasizes using multi-functional teams to solve problems
• Teams use basic statistical tools to collect and analyze data
• Uses tools such as:
  • Check sheets
  • Pareto diagrams
  • Histograms
  • Run charts
  • Flow charts
  • Cause and effect diagrams
  • Scatter diagrams
  • Force field analysis

Credentialing

• Process by which an agent qualified to do so grants formal recognition to and records such status of entities (individuals, organizations, processes, services, or products) meeting predetermined and standardized criteria

ISO/ QS9000

• ISO9000 was developed as a standard for business quality systems
• To be certified, businesses needed to document their quality system and ensure adherence to it with reviews and audits
• A key element was the identification of non-conformances and a Corrective action system to prevent re-occurrences
• Specific quality improvement methodologies were not prescribed
• The automotive industry adopted the QS9000 standard for their suppliers to require the use of specific practices in quality planning and in production operations