Quality Improvement Basics PDF

Chapter 7 Quality Improvement Basics  To Err Is Human (Kohn, Corrigan, & Donaldson, 2000)- medical errors, concluding that between 44,000 and 98,000 people die every year from these errors. people struggling to perform within a system that is riddled with opportunities for mistakes to hap...

Chapter 7 Quality Improvement Basics  To Err Is Human (Kohn, Corrigan, & Donaldson, 2000)- medical errors, concluding that between 44,000 and 98,000 people die every year from these errors. people struggling to perform within a system that is riddled with opportunities for mistakes to happen. Crossing the Quality Chasm (Institute of Medicine, 2001)- outlined a number of goals for improving the quality and performance of the U.S. healthcare system, as well as some of the methods for achieving those goals. The first section the more common definitions of quality, the importance of healthcare quality, and key figures in quality improvement. The second section strategic framework for improving quality and performance based on the Baldrige Award criteria. The third section Common elements of quality improvement, The fourth and fifth sections several approaches for implementing quality improvement as well as discussing the tools and techniques of quality improvement.  Definition of Quality Institute of Medicine: – “degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge.” – high-quality health services should achieve desired health – outcomes for individuals- matching their preferences for variety. – Second, they should achieve desired health outcomes for populations, matching the societal preferences of policy makers and third-party payers for efficiency. – third, they should adhere to professional standards and scientific evidence, consistent with the clinical focus and preferences of healthcare providers for effectiveness.  Definition of Quality Donabedian conception of quality as: – Structure – material and human resources of an organization and the facility itself- Quality of personnel e.g (registered nurse, board-certified physician, etc.), while the quality of facilities lies in accreditation (in hospitals through The Joint Commission). – Process –Actual delivery of care, quality processes both in management and production of health care – Outcomes – quality resulting from the application of structural and process variables like health status of the patient.  Definition of Quality (cont’d) Donabedian’s four parts 1. Technical management of health and illness-focuses on the clinical performance of healthcare providers 2. Interpersonal relationships between providers and their clients-health service quality is driven both by clinical and nonclinical processes 3. Amenities of care-speak to the patient's interest in pursuing individual well-being (or variety) 4. Ethical principles guiding care-speak to the provider's interest in furthering societal and organizational well- being (or effectiveness).  Definition of Quality (Cont’d.) Two quality questions: 1. Are the right things done? (effectiveness) 2. Are things done right? (efficiency) Effectiveness is defined as “providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse)” Efficiency is defined as “avoiding waste, in particular waste of equipment, supplies, ideas, and energy” (IOM, 2001).  Why Is Quality Important? Underuse – failure to provide a service whose benefit is greater than its risk. – 54.9% of patients receive recommended care. Overuse – use of service when risk outweighs its benefits. – Uncritical use of antibiotics, especially in consumer products. Misuse – risk that service is provided badly, reducing benefit to patient. – Medical errors, medication errors.  Why is Quality Important? One of the key issues in healthcare quality is the appropriate use of scarce resources to improve the health of both individuals and the entire population. Underuse – failure to provide a service whose benefit is greater than its risk when doctors or hospitals neglect to give patients medically necessary care or to follow proven health care practices – Underuse of Beta Blocker prescription after first heart attack – One study showed that only one in 20 women are consistently getting an annual breast cancer screening mammogram, despite the fact that regular mammograms are clearly associated with reduced risk of death from breast cancer.2 – Nearly 10,000 deaths from pneumonia could be prevented each year with a one time vaccination. Yet in 2005 only 56 out of 100 adults age 65 and older received the shot.  Why is Quality Important? Overuse – use of service when risk outweighs its benefits occurs when a drug or treatment is given without medical justification – Uncritical use of antibiotics, especially in consumer products – For example, antibiotics are prescribed inappropriately for children’s ear infections 80 percent of the time despite the finding that these infections get better within three days without antibiotics. – In health care, more is not always better. More spending and treatment does not translate into better patient outcomes and health. For example, when used appropriately, MRI’s and other imaging exams are valuable. But MRI’s often don’t change the treatments prescribed or a patient’s outcome, in which case the technology is an unnecessary cost.  Why is Quality Important? Misuse – risk service is provided badly reducing benefit to patient Misuse is another way of describing medical errors. It occurs when a patient doesn’t fully benefit from a treatment because of a preventable problem – or when a patient is harmed by a treatment. – Between 44,000 and 98,000 people die annually from preventable errors—more than from car accidents, breast cancer or AIDS combined – Misuse includes avoidable medical errors like prescribing a drug the patient is allergic to, for example a patient who gets a rash after receiving penicillin for strep throat, despite having a known allergy to that antibiotic  Relevance of Health Information Technology Health Informatics: the multidisciplinary field in which information technology is brought to bear on the health care system to improve quality, raise efficiency, and lower costs. Health Analytics: the use of quantitative measures to drive fact-based decision making. Data Mining: the use of sophisticated analytical tools to understand and predict a variety of health care outcomes.  Common Elements of Quality Improvement Measurement – Definition – Reliability – Validity Process Variation and Statistical Process Control – Special Cause Variation – Common Cause Variation Common Elements of quality improvement Measurement – Definition-definition of the concept to be measured, concept to be measured (e.g., wait times) needs to be defined in very specific terms. E.g wait times could be defined as the time interval between the arrival of a patient at the office and the time he or she is first seen by the doctor. – Reliability-(e.g., consistent)-means that if a measure is taken at several points over time or by various people, the measure will generally be consistent (that is, not vary too much). – Validity-(e.g., accurate)-accuracy of the measure Common Elements of quality improvement Process Variation-range of values that quality metric can take as a result of different causes within the process. – Special Cause Variation-due to unusual,infrequent, or unique events – Common Cause Variation-due to the usual or natural causes of variation within a process. Statistical Process Control-method by which process variation is measured, tracked, and controlled in an effort to improve the quality of the process.  Approaches in quality improvement 1. Continuous Process Improvement (CQI) “A structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations.” Based on process part of Donabedian’s definition. TQM/CQI’s five dimensions: 1. Process focus 2. Customer focus 3. Data-based decision making 4. Employee empowerment 5. Organization-wide scope FOCUS-PDCA  FOCUS/PDCA Find – identify a process problem. Organize – put together a team to work on process. Clarify – use techniques to clarify the problem: – Geographic mapping – Flowcharting Understand – measure and collect data to document the problem. Select – identify process improvements for implementation.  FOCUS/PDCA (Cont’d.) Plan – create an implementation plan for taking the process to the next level. Do – implement and test the new process. Check – evaluate the measures used and assess outcomes. Act – assure continuation of newly implemented process, if successful, or redo the process, if not successful.  2. Six Sigma “Data-driven quality methodology that seeks to eliminate variation from a process.” Six sigma required resources like – up-front training in quality improvement tools and concepts, time and personnel resources and long term management commitment for quality improvement. Large HR component – Quality training and personnel – Leadership DMAIC  DMAIC Define – delimit scope of work and time frames for completion. Measure – create and apply measures and metrics. Analyze – assess and flowchart the process. Improve – specify the steps to be taken to meet goals. Control – assure permanence of the improvements.  Toyota Production System/Lean Rigorous definition of value. Relentless pursuit of removing waste from the system. Waste consists of overproduction, inventory, transportation, overprocessing, defects, waiting, and underutilization of staff.  Toyota Production System/Lean (Cont’d.) Attitude of continuous improvement. Value creation. Unity of purpose. Respect for people who do the work. Visualization. Flexible regimentation.  Quality Improvement Tools Process mapping – Flowchart – Workflow diagram Data collection – Check sheet – Chart abstractions or chart audits Process analysis – Cause-and-effect (fishbone) diagram – Pareto chart Workflow diagram Flowchart  Assignment 1. What is the meaning of EHR? 2. What is the meaning of EMR? 3. Discuss the difference between EHR and EMR? 4. What are the benefits of both of them? 5. What are the disadvantages?