Chapter 3 Quality in healthcare.pptx

Quality, Patient Safety, and Communication Learning Objectives Define the meaning of quality in health care services. Understand the basic tools used in quality improvement projects. Describe established methods of quality improvement such as Six Sigma and Lean Management. Understand the importanc...

Quality, Patient Safety, and Communication Learning Objectives Define the meaning of quality in health care services. Understand the basic tools used in quality improvement projects. Describe established methods of quality improvement such as Six Sigma and Lean Management. Understand the importance of monitoring quality to promote better patient outcomes. Introduction • Provision of high-quality care in a safe environment is the focus of today's health care industry • Achieving this goal requires the integration of multiple disciplines Quality Considerations • Quality of a service or product refers to the sum of its properties that serve to satisfy the needs of its consumer. • The National Academy of Medicine suggests the following dimensions in health care quality (STEEP): o Safety o Timeliness o Effectiveness o Efficiency o Equity o Patient-centeredness Plan-Do- Study-Act (PDSA) Cycle Plan Phase: • • • clear goals are set for the quality improvement process Goals should be SMART: Specific, Measurable, Achievable, Realistic, and Time-bound. Determine the specific aim, duration, data collection strategy, and the team that will run the quality improvement project. Fishbone diagram the fishbone (or Ishikawa) diagram to systematically evaluate the different factors that affect the process and contribute to the problem, that is, people, technology, environment, materials, equipment, and methods Plan-Do- Study-Act (PDSA) Cycle • Do Phase: o The intervention is begun, and observations are recorded. o Collect data and record the observations. • Study Phase: Analyze results and derive conclusions • Act Phase: based on the analysis, change the process for improvement; plan the next cycle. Six Sigma • Six Sigma adopts the DMAIC (Define-Measure-Analyze-Improve-Control) cycle for continuous quality improvement o Define: Describe and validate the problem, create solutions, create a process map and a timeline for completion of the project o Measure: Identify metrics, develop data collection plan, collect baseline data Six Sigma o Analyze: Evaluate collected data in the measure phase, determine root causes for the problem, and estimate the relative impact of each. o Improve: Discuss, develop, and implement solutions to the root cause(s), confirm that the intervention is well targeted. o Control: Continue to implement solutions and follow metrics to ensure maintenance and adoption. Origin of the Term Six Sigma • Sigma (σ) is a Greek letter that is used to note standard deviation in a normally distributed population • One standard deviation from the mean in each direction (i.e., ±1σ) contains approximately 68% of the population • At Six Sigma, the rate of failure would be 3 in 1 million (or 0.000003) • The Six Sigma process has a goal of a very, very small error rate Normal (Gaussian) Distribution Lean Management • A business management philosophy which focuses on eliminating waste or non–value added activities • Eliminating waste of time, excess work, and unevenness of product are the goals • Lean management uses tools similar to PDSA and Six Sigma with emphasis on waste elimination The Evolution of Quality in Health Care in the United States • Identification of process components • Increasing efficiency (reducing waste) • Standardization (reducing common variation) • A teamwork approach in implementing solutions Value-Based Purchasing Program • Rewards or penalizes hospitals based on their performance in the domains of process measures (also called core measure compliance), outcomes, patient experience, and efficiency • The health care industry is now adopting principles of quality improvement quickly Disease Management • An organized strategy of delivering care to a large group of individuals with chronic disease to improve outcomes and reduce cost. • Four essential components: 1) An integrated health care system that can provide coordinated care across the full range of patients’ needs 2) A comprehensive knowledge base regarding the prevention, diagnosis, and treatment of disease that guides the plan of care 3) Sophisticated clinical and administrative information systems that can help assess patterns of clinical practice 4) A commitment to continuous quality improvement Monitoring Quality in Respiratory Care • Strategies to monitor quality include: • Intrainstitutional monitoring practices o Centralized government monitoring bodies such as the Centers for Medicare and Medicaid Services (CMS) o Independent agencies such as The Joint Commission (TJC) Or Central Board for Accreditation of Healthcare Institutes (CBAHI) • Institutional quality assurance often uses skills checks or competencies. • Many health care organizations seek voluntary accreditation Nine Steps for Quality Assurance Plan 1. Identify problem 2. Determine cause of problem 3. Rank problem 4. Develop strategy for resolving problem 5. Develop appropriate measurement techniques 6. Implement problem-resolution strategy 7. Analyze and compile results of intervention 8. Report results to appropriate personnel 9. Evaluate intervention outcome TJC Standards for Performance Improvement • Quality care remains the first goal of hospitals. • Performance improvement (continuous quality improvement) is an ongoing process designed to detect and correct factors that interfere with quality and cost-effective healthcare. • The hospital collects data to monitor its performance • The hospital compiles and analyzes data • The hospital improves performance on an ongoing basis Quality- Monitoring Benchmarks • Monitoring the correctness of respiratory care plans • Monitoring the consistency of formulating respiratory care plans among therapist evaluators • Evaluating the efficacy of algorithms or protocols • Evaluating the overall effectiveness of the protocol program Thank You