Healthcare Quality PDF

7/1/2024 Healthcare Quality FINAL REVISION Prepared AND PRESENTED BY: Dr/ Wesam Nageib (+966548794731) Pharmacist , CPHQ , LSSBB, MSC, ISQUA,TOT,MQM, EFQM 1...

7/1/2024 Healthcare Quality FINAL REVISION Prepared AND PRESENTED BY: Dr/ Wesam Nageib (+966548794731) Pharmacist , CPHQ , LSSBB, MSC, ISQUA,TOT,MQM, EFQM 1 Mind Maps  7/1/2024 KEY DIMENSIONS OF QUALITY Appropriateness  Provided services are relevant to customer’s needs – CORRECT as judged by peers Timeliness  Care provided at most beneficiary time. Availability  Care accessible and obtainable when needed by customer. Competency  Practitioners adhering to the standards when providing the care. Continuity  coherent unbroken succession of services Effectiveness = Outcome  Care provided in right manner to achieve the desired outcome. Efficacy = Capacity  Potential Capacity or Capability of care to produce the desired outcome. Efficiency = Resources  Relationship between OUTCOME to the RESOUCES Prevention Early Detection  Interventions (identification of risk factors)  Promote health and prevent diseases. Respect and Caring  Service providers are sensitive to the customer’s needs and involving customer in decision. Safety  Minimizing risk of adverse outcome for both customer and provider. Mind Maps Mind Maps  7/1/2024 A customer is one who receives goods or services. Customer satisfaction is viewed in healthcare as an essential component of success in delivering Value for the consumer includes the price of care, interpersonal quality. interactions, and the quality of the service received. DR/WESAM NAGEIB ([email protected]) 5 Special problems for quality management @ Ambulatory Care  Medical records are still poorly developed.  Difficult to predict the outcome of the ambulatory treatment.  Diet and medication are under the control of the patient.  access to specialty care Mind Maps  7/1/2024 Mind Maps TOPIC 2: LEADERSHIP STYLES 8 DR/WESAM NAGEIB ([email protected])  7/1/2024 Successful Leader and Manager To summarize : Alignment, aspiration vision and To summarize : Manage day to day activity and leading by 9example DR/WESAM NAGEIB ([email protected]) compliance The cost of quality Price of nonconformance (PONC) : this includes the expenses associated with correcting the error. The price of conformance (POC): includes expenses of executing quality and do the write thing from the beginning. The cost of quality refers to the costs to prevent non-conformance from happening and the costs incurred when non-conformance in products and services occurs (cost of poor quality). EX.medical error. Identifying and reporting the Cost of Quality (COQ) and Cost of Poor Quality (COPQ) activities of the quality program are important, to support the organization's commitment to quality with clear financial data. 10 DR/WESAM NAGEIB ([email protected])  7/1/2024 11 DR/WESAM NAGEIB ([email protected]) Top leader and governing Set strategic plan. body Departmental action plans. Budget , process ,review and evaluate day to day work. Vision Mission Values Make SWOT analysis Set Goals , ( strength, weakness, Objectives strategic opportunities, initiatives and action threats)12 DR/WESAM NAGEIB ([email protected]) plan.  7/1/2024 DR/WESAM13NAGEIB ([email protected]) Donabedian’s Paradigm (Systems Approach) – Causal Relationship - Healthcare Model – Donabedian’s Model Mind Maps  7/1/2024 Mind Maps Mind Maps  7/1/2024 Managed care payment method: Prepayment for services with a fixed number of dollars for Capitation a fixed number of persons regardless of care the patient received. ‫مبلغ ثابت سنويا بصرف النظر عن الخدمات المقدمه‬ A fixed amount (for example, $15) you pay for a covered Co- health care service, usually when you get the service. The Payment amount can vary by the type of covered health care service. ‫نسبة التحمل‬ The amount you owe for health care services your health Deductible insurance or plan covers before your health insurance or plan begins to pay.‫ماتدفعه شركات التأمين لمقدمى الرعايه الصحيه‬ 17 DR/WESAM NAGEIB ([email protected]) Mind Maps  7/1/2024 Important Notes For Exam Seeking for accreditation: 1. Leadership commitment. 2. Becomes familiar with the appropriate standards. 3. Assign a team for the accreditation. 4. Standards education. 5. Communicate accreditation process to all staff. (Through the accreditation team.).. 6. Educate all staff members the FAQs by the surveyors. And check compliance to standards. 19 DR/WESAM NAGEIB ([email protected]) Identify For improvement ACT the gap Key to effective benchmarking is to be sure you are comparing the same processes in both organizations. 20 DR/WESAM NAGEIB ([email protected])  7/1/2024 1. Empowerment ‫التمكين‬  Giving employees greater responsibility and authority and information they need to make wise ‫تشجيع‬ recommendations or decisions and solve problems. Empowered staff are : ‫اشراك في اتخاذ‬ Properly trained. ‫القرار‬ Informed about and aligned with organizational strategies. Authorized to act within parameters and feel secured (no fear). ‫مصرح له بالتصرف ضمن معايير‬ Empowerment enables people to: Take ownership of their jobs and make decision ‫تمكين‬ concerning their department. Take responsibility for their decisions. Add value to their 21 jobs. (the result) DR/WESAM NAGEIB ([email protected]) 2.Negotiation is the best way in conflict resolution DR/WESAM NAGEIB ([email protected]) Negotiation: Negotiation is the art of conferring ‫التفاوض هو فن التشاور‬, discussing, or bargaining ‫ مساومه‬to reach agreement  Types of negotiation 1. -Hard negotiation: Out for "the kill“.‫كأنه بيدى أوامر‬ 2. -Soft negotiation: Must be liked by the other side, giving in to ensure a good feeling.. ‫يجب أن يكون مرغوب من الجانب اﻵخر‬  Principled or interest-based negotiation: win-win. ‫الكل يطلع كسبان‬ 1.Focus on the problem, not role as friends or enemies. ‫ركز على حل المشكله دون تحيزلصديق او عدو‬ 2.Separate issues from people; ‫افصل القضايا عن الناس‬ 3.Search for mutual gain based on each person's real interests. ‫ابحث عن الربح‬ ‫المتبادل‬ 22  7/1/2024 Decision by consensus ‫قرار باﻻجماع‬  Consensus is a group discussion where everyone’s opinions are heard and understood, and a solution is created that respects that opinions. All support  Consensus is not what everyone agrees to. decision  But, an acceptable resolution , one that can be supported by everyone, even if not the favourite of each one. Consensus occurs when the majority agrees on a certain course of action and everyone else in the group is willing to proceed for the sake ‫مصلحة‬of the group, even some may not have chosen that course of action and would prefer another. 23 DR/WESAM NAGEIB ([email protected]) DR/WESAM NAGEIB ([email protected]) Resiliency :is the process of adapting well in the face of diversity ,trauma ,tragedy , threats and any significant source of Stress then bounce back to the normal state..‫ ثم اﻻرتداد إلى الحالة الطبيعية‬،‫عملية التكيف بشكل جيد في مواجهة الشدائد والصدمات‬ 24  7/1/2024 Change models: ‫اثبت‬ ‫التغيير‬ ‫تحالف قوى‬ Leadership commitment 25 DR/WESAM NAGEIB ([email protected]) Lewin’s change Model: Lewin’s change Model: For change to occur , driving forces must be stronger than restraining forces. More impact may be achieved by removing restraining forces than by adding more driving forces. 26 DR/WESAM NAGEIB ([email protected])  7/1/2024 Palmer’s change model: 1st assess readiness by using the change readiness guidelines 1st step (assess) 27 DR/WESAM NAGEIB ([email protected]) Stages of Team Development 28 DR/WESAM NAGEIB ([email protected])  7/1/2024 Help in good decision making DR/WESAM NAGEIB ([email protected]) 29 Categorical data Continuous data: Non-parametric parametric DR/WESAM NAGEIB ([email protected]) Also Known As: Also Known As: Attribute Variable ‫ارقام صحيحه ﻻ‬ Discrete ‫يمكن ان‬ Quantitative ‫تحوى عﻼمات‬ Nominal ‫تحوى ارقام‬ Interval ‫عشريه‬ Ordinal ‫عشريه‬ Ratio Qualitative Examples: Members, Patients, Births, Procedures, Examples: Age, Height, Weight, Temperature, Occurrences, Gender Time, Charges (money), LOS Measure of central tendency: median(ordinal) or Measure of central tendency: mean mode(nominal) Usual statistical test of difference between 2groups: Usual statistical test of difference between 2groups: Chi Square T test Usual display tools: Usual display tools: Histogram Table Run chart Scorecard Control chart Pareto Scorecard (not the best to use) 30 Bar  Data display over time = use run or control chart  7/1/2024  DR/WESAM NAGEIB ([email protected]) 31  DR/WESAM NAGEIB ([email protected]) 32  7/1/2024 DR/WESAM NAGEIB ([email protected]) 33 Mind Maps  7/1/2024 When developing a questionnaire or other data collection tool, there are certain terms that need to be understood. Sensitivity The ability of a measure, test, or tool (study design, screening tool, or lab test) to identify and select all positive cases or specified variations or deviations with few "false negatives. Specificity The ability of a measure, test, or tool to to exclude those negative cases with few "false positives".. Usability The relative ease with which the indicator can be understood or the tool can be used. The ability of the indicator or tool to identify, capture, and measure the needed Reliability information in reproducible way.‫طلع نفس الن جه ل مره اق س بها‬ Validity the ability to measure what is really desired to be measured.= accuracy Stratification The classification of data into homogeneous groups or subsets, e.g., the study of UTI by ‫التقس م لمجموعات‬organism; by catheterization, by surgical procedure, by nursing unit. ‫مماثله‬ DR/WESAM NAGEIB 35 ([email protected]) Mind Maps  7/1/2024 Common cause & special cause variation Common cause variation Special cause variation Noise. Natural problems. Assignable cause. Random cause. Unusual problem. Quantifiable. Sporadic causes. Anticipated. Non quantifiable. Chronic. Non anticipated. Intrinsic , inlier. No need for intensive analysis Acute. only ongoing. Extrinsic ,outlier. DR/WESAM NAGEIB Need intensive analysis. ([email protected]) 37 38 DR/WESAM NAGEIB ([email protected])  7/1/2024 (SIGNS OF PRESENCE OF SPECIAL CAUSE VARIATION) One point outside the control limits. Two points in Zone A. Four points in Zone B. Eight successive points in Zone C on the same side of the centre line. DR/WESAM NAGEIB ([email protected]) 39 conclusions Relationship Prioritization Flow chart. Multi-voting. Fishbone. Prioritization matrix. 5 why ?. Pareto. Tree diagram. Remove PDPC. waste steps: Value-stream Interrelation diagram. map. Idea collection: brainstorming Decrease Nominal resistance : Delphi Force-field analysis 40 DR/WESAM NAGEIB ([email protected])  7/1/2024 Conclusions: Problem solving : Data categorization: Affinity diagram. A3 report. Lotus diagram PDPC (tree diagram with solutions). Tracking : Data display: Checklist. Story board Gant chart 41 DR/WESAM NAGEIB ([email protected]) Mind Maps  7/1/2024 DR/WESAM NAGEIB ([email protected]) 43 DR:WESAM NAGEIB (PHARMACIST,CPHQ,CSSYB) 44 [email protected]  7/1/2024 DR:WESAM NAGEIB (PHARMACIST,CPHQ,CSSYB) 45 [email protected] Mind Maps  7/1/2024 Malcom Baldridge (National Quality Award)  Focus on staff as human resources to have this award. Magnet Recognition Program  Developed by American Nurse Credentialing Program for nursing excellence.  Focus on transformational leadership (leader by motivation and inspiration) Center for Improvement in Healthcare Quality (CIHQ) & DNV JCI Mind Maps 48 DR/WESAM NAGEIB ([email protected])  7/1/2024 The ADDIE Model for Training Program Development (A)Analysis : (assess the needs of the organization, pre test and goals). (D) Design: (teaching strategies and develop course materials). (D) Development: (development , train instructors and pilot test). (I) Implementation. (E) Evaluation (measure).  Training is most effective when it provides learners with a clear statement of what they must be able to do as a result of training, and how their performance will be evaluated." The best outcome of any training is: Attitude change (A)+ skills change(S)+ knowledge change(K) = behavior change(B) 49 DR/WESAM NAGEIB ([email protected]) Mind Maps  7/1/2024 Mind Maps deming shewart Mind Maps  7/1/2024 Intensive analysis Initial analysis DR/WESAM NAGEIB([email protected]) 53 Mind Maps  7/1/2024 Utilization review Physical therapy, X- rays, lab tests and ultrasounds LOS(length of stay) Multiple visits Trigger 55 DR/WESAM NAGEIB ([email protected]) ‫يعتبر كوسيلة اﻻتصال بين‬ HCW DR/WESAM NAGEIB ([email protected]) 56  7/1/2024 Definition Of Population Health  The (WHO)defines Population Health as “the health outcomes of a group of individuals.  Population Health is about improving the health of a defined group of people based on SDOH.  (SDOH) Social Determinants of Health,:such as medical care systems, the social environment, and the physical environment, have biological impact on individuals in part at a population level. 7/1/2024 7/1/2024  7/1/2024  Care Transitions occur when a patient moves from one health care provider or setting to another.  The American Case management Association(ACMA) Standards to ensure optimal transition of care standard1 Identify patients at risk of poor transitions. Standard2 Complete a comprehensive transition assessment. standard3 standard4 Establish a dynamic care management plan. standard5 Communicate essential care transition information to key stakeholders. Mind Maps  7/1/2024 What is the meaning of risk?? The Risk is : Possibility of a loss or injury due to dangerous element or factor that has the potential to interfere with an organization's ability to deliver medical care. (‫احتمالية حدوث الضرر)لم يحدث بعد‬ Hazard Risk HARM 65 DR/WESAM NAGEIB ([email protected]) Risk management in healthcare  A formal attempt to control liability ‫المسؤليه‬, prevent or reduce financial loss, and protect the financial assets of the organization. The reduction of potential financial loss due to damage or patient injury (Potentially compensable events). ‫قضايا تعويض‬ What is the goal of risk manager? ‫الترتيب مهم‬ (1)To identify and mange risks. (2)To prevent or minimize risk of harm to patients , visitors , healthcare professional and staff. (3) To identify opportunities for improvement. (4)Reducing not eliminating potential financial loss. 66 DR/WESAM NAGEIB ([email protected])  7/1/2024 Risk control includes: Eg :organ transplantation Risk transfer e.g making referrals e.g :unit dose medication to minimize dosing errors. 67 DR/WESAM NAGEIB ([email protected]) Cost Analysis Methods 1. Cost-Benefit Analysis(CBA) = monetary / monetary income Comparing/evaluating quantitatively all costs incurred and benefits returned for each proposed service or program. The overriding question: Is the program or service worthwhile? ‫جدير باﻻهتمام‬  The decision is a good one , if resulting in a positive rather than outcome negative "return on investment" 68 (ROI). DR/WESAM NAGEIB ([email protected])  7/1/2024 'Return On Investment - ROI‘:  A performance measure used to evaluate the efficiency of an investment or to compare the efficiency of a number of different investments.  To calculate ROI, the benefit (return) of an investment is divided by the cost of the investment; the result is expressed as a percentage or a ratio. The return on investment formula: cost = benefit at this point DR/WESAM NAGEIB 69 ([email protected]) 2- Cost-Effectiveness Analysis (CEA) = Monetary / Outcome  A comparison of costs (expenditures) ‫النفقات‬in monetary units with effects (outcomes) but non monetary units, e.g., reduced morbidity or mortality reduced infection rate, increase patient satisfaction. DR/WESAM NAGEIB CPHQ,CSSYB 70 ([email protected])  7/1/2024 Elements of safety culture ( safety program) Open culture 71 DR/WESAM NAGEIB ([email protected]) Mind Maps  7/1/2024 Mind Maps DR/WESAM NAGEIB ([email protected]) 74  7/1/2024 Patient involved Don’t forget to involve patient in SS marking. DR/WESAM NAGEIB ([email protected]) 75 Types Of Errors Active Error Latent Errors an error associated with the errors in the design, organization , performance of the ‘front-line training, or maintenance that lead operator. to operator errors. a complex system and whose effects are felt almost They may lie dormant in the system immediately. for lengthy periods of time. They represent root causes of Synonym : The sharp end refers to adverse events. the personnel or parts of the health Synonym : The blunt end refers to care system in direct contact with the many layers of the health care patients(e.g., an orthopedist who system not in direct contact with operates on the wrong leg) or (e.g., patients, but which influence the nurse programming an intravenous personnel and equipment at the pump. 76 DR/WESAM NAGEIB ([email protected]) sharp end who do contact patients.  7/1/2024 1. ROOT CAUSE ANALYSIS  is a systematic approach to understanding the causes of an adverse event and identifying system flaws that can be corrected to prevent the error from happening again.  RCAs are retrospective: they look back at an error that occurred. (RCA) is a reactive approach  Focusing on system causes, rather than blame, is the central feature of root cause analysis.  A systems approach to error asks, “What circumstances led a reasonable person to make reasonable decisions that resulted in an undesirable outcome?”‫ما الظروف ال أدت لذلك‬  A root cause is a latent, vulnerability ‫ ذو تأث عا‬in a system that allows an error to occur; changing or correcting the root cause could help prevent the error from happening again. 77 DR/WESAM NAGEIB ([email protected]) 2.FMEA 78 DR/WESAM NAGEIB ([email protected])  7/1/2024 AHRQ Quality Indicators The current AHRQ(Agency for Healthcare Research and Quality) QI modules represent various aspects of quality: a) Prevention Quality Indicators. b) Inpatient Quality Indicators. c) Patient Safety Indicators. d) Pediatric Quality Indicators. DR/WESAM NAGEIB ([email protected]) 79 Rules that must be followed to the line. Empower any worker to speak up and to stop the line regardless of rank or seniority. Red rules are part of just culture. Examples: Patient identification. Time-outs before an invasive procedure. Sponge count reconciliation. DR/WESAM NAGEIB 80 ([email protected])  7/1/2024 DR/WESAM NAGEIB ([email protected]) 81