Lecture 3 Quality management approaches.pptx

Healthcare Quality and Patient Safety HS 415 Lecture 3 Continuous Quality Improvement and Total Quality Management Dr. Fahad Khan Azeez [email protected] Learning Objectives • Explain the concept of continuous quality improvement • Describe steps of improving a process using CQI techniques •...

Healthcare Quality and Patient Safety HS 415 Lecture 3 Continuous Quality Improvement and Total Quality Management Dr. Fahad Khan Azeez [email protected] Learning Objectives • Explain the concept of continuous quality improvement • Describe steps of improving a process using CQI techniques • Explain the relationship of cost to quality • Get familiar with the Total quality management (TQM) philosophy • List the principles used in TQM Continuous quality improvement (CQI) • CQI is an approach to quality management that builds upon traditional quality assurance methods – by emphasizing the organization and systems • It focuses on “process” rather than the individual • It recognizes both internal and external “customers” • It promotes the need for objective data to analyze and improve processes. Continuous quality improvement (CQI) – A quality philosophy that emphasizes ongoing incremental changes to an organizations products and processes to increase customer satisfaction • Using CQI concepts, quality in healthcare may be described as follows – A 'health care delivery system' is a series of interlinked processes, each of which results in one or more outputs. CQI is a Process (Cycle) Core Concepts of CQI • Quality is defined as meeting and/or exceeding the expectations of our customers. • Success is achieved through meeting the needs of those we serve. • Most problems are found in processes, not in people. • CQI does not seek to blame, but rather to improve processes. • Unintended variation in processes can lead to unwanted variation in outcomes, and therefore seek to reduce or eliminate unwanted variation. Core Concepts of CQI • It is possible to achieve continual improvement through small, incremental changes using the scientific method. • Continuous improvement is most effective when it becomes a natural part of the way everyday work is done. Core Steps in Continuous Improvement • Form a team that has knowledge of the system needing improvement. • Define a clear aim. • Understand the needs of the people who are served by the system. • Identify and define measures of success. Core Steps in Continuous Improvement • Brainstorm potential change strategies for producing improvement. • Plan, collect, and use data for facilitating effective decision making. • Apply the scientific method to test and refine changes Importance of CQI in Healthcare • CQI theory is important in the medical setting because it 1. gives a rational definition of quality that applies in all health care settings, 2. clearly shows the relationship between health care costs and quality, and 3. leads to a system under which the highest quality care can consistently be delivered at the lowest justifiable cost CQI and Cost Control A system for Continuous Quality Improvement and Cost Control • Achieving high quality and appropriate cost reductions involves three major steps: – prepare to improve, – implement, and – innovate Preparing to improve 1. Find a process – The first step is to choose a process that needs quality improvement and cost control – For example, admission to the hospital, billing, or analyzing a single blood test are all definable processes Preparing to improve 2. Assemble a team that knows the process. – Those who best understand a process are nearly always those who perform it on a daily basis— frontline workers. – The team must have an understanding of • • • • continuous quality improvement principles, statistical quality control, the use of data management systems, and access to management so that organizational roadblocks to improvement can be overcome. Preparing to improve 3. Identify customers, identify process outputs, and measure customer expectations regarding the outputs 4. Document the process – key process factors (KPFs) are process steps that causally determine whether an output will meet quality expectations. – The team must explicitly document—in written form— those KPFs that lead to the desired output Preparing to improve 5. Generate output and process specifications • A specification is a measurable, statement regarding an important attribute of an output(a customer expectation) or the (sub)process that produces it (key process factors). • Quality cannot be achieved without a sufficient set of measurable specifications that reflect customer expectations and key process factors Implement 6. Eliminate inappropriate variation – The goal is to detect quality events (outcomes) in sub processes and final outputs – Then to relate them to variation in the performance of KPFs in the process. • two types of Variation • Random (Common cause) • Specific (Special cause) • Random – Also called Common cause variation – It is inherent in every process (i.e., it is always present). – The effect of this type of variation on performance is usually minimal and results from the regular rhythm of the process • The different types of outpatient diagnostic tests scheduled by the hospital call center are one example of factors that can create common cause variation in a process. Each test is different, so the time required to schedule them will vary a bit. • Special cause variation results from factors that aren’t inherent in the process and somehow find their way into it. – They infrequently affect the process, but when they do, their impact on performance can be huge. – • Example : Assigning a new part time employee to perform tests in the lab because the usual employee had to go on an emergency leave Innovate 7. Document continuous improvement – Team members can generate ideas about how the process may be changed to improve quality ("lead the customer") or increase productivity. – Use of fundamental knowledge Total Quality Management (TQM) • defined as – a management philosophy that focuses on meeting customer needs and on continuous improvement. • TQM relies on the active involvement of all functional areas and all employees. TQM -Principles • Focus on the customer. – Quality is based on satisfying, and even delighting, the customer. • Top-management leadership and support. – Management is ultimately responsible for quality and must communicate the quality vision to the organization and provide support for it. • Employee involvement. – Employees are key to quality. They must buy into the vision and be empowered to reach the goal. TQM -Principles • Systems thinking. – Everything is related to everything else. Quality will not be achieved without crossfunctional involvement. • Continuous improvement. – Quality is a moving goal. To achieve it, the organization must continuously improve. • Data-based decision making. – The tools and techniques of quality management are needed to ensure quality. References • McLaughlin, C. P., & Kaluzny, A. D. (2004). Continuous quality improvement in health care: theory, implementation, and applications. Jones & Bartlett Learning. • Walburg, J., Bevan, H., & Wilderspin, J. (Eds.). (2006). Performance management in health care: improving patient outcomes: an integrated approach. Psychology Press.