Patient Reported Outcome Measures (PROMs) PDF

12/15/23 3003 Final review 1 Patient Reported Outcome Measures (PROMs) • PROM’s are tools used to gain insight from the perspective of the patient: • into how aspects of their health, and • the impact the disease and its treatment are perceived to be having on their lifestyle and subsequently the...

12/15/23 3003 Final review 1 Patient Reported Outcome Measures (PROMs) • PROM’s are tools used to gain insight from the perspective of the patient: • into how aspects of their health, and • the impact the disease and its treatment are perceived to be having on their lifestyle and subsequently their quality of life. • They are typically self-completed questionnaires, which can be completed by a patient or individual about themselves, or by others on their behalf. Meadows, K. A. (2011). Patient-reported outcome measures: an overview. British journal of community nursing, 16(3), 146-151. 2 2 1 12/15/23 Patient Reported Outcome Measures (PROMs) • Why are PROMs important? • Couldn’t we be satisfied with clinical outcomes such as HbA1c (measure of sugar levels) for a patient with diabetes. • However, clinical outcomes do not provide the full picture on the impact the disease might be having on the patient’s QoL, for example: • because of the restrictions on their social activities as a consequence of a fear of going into a hypo-glycaemic coma. Meadows, K. A. (2011). Patient-reported outcome measures: an overview. British journal of community nursing, 16(3), 146-151. 3 3 Patient Reported Outcome Measures (PROMs) • Common constructs measured by PROMs include: • health status: focus on the quality of health including biological and physiological functioning. • QoL: t is based on the individual’s subjective evaluation of the psychological, physical and social aspects of their life, which is changing over time as a result of different influences such as treatment • health-related quality of life (HRQoL): the degree to which the treatment and the disease as perceived by the individual to impact on those aspects of their life - in addition to health – which are considered important. Meadows, K. A. (2011). Patient-reported outcome measures: an overview. British journal of community nursing, 16(3), 146-151. 4 4 2 12/15/23 Quality Improvement Tools (t/f question) • QI models vs QI improvement tools: it is difficult to understand the difference between them • QI models focus on the design of QI efforts • QI tools are the tangible materials and activities that take the design from an abstract concept to a concrete structure. • In QI, different tools have different purposes. Joshi, M., Ransom, S. B., Ransom, E. R., & Nash, D. B. (Eds.). (2022). The healthcare quality book: vision, strategy, and tools. Chicago, IL, USA:: Health Administration Press. 5 Quality Improvement Tools: Categories • Organized into seven categories: 1) 2) 3) 4) 5) 6) 7) Cause analysis Evaluation and decision-making Process analysis Data collection and analysis Idea creation Project planning and implementation Knowledge transfer and spread techniques Joshi, M., Ransom, S. B., Ransom, E. R., & Nash, D. B. (Eds.). (2022). The healthcare quality book: vision, strategy, and tools. Chicago, IL, USA:: Health Administration Press. 6 3 12/15/23 Quality Measurement • Key themes in quality measurement o Safe—Avoiding harm to patients from the care that is intended to help them o Timely—Reducing waits and sometimes harmful delays for both those receiving care and those giving care o Effective—Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those who are not likely to benefit (i.e., avoiding underuse and misuse, respectively) o Efficient—Avoiding waste, including waste of equipment, supplies, ideas, and energy o Equitable—Providing care that does not vary in quality because of patients’ personal characteristics, such as gender, ethnicity, geographic location, or socioeconomic status o Patient centered—Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions Joshi, M., Ransom, S. B., Ransom, E. R., & Nash, D. B. (Eds.). (2022). The healthcare quality book: vision, strategy, and tools. Chicago, IL, USA:: Health Administration Press. Chapter 8 7 QI Models or Approaches • Several models guide the process for quality improvement (QI) • QI models have different names, but they share several core formats: 1) Identify the problem 2) Measure current performance 3) Perform a cause analysis 4) Develop and implement an improvement strategy 5) Measure the effect of the intervention 6) Modify, maintain, or spread the intervention Joshi et al. (2022). Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 8 8 4 12/15/23 Approaches to QI • Donabedian’s structure, process and outcome • PDSA (Plan-Do-Study and Act) Cycle • Deming’s principles • Sigma • Lean principles • STEEEP • Six Sigma principles Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 9 9 Donabedian’s approach • Measurement and evaluations of care quality can be classified in terms of one of three measures: • Structure • Process • Outcome Copyright © 2022 Foundation of the Am erican College of Healthcare Executives. Not for sale. 10 10 5 12/15/23 Measurement: Structure • Structure measures focus on the relatively static [fixed] characteristics of the individuals who provide care and the settings in which the care is delivered. • E.g., education, training, certification; facility setting; equipment • Structure-focused assessments are most revealing when deficiencies are found. • Good quality is unlikely if those who provide care are unqualified, or if [the] necessary equipment is missing or in disrepair. Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 11 11 Measurement: Process • Process measures focus on what takes place during the delivery of care. • Two aspects: • Appropriateness: whether the right actions were taken • E.g., whether the correct test was ordered • Skill: how well the actions were carried out • E.g., how well a surgeon completed a procedure Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 12 12 6 12/15/23 Measurement: Outcome • Outcome measures focus on whether the goals of care were achieved. • E.g., whether a patient’s pain subsided, the condition cleared up, or the patient regained full function • Many factors that determine clinical outcomes (e.g., genetics, environmental factors) are not under the clinician’s control. Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 13 13 Measurement – Donabedian (Structure, Process, Outcome) Type of Measure Focus of Assessment Metric Benchmark Structure Nurse staffing in nursing homes Hours of nursing care per resident day At least four hours of nursing care per resident day Process Patients undergoing surgical repair of hip fracture Percentage of patients 100% receive who received antibiotics on day of prophylactic antibiotics surgery on day of surgery Outcome Hospitalized patients Rate of falls per 1,000 Fewer than five falls patient days per 1,000 patient days Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 14 14 7 12/15/23 “Phases of quality management cycle” PDSA Cycle • Plan. What are you trying to accomplish? What do you think will happen? What will you measure? Who will do what, where, and when? • Do. Educate and train staff, carry out the plan, document problems and unexpected observations, begin analysis of the data. Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 15 15 PDSA Cycle • Study. Assess the effect of the change and determine the level of success as compared to the goal/objective, compare results to predictions, summarize lessons learned, determine what changes need to be made. • Act. Act on what you have learned, perform necessary changes, identify remaining gaps in process or performance, carry out additional cycles. Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 16 16 8 12/15/23 Lean Model • Lean model of improvement is used to eliminate inefficiencies adversely affecting performance. • https://www.youtube.com/watch?v=PRwSIp3VyPE Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 17 17 Lean Model • Healthcare organizations eliminate waste and thus improve efficiency and quality by applying the five Lean principles of process improvement: 1. Value. Identify what is important to the customer and focus on it. 2. Value stream. Ensure all activities are necessary and add value. 3. Flow. Strive for continuous processing through the value stream. 4. Pull. Drive production with demand. 5. Perfection. Prevent defects and rework. Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 18 18 9 12/15/23 Lean Model: Value Driven • The underlying and unique philosophy of Lean, in comparison to other QI methods, is the elimination of processes that do not add value to the product or service from the customer's perspective. • Lean differentiates between value-added (VA) and non-value-added (NVA) activities with the goal of eliminating NVA activities. • In Lean work, front-line personnel are in control, supported by managers, as they are directly able to know what changes are needed and how to implement changes.1 1. Cohen RI. Lean methodology in health care. Chest. 2018;154(6):1448-1454. Ojo, B., Feldman, R., & Rampersad, S. (2022). Lean methodology in quality improvement. Pediatric Anesthesia, 32(11), 1209-1215. 19 19 Six Sigma • The aim of Six Sigma is to reduce variation in key business processes. • Overview of six sigma in healthcare • https://www.youtube.com/watch?v=qPzuTGl9ke0 Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 20 20 10 12/15/23 Six Sigma • Five steps to use six sigma (DMAIC): • Define the problem • Measure key aspects of the process • Analyze the data • Improve the system • Control and sustain the improvement Note: see case example, exhibit 5.7, Spath, p. 138 Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 21 21 “Characteristics of reliable healthcare service.” • What is reliable in healthcare? • Reliability measures how consistent the quality and safety of health care systems or processes perform over a required period of time. A highly reliable system has a lower risk of errors and process failures that can cause patients harm. • STEEP 22 11 12/15/23 23 STEEEP Measures - characteristics of Healthcare Quality • STEEEP: • Safety • Timeliness • Effective • Efficient • Equitable • Patient-Centered Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 24 24 12 12/15/23 Safety • Safe: Avoiding harm to patients from the care that is intended to help them. • Zero Harm • The Model for Improvement advocated by the Institute for Healthcare Improvement (IHI) is based upon three interdependent types of measures: 1. process measures 2. outcome measures 3. balancing measures • Preventable vs. Nonpreventable Adverse Events Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 25 25 Timeliness • Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care. • Same-day access to care • Patient experience feedback is critical for evaluation of timeliness. • Consumer Assessment of Healthcare Providers and Systems (CAHPS) Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 26 26 13 12/15/23 Effective • Effective: 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 misuse, respectively). • Segmenting the population, and then standardizing how patients are identified for that segment. • Patient reported outcome measures (PROMs) Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 27 27 Efficient • Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy • Imperative to control healthcare spending increases Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 28 28 14 12/15/23 Equitable • Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. • Most fundamental data are how individual patients and caregivers identify themselves in terms of race, ethnicity, and sex. Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 29 29 Patient-Centered • Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. • An important step in use of patient experience measures is recognizing that the goal is not evaluating clinicians or organizations, but improving the reliability with which patients’ needs are met. Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 30 30 15 12/15/23 Definition of communication • “the transmission of ideas, feelings, and actions from one individual to another through a medium. This Photo by Unknown Author is licensed under CC BY Tijani-Eniola, O. (2008). Effective communication strategies for improving health outcomes. Permanente Journal, 12(3), 70-74. 31 Purpose of effective patient-centered communication (PCC) • PCC is essential for the delivery of high-quality healthcare. • Improves patient satisfaction and health outcomes • Promotes patient adherence to treatment • Promotes proper diagnosis of patient condition. • Provides psychosocial support for enhancing the healing process of patients and increases their well-being and quality of life Morris, M. A., Clayman, M. L., Peters, K. J., Leppin, A. L., & LeBlanc, A. (2015). Patient-centered communication strategies for patients with aphasia: Discrepancies between what patients want and what physicians do. Disability and health journal, 8(2), 208-215. Amutio-Kareaga, A., García-Campayo, J., Delgado, L. C., Hermosilla, D., & Martínez-Taboada, C. (2017). Improving communication between physicians and their patients through mindfulness and compassion-based strategies: a narrative review. Journal of clinical medicine, 6(3), 33. 32 16 12/15/23 Purpose of effective patient-centered communication • To elicit and understand patients’ perspectives (e.g., concerns, ideas, expectations, needs, feelings, and functioning) • To understand their psychosocial and cultural contexts • To ensure they understand their health problems and treatments options • To involve them in the decision-making process • To reach a shared understanding of their problems and the treatments that are concordant (consistent) with their values [23]. Morris, M. A., Clayman, M. L., Peters, K. J., Leppin, A. L., & LeBlanc, A. (2015). Patient-centered communication strategies for patients with aphasia: Discrepancies between what patients want and what physicians do. Disability and health journal, 8(2), 208-215. Naughton, C. A. (2018). Patient-centered communication. Pharmacy, 6(1), 18. 23. Marvel, M.K.; Epstein, R.M.; Flowers, K.; Beckman, H.B. Soliciting the patient’s agenda: Have we improved? JAMA 1999, 281, 283–287. [CrossRef] [PubMed] 33 Modes of communication • The modes [method] of communication are divided into two main categories: o written o oral/verbal communication • Communication in a clinical environment can be horizontal or vertical: o Horizontal communication is when providers of care, be they nurses, dieticians, doctors and any one responsible for delivering care to the patient share information with one another. o Example: when requesting for a procedure, referring a patient, and communicating decisions about the proposed line of care. Tijani-Eniola, O. (2008). Effective communication strategies for improving health outcomes. Permanente Journal, 12(3), 70-74. 34 17 12/15/23 Modes of communication (cont’d) • Vertical communication involves communicating directly with patients or patient families. • For example: when taking history from a patient, explaining the investigations that need to be done, explaining a diagnosis or outlining treatment options. • It is common for some clinical communication to occur via email, phone or video conferencing. • The same rules guiding communicating effectively when face to face largely apply when information is transmitted through an electronic medium. Tijani-Eniola, O. (2008). Effective communication strategies for improving health outcomes. Permanente Journal, 12(3), 70-74. 35 What is service recovery? • Service recovery refers to an organization’s entire process for facilitating resolution of dissatisfactions, whether or not visible to patients and families (Hayden et al., 2010). • Service recovery is about restoring trust and confidence in an organization’s ability to "get it right." • When patients repeatedly experience breakdowns in service, they begin to lose confidence in the care they receive. Agency for Healthcare Research and Quality. Service Recovery Programs. https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/6strategies-for-improving/customer-service/strategy6p-servicerecovery.html#:~:text=Service%20recovery%20is%20the%20process,in%20customer%20or%20clinical%20service. Hayden, A. C., Pichert, J. W., Fawcett, J., Moore, I. N., & Hickson, G. B. (2010). Best practices for basic and advanced skills in health care service recovery: a case study of a re-admitted patient. The Joint Commission Journal on Quality and Patient Safety, 36(7), 310318. 36 36 18 12/15/23 Definition/description • Service recovery is a strategic issue in the delivery of any services, including healthcare. • Definitions include: o “the actions that a service provider takes to respond to service failures” o “doing things very right the second time” • A successful recovery can restore a dissatisfied customer to a state of satisfaction. Ashill, N. J., Carruthers, J., & Krisjanous, J. (2005). Antecedents and outcomes of service recovery performance in a public health-care environment. Journal of Services Marketing, 19(5), 293-308. 37 Importance • Customer (patient/family) evaluations of healthcare experiences are dependent on frontline health professionals (FHPs) meeting their expectations. • However, as with all services, healthcare encounters often fall short of customer expectations. • Service failures include medical errors, lengthy wait times and poor bedside manners. • Effective service recovery is therefore critical to healthcare service quality (Ashill et al., 2005). McQuilken, L., Robertson, N., Abbas, G., & Polonsky, M. (2020). Frontline health professionals’ perceptions of their adaptive competences in service recovery. Journal of Strategic Marketing, 28(1), 70-94. 38 19 12/15/23 Best practices for basic service recovery: HEARD • Service recovery is achieved by: • Hearing the person’s concern • Empathizing with the person raising the issue • Acknowledging, expressing Appreciation to the person for sharing, and Apologizing when warranted • Responding to the problem, setting timelines and expectations for follow-up • Documenting or Delegating the documentation to the appropriate person Hayden, A. C., Pichert, J. W., Fawcett, J., Moore, I. N., & Hickson, G. B. (2010). Best practices for basic and advanced skills in health care service recovery: a case study of a re-admitted patient. The Joint Commission Journal on Quality and Patient Safety, 36(7), 310318. 39 39 Measures of Quality of Care in Hospitals • Patient satisfaction: • • • • • increases patient retention increases willingness to recommend, improves the rate of patient compliance with physician advice and requests. improves trust, and loyalty decreases the number of lawsuits. Al-Damen, R. (2017). Health care service quality and its impact on patient satisfaction “case of Al-Bashir Hospital”. 40 40 20 12/15/23 Positive experiences • • • • Personalized Care and Communication Timely Access to Services Coordination of Care Patient Education and Engagement 41 Positive experiences • Personalized Care and Communication: o o o Highlight instances where patients felt heard, respected, and cared for by healthcare professionals. This can include examples of effective communication and empathy during consultations. (Reference: Patient-Centered Care: Definition and Misconceptions, BMJ, 2017) 42 21 12/15/23 Positive experiences • Timely Access to Services positively impact patients’ experiences: o prompt appointments o reduced waiting times, and o efficient scheduling positively impact patients' experiences. o (Reference: Improving Timely Access to Primary Care, JAMA, 2017) 43 Positive experiences • Coordination of Care: • • Emphasize the importance of seamless transitions between different healthcare providers and settings, leading to better patient experiences. (Reference: The Impact of Care Coordination on Patient Experience, Healthcare Management Review, 2019) 44 22 12/15/23 Positive experiences Patient Education and Engagement: • • • providing patients with information about their conditions and involving them in decision-making can enhance their overall healthcare experience. (Reference: Shared Decision-Making in Healthcare: Achieving PatientCentered Care, JAMA, 2017) 45 Negative experiences • Long Wait Times and Delays • Lack of Communication: • Inadequate Access to Healthcare • Medical Errors and Safety Concerns 46 23 12/15/23 Patient satisfaction as measure of patient experience • Systematic review identified several determinants of healthcare services, which have a role in patient satisfaction: 1) technical care, 2) Interpersonal care, 3) Physical environment, 4) Access 1) 2) 3) accessibility, availability, and finances), Ask students to summarize each of these determinants and report back to class using the source citation. 5) Organisational characteristics, 6) Continuity of care, 7) Outcome of care, 8) Patient-related characteristics Batbaatar, E., Dorjdagva, J., Luvsannyam, A., Savino, M. M., & Amenta, P. (2017). Determinants of patient satisfaction: a systematic review. Perspectives in public health, 137(2), 89-101. 47 Benefits of visitation • Family [relative, friends] presence during serious illness has been associated with physical and psychological benefits for both patient and family. • For people receiving palliative care, the presence of family members and loved ones, and the opportunity to say goodbye when death is close, have been described as key components of dying well (the so called “good death”) • Dying alone, however, may result in a “bad death,” a negative experience not just for the dying person but also for family and care staff. Russell, B., William, L., & Chapman, M. (2022). An ethical framework for visitation of inpatients receiving palliative care in the COVID-19 context. Journal of Bioethical Inquiry, 19(2), 191-202. 48 24 12/15/23 The Institute of Medicine’s (IOM) “The Urgent Need to Improve Health Care Quality” • “Adverse events and their classification” • Establishes the classification scheme of “overuse, underuse, and misuse” to categorize quality defects. • Overuse: when patients are prescribed medicine or treatment without a logical reason. • A common example of overuse is when antibiotics are prescribed to treat things that heal without antibiotics, such as ear infections and sinus infections. Joshi et al. (2022). Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 49 49 IOM’s “The Urgent Need to Improve Health Care Quality” • Underuse: when medical professionals fail to provide patients with the appropriate medicine or treatments or neglect to follow general healthcare practices. • Close to 100,000 patients die each year due to underuse. Joshi et al. (2022). Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 50 50 25 12/15/23 IOM’s “The Urgent Need to Improve Health Care Quality” • Misuse: Misuse is another name for malpractice. • It's when a patient doesn't receive the full effect of a treatment or is harmed by a treatment due to preventable errors. • Examples include prescribing medicine that contains ingredients a patient knows they are allergic to, making surgical errors or operating on the wrong surgery site, and prematurely discharging a patient from the hospital. Joshi et al. (2022). Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 51 51 https://health.gov/healthypeople/priority-areas/social-determinants-health 52 52 26 12/15/23 Importance of Social Determinants of Health • Social determinants of health contribute significantly to premature death and diseases particularly among vulnerable groups such as women, children, the elderly and minority groups. World Health Organization. (2008). Social determinants of health (No. SEA-HE-190). WHO Regional Office for South-East Asia. 53 53 Health Disparities • Health disparities are defined as: • “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States” (National Institutes of Health, 2010b, para.1). • Health disparities signify a difference in access, utilization, quality of care, health status, health environment, or health outcome between groups. Buschbinder (2019), 4th ed. Health Care Management. Ch. 14 54 27 12/15/23 Examples of Health Disparities • Some of the most striking disparities compared to other reference groups include: • • • • Shorter life expectancy and higher rates of substance abuse Infant mortality Birth defects Higher incidence of cancer, diabetes, stroke, cardiovascular disease, sexually transmitted diseases, and mental illness Buschbinder (2019), 4th ed. Health Care Management. Ch. 14 55 Health Inequity • Health inequities: • Are avoidable inequalities in health between groups of people within countries and between countries. • These inequities arise from inequalities within and between societies. • Social and economic conditions and their effects on people’s lives determine their risk of illness and the actions taken to prevent them becoming ill or treat illness when it occurs (World Health Organization, 2008). 56 28 12/15/23 Health Equity • “Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health”. • To achieve this requires ongoing societal efforts to: • Address historical and contemporary injustices; • Overcome economic, social, and other obstacles to health and health care; and • Eliminate preventable health disparities. • To achieve health equity, we must change the systems and policies that have resulted in the generational injustices that give rise to racial and ethnic health disparities. https://www.cdc.gov/healthequity/whatis/. Accessed July 30, 2023 57 Quality Management • A way of doing business • Goal: Achieve maximum customer satisfaction at the lowest overall cost to the organization while continuing to improve the process. “When broken down, quality control management can be segmented into four key components to be effective: quality planning, quality control, quality assurance, and quality improvement.” – added from google Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 58 29 12/15/23 Quality Management Activities Measurement How are we doing? Yes Assessment Are we meeting expectations? The three primary quality management activities are parts of a closely linked cycle Activities: quality planning, quality control and quality improvement No Improvement How can we improve performance? Spath, P., & DeVane, K. A. (2022). Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 59 The Juran Triology 60 30 12/15/23 Quality Framework at HMC Quality Improvement: systematic approach for improvement - Strategy for continuous improvement - System oriented - Sustained improvement HHQI Quality Improvement Quality Planning: process of managing quality – Strategy of prevention – Process oriented QPS, IC, RM, CPESE Quality Planning HMC RACS Quality Control Quality Control: verifying the quality of output – Proactive – Strategy of detection – Product oriented – Reactive 61 Healthcare quality management • Science of quality improvement and high reliability is being increasingly applied to healthcare delivery. • The rules and tools continue to evolve. • The goal remains the same: continuous improvement. Spath, P., & DeVane, K. A. (2022). Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 62 31 12/15/23 Triple Aim/Quadruple Aim Triple Aim: True improvement instead relies on interdependent efforts of three aims: 1) Improving the experience of care; 2) Improving the health of (identified) populations; and 3) Reducing per capita costs of healthcare (Berwick 2008). Joshi et al. (2022). Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 63 63 Institute of Healthcare Improvement: Triple Aim • Better Care: Improve the overall quality, by making healthcare more patientcentered, reliable, accessible, and safe. • Healthy People/Healthy Communities: Improve the health of the US population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care. • Affordable Care: Reduce the cost of quality healthcare for individuals, families, employers, and government. Spath, P., & DeVane, K. A. (2022). Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 64 32 12/15/23 Cause and Effect Diagram A Cause & Effect diagram is useful in sorting out all the causes of variation and sorting out mutual relationships 65 Fishbone diagram as a cause and effect analysis tool Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 66 33 12/15/23 Cause & Effect Diagram Equipment Method Effect Environment People Cause 67 Fishbone Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 68 34 12/15/23 The 5 Whys method for root cause analysis of quality problems • 5 Whys method helps you find the root causes of any issue by asking a series of why questions. • It is used to identify and solve quality problems in your projects or operations. • This technique was originally developed by Sakichi Toyota who stated that “by repeating why five times, the nature of the problem as well as its solution becomes clear.” • Steps: • Define the problem precisely • Then ask the “why” question five times drilling down into a problem, and ask “how” five times to develop the details of a solution to the problem. Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale. 69 70 35