Lec 11 quality management in healthcare.pdf

Quality Management in Healthcare  Objectives By the end of this session, students will be able to:  Recognize the meaning of quality  Understand principles of quality in healthcare  Identify the relationships between quality expectations & customers  Recognize dimensions of qua...

Quality Management in Healthcare  Objectives By the end of this session, students will be able to:  Recognize the meaning of quality  Understand principles of quality in healthcare  Identify the relationships between quality expectations & customers  Recognize dimensions of quality in healthcare  Describe quality auditing & its types  Recognize benchmarking & its types 2  What is quality ?  In his classic text on health care quality Donabedian (the father of quality in healthcare) presented a fundamental concept regarding the nature of any activity designed to produce a consistent result  The Process component may itself be regarded as consisting of: 3  Quality is formed from the individual's perceptions of the output and is rooted within the individual's personal frame of reference.  Quality is a relative term with no fixed unit of measurement, that is, a unit-less value system.  Quality is assessed by comparison to other similar items or events, so that static terms of "good quality" or "bad quality”, as fixed measures, have no firm meaning over time - there is really only "better quality" or "worse quality“. 4 Again.. What is quality ? “Do it right.. the first time”  Quality is compliance with standards.  Standards are created by experts  When customers of healthcare define quality, they judge it based on their expectations.  Expectations could be continuously improved. 5 Quality & customers  A customer is any organization or individual who makes quality judgments about, or has expectations regarding, an output.  Although it is impossible to mandate quality expectations, it is possible to: (1) clearly identify customer groups, (2) clearly measure their expectations, and (3) change their expectations over time, through customer education. 6 Customers of healthcare  Internal customers: owners, management, & employees.  External customers: clients & their relatives, local communities, referring physicians, suppliers, & payers. 7 Quality & expectations  The foundation for comparison of quality is contained within the individual's past personal experiences and prejudices.  This personal history is expressed as expectations: when positive expectations are met, then quality is judged to be acceptable; when expectations are exceeded, then quality is judged to be excellent. 8  Customer expectations  Content quality: expectations regarding the physical attributes of the output/product. - Does the output functionally meet the customer's expectations? Ex. Cure, success of care plan  Delivery quality: expectations about the nature of the interaction between the producer & the customer. - Does the customer's interaction with the organization's employees meet the customer's expectations? Ex. Client’s satisfaction, employee’s satisfaction 9 High quality.. “Quality is the degree of customer satisfaction”  Customer expectations continually change; the definition of quality can therefore be expanded as follows: High quality is achieved by continual improvement in terms of customer’s expectations.  The aim of continuous quality improvement is to meet the customer, not just the competition. 10 Main quality leaders 11 Old & new quality concepts 12  Development of quality systems Quality Management Description System Quality Control QC Early, simple initiatives relate quality to compliance with predefined, measurable standards. Later on, experts viewed QC as fragmented and insufficiently integrated into the process of management. Quality Assurance QA It became the common term during the 1980s. Served well with the Donabedian concepts of examining health care quality as an element of structure, process & outcome. Continuous Quality Continuous process. Improvement CQI Identify areas of improvement. Cost effective. Multi-teams. 13  Dimensions of quality  Appropriateness The degree to which the care/intervention is relevant to the patient's clinical needs, given the current state of knowledge.  Continuity of care The coordination of needed healthcare services for a patient or specified population among all practitioners & across all involved organizations over time. 14  Effectiveness The degree to which care is provided in the correct manner, given the current state of knowledge, to achieve the desired or projected outcomes for the individual.  Efficiency The relationship between the outcomes (results of care) & the resources used to deliver care. 15  Respect and Caring The degree to which those providing services do so with sensitivity for the individual's needs, expectations, & individual differences..  Competency The practitioner's ability to produce both the health & satisfaction of customers. The degree to which the practitioner adheres to professional &/or organizational standards of care & practice 16  Safety The degree to which the risk of an intervention... & risk in the care environment are reduced for a patient & other persons including health care practitioners.  Timeliness The degree to which needed care & services are provided to the patient at the most beneficial or necessary time. 17  Quality auditing  An audit is a systematic & official examination of structure, process, & outcome to evaluate performance.  Auditing can occur retrospectively, concurrently, prospectively, or multiple screening.  Auditing can be internally or externally. 18 Structure audit  Structure audits assume that a relationship exists between quality care & appropriate structure. Structure audits ensure that healthcare services are provided in a safe & effective environment.  Examples of structure audits: o Healthcare environment, fire exits, fire extinguishers o Patient call lights in place o Staffing ratio, staffing mix o ER / clinic waiting times 19  Process audit  Process audits measure how care is provided. Process audit assumes a connection between process & quality of care. Process audit evaluates & improve practice standards & provider’s compliance to these standards.  Examples of process audits: o Patient care plans o Compliance to procedure manuals o Nursing protocols o Medication reconciliation (double check) 20  Outcome audit  Outcome audit can be defined as the end result of care. Outcome audits assume that the results demonstrate the quality of care that was provided. Outcome audit is the most valid indicators of quality outcomes.  Examples of outcome audits: o Mortality & morbidity rates o Average length of stay o Nosocomial infection o Adverse events o Patient’s fall rates & restraint use 21  Benchmarking  Benchmarking is the process of comparing one’s processes & performance with one’s previous or other’s processes & performance.  Example: comparing hospital’s current performance with last year performance, & comparing the hospital’s current performance with other hospital’s performance. 22 Uses of benchmarking  Evaluation  Elimination of mistakes  Bridging the gabs  Standardization  Improvement 23 Types of benchmarking Type Description Structure Comparison of staffing ratio & mix, benchmarking settings, & environment. Process Comparison of procedures, protocols, & benchmarking policies. Outcome Comparison of mortality rates, adverse benchmarking events, & nosocomial infections. Financial Comparison of budgets, expenses, & benchmarking revenues. 24 Benchmarking process  Select the subject to be benchmarked.  Select an area of benchmarking (ex. Unit’s previous results, other unit’s results, other organization’s results).  Gather data.  Analyze data.  Compare results.  Interpret results. 25