THE VALUES OF THE HEALTH SYSTEM AND WIDER SOCIETY

FATHER of CQI

DEMING

APPRECIATION FOR A SYSTEM

KNOWLEDGE ABOUT VARIATION

THEORY OF KNOWLEDGE

PSYCHOLOGY

FOCUS

FIND A PROCESS TO IMPROVE

ORGANIZE TEAM THAT KNOWS THE PROCESS

CLARIFY KNOWLEDGE OF THE PROCESS

UNDERSTAND CAUSES OF PROCESS VARIATION

SELECT THE PROCESS IMPROVEMENT

PDSA (SHEWHART)

DEFINITIONS of QUALITY

QUALITY REFLECTS THE VALUES OF THE HEALTH SYSTEM AND WIDER SOCIETY (DONABEDIAN)

3 ASPECTS TO CARE: STRUCTURE, PROCESS, AND OUTCOMES

INCLUDES INTERPERSONAL RELATIONSHIPS, TECHNICAL CARE, ACCESS, AND CONTINUITY OF CARE

QUALITY OF CARE IS THE DEGREE TO WHICH THE PROCESS OF CARE INCREASES THE PROBABILITY OF DESIRED OUTCOMES AND REDUCES UNDESIRED OUTCOMES (US OFFICE OF TECHNOLOGY ASSESSMENT)

PATIENT (AND THEIR PERSPECTIVE) AT THE CENTER OF CARE

MUST BE LINKED TO EFFECTIVE TREATMENTS FOR A CONDITION

4

CONTINUOUS QUALITY IMPROVEMENT (CQI)

STRUCTURED ORGANIZATIONAL PROCESS

REQUIRES MEASUREMENT

INVOLVES PERSONNEL

TO PLAN AND EXECUTE A CONTINUOUS FLOW OF IMPROVEMENTS

PROVIDES QUALITY HEALTH CARE

MEETS OR EXCEEDS EXPECTATIONS

EVOLVED OVER TIME AND ACROSS COUNTRIES

NEED FOR CQI IS INCREASING

EVIDENCE SHOWS LITTLE IMPROVEMENT IN SAFETY AND QUALITY OF CARE OVER THE PAST DECADE!

IMPROVING QUALITY of CARE

DONALD BERWICK, INSTITUTE FOR HEALTHCARE IMPROVEMENT

IMPROVE THE EXPERIENCE OF CARE (PERCEPTION)

IMPROVE THE HEALTH OF POPULATIONS

REDUCE THE PER CAPITA COSTS OF HEALTH CARE

AT THE MICRO LEVEL, IT INVOLVES PROFESSIONAL RESPONSIBILITY AND DEVELOPMENT

CQI and the SCIENCE of INNOVATION

DONALD BERWICK, FOUNDER OF THE INSTITUTION FOR HEALTHCARE, HAS IDENTIFIED 7 RULES FOR DISSEMINATION OF INNOVATION IN HEALTH CARE

FIND SOUND INNOVATIONS

FIND AND SUPPORT INNOVATORS

INVEST IN EARLY ADOPTERS

MAKE EARLY ADOPTER ACTIVITY OBSERVABLE

TRUST AND ENABLE REINVENTION

CREATE SLACK FOR CHANGE

LEAD BY EXAMPLE

ORGANIZATION CENTERED QI STRATEGIES

DEMING

14 POINTS BECAME ACCEPTED

OFFERED A SYSTEM VIEW OF QUALITY IMPROVEMENT

HOSPITALS

ACCREDITATION MOVEMENT EARLY IN THE 20TH CENTURY

TCM CAME TO ATTENTION FROM JAPANESE INDUSTRY IN 1980

JCAHCO WAS AN EARLY ADOPTER AND PROMOTER OF QI

NCQA FOLLOWED SOON WITH ITS ACCREDITATION PROCESSES

FEATURES

MAJOR FOCUS BECAME THE CONTEXT OF QI WORK

KNOWLEDGE WORK BECAME AN ACCEPTED PART OF QI

CUSTOMER FOCUS BEGAN TO ENTER QI

CONCEPTUAL FRAMEWORK of QUALITY

QUALITY HEALTH CARE MUST BE: (IOM)

SAFE (AVOIDING INJURY TO PATIENTS)

EFFECTIVE (BENEFIT THOSE IN NEED)

PATIENT-CENTERED (RESPECTFUL AND RESPONSIVE)

TIMELY (REDUCING WAITS AND/OR HARMFUL DELAYS)

EFFICIENT (AVOIDING WASTE)

EQUITABLE (CARE DOES NOT VARY BECAUSE OF GENDER, AGE ETC.)

REGULATORY AGENCIES and ACCREDITATION

REGULATORY MECHANISMS (ACCREDITATION) HAVE LED TO GREATER DIFFUSION OF CQI

CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) HAVE LED A SERIES OF INITIATIVES THAT REQUIRE HOSPITALS TO REPORT ON QUALITY MEASURES

QUALITY IMPROVEMENT ORGANIZATIONS (QIOS) REPORT EXTENSIVE CQI ACTIVITIES AND FINDINGS ASSOCIATED WITH THESE ACTIVITIES

JOINT COMMISSION HAS NOTED THE USE OF ROBUST, EVIDENCE BASED MEASURES, LINKING PROCESS PERFORMANCE AND PATIENT OUTCOMES

ORGANIZATIONS

GOVERNMENT

NONPRFOFIT

FOR-PROFIT

ACCREDITATION

What are examples from each category that focus on healthcare quality improvement?

SIX SIGMA (Deming/Juran)

SIX SIGMA (GREEK SYMBOL IN STATISTICS TO MEASURE VARIATION) UTILIZES STATISTICAL METHODS TO IDENTIFY AND REMOVE ERRORS AND MINIMIZE VARIABILITY IN PROCESSES

LEAN METHODOLOGY IS USED WITH SIX SIGMA

A SYSTEMATIC APPROACH TO IDENTIFYING AND ELIMINATING WASTE

LEAN SIX SIGMA USED IN A WIDE RANGE OF HEALTH CARE APPLICATIONS, AND PROVIDES A SYNERGISTIC METHODOLOGY FOR ANALYZING, AND REDUCING OR ELIMINATING WASTE IN HEALTH CARE PROCESSES

LEAN AND SIX SIGMA METHODS ARE PARALLEL TO AND CAN BE USED WITH APPROACHES LIKE PDSA

P

Process mapping

C

Control

D

M

A

I

Define

Measure

Analyze

Improve