Post on 29-Dec-2015
Defining Quality2013 Albuquerque Area Dental Chiefs/PreventionCoordinators Meeting
June 05, 2013
Kristina Rogers, MMI, CPCJohn M. Shutze, MPH, CQIA
Learning Objectives
• Define Quality
• Identify Approaches to Quality
• Identify Types of Measures for Quality
Defining Quality Quality Philosophies & Definitions
Approaches to Quality
Picking Appropriate Quality Measures
Activity
• Draw An Image Of Quality–First Thing That Comes To Mind
• 5 Minutes Total To Complete This Exercise
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What Is Quality? Quality Philosophies
Definitions of Quality
Quality Philosophies
Quality Guru
1. W.E. Deming
2. Joseph Juran
3. Philip Crosby
View of Quality
1. It’s Up To
Management
2. It’s Not Accidental
3. Quality Vaccine
Common Definitions
I’ll Know It When I
See It
Fitness For Use
Conformance to
Requirements
What Is Quality?
• Know It When I See It
• Fitness for Use
• Conformance to
Requirements
• Meeting Customer
Expectations
• Exceeding Customer
Expectations
• Superiority to
Competitors
• Safe
• Effective
• Patient-Centered
• Timely
• Efficient
• Equitable
Approaches To Quality IHI/PDSA
Lean
Six Sigma
Accreditation
IHI/Model for Improvement
PDSA Cycles
• Increase Belief Change Will Result in Improvement
• Small Tests = Small Risk
• Rapid Cycle Testing = Quick Feedback
• Multiple Cycles = Iterative Learning
• List of Changes & Outcomes for an Improvement
Process
LeanEliminating Waste & The Pursuit of Perfection
What Is Lean?
• Toyota Production
System
• Reduce Waste (muda)
• Change for the Better
(kaizen)
• More Customer Value
• Pursue Perfection
Six SigmaEliminating Errors & Improving The Bottom-Line
What Is Six Sigma?
• Motorola
• Fact-Based, Data Driven
• Defect
Reduction/Prevention
• Customer Centered
• Bottom-Line Results
• Project Based
AccreditationJoint Commission
Patient-Centered Medical Home
Accreditation to Drive Quality
• Systems Approach
• Set of Standards
• Provides Direction
• Helps Build Capacity
Summary of Approaches
Focus Methodology
IHI/PDSA Set Aims, Establish Measures & Test Changes PDSA
Lean Eliminate Waste Gemba, 5-S, Value Stream Map
Six Sigma Reduce Variation DMAIC
Lean Sigma
Increase Speed & Reduce Variation Six Sigma, Lean
Approaches & ToolsIHI Lean Six Sigma
Process Analysis
Process Flowchart X X
Spaghetti Diagram X
Cause Analysis
5-Whys X
Fishbone Diagram X X X
Data Collection & Analysis
Check Sheet X X
Pareto Chart X X
Scatter Plot/Diagram X
Histogram X
Run Chart X X
Control Chart X X
* Additional tools are available for each approach. The primary references used for this toolkit include the Institute for Healthcare Improvement (IHI) and the American Society for Quality (ASQ). Lean Sigma uses a combination of tools from both the lean and six sigma.
Picking Quality Measures Uses of Measures
Types of Measures
Developing Measures
Uses of Quality Measures
Quality Measure
s
Improvement
ResearchAccountabilit
y
Uses of Quality Measures
Improvement Research Accountability
Purpose Practice New Knowledge
Discover New Knowledge
Evaluating, Judging
Performance
Uses of Quality Measures
Improvement Research Accountability
Purpose Practice New Knowledge
Discover New Knowledge
Evaluating, Judging
Performance
Tests Many Sequential, Observable
One Large Test
No Test, Evaluate Current
Performance
Uses of Quality Measures
Improvement Research Accountability
Purpose Practice New Knowledge
Discover New Knowledge
Evaluating, Judging
Performance
Tests Many Sequential, Observable
One Large Test
No Test, Evaluate Current
Performance
Data“Just Enough,”
Small Successive Samples
All Relevant, Available
Data
“Just In Case” Data, As Much As
Possible
Uses of Quality Measures
Improvement Research Accountability
Purpose Practice New Knowledge
Discover New Knowledge
Evaluating, Judging
Performance
Tests Many Sequential, Observable
One Large Test
No Test, Evaluate Current
Performance
Data“Just Enough,”
Small Successive Samples
All Relevant, Available
Data
“Just In Case” Data, As Much As
Possible
Duration
Sequential TestsLong Period
To Get Results
No Tests
Types of Measures
Measure Type
1. Structural
2. Process
3. Outcome
4. Balancing
Focus
1. Infrastructure & Capacity
2. Delivery of Care
3. Ultimate Goal
4. Different Perspectives
A Good Measure Is…
• Aligned With The Mission
• Important to Customers
• Actionable
• Accessible to People
More Tips…
• Plot Data Over Time
• Use Sampling
• Make It Routine
• Use Qualitative & Quantitative Data
The Details
MeasureNumber of Fluoride Applications for 0-5 year olds
Operational Definition
Sum of ADA Codes 1203, 1206, and V07.31
Baseline FY 2012 – 438
Target FY 2013 – 25% increase to 548
Owner John Doe, Dental Hygienist
Data Source
National Dental Data Mart
Frequency Quarterly
ActionsReview current projects. Brainstorm ideas for improvement
DisplayBar graph broken down by quarter, comparing current FY quarter to previous FY quarter
Questions?
ReferencesAssociates in Process Improvement (August, 2007). The improvement handbook: models, methods & tools for improvement. Version for : IHI Improvement Advisor Development Program.
Bauer, J.E., Duffy, G.L., Westcott, R.T. (2006). The quality improvement handbook (2nd ed.). Milwaukee, WI: American Society for Quality
Bialek, R., Duffy, G.L., Moran, J.W. (2009). The public health quality improvement handbook. Milwaukee, WI: American Society for Quality.
Duke, O. (Sept, 2008). Driven by metrics. Quality Progress. Milwaukee, WI: American Society for Quality.
National Quality Measures Clearinghouse. Tutorials on quality measure. Available at: www.qualitymeasures.ahrq.gov/tutorial/index.aspx