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![Page 1: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/1.jpg)
Defining Quality2013 Albuquerque Area Dental Chiefs/PreventionCoordinators Meeting
June 05, 2013
Kristina Rogers, MMI, CPCJohn M. Shutze, MPH, CQIA
![Page 2: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/2.jpg)
Learning Objectives
• Define Quality
• Identify Approaches to Quality
• Identify Types of Measures for Quality
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Defining Quality Quality Philosophies & Definitions
Approaches to Quality
Picking Appropriate Quality Measures
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Activity
• Draw An Image Of Quality–First Thing That Comes To Mind
• 5 Minutes Total To Complete This Exercise
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09000 5 87654321540 04 98765432103 9876543210987654321021 987654321098765432100Hours
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09000 4 87654321530 04 98765432103 9876543210987654321021 987654321098765432100Hours
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09000 3 87654321520 04 98765432103 9876543210987654321021 987654321098765432100Hours
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09000 2 87654321510 04 98765432103 9876543210987654321021 987654321098765432100Hours
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09000 1 87654321500 04 98765432103 9876543210987654321021 987654321098765432100Hours
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What Is Quality? Quality Philosophies
Definitions of Quality
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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
![Page 12: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/12.jpg)
Common Definitions
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I’ll Know It When I
See It
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Fitness For Use
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Conformance to
Requirements
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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
![Page 22: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/22.jpg)
Approaches To Quality IHI/PDSA
Lean
Six Sigma
Accreditation
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IHI/Model for Improvement
![Page 24: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/24.jpg)
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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
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LeanEliminating Waste & The Pursuit of Perfection
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What Is Lean?
• Toyota Production
System
• Reduce Waste (muda)
• Change for the Better
(kaizen)
• More Customer Value
• Pursue Perfection
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Six SigmaEliminating Errors & Improving The Bottom-Line
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What Is Six Sigma?
• Motorola
• Fact-Based, Data Driven
• Defect
Reduction/Prevention
• Customer Centered
• Bottom-Line Results
• Project Based
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AccreditationJoint Commission
Patient-Centered Medical Home
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Accreditation to Drive Quality
• Systems Approach
• Set of Standards
• Provides Direction
• Helps Build Capacity
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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
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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.
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Picking Quality Measures Uses of Measures
Types of Measures
Developing Measures
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Uses of Quality Measures
Quality Measure
s
Improvement
ResearchAccountabilit
y
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Uses of Quality Measures
Improvement Research Accountability
Purpose Practice New Knowledge
Discover New Knowledge
Evaluating, Judging
Performance
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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
![Page 38: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/38.jpg)
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
![Page 39: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/39.jpg)
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
![Page 40: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/40.jpg)
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
![Page 41: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/41.jpg)
A Good Measure Is…
• Aligned With The Mission
• Important to Customers
• Actionable
• Accessible to People
![Page 42: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/42.jpg)
More Tips…
• Plot Data Over Time
• Use Sampling
• Make It Routine
• Use Qualitative & Quantitative Data
![Page 43: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/43.jpg)
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
![Page 44: Defining Quality 2013 Albuquerque Area Dental Chiefs/Prevention Coordinators Meeting June 05, 2013 Kristina Rogers, MMI, CPC John M. Shutze, MPH, CQIA.](https://reader037.fdocuments.in/reader037/viewer/2022110403/56649e735503460f94b72445/html5/thumbnails/44.jpg)
Questions?
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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