HEALTHCARE QUALITY

CONCEPTS

Chapter 1

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Changing Perspectives in Quality• Participants can identify 3 types of

disruptive behavior.

• Participants can identify 2 types of difficult conversations in healthcare that if avoided can jeopardize patient safety.

• Participants can identify 2 skills that are essential to effective communication.

“Quality in a product or service is not what the

supplier puts in. It is what the customer

gets out and is willing to pay for.”

Peter F. Drucker

QUALITY, COST, AND RISK INTEGRATION

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=Quality of Care/Services + Outcomes

Cost

Value

NON-INTEGRATED PERSPECTIVE

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Mgmt

Governance

Clinical

Support

Integrated Perspective5

QUALITY MANAGEMENT:BASIC PRINCIPLES

• Productive Work is Accomplished Through Processes.

• Sound Customer-Supplier Relationships are Absolutely Necessary for Sound Quality Management.

• The Main Source of Quality Defects is Problems in the Process.

• Poor Quality is Costly.

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QUALITY MANAGEMENT:BASIC PRINCIPLES

• Understanding the Variability of Processes is Key to Improving Quality.

• Quality Control Should Focus on the Most Vital Processes.

• The Modern Approach to Quality is Thoroughly Grounded in Scientific and Statistical Thinking.

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QUALITY MANAGEMENT:BASIC PRINCIPLES

• Total Employee Involvement is Critical.• New Organizational Structures Can Help Achieve

Quality Improvement.• Quality Management Employs: – Quality planning– Quality control (measurement)– Quality Improvement

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TOTAL QUALITY MANAGEMENT

• An Organizational Management Philosophy and Top-Level Commitment to Foster a Belief in the Value of:

Customers

Employees/staff

Management

Teamwork

Deming’s 14 points

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CONTINUOUS QUALITY IMPROVEMENT

CQI is a Management Approach of Study and Improving Processes

It is a Management Method for Creating TQM

At CQI’s Core is a Quality Culture/Patient Safety Culture

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CONTINUOUS QUALITY IMPROVEMENT

Organizational CommitmentQuality CultureCustomer FocusTeam Emphasis on Improving Systems and ProcessesConstant Learning and Improving

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RESPONSIBILITIES OF THE QUALITY PROFESSIONAL

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Understand Principles of TQM and CQI Develop a Healthcare Quality Strategy Participate in Preparation for External

Awards Articulate to Leadership How to Use

TQM and CQI Data Measurement Assessment Improvement

Lead and facilitate change within the organization

SYSTEMS THINKING

System:Perceived whole whose elements

hang together effecting each other

Systems Thinking:

A body of principles, methods, and tools focused on the interrelatedness of forces

in a system

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PROCESSES IN SYSTEMS THINKING14

Systemic Structure Key Components:

Process flows,Attitudes & perceptions,Ways decisions are made, HierarchyThe system working with all its

parts

PROCESSES IN SYSTEMS THINKING15

Four Levels in Systems:

Events (occurrences) Patterns of Behavior (trends over

time) System Structure (decisions,

relationships, efforts, targets, incentives, etc.)

Mental Models (beliefs, assumptions, mind sets about ways work gets done)

SYSTEMS THINKING -PROCESS TOOLS

• Cause and Effect Relationships

• Process Diagrams Show a Flow or Sequence of Activities

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A affects B affects C

A then B then C

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• Who are the various owners of the process?

• What group of people have some stake or ownership of different parts of the process?

• You can address the symptoms, but until you address the problem you can not resolve it

• Addressing the symptoms is call the Band-Aid approach

Systems Thinking

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• MD writes order• Sent to Pharmacy by Nursing• Pharmacy fills the order• Pharmacy sends the medication up to the Nursing

Unit• Nurses give the medication• Nurses & MD monitors the patient’s condition

Medication Process

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• What if the doctor’s handwriting can not be read and doctor is not available?

• What if the Pharmacy decides not to fill it until later? Or if the Pharmacy has no medication

• What if it does not get to the unit until after the time it was needed?

• What if the nurses are too busy to be able to give the medication on time?

Medication Process

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• What if Nursing decides to change the times they administer the medications and does not tell the Pharmacy?

• What if the Pharmacy does not have a medication and does not contact the doctor until after clinic hours and the MD is not on call?

• What if Pharmacy decides to send the medication in 2 pouches instead of just one?

Medication Process

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• You need to examine the players and determine who will be affected by any actions that you take

• You want to expand your clinic? – How many more practitioners ?– Nursing staff to run the clinic & move patients around?– Lab work increase of workload?– Radiology increase of workload?– Pharmacy have needed medications?

• CAN NOT DO IT BY YOURSELF when you want to do something like this

Systems Thinking

THE CONCEPT OF CUSTOMER

• “Customer” – One Who Receives Goods or Services

• External Customer – Those Outside the Organization Receiving Services

• Internal Customer – Those Performing Work, but Dependent On Others Within the Organization Performing Work

• Customer Supplier Relationships22

CUSTOMER FOCUS• Listen To & Communicate With Customers;• Identify and Address True Needs;• Optimize Treatment Patterns and Outcomes:• Enhance Performance of Internal Processes;• Respond to Requests For Information;• Build Trust, Respect, and Loyalty in

Relationships• Patient Centered Care• Coordination of Care

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Keeping the Customer in Mind

• Dissemination of cultural transformation and performance improvement information

within the organization and

to our customers!

IDENTIFYING CUSTOMERS AND THEIR NEEDS

• Identifying Customer Needs & expectations:Surveys and interviews Focus groupsResearchBrainstormingTeams

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ORGANIZATIONAL CULTURE

• Culture – Basic Set of Assumptions About People, How People Work Together and How Work Gets Done.

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IMPACT OF ORGANIZATIONAL CULTURE

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Organizational EthicsPatient Safety Corporate ComplianceOrganizational ChangePerformance and ProductivityInternal and External Customers

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Quality & Patient Safety Culture

• Most organizations have different organizational cultures, including different healthcare organizations

• Healthcare must change into a Quality and Patient Safety culture if we are to survive

• There must be a Patient Centered culture

• Care must be Evidence-Based

• Teamwork is essential

CULTURAL TRANSFORMATION

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Just Culture – Blame FreeAdoption of “Quality / Patient Safety

Culture” Commitment to ExcellenceLong-range Strategic PlanningFlexible Management StylesSystems ThinkingDelegation and EmpowermentTeam BuildingIncrease Communication

CULTURAL TRANSFORMATION

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Visionary Leadership

Systems ThinkingInspiration

Management’s Commitment

Team BuildingCalculated Risk TakingImplementation

Employee Involvement

EngagementInnovation

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So, How Do We Get There?• Need to start with defining quality at an

organization

• Assess where the organization is in terms of the organizational culture

• Develop and design what the new Quality / Patient Safety Culture will look like and how to get there

REDESIGNING THE ORGANIZATION

Sustained Approach

Downsizing

Restructuring/Rightsizing

Organizational Structure

Reengineering

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REEINGINEERING

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INTEGRATED DELIVERY SYSTEMS

• Types:–Horizontal

–Vertical

• Degrees of Integration

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Hospital A Hospital B Hospital C Hospital

D

Hospital

Clinic

LTC

Rehab

EVALUATING CLINICAL INTEGRATION

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Other Leadership Topics

• Awareness of Statutory & Regulatory Requirements– OSHA– HIPAA– PPACA

• Quality & Reimbursement– Capitation– Pay for Performance