Pierre Barker

Jens Jensen

Nirav Shah

Modern Quality Control

Deming and Berwick

“Cease dependence on inspection to

achieve quality. Eliminate the need for

inspection on a mass basis by building

quality into the product in the first place”

- Out of the Crisis. W. Edwards Deming

“Those of era 2 believe in accountability, scrutiny,

measurement, incentives, and markets. Era 2 has

brought with it excessive measurement, much of

which is useless but nonetheless mandated.”

Dr. Joseph M. Juran’s “Trilogy” 3

QUALITY PLANNING

QUALITY IMPROVEMENT

QUALITY CONTROL

Juran Trilogy: All three elements are

needed

4

PERFORMANCE SHIFT

Chronic waste (opportunity for improvement)

Sporadic spike

Source: Juran J, Godfrey AB, eds. Juran’s Quality

Handbook: Fifth Edition. New York: McGraw-Hill, 1999.

Juran Trilogy: All three elements are

needed

5

PERFORMANCE SHIFT

Chronic waste (opportunity for improvement)

Sporadic spike

Source: Juran J, Godfrey AB, eds. Juran’s Quality

Handbook: Fifth Edition. New York: McGraw-Hill, 1999.

Juran Trilogy: All three elements are

needed

6

PERFORMANCE SHIFT

Chronic waste (opportunity for improvement)

Sporadic spike

Source: Juran J, Godfrey AB, eds. Juran’s Quality

Handbook: Fifth Edition. New York: McGraw-Hill, 1999.

How do we measure and who measures?

Priorities, structures (e.g. Quality Directorate), data systems, learning system, sense making, strategic deployment, building capability

Leadership and Management

Components of quality: planning,

quality control and quality improvement7

Quality

ImprovementMotivation/Leadership

Efficient Systems

Reflective Data

Context-sensitive learning

• Internal monitoring –

continuous measurement

• External Inspection –

intermittent inspection

• Internal and external

regulations

Quality Control IMPROVED

OUTCOMES

New Designs, re-designs

Innovations, new tools in response

to customer needs and experience

Quality Planning

Jens Winther Jensen, MD, Steering Committee Chairman

The Danish Clinical Registries

Senior Fellow Institute for Healthcare Improvement

Welcome to Denmark

Challenges

Economy

New treatments

Expectations and

demand

Variation in outcomes

Patients are hurt

Patientens wishes

often not in line with

physicians

Inequalities in health

Structual activity

Focus in productivity an

economy

Much attention on

defining the whats right

in the clininic

Employees express they

run too fast

11

Hamster Wheel

April 2015: Denmark to stop

hospital accreditation

Bent Hansen,

President of

Danish Regions

'Quality work must be simplified and focused. The time has

come to strengthen it by putting the patient at the centre,

rather than focusing on compliance with a variety of

standards. Accreditation has been justified and useful, but

we move on. We need a few national targets to be met

locally with strong commitment from the staff and with room

for local solutions.'

Grand, J. Le. (2010). Knights and Knaves Return: Public Service Motivation and the Delivery of Public Services. International Public Management Journal, 13(1), 56–71.

Mental Models of GovernancePublic service motivation and the delivery of public services

LeGrand’s Categories

Choice

Voice

Mistrust

Trust

Derek’s Translation

Competition

Patient co-production

Command and control

Collaboration

Grand, J. Le. (2010). Knights and Knaves Return: Public Service Motivation and the Delivery of Public Services. International Public Management Journal, 13(1), 56–71.

A new balance

Quality improvement

Innovation Control

Supervision

Excellent qualityUnacceptablequality

Health Care system units

Control and command Cooperation and trust CompetetionUsers voice

Steering paradigms

Governance review of hospitalsSuggestions for procedures and rules simplification, Maj 2015

Review

An excess of generalised and standardised procedure- and monitoring demands

Employees use a lot of time on tasks which are questioned by employees and their leaders

Implementation overload – not the specific standard or monitoring but the overall burden and trend

Fear of not being accredited has produced a large number of local quality standards and guidelines

Reduced local room for leadership

Quality problems and standards are defined externally

Leadership role reduced to implementation

New Danish Quality Program

- current components

National quality targets

Learning and quality teams

Leadership development program

New extended role of clinical

registries

Quality Control

Routine everyday monitoring part of your management

practice

Role of intermitted external inspection?

Whose responsibility is it?

Government

Healthcare Regions

Hospitals

Administrators

Profession

Measurement for improvement,

research and accountability