QUALITY AND CONTROL

STRATEGIC MANAGEMENT IN HEALTHCARE

MARCH 29, 2005

HEALTHCARE QUALITY

• OUTCOMES

• PATIENT SATISFACTION

CUSTOMERS

• PATIENTS

• ANY DOWNSTREAM USER OF OUTPUT

QUALITY

• DOING THE RIGHT THINGS RIGHT

CQI

• CONTINUOUS QUALITY IMPROVEMENT

• IF IT AIN’T BROKE IT CAN STILL BE IMPROVED

CQI

• 90% OF US HOSPITALS HAVE A PROGRAM

• 65% HAVE MORE THAN 6 CQI PROJECTS

GOAL OF PROCESS IMPROVEMENT

• DO IT RIGHT THE FIRST TIME

• 99% IS NOT GOOD ENOUGH

DEMING

• POOR QUALITY– IS THE RESULT OF BADLY DESIGNED OR

MALFUNCTIONING PROCESSES– CAN BE PREVENTED– PREVENTED BY REDUCTION OF

VARIABILITY

JURAN

• QUALITY IS FITNESS FOR USE - FREE FROM DEFICIENCIES AND MEETING CUSTOMER NEEDS

• QUALITY TRILOGY– PLANNING– CONTROL– IMPROVEMENT

OUTLIERS

• UNDESIRABLE– PREVENT FUTURE OCCURRENCES

• DESIRABLE– CAN IT BE DUPLICATED?

CQI AND CONTROL

• PROCESSES CAN BE IMPROVED

• CONTROL IS DIRECTED AT PROCESSES

• INPUT CONTROL IS NO SUBSTITUTE FOR PROCESS AND OUTPUT CONTROL

CONTROL MONITORING POINTS

• INPUTS - PROSPECTIVE– FEED FORWARD CONTROL

• PROCESSES - CONCURRENT– SCREENING CONTROL

• OUTPUTS - RETROSPECTIVE– FEEDBACK CONTROL

CONTROL METHODS

• BUDGETING

• COST ALLOCATION

• FINANCIAL STATEMENTS

• RATIO ANALYSIS - % OF EXPECTED

• OPERATIONAL ACTIVITY ANALYSIS

• BENCHMARKING

• FINANCIAL ANALYSIS

RISK MANAGEMENT

• AVOID OR REDUCE LOSSES/MISTAKES

• MITIGATE THE DAMAGE FROM LOSSES/MISTAKES

• INSURE AGAINST LOSSES/MISTAKES

• OBEY THE LAW

STEPS IN RISK MANAGEMENT

• IDENTIFY

• EVALUATE

• REDUCE/ELIMINATE

• TRANSFER/INSURE

WHEN A LOSS OCCURS

• SECURE THE RECORDS

• MITIGATE DAMAGES

• DON’T ADD INSULT TO INJURY

• BE SMART ABOUT BILLS

SELF-INSURANCE

• YOU ARE YOUR OWN INSURANCE COMPANY

• REINSURANCE OR UMBRELLA IS USUALLY NECESSARY

• DEDUCTIBLE IS A FORM OF SELF-INSURANCE

INCIDENT REPORTS

• MAY BE USED FOR NUMBERS ONLY

• SERIOUS PROBLEMS NEED A FAST TRACK

• MUST HAVE A CORRECTIVE ACTION COMPONENT - DON’T JUST DOCUMENT YOUR STUPIDITY!

INDEMNIFY & HOLD HARMLESS

• USUALLY A STUPID IDEA FOR BOTH PARTIES

• DON’T EVER SIGN ONE YOURSELF

• INSURANCE OR A BOND IS THE RIGHT WAY TO DO THIS