QUALITY ASSURANCE & CHANGE

STRATEGIC MANAGEMENT IN HEALTHCARE

3 MARCH , 2009

QUALITY

• DOING THE RIGHT THINGS RIGHT, THE FIRST TIME & EVERY TIME

– Quality of conformance – absence of defects

– Quality of design – customer satisfaction

CUSTOMERS

• PAYORS

• PATIENTS

• ANY DOWNSTREAM USER OF OUTPUT

• VIRTUALLY EVERYONE IN YOUR ORGANIZATION

HEALTHCARE QUALITY

• MEDICAL OUTCOMES

• PATIENT SATISFACTION

• CLIENT SATISFACTION

EVALUATION OF QUALITY

• ACCURATE DIAGNOSES• IMPROVEMENT AT DISCHARGE• MORBIDITY & MORTALITY• EFFICACY OF TREATMENT

• TOTALITY OF A PRODUCT THAT BEARS ON ABILITY TO SATISFY NEEDS OR WANTS

CQI

• CONTINUOUS QUALITY IMPROVEMENT

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

• IF IT ISN’T PERFECT MAKE IT BETTER

CONTINUOUS QUALITY IMPROVEMENT

• PROACTIVE APPROACH THAT ASSUMES ALL PROCESSES CAN BE IMPROVED

• ASSUMES A REASONABLE LEVEL OF QUALITY TO BEGIN WITH

• ASSUMES YOU ARE DOING THE RIGHT THINGS ALREADY

ELEMENTS OF CQI

• ORGANIZATION WIDE

• PROCESS FOCUSED

• TEAM-BASED

• PROSPECTIVE AND ONGOING

• USES OUTPUT OR INSPECTION MEASURES

• CUSTOMER DRIVEN

GOAL OF PROCESS IMPROVEMENT

• DO IT RIGHT THE FIRST TIME– CORRECTIONS ARE EXPENSIVE

• 99% IS NOT GOOD ENOUGH– 6000 STEPS TO BUILDING A CAR– 60 THINGS WRONG WITH YOUR CAR– SOME WILL BE FATAL FLAWS

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

CROSBY

• QUALITY IS FREE – WHAT COSTS IS NONQUALITY PRODUCTION

• COST OF QUALITY– NONCONFORMANCE – COST TO FIX IT– CONFORMANCE – COST TO EVALUATE

AND IMPROVE

OUTLIERS

• UNDESIRABLE– PREVENT FUTURE OCCURRENCES

• DESIRABLE– CAN IT BE DUPLICATED?

HEALTHCARE QUALITY

• YOUR BODY IS NOT A CAR

• ALL TREATMENTS HAVE RISKS

• ALL TREATMENTS HAVE FAILURES

• EVERYONE IS GOING TO DIE

ORGANIZATIONAL CHANGE

Organizational Change

• Any discernable modification in any aspect of an organization’s purpose or objectives. culture, strategies, tasks, technologies, people, or structures.

Managing Change

• Four stage model– Identification– Planning– Implementation– Evaluation

Why Change

• Organizations, like people, are always growing or dying.

• Changes carry a variety of costs and should never be undertaken unless reasons are compelling.

Resistance to Change

• When people are part of the status quo, even minor changes are disruptive.

• Individuals pay selective attention to the environment according to their interests and selectively interpret the information they receive.

• All change is personal and personnel.

Reasons for Resistance

• Insecurity or uncertainty• Inconvenience• Implies the current situation is bad• Relationships change• Individual and group status changes• Economic losses• Resentment of exercise of power• Union opposition

Personal & Personnel

• RIF & pay cuts

• Hiring freeze

• Downsizing means more work for fewer people.

• New jobs go to new people

• Survivor guilt

Reducing Resistance

• Education and communication

• Participation

• Support adjustment

• Negotiate agreement

• Manipulate or co-opt the opposition

• Coercion – inappropriate?

Platitudes/Truths

• Diapers and politicians should be changed regularly and for the same reason.

• No one likes to be changed but a baby.

• All change is stressful.