Quality Measurement:It’s Everyone’s Responsibility

Kay Bensing, MA, RNADVANCE for Nurses

Objectives

• Identify three resources that provide the best information about quality healthcare.

• Describe the role of allied healthcare professionals in advocating for quality care.

• Discuss the relationship of collaboration to quality.

Measuring Personal Quality

How much time do you spend selecting?

Quality Defined

Over the years, quality in healthcare has been defined in many different ways

• Agency for Healthcare Research and Quality definition:“Doing the right thing at the right time in the right way for the right person — and achieving the best possible results.”

Quality: A National Priority

Healthcare Research and Quality Act of 1999• Agency for Healthcare Research and

Quality reauthorized• Mission: “Serve as a scientific and

research agency for all Americans”• (www.ahrq.gov) is one of best resources

for healthcare professionals

History of Quality Measurement

• Joint Commission beginnings — American College of Surgeons (1951) retrospective data

• Deming’s 14 points to Improve Quality — quality circles (1970s)

• Donabedian — Quality Assurance model — process and outcomes

• Donald Berwick, MD — total quality management (TQM)

QA and CQI Differences

QA• Driven by regulatory and accrediting agencies• Focus on who is responsible for errors• Relies on inspections to identify errors• Periodically measures quality• Management is top to bottomCQI• Internally driven• Systems approach• Seeks to prevent errors by clarifying and

improving processes• Shared governance leadership

Leapfrog Group

In 1998, Fortune 500 companies met to discuss inferior care they were purchasing for their employees.

• Collaboration among 170 companies initially. Goal was to provide incentives for providers if “big leaps were made in safety, quality and healthcare value.”

• Incentives included computerized order-entry for physicians, EBP hospital referral, intensivists in critical care, meet Leapfrog Safe Practice Scores based on National Quality Forum-endorsed safe practice data

Seminal Quality Documents

Institute of Medicine Studies

1999 – “To Err is Human”

2001 – “Crossing the Quality Chasm: A New Healthcare System for the 21st Century”

Crossing the Quality Chasm Indicators

• Safety• Effectiveness• Patient-centered

care• Timeliness• Equity• Efficient

“Many people don’t think there is any problem related to quality in healthcare.”

– Trudy Lieberman, Consumer Reports, 2002

“Americans believe bigger is better, the doctor is always right and we have the best healthcare system in the world.”

Rand Corporation Study

• June 2003• Largest and most comprehensive study

about quality of care done at the time• Research included Americans with health

insurance• Examples of findings: Only 45% of post-MI patients received beta

blockers. Only 39 percent of patients diagnosed with

pneumonia received recommended care.

National Commissionfor Quality Assurance

• The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving healthcare quality.

• NCQA has helped to build a consensus around important healthcare quality issues by working with large employers, policymakers, doctors, patients and health plans.

Healthcare Effectiveness Data& Information Set (HEDIS)

HEDIS® Measure Development ProcessDeveloping a measure is a multistep process:• Identifying the clinical area to evaluate• Conducting an extensive literature review• Developing the measure with the

appropriate MAP and other panels• Vetting with various stakeholders• Performing a field-test that looks at

feasibility, reliability and validity

NCQA Report 2008

• Good News: 1 in 3 Americans are enrolled in health plans that measure quality

• Blood pressure control rates improved 76% in 6-year period

• Bad news: 50 million Americans are uninsured• Still too many areas where there is a lack of

evidence about what is best care for patients• Beta blockers prescribed for post-MI patients

still low

Nursing Contributions to Quality

• Nursing’s Safety and Quality Initiatives introduced in 1994 by ANA Board of Directors

• Linda Aiken’s research• Magnet hospitals

Systems View of Health-Related Programs

Systems View for three primary care programs: training session for CHWs, diarrhea control program and drug supply

• Inputs CHWs, Trainers, Teaching Material• Processes Training sessions• Outcomes Competent CHWs* The outcomes of one system often become the

inputs of another.

Foundations of Quality Monitoring

• Data collection – routine activity integrated into daily tasks

• Data collected regularly and over time so trends can be monitored

• Data used to identify presence and causes of system problems that can result in poor perfromance

• Data used to guide management decisions

Measuring Quality Data

• Ongoing Monitoring• Spot Checks• Incremental Approach

Steps in Quality Monitoring

Step 1: Decide what information you need

1. Select health services to be monitored2. Describe process of care3. Draw systems review of the services4. Make critical standards explicit5. Develop performance standards

Measuring Quality

Step 2: Collect the data

1. Choose appropriate data collection methods

2. Design monitoring tools3. Test the tools4. Select monitoring strategy5. Collect data

Measuring Quality

Step 3: Use the information and results

1. Tabulate results2. Analyze results3. Interpret and use results4. Design a data storage and retrieval

system5. Disseminate information

What is Six Sigma?

Developed in mid-1980s by Motorola tocome up with solutions to counter• customer dissatisfaction• competitive pressures

Six Sigma Philosophy

• What is critical to customers?• How well are you performing today?• How can you leverage facts and data?• How can you sustain improvement?

Have Fun

Familiarize and use resources

Good care and quality is your responsibility

About This Presentation

• Brought to you by ADVANCE for Nurses.• Merion Publications Inc. is an approved provider

of continuing nursing education by the Pennsylvania State Nurses Association (No. 221-3-O-09), an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Visit http://www.advanceweb.com/ce to be tested on this presentation.