Supplies Management, Ordering, And Utilization

7/29/2019 Supplies Management, Ordering, And Utilization

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Continuous Quality Improvement, RiskManagement


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Clinton (1993) (healthcare reform)

Six principles basic toSecurity Act:

1. security: guaranteeingcomprehensive benefitsto everyone

2. Simplicity : cutting redtape and consequently

simplifying the system

3. savings: controlling thecosts of health care

4. Quality: making healthcare better

5. Choice: preserving and

increasing the optionsavailable

6. Responsibility: makingeveryone responsiblefor health care


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Choice - the right tochoose ones healthcare provider toprotect the doctor-

patient relationship


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Quality standards areoften set byprofessional bodiesand promulgated

through: A. Codes of ethics

Standards of care

Standards of performance

Practice guidelines

Monitored through: 1. accreditation

Peer review

Certification processes


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Outlines standards ofcare

1. Assessment

2. Diagnosis

3. Identification ofoutcomes

4. Planning

5. Implementation

6. evaluation

Standards of professionalperformance1. Quality of care2. Performance appraisal3. Education4. Collegiality5. Ethics6. Collaboration7. Research8. Resource utilization


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Deming (1982) Total Quality

Management (TQM)

Continuous QualityImprovement (CQI)

Plan-do-check-act(PDCA)

Chain reaction:a. Improve qualityb. Decrease costs with

fewer mistakes, less re-work, fewer delays,

better use of time andmaterialsc. Improve productivityd. Capture the market with

better quality at lowerprizes

e. Stay in businessf. Provide jobs


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1. cause-and-effectchart

2. Flow chart

3. Pareto chart

4. Histogram5. Run (trend) chart

6. Scatter diagram

7. Control chart

Others: Checklist

Pie charts

Time charts

Decision matrices

Affinity charts

Tree diagrams

Relationship diagrams

Force-field analysis

Bar graphs


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Vilfredo Pareto,contains both bars anda line graph, whereindividual values are

represented indescending order bybars, and thecumulative total isrepresented by the

line.
http://en.wikipedia.org/wiki/Vilfredo_Paretohttp://en.wikipedia.org/wiki/Bar_charthttp://en.wikipedia.org/wiki/Line_charthttp://en.wikipedia.org/wiki/Line_charthttp://en.wikipedia.org/wiki/Bar_charthttp://en.wikipedia.org/wiki/Vilfredo_Paretohttp://en.wikipedia.org/wiki/Vilfredo_Paretohttp://en.wikipedia.org/wiki/Vilfredo_Pareto


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a histogram is agraphicalrepresentation showinga visual impression of

the distribution of data


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Plan: Plan the change

Identify the opportunities

Develop vision statement

Collect data to defineproblems andopportunities

Use CQI tools to organizedata and thinking

Decide on improvementinitiatives

Do Implement the planned

change

Implement initiatives

Test with a trial run

Identify costs, people andmaterials

Educate staff andmanagement aboutchanges in the process


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Check: Observe the effect of

change

Monitor progress ofinitiatives

Meet with staff to discusschanges

Delegate staff to monitorresults

Compare new data withoriginal data, using CQItools

Use CQI tools to monitorresults

Act: Adjust as necessary

Incorporate changes intodepartment policies

Inform and educate all

involved

Distribute new policies tokey individuals

Look for newopportunities


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Quality planning:1. Determine who the

customers are2. Determine the needs of

the customers3. Develop product features

that respond tocustomers needs

4. Develop the processesthat produce thoseproduct feature

5. Transfer the resultingplans to the operatingforces

Quality Control:1. Evaluate actual quality

performance

2. Compare actualperformance with

quality goals3. Act on the difference


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Quality Improvement:1. Establish the

infrastructure needed tosecure annual qualityimprovement

2. Identify the specificneeds for improvement,which become theimprovement projects

3. Establish a project teamwith responsibilities forbridging the project tosuccessful closure

4. Provide the resources

and training needed byteams to diagnose theproblems, develops aremedy, and establishcontrols to maintain the

gains


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14 Steps:1. Commitment from

management

2. Use of quality

improvement teamscomposed of peoplewith processknowledge andcommitment

3. Quality measurementto identify the areasthat needimprovement and

change4. Measuring the cost of

quality andnonquality

5. Quality awareness by

all personnel


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6. Corrective actionsthrough opportunitiesfor improvement

7. Zero defects planning do it right the firsttime

8. Employee educationfor qualityimprovement

9. Zero defect day asdemonstration ofcommitment toquality

10. Goal setting towardzero defects11. Error-causal removal

by removing barriers12. Recognition for

meeting goals


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13. Quality councils toassist people inquality improvement

14. Do it all over again

Defines quality as:conformance torequirements

Believes that thesystem for creatingquality is prevention oferrors instead ofappraisal


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Donabedian: Known for his structure,

process and outcomecriteria for qualityassessment

Berwick: Stresses the importance

of improving processtoward qualityimprovement


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10 rules of Redesign1. care is based on

continuous healingrelationships

2. Care is customized

according to clientneeds and values

3. Client is the source ofcontrol

4. Knowledge is hared and

information flows

5. Decision making isevidence based

6. Safety is a systemissues

7. Transparency is

necessary8. Needs are anticipated

9. Waste is continuouslydecreased

10. Cooperation among

clinicians is a priority


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Challenges ofredefined imperatives:1. Reengineered care

processes

2. Effective use of

informationtechnologies

3. Knowledge and skillsmanagement

4. Development ofeffective teams

5. Coordination of careacross patientconditions, services and

sites of care over time


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Quality Assurance:a. Detection oriented

b. Reactive

c. Narrow focus

d. Getting by

e. Tradition and safety

f. Busyness

g. Leadership not vested

h. Leader as director

i. Employee asexpendable

Quality Improvement:a. Prevention oriented

b. Proactive

c. Cross-functional

d. Raising standards

e. Experimentation andrisk

f. Productivity

g. Leadership leading

h. Leader as empowereri. Employee as customer


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Quality Assurance:j. Responsibility of few

k. Problem solving byauthority

l. We-they thinking

m. Cynicism

Quality Improvement:j. Responsibility of all

k. Problem solving by all

l. Organizationalperspective

m. New optimism


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Standards are writtenvalue statements thatdefine a predeterminedlevel of expected

performance:a. Structureb. Process

c. Outcome

Structure standards:physical environment,structure ormanagement

Process standards:related to delivery ofcare

Outcome standards:results of the care or

administration


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Nursing audits: are basicform of data collection1. Structure audits: donewith check list->that can note the presenceand absence of policies,procedures, medical records,physical facilities,equipment, organizationalstructure, caregiversknowledge and experience,adequate staffing

2. Process audits: relatedto care-> implementingphysicians orders,observing symptoms,

implementing nursingprocedures, dischargeplanning, teaching andcharting


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3. Outcome audits:observe the result ofthe care or how thepatients health statuschanged as a result ofthe interventions-> related to physical

health status, mental healthstatus, physical function,health behaviors, utilizationof services and satisfactionwith the service received


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Bar graph: series ofbars representingsuccessive changes invalue of a variable or

different data sets

Benchmarking:process of identifyingbest practices andcomparing them with

the agencys practicesto improveperformance


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Brainstorming:process of creating afree flow of ideaswithout fear of

criticism and thenthinking about thegood in the wild ideasthat were generated

Cause-and-effectdiagram: (fishbonediagram) used toidentify the root causes

of a problem oroutcome


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Radar charts: circulardisplays of before-and-after data todemonstrate progress

made or lost


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Run chart: line graphthat displays thevariations in data overtime. Quick

assessment of patternsand trends


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Scatter diagrams:determinerelationships betweentwo variables- Reflects correlations butdo not explain causation

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