FINALS : Continuous Quality Improvement and Risk Management Flashcards
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A specific type of controlling refers to activities that are used to evaluate, monitor, or regulate services rendered to consumers
Quality control
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
Quality health care
The criterion or standard is determined. Information is collected to determine if the standard has been met. Educational or corrective is taken if criterion has not been met.
Quality control process
Predetermined level of excellence that serves as a guide for practice
Standard
Means of determining the quality of nursing that a patient receives
Standard of practice
Diagnosis-based, step-by-step interventions for providers to follow
Standardized Clinical Guidelines
A systematic and official examination of a record, process, structure, environment or account
Audit
Audit performed after the patient receives service
Retrospective audit
Audit performed while the patient is receiving service
Concurrent audit
Most effective audit
Concurrent audit
Audit utilized for future direction
Prospective audit
Assumption that a relationship exist between quality care and appropriate structure
Structure audit
Total Quality Management other name
Continuous Quality Improvement
Quality assurance goal
Quality nursing care with a difference
Standards or criteria :
- 7 M’s of Management (Money, Manpower, Machine, Materials, Methods, Moment (time) and Manager)
- Quality service
- Environment
- Resources
- Mechanisms and Strategies
- Qualification Standards are met when hiring personnel and managers
Structure
Standards or criteria :
- Nursing Process
- Clinical guidelines and protocol
- Standard Operating Procedure
- Steps or Process flow
- Identify the patient prior to giving of medication
- Shorten the admission process
Process
Standard or criteria :
- Performance appraisal
- Performance evaluation (staff of personnel)
- Self-evaluation or personnel evaluation
- Customer satisfaction
- Percentage of accomplishments
- Patient reported 80% satisfaction
Outcome
Customer satisfaction
OUTCOME
TQM : Continuous process improvement
Kaizen
TQM : Things will work as they are supposed to
Atarimae Hinshitsu
TQM : Examine how user applies the product
Kansei
TQM : Things should have aesthetic quality
Miryokuteki
Systematic process to improve outcome based on customer needs
Quality improvement
Continuous and long-term improvement in processes and output
PROCESS
Steps to ensure full involvement of entire work force
STRUCTURE
Quality assurance vs quality improvement
“doing it right”
Quality assurance
Quality assurance vs quality improvement
“doing the right thing”
Quality improvement
Quality assurance vs quality improvement
ASSESS/ MEASURE PERFORMANCE
Quality assurance
Quality assurance vs quality improvement
Whether performance meet standard
Quality assurance
Quality assurance vs quality improvement
Improve if not meeting the standard
Quality assurance
Quality assurance vs quality improvement
Efficiency
Quality assurance
Quality assurance vs quality improvement
Reactive Process
Quality assurance
Quality assurance vs quality improvement
Meet customer’s needs
quality improvement
Quality assurance vs quality improvement
Build /Assess work process
quality improvement
Quality assurance vs quality improvement
Identify opportunities for improved performance
quality improvement
Quality assurance vs quality improvement
Scientific approach to assessment and problem solving
quality improvement
Quality assurance vs quality improvement
CONTINUOUS improvement - ongoing management strategy
quality improvement
Quality assurance vs quality improvement
Interprets process and outcome
quality improvement
Quality assurance vs quality improvement
Effectiveness
quality improvement
Quality assurance vs quality improvement
Proactive
quality improvement
6 strategies for quality improvement
PDCA (plan, do, check, act) cycle or (plan, do, study, act)
FOCUS methodology
Benchmarking
Regulatory requirements
Sentinel Events monitoring
Balanced scorecard concept
PDCA begins with 3 questions:
WHAT – trying to accomplish
HOW – change is an improvement
WHAT – changes will result in improvement
PDCA cycle : Develop a change, test, activity aimed for improvement
Plan
PDCA cycle : Carry change, test out – small scale
Do
PDCA cycle : Study results to evaluate what was learned and what can be predicted
Check
PDCA cycle : Adopt the change, send through cycle again, under different conditions, abandon the idea
Act
FOCUS :
- improvement area
- Key: “WHAT IS THE PROBLEM?”
- Opportunity for improvement, obtain support data of existence
Focus
FOCUS :
- team that knows the process
- staff – directly participate in the process
- Team leader
Organize
FOCUS :
- happenings in current process
- Use FLOW DIAGRAM – illustrates process
Clarify
Analyze level of process:
Identify too many steps in a process, not well defined, long waits between process
Macro
Analyze level of process:
Examining decision points, redundancy of processes, waiting time areas, rework loops and handoffs
Micro
FOCUS :
- degree of change needed
- team review data gathered, literature on the topic, competitive benchmarks
- How organizations doing this process?
Understand
FOCUS :
- ___the problem
- select solution for improvement – involve staff
- Implementation plan – check progress of solution
- Identify activity to complete, who is responsible, when it will be done
Solve
Measuring and comparing results
Benchmarking
Key work process vs. “best performers”
Benchmarking
Identify gaps in performance and options for improvement
Benchmarking
JCAHO meaning
Joint Commission on Accreditation of Healthcare Organizations
JCAHO new name
JCI or Joint Commission International
Preparing for accreditation survey – used to begin improvement strategies
Regulatory Requirements JCI
Unexpected occurrence causing death or serious physical or psychological injury
Adverse SENTINEL EVENT
____ provides opportunities for improvement
analysis
Type of sentinel event which identifies strategies for future events
Linking sentinel event review
KEY of sentinel event monitoring
Sharing information to all
- Progress measurement – balance between: MEDICAL, PATIENT SATISFACTION, COST OUTCOMES
- Change in an area must be evaluated – how it affects balance of another
Balanced scorecard concept
4 key areas evaluated in balanced scorecard concept
- Functional status of patient
- Clinical status of patient
- Patient satisfaction
- Cost of care
4 Problem Identification Tools
- Affinity Diagram
- Brainstorming
- Flowchart
- Nominal Group Technique
Who made the affinity diagram
Jiro Kawakita (1960), JK METHOD
Problem Identification Tools :
- tool used to organize ideas and data
- one of the 7 Management and Planning Tools
- commonly used within project management allows large numbers of ideas to be sorted into groups for review and analysis
Affinity diagram
Problem Identification Tools :
- tool used to organize ideas and data
- one of the 7 Management and Planning Tools
- commonly used within project management allows large numbers of ideas to be sorted into groups for review and analysis
Affinity diagram
Problem Identification Tools :
- Group creativity technique
- designed to generate a large number of ideas for the solution of a problem
- proposed that groups could double their creative output with brainstorming
Brainstorming
Brainstorming was first popularized in the late 1930s by ____ in a book called ____
Alex Faickney
Applied Imagination
Brainstorming Rule :
- This rule is a means of enhancing divergent production, aiming to facilitate problem solving through the maxim, quantity breeds quality.
- The assumption is that the greater the number of ideas generated, the greater the chance of producing a radical and effective solution.
Focus on quantity
These are intended to reduce social inhibitions among groups members, stimulate idea generation, and increase overall creativity of the group.
4 Basic rules in brainstorming
Brainstorming Rule :
- In brainstorming, criticism of ideas generated should be put ‘on hold’. Instead, participants should focus on extending or adding to ideas, reserving criticism for a later ‘critical stage’ of the process. By suspending judgment, participants will feel free to generate unusual ideas
Withhold criticisms
Brainstorming Rule :
- To get a good and long list of ideas, unusual ideas are welcomed. They can be generated by looking from new perspectives and suspending assumptions. These new ways of thinking may provide better solutions.
Welcome unusual ideas
Brainstorming Rule :
- Good ideas may be combined to form a single better good idea, as suggested by the slogan “1+1=3”. It is believed to stimulate the building of ideas by a process of association.
Combine and improve ideas
Problem Identification Tools :
- common type of chart - represents algorithm or process
- shows steps as boxes of various kinds, and their order by connecting these with arrows
- used in analyzing, designing, documenting or managing a process or program in various fields
Flowchart
The “flow process chart” introduced by ____
Frank Gilbreth
Types of flowcharts : Shows document flow through system
Document flowcharts
Types of flowcharts : Data flows in a system
Data flowcharts
Types of flowcharts : controls at a physical or resource level
System flowcharts
Types of flowcharts: Controls in a program within a system
Program flowchart
Problem Identification Tools :
- type of brainstorming - all participants have an equal say in the process
- used to generate a ranked list of ideas
- Participants are asked to write their ideas anonymously
Nominal Group Technique
Nominal Group Technique : Participants ideas written anonymously, moderator collects and each is voted on by show of hands
Distillation
Nominal Group Technique :
After distillation, the ____ ideas may be sent back to the group or to subgroups for further ____.
- top ranked
- brainstorming
6 Problem Description Tools
Bar Graph
Check Sheet
Force Field Analysis
Line Graph
Pareto Graph
Pie Chart
Problem Description Tools :
- rectangular bars with lengths proportionate values that they represent
- used for comparing two or more values taken over time or on different conditions, usually on small data sets
Bar graph
Problem Description Tools :
- simple document – used for collecting data in realtime and location where data is generated
- typically a blank form - quick, easy, and efficient recording of the desired information - quantitative or qualitative
Check sheet
Quantitative check sheet is called ____
Tally sheet
Basic types of Check Sheets :
- A trait such as a defect or failure mode must be classified into a category.
Classification
Basic types of Check Sheets :
- The physical location of a trait is indicated on a picture of a part or item being evaluated.
Location
Basic types of Check Sheets :
- The presence or absence of a trait or combination of traits is indicated. Also number of occurrences of a trait on a part can be indicated
Frequency
Basic types of Check Sheets :
- A measurement scale is divided into intervals, and measurements are indicated by checking an appropriate interval.
Measurement scale
Basic types of Check Sheets :
- The items to be performed for a task are listed so that, as each is accomplished, it can be indicated as having been completed.
Check list
Problem Description Tools :
- framework for looking at factors (forces) that influence a situation systematically
Forcefield analysis
Force Field Analysis :
- driving movement toward a goal
Helping forces
Force Field Analysis :
- blocking movement toward a goal
Hindering forces
Force Field Analysis was developed by ____
Kurt Lewin
Problem Description Tools :
- special type of bar chart -values being plotted are arranged in descending order
- accompanied by a line graph - shows the cumulative totals of each category, left to right.
Pareto graph