Modules 4-5 Flashcards
What is the number one thing that makes change hard?
barriers
List common barriers
individuals, resources, systems, education, other
What is Six Sigma
It is a quality improvement philosophy that strives to eliminate defects through reduction of variation in a process
What does Six Sigma focus on?
Stakeholder engagement, data analysis, eliminating waste, improving outcomes
What factors influence which leadership style to use?
personal background, staff, the organization
BARRIERS: Individuals
- attitude (i.e., fear of change, lack of self-control)
- practice skills (i.e., limited communication skills)
BARRIERS: Resources
- lack of management, incentives, protocols, guidelines
BARRIERS: Systems
- Limited acceptance by other health care professionals
BARRIERS: Education
Knowledge and training
BARRIERS: Other
Lack of mentors and models, lack of vision
Autocratic Leadership Style
- classical approach
- manager retains power and decision-making authority
Bureaucratic Leadership Style
- manages “by the book”
- Everything done according to procedure or policy
– business focused. it’s not about the employees
Democratic Leadership Style
- aka participative style
- allows staff to establish goals
- encourage growth and promotions
Laissez-Faire Leadership Style
- aka the “hands-off style”
- minimum intervention from leader
- Full autonomy for workers
What is Negotiation?
A voluntary attempt, through direct dialogue, to resolve conflicts that arise from competing needs, interests, and goals.
How do you prepare for a negotiation?
-recognize you’re preferred negotiation style
-frame, plan, and strategize
What are the different styles of negotiation?
Distributive (win/lose)
Integrative (win/win)
mixed-motive
What factors could affect negotiations?
- negotiating in teams
- multi-party negotiations
- power imbalances (who has the resources)
- history
- personalities
- time
Essentials for Negotiating:
Effective negotiators…
- recognize the choices that they need to make
- recognize and adapt to others’ behaviors
- Are both empathetic and assertive
- Carry the burden of moving negotiations ahead
What are the roles in a Lean Six Sigma Project?
- master black belt
- black belt
- green belt
- yellow belt
Master Black Belt
- Teach, coach, and mentor black and green belts to ensure the methodology and tools are being applied properly
- advisor
- Master
Black Belt
- lead, execute, and complete the project
- Can lead complex, business critical projects
- Expert
Green Belt
- Support Lean Six Sigma projects through executing a subset of tools and phases
- Able to do the work in a capable manner
- Practitioner
Yellow Belt
- Plays a small role in the process of developing knowledge
- Understand the process and what they have to do
- Introductory
White Belt
- Plays a small role in the process of developing knowledge
- All those who have to interact with the process
- Awareness
Six Sigma
- More focused on reducing defects (variation) and increasing productivity
Lean
- Adopt many ideologies from just-in-time manufacturing
- Strive for perfection
What is Lean Six Sigma?
- Standard of excellence equates to 3.4 defects per million opportunities (DPMO)
- Centered on the concept that any process variation can be reduced using data collection, statistical tools, and sustained process monitoring
- Sigma measures the variability of a process concerning specification limits (set by customer)
- Sigma level is a metric that represents how well a process is performing, how much variation there is, and how likely a defect will occur
Who created the 5 principles of LEAN thinking?
Jim Womack and Daniel Jones
What are the 5 principles of LEAN thinking?
- value
- create value stream
- flow and pull
- empowerment
- perfection
5 principles of LEAN thinking:
Value
customers will pay a certain price for a good/service based on the associated value they place on it
5 principles of LEAN thinking:
Create Value Stream
visualize and map out high-level actions of the entire process to identify value-added activities that can be eliminated, time delays, and waste (non-value-added activities)
5 principles of LEAN thinking:
Flow and Pull
increase flow of products/services through the value stream based on pull of customer demand (just-in-time)
5 principles of LEAN thinking:
Empowerment
empowering employees provides greatest customer value and works to eliminate waste
5 principles of LEAN thinking:
Perfection
working towards zero defects and zero waste
What does DMAIC stand for?
Define
Measure
Analyze
Improve
Control
DMAIC: Define
involves selecting a project based on business, operational, or customer needs and aligning with organizational strategy
DMAIC: Measure
involves data collection, validation of the measurement system, and initial documentation or variation
DMAIC: Analyze
Uses date to establish the main inputs (causes) that affect the outputs (problem)
DMAIC: Improve
identifies the improvements/solutions to optimize the outputs and reduce defects
DMAIC: Control
uses documentation, monitoring, and accountability assignment to maintain the gains made by process improvements
Project Identification - Pareto Priority Index
PPI = [(Savings $) x (Probability of Success)]/(Cost x Completion Time)
What Is the Pareto Priority Index equation used for?
To help identify/prioritize which tasks/projects to focus first
SIPOC
Supplier
Input
Process
Output
Customers
What is SIPOC?
- A process that is a series of steps or actions that transform inputs (x) into outputs (y)
- A tool used by a Six Sigma project team to further define a project not fully scoped
provides general direction and is considered ‘voluntary’
guideline
Method(s) that has/have consistently shown results superior to those achieved with other means
best practice
intermediary measures between an intervention and an outcome
process/performance indicator
What we measure
metric
measurement norm when compared to similar entities
benchmark
Formal statement of a principle, course, or plan of action that should be followed; thou must
policy
Provides detailed steps someone needs to follow to achieve a recurring task; thou shall
procedure
Specifies uniform uses of specific technologies or configurations
standard
Detailed plan of a scientific or medical experiment, treatment, or procedure; requires written order by provider before it can be initiated
protocol
The result of a performance; an observable or measurable terminal event
outcomes
ensuring that policies, procedures, and activities are consistent with rules, regulations, and standards
compliance
how well a certain activity is accomplished (e.g., meeting vs. not meeting expectations
performance
ECHO model is an integrated approach that is a theoretical basis for consideration of potential trade-offs among variables in optimizing allocation of health care resources. The VARIABLES in the ECHO model are:
clinical
humanistic
economic
T/F
Traditionally, outcomes in pharmaceutical products or services were measured based on economic efficiency and quality whereas today the focus is more on clinical-based
False
OUTCOME, PROCESS, STRUCTURAL?
% of pts with T2DM who have an A1C at goal of < 7%
outcome
OUTCOME, PROCESS, STRUCTURAL?
% of pts with HTN who had elevated BP values upon presentation to clinic had a repeat BP value recorded
process
OUTCOME, PROCESS, STRUCTURAL?
% of pts with T2DM diagnosis who are being seen daily by a PharmD
structural
T/F
Historically, quality measures focused on structural and process whereas today the focus has shifted to outcomes
True
T/F
KPIs and KSIs as metrics have an external application and can be used when comparing similar entities within the same sector
False
When choosing healthcare quality measure, the monitoring system must support ongoing awareness of performance trends and emerging issues and essential elements include
- periodically assess sustainability
- develop report formats to provide clear communication
- establish a schedule for regular reporting
T/F
Effective dashboards can be beneficial in their ability to visualize single data points and provide greater accessibility and accountability in the use of data information
false
T/F
An effective dashboard is created with a top-down approach in terms of organizational hierarch (e.g., executive dashboards should feed into departmental dashboards)
false
An effective dashboard should:
(4 options)
- have clearly defined roles in place for ownership or metrics
- tell a story
- be intuitive
- have experts on the data at the department level
When designing metrics, they should be what?
(5 options)
- time bound
- measurable
- attainable
- relevant
- specific
Results from the SURMOUNT studies for the newest GLP-1 RA to hit the market, tirzepatide (Mounjaro) demonstrated a weight loss exceeding that reported from other GLP-1 DAs in use. As an Amb care pharmacist working in an internal med clinic you have a large population of pts w/ T2DM being treated with a GLP-1 RA many of whom have converted over to tirzepatide. You are interested in determining how many of those pts who have converted to trizepatide have experienced improvement In weight loss. You develop a surgery to send to those pts to assess the impact. The survey is an example of which type of outcome?
Humanistic
Compliance
Ensures that policies, procedures, and activities are consistent with laws, rules, regulations, and standards
Performance
Tells us how well a certain activity is doing whether you are accomplishing what was intended
Outcomes
The result of a performance and is a terminal event
(An observable or measurable terminal event)
ECHO model assists in…
planning, conducting, and evaluating pharmaceutical products and services from a multi-dimensional perspective
benchmarks
Measurement ‘norms’ that are used when comparing to similar entities
Lean focuses on…
waste reduction
Six Sigma focuses on…
emphasizes variation reduction
RCA
retrospective review of system processes to determine the root cause of an adverse event to outcome
-what went wrong
FMEA
prospective review of system processes to determine areas of high risk or vulnerability before they lead to an adverse event or outcome
-what could go wrong
Dashboards
Method by which you can track, trend and communicate process improvement and outcome measures
What is the ECHO Model?
A combination of traditional clinical-based outcomes with more contemporary measures of economic efficiency and quality
Economic evaluations focus on:
cost-of–illness
cost-minimization analysis
cost-benefit analysis
cost-effectiveness analysis
cost-utility analysis
Humanistic evaluation focus on:
Quality of life
Patient preferences
Patient Satisfaction
Willingness-to-pay`
Quality
increase probability of positive outcomes and decrease probability of negative outcomes
Historical Focus
structure and process
Current Focus
outcomes
T/F
With VBC, healthcare organizations and providers do not assume more risk.
False
W/ VBC healthcare organizations and providers, they DO assume more risk
Donabedian Model
Quality measure classified as structural, process, or outcome
Pharmacy Standard of Care
What a reasonable and prudent pharmacist would do under the same circumstances
Guideline
Provides general direction. additional advice, and support for policies, standards or procedures
-voluntary
Best Practice
method(s) that has/have consistently shown results superior to those achieved with other means
Policy
relates to a decision of the governing body of an organization and is typically an internal organizational decision that aids how it functions
-thou must
Procedure
Provides detailed mandatory steps someone needs to follow to achieve a recurring task or comply with a policy
-thou shall
standard
specifies uniform uses of specific technologies or configurations
protocol
Detailed plan of a scientific or medical experiment, treatment, or procedure
Six Sigma
eliminate/avoid defects
Lean
eliminate/remove/minimize waste
Event Flow Diagram
Trace chronology of events that led to the adverse event or near miss
5 Why’s Analysis
When looking at one major cause and need to drill-down to arrive at one root cause
Fishbone Diagram
When looking at numerous major causes and need down probing to arrive a numerous root causes based on ‘cause and effect’ relationships
Hazard Score =
severity x probability of occurrence x probability of detection
HR = severity x POO x POD
Pharmacy Quality Assurance
- performance measures
- monitoring measures
- quality improvement indicators
Performance measure
intended to evaluate the quality …
- e.g., proportion of days covered: statins and statin use in DM pts
monitoring measures
intended to promote standardized documentation and reporting …
- e.g.,med therapy problem resolution
quality improvement indicators
intended to asses improvement …
- e.g., provisions of MTM svc’s post hospital discharge and readmission of pts provided MTm sec’s post hospital discharge
Essential elements of choosing health care quality
- choose a limited set of effective measures
- establish a schedule for regular reporting
- develop a report formats to provide clear communication
- establish procedures for acting on identified problems
- assess sustainability periodically
Good health data visualization helps healthcare teams and organizations to:
- simplify data information
- increase collaboration
- avoid data misinterpretation
