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HMGT 6332 > Quality > Flashcards

Quality Flashcards

1
Q

3 core problems in healthcare

A

Access
Quality
Cost

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2
Q

Definition of access

A

Access is a measure of the “fit” between characteristics of providers and health services and characteristics and expectations of clients.

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3
Q

Five dimensions of access

A

Availability (adequacy of supply of physicians and facilities)
Accessibility (location wise)
Accommodation (manners, like systems, hours, service)
Affordability
Acceptability(satisfaction)

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4
Q

Number of Americans died because of healthcare

A

48 million in 2011

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5
Q

United States health expenditures in 2010

A

2.5 trillion and $8,402 per capital

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6
Q

Average US life expectancy and rank

A

Rank 27th, 78 years

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7
Q

Highest life expectancy country in the world

A

Japan 81 years( per capita expenditure half of the US)

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8
Q

Factors contributing to growth in costs

A
  • The prevalence of chronic diseases(慢性病的流行）
  • Changing nature of disease management（感染数量增加）
  • Increasing complexity of healthcare (knowledge, technology, training systems, longer life spans)
  • growth in demand for healthcare(population and longer life span)
  • structural factors(为了更好的质量要走一步一步重复的程序和流程）
  • shortage of healthcare providers
  • administration and payroll costs(太多行政人员）
  • uncompensated care(free healthcare)
  • social factors(drug和酒精滥用，在healthcare上花钱越来越多，STDs，肥胖）
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9
Q

Factors contributing to poor quality

A
  • Localized consumption
  • Low elasticity of demand of healthcare(质量没有因为需求上去而跟上)
  • Need for specialized knowledge by consumers(医疗知识太专业，病人无法分辨医疗质量的好坏)
  • Non-discretionary nature of demand for healthcare(受伤发生得很偶然）
  • market impecfactions
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10
Q

Need for quality in healthcare（提高质量的必要性）

A
  • error(44000 Americans die b/c medical errors)
  • variation(races&minorities, diseases, locations, institutions)
  • usage(overuse, underuse, misuse)
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11
Q

Perfect market

A
  • complete information sharing
  • a lot of buyers and sellers
  • no barrier to entry
  • the product is not branded
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12
Q

Difference between lean and six sigma

A

Lean - cut waste

Six sigma - reduce variations

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13
Q

Who introduced six sigma

A

Bill Smith from Motorola in 1987

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14
Q

DMAIC (for existing process)

A 
Define
Measure
Analyze
Improve
Control
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15
Q

DMADV (for new process)

A 
Define
Measure
Analyze
Design
Verify
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16
Q

Hipporate and Galen

A

Theory of humor

17
Q

William Harvey

A

1628 Discovery of circulation of blood

18
Q

James Lind

A

1747 Discovery that citrus fruits prevent scurvy

19
Q

Florence Nightingale

A

1855Hygiene

20
Q

Ignza Semmelweis

A

1848 Washing hands after autopsies

21
Q

The establishment of American medical Association

A

1847

22
Q

Minimum standards

A

Launched in 1917

  • Organizing hospital medical staff
  • limiting staff membership to well-educated competent and a licensed physicians and surgeons
  • framing rules and regulations to ensure regular staff meetings and clinical review
  • Keeping medical records that included the history and physical examination and laboratory results and establishing supervise diagnostic and treatment facilities such as clinical laboratories in the radiology department
23
Q

Joint commission on Accreditation of hospitals established

A

1951

Abandoned minimum standards in 1966

24
Q

Difficulties in defining quality in healthcare

A 
Problems of defining service
Scoop of the definition of quality (is it individual or public)
Quality of care for special population
Goal of care: longevity or quality
Presence of comorbidities（同时患有好几种疾病）
Patient preference 
Inadequate knowledge of medical science
25
Q

The definition of quality by Institute of medicine

A

The degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with current professional knowledge

26
Q

The definition of quality by Institute of medicine is

A
  • includes a measure of scale
  • encompasses a wide range of elements of care
  • identifies both individuals and populations as proper target for quality assurance efforts
  • is go oriented
  • recognize a stochastic attributeattribute of outcome but values expected net benefit
  • Underscores the importance of Outcomes and links the process of healthcare with outcomes
  • highlights importance of individual patient’s and society’s preferences and values
  • emphasizes constraints on professional performance by medical science
27
Q

Individual Measures of quality assurance

A
  • professionalism
  • accountability
  • licensing
  • certification and recertification
  • accreditation
  • hospital privileges
  • critical pathways
  • Report cards
28
Q

Institutional forces for quality

A
  • mandatory reporting of hospital errors
  • voluntary reporting of hospital errors
  • professional standards review organization (PSROs)
  • Peer review organization
  • Quality improvement organization
  • consumer activism
29
Q

The problem of report cards

A
  • goal distortion（更多关注硬件设施）
  • Cream-skimming（医生选择低风险的患者，而不是病危患者）
  • complexity of information
30
Q

SIMPA

A 
Specified value 
identify value stream 
make it flow 
pull
always improving
31
Q

Difficulties of estimating value

A
  • costs(indirect costs,uninsured patients, overuse, new technologies)
  • benefits(patient,institutions, society)
  • quantifying costs and benefits
32
Q

Categories of waste(downtime)

A 
Defects
over-processing 
waiting 
Non-utilized resources
transportation
Inventory
motion 
excess production
33
Q

Reasons for waste in healthcare

A 
Reasons for transportation waste 
lack of access 
increasing use of emergency facilities 
reasons for inventory waste 
routines 
failure to fix the root cause
defensive medicine (scared of malpractice)
direct to consumer marketing
Fraud
Fragmentation and lack of coordination
Fee for service(The number of patients matters)
34
Q

5S

A 
Sort 
straighten 
shine 
standardize 
sustain
(Safety)
35
Q

Cando

A 
Clearing up 
arranging 
neatness 
discipline 
Ongoing improvement
36
Q

Value stream mapping

A

The step creates value for the customer
the step enables value to be created
the step does not create value = waste

37
Q

Make it flow quality at source

A

Poke- yoke
Jidoka
Crew resource management

HMGT 6332 (2 decks)

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