Quality Flashcards
3 core problems in healthcare
Access
Quality
Cost
Definition of access
Access is a measure of the “fit” between characteristics of providers and health services and characteristics and expectations of clients.
Five dimensions of access
Availability (adequacy of supply of physicians and facilities)
Accessibility (location wise)
Accommodation (manners, like systems, hours, service)
Affordability
Acceptability(satisfaction)
Number of Americans died because of healthcare
48 million in 2011
United States health expenditures in 2010
2.5 trillion and $8,402 per capital
Average US life expectancy and rank
Rank 27th, 78 years
Highest life expectancy country in the world
Japan 81 years( per capita expenditure half of the US)
Factors contributing to growth in costs
- 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）
Factors contributing to poor quality
- 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
Need for quality in healthcare（提高质量的必要性）
- error(44000 Americans die b/c medical errors)
- variation(races&minorities, diseases, locations, institutions)
- usage(overuse, underuse, misuse)
Perfect market
- complete information sharing
- a lot of buyers and sellers
- no barrier to entry
- the product is not branded
Difference between lean and six sigma
Lean - cut waste
Six sigma - reduce variations
Who introduced six sigma
Bill Smith from Motorola in 1987
DMAIC (for existing process)
Define Measure Analyze Improve Control
DMADV (for new process)
Define Measure Analyze Design Verify
Hipporate and Galen
Theory of humor
William Harvey
1628 Discovery of circulation of blood
James Lind
1747 Discovery that citrus fruits prevent scurvy
Florence Nightingale
1855Hygiene
Ignza Semmelweis
1848 Washing hands after autopsies
The establishment of American medical Association
1847
Minimum standards
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
Joint commission on Accreditation of hospitals established
1951
Abandoned minimum standards in 1966
Difficulties in defining quality in healthcare
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
The definition of quality by Institute of medicine
The degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with current professional knowledge
The definition of quality by Institute of medicine is
- 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
Individual Measures of quality assurance
- professionalism
- accountability
- licensing
- certification and recertification
- accreditation
- hospital privileges
- critical pathways
- Report cards
Institutional forces for quality
- mandatory reporting of hospital errors
- voluntary reporting of hospital errors
- professional standards review organization (PSROs)
- Peer review organization
- Quality improvement organization
- consumer activism
The problem of report cards
- 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
SIMPA
Specified value identify value stream make it flow pull always improving
Difficulties of estimating value
- costs(indirect costs,uninsured patients, overuse, new technologies)
- benefits(patient,institutions, society)
- quantifying costs and benefits
Categories of waste(downtime)
Defects over-processing waiting Non-utilized resources transportation Inventory motion excess production
Reasons for waste in healthcare
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)
5S
Sort straighten shine standardize sustain (Safety)
Cando
Clearing up arranging neatness discipline Ongoing improvement
Value stream mapping
The step creates value for the customer
the step enables value to be created
the step does not create value = waste
Make it flow quality at source
Poke- yoke
Jidoka
Crew resource management
