Quality Management Flashcards
Quality =
Measure of excellence or free from defects/deficiencies
Quality is typical measured by
Subjective opinion of relevant others
Outcomes and/or processes
Triple Aim
Decrease Costs
Better care for individuals (quality, satisfaction)
Better health for population
6 dimensions/aims for quality of health care
Safety - most important Effective Patient entered Timely Efficient (EBP) Equitable
Ability to influence quality - how can the consumer influence it
Give feedback
Compliant with episode of care
Using their resources
Ability to influence quality - how can the provider of service influence it
EBP
Seek feedback
Striving to always improve
Ability to influence quality - how can management influence it
Policies and procedures that are implements
Listen to staff to know what is working or not
Supporting their staff in ability to attain additional education
Ability to influence quality - how can regulatory bodies influence it
Make sure their min standards are met
Ability to influence quality - how can the media influence it
People are influenced by what they see
News stories
Commercials/ads
Ability to influence quality - how can the organization influence it
Amount of time they allow for pt - or if there is overlap
Support for con ed
Structure of the organization and their mission
Performance improvement
methodology to improve performance of organization and individual
Performance management
Process of improving effectiveness to accomplish mission and goals
Quality Improvement
Look more closely to define and close a gap between current and expected performance outcomes
Ways to establish, measure and monitor quality
Quality assurance
Quality Management
Total Quality Management
Continuous Quality Improvement
Quality Assurance
Identification of a process to determine the quality of a product or service
Systematic process to check to see if a product or service is meeting specified requirements
Retrospective
Quality Management
Structured system to achieve max customer satisfaction while maintain org efficiency and cont to improve process
Quality Management - A system of
Org structures
Policies and procedures
Responsibilities
Evaluation mechanisms
Total Quality Management
Integrates all functions to meet customer needs and organizational objectives
Optimal would be that needs = objectives
Total Quality Management - Emphasis on 4 aspects
1 Adequate processes
2 Competence
3 Soft elements
4 Infrastructure
Continuous quality improvement
Always looking for a better way
Learn from every interaction to improve
Most things can be improved
Systems/methods/approaches
5 Whys
FOCUS PDSA
Lean
Six Sigma
Systems/methods/approaches - 5 whys
Ask why 5 times
Why the failure has occurred - and then why - why and keep going
Get to the root cause/causes of the problem
Systems/methods/approaches - FOCUS PDSA or PDCA
F - find a process to improve
O - organize a knowledgeable team
C - clarify current knowledge of process
U - understand variability and capability
S - select plan for continuous improvement
PDSA or PDCA
Plan - Do - Select/Check - Act
Provides rapid feedback
Systems/methods/approaches - Lean
reduce or minimize variability
Eliminates waste
Usually combined with another
Systems/methods/approaches - Lean - 7 types of waste and then will look at things you can do to decrease the waste
Waiting Overproduction Rework/defects Motion Inventory Processing Unnecessary Transporting
Systems/methods/approaches - Another aspect you look at with Lean process
Value added - added and makes it better for customer
Nonvalue added - is it really necessary to keep that component
Business value added - not really add value to pt but might be regulatory for the business
Systems/methods/approaches - 2 common activities with Lean
5 S events - look at inventory where it is and make changes
Kaizen events - bring group of people together and make incremental changes - as you make changes you do obs and ensure that changes are meeting expectations that you wanted them to
Systems/methods/approaches - Six sigma
Trying to reduce waste to a percentage of 99.99966%
Focus on improving quality by reducing number of defects
Go through significant training to get master black belt
Systems/methods/approaches - Six sigma based on
DMAIC Define Measure Analyze Improve Control
QA vs. CQI
QA - inspecting, after the fact, blame gets put on people, and each dept is responsible for looking at it
CQI - focus is on prevention, looking at the processes - take blame game out and say everyone has will and skill to do their job, everyone has the responsibility
To meet triple aim we all need to be involved
Comparative cost of quality
Prevention - $1 (prevent efforts/CQI)
Appraisal - $10 (inspection and trying to catch errors)
Failure - $100 (someone has really bad exp with your clinic)
Key principles for total quality management
Customer focused Management commitment Employee commitment Employee empowerment Fact based decision making Continuous improvement
Components
Objective measurement of outcome Identification of issue Measurement of variation Identification of causal factors Develop process to address causal factors Implement process Reassessment of outcomes
Variation =
Something different than what was expected
Can have a positive and negative impact (unexpected 30% inc in referrals for month)
Basic assumption (with variation) =
A variation in input leads to inconsistency in output or outcome (so you have to look further to know if good or bad)
Two types of variation
Common cause
Special cause
Two types of variation - Common cause
Due to the process - thought of as a normal byproduct of the process
To reduce variation, must redesign the process
Two types of variation - Special cause
Is not due to the process, is due to something outside of the process
To reduce variation, must identify the external cause and fix the cause
Benchmarking
Look at your organizations internal processes and compare to similar organizations
Identify, understand and adapt exceptional practices
Quality improvement tools
Tools to help identify and quantify the cause of the quality problem
Quality improvement tools - Affinity diagram
Organize many ideas into groups, understand a process
Quality improvement tools - Affinity diagram - Useful when
Identify and focus on major issues
At start of a project
In solution planning
Quality improvement tools - cause and effect
Fishbone diagram
Helps identify many causes for a problem and sorts ideas into useful categories
Quality improvement tools - cause and effect - example
PTs scheduled in gym have difficulty getting started on time for afternoon pts
Spine - pt late for apt
Ribs - causes
Quality improvement tools - Check sheet
Used for data that can be observed and collected by same person
Collecting data on frequency or pattern
Quality improvement tools - Check sheet - example
Telephone interruptions tally sheet - tally the reasons why
Quality improvement tools - Flow chart
Tracks the actual work steps and the flow of those steps to understand a process and study it
Check in process for new patients
Identify main components - macro map and then get into the details
Quality improvement tools - Histograms
Specialized bar chart that plots the freq of responses
Gives estimate of what does not meet specifications
Analyze whether process meets requirements
Quality improvement tools - Pareto chart
Focus on key problems
Demonstrate the freq of or size of a problem
Helps define largest potential for improvement
Quality improvement tools -Pareto rule
20% of the sources (of a variation) can cause 80% of any problems
So focus on that 20% and you will get 80% improvement
Quality improvement tools - Run/Trend chart
Line graphs
Track data over a specified time period watching for trends
Once have process limits determined - can use control chart
Quality improvement tools - Control chart
Monitor processes to show how it is performing and how the process and capabilities are affected by damage
This info is then used to ensure process is stable
Once identified QI project that needs to complete - and gathered data and put things in place - now monitoring - Remaining steps?
Make sure the development of process (P and P) is to address causal factors
Implementation of PandP and everyone is aware
Final step
Reassessment of outcomes
Use same assessment and tracking tools
Chart progress
Re evaluate new P and P for their effectiveness
How do we participate?
We need to have a will
Do not be complacent - be out there and look for ways to do it better
Ideas
Execution
Which tool for identifying reasons your referrals have declined
Cause and Effect - Fishbone
Which tool for understanding why your accounts receivable is over 60 days
Flow chart or fishbone
Control chart might have told you that you have the problem, but fish or flow will tell you why
Which tool to show you areas to focus on with documentation training with staff
Pareto chart
Will focus you to the areas where you have to do the most training
Will give you the biggest bang for you buck
Which tool to track therapist productivity so you can see that they are seeing appropriate number of patients
Control chart or Run chart
Depends on if you are asking the question to get data or after something has been put in place
