study designs and quality concepts Flashcards
What are the tools for a quality toolbox?
- Gap analysis
- Root cause analysis (RCA)
- Failure mode effect analysis (FMEA)
- Control charts
- Checklists
- Guidance documents
Ongoing continuous cycle that focuses on patient clinical outcomes, customer satisfaction, and service
Performance Improvement
What are the three focuses of performance improvement?
- clinical outcomes
- customer satisfaction
- Service
Example of Performance improvement
PDSA (plan, do, study, act cycle
What to err is human brought attention to
- patient safety and medical errors
- 2% of all deaths are due to preventable medical errors
What did crossing the quality chasm cover?
- calls for changes to healthcare processes to improve quality of care
- set up framework for healthcare quality improvement
- stresses importance of patient and family centered care
Parts of robust performance improvement programs
- measure how facility or organization perform RCA
- reports individual physician or unit rates
- benchmarks infection rates against community, state, and national averages
Strategic plan steps
1) analysis of the organization
2) forming conclusions about what an organization must do as a result of issues facing the organization
3) action planning
Determines organization will go in the future and what the organization must do in order to reach the goal, mission, or vision
Strategic Plan
Culture to create and need senior leadership buy in
create quality culture
Technique used to compare best practices with the current processes and determine the steps to take to move from a current state to a desired future state
gap analysis
Takes retrospective look at adverse outcomes and determines what happened and why it happened and what an organization can do to prevent the situation from recurring
Root cause analysis
How to collect info for a root cause analysis
- structured interviews
- document reviews
- field observations
Key word for when to do a root cause analysis?
Sentinel event
What does the RCA process consider?
- human and other factors
- Process or system involved
- underlying causes and effects of the process
- Risks and potential contributions to failure
What to avoid in RCA
NO individual blame
Limitations of RCA?
- Must delve deep to determine process changes needed
- Expensive, time consuming, labor intensive
- May require training on techniques goals and outcomes
What chart goes best with the RCA?
Fishbone or ishikawa diagram
Root cause analysis main issues: procedures/ standards
- No procedure
- Poor procedure
- well written procedure, but out of date
Root cause analysis issues: people
- poorly trained
- NO training
- people were trained, but chose not to follow the procedure
proactive, preventative approach to identify potential opportunities for error
Failure mode effect analysis
Utilized to investigate public health issues and improve hc outcomes, points out what org should plan for and how to use resources and guide efforts within a framework
SWOT analysis (strength, weaknesses, opportunities, threats)
process of prioritizing large list of topics into a final selection for performance improvement
Multivoting
prevention of infection within organization by writing simple steps, implement into daily work and from aviation
checklists
Used to ID how processes change over time
Run charts
allow for the mean or average to be determined and show changes to the mean/ average
Run chart
Demonstrate special cause variation when there is a steady pattern of observation points falling above or below the mean/ average line in an equal pattern
Run chart
Gather large amount of language data and creatively group the data based on lines of natural relationships
Affinity diagrams
When are affinity diagrams typically used?
After brainstorming sessions or customer surveys
Series of vertical charts arranged and sorted in descending order of height from left to right with a cumulative percent line on the y-axis
Pareto charts
Allow a team to ID where their efforts will produce the greatest value, implying that 80% of the benefits will stem from 20% of the causes
Pereto charts
True or false: a line graph shows how long an issue has existed
True
True or false: a pareto chart is used to prioritize opportunities for improvement
True
True or false: pareto charts can be used to show many different views of a given data set
True
For pareto analysis, what data should be collected for analysis (think the w questions)
Who
Where
What
When
Concentrates on precision and accuracy that leads to defect free products or services
Six Sigma and the lean approach
What are strategies used in six sigma and the lean approach?
- value stream mapping
- transactional mapping
- just-in-time training
What is the main format for six sigma and lean approach?
DMAIC
Define
Measure
Analyze
Improve
Control
part of PDSA: ID responsibilities for the program, process mapping or gap analysis
Plan
part of PDSA: plan is executed (strategies implemented)
Do
part of PDSA: analysis of actions, developing pilot programs and conducting strategic planning activities
Study
What quality tools can be used during the study phase of PDSA?
RCA or FMEA
part of PDSA: institute strategies and measure the effect of the action on the project
Act
Patient harm that is the result of treatment by the healthcare system rather than from the health condition of the patient?
Adverse event
