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Quality Management in Healthcare
BSHS 4210: Capstone Project
What is Quality?
The Institute of Medicine (IOM) defines
quality of care as “the degree to which
health services for individuals and
populations increase the likelihood of
desired health outcomes and are consistent
with current professional knowledge”.
What is Quality Management?
The effort we make to continuously improve
our ability to meet or exceed our customers’
needs and expectations.
Note: The definition of quality management is
not confined to a patient’s needs. Patients don’t
always know what they need in healthcare.
However, they know what they expect. (Think
about non-health expectations of a provider).
How do organizations achieve quality?
Achieving quality requires
knowledge of customer
expectations, knowledge of output
performance, knowledge of
process, and management of
employee actions to continuously
improve the processes.
Step 1: Identify your customer
The one you serve
The one that
receives benefits
of your labor
The reason you
have a job
Internal customers vs. External customers
Internal
• Nurses
• Physicians
• Students
• Employees
• Trainees
• Departments
• Committees
External
• Patients
• Patient’s families
• Visitors
• Referring physicians
• Doctor’s offices
• Third-party payers
Step 2: How are you meeting your
customer’s needs?
Don’t just mail out a survey, talk to them.
Break down barriers and communicate
Discuss needs and expectations
Step 3: Measure output performance
Joint Commission Survey
Patient Surveys
Employee Surveys
Six Dimensions of Healthcare Performance
The 2001 Institute of Medicine (IOM) report, Crossing the Quality
Chasm: A New Health System for the 21st Century identified six key
dimensions of health performance that need improving
Healthcare should be:
Safe
Effective
• Unintended
patient
injuries should
be avoided
• Based on
scientific
knowledge,
service should
be provided to
all who could
benefit.
Services
should not be
provided to
people who
are not likely
to benefit. We
should avoid
underuse of
services as
well as
overuse
Patient –
centered
• This means
providing care
that is
respectful of
and
responsive to
individual
patient
preferences,
need, and
values and
ensuring that
patient values
guide all
clinical
decisions
Timely
Efficient
Equitable
• We should
reduce waits
and
sometimes
harmful delays
for those who
receive care
• We should
avoid wastes
of equipment,
supplies, ideas
and energy
• This means
that
healthcare
should not
vary in quality
because of a
patient’s
personal
characteristics
such as
gender,
ethnicity,
geographic
location, and
socioeconomic
status
Quality Improvement Models
LEAN Model
This model defines value by what a
customer (i.e., patient) wants. It maps
how the value flows to the customer (i.e.,
patient), and ensures the competency of
the process by making it cost effective
and time efficient.
Goal: Efficiency – Improve flow and
eliminate waste
Six Sigma Models
Six Sigma: Six Sigma is a measurement-based strategy for process
improvement and problem reduction. It is completed through the application
of the QI project and accomplished with the use of two Six Sigma models:
1) DMAIC (define, measure, analyze, improve, control), which is designed to
examine existing processes, and
2) DMADV (define, measure, analyze, design, verify) which is used to develop
new processes.
Goal: Effectiveness – Eliminate defects and reduce variations
Model for Improvement: PDSA Cycle
Plan a change
Do the change
Study the results
Act on the results
• What changes
are we going
to make based
on our
findings?
• What were
the results?
• What exactly
are we going
to do?
Act
Plan
Study
Do
• When and
how did we do
it?
Model for Improvement: PDSA Cycle
This model focuses on three questions to set the aim or
organizational goal, establish measures, and select changes:
1.
2.
3
• What are we trying to accomplish? (Aim)
• How will we know that change is an improvement? (Measure)
• What change can we make that will result in an improvement?
(Process)
In-class Group Activity
•
•
•
•
•
Get into groups of 2
Choose a healthcare organization
Describe how this healthcare
organization has already or is expected
to contribute to improving
performance in each of the key
dimensions identified by the IOM.
What are some factors that could
inhibit improvements in these areas?
Use publicly available data to measure
performance (Medicare)
References
•
•
http://www.stratishealth.org/documents/QI-Basics-facilitator-guide.pdf
•
http://www.stratishealth.org/expertise/quality/QIBasics.html
•
https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf
•
http://www.mass.edu/mcncps/orientation/PowerPoint/Quality.pdf
•
https://www.cms.gov/medicare/provider-enrollment-and-certification/qapi/downloads/pdsacycledebedits.pdf
•
Health Care Quality Management Student Workbook – 4th Edition
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