Download - Our Problem To Solve
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“Quality is never an accident; it is always the result of high
intention, sincere effort, intelligent direction and skilled
execution. It represents the wise choice of many
alternatives” – Willa Foster
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“We don’t have a health care delivery system in this country. We have an expensive plethora of
uncoordinated, unlinked, economically segregated, operationally limited micro
systems, each performing in ways that too often create
suboptimal performance both for the overall health care
infrastructure and for individual patients”.
George Halvorson, Author of Health Care Reform Now!: A Prescription for Change.
Our Problem To Solve
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The Formula
Health Information Technology
Continuous Quality Improvement
Meaningful Use
Structure and ProcessIncorporating Evidence-Based Standards
of Care
Providers
Outcome
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The Window of Opportunity is Now
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An ongoing effort to provide services that
meet or exceed customer expectations through a structured,
systematic process for creating organizational
participation in planning and implementing
quality improvements based on meaningful
use of data that results in improved outcomes.
What is this thing called Continuous Quality Improvement ?
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How do Quality Assurance and Quality Improvement Compare ?
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Why Invest in System-wide Continuous Quality Improvement? Providing ongoing feedback improves patient
outcomes, health center operations and systems by encouraging continuous adjustments of programs, policies and activities.
Collecting information about how things are done and the results helps to understand how health center initiatives develop and disseminate lessons others can profit from.
Involving all members of the health system, people who haven’t had a voice gain the opportunity to better understand and contribute.
Finally, effective quality programs helps hold everyone accountable to health center expected outcomes and to the grant makers who provide funding.
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STRUCTURE: Quality is not just about implementing a system or working towards a set of standards. It is an attitude, a way of working, that not only improves an organization butalso the way the organization works.
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An organizational culture centered in Qualityis a MUST.Involvement of People: Service Providers, Executive Management, Managers, Supervisors, Staff, Contractors, Board Members, Everyone!!!!!!
Building A Successful Quality ProgramStructure –First Things First
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Who are the members? What are the roles and responsibilities? What is the meeting format? (who staffs,
minute-taking, participation requirements, confidentiality, etc.)
Where does the Committee report? When does the Committee meet? How long do committee members serve?
The Quality Committee Structure
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Safe: Avoid injuries to patients from the care that is intended to help them.
Effective: Match care to science; avoid overuse of ineffective care and underuse of effective care.
Patient-Centered: Honor the individual and respect choice.
Timely: Reduce waiting for both patients and those who give care.
Efficient: Reduce waste. Equitable: Close racial and ethnic gaps in health status.
Source: Crossing the Quality Chasm: A New Health System for the 21st Century. Institute of Medicine. 2001
You Must Take Aim: Targeting Your Quality Improvement Activities.
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Basic Tenets of Quality Improvement
What are we trying to accomplish?
What change can we make that will result in improvement?
How will we know a change is an improvement?
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QM Program Description QM Work Plan Provider Credentialing and Privileging Peer Review Process Assessing Organizational Satisfaction (Employee, Provider
and Patient) Complaint Management Incident Management Infection Prevention and Control Management Medical Record Standards Medical Record Review Process Confidentiality and Privacy of Personal Health Information Use of Clinical Protocols
Primary Quality Related Policies and Procedures
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Meeting Community Health Center HRSA QA/QI Program Requirements.
The QA/QI program must: Include clinical services and management Maintain the confidentiality of patient records Include a Clinical Director whose focus of
responsibility is to support the QA/QI program and the provision of high quality patient care.
Include periodic assessment of the utilization and quality of services provided or proposed to be provided.
Quality Program Description
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Key Components: I. OverviewII. Quality Program StructureIII. Quality Improvement MethodologyIV. Communication and CoordinationV. Confidentiality and Privacy of Information
VI. Program Review Process (Timeframes) VII. Health Care and Business Plan
QA/QI Program Description
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Performance Measures and Key Activities Tracker
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Personnel Data Management Data Processing,
Analysis and Reporting
Prevent a Headache: Make Sure you Have the Right Tools and Resources
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PROCESS: Knowing is not enough; we must apply. Willing is not enough; we must do. - Goethe
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Increasing the Value of Your Results
Analyze and Synthesize Findings
Identify Program Performance Standards
Interpret the Findings
Make Judgments/Recommendations
Share the Results
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Monitoring and Tracking – Establishing Performance Targets and Benchmarks If you don’t know your destination … you
won’t know which way you are heading.
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System Wide Quality Work Plan
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Systematically identifying patterns in the information gathered and deciding how to organize, classify, interrelate, compare, and display it.
Data Analysis
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Effectively Communicating Performance
Captivating –Focuses on things that are timely and meaningful.
Credible – This is for real – Data-driven performance based on sound methodology and performance standards.
Continuous – Displays results over time with summary of findings.
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Example:Diabetes Management
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Satisfaction with Case Management
93.33%87.10%
93.18%
97.73%
94.03%
100.00%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Helpfulness of Staff Needs were Met
2004 2005 2006
Goal: 90%
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DEMING’S Model:Plan: Analyze the process, determine what changes would most improve the process, and establish a plan for making the improvement; Do: Put your change into motion; Study: Check to see whether the change is working; Act: If the change is working, implement it on a larger scale. If the change is not working, refine it or reject it and begin the cycle again.
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PLAN: Understanding Clinical Standard Variation
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The solution(s) most likely to be successful should be implemented.
It is often preferable to do this on a small scale to see if the change(s) will work.
Make the data collection easy enough and the time frames short enough so that data collection can be repeated frequently to allow for trending of changes over time.
Allow enough time to improve performance.
Do: Things to Consider
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Study the data in order to determine:
1. What were the findings? 2. Did the improvement
action(s) effect a change?
3. What were the positive and negative effects?
4. What are the potential causes contributing to these effects?
5. What could have been done better?
6. What would we change and do differently?
Study: Things to Consider
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Act on what you learned. Continue to make improvements in the process
by going through the cycle again, starting at Plan. Don’t forget a good outcome starts with a good
process.
Act: Things to Consider
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OUTCOME: “Quality is not an act. It is a habit.” Aristotle, Greek philosopher and scientist.
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Hierarchy of Effective Quality Program Effects
Participation
Reactions
Learning
Actions
System and Environmental Change
Health Outcomes
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Improves outcomes for consumers Improves consumer satisfaction Improves workforce retention and satisfaction Increases use of preventive interventions Increases best practices/innovation Foundation for performance based incentives Reduces waste Reduces rework Reduces errors Saves resources Reduces liability Improves processes for persons served/other stakeholders
VALUE OF HIGH QUALITY
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Thank you ... Questions?
