a. A review of National Patient Safety Goals

b. Leapfrog Group's Safe Practices

c. A review of the Shewhart Cycle (Plan, Do, Check, Act)

d. A Root Cause Analysis (RCA)

The correct answer is: (d) RCA - which is a process that will help to identify overt or underlying causes of such an event. The RCA should focus on processes not employees. The RCA should result in a process improvement that may include training or education that should eliminate or significantly reduce potential sentinel events.

According to the book Applying Quality Management in Healthcare:  A Process for Improvement, “CQI tools focus a team’s problem-solving efforts and provide a document trail that managers may use to organize and record the improvement process and results of the project”.   These tools fall into four major categories.  Which of the following is NOT a category of CQI tools:

1. Identifying customer expectations
2. Identifying solutions
3. Documenting a process
4. Diagnosing the problem
5. Monitoring progress

Answer:  b.  Identifying solutions

In the Shewhart Cycle, there are four steps.  These steps are linked to represent the cyclical nature of the approach.  According to the book Applying Quality Management in Healthcare:  A Process for Improvement, “the new process of intervention is implemented on a small scale to test its effectiveness” is done in which step of the Shewhart Cycle?

1. Plan
2. Do
3. Check
4. Act

Answer:  b.  Do

Under the heading of “Performance and Process Improvement”: What are examples of reduction of waste and reduction in cycle time in the delivery of health care services, and how does their successful accomplishment serve the interests of customers?

Lean is a philosophy value.  Value is defined by the customer.  Waste is non-value added and a customer dissatisfier.  Lean tools are utilized to eliminate wastes, increase speeds, minimize inventories, simplify processes, improve flows, and mistake proof processes.    There are seven categories of waste which are as follows:

Processing Time

Avoid idle process time. Provide people with adequate tools and training to do the job properly.  Organize flow of information of parts to support the vital process needs. Simplify complex processes and steps. Eliminate unnecessary steps; and combine steps which could simplify the process and make it easier to manage.

Transportation

Eliminate movement of materials or information that does not add value to the product.

Motion

Improve office or plant layout. Re-arrange poor layout of people, machines work stations, equipment and supplies, raw materials, work-in-process and finished goods. Arrange work stations to improve the continuous flow of the process.   Avoid waste of motion and multiple handling of goods and information. Don’t waste energy on non-value adding work.

Overproduction

Produce only the exact amount of goods the customer wants exactly when the customer wants them. Overproducing is a waste of time, materials and opportunity.  Overproduction is a loss in time and money that could have been spent on products or services desired by customers.  

Rework - Repair/Rejects

Eliminate administrative mistakes.   Similarly, eliminate failures. Design close loop systems to avoid defects, mistakes or failures that lead to rework. Inadequate telephone customer service.

Waiting

Eliminate or decrease wait times. Make sure that nothing sits, so there is a steady flow to the customer (output). Balance the output. Provide a pull system, one-piece flow.

Inventory

Having too much of an item taking up space or too little of a needed item for a needed task.  Not having the inventory accessible in an ordered and understandable stored place.

Overlooking Opportunities

How well is the skills and talents or staff being utilized.  Take time out  to step back and evaluate the entire process. Evaluate necessities and/or find ways to simplify. Look at the BIG PICTURE to continually improve the whole process.

In addition there are many examples of wasted health care including:  routine blood typing when not clinically indicated; adverse drug events causing iatrogenic injuries which require new counter measures and may add to the cost of malpractice; phone calls by clinicians seeking laboratory results when not posted in a timely manner; use of costly antibiotics when not indicated; failure to teach parents of young asthma patients contemporary prevention techniques.  

Many of the above forms of waste also add to increased cycle time. Examples of reduction in cycle time include:  immediate access to sub-specialists; full use of the hospital; factory; seven days per week; real time electronic transfer of clinical information; reduction in delays of scheduling diagnostic procedures.

http://www.jointcommission.org/AccreditationPrograms/Hospitals/Standards/09_FAQs/MS/Ongoing_Professional_Practice_Evaluation.htm

Currently our hospital is experiencing some concerns in regards to our Picker scores.  Hospital cleanliness, nurse response, unit noise are three concerning areas.  We have been through all the educational sessions etc and improvement still not being seen to the levels we would like.  We are considering developing an internal competition amongst units to see if that could get all staff to "buy in" .  This would include nurses, physicians, nutritional staff, housekeeping etc.

 I was wondering if anyone else out there could share some ideas or had some similar strategies that have worked.

Thanks

We have an aggressive Quality Manager - and because we've only been doing active, official CQI projects - we continue to have difficulty obtaining measurable outcomes from some of our departments.  To provide additional information - we're a hospital within a hospital; even though we're our own facility (our own staff, BOD, etc) we lease several services from the host facility (i.e. housekeeping, Dietary support) and it is from those departments I'm having difficulty getting them to see how come we need to measure quality - mostly I hear 'I take care of it, Barb'

on a more interesting note - our hospital is becoming a participant in the ICU safe table project; and one of the most exciting aspects of our participation is getting our CMO involved as well as our other disciplines - it is not just nursing or RT - it is everyone working on processes to improve our outcomes and taking us on the journey to being a center of excellence for ventilatory weaning

A good patient care plan will address all of the following except:

A.  Treatment goals

B. Assessment

C.  Measures of progress and a time schedule for improvement

D. Maximizing the DRG payment

Answer is D.

a.  Total Quality involves eliminating defects while Continuous Quality Improvement refers to the manager's role and contribution to organizational effectiveness.

b.  Total Quality is a strategic concept, whereas Continuous Quality Improvement is one of three principles that support a Total Quality strategy.

c.  In both, the goal is not only to improve the average performance, but also to reduce inappropriate variations in the process.

d.  Total Quality is only utilized by managers while Continous Quality Improvement is utilized by everyone in an organization.

Correct answer:

(b)  "Total Quality is "a philosophy or an approach to management that can be characterized by its principles, practices, and techniques.  Its three principles are customer focus, continuous improvement, and team work." (Packet of information, Chapter 1: Concepts of Quality Management, pg. 10)