Which of the following is NOT one of the purposes that successful information systems that supplement clinical performance should support: 

A.  Education

B.  Caregiving

C.  Staff reward and recognition

D.  Monitoring and goal setting

Answer:   C :  Griffen text page 185. 

B.  Clinical Quality and Measurement Department

C.  The governing body

D.  The Chief Clinical Officer

B.  Continuous improvement emphasizes the necessity of organization-wide commitment.

C.  Continuous improvement assumes that the customer's perspective is dominant.

D.  Continuous improvement is always subordinate to financial considerations.

Answer: D.  Griffith, Chapter Five:  Clinical Performance

1.  Ensuring that safety systems are in place

2.  Identifiying gaps between actual and desired performance

3.  Nurturing committment to qualit principles and leading by example

4.  Holding people accountable. 

(p 192, The Well Managed Healthcare Organization)

I have had the opportunity to see many hospital and medical centers in my career as an outside consultant.  I must say that each have a different attitude, focus, and drive for quality and none ever professed that quality was second to any other goal, such as financial stability and profitability but it does not take long to see segregate between them if one focuses on the culture of the organization and not the mission on the wall.  What are your thoughts?

Griffith notes that clinical performance depends on the interwoven premises of quality, appropriateness, and efficiency.  The Institute of Medicine developed standardized definitions for each of these.  The model itself though is not new.  This is actually an integrative model of A. Donabedian published in the 80’s. This integrative model discussed the relationship between health, quality, and resource expenditure.  It also further examined both clinical and production efficiencies. 

Avedis Donabedian was a forefather in quality models for health care.  His publications reach back into the 1960’s with his model of quality medical care that had three main components- structure, process, and outcomes.  This is reflective of the discussion of benchmark measures by Diane Kelly.  Dr. Donabedian studied healthcare quality and efficiency before regulatory mandates or financial constraints; yet, his concepts remain relevant and cited still today. 

Avedis Donabedian, John R. C. Wheeler and Leon Wyszewianski (1982).Quality, Cost, and Health: An Integrative Model. Medical Care, Vol. 20, No. 10 ,pp. 975-992

Avedis Donabedian (1966).Evaluating the Quality of Medical Care. The Milbank Memorial Fund Quarterly, Vol. 44, No. 3, Part 2: Health Services Research I. A Series of Papers Commissioned by the Health Services Research Study Section of the United States Public Health Service. Discussed at a Conference Held in Chicago, October 15-16, 1965 ,pp. 166-206

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.

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

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)

Total quality defined as" a philosophy or an approach to management that can be characterized by its principles,practices,and techniques.which of the followingi s not one of the three priniciples of total quality:

A- Management behavior

B-Teamwork

C-Customer focus

D-Continuous improvement

Answer    A. Source : On line packet

Three Principles of Total quality

Chapter 2

Quantitative management:

We have the tools for Rules; Risk management principles; Qualitative performance process; we have clinical pathway management of successful approach; we do the utilizations, and more and more, but we should not forget, all of above are based on the three premises:

They are the community at large must establish the level of the economy; the community decision cannot be intelligent made without extensive input and advice from healthcare professionals; and the last the control of cost and quality depends on the entire institutional infrastructure.

Dianne Kelly spoke a bit about Evidence-based Management and the need to integrate research-informed management practices into our leadership.  

My question: how are real-life leaders supplementing themselves with a diet of evidence-based management information?  Is there a source that you go to aside from the NY Times Bestseller list on business management or the HBR?  I am looking for low cost, sharp and efficient sources of evidence-based management information, written for the busy healthcare manager.  

Thanks!  ~CP

A trend I have noticed in hospitals I have worked is the tendency to implement lots of QA/QI programs (until this section in the tutorial, I thought they were the same thing) but unable to sustain any given one's momentum. 

A great new program will be implemented, everyone is enthusiastic, and it's dead in 6 months.  Another program will be implemented, and the whole process repeats itself. 

Over time the staff become cynical of any new program, because they know it's the "flavor of the month" or "program of the month".

Has anyone else noticed this type of thing?

I noticed a recent post on Lean and Six sigma being applied in healthcare and pros/cons of each. I have been trained as a Black Belt and have also received Lean Six sigma training at my previous health system. That health system actually employed Black belts to roll out this methodology across the system and complete various projects. There were some great successes and some hurdles along the way as well. My feeling on the issue is the methodology and statistical tools used can be very beneficial and infuse a more data driven approach into a culture. Furthermore, the focus on the processes involved can uncover hidden barriers and non value added steps in the processes. The major hurdles encountered were related to change management and lack of support from senior level admin., which seemed to decide the fate of these projects instead of the methodology itself.

I was curious if others have had favorable/unfavorable experiences with either of these performance improvement methodologies? Thoughts?