Quality and Performance Improvement

Control Charts

Thu, 18 Mar 2010 20:25:29 GMT

Control charts illustrate two different types of variation. Those types are random variation andd assignable variation. The random variation is the natural variation in the process, and is also referred to as noise. Assignable variation indicates a change in the process. It can be identified in the control chart when a value is above the upper control limit or below the lower control limit, or three to four successive values that are closer to the control limits than the mean, or eight or more consecutive points that lie on the same side of the mean.

Quality Definitions

Thu, 18 Mar 2010 14:04:50 GMT

Efficacy - capability of a health service under ideal conditions and applied to the right problem to provide the desired effect (used in relation to clinical research and trials)
Appropriate - efficacious treatment applied to the right patient at the right time. (Example: childhood immunization schedules, antibiotic therapy)
Effectiveness - how well an approach/process taking place in the usual practice setting accomplishes its intended purpose (Example: nosocomial infection rates, employee needle sticks)
Efficiency - how well you do compared to standard, actual versus expected performance (Example: cost per unit of measure, turnaround times)

Shewhart Cycle

Wed, 24 Feb 2010 02:41:14 GMT

The systematic approach to improvement, known as the Shewhart Cycle, is made up of all but one of the steps listed below. Which steps is not a part of the process?

a. Plan -study the process

b. Research - accumulate data

c. Do - make the change on a small scale

d. Check - oserve the effects

e. Act - identify what was learned

Correct answer: B - figure 3.1 chapter #3 handouts

Clinical Performance and Information Systems

Sun, 14 Feb 2010 21:53:25 GMT

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.

In a well managed HCO, the ultimate accountability for clinical performance resides in the:

Fri, 12 Feb 2010 02:33:48 GMT

A. Chief Executive Officer

B. Clinical Quality and Measurement Department

C. The governing body

D. The Chief Clinical Officer

Answer: C. Griffith, Chapter five: Clinical Performance

Which of the following is not a distinguishing characteristic of continuous improvement compared to earlier approaches?

Fri, 12 Feb 2010 02:18:12 GMT

A. Continuous improvement assumes no upper limit in quality - improvement in complex systems is always possible.

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

Dimensions of Care

Tue, 09 Feb 2010 13:36:17 GMT

Which of the below listed is not a dimension of care related to inpatient care (customer needs/expectation):

1. emtional support

2. family & friends involvement

3. coordination of care

4. respect for values

5. respect for expressed needs

6. all the above

answer: 6

The role of Senior Management in Quality Improvement

Mon, 08 Feb 2010 02:03:53 GMT

Responsibility for quality improvement and patient safety rests on each and every employee in the hospital. What is the role of Senior Management in establishing an organizational culture of quality and safety?

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)

Balanced Score Card

Sun, 07 Feb 2010 22:13:05 GMT

According to the handouts (page 172, chapter 10) the balanced score card should have 4 data points: customer, internal, innovation & learning, and financial. I assume these are not absolute. At my organization, we have 5 data points on our balanced score card: people, clinical & administrative quality, customer, growth & development, and financial. For those of you that utilize a balanced score card approach, how many and what data points do you utilize? Do you modify the published approach, as my organization does, or do you stick with the published version?

Quality and Culture

Sun, 07 Feb 2010 21:20:15 GMT

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?

Four Major Components of Improvement Tools

Sat, 06 Feb 2010 19:46:53 GMT

According to this week's reading, improvement tools fall into four major categories:

1. Identifying customer and stakeholder expectations

2. Documenting a process

3. Diagnosing the problem

4. Monitoring progress

I think most organizations follow this line for clinical processes, but what about customer/patient experience processes? Do we always monitor progress and provide feedback and further insight? I am working right now on a noise reduction campaign at my facility and have noticed how staff buy-in (just making them aware of the problem) has influenced ownership. Due to vigilant monitoring and internal publicity, even volunteers have come up with noise-reducing ideas that have been effective. Team members are asking questions and holding each other accountable--even our facilities staff have stepped up to remove noisy wheels on carts! Engagement of all parties is certainly key in continuous process improvement, so that efforts aren't viewed as a 'flavor of the month', in my mind.

Source: Chapter 3, The Manager's Toolbox, page 42

healthcare quality model

Sat, 06 Feb 2010 08:27:57 GMT

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