Quality Management in Your Practice: A Nuts and Bolts Primer

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Quality Management in Your PracticeA Nuts and
Bolts Primer

• Richard P. Dutton, MD MBA
• Executive Director
• Anesthesia Quality Institute

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Some people need feedback on their work
performance
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Introduction

• I am an anesthesiologist.
• I have led QM programs at the department and
  hospital levels
• Now I get to try it at the national level!

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Introducing Yourself

• Please send us a message (in the system or by
  email to j.mlodoch_at_asahq.org)
• Who are you? What is your title?
• Why are you listening?
• Do you have any specific questions or topic
  areas?

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Why Have Quality Management?

• To improve patient outcomes
• To improve business efficiency
• To meet regulatory requirements

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The Challenge
The government wants to know that Ma and Pa are
getting the healthcare they deserve and that
our taxes pay for.
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The Eight Step Program One

• Whos in charge here?
• An effective QM program often depends on the
  initiative of a single person

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What the leader does

• Promotion of open dialogue
• Timely feedback
• Getting "buy in" from providers
• Support after a bad outcome
• Accurate analysis by experts
• A forum for discussion
• Prevention of future events

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The Eight Step Program Two

• What do we need to know?
• Sometimes, knowing your destination makes it
  easier to find the best route

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Typical QM Questions

• How many cases did we do last year?
• How many deaths?
• Anesthesia related?
• Preventable?
• How many complications?
• How satisfied are our patients?
• How do our results compare with others?

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Data Indicators

• Business (numbers, times, dollars)
• Outcomes (deaths, complications)
• Processes
• Steps that lead to outcomes
• Often problematic
• Focused reviews
• Sentinel events

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The Quality Triangle
Risk Factors
Process
Outcomes
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The Eight Step Program Three

• Gather the data!
• First, steal as much as you can
• Only then consider making your own

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He who has the data controls the future
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What to Collect?

• Administrative data
• AIMS data
• Hospital EHR data
• Quality and outcome data
• Your group
• Other specialties
• Patient satisfaction information
• Anecdotes

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How to Make Your Own Data

• http//aqihq.org/AQIVendors.aspx

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The Eight Step Program Four

• Share with your friends
• Produce a regular QM report
• Publish it internally
• Excerpt it externally

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We have lots of information technology, we just
dont have any information
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Who has your data already?

• The federal government
• CMS Medicare Data
• AHRQ CAHPS Data
• Private insurance companies
• The Joint Commission
• The ABA
• Your IT vendors

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Data Safety

• You cannot hide your data
• You can see yourself as others will see you
• You can pre-empt illegitimate use

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The Eight Step Program Five

• Capture the interesting cases
• One of your goals should be to learn from the
  mistakes of others -- this is more
  fun than making the mistakes
  yourself.

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Lessons From Aviation

• FOQA and other safety risk management programs
  are based on trust.
• Keeping this data confidential is the key to
  acquiring it in the first place.

The US National Civil Aviation Review Commission
Chaired by Senator Norman Mineta Avoiding
Aviation Gridlock Reducing the Accident Rate,
December 1997.
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Focus on Systems

• Not about weeding out "bad apples
• W. Edwards Deming 94 of the potential for
  improvement resides in system performance, only
  6 is individual
• Duttons corollary system performance usually
  equals communication

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Management BY Anecdote

• Over-reaction to isolated events
• Layered bureaucracy
• Failure to discover root causes
• Failure to assess both benefits and risks
• Frequent disposal of both baby and bathwater!

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Management OF Anecdotes

• Have a process for addressing sentinel events
• Discovery
• Reporting
• Disclosure
• Fact finding who?
• Analysis
• Discussion and System Changes

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The Eight Step Program Six

• Change things.
• Dont be afraid to tinker with your systems and
  processes.

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PACU Reintubation Rate
Rocuronium Introduced
Provider Education and Rocuronium Removed
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The Eight Step Program Seven

• Lather, rinse, repeat
• QM becomes easier over time, and more effective.
  You want to embed this
• process in the fabric of your
• practice.

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Control Chart Analysis
Anesthesiology

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The Eight Step Program Eight

• Report your data externally. Collect benchmarks
  you can use.
• Participate in the AQI!

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Where is the Improvement?
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• The unexamined life is not worth living.

-- Socrates, Apology 38a
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Contact Us!

• www.aqihq.org
• or
• r.dutton_at_asahq.org