QUALITY IMPROVEMENT/ PERFORMANCE IMPROVEMENT - PowerPoint PPT Presentation

Loading...

PPT – QUALITY IMPROVEMENT/ PERFORMANCE IMPROVEMENT PowerPoint presentation | free to download - id: 4488d2-MDc5N



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

QUALITY IMPROVEMENT/ PERFORMANCE IMPROVEMENT

Description:

quality improvement/ performance improvement quality framework health system performance/quality institute of medicine study to err is human(2000): 44, 000 -98,000 ... – PowerPoint PPT presentation

Number of Views:1543
Avg rating:3.0/5.0
Slides: 64
Provided by: jaba
Learn more at: http://www.ualr.edu
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: QUALITY IMPROVEMENT/ PERFORMANCE IMPROVEMENT


1
QUALITY IMPROVEMENT/ PERFORMANCE IMPROVEMENT
2
QUALITY FRAMEWORK
HEALTH SYSTEM (Social/Political Definition)
QUALITY ASSESSMENT (Tools Techniques)
CLINICAL CARE (Professional Definition)
QUALITY ASSURANCE (Tools Techniques)
SERVICE (Customer Definition)
3
HEALTH SYSTEM PERFORMANCE/QUALITY
4
INSTITUTE OF MEDICINE STUDY
  • TO ERR IS HUMAN(2000)
  • 44, 000 -98,000 DEATHS EACH YEAR IN HOSPITALS
  • MORE PEOPLE DIE OF MEDICAL ERRORS THAN MOTOR
    VEHICLE ACCIDENTS
  • COST 17- 29 BILLION EACH YEAR
  • ERRORS IN DIAGNOSIS, TREATMENT AND PREVENTION
  • TOO MUCH CARE, TOO LITTLE CARE, WRONG CARE

5
INSTITUTE OF MEDICINE REPORT CROSSING THE QUALITY
CHASM (2001)
  • REDESIGNING HEALTH SYSTEMS
  • SAFE
  • EFFECTIVE
  • PATIENT CENTERED
  • TIMELY
  • EFFICIENT
  • EQUITABLE

6
DONABEDIAN MODEL OF QUALITY
OUTCOMES
STRUCTURE
PROCESS
7
DONABEDIAN MODEL
  • STRUCTURE
  • PHYSICAL STRUCTURE, FACILITIES, EQUIPMENT
  • ORGANIZATIONAL FORM
  • ADMINISTRATIVE STRUCTURE
  • STAFF STRUCTURE/QUALIFICATIONS
  • FISCAL HEALTH
  • PROCESS
  • DIAGNOSIS
  • TREATMENT
  • SURGERY
  • CONSULTATION/REFERRAL
  • COORDINATION CONTINUITY
  • OUTCOMES
  • HEALTH OUTCOMES
  • MORTALITY
  • COMPLICATIONS
  • SATISFACTION

8
QUALITY ASSESSMENT
9
PERFORMANCE MEASURES
  • STRATEGIC MEASURES
  • GOALS
  • OBJECTIVES
  • MARKET POSITION
  • FINANCIAL MEASURES
  • NET INCOME
  • MARGIN
  • DAYS IN RECEIVABLES

10
PERFORMANCE MEASURES
  • OPERATIONAL
  • COST PER PROCEDURE
  • STAFF PER UNIT OF SERVICE
  • SUPPLY COST PER UNIT OF SERVICE
  • CLINICAL (ADMINISTRATIVE VIEW)
  • VISITS PER HOUR
  • ADMISSIONS PER WEEK
  • AVERAGE TESTS PER PATIENT
  • CLINICAL (PROFESSIONAL VIEW)
  • APPROPRIATE OF DIAGNOSIS
  • APPROPRIATENESS OF TESTS
  • APPROPRIATENESS OF THERAPY

11
PERFORMANCE MEASURES
  • SERVICE
  • NON-CLINICAL
  • APPOINTMENT WAIT TIME
  • VISIT WAIT TIME
  • COURTESY OF STAFF
  • INFORMATION
  • CLINICAL (PATIENTS VIEW)
  • TIME WITH PROVIDER
  • INFORMATION ABOUT HEALTH PROBLEM
  • RESOLUTION OF PROBLEM

12
QUALITY ASSESSMENT AND ASSURANCE TOTAL QUALITY
MANAGEMENT
13
WHY QUALITY IMPROVEMENT?
  • INCREASED DEMANDS FROM CUSTOMERS (PATIENTS,
    PROVIDERS, PAYORS, EMPLOYERS)
  • NATIONAL FOCUS ON QUALITY
  • COSTS OF POOR QUALITY
  • LEGAL ISSUES/LIABILITY
  • INCREASED REGULATORY REQUIREMENTS
  • REDUCED REIMBURSEMENT (NEED TO BE MORE EFFICIENT)

14
MAJOR COMPONENTS OF TOTAL QUALITY MANAGEMENT/ CQI
  • 1. A CULTURE OF TRUST
  • 2. A FOCUS ON CUSTOMER NEEDS AND DEMANDS
  • 3. FOCUS ON PROCESS AND OUTCOMES
  • 4. A CROSS-DISCIPLINARY APPROACH USING TEAMS
  • 5. SCIENTIFIC AND SYSTEMATIC ANALYSIS OF
    PROCESSES
  • 6. EMPOWERMENT OF EVERYONE IN THE ORGANIZATION TO
    PARTICIPATE AND MAKE A CONTRIBUTION
  • 7. A COMMITMENT TO THE CONTINUOUS IMPROVEMENT OF
    PEOPLE AND PROCESS

15
FOCUS OF TQM/CQI
  • PROCESS 85 OF THE PROBLEM
  • PEOPLE 15 OF THE PROBLEM
  • A SIGNIFICANT AMOUNT OF TIME IS DEVOTED TO
    TRAINING PEOPLE TO PARTICIPATE IN A PROCESS THAT
    DOES NOT WORK VERY WELL, RATHER THAN IMPROVING
    THE PROCESS

16
W. EDWARDS DEMMING FOURTEEN POINTS OF QUALITY
MANAGEMENT
  • 1. Create constancy of purpose for improvement of
    products and services
  • 2. Adopt the new philosophy
  • 3. Cease dependence on inspection
  • 4. End the practice of awarding business on price
    tag alone
  • 5. Improve constantly and forever the system of
    production and service
  • 6. Institute training
  • 7. Institute leadership

17
W. EDWARDS DEMMING FOURTEEN POINTS OF QUALITY
MANAGEMENT
  • 8. Drive out fear
  • 9. Break down barriers between staff areas
  • 10. Eliminate slogans, exhortations, and
  • targets for the work force
  • 11. Eliminate numerical quotas
  • 12. Remove barriers to pride of workmanship
  • 13. Institute a vigorous program of education and
    retraining
  • 14. Take action to accomplish the transformation

18
DEMMING QUALITY CHAIN REACTION
19
PHILLIP CROSBYS FRAMEWORK
  • FOUR ABSOLUTES OF QUALITY
  • 1. Quality has to be defined as conformance to
    requirements, not as goodness
  • 2. The system for causing quality is prevention,
    not appraisal
  • 3. The performance standard must be zero defects,
    not that close enough
  • 4. The measurement of quality is the price of
    nonconformance, not indexes

20
PHILLIP CROSBYS FRAMEWORK FOURTEEN STEPS TO
QUALITY IMPROVEMENT
  • 1. Management commitment
  • 2. Quality improvement team
  • 3. Measurement
  • 4. Cost of quality
  • 5. Quality awareness
  • 6. Corrective action
  • 7. Zero defect planning
  • 8. Employee education
  • 9. Zero defect day
  • 10. Goal setting
  • 11. Error-cause removal
  • 12. Recognition
  • 13. Quality councils
  • 14. Do it over again

21
J. M. JURAN QUALITY FRAMEWORK
  • 1. QUALITY PLANNING
  • 1. Determine who the customers are
  • 2. Determine the needs of the customers
  • 3. Develop product features that respond to
    customer needs
  • 4. Develop processes able to produce the product
    features
  • 5. Transfer the plans to the operating force

22
J. M. JURAN QUALITY FRAMEWORK
  • 2. QUALITY CONTROL
  • 1. Evaluate actual product performance
  • 2. Compare actual performance to product goals.
    Act on the difference
  • 3. QUALITY IMPROVEMENT
  • 1. Establish the infrastructure
  • 2. Identify the improvement projects
  • 3. Establish project teams
  • 4. Provide the teams with resources, training and
    motivation to diagnose the causes, stimulate
    remedies and establish controls to hold the gains

23
FOCUS-PDCA FRAMEWORK
  • FOCUS
  • Find a process to improve
  • Organize a team that knows the process
  • Clarify current knowledge of the process
  • Understand sources of process variation
  • Select the process improvement
  • PDCA
  • Plan the improvement strategy
  • Do the implementation of the improvement
  • Check to make sure implementation is working
  • Act to hold the gain or continue to improve

24
PDCA
25
FLOW CHART COMPONENTS
26
FLOW CHART EXAMPLE
27
EXAMPLE-CAUSE AND EFFECT DIAGRAM
28
PARETO CHART
29
EXAMPLE - HISTOGRAM
30
EXAMPLE -RUN CHART
31
EXAMPLE SCATTER DIAGRAM
32
EXAMPLE- CONTROL CHART
33
SIX SIGMA APPROACH
34
WHAT IS SIX SIGMA
  • MANAGEMENT SYSTEM THAT IS DESIGNED TO IMPROVE
    PROFITS AND CUSTOMER SATISFACTION
  • A QUANTITATIVE APPROACH USING SCIENTIFIC METHODS
  • APPLICATION OF STATISTICAL PROBLEM SOLVING TOOLS
    TO DEFINE WASTEFUL COSTS AND STEPS FOR
    IMPROVEMENT
  • FOCUS ON REMOVING NON VALUE ADDED ACTIVITIES THAT
    IMPROVE CUSTOMER SATISFACTION AND INCREASE
    FINANCIAL OUTCOMES

35
COMPARISON WITH TQM
TQM SIX SIGMA
TYPICALLY GRASS ROOTS DRIVEN TOP DOWN IMPLEMENTATION
INCREMENTAL IMPROVEMENT (10-15) BREAKTHROUGH IMPROVEMENT (50-100)
FOCUS IS ONGOING FOCUS IS SHORT TERM PROJECTS
GOAL IS MORE WITH MORE GOAL IS MORE WITH LESS
CONSENSUS DRIVEN DATA DRIVEN STATISTICAL ANALYSIS
36
OBJECTIVE OF SIX SIGMA
  • IDENTIFY AND REDUCE VARIATION
  • IDENTIFY AND REDUCE NON VALUE ADDED ACTIVITIES
  • UNDERSTAND AND OPTIMIZE PROCESS OUTCOMES
  • y f (x1 x2 x3.xn)
  • where
  • y process outcomes
  • x process inputs

37
SIX SIGMA VARIATION
SIGMA LEVEL DEFECTS PER MILLION YIELD
1 697,700 30.23
2 308,700 69.15
3 66,810 93.32
4 6,210 99.38
5 233 99.98
6 3.4 99.99966
38
SIGMA VARIATION GOOD VERSUS SIX SIGMA
99 GOOD (3.8 SIGMA) 99.99966 (6 SIGMA)
5,000 incorrect surgical operations per week 1.7 incorrect operations per week
200,000 wrong drug prescriptions each year 28 wrong prescriptions per year
1,010 errant pediatric orders .34 errant pediatric medication orders
39
SIX SIGMA STRUCTURE
  • QUALITY COUNCIL/COMMITTEE
  • CHAMPIONS (EXECUTIVES)
  • MASTER BLACK BELT
  • BLACK BELTS (CERTIFIED)
  • GREEN BELTS
  • CHANGE MANAGEMENT COACHES
  • TEAM MEMBERS

40
VOICE OF CUSTOMER VOC
  • CTS CRITICAL TO SATISFACTION
  • CTQ -CRITICAL TO QUALITY
  • CTD CRITICAL TO DELIVERY
  • CTC CRITICAL TO COST

41
DMAIC PROCESS
  • DEFINE
  • MEASURE
  • ANALYZE
  • IMPROVE
  • CONTROL

42
DEFINE
  • WHO IS THE CUSTOMER?
  • WHAT DO THEY WANT?

43
MEASURE
  • WHAT IS THE BASELINE PERFORMANCE?
  • WHAT IS THE CUSTOMERS EXPERIENCE?

44
ANALYZE
  • WHAT ARE THE PROCESS INPUT VARIABLES?
  • WHAT VARIABLES IF CONTROLLED WILL ACHIEVE
    PERFORMANCE LEVEL?

45
IMPROVE
  • WHAT ARE THE SPECIFICATIONS FOR THE PROCESS
    VARIABLES NEEDED TO ACHIEVE PERFORMANCE GOAL?

46
CONTROL
  • WHAT IS THE CAPACITY OF THE PROCESS INPUT
    VARIABLE?
  • WILL THEY PERFORM TO THE ESTABLISHED SPECS?

47
TOOLS
  • PROCESS MAP (FLOW CHART)
  • CAUSE AND EFFECT DIAGRAM
  • STATISTICAL TESTS
  • PARETO CHARTS
  • MOST OF TOOLS USED IN TQM CAN ALSO BE APPLIED IN
    SIX SIGMA

48
BENCHMARKING
  • WORLD CLASS
  • BEST IN COUNTRY
  • BEST IN INDUSTRY
  • BEST IN REGION
  • BEST IN SIZE
  • BEST IN SPECIALTY

49
TYPES OF BENCHMARKING
  • INTERNAL
  • EXTERNAL COMPETITIVE
  • EXTERNAL INDUSTRY
  • EXTERNAL GENERIC
  • COMBINED EXTERNAL AND INTERNAL

50
SOURCES OF BENCHMARKING DATA
  • PROFESSIONAL ASSOCIATIONS
  • CONSULTANTS
  • ACCREDITATION ORGANIZATIONS
  • INDEPENDENT FIRMS
  • UNIVERSITIES
  • RESEARCH ORGANIZATIONS
  • FEDERAL OR STATE SOURCES

51
BALDRIGE AWARD
52
EXTERNAL REGULATION OF QUALITY
53
PSRO-PROFESSIONAL STANDARDS REVIEW ORGANIZATION
  • ESTABLISHED 1972
  • MEDICARE, MEDICAID, MATERNAL AND CHILD HEALTH
  • REVIEW MEDICAL NECESSITY
  • QUALITY THAT MEETS PROFESSIONAL STANDARDS
  • COST

54
PSRO-PROFESSIONAL STANDARDS REVIEW ORGANIZATION
  • CONCURENT REVIEW OF ADMISSIONS
  • MEDICAL CARE EVALUATION STUDIES
  • PROFILE ANALYSIS
  • EVENTUALLY BECAME PRO AND ARE NOW KNOW AS A
    QUALITY IMPROVEMENT ORGANIZATION (QIOs)

55
ARKANSAS FOUNDATION FOR MEDICAL CARE
  • ARKANSAS QIO
  • RESPONSIBLE FOR IMPLEMENTATION OF THE HEALTH CARE
    QUALITY IMPROVEMENT PROGRAM FOR ARKANSAS (HCQIP)
  • REVIEW ADMISSIONS, LENGTH OF STAY, PROCEDURE
  • HEALTH DATA SOLUTIONS-PERFORMANCE MEASUREMEMT
    DIVISION FOR PROGRAMS LIKE ORYX-HAVE 125
    PERFORMANCE MEASURES
  • WORK WITH NURSING HOMES ON QUALITY MEASURES
  • WORKING WITH HOSPITALS AND PHYSICIANS TO IMPROVE
    PERFORMANCE FOR THE (HCQIP)
  • HEDIS SURVEY FOR MEDICARE

56
ARKANSAS FOUNDATION FOR MEDICAL CARE
  • HEALTH CARE QUALITY IMPROVEMENT PROGRAM
  • ACUTE MYOCARDIAL INFARCTION
  • PNEUMONIA
  • SURGICAL INFECTION PREVENTION
  • HEART FAILURE
  • DIABETES
  • ADULT IMMUNIZATION
  • BREAST CANCER PREVENTION

57
OTHER CMS PROGRAM
  • NURSING HOME COMPARE
  • HOME HEALTH COMPARE
  • DIALYSIS COMPARE

58
JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE
ORGANIZATION
  • ORYX
  • ACUTE MYOCARDIAL INFECTION
  • HEART FAILURE
  • COMMUNITY ACQUIRED PNEUMONIA
  • PREGANCY AND RELATED CONDITION
  • SAFETY
  • 6 SAFETY GOALS

59
MEDICARE MODERNIZATION ACT OF 2003 QUALITY
DEMONSTRATIONS
  • 5 YEAR DEMONSTRATION PERIOD
  • FINANCIAL INCENTIVES
  • APPROPRIATE USE OF BEST PRACTICES
  • EXAMINATION OF SERVICE VARIATION
  • OUTCOMES MEASUREMENT
  • SHARED DECISION MAKING BETWEEN PROVIDERS AND
    PATIENTS
  • APPROPRIATE USE OF CULTURALLY AND ETHNICALLY
    SENSITIVE CARE
  • FINANCIAL IMPACTS
  • NEW SERVICES NOT COVERED

60
MEDICARE MODERNIZATION ACT OF 2003 QUALITY
DEMONSTRATIONS
  • VOLUNTARY CHRONIC CARE IMPROVEMENT PROGRAM
  • IMPROVE QUALITY OF CARE TO MEDICARE BENEFICIARIES
    WITH CHRONIC CONDITIONS (CHF, DIABETES, COPD)
  • DEFINE METHODS FOR BENEFICIARIES TO DIRECT THEIR
    OWN CARE NEEDS AND SERVICES
  • EVALUATE PRACTICES FOR SELF-DIRECTED CARE
  • EXAMINE CLINICAL AND COST EFFECTIVENESS

61
MEDICARE MODERNIZATION ACT OF 2003 QUALITY
DEMONSTRATIONS
  • CARE MANAGEMENT PERFORMANCE
  • PHYSICIANS PAID TO ADOPT AND USE HEALTH
    INFORMATION TECHNOLOGY AND EVIDENCE BASED
    OUTCOMES TO
  • PROMOTE CONTINUITY OF CARE
  • STABALIZE MEDICAL CONDITIONS
  • PREVENT OR MINIMIZE ACUTE
  • EXACERBATIONS OF CHRONIC
  • CONDITIONS
  • REDUCE ADVERSE HEALTH
  • OUTCOMES
  • PAY WILL BE BASED ON PERFORMANCE, BUT MUST BE
    BUDGET NEUTRAL

62
MEDICARE MODERNIZATION ACT OF 2003 QUALITY
DEMONSTRATIONS
  • ESRD DEMONSTRATION
  • CASE MIX ADJUSTED PAYMENT FOR ESRD SERVICES
  • 500 FACILITIES
  • 3 YEARS
  • 1.6 ADJUSTMENT

63
PAY FOR PERFORMANCE
  • BASIS FOR PAYMENT
  • DEFINED TARGET/GOAL
  • DEMONSTRATE IMPROVEMENT
  • BENCHMARK
  • PAYMENT CRITERIA
  • PROCESS CRITERIA
  • STRCTURAL CRITERIA
  • PAYMENT BASE
  • SINGLE CRITERIA
  • MULTIPLE CRITERIA
About PowerShow.com