Introduction of Quality
Management and Improvement
in Healthcare
Objectives
To gain an understanding of what quality and
total quality management is.
To highlights the quality improvement
process and its importance.
To present the Model for Improvement and
PDSA cycle
To introduce measurement in quality
improvement
Defining Quality
IOM – The degree to which health services for
individuals and populations increase the likelihood of
desired health outcomes and are consistent with
current professional knowledge.
Donabedian - The systematic measurement and
evaluation of the predetermined outcomes of a
process, and the subsequent use of information to
improve the process based on expectations of the
customer.
What is quality???
Quality is often used to signify ‘excellence’ of
a product or service ”.
Quality is doing the right things right from
first time.
The perception of the degree to which the
product or service meets the customer's
expectations.
Total Quality management:
Is holistic , organizational – wide approach to
improve and maintain quality. All of
organization’s activities and resources are
directed toward achievement of goal that is ,
customer satisfaction with care given.
We need quality effects and
improvement in the
environment through all the
followings
QC & QA focus on meet needs of
patients and performance..
While
TQM focus on all quality
approaches
Structure, Process, and Outcome
Structure
leads to
Process
leads to
Outcome
14
Structure, Process, and Outcome
Structure: is the arrangement of parts of a care
system or elements that facilitate care; the care
environment; evidence of the organization's
ability to provide care to patients, e.g.:
Resources
Equipment
Numbers of staff
Qualifications/credentials of staff
Work space
15
Structure, Process, and Outcome
Process: refers to the procedures, methods,
means, or sequence of steps for providing or
delivering care and producing outcomes. In other
words, processes are activities that act on an "input"
from a "supplier" to produce an "output" for a
"customer" e.g.
- Clinical Processes
- Care Delivery Processes
- Administrative and Management Processes
16
Structure, Process, and Outcome
Outcome: refers to the results of care,
adverse or beneficial e.g.
Clinical:
- Short-term results of specific treatments and
procedures
- Complications - Adverse events - Mortality
Functional:
- Long-term health status
- Activities of daily living (ADL) status
Perceived:
17
- Patient/family satisfaction
What does health care quality
mean ?
Quality means different things to
different people
To the PATIENT:
Get well – feel better – recover
Skilled and helpful staff
Effective health outcomes
Welcoming atmosphere
What is health care quality mean?(Cont.)
To the STAFF:
Standards of care
Up to date and working
equipment
Continuing education and
training
Effective team work
What is health care quality ?(Cont.)
To the HOSPITAL MANAGEMENT
Positive health outcomes for patients
Continuous quality development at
all levels of the organization
Providing education and training for
staff
Stable and trained work force.
What is health care quality ?(Cont.)
To the GOVERNMENT & POLICY
MAKERS:
Effective health care system
Improved quality of life for people
Research-based continuous quality
development
Monitoring of results/achievements and
taking actions to improve outcomes
Dimensions of quality
High- quality care is efficacious,
appropriate, effective, safe, efficient, and
coordinated over time and across practitioners and
settings. It is also available when needed, delivered in
a timely fashion, and perceived by the patient to be
provided in a manner that is respectful
and caring.
Dimensions of quality
Accessibility.
Appropriateness.
Continuity.
Effectiveness.
Efficacy.
Efficiency.
Patient respect and care.
Safety.
Timeliness.
JCAHOs, 1990
Accessibility
"The ease with which users
can obtain the care that they
need when they need it"
Appropriateness of Care
"The degree to which the correct care (the
care that is relevant to the patient’s/users
medical needs) is provided, given the current
state of knowledge".
Continuity of care
"The degree to which the care
needed by patients/users is
coordinated among
practitioners, organizations
and over time".
Effectiveness of Care
"The degree to which the care
given to patients/users is
provided correctly (i.e.
without error), given the
current state of knowledge".
Doing the right thing.
Efficacy of Care
"The degree to which a
service/care has the potential
to meet the need for which it is
planned under ideal
circumstances."
BACK
Patient Perspective Issues
"The degree to which
patients/users and their
families are satisfied with their
care and involved in the
decision-making processes of
their care and to which those
providing the care do so with
sensitivity and respect for the
BACK
patient’s needs, expectations
Safety of the Care Environment
"The degree to which the
environment is free from risk
(hazard or danger) for both
users and providers."
BACK
Timeliness of Care
"The degree to which care is
provided to patients/users
when it is needed i.e., at the
most beneficial or necessary
time."
Acceptability:
Conformity to the wishes,
desires, and expectations of
patients and responsible
members of their families.
Equity:
Conformity to a principle that
determines what is just or fair
in the distribution of health
care and its benefits among the
members of a population.
Efficiency of Care
"The relationship between the
outcomes (results of care) and
the resources used to deliver
the care".
"The degree to which the care
received
has the desired effect with a
minimum
of effort, expense or waste.“
BACK
Quality is free..
If you do a quality job it will not
cost you, what costs you is non
quality.
Benefits of Quality Management/improvement
Quality Improvement
Improved Productivity
· Improved outputs (product/service)
· Better resource use (Efficiency)
Decreased Production Costs
Lower Prices
Increased Customer Satisfaction
Increased Market Share/Enhanced competitive position
Increased Profit
What Are Performance
Measures?
PERFORMANCE MEASURES ARE
USED AT THE TREATMENT
PROGRAM LEVEL FOR
QUALITY IMPROVEMENT
What is an Indicator?
37
Indicators are reliable and valid
measures used to screen/assess
organizational and practitioner
performance issues, but not direct
measures of quality
38
Types Of Indicators
Outcome Indicator measures what happens or
does not happen as the result of a process or
processes;
Process Indicator measures a discrete activity
that is carried out to provide care or service
Structure indicator measures the inputs to the
process and resources allocated to provide care
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NEW HAMPSHIRE
QUALITY
INITIATIVES
ELIMINATING HARM
Harm – an injury in association with medical care
(including the absence of indicated medical
treatment) that requires or prolongs hospitalization
and/or results in permanent disability or death.
NEW HAMPSHIRE PARTNERSHIP FOR PATIENTS
GOAL:
The hospitals will work collaboratively to
eliminate those instances of patient harm
that could have been prevented if the
evidence-based processes and systems
known to improve patient safety had
been implemented and followed.
PATIENT SAFETY
CHECKLIST
Every hospital and ambulatory surgery center to adopt and
post a safety checklist in all procedure areas where an incision
is made or anesthesia is administered.
Differs from the common “time-out” process which
confirms site, patient and procedure.
Improves team communication and promotes consistency
of delivery of care. Ensuring safe care at three critical
junctures:
Prior to anesthesia
Prior to incision or procedure
Prior to exiting the operating room or procedure
area
“The checklist is only as good as the team believes it is”
HAND HYGIENE CAMPAIGN
SPONSERED CAMPAIGN: The NH Healthcare Quality Assurance
Commission (HQAC) with the NH Foundation for Health Communities
(FHC).
To reduce the risk of healthcare-associated infections in
the state.
Every hospital and ambulatory surgery center:
Submitted compliance data every six months.
Developed hand hygiene improvement strategies
in the following categories:
1. Leadership and accountability
2. Measurement and feedback
3. Education and training
4. Availability and convenience of hand hygiene
products
5. Marketing and communication
INSTITUTE FOR HEALTHCARE
IMPROVEMENT
TRIPLE AIM INITIATIVE • New designs that
better identify
Better
problems and
Care for
solutions further
Individu
als upstream and
outside of acute
health care
• Patients can
Better expect less
Health complex and much
for more coordinated
Populatio care and the
ns burden of illness
will decrease
Reducin • Lessen the
g per pressure on
capita publicly funded
cost of health care
health budgets and
care businesses.
Conclusion
-Quality means doing the right things right the first time.
-TQM is the integration of all functions and processes
within an organization in order to achieve continuous
improvement of the quality of services. The goal is
customer satisfaction.
- Approaches of quality include QC,QA,TQM and CQI.
-Dimension of quality (safety, continuity,
timeliness ,effectiveness of care ,efficiency and efficacy
of care……).
