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Healthcare Quality Concepts

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BASIC CONCEPTS OF QUALITY QUALITY ASPECTS OF QUALITY FRAMEWORK OF QUALITY QUALITY MANAGEMNT CUSTOMER CONCEPT QUALITY CONTROL QUALITY ASSURANCE TOTAL QUALITY MANAGEMENT

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<ul><li>Quality in healthcare means providing the right services in the right way from the first time and every time for every patient regardless to his/her ability to pay 24hours/7days a week/ 365 days/year </li></ul><ul><li>Brown 2001 </li></ul>What is Quality What is Quality

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<ul><li>The Institute of Medicine defines quality as: </li></ul><ul><li>&quot; The degree to which health care services for individuals and populations increase the probability of desired health outcomes and are consistent with current professional knowledge of best practice.&quot; </li></ul>

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<ul><li>Quality is conformance to standards & requirements. </li></ul>What is Quality

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<ul><li>Quality is the degree to which performance meets expectations. </li></ul>What is Quality

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<ul><li>Quality denotes an excellence in services, especially to the degree they conform to standard requirements and satisfy customers. </li></ul>What is Quality

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What is right in Healthcare

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<ul><li>Appropriateness </li></ul><ul><li>The degree to which the care/intervention is relevant to the patient's clinical needs, consistent to the current state of knowledge. </li></ul><ul><li>Efficacy </li></ul><ul><li>The potential, capacity, or capability to produce the desired effect or outcome, as already shown, e.g., through scientific research (evidence-based) findings </li></ul>Two Quality Dimensions Make It The Right Thing Dimensions of Quality

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How To Do It Right Eight Quality Dimensions Must Be Achieved To Do It Right

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<ul><li>Availability </li></ul><ul><li>The degree to which appropriate care/intervention is obtainable to meet the patient's needs. </li></ul><ul><li>Timeliness </li></ul><ul><li>The degree to which needed care and services are &quot;provided to the patient at the most beneficial or necessary time. </li></ul>

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<ul><li>Effectiveness </li></ul><ul><li>The degree to which care is provided in the correct manner, given the current state of knowledge, to achieve the desired or projected outcome(s) for the individual. </li></ul><ul><li>Efficiency </li></ul><ul><li>The relationship between the outcomes (results of care) and the resources used to deliver care </li></ul>Dimensions of Quality

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<ul><li>Safety </li></ul><ul><li>The degree to which the risk of an intervention ... and risk in the care environment are reduced for a patient and other persons including health care practitioners. </li></ul><ul><li>Competency </li></ul><ul><li>The practitioner's ability to produce both the health and satisfaction of customers. The degree to which the practitioner adheres to professional and/or organizational standards of care and practice </li></ul>Dimensions of Quality

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<ul><li>Continuity </li></ul><ul><li>The coordination of needed healthcare services for a patient or specified population among all practitioners and across all involved organizations over time. </li></ul><ul><li>Respect and Caring </li></ul><ul><li>The degree to which those providing services do so with sensitivity for the individual's needs, expectations, and individual differences, and the degree to which the individual or a designee is involved in his or her own care decisions. </li></ul>

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FRAME WORK OF QUALITY <ul><li>Structure </li></ul><ul><li> leads to </li></ul><ul><li>Process </li></ul><ul><ul><ul><ul><li>leads to </li></ul></ul></ul></ul><ul><li>Outcome </li></ul>

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Structure, Process, and Outcome <ul><li>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.: </li></ul><ul><ul><ul><li>Resources </li></ul></ul></ul><ul><ul><ul><li>Equipment </li></ul></ul></ul><ul><ul><ul><li>Numbers of staff </li></ul></ul></ul><ul><ul><ul><li>Qualifications/credentials of staff </li></ul></ul></ul><ul><ul><ul><li>Work space </li></ul></ul></ul><ul><ul><ul><li>? </li></ul></ul></ul>

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Structure, Process, and Outcome <ul><li>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 &quot;input&quot; from a &quot;supplier&quot; to produce an &quot;output&quot; for a &quot;customer&quot; e.g. </li></ul><ul><li>- Clinical Processes </li></ul><ul><li>- Care Delivery Processes </li></ul><ul><li>- Administrative and Management Processes </li></ul>

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Structure, Process, and Outcome <ul><li>Outcome: refers to the results of care, adverse or beneficial e.g. </li></ul><ul><li>Clinical: </li></ul><ul><li>- Short-term results of specific treatments and procedures </li></ul><ul><li>- Complications - Adverse events - Mortality </li></ul><ul><li>Functional: </li></ul><ul><li>- Long-term health status </li></ul><ul><li>- Activities of daily living (ADL) status </li></ul><ul><li>Perceived: </li></ul><ul><li>- Patient/family satisfaction </li></ul>

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The Concept of Outcomes Management <ul><li>The resulting data, called outcome measures, are measures of performance. </li></ul><ul><li>“ Outcomes Management&quot; refers to a &quot;technology of patient experience designed to help patients, payers, and providers make rational medical care-related choices based on better insight into the effect of these choices on the patient's life&quot; [Ellwood, 1988]. </li></ul>

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Outcomes management depends on the following four developing techniques <ul><li>Practitioner reliance on standards and guidelines in selecting appropriate interventions </li></ul><ul><li>Routine and systematic measurement of the functioning and well-being of patients, along with disease-specific clinical outcomes, at appropriate time intervals </li></ul><ul><li>Pooling of clinical and outcome data on a massive scale </li></ul><ul><li>Analysis and dissemination of results (outcomes) from the segment of the database pertinent to the concerns of each decision maker </li></ul>

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The Concept of Process Variation <ul><li>Variation is &quot;change or deviation in form, condition, appearance, extent, etc., from a former or usual state, or from an assumed standard.&quot; &quot;Variation&quot; generally refers to the whole process or a step in the process. </li></ul><ul><li>V ariance is &quot;a changing or tendency to change; degree of change or difference; divergence; discrepancy.&quot; This term generally refers to specific data or information. </li></ul>

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Aspects of Quality <ul><li>Measurable Quality </li></ul><ul><li>Appreciative Quality </li></ul><ul><li>Perceptive Quality </li></ul>

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Measurable Quality <ul><li>Can be defined objectively as compliance with, or adherence to standards. </li></ul><ul><li>Clinically, these standards may take the form of practice parameters or protocols, or they may establish acceptable expectations for patient and organizational outcomes. </li></ul><ul><li>Standards serve as guidelines for excellence. </li></ul>

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Appreciative Quality <ul><li>Is the comprehension and appraisal of excellence beyond minimal standards and criteria. </li></ul><ul><li>Requires the judgments of skilled, experienced practitioners and sensitive, caring persons. </li></ul><ul><li>Peer review bodies rely on the judgments of like professionals in determining the quality or non-quality of specific patient-practitioner interactions. </li></ul>

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Perceptive Quality <ul><li>Is the degree of excellence which is perceived by the recipient or the observer of care rather than by the provider of care. </li></ul><ul><li>Is generally based more on the degree of caring expressed by physicians, nurses, and other staff than on the physical environment and technical competence. </li></ul>

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Quality Management Trilogy <ul><li>Quality Planning </li></ul><ul><li>Quality Control </li></ul><ul><li>Quality Improvement </li></ul>

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The Quality Management Trilogy <ul><li>Quality Planning includes: </li></ul><ul><ul><li>Identifying and tracking customers, their needs and expectations. </li></ul></ul><ul><ul><li>Designing new or redesigning systems, services, or functions based on customer needs and expectations. </li></ul></ul><ul><ul><li>Identifying function and process issues critical to effective outcomes; and developing new processes capable of achieving the desired outcome. </li></ul></ul><ul><ul><li>Setting quality improvement objectives based on strategic goals. </li></ul></ul>

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The Quality Management Trilogy <ul><li>Quality Control/Measurement includes: </li></ul><ul><ul><li>Developing process and outcome performance measures. </li></ul></ul><ul><ul><li>Measuring actual performance and variance from expected. </li></ul></ul><ul><ul><li>Summarizing data and performing initial assessment/ analysis. </li></ul></ul><ul><ul><li>Measuring and describing process variability. </li></ul></ul>

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The Quality Management Trilogy <ul><ul><li>Quality Control/Measurement includes: cont.. </li></ul></ul><ul><ul><li>Measuring and tracking outcomes of populations. </li></ul></ul><ul><ul><li>Performing intensive assessment as data dictates. </li></ul></ul><ul><ul><li>Providing accurate, timely feedback. </li></ul></ul><ul><ul><li>Using the data to manage, evaluate effectiveness, maintain Quality Improvement gains, and facilitate Quality Planning. </li></ul></ul>

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The Quality Management Trilogy <ul><li>Quality Improvement includes: </li></ul><ul><ul><li>Collaboratively studying and improving selected existing processes and outcomes in governance, management, clinical, and support activities; </li></ul></ul><ul><ul><li>Analyzing causes of process failure, dysfunction, and/or inefficiency; </li></ul></ul><ul><ul><li>Systematically developing optimal solutions to chronic problems; </li></ul></ul><ul><ul><li>Analyzing data/information for better or best practice. </li></ul></ul>

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Quality Management Principles <ul><li>Leadership commitment is the Key. </li></ul><ul><li>Focus on systems not on individuals. </li></ul><ul><li>All decisions are based on information derived from reliable data. </li></ul><ul><li>Quality is what is perceived by the customer as quality. </li></ul><ul><li>Quality management is preventive and proactive not reactive or a quick fix. </li></ul>

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Quality Management Principles <ul><li>Quality empowers people; it does not police them. </li></ul><ul><li>The modern approach to quality is thoroughly grounded in scientific and statistical thinking. </li></ul><ul><li>Total employee involvement is critical. </li></ul><ul><li>Sound customer-supplier relationships are absolutely necessary for sound quality management . </li></ul>

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Principles of Customer Service

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The Concept of Customer

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<ul><li>A &quot;customer&quot; is one who receives services. </li></ul><ul><li>It is a concept utilized in Total Quality Management philosophy to identify the needs, expectations, and preferences of all who are affected by the healthcare services we provide. </li></ul><ul><li>Customers are our &quot;dependents&quot;; they rely on us for a service or product. </li></ul>

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The Concept of the External Customer

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<ul><li>&quot;External customers&quot; include the patient, family, and others outside the organization receiving services from the organization. </li></ul>

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Examples of External Customers <ul><li>Patients/families [some care givers argue that patients become internal customers while receiving care]. </li></ul><ul><li>Physicians. </li></ul><ul><li>Purchasers:- </li></ul><ul><ul><li>Insurance companies and health plans. </li></ul></ul><ul><ul><li>Employers. </li></ul></ul><ul><ul><li>Government agencies. </li></ul></ul>

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<ul><li>Regulators and accrediting agencies. </li></ul><ul><li>Vendors/suppliers (goods and services, including registries). </li></ul><ul><li>Educational institutions. </li></ul><ul><li>Attorneys. </li></ul><ul><li>Community businesses, agencies, and residents. </li></ul>

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The Concept of the Internal Customer

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<ul><li>&quot;Internal customers&quot; are those performing work, but dependent on others performing work, within the organization. </li></ul><ul><li>An employee can be a customer when she or he receives material, information, or services from others in the organization. </li></ul><ul><li>Conversely, an employee also can be a supplier, when she or he provides material, information, or services to others in the organization or to external customers. </li></ul>

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Examples of Internal Customers <ul><li>Admitting/reception/front office staff </li></ul><ul><li>Administrative services staff. </li></ul><ul><li>Ancillary staff. </li></ul><ul><li>Technicians. </li></ul><ul><li>Care coordination/social services staff. </li></ul><ul><li>Communications staff. </li></ul><ul><li>Human resource staff. </li></ul><ul><li>Facility management staff </li></ul><ul><li>Finance staff. </li></ul><ul><li>Medical/clinical record staff. </li></ul><ul><li>Nurses, aides, medical assistants. </li></ul><ul><li>Performance improvement/quality management/review staff. </li></ul><ul><li>Pharmacists. </li></ul><ul><li>Physicians, med. directors, other independent practitioners. </li></ul><ul><li>Support service staff. </li></ul><ul><li>Volunteer staff. </li></ul>

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QUALITY CONTROL <ul><li>is the operational techniques and activities that are used to fulfill the requirements for quality, and to check and assess the quality of the outcomes. </li></ul>

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QUALITY ASSURANCE <ul><li>is all systematic and planned actions which are necessary to provide adequate confidence that a service will satisfy the given requirement for quality </li></ul><ul><li>i.e provides services of a high quality </li></ul>

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QUALITY MANAGEMENT <ul><li>i s a systematic set of operating procedures which is organization wide, documented, implemented and maintained while ensuring the best performance in a consistent manner </li></ul>

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QM Vs QA The Prime Focus of Quality Management Quality Assurance Achieving results that satisfy the requirements for quality. Demonstrating that the requirements for quality have been (and can be) achieved. Motivated by stakeholders internal to the organization, especially the organization’s management Motivated by stakeholders, especially customers, external to the organization Goal is to satisfy all stakeholders Goal is to satisfy all customers. Effective, efficient, and continually improving, overall quality-related performance is the intended result. Confidence in the organization’s services is the intended result Scope covers all activities that affect the total quality-related business results of the organization Scope of demonstration coves activities that directly affect quality-related process and product results

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TOTAL QUALITY MANAGEMENT <ul><li>THE LATEST APPROACH </li></ul><ul><li>IT IS THE PROCESS OF INDIVIDUAL & ORG. DEVELOPMENT, THE PURPOSE OF WHICH IS TO INCREASE THE LEVEL OF SATISFACTION OF ALL THE STAKEHOLDERS </li></ul>

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Philosophy of T.Q.M. <ul><li>Definition </li></ul><ul><li>An organization wide management philosophy and top level commitment to provide value to all customers through: </li></ul><ul><li>Creating an environment of C.I . of people skills and processes </li></ul><ul><li>Building excellence into every aspects of the organization </li></ul>

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Philosophy of T.Q.M. <ul><li>T.Q.M. resulted in </li></ul><ul><li>Increased customer satisfaction </li></ul><ul><li>Increased productivity </li></ul><ul><li>Decreased costs </li></ul>

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Philosophy of T.Q.M. <ul><li>Key concepts of T.Q.M. </li></ul><ul><li>Top management leadership </li></ul><ul><li>Creating Best frame work of quality </li></ul><ul><li>Customer focus </li></ul><ul><li>Process focus </li></ul><ul><li>Process Improvement </li></ul>

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Philosophy of T.Q.M. <ul><li>Employee education and training </li></ul><ul><li>Learning by practice and teaching </li></ul><ul><li>Benchmarking </li></ul><ul><li>Quality managements and statistics </li></ul><ul><li>Recognition and rewards </li></ul>

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<ul><li>We are here to help you if I can. </li></ul>

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<ul><li>We are in this together for the long haul </li></ul>

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<ul><li>I know that most of you are trying very hard. </li></ul>

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<ul><li>But things can go wrong. </li></ul>

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<ul><li>My job is to notice opportunities for improvement </li></ul>

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<ul><li>And to give you means to do your job even better than you do now. </li></ul>

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Always remember Quality Quality is an ongoing journey and not an end point Quality is an endless race

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Thank You