4. QUALITY DEFINITION
A MEASURE OF EXCELLENCE
A STATE OF BEING FREE FROM DEFECTS,
DEFICIENCIES AND SIGNIFICANT
VARIATIONS.
STRICT AND CONSISTENT COMMITMENT TO
CERTAIN STANDARDS THAT ACHIEVE
UNIFORMITY OF A PRODUCT IN ORDER TO
SATISFY SPECIFIC CUSTOMER OR USER
REQUIREMENTS.
http://www.businessdictionary.com/definition/quality.html#ix
)
5. IS IT TIME TO TAKE A HARDER LOOK
AT THE QALY*?
HOW MUCH A PERSON’S HEALTH ACTUALLY
COST?
HOW DO YOU DETERMINE THAT?
SHOULD HIGH-PRICED BIOLOGICS BE
COVERED IF THEY ARE NOT COST-
EFFECTIVE?
Amanda Brower, Biotechnol Healthc v.5(3); Sep-Oct 2008
6. PUTTING A PRICE ON
TREATMENT
HEALTH CARE IS CHANGING RAPIDLY.
ALL THINGS TO ALL PEOPLE-
IMPOSSIBLE.
MAKE CHOICES
HOW MUCH LONGER THE TREATMENT
WILL ALLOW YOU TO LIVE,
HOW IT IMPROVES THE LIFE YOU HAVE.
J Bone Joint Surg Am. 2005 Jun;87(6):1253-9.
7. ORTHOPAEDIC COMMUNITY
UNDERSTAND AND APPLY ECONOMIC
EVALUATIONS
IT CAN BE USEFUL FOR SETTING
PRIORITIES AND GUIDING RESEARCH.
Cost-utility analyses in orthopaedic
surgery.
Harvard Center for Risk Analysis, Harvard School
8. HEALTH SYSTEMS IN THE UNION - EFFORTS
TO ENSURE IMPROVING QUALITY AND
SAFETY STANDARDS TAKING INTO ACCOUNT:
ADVANCES IN MEDICAL SCIENCE
GOOD MEDICAL PRACTICES
NEW HEALTH TECHNOLOGIES.
DIRECTIVE 2011/24/EU OF THE EUROPEAN PARLIAMENT
10. THE FUTURE STARTS TODAY, NOT
TOMORROW.
Pope John Paul II
11. “TO MAKE NO MISTAKES IS NOT IN THE
POWER OF MAN; BUT FROM THEIR
ERRORS AND MISTAKES THE WISE AND
GOOD LEARN WISDOM FOR THE
FUTURE.
” Plutarch. 46 – 120 AD,
12. MEDICAL ERRORS
“PATIENTS’ PERCEPTIONS AND EXPERIENCE
OF CARE ARE VERY IMPORTANT.
PATIENTS MAY MISCHARACTERIZE AN
OUTCOME AS AN ADVERSE EVENT OR
COMPLICATION -LACK SPECIFIC MEDICAL
KNOWLEDGE
Council on Research and Quality AAOS
13. ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL
ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED
OUTCOME
AND WHEN THESE CANNOT BE
ATTRIBUTED TO THE INTERVENTION OF
SOME CHANCE AGENCY.
Professor James Reason
14. ΕRROR IS ¨ΑN ACTION OR
DECISION THAT RESULTS IN ONE
OR MORE UNINTENDED
NEGATIVE OUTCOMES
(STRAUCH Barry (2004). Investigating human
error: incidents, accidents, and complex systems.
Ashgate (Aldershot, UK),
15. WHEN FACED WITH UNCERTAINTY,
A SUBJECT CAN MAKE TWO POSSIBLE
ERRORS IN THE DECISION MAKING
PROCESS:
A TYPE I ERROR IS A FALSE-POSITIVE.
A TYPE II ERROR IS A FALSE-NEGATIVE, OR THE SIDING WITH SKEPTICISM.
Haselton, M. G., & Buss, David. (2000)
Error Management Theory: A New Perspective on Biases in Cross-Sex Mind Reading
16. REDUCING MEDICAL ERRORS AND ADVERSE EV
Medical errors account for at least 44,000, and
perhaps as many as 98,000 deaths per year in
the United States. They increase disability and
costs and decrease confidence in the health care
system.
Annu Rev Med. 2012;
Johns Hopkins University School of Medicine
17. MEDICAL ERROR (HUMAN ERRORS IN
HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE
(whether or not it is evident or harmful to the
patient).
This might include an inaccurate or incomplete diagnosis
or treatment of
a disease,
injury,
syndrome,
behavior,
infection,
. etc
Zhang, J., Patel, V.L., & Johnson, T.R (2008).
19. CAUSES
INADEQUATE DOCTOR-PATIENT COMMUNICATION
NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT
FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN
NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES,
NON-COMPLIANCE WITH THE PROFESSIONAL-
SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS .
http://www.aaos.org/
20. COGNITIVE FACTORS ARE CRITICAL
AT VARIOUS LEVELS OF THE HEALTHCARE
SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al
Am Med Inform Assoc. 2002 Nov-Dec; 9(6 Suppl 1): s75–s77.
In science, cognition is a group of mental processes that includes attention, memory, producing and understanding language,
learning, reasoning,
problem solving, and decision making.
21. AT THE LOWEST CORE LEVEL,
IT IS INDIVIDUALS WHO TRIGGER ERRORS.
( most critical role here).
NEXT LEVEL,
INTERACTIONS BETWEEN AN INDIVIDUAL
AND TECHNOLOGY.
AT THE NEXT LEVEL,
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO
INTERACT S WITH COMPLEX TECHNOLOGY .
AT THE NEXT FEW LEVELS UP,
ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS.
22. MEDICAL ERRORS INVOLVING
TRAINEES:
ERRORS IN JUDGMENT ( [72%]),
TEAMWORK BREAKDOWNS ( [70%]),
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE
( [58%]).
Trainee errors appeared more complex than
nontrainee errors
Houston Center for Quality of Care and Utilization Studies, USA.
Arch Intern Med. (2007)
23. REVIEWS OF LIABILITY CLAIMS
AGAINST SURGEONS:
MOST ERRORS ARE PREVENTABLE.
COMPETENT SURGEONS.
FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE
PATIENT FACTORS
FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE.
Adv Surg. (2009).
Department of Surgery, Louisiana State University Health
Sciences
24. COGNITIVE ERROR - MEDICAL
INJURY: -CLAIMS IN JAPAN.
COGNITIVE ERRORS ( ERROR IN JUDGMENT)
WERE COMMON
POOR TEAMWORK (11/274, 4%) and
TECHNOLOGY FAILURE (5/274, 2%) were less
common.
REDUCTION OF THIS TYPE OF ERROR IN
JUDGMENT IS REQUIRED TO PRODUCE
SAFER HEALTHCARE.
J Hosp Med. (2011)
University of Tsukuba Japan.
26. PATERNALISTIC MODEL
ONLY INFORMATION ON RISKS AND
BENEFITS OF A PROCEDURE THAT THE
PHYSICIAN THINKS
. Indications
Unconscious patients
Patient is ill and unable to engage in a
discussion
27. INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL
OVER SURGICAL DECISION MAKING,
AND THE PHYSICIAN'S VALUES ARE NOT
DISCUSSED.
NOT IDEAL for patient care in most
situations
29. DELIBERATIVE MODEL
SIMILAR TO THE INTERPRETIVE
BEYOND THE INTERPRETIVE MODEL
PHYSICIAN MUST CONSCIOUSLY
COMMUNICATE TO THE PATIENT HIS OR HER
HEALTH VALUES;
http://www.medicine.ox.ac.uk/bandolier/painres/download/whatis/QALY
.pdf
30. WHEN OBTAINING INFORMED
CONSENT FOR TREATMENT
The orthopaedic surgeon is obligated to present
to the patient or to the person responsible for the
patient, in UNDERSTANDABLE TERMS,
PERTINENT MEDICAL FACTS AND
RECOMMENDATIONS CONSISTENT WITH
GOOD MEDICAL PRACTICE.
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
31. SUCH INFORMATION SHOULD
INCLUDE
Alternative modes of treatment,
Objectives,
Risks and possible complications of
treatment,
Complications and consequences of no
treatment.
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
32. COUNCIL ON RESEARCH AND QUALITY
-AAOS
EDUCATE ITS MEMBERS, THE PUBLIC,
AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice,
orthopaedic devices
biologics regulatory pathways and standards
development,
patient safety,
occupational health,
technology assessment, and
other areas of importance.
33. The Patient Protection and Affordable Care
Act (PPACA) -pressure on providers:
to improve outcomes
lower the cost of care.
Market forces being exerted by both
consumers and businesses -demand for better
healthcare at lower costs.
http://www.aaos.org/news/aaosnow/jan13/advocacy7.asp
34. MEASURE QUALITY /COST
QUALIFIED PHYSICIANS TO MEASURE
QUALITY / VALUE
PUBLIC AND PRIVATE PAYERS HAVE
BEGUN TO DEVELOP THEIR OWN RATING
AND PAYMENT SYSTEMS TO MEASURE
PROVIDER COST AND QUALITY
Kevin J. Bozic, AAOS Council on Research and Quality
35. FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND
QUALITY CHALLENGES.
MEASUREMENT OF QUALITY AND
PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION.
AAOS Council on Research and Quality
36. DEFINITIONS OF QUALITY OF
CARE
NO CONSENSUS ON HOW TO DEFINE
QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC
FRAMEWORK
(from European Observatory of Health System and policies
Odservatory studies No 12)
37. DEFINITIONS OF QUALITY OF CARE
THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH
OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE.
Doing the right things (what)
•
to the right people (to whom)
•
at the right time (when)
•
and doing things right first time.
38. PERFORMANCE MANAGEMENT AND
QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND
QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE
EFFECTIVENESS
Centers for Disease Control and Prevention
http://www.cdc.gov/stltpublichealth/performance/
39. MEDICAL ETHICS AND VALUES
ARE FUNDAMENTAL ASPECTS OF
HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations –
Peter M. Ginter - 2013
40. UNIVERSITY OF PENNSYLVANIA
HELATH SYSTEM
CORE VALUES ARE:
EXCELLENCE/ CREATIVITY AND INNOVATION.
INTEGRITY
.
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
.
TEAMWORK AND COLLABORATION
TRADITION
.
41. THE NHS WAS CREATED OUT OF THE
IDEAL THAT GOOD HEALTHCARE
SHOULD BE AVAILABLE TO ALL,
REGARDLESS OF WEALTH
.
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED, NOT ABILITY
TO PAY
(July 5 1948-now)
42. COMPREHENSIVE SERVICE,
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS, THEIR
FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERS’ MONEY AND THE MOST
EFFECTIVE, FAIR AND SUSTAINABLE USE OF FINITE
RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
43. RIGHTS AS AN NHS PATIENT COVER.
HEALTH SERVICES ACCESS,
QUALITY OF CARE ,
INFORMATION,
CONFIDENTIALITY,
RIGHT TO COMPLAIN
IF THINGS GO WRONG.
PUBLIC FUNDS
WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES.
http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx
