Quality in Health CareKiran Hanjar 1MS12MIA03 II sem, IEMMSRIT

Introduction

• The history of quality in health care may be traced back to the 1860s

• In 1914, in the Untied States E.A. Codman (1869–1940) studied the results of health care with respect to quality, and emphasized the issues

• Over the years, many other people have contributed to the field of quality in health care

• Each year billions of dollars are being spent on health care worldwide. For example, in 1992 the United States spent $840 billion on health care, or 14% of its gross domestic product (GDP)

Health Care Quality Terms and Definitions

• Health care. This is services provided to individuals or communities for promoting, maintaining, monitoring, or restoring health

• Quality. This is the extent to which the properties of a product or service generate/produce a desired outcome

• Quality assurance. This is the measurement of the degree of care given (assessment) and, when appropriate, mechanisms for improving it.

• Total quality management. This is a philosophy of pursuing continuous improvement in each and every process through the integrated efforts of all concerned individuals associated with the organization

• Quality of care. This is the level to which delivered health services satisfy established professional standards and judgements of value to consumers

• Quality improvement. This is the total of all the appropriate activities that create a desired change in quality

Health Care Quality Terms and Definitions

• Clinical audit. This is the process of reviewing the delivery of care against established standards to identify and remedy all deficiencies through a process of continuous quality improvement

• Cost of quality. This is the expense of not doing effectively all the right things right the first time.

• Quality assessment. This is the measurement of the degree of quality at some point in time, without any effort for improving or changing the degree of care.

• Dimensions of quality. These are the measures of health system performance, including measures of effectiveness, appropriateness, efficiency, safety, continuity, accessibility, capability, sustainability, and responsiveness.

• Adverse event. This is an incident in which unintended harm resulted to an individual receiving health care.

Reasons forthe Rising Health Care Cost

REASONSAging population

Other specialization of physicians

Variance in practice and poor

incentives to control cost

Cost of poor quality

Medical malpractice

Use of new technology

Comparisons of Traditional Quality Assurance and TQM with Respect to

Health CareNo. Area

(characteristic)

Traditional qualityassurance

Total quality management

1 Purpose Enhance quality of patientcare for patients

Enhance all products andservices quality for

patientsand other customers

2 Aim Problem solving Continuous improvement,

even when no deficiency/problem is identified

3 Leadership Physician and clinicalleaders (i. e., clinical staff

chief and quality assurance

committee)

All leaders (i. e., clinical and

non-clinical)

4 Customer Customers are revieworganizations and

professionalswith focus on

patients

Customers are review organizations,

patients, professionals,and others

Continued…

No.

Area (characteristic)

Traditional qualityassurance

Total quality management

5 Scope Clinical processes andoutcomes

All processes and systems(i. e., clinical and non-

clinical)

6 Focus Peer review verticallyfocused by clinical process

or department

Horizontally focused peerreview for improving all

processes and individuals

7 People involved Appointed committeesand quality assurance

program

Each and every person involved

with process

8 Methods Includes hypothesis testing,

chart audits, indicatormonitoring, and nominal

group techniques

Includes checklist, force field

analysis, qualityfunction deployment,

controlchart, fishbone diagram,

Pareto chart

9 Outcomes Includes measurement and

monitoring

Includes also measurementand monitoring

No. Area (characteristic)

Quality improvement Quality assurance

1 Goal Satisfy customer requirements Regulatory compliance

2 Participants Every associated person Peers

3 Viewpoint Proactive Reactive

4 Focus All involved processes Physician

5 Review technique Analysis Summary

6 Customers Patients, caregivers, payers,technicians, supportstaff, managers, etc.

Regulators

7 Performance measure

Need/capability External standards

8 Direction Decentralized through themanagement line of authority

Committee or central coordinator

9 Functions involved Many (clinician and supportsystem)

Few (mainly doctors)

10 Action taken Implement appropriate improvements

Recommend appropriateimprovements

11 Defects studied Special and common causes Outliers special causes

Comparisons of quality assurance and quality improvement in health care

institutions

Health Care-related Quality Goals

Four important health care-related quality goals•Aim to maximize patients’ and families’ involvement in the care experience by using shared decision making and improving patient involvement in care choices.•Ensure, in an effective manner, the assessment of employee, patient, and medical staff satisfaction periodically by incorporating survey standards and benchmarking.•Implement recommendations concerning compassionate care of dying and carefully address the spiritual needs of patients and families through pastoral care.

Health Care-related Quality Goals

GOALS

Goal I: Provide a good person-centered

compassionate care that respects dignity

of all individuals

Goal III: Effectively support a quality

management mechanism that is useful for further

coordination of care across the continuum

of providers

Goal II: Establish a good system

perspective on analyzing and

communicating information, data on the quality, cost of

care

Goal IV: Engage all employees, physicians and board members in

system efforts to implement TQM

Ten steps that can be used in improving quality in the health care system

Quality Tools for Use in Health Care

Methods for improving

quality in health care

Prioritization matrix

Affinity diagram

Process flow chart

Control chart

histogram

Scatter diagram

Cause & effect

diagram

Check sheets

Force field

analysisMultivoting

Cost benefit analysis

Brainstorming

Implementation of Six Sigma Methodology in Hospitals

Steps involved in the implementation of DMAIC Six Sigma methodology

Potential advantages of implementation of Six Sigma

methodology in hospitals

• Measurement of essential health care performance requirements on the basis of commonly used standards.

• Establishment of shared accountability with respect to continuous quality improvement.

• The implementation of the methodology with emphasis on improving customers’ lives, could result in the involvement of more health care professionals and support personnel in the quality improvement effort.

• Better job satisfaction of health care employees.

Implementation Barriers

Barriers

Governmental regulations

Risk of methodology

Poor support from

physicians

Rather long project ramp

up times

Difficulty in obtaining base-line data on

process performance

Nursing shortage

Costs(start-up &

maintenance)

Reference:•Applied Quality and Reliability, B.S.Dhillon