Healthcare and Quality Management

Quality Management
refers to the overall management of systems in order to improve the quality of services
Quality Improvement
a formal approach to analyzing performance and systematic efforts to improve performance
Quality Assurance
refers to a process used to determine who was responsible for an error
– evaluation approaches still used in practice, including:
> staff review committees and audits
> utilization review
> risk management
> professional review organization
Variation in Services
patterns of wide variation in healthcare practice, including regional variations and small-area variations, indicating EBP guidelines are not being adequately used to guide effective care
Underuse of Services
many do not receive necessary care resulting in needless complications that add costs, reduce productivity, and result in unnecessary mortality
– ex. mortality rates for those who had suffered a heart attack and who received beta blockers was 43% lower than non-recipients, yet only 21% of eligible patients received beta blockers
Overuse of Services
many receive health care services that are unnecessary, increase costs, and may endanger health. Research has shown this occurs across all populations
– ex. an analysis of hysterectomies found that one in six operations was inappropriate
Misuse of Services
high rates of injury and death occur during the course of patient treatment
– ex. a study of injuries to patients found that 3.7% experienced adverse events, of which 13.6% led to death and 2.6% led to permanent disability; 25% of the adverse events were direct results of negligence
Disparities in Quality
Quality problems affect all populations but are most notable among members of ethnic and racial minority populations
– ex. researchers examined the use of thrombolysis (‘clot busters’) for patient who had experienced a heart attack and found that black Medicare beneficiaries were significantly less likely than whites to receive this life-saving treatment
6 Aims for Quality Improvement in Healthcare
– safety
– effectiveness
– client-centered
– timeliness
– efficiency
– equity
avoiding injuries to patients from the care intended to help them
providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit
providing care that is respectful of and responsive to individual client preferences, needs, and values, and ensuring that client values guide all clinical decisions
reducing waits and sometimes harmful delays for both those who receive and those who give care
avoiding waste, including waste of equipment, supplies, ideas, and energy
providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
Main Stakeholders in Healthcare
– healthcare professionals
> technical quality – accurate diagnosis, appropriate therapy, resulting health outcome
– Payers (ex. insurance companies)
> cost and cost-effectiveness
– Employers (ex. hospitals; manufacturers)
> cost containment; healthy and productive employees
– clients (can be individuals or families or the population)
> competency resulting in positive health outcome as well as compassionate care
attributes of setting where care is delivered such as physical equipment and the facilities themselves; resources availability
how healthcare is provided and how the system works
the end results of the healthcare provided (ex. patient health status; did care provided make a difference)
FADE Model Steps
– focus
– analyze
– develop
– execute
– evaluate
define and verify the process to be improved
collect and analyze data to establish baselines, identify root causes and point toward possible solutions
based on the data, develop action plans for improvement, including implementation, communication, and measuring/monitoring
implement the action plans, on a pilot basis as indicated
install an ongoing measuring/monitoring (process control) system to ensure success
PDSA Model
– Plan: plan a change or test of how something works
– Do: carry out the plan
– Study: look at the results, what was found
– Act: decide what actions should be taken to improve
* repeat as needed until the desired goal is acheived
Six Sigma
– measurement based strategy for process improvement
– accomplished through use of two models:
> DMAIC (define, measure, analyze, improve, control) is applied to existing processes for incremental improvement
> DMADV (define, measure, analyze, design, verify) is applied to develop new processes that assure quality is met
Continuous Quality Improvement (CQI)
– an approach to quality management that builds upon traditional quality assurance methods by emphasizing the organization and systems
– refers to analysis methods used to look at the work systems and processes of an organization
– focuses on processes rather than individuals
– recognizes both internal and external ‘customers’
– promotes the use of objective data to analyze and improve processes
Total Quality Management (TQM)
– refers to methods for ensuring that all activities necessary to service provision are effective and efficient with respect to the system and its performance
– is a set of management practices throughout the organization that ensure the organization consistently meets or exceed customer requirements
Quality Improvement
– intent is to improve current practice.
– for internal use only
– data is confidential
– action is within existing standards of care
– IRB approval NOT necessary
– intended to create generalized knowledge
– desire to publish or present
– testing new methods
– needs IRB approval!
Agency for Healthcare Research and Quality (AHRQ)
mission is to improve quality, safety, efficiency, and effectiveness of health care for all Americans
– supports research on:
> health care systems
> quality
> cost issues
> outcomes and quality care
National Quality Strategy: 3 broad aims
– Better care: improve overall quality, by making health care more patient centered, reliable, accessible, and safe
– Healthy people/Healthy communities: improve the health of the U.S. population by supporting proven interventions to address behavioral, social and environmental determinants of health in additions to delivering higher-quality care
– Affordable care: reduce the cost of quality health care for individuals, families, employers, and government
National Quality Strategy: 6 priorities
– making care safer by reducing harm caused in the delivery of care
– ensuring that each person and family is engaged as partners in their care
– promoting effective communication and coordination of care
– promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease
– working with communities to promote wide use of best practices to enable healthy living
– making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery methods
Examples of Healthcare Quality Monitoring
– surveys
– focus groups
– maintenance of monitoring databases
Nurse’s Role in Quality Management and Improvement
– nurse administartion is responsbile for developing formalized quality management programs
> review organizational structure, personnel, and environment (structure)
> focus on standards of nursing care and methods of delivery
> analyzing outcomes of care
Quality and Safety Education for Nurses (QSEN)
The overall goal is to prepare future nurses who will have the knowledge, skills and attitudes necessary to continuously improve the quality and safety of the healthcare systems within which they work.
QSEN Competencies
– patient-centered care
– teamwork and collaboration
– evidence-based practice
– quality improvement
– safety
– informatics

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