IOM: 6 Aims of Quality Healthcare – Flashcards
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Additional reports
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1.2003: Key Capabilities of an Electronic health Record 2. 2004: Keeping Patients Safe: Transforming the Work Environment of nurses 3. 2004: Quality Through Collaboration: Improving the Quality of Rural Health Care in America 4. 2005: Performance Measures: Accelerating Improvement 5. 2006: Preventing Medication Errors In process: Pathways to Quality health series
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IOM Report
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1.2000 To Err is Human: called to attention three categories of quality defects: a) Underuse: scientifically based practices not used as often as they should be b) Overuse: especially of imaging procedures and prescription antibiotics c) Misuse: when a proper procedure is not administered correctly
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2002 Crossing the Quality Chasm
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Identified 2 specific aims for quality that a health care system must fulfill to deliver quality care
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1. Safe
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1.Care should be as safe for patients in health care facilities as in their homes 2. Measured by: overall mortality rates or the percentage of patients receiving safe care
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2. Effective
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1.The science and evidence behind health care should be applied and serve as the standard in the delivery of care 2. Measured by: How well evidence-based practices are followed, such as percentage of time diabetic patients receive all recommended care at each visit
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3. Efficient
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1.Care and service should be cost-effective, and waste should be removed from the system 2. Measured by: analysis of costs of care by patient, provider, organization, and community
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4. Timely
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1.Patients should experience no waits or delays in receiving care or service 2. Measured by: waits or delays in care or service
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5. Patient Centered
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1.The system of care should revolve around the patient, respect patient preferences, and put the patient in control 2. Measured by: patient and family satisfaction
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6. Equitable
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1.Unequal treatment should be a fact of the past and disparities in care should be eradicated 2. Measured by: differences in quality measurements by race, gender, income and other population-based demographic and socioeconomic factors
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Quality
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The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
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Quality evaluated on
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1. Structure 2. Process 3. Outcomes
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Structure
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1.Structure is the opportunity to receive healthcare where available 2. It is comprised of the organization's physical and staff characteristics 3. This includes facilities, personnel, services
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Process
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1.Process is what is done to or with health care consumers. 2. It is comprised of both clinical and interpersonal care within the organization 3. This includes all elements of patient care
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Outcomes
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1.Outcomes are the near-term results of health care 2. They are comprised of the consumer's health status and perceptions 3. Measured by success of treatment, lack of complications, patient and family satisfaction
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IOM Ten "Rules" :Guidelines for redesigning the system of car for ensuring increased quality of services
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1. Care based on continuous healing relationships 2. Customization based on patient needs and values 3.The patient is the source of control 4.Shared knowledge and the free flow of information 5. Evidence-based decision-making 6.Safety as a system property 7.The need for transparency 8.Anticipation of consumer needs 9.Continuous decrease in waste 10.Cooperation among clinicians
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Implement aims and rules
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1. Require the organization to identify areas for improvement (quality aims) 2. Implement interventions to improve performance (the quality rules) 3. This requires most organizations to shift focus to include and emphasize service quality rather than the number served
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Implementing the IOM Guidelines
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1.Address the mission and vision statements a) "mission" refers to the overall function of an organization, or what gets accomplished b) "vision" refers to the desired future state for the organization: future foals or plans 2. Must emphasize quality in both mission and vision statements
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Implementing... #1
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1. Create a quality management plan 2. This means creating an organization that provides the means to monitor (assess, evaluate, ensure, improve) quality. 3. Will probably be multi-disciplinary 4. Requires measurement system, active, participating team who provide feedback and encouragement
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Implementing...#2
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1.Building an organizational framework for quality 2. Performance improvement involves several domains: a) Financial b) Innovation and growth c) Consumer perspective d) Operations e) IOM Aims can provide basis for metrics is all domains
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Implementing... #3
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1.Using evidence-informed practice in clinical work 2. Decisions on patient care need to be based on best evidence 3. A structure to conduct trend analysis is necessary for measuring clinical outcomes and identifying improvement opportunities 4. Another structure is needed for training and to assure that staff are current on best practices
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Implementing...#4
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1.Conducting utilization review 2. Helps assure that services are medically appropriate 3. Can determine things like service variables, why patients withdraw from treatments prematurely, variations in care based on demographics
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Health Care must be safe
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1.Errors are expensive and cost lives and cause injuries 2. "First, do no harm" 3. Health care must be fundamentally re-designed to make safety a design function rather than the individual health care provider's responsibility 4. "You can't make planes safer by asking pilots not to crash."
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Safety
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1.Errors are not symptoms of a bad character or incompetence but of a fundamentally faulty system 2. To change the system, we need an environment where learning from mistakes is acceptable and expected 3. A culture of safety is the foundation on which successful safety efforts are built 4. System changes can be as basic as modifying forms, reorganizing medication storage, or giving patients information brochures to adopting EMR and abolishing punishments for making errors 5. Requires culture of support
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Healthcare must be effective
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1.Health care should match science with neither overuse nor underuse of the best available techniques 2. Common cause (of misuse) is reliance on tradition, anecdotal information, and personal experience 3. Evidence-based: "the integration of best research evidence with clinical expertise and patient values" 4. Often means following clinical protocol 5. Evidence based care includes sophisticated methods of evidence collection, analysis, and integration
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Healthcare must be patient centered
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1.A 1984 study showed that a physician will listen to a patient for 18 seconds before interrupting 2. Patient-centered care considers patient's cultural traditions, personal preferences and values, family situations, their lifestyles 3. Patient needs to be fully informed, and a partner in decision making, and care 4. Patients need access to information, tools for self-care 5. Technology is useful: MyChart is an example
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Healthcare must be timely
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1.Health care should happen promptly 2. Waiting can take an emotional toll: can mean wasted time, lost continuity, frustration 3. Many organizations have shown that it is possible to change the system functions that have kept waits and delays a chronic part of the system 4. Requires coordinated, sustained, system-wide effort
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Healthcare must be efficient
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1.Fragments health care results in wasted effort, materials, medication, money and trust 2. Discussion: efficiency vs quality? Is it a choice? 3. "We can have both, but we must challenge some of our assumptions and redesign the way we work." 4. Match the work to the worker 5. Reduce paperwork and redundancies 6. Streamline scheduling 7. Appointment reminders 8. Centralize services
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Healthcare must be equitable
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1.One of the most painful weakness of the health care system is its failure to provide care of equal quality to everyone, regardless of race, age, gender, ethnicity, geographic location, or other demographic characteristic 2. This will require substantial changes in many elements of the care delivery system at all level
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To achieve these goals
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1.Achieving the 6 aims will require fundamental changes to the whole healthcare system 2. All levels require dramatic improvement, from the patient's experience 3. To the vast environment of policy, payment, regulation, accreditation, litigation and professional training 4. That shapes the behavior, interests and opportunities in health care 5. Microsystems, caregiving teams, health care systems and organizations must all evolve
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Transforming work environment
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1.2004 report recommended fundamental transformation in the work environment of nurses 2. Changes in how the workforce is deployed 3. Changes in how work processes are designed 4. Changes in leadership, management and culture of organizations
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Progress?
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1.Report posed provocative question: Do hospitals and long-tern care facilities deliver their services as safely and reliably as the nuclear power and aviation industries? 2. ION: Most health care organizations can not be considered "high reliability" organizations, that is, high-risk enterprises with low accident rates
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Nurse Led initiatives 1
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1. Transforming Care at the Bedside a) Sought to improve care by empowering frontline nurses to address quality and safety on their units b) Quality Improvement initiative funded by RWJ and Institute for Quality Improvement this is staff-nurse based c) Goals are improve care quality by focusing on nurse-identified problems and team-oriented solutions d) Participants have reported measurable improvements in patient safety and staff morale e) Decreased staff turnover
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Nurse Led initiative 2
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1.Ensure adequate staffing 2. Controversy persists on what constitutes "adequate staffing" and who should define it 3. Some states have addressed the issue by statute a) California: mandated ratios b) Washington: "Safe Nurse Staffing Act", required hospitals to establish committees to oversee staffing c) Minnesota: act requires health care facilities to consider staffing when evaluating adverse events d) Illinois: amended licensing act to require public disclosure of hospital staffing plans e) Maine, DC stopped seeking mandates citing nursing shortage
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Nurse Led initiative 3
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1.Curb Unprofessional and disruptive behavior (micro aggression 2. "will take multiple interventions, a commitment of hospital leadership, and engagement of staff at the unit level" 3. Code of Conduct, system for reporting behaviors a) One-time event—Informal, "cup of coffee" intervention b) Apparent pattern--Awareness intervention c) Pattern persists—guided intervention d) No change—disciplinary intervention e) Problems; reluctance to report, fears of retaliation
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Nurse Led initiative 4
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1.Harness Nurse leadership 2. Expanding responsibilities and visibility of nurse leaders 3. Promote education for transformational nurse leaders 4. Put nursing leaders on governing boards to provide nursing perspective, expertise, insight and knowledge of patient care 5. Promote interdisciplinary collaboration, nurses on care and leadership teams
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Leaders in patient Safety and Workplace Improvement
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1. AHRQ 2. ANA 3. AONE 4. NQF 5. The Joint Commission 6. American Nurses Credentialing Center
