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The Reason We’re All Here …

Welcome to HCA 622 – Quality appraisal and Evaluation.

Each of the presentationa with this slide – it is after all, why we are all here!

Contact Information:

Please see the contact information that your instructor has provided in Blackboard.

We are here to help you in any way that we can.

Our job is:

To guide you through the materials;

Cleary communicate assignments and expectations; and

Help you learn from the materials as future leaders in healthcare.

KEY POINT:

Make sure that you are checking your National University email boxes.

There was a change made a number of months ago and you will not longer receive email to your home email.

You will receive information and updates from your instructor through your NU email only.

Week 1: Session 1 Agenda

Reminder - Introductions

Course Overview

Review and discuss session topics

Review Assignments, due dates and expectations

Parking Lot items, if any

Q&A

Wrap-up

Our lecture sessions for this first week with begin with some basic course information that you will need to be successful with your course.

Key Concepts and Ideas

Quality and Patient Safety are the same thing!

How can we say that we are providing quality care if people are being injured?

These concepts and tools are applicable to you, no matter what your role and experience in health care has been.

It is the responsibility of all those involved in health care to assure that we are providing safe, efficient and effective care to our patients, families and communities.

Key Concepts and Ideas

What are the origins of Quality/Patient Safety in healthcare?

What are some of the core concepts and tools?

What are some of the key implementation strategies?

How all of this affects you as leaders!

As described in the course outcomes, this course will provide a broad overview of the key concepts, history, evolution, model, tools and implications for quality and patient safety in the health care arenas.

So, let’s get started!

Reminder: Introductions

Majors

Experience have you had with Quality or Patient Safety

Participation?

Quality tools or techniques

Where you hope to be in the next 3-5 years in your career goals

Course Expectations

What are you most interested in learning more about?

Please be sure that you provide your introduction for Week One DQ1 as soon as possible.

This will provide me valuable information on how we move forward with the course.

Pre-reading

Pre-reading is a requirement of this course.

Reviewing each chapter prior to the class means that we can use class time to review key concepts and theories, and apply our learning to examples from our case studies and the real world, rather than simply covering basic material

In order for learning to be effective learning tool, you must be prepared.

Different order for chapters

It is important to note that our text is an excellent series of writings by some of the key experts in quality and patient safety.

In order to provide the best overview in the time we have, the order of the chapters has been changed – please make note of that!

Making the Best Use of Your Time

This course is about approaches, strategies and tools which are intended to make healthcare safer, more effective, and more appropriate.

Think about it in the light of your other studies, your work, public and political debates about the provision of healthcare, and in relation to what you hear from the media, your friends and family

Why does healthcare require continuous quality improvement?

How are or can they be applied to the ‘real’ world?

How are or can they be applied to you a leaders?

The course consists of:

Pre-reading from the required text; two optional scheduled lectures sessions to provide additional information on the text; weekly exercises to help assure the adoption of key concepts including the use of a Reflection Journal; weekly discussion questions designed to engage you with your colleagues on a variety of issues that affect you and all those in the health care area; weekly quizzes on the materials covered; and two in-depth papers on topics to broaden your knowledge and understanding of the topics.

The course also offers extra resources each week to broaden your experience and bring what is happening in the health care environment into your online learning.

Apply standards in health care quality/patient safety.

Comprehend tools, models, and strategies for quality improvement/patient safety.

Describe the development of a quality measurement approach that includes data collection planning, data analysis, and statistical process control methods.

Explain leadership and strategic planning for quality/patient safety, including its institutionalization and sustainability.

Employ techniques for creating an organizational culture that fosters quality/patient safety.

Examine and illustrate quality improvement/patient safety initiatives by proposing a problem and addressing it by developing metrics and expected outcomes, in a group, collective effort.

HCA 622 Course Learning Outcomes

The course learning outcomes provide a broad overview of what we will be addressing in the course.

The course outline specifically address the learning outcome we are addressing for each section.

Ransom, Elizabeth R.(2008). Health Quality Book: Vision, Strategy and Tools. 3nd Edition. Chicago, Illinois: Healthcare Administration Press

HCA 622 Required Textbook

Extra Credit Opportunity!

Read, summarize, present

Nance, John J.(2008). Why Hospitals Should Fly. 2nd Edition. Bozeman, Montana: Second River Healthcare

These are the text for our course.

The Healthcare Quality Book is our required text and there will be an extra credit optional book for those of you who would like to read Why Hospitals Should FLY, an excellent refection on quality and safety written in a fun way almost as a novel.

The instructions for the extra-credit assignment can be found in Week One Blackboard.

Optional Class Meetings:

To Be Announced

Times will be set by your instructor.

These session are optional, but really bring the materials to life!

You will receive an invite via your National University email box.

Recordings of the session will be provided.

Class Schedule:

Game Plan

Upon completion of this course, you will be able to competently articulate key concepts and uses of the fundamentals of continuous quality improvement/patient safety in healthcare and the value they provide to the industry, staff, organizations, consumers and the communities they serve.

In order to be successful:

Complete required readings and other assigned course resources

View weekly videos when assigned

Respond to weekly discussion threads and interact with other student posts

Utilize your Reflection Journal after each live or recorded session.

Complete course project assignments

Develop thought-provoking case study responses which demonstrate knowledge of course topics

Take weekly quizzes

Enjoy!

HCA 622 Week One Roadmap

√ Please read Chapters 1,4,2,14,16 in the required text prior to our first class

√ In order to get the most out of the course, pace yourself by completing something everyday

√ Catch up as needed over the weekend

√ All graded assignments must be turned in no later than Sunday at midnight PT each week

HCA: 622 Quality Appraisal and Evaluation– WEEK ONE ROADMAP
	Monday	Tuesday	Wednesday	Thursday	Friday	Sat/Sun
Themes		Course Overview, Introductions, Healthcare Quality and the Patient, Foundation, Processes, Tools Basic Concepts		Leadership for Quality, Implementing Quality/Patient Safety as a Core Organizational Strategy
Readings	Review Course Outline and read all items under Week One tab	Read Chapters 1, 4, 2, 14, 16 in required text
Film Festivals
Discussion Questions	Complete DQ1 – Student Introductions				Complete DQ2
Exercise			Reflection Journal #1		Reflection Journal #2
Assessments						Complete Quiz #1
Case Studies			Introduce Week Two Paper			Plan for Week Two Paper
Course project			Introduce Project

Each week in Blackboard, you will see that week’s roadmap.

This provides you basic information about due dates and assignments and is a valuable tool.

Refection Journal

One of the most important ways that we learn, in our course work, is from one another.

What is a Refection Journal?

A reflection journal is a personal record of a student's learning experiences. It is a space where you can record and reflect upon your observations and responses to what you are reading and hearing, which can then be used to explore and analyze how these learnings will affect you in your role today and in your role as a future leader.

Following each of the lecture sessions, as you participate or watch the recording, reflect on what you believe were the key take-aways from that session and the chapters associated with it.

The Reflection Journal give you an opportunity to reflect on the most important concepts and take-aways for you.

Use this an opportunity to reflect on what you think are the most important ideas to help you as you move forward in your leadership role.

There is no right or wrong answer here, and you may review and respond to your classmates on their reflections.

This should provide a good leadership take-away for you at the end of the course.

HCA 622 Grades

Assignment	Grade percent
Exercises (Reflection Journals)	10%
Respond to 2 written discussion threads (including at least 2 responses to another student post for each DQ)	20%
Weekly Quizzes (Weeks 1 – 3)	15%
Final	20%
Week Two Case Study	15%
Complete Course Project – TBA	20%

As found in the course outline, these are the breakdown of the assignments and points.

How to excel in discussion threads

Read the question/s carefully and make sure you have addressed all of them

Incorporate your opinions and reflection

Check for basic grammar, spelling and punctuation

Focus on quality vs. quantity, however a quality response will typically average between 200-250 words

Use complete sentences, APA format

Use at least one outside resource (besides the book) for your initial DQ

Add references when citing sources

Do not use an attachment for your response. Copy and paste from Word if you need to work outside BB.

Respond to at least 2 other student posts for each DQ

Discussion Boards!

Not comprehensive – only cover the material discussed that week

Open up on Friday morning and available until Sunday evening 12 midnight PT

10 questions – all T/F or multiple choice, (with the exception of the final)

Once you start, you have 60 minutes

HCA 622 Weekly Quizzes

Extra Credit Opportunity (Optional)

Extra Credit (5 Points)

Read the book “Why Hospitals Should Fly”

Prepare a 7-10 minutes Power Point presentation that addresses the following:

For a future health care leader, what are the three most important concepts that the book presents?

Justify why you chose these three concepts.

What are your” lessons learned” from the book?

Your presentation will be posted on Blackboard for your classmates to see!

Questions? Please let your instructor know if you have questions!

Let’s get started!

Introduction

This session provides a broad overview of quality and patient safety in healthcare, why they are so important and an introduction to the key concepts that we will explore during our course work.

Week One

CHAPTER 1

Health Care Quality/Patient Safety and the Patient

CHAPTER 4

Quality Improvement: The Foundation, Processes, Tools and Knowledge Transfer

CHAPTER 2

Basic Concepts of Healthcare Quality/Patient Safety

CHAPTER 14

Leadership for Quality

CHAPTER 15

Implementing Quality as a Core Organizational Strategy

These are the chapters that we will review for our first week together.

It is important to read your text, as I will be highlighting key concepts.

Everything Ties Together!

You are Quality champions!

Especially LEADERS!

Two key foundational concepts to keep in mind as we begin our work are:

As you each aspire to engage a role in leadership, or expand your current role, each leader is responsible for the quality, safety and services for their areas of responsibility; and

Key Concept!

Quality/Patient Safety

How can we say that we provide “quality care”

if we are harming people?

We can not talk about “quality” without including patient safety. How can we say that we have quality of care if patients are experiencing medical errors?

Chapter 1: Healthcare Quality and the Patient Chapter Outline

The current State of Healthcare: Five Important Reports

“The Urgent Need to Improve Healthcare Quality”

To Err Is Human

Crossing the Quality Chasm

National Healthcare Quality Report

National Priorities and Goals

The Institute of Medicine’s Six Aims for Improvement

The Current State of Health Care

We begin our work with a reflection on the current state of healthcare and some of the key influences for how we approach quality/patient safety today.

Beginning in 1998, a series of reports from the Institute of Medicine and other sources identified profound opportunities for improvement throughout the U.S. Healthcare System.

The Institute’s reports, To Err is Human in 2000, and Crossing the Quality Chasm in 2001, set the stage for vast array of changes in health care addressing the need for improvement.

Key Reports in the Quality/Patient Safety Journey

Five major reports identify gaps and call for action:

The National Roundtable on Health Care Quality’s “The Urgent Need to Improve Health Care Quality” (1998)

The Institute of Medicine’s (IOM) To Err Is Human (2000)

IOM’s Crossing the Quality Chasm (2001)

The Agency for Healthcare Research and Quality’s (AHRQ) National Healthcare Quality Report (2003–2011)

National Priorities Partners' (NPP) National Priorities and Goals (2008)

The Current State of Healthcare: Quality and Patient Safety

Modern medical care is complex, expensive, and at times dangerous.

Across the world, hospital patients are harmed 9.2% of the time, with death occurring in 7.4% of these events.

Furthermore, it is estimated that 43.5% of these harm events are preventable (de Vries et al., 2008; Landrigan et al., 2010).

We start by exploring the current state of health care in the U.S today and compared to the rest of the world.

The following facts show where we are today:

The 3rd lead leading cause of death in the U.S. is medical errors (after heart disease and cancer) ;

Across the world, patients are harmed 9.2% of the time with death occurring in 7.4% of the events;

It is estimated that 43.5% of these harm events are preventable; and

Although the U.S. spends the most per capita per patient of any low- or middle-income country, we rank 33/36 for infant mortality and 28/36 for life expectancy.

The Current State of Healthcare: Cost of U.S. Healthcare

The U.S. Healthcare system is much more expensive, but not significantly better than other healthcare systems around the world (Leonhardt 2009)

The U.S. spends more per capita for health care than any other country, yet ranks 33/36 in infant mortality, 28/36 in life expectancy, with Americans less satisfied with their care than the English, Canadians or Germans (United Health Foundation, 2018)

Making the Case for Error Prevention

The Human Cost

Between 2.9% to 3.7% of all hospitalized patients experience an adverse medical event each year.

-53% - 58% are attributable to errors

-27% - 29% are attributable to negligence

-Between 8.8% to 13.6% of these events result in death.

-Most result in disability lasting up to 6 months

Source: “To Err is Human” Institute of Medicine, 12/99

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public. Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863.

Nearly 150 years later, the National Academy of Sciences has expanded into what is collectively known as The National Academies, which comprises the National Academy of Sciences, the National Academy of Engineering, the National Research Council, and the IOM.

As we reflect back on the data from the first To Err is Human report, it is important to note that these original numbers for both quality and cost were an underestimation.

Making the Case for Error Prevention

The Financial Cost

Medical errors cost the nation $17 - $29 billion

-Over 50% in direct healthcare costs

Medication errors alone can increase average hospital costs approximately $4,700 per admission

-That extrapolates to about $2 billion for the nation as a whole

Medication errors in Nursing Homes cost about $3.6 billion

Source: “To Err is Human” Institute of Medicine, 12/99

Why is this Important for Our Future Health Care Leaders - YOU?

3rd leading cause of death in the U.S. - more people die from medical errors than from breast cancer or AIDS or motor vehicle accidents

7 out of 100 admissions experience a preventable medication errors

Our true purpose

Sorrel King…

https://www.youtube.com/watch?v=JeVcXhvPvbU

“This problem is unlike cancer or AIDS or

other epidemics, where we must wait

for a scientific breakthrough in order to save lives.”

The “Face of Quality/Patient Safety

You were asked to review the video in Week One on the Josie King Story, the true story of the death of an eighteen-month-old child because of a series of medical errors at one of the most prestigious hospitals in the country, John Hopkins.

It is very important to “put a face” on our discussion as we move forward. These are not just numbers, but lives lost and families destroyed.

How does this impact you?

This could be your baby or Mom or brother!

Each of us will experience health care as a patient, or the mother, or sister, or the son of a patient at some point in our lives.

This course spells out how you, as a future health care leader, can make a difference in these numbers.

IOM’s To Err Is Human

Captured the attention of key stakeholders for the first time

Framed the problem in a way everyone could understand

Led to the identification of patient safety as a solidifying force for policymakers, regulators, providers, and consumers

A Wake-up Call!

Setting the Aims

In the year 2000, when the first IOM report was published, it shown a light on the existence of medical errors, their numbers and costs.

The Big Bang of CQI

Institute of Medicine

To Err is Human (2000)

Crossing The Quality Chasm (2001)

Data already know, but these report galvanized the press, the public, professional groups and regulators

Increased demands for accountability and professional responsibility

Transfer of concerns from managerial responses, to across the board responsibility

The next report provided a path to begin to address these issues and has provided a path to the current state of how the U.S. is addressing them.

IOM’s Crossing the Quality Chasm

Offers a new framework for a redesigned US healthcare system

Identifies six aims for improvement:

Safe

Effective

Efficient

Timely

Patient centered

Equitable

The IOMs framework addressed six aims for quality and safety to include: care that is safe, effective, efficient, timely, patient-centered and equitable.

These aims have been adopted here and throughout the world.

The framework has provided us a way to begin to address the need for improvements in care and service, and we will be exploring the use of this framework, quality model and tools use as well as examples throughout our work together.

IOM’s Six Aims for Improvement

Aim	Definition
Safe	Care should be as safe for patients in healthcare facilities as in their homes.
Effective	The science and evidence behind healthcare should be applied and serve as standards in the delivery of care.
Efficient	Care and service should be cost-effective, and waste should be removed from the system.
Timely	Patients should experience no waits or delays when receiving care and service.
Patient centered	The system of care should revolve around the patient, respect patient preferences, and put the patient in control.
Equitable	Unequal treatment should be a fact of the past; disparities in care should be eradicated.

NPP’s National Priorities and Goals Partnership (2008)

Focused on national performance improvement efforts that address four major challenges:

Eliminating harm, eradicating disparities, reducing disease burden, and removing waste

Highlights primary strategies that drive care improvement:

Performance measurement

Public reporting

Payment systems

Research and knowledge dissemination

Professional development

System capacity

This is the Affordable Care Act

Another critical report was the genesis of what we know today as the Accountable Care Act, which we will review in depth during the course.

The Four Levels of the Healthcare System

The underlying framework for achieving the IOM’s Six Aims for Improvement depicts the healthcare system in four levels, all of which require changes.

The IOM’s framework provides a structured way to review and understand our key systems and microsystems in health care.

It is always important to note that everything in quality and safety begins with the patient!

Case Study: Reducing Surgery-Related Mortality and Complications

University of Washington Medical Center

Problem: Great variation in surgical quality across and within institutions

Solution: Implement a surgical checklist

We will be reviewing examples of evidence-based best practices and studies throughout the course work.

Conclusion

Healthcare Quality/Patient Safety are not what they should be.

The patient is paramount in quality improvement efforts.

There is promising evidence of the capacity for significant improvement.

Many examples of breakthrough improvements are happening today.

Call to action for all healthcare leaders/stakeholders to continue to rethink and redesign systems.

We have stated our case that we have work to do – this course will provide you a framework, concepts and tools to move forward with this work in your current and future leadership roles.

Questions? Contact your professor for questions!

Chapter 4: Quality Improvement: Foundation, Processes, Tools and Knowledge Transfer Techniques Chapter Outline

The Quality Foundation

Quality Improvement Processes and Approaches

Quality Tools

Knowledge Transfer and Spread Techniques

Case Study

Conclusion

History of Health Care Quality

Before we begin our work drilling down on the models, tools and techniques, it is helpful to review the history of the current quality/patient safety models and their history and origin.

A bit of history!

The health care quality model that is currently in use has its origins in industrial quality.

A focus on the quality of products or services has been a part of the industry model since its inception. However, a quiet revolution in how industry, and then health care viewed and addressed quality began in the early 1930s in the U.S.; and then radically changed following the expansion of this early model into Japan after the second world war.

Following the second world war, the U.S. sent a group of engineers, who had started this CQI work in the U.S., to Japan to help them rebuild their industry. Led by Dr. Edward Deming and others, these concepts were implemented in Japanese industry and aggressively improved.

After the 20 years of aggressive pursuit of these CQI concepts, in the early 1980s, the U.S. found that their products were being overtaken by the superior quality of the products from Japanese industry – whether it was automobiles or computers.

The U.S. then invited Dr. Deming and other quality leaders working in the U.S. and Japan, to introduce the CQI model and tools to U.S industry.

Following successful implementations in a number of key industries, the health care industry, as a major vendor to industry for the health care of their workers, was challenged to implement this model in health care.

Creating a Mind Set

Deming’s Major Quality Goals

Customer awareness

(Delight the customer)

Patients

Physicians

Employees

Payors

Process awareness (system)

Process focus/data is key!

-Complex processes cause problems, not

people

Use P.I. tools to understand your process

Continuously improve your process

Knowledge of variation

People awareness

Leadership

Resistance to change

Teamwork

Opportunity to participate – people doing the work

Training and support

Dr. Deming’s Model

We will be exploring thes Continuous Quality Improvement (CQI) concepts, the model and the tools throughout this course.

This is a broad set of key organizational and leadership actions that may be called, “Dr. Deming’s three-legged stool”. For those of you not familiar with a three-legged stool, it is a stool built to hold a huge amount of weight – by the placement of the three legs (known as a milk stool!). If any one leg is missing – the stool will not stand up.

The broad definition of the three legs or core concepts, which we will study in depth are:

1) Customer awareness – starting always with what is important to the customer and seeking to meet or exceed their expectations;

2) Process awareness – the concept that all work can be broken down into steps and then improved with the use of data and statistical tools; and lastly

3) People awareness, which includes the role of leadership in establishing a safe environment for all staff to be a part of the planning and improvement processes.

Definition of CQI Continuous Quality Improvement

CQI is defined as a structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations

Key Definitions and Concepts of CQI

What began as quality assurance, “conforming to specifications or having a product that meets predefined standards”, moved to CQI which is defined as “a structured organizational process involving personnel in planning a continuous flow of improvements to provide quality health care that meets or exceeds expectations”.

One of the key foundation pieces in this structure is that of leadership support, which is why this is a key foundation piece for future leaders.

Institutional Improvement

The focus here is on a defined structure and the continuous improvement of all aspects of how care is provided.

Key Definitions

1 - care better than we have ever seen, 2 - health better than we have ever known, 3 - cost we can all afford, …for every person, every time.

IHI (2007)

According to Dr. Donald Berwick, a noted U.S. quality/patient safety leader, improving quality has three aims:

(1) Improving the experience of care;

(2) Improving the health of populations, and

(3) Reducing the cost of health care. (“The triple aim: Care, health, and cost”: Berwick et.al, 2008: 759).

The triple aims are core to the quality/patient safety model and will be reviewed and referenced throughout our course work.

Characteristics of CQI

• a link to key elements of the organization’s strategic plan;

• a quality council made up of the institution’s top leadership;

• training programs for personnel;

• mechanisms for selecting improvement opportunities;

formation of process improvement teams;

• staff support for process analysis and redesign;

• personnel policies that motivate and support staff participation in process improvement;

• application of the most current and rigorous techniques of the scientific method and statistical process control.

Which do your think are the most important?

Core Characteristics of CQI

We have already presented the “three-legged stool”.

In addition, CQI is tied to the key strategies of the organization; is led by organizational leadership; is focused on utilizing the knowledge of all staff at all levels to include training on the tools and concepts; provides time, resources and support in identifying and improving key processes; is data driven, customer focused and has a specific structure and tool kit.

Functions of CQI

Empowering all staff to participate in CQI;

Valuing and responding to customer preferences;

Utilizing a multidisciplinary approach;

Establishing mechanisms to support best practices through planned organizational learning;

Providing motivation for a rational, data-based, cooperative approach to CQI.

The key functions of quality are reflected above and we will look at each in-depth.

We see the broad components of CQI in industry reflected in health care CQI, such as leadership, but health care CQI does have some different components to include:

Engaging physicians and managers in the process;

Recognizing that in health care, we have many customers including first, our patients, but also physicians, insurers and the broader community; and

Calling out the interdisciplinary nature of health care and the importance of teams.

In addition, the importance of identifying and implementing evidence-based practices and the critical component of establishing a culture of excellence and safety are also identified.

Structural Elements of CQI

Use of process improvement teams

Use of the seven CQI tools

Gain commitment from top management

Utilize data and statistical analysis

Develop and review customer satisfaction measures

Use benchmarking

Engage in redesign of processes

As the definition indicates, there are models and tools that we have adapted from industry that provide an ongoing framework for our quality/patient safety work.

Quality Improvement Processes and Approaches

Quality improvement approaches:

PDCA/PDSA cycle

Baldrige Criteria and related systems

Lean/Toyota Production System

Six Sigma

“The key to TQM is not in

understanding it...

but in actually doing it.!”

Donald Weintraub, ODI

Prism - 1st Quarter 1991

Quality Improvement Processes and Approaches: Shewhart Cycle/PDCA or PDSA

Plan – What are you trying to accomplish? What do you think will happen? Who, what, where, and when?

Do – Educate and train staff, carry out the plan, document problems and unexpected observations, begin analysis of the data.

Check/Study – Assess the effect of the change and determine the level of success as compared to the goal/objective, compare results to predictions, summarize lessons learned, determine what changes need to be made.

Act – Act on what you have learned, perform necessary changes, identify remaining gaps in process or performance, carry out additional cycles.

Basic Quality Models

PDSA

The basic process used in CQI is the Plan, Do, Study, Act model.

Introduced by Walter Shewart at Bell Laboratories in 1939, it has continued to evolve and provides a framework for the CQI process.

Plan - It begins with Plan - planning, identification of what needs to be improved and how we can measure our improvement;

Do – carrying out a change or a test to see if we have accomplished what we planned;

Study – studying the results to see what we learned;

Act – adopting the change or abandoning it and going through the cycle again.

It is a continuous process, carrying out by a team of individuals who are doing the day-to- day work and support by leadership using a data-driven, tools-supported process.

Quality Improvement Processes and Approaches: API Improvement Model

Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to

Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.

API Model for Improvement

The API Improvement Model provides a framework for the use of PDSA by introducing three questions to being each quality process including:

What are we trying to accomplish?

How will we know if a change is an improvement?

What change can we make that will result in Improvement?

The model then roles in to the PDSA cycle which is a continuous process of improving all we do.

The Evolution of Six Sigma: From the Business Industry to Healthcare

1920’s

1950’s

1980’s

1990’s

2000

2004

Walter Shewhart: Statistical Process Control / PDSA

W. Edwards Deming: 14 Points / 7 Diseases

Joseph Juran: Quality Planning / CQI

1970’s

Total Quality Management

Motorola coins term: 6s

GE adopts 6s

6s in

Healthcare

The Continuous Evolution of Heath Care Quality

Healthcare quality has and is evolving and we will spend time exploring the continuum from Quality Control/Assurance to Six Sigma and Lean – to help us understand the next steps in the quality/patient safety evolution (revolution?)

We will be spending more time on these core concepts as we move through the course.

Aim at 95%!

For many decades in health care quality, we accepted the fact that a 95% compliance rate was as good as we could do and that if we were at 95% compliance, say for infections in the ICU (remember Josie King?) that we had done our jobs.

I have always asked the question – what about the other 5% who got the infections!

The following slide illustrates for us the difference between 95% and 99%!

Like a 747 crashing every day!

This simple graphic shows us the difference between a quality metric of 99% vs. a quality metric at Six Sigma – quite the difference!

Like one 747 jet crashing every day!

Quality Improvement Processes and Approaches: Lean/Toyota Production System

Lean manufacturing or Toyota Production System (TPS) focuses on the removal of waste (muda) and improving flow.

Seven forms of waste:

Overproduction

Waiting

Unnecessary transport

Over processing

Excess inventory

Unnecessary movement

Defects

Place the needs of the customer first.

Other concepts we will be exploring!

Quality Tools: Basic Quality Tools

Basic quality tools are used to define and analyze discrete processes that usually produce quantitative data.

Examples of basic quality tools:

5 Whys

Flow diagram

Control chart (statistical process control)

Histogram

Cause-and effect/fishbone

Pareto chart

In order to improve quality and patient safety, there are numerous sets of quality and statistical tools available for use in these processes.

We will be reviewing a number of these.

Quality Tools: Other Quality Tools

Examples of other quality tools:

Benchmarking

Failure mode and effects analysis

Flowchart

Spaghetti diagram

Mistake proofing (poka yoke)

Less than $8.00 on Amazon!

This is a great resource at very low cost for your leadership tool kit!

Factors Influencing Successful CQI Implementation

Leadership

Vision

Constancy

Purpose

Culture of Excellence

Statistical Thinking

Empowerment

Teamwork

Motivation

CQI

Communication/Feedback

Systems Thinking

Customer Focus

We have begun to study the concepts and tools that make up the quality/patient safety process.

As stated earlier, a key component to this process is leadership driving the organization toward a higher quality, safer environment for patients and staff.

We then begin to build the quality framework or culture of excellence that includes the key components of Dr. Deming’s Model.

This sets the framework for a model to continuously review everything we do in order to provide continuous improvement of care, safety and service.

Conclusion

The strength of an organization depends on the foundation on which it was built and the strength of the systems, processes, tools, and methods used to sustain benchmark levels of performance and to identify and improve performance when expectations are not being met.

Questions – let your professor know if you have questions!

Week 1: Session 2 Agenda

Don’t forget your Reflection Journal Entries!

Review and discuss session topics

Review Assignments, due dates and expectations

Parking Lot items, if any

Q&A

Wrap-up

HCA 622 Week One Roadmap

√ Please read Chapters 1,4,2,14,16 in the required text prior to our first class

√ In order to get the most out of the course, pace yourself by completing something everyday

√ Catch up as needed over the weekend

√ All graded assignments must be turned in no later than Sunday at midnight PT each week

HCA: 622 Quality Appraisal and Evaluation– WEEK ONE ROADMAP
	Monday	Tuesday	Wednesday	Thursday	Friday	Sat/Sun
Themes		Course Overview, Introductions, Healthcare Quality and the Patient, Foundation, Processes, Tools Basic Concepts		Leadership for Quality, Implementing Quality/Patient Safety as a Core Organizational Strategy
Readings	Review Course Outline and read all items under Week One tab	Read Chapters 1, 4, 2, 14, 16 in required text
Film Festivals
Discussion Questions	Complete DQ1 – Student Introductions				Complete DQ2
Exercise			Reflection Journal #1		Reflection Journal #2
Assessments						Complete Quiz #1
Case Studies			Introduce Week Two Paper			Plan for Week Two Paper
Course project			Introduce Project

Each week in Blackboard, you will see that week’s roadmap.

This provides you basic information about due dates and assignments and is a valuable tool.

week one reflection 1-2 pages APA format

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