Transcript Quality Improvement - Health Science Education

Quality Improvement
What is QI?
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Quality Improvement is a formal approach to
the analysis of performance and systematic
efforts to improve it. There are numerous
models used.
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These models are all means to get at the same
thing: Improvement. They are forms of
ongoing effort to make performance better.
Why QI
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To improve outcomes!!!!!
In industry, quality efforts focus on topics like
product failures or work-related injuries.
In administration, one can think of increasing
efficiency or reducing re-work.
In medical practice, the focus is on reducing
medical errors and needless morbidity and
mortality.
Who is Responsible for QI?
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Everyone!!!!
Nurses
 Doctors
 Assisstants
 Everyone in the building
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How Do You Define Quality?
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The definition of quality often depends on the
stakeholders. Stakeholders are, as the name
implies, people with some stake or concern in
the process.
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In Healthcare, the definition of quality can be
complex and controversial because of the
different views of people with a stake in good
Healthcare. Let’s look at a few different
stakeholders. What does each of these
stakeholders want?
Providers
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Providers:
Tend to view quality in a technical sense –
accuracy of diagnosis, appropriateness of
therapy, resulting health outcome
Payers
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Payers:Focus on cost-effectiveness.
Employers
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Want both to keep their costs down, and to get
their employees back to work quickly.
Patients
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Want compassion as well as skill with clear
communication.
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Can you see any conflicts between what these
stakeholders want? The decisions around the
conflicts often determine if a QI project will be
a success.
Quality in Healthcare
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If you wanted to get a sense of the quality of
healthcare delivery, how would you go about it?
You could ask each of the providers if they were
following the guidelines for a specific disease
You could ask providers to keep track of their errors
or “near misses”
Can you imagine any reason these methods may not
work?
Can you imagine any reason these
methods may not work?
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Earnest Interviewer: Have any of your patients
gotten worse because of treatment you provided?
Reluctant Provider: Er, um… No, never, of course
not.
EI: Do you use the approved guidelines for this
condition?
RP: Of course—every time!
EI: What about the time . . . ?
RP: (interrupting) Well, that was a special case.
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These methods would be fraught with
problems of validity and reliability. Self-report
of errors is shown to be low and, particularly if
there is a potential punitive response, reporting
would be infrequent and inaccurate.
This leaves us with a deficit in how we can
assess quality.
QI in a Healthcare Setting
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One means of getting around the problems with selfreport is to use more objective data.
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You start with a small problem. Perhaps you want to see
how well your group is doing with patients with a chronic
disease, such as diabetes, asthma, or hypertension. From
that point you can narrow your focus even further.
Decide what aspect of care you think might be a problem.
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How about assessment of how well the condition is being
controlled?
Within an office visit what measurements would be useful?
Measurement: Process and Outcome
Indicators
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Measures
There are 3 types of measures used in quality work:
Structure: Physical equipment and facilities
Process: How the system works
Outcome: The final product, results
Structure and process are easier to measure; outcome
is more important.
Can you think of an example in
Healthcare?
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If you were concerned about reducing prenatal
mortality, you might look at
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Structure
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Process
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Availability of physicians and/or midwives providing obstetrical
care.
Percent of mothers receiving prenatal care prior to 12 weeks
gestation.
Percent of mothers taking prenatal vitamins.
Percent of smoking mothers counseled to quit.
Outcome
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Neonatal mortality rate
Pre-maturity rate.
Methods of Quality Improvement
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FADE
PDSA
DMAIC
DMADV
Things Quality Improvement is NOT
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Performance Improvement
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The terms quality improvement and performance
improvement are sometimes used interchangeably.
Performance Improvement means a change in the system
performance. In Healthcare, this is often used to refer to
administrative systems, as contrasted to QI as impacting the
actual quality of healthcare.
Research
The distinction between QI and research is an
important one. There is a spectrum, and it can be
blurry sometimes, but there are some key points (with
legal implications!).
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QI:
Intent is to improve current practice. For internal use only.
By definition, the data is confidential.
Action is within existing standards of care.
Institutional Review Board (IRB) approval is not necessary.
Research:
Intended to create generalized knowledge.
Desire to publish or present.
Testing new methods.
Needs approval!
Summary
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Key points to remember.
Improving Healthcare quality is our
responsibility.
Measurement and improvement are possible.
Identify the root cause before making changes.
Be creative in developing solutions.
THINK OUTSIDE THE BOX!
Any Questions??
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http://patientsafetyed.duhs.duke.edu/module_a/module_overview.html