Transcript INTRODUCTION TO QUALITY MANAGEMENT

INTRODUCTION TO
QUALITY MANAGEMENT
DIAGNOSTIC IMAGING IS
THE MULTI-STEP PROCESS
THERE ARE NUMEROUS SOURCES OF
VARIABILITY
IN BOTH HUMAN FACTORS AND
EQUIPMENT THAT CAN PRODUCE
SUBQUALITY IMAGES
THE PURPOSE OF QUALITY
MANAGEMENT PROGRAM IS TO
CONTROL OR MINIMIZE THOSE
VARIABLES
VARIABLES IN DIAGNOSTIC
IMAGING
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EQUIPMENT
IMAGE RECEPTOR
PROCESSING
VIEWING CONDITIONS
COMPETENCY OF THE
TECHNOLOGIST, INTERPRETER, AND
SUPPORT STAFF.
LEVELS OF QUALITY OF
GOODS
• EXPECTED QUALITY
• PERCEIVED QUALITY
• ACTUAL QUALITY
SINCE 1980 HEALTHCARE
DELIVERY IS UNDERGOING
DRAMATIC CHANGES!!
THESE CHANGES ARE GREATLY AFFECTING
DIAGNOSTIC IMAGING DEPARTMENTS
HEALTHCARE CHANGES
CHANGES IN HEALTH CARE
THAT AFFECT IMAGING
DEPARTMENTS
• ADVANCES IN TECHNOLOGY
• LEGISLATION AND GOVERNMENT
REGULATIONS
• JCAHO PROCEDURES
• CORPORATE BUYOUTS AND MERGERS
• METHODS OF REIMBURSEMENT FOR
SERVICES
ADVANCES IN TECHNOLOGY
COST OF INSTALLATION & MAINTENANCE
LEGISLATION AND
GOVERNMENT REGULATIONS
• SAFE MEDICAL ACT 1990
• MAMMOGRAPHY QUALITY
STANDARDS ACT OF 1992
INCREASED RESPONSIBILITY OF DIAGNOSTIC DEPARTMENT
MANAGERS AND STAFF TO DOCUMENT PROPER EQUIPMENT
OPERATION AND PROCEDURES.
CORPORATE BUYOUTS
AND MERGERS
CORPORATE BUYOUTS
AND MERGERS
BUYOUTS
MERGERS
SINCE 1980 1,000 HOSPITALS CLOSED
JCAHO PROCEDURES
QA
TQM
METHODS OF
REIMBURSEMENT FOR
SERVICES
• HMO’S
LOWER REIMBURSMENT RATE!!!
HISTORY OF Q.M.
• 1900 FREDERICK WINSLOW – FATHER OF
SCIENTIFIC MANAGEMENT
CONCEPT OF SCIENTIFIC MANAGEMENT
UNTIL 1980
HISTORY OF Q.M.
• 1980 W. EDWARDS DEMING & JOSEPH
JURAN
• CONCEPT OF QUALITY IMPROVEMENT
SOME IMAGING DEPT.
SINCE 1930s
SYSTEMATICALLY
MONITOR THEIR
EQUIPMENT TO SAVE
MONEY AND INCREASE
EFFICIENCY
GOVERNMENTAL ACTIONS
• 1968 RADIATION CONTROL FOR HEALTH
AND SAFETY ACT
• 1980 OSHA
• 1981 CONSUMER PATIENT RADIATION
HEALTH AND SAFETY ACT
• SMDA OF 1991
• 1992 MQSA
• 1996 HIPPA
• 2000 CARE ACT
1968 RADIATION CONTROL FOR
HEALTH AND SAFETY ACT
• REQUIRED US DEPT. OF HEALTH TO DEVELOP
AND ADMINISTER STANDARDS THAT WOULD
REDUCE HUMAN EXPOSURE FROM ELECTRONIC
DEVICES.
• BRH – REG. ACTION IN 1974 TO CONTROL THE
MANUFACTURE AND INSTALLATION OF
MEDICAL AND DENTAL DIAGNOSTIC
EQUIPMENT
JACHO ADOPTED THESE RECOMMENDATIONS
1980 OSHA
• IN RESPONSE TO OUTBREAK OF HIV AND HEPATITIS B
VIRUSES, MANDATED THE POLICY ON BLOOD-BORNE
PATHOGENS.
• OSHA ALSO MONITORS WORKPLACE FOR OCCUPATIONAL
EXPOSURE TO RADIATION AND CHEMICALS.
1981 CONSUMER PATIENT RADIATION
HEALTH AND SAFETY ACT
• ADDRESSED ISSUES OF UNNECESSARY REPEAT EXAMS
• IT ESTABLISHED MINIMUM STANDARD FOR
ACCREDITATION OF EDUC. PROGRAMS IN RADIOLOGIC
SCIENCEAND FOR THE CERTIFICATION OF EQUIPMENT
OPERATORS!!!!!!
SMDA OF 1991
• REQUIRES MEDICAL FACILITY TO
REPORT TO FDA ANY MEDICAL
DEVICE THAT CAUSED INJURY OR
DEATH OF A PATIENT!
1992 MQSA
• MANDATED Q.A. PROGRAMS FOR ALL
FACILITIES PERFORMING
MAMMOGRAPHY STUDIES – FDA
APPROVAL.
• IT ALSO SPECIFIED STANDARD AND
REQUIREMENTS FOR EQUIPMENT,
TECHNOLOGISTS, DOCTORS
INTERPRETING THE RADIOGRAPHS, AND
MEDICAL PHYSICISTS.
HIPAA OF 1996
• SIMPLIFICATION OF H.C.
STANDARDS TO ESTABLISH
NATIONAL STANDARDS FOR
HEALTHCARE E-COMMERCE
• CONFIDENTIALITY OF PATIENT
RECORDS!!!!!!
JCAHO
• INCE 1970 REQUIRES HOSPITALS
AND OTHER HEALTHCARE
PROVIDERS TO PERFORM AND
DOCUMENT Q.M. PROCEDURES FOR
THE FACILITIES TO GET
ACCREDITATION
ACCREDITATION IS VOLUNTARY!!!
LACK OF ACCREDITATION
HOSPITALS MAY NOT BE
ABLE TO
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HAVE RESIDENCY PROGRAMS
HOLD CERTAIN LICENSES
HAVE MEDICAID CERTIFICATION
RECEIVE MALPRACTICE
INSURANCE
QUALITY ASSURANCE
• IS AN ALL-ENCOMPASING
MANAGEMENT PROGRAM USED TO
ENSURE EXCELLENCE IN
HEALTHCARE THROUGH THE
SYSTEMATIC COLLECTION AND
EVALUATION OF DATA.
PRIMARY OBJECTIVE:
ENHANCEMENT OF PATIENT CARE
QUALITY MANAGEMENT
• PART OF THE QA ASSURANCE
PROGRAM THAT DEALS WITH
TECHNIQUES USED IN MONITORING
AND MAINTENANCE OF THE
TECHNICAL ELEMENTS OF THE
SYSTEMTHAT AFFECT THE
QUALITY OF THE IMAGE
Q.M. DELAS WITH
EQUIPMENT AND
INSTRUMENTATION
QUALITY CONTROL
LEVELS OF TESTING
• NONINVASIVE- SIMPLE
• NONINVASIVE AND COMPLEX
• INVASIVE AND COMPLEX
CONTINUOUS QUALITY
IMPROVEMENT
• INCORPORATED BY JCAHO IN 1991
C.Q.I.
KAIZEN
CQI SYNONYMS
• TQM- TOTAL QUALITY
MANAGEMENT
• TQC - TOTAL QUALITY CONTROL
• TQI – TOTAL QUALITY
IMPROVEMENT
• SQC – STATISTICAL QUALITY
CONTROL
C.Q.I DOES NOT REPLACE
QA
INSTEAD OF JUST ENSURING &
MAINTAINING QUALITY IT CONTINUALLY
IMPROVES QUALITY BY FOCUSING ON
IMPROVING THE SYSTEM
FOCUS IS ON THE ORGANIZATION AS
THE WHOLE
C.Q.I
• INTERNALLY MOTIVATED
• EVERY EMPLOYEE CONTRIBUTES
TO THE SUCCESS OF THE
ORGANIZATION
C.Q.I. PROCEES
IMPROVEMENT PREMISES
• 85/15 RULE
• 80/20 RULE
• WORKERS KNOW THEIR WORK
BETTER THAN OUTSIDER
• STRUCTURED PROBLEM SOLVING
SUCCESSFUL IN PROBLEM SOLVING
• QUALITY IMPROVEMENT – JOB OF
EVERYONE IN THE ORGANIZATION
PROCESS
• ORDERED SERIES OF STEPS THAT
HELP ACHIEVE A DESIRED
OUTCOME.
PARTS OF THE PROCESS
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SUPPLIER
INPUT
ACTION
OUTPUT
CUSTOMER : INTERNAL
EXTERNAL
PROBLEM IDENTIFICATION
AND ANALYSIS:
• TEAMS – 2 PEOPLE OR MORE!
IDEAL: 6 – 12 PEOPLE
GROUP DYNAMICS TOOLS
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BRAINSTORMING
FOCUS GROUPS
QUALITY IMPROVEMENT TEAM
QUALITY CIRCLES
MULTI-VOTING
CONSENSUS
WORK TEAMS
PROBLEM SOLVING TEAMS
1985- JCAHO 10- STEP
MONITORING AND EVALUATION
PROCESS
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ASSIGN RESPONSIBILITY
DELINEATE THE SCOPE OF CARE SERVICE
IDENTIFY THE IMPORTANT ASPECTS OF CARE AND
SERVICES
IDENTIFY INDICATORS
ESTABLISH MEANS TO TRIGGER EVALUATION
COLLECT AND ORGANIZE DATA
INITIATE EVALUATION
TAKE ACTION TO IMPROVE CARE AND SERVICES
ASSESS EFFECTIVENESS OF ACTIONS AND MAINTAIN
IMPROVEMENTS
COMMUNICATE RESULTS TO AFFECTED INDIVIDUALS
ASSIGN RESPONSIBILITY
DELINEATE THE SCOPE OF CARE
SERVICE
IDENTIFY THE IMPORTANT
ASPECTS OF CARE AND SERVICES
IDENTIFY INDICATORS
• SENTINEL EVENT – INDIVIDUAL EVENT SIGNIFICAN
EVENT TO TRIGGER FURTHER REVIEW.
• AGGREGATE DATA – RELATES TO QUANTIFICATION OF
PROCESS RELATED TO MANY CASES.
INDICATORS:
• APPROPRIATNESS OF CARE – IS IT NECESSARY?
• CONTINUITY OF CARE – DEGREE OF COORDINATION
AMONG PRACTITIONERS.
• EFFECTIVENESS OF CARE – THE LEVEL OF BENEFIT.
• EFFICACY – THE LEVEL OF BENEFIT UNDER IDEAL
CONDITIONS
• EFFICIENCY – OUTCOME OBTAINED WHEN THE HIGHEST
QUALITY CARE IS DELIVERED.
• RESPECT & CARING
• SAFETY IN THE CARE ENVIRONMENT
• TIMELINESS OF CARE
• COST OF CARE
• AVAILABILITY OF CARE
ESTABLISH MEANS TO TRIGGER
EVALUATION
COLLECT AND ORGANIZE DATA
INITIATE EVALUATION
TAKE ACTION TO IMPROVE
CARE AND SERVICES
ASSESS EFFECTIVENESS OF
ACTIONS AND MAINTAIN
IMPROVEMENTS
COMMUNICATE RESULTS TO
AFFECTED INDIVIDUALS
JACHO CYCLE FOR
IMPROVEMENT
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DESIGN.
MEASURE
ASSESS
IMPROVE
DESIGN.
• SYSTEMATIC PLANNING AND
IMPLEMENTATION
MEASURE
• COLLECTION OF VALID AND
RELIABLE DATA
ASSESS
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HISTORICAL DATA
DESIRED PERFORMANCE LIMITS
PRACTICE GUIDELINES
EXTERNAL REFERENCE DATABASE
BENCHMARKING
IMPROVE
DATA
ANALYSIS
IMPROVE