“Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skilled execution. It represents the wise choice of many alternatives” – Willa Foster
Our Problem To Solve “We don’t have a health care delivery system in this country. We have an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited micro systems, each performing in ways that too often create suboptimal performance both for the overall health care infrastructure and for individual patients”. George Halvorson, Author of Health Care Reform Now!: A Prescription for Change.
The Formula Health Information Technology Continuous Quality Improvement Meaningful Use Providers Outcome Structure and Process Incorporating Evidence-Based Standards of Care
What is this thing called Continuous Quality Improvement ? An ongoing effort to provide services that meet or exceed customer expectations through a structured, systematic process for creating organizational participation in planning and implementing quality improvements based on meaningful use of data that results in improved outcomes.
Why Invest in System-wide Continuous Quality Improvement? • Providing ongoing feedback improves patient outcomes, health center operations and systems by encouraging continuousadjustments of programs, policies and activities. • Collecting information about how things are done and the results helps to understand how health center initiatives develop and disseminate lessons others can profit from. • Involving all members of the health system, people who haven’t had a voice gain the opportunity to better understand and contribute. • Finally, effective quality programs helps hold everyone accountable to health center expected outcomes and to the grant makers who provide funding.
STRUCTURE: Quality is not just about implementing a system or working towards a set of standards. It is an attitude, a way of working, that not only improves an organization butalso the way the organization works.
Building A Successful Quality ProgramStructure –First Things First An organizational culture centered in Quality is a MUST. Involvement of People: Service Providers, Executive Management, Managers, Supervisors, Staff, Contractors, Board Members, Everyone!!!!!!
The Quality Committee Structure Who are the members? What are the roles and responsibilities? What is the meeting format? (who staffs, minute-taking, participation requirements, confidentiality, etc.) Where does the Committee report? When does the Committee meet? How long do committee members serve?
You Must Take Aim: Targeting Your Quality Improvement Activities. Safe: Avoid injuries to patients from the care that is intended to help them. Effective: Match care to science; avoid overuse of ineffective care and underuse of effective care. Patient-Centered: Honor the individual and respect choice. Timely: Reduce waiting for both patients and those who give care. Efficient: Reduce waste. Equitable: Close racial and ethnic gaps in health status. Source: Crossing the Quality Chasm: A New Health System for the 21st Century. Institute of Medicine. 2001
Basic Tenets of Quality Improvement What are we trying to accomplish? What change can we make that will result in improvement? How will we know a change is an improvement?
Primary Quality Related Policies and Procedures QM Program Description QM Work Plan Provider Credentialing and Privileging Peer Review Process Assessing Organizational Satisfaction (Employee, Provider and Patient) Complaint Management Incident Management Infection Prevention and Control Management Medical Record Standards Medical Record Review Process Confidentiality and Privacy of Personal Health Information Use of Clinical Protocols
Quality Program Description Meeting Community Health Center HRSA QA/QI Program Requirements. The QA/QI program must: • Include clinical services and management • Maintain the confidentiality of patient records • Include a Clinical Director whose focus of responsibility is to support the QA/QI program and the provision of high quality patient care. • Include periodic assessment of the utilization and quality of services provided or proposed to be provided.
QA/QI Program Description Key Components: I. Overview II. Quality Program Structure III. Quality Improvement Methodology IV. Communication and Coordination V. Confidentiality and Privacy of Information VI. Program Review Process (Timeframes) VII. Health Care and Business Plan
Prevent a Headache: Make Sure you Have the Right Tools and Resources Personnel Data Management Data Processing, Analysis and Reporting
PROCESS: Knowing is not enough; we must apply. Willing is not enough; we must do. - Goethe
Increasing the Value of Your Results Analyze and Synthesize Findings Interpret the Findings Make Judgments /Recommendations Share the Results Identify Program Performance Standards
Monitoring and Tracking – Establishing Performance Targets and Benchmarks If you don’t know your destination … you won’t know which way you are heading.
Data Analysis Systematically identifying patterns in the information gathered and deciding how to organize, classify, interrelate, compare, and display it.
Effectively Communicating Performance Captivating –Focuses on things that are timely and meaningful. Credible – This is for real – Data-driven performance based on sound methodology and performance standards. Continuous – Displays results over time with summary of findings.
DEMING’S Model: Plan: Analyze the process, determine what changes would most improve the process, and establish a plan for making the improvement; Do: Put your change into motion; Study: Check to see whether the change is working; Act: If the change is working, implement it on a larger scale. If the change is not working, refine it or reject it and begin the cycle again.
Do: Things to Consider The solution(s) most likely to be successful should be implemented. It is often preferable to do this on a small scale to see if the change(s) will work. Make the data collection easy enough and the time frames short enough so that data collection can be repeated frequently to allow for trending of changes over time. Allow enough time to improve performance.
Study: Things to Consider Study the data in order to determine: What were the findings? Did the improvement action(s) effect a change? What were the positive and negative effects? What are the potential causes contributing to these effects? What could have been done better? What would we change and do differently?
Act: Things to Consider Act on what you learned. Continue to make improvements in the process by going through the cycle again, starting at Plan. Don’t forget a good outcome starts with a good process.
OUTCOME: “Quality is not an act. It is a habit.” Aristotle, Greek philosopher and scientist.
Hierarchy of Effective Quality Program Effects Health Outcomes System and Environmental Change Actions Learning Reactions Participation
VALUE OF HIGH QUALITY Improves outcomes for consumers Improves consumer satisfaction Improves workforce retention and satisfaction Increases use of preventive interventions Increases best practices/innovation Foundation for performance based incentives Reduces waste Reduces rework Reduces errors Saves resources Reduces liability Improves processes for persons served/other stakeholders