“Taking a Sneek Peek at the Global Role of Quality in Health Care”

1. “Taking a Sneek Peek at the Global Role of Quality in Health Care” Tina MacDonald October 13, 2005 - ASQ

3. Goals for Tonight • Definition, Measurement, and Evaluation of quality in health care • Past, Present, and Future QM programs in health care • Current Focuses - Risk Management

4. “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (The Institute of Medicine (IOM) 1990) Patients getting the right medicine, treatment or test at the right time, given the patient's condition Defining “Quality” in Health Care

5. No two patients are the same and statistical data can be false leading. For example: Mortality Rates – Hospital A stats may look better than Hospital B But in fact – maybe Hospital A had younger and healthier patients Infection rates – Hospital A stats may look better than Hospital B But in fact – maybe Hospital A had patients in better health prior to admission (ie: no diabetes. Diabetic patients are more prone to getting infections) Patients are not “Widgets”

6. Measuring and Evaluating Numerous ways that health care facilities are measuring and evaluating quality • Accreditation • Voluntary • Creation of teams whereby a Self Assessment is done comparing current processes to the accreditation national standards • Developed through consultation with health professionals across the country • Professional health care personnel (CEOs, etc) are called “surveyors” and they come in to audit and interview the teams • A final report is given

7. Leapfrog • A group created for health insurance “buyers” to have more of an understanding and input into lower health care costs 3. Health Care Report Cards – Ontario Hospital Association • Comparing one hospital to another hospital • Public knowledge • Balanced scorecard looks at • Clinical Utilization and Outcomes • System Integration and Change • Financial Performance and Condition • Patient Satisfaction

8. After the Second World War – “U.S. health care is the best!” 1970s and 1980s – Health care expenditures would consume an ever increasing percentage of the country’s gross domestic product Further development of more advanced diagnostic and therapeutic modalities Rise in the cost of health care far exceeded the rise in the cost of living in the United States Past, Present, Future

9. Enter managed care - • Attempts to reduce utilization of health care through, " QA” and “case management” = health maintenance organizations (HMOs) • Relieved increasing costs – only temporarily • Patients valued “choice” of providers - not value or trust HMO medical directors • Patients and government authorities began legal actions against HMOs • Rising costs + increased patient awareness + interest + knowledge + access to information about “the right care, at the right time, at the right place, by the right provider” Now, more than ever, health care providers needed to demonstrate the “quality of their care”.

10. Result? • “At DMC (Detroit Medical Centre) – we will have you out of the emergency department before the others would even be bringing you in.” • “Do you have a BEAUMONT doctor?” (Sound familiar?)

11. Current Trends – No longer look at just the outcomes but look at the “process” related to the outcome • Quality-improvement techniques/ tools to decrease medical errors and help ensure patient safety • Eliminating waste and rework • Patient-handling increase capacity and flow = decrease wait times and potentially harmful delays in care

12. Insurance reimbursement based on good “quality reports” from accreditation, etc • Aiming for a safer, more efficient, cost-effective system that better satisfies patients and healthcare workers • CEO “walk abouts” • Patient Focus Groups • Baldrige for Healthcare Network • SIX SIGMA • FEMA • LEAN • ISO

13. ISO for Health Care = IWA-1 • ISO 9000 standards written into health care terms • At Windsor Regional Cancer Centre we did not have this advantage and part of the hard work was educating the consultants and auditors on health care processes! • Version 2 released on October 1, 2005 – only in US right now

14. Why Push for IWA? • Auto industry states that over $1,000 of a total price of a car is HEALTH CARE BENEFITS!! • GM Chairman and CEO Rick Wagoner has said that US health care costs are rising at an annual rate of 14 % - 18 % and already account for 15% of gross domestic product • Preventable hospital errors cause almost 100,000 deaths a year in US Result = primary reason for uncompetitiveness of North American operations

15. History of IWA • 1988 • ASQ and Automotive Industry Action Group (AIAG) together created the IWA document • 2001 • Released with consensus of 130 healthcare experts from 17 countries • 2001 – 2005 • Required three year review and any changes done • 2005 • U.S. publication and distribution

16. Encouragement for IWA • Awards • Pennsylvania proposed bill would require 20% discount of insurance premiums – QM system • Slowly but surely IWA is moving and being implemented across the world • EUROPE - very ISO orientated for health care • BRAZIL - currently considering IWA

17. !!! Medicare/ Medicaid appointments made for AIAG to meet with them !!! • Ideally – the “BIG 3” would like to see that IWA be implemented at hospitals - or they may not subscribe to health care benefits with those hospitals • Original talk was a goal of 5 years

18. Do I miss being ISO registered? YES !! And now that it is gone – FINALLY my colleagues realize the importance of having a formal system in place 

19. Risk Management in Health Care • Staffing levels • Patient Safety/ Medical Errors • Access to Care • Waiting times

20. Environment / Health and Safety • SARS • “No lift policies” • Violence in the Workplace • Hazardous Control Programs

21. Hazardous Control Program • National Alert • List of common pharmaceutical drugs and chemotherapy drugs considered “hazardous” to workers • Creation of a Hazardous Control Program • First in Canada and possibly North America to have such an extensive program • Research grants being investigated for implementing medical surveillance (urine samples) and biological surveillance (sampling) • ? Malaysia 2006 National Conference 

23. THE END Acknowledgements to Mr. Dan Reid of AIAG and Mr. Mickey Christensen of TQM Systems