HINF 461: Quality Improvement Exam Preparation Guide

Quality Improvement (QI)

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.

What is the goal of QI

to improve organizational process and outcomes

Total Quality Improvement (TQI)

A management philosophy and method; in the industry, QI is referred to as TQI.

Continuous Quality Improvement (CQI)

In healthcare, QI is referred to as CQI.

What are the other names of QI

Quality Assurance (QA), Quality, Quality Control, Total Quality Management, and Continuous Quality Improvement

What does QI involve?

providing customers with products and services that constantly meet customer needs and expectations

How does QI differ from the management methods?

Recognizes the importance of customer needs in quality and that those needs will change over time due to education, economics, technology, and culture.

Importance of Quality Improvement

A way of achieving product, process, and service perfection.

Ongoing Process of QI

Patient care continually undergoes change, including new research, guidelines, clinical procedures, and technologies.

Localized Improvements

An ad hoc team is developed to look at specific process problems or opportunities.

Organizational Learning in TQI

Occurs when TQI is documented and results in the development of policies and procedures that are implemented.

Reasons for TQI in Healthcare Organizations

Accreditation, cost control, competition, and pressure from employers.

Basic TQI Strategies

Conformance to requirements, competitive advantage, and true process improvement.

Kaizen

Dynamic change, changing expectations, and continuous efforts to address change.

Philosophical Elements of QI

Process optimization, continuing improvement, organizational learning, and data-driven analysis.

Structural Elements of QI

Top management commitment, statistical measures, customer satisfaction measures, benchmarking, and redesign of processes from scratch.

Deming's 14 Points for QI

A set of principles aimed at improving quality in organizations, including creating a statement of aims, learning new philosophies, and driving out fear.

Point 1 of Deming's 14 Points

Create and publish a statement of the aims and purposes of the company for all employees to see.

Point 2 of Deming's 14 Points

Learn the new philosophy.

Point 3 of Deming's 14 Points

Inspect to improve processes and reduce costs.

Point 4 of Deming's 14 Points

Do not award business on the basis of price tag alone.

Point 5 of Deming's 14 Points

Improve the system of production and service.

Point 6 of Deming's 14 Points

Train.

Point 7 of Deming's 14 Points

Team leadership.

Point 8 of Deming's 14 Points

Drive out fear. Create trust. Create a climate of innovation.

Point 9 of Deming's 14 Points

Optimize company team, group and staff purposes

Point 10 of Deming's 14 Points

Eliminate numerical goals, poster and slogans asking for new productivity.

Point 11 of Deming's 14 Points

Eliminate work standards that prescribe numerical goals.

Point 12 of Deming's 14 Points

Eliminate management by objective

Point 13 of Deming's 14 Points

Remove barriers that rob people of pride in workmanship.

Point 14 of Deming's 14 Points

Encourage education and self-improvement for everyone.

Point 15 of Deming's 14 Points

Take action to accomplish transformation

Walter Shewhart

Father of quality control who introduced control charts.

Feigenbaum

Introduced total quality control. Developed a system of integration on the function of QI from: conception, planning, design, and set-up.

Juran

Developed a quality trilogy consisting of quality planning, quality control, and quality improvement.

Crosby

Focused on changing corporate culture and attitudes with the zero defects theory.

Ishikawa

Promoted total organizational participation and introduced the fish bone diagram and just in time process.

Total Quality Improvement (TQI)

A systematic approach to improving quality in healthcare that focuses on customer satisfaction, profitability, employee satisfaction, reduced costs, improved patient survival, and better continuity of care.

Benefits of TQI

Includes customer satisfaction, profitability, employee satisfaction, reduced costs, improved patient survival, and better continuity of care.

Advantages of TQI

Improves quality of care while empowering healthcare professionals, enhances worker motivation and accountability, leverages staff knowledge and skills, and strengthens organizational effectiveness.

Quality and organizational survival

Healthcare organizations address gross inefficiencies and cost containment.

There were two key components that devised the path forward, that was creating:

A system to standardize and make transparent all EHR change requests and the

processes. And, a governance structure that could be relied upon by both EHR users and EHR

stewards within IMIT

EHR change requests

A system to standardize and make transparent all electronic health record change requests and processes.

Governance structure for EHR

A reliable structure for both EHR users and EHR stewards within IMIT.

Quality Improvement (QI)

The extent to which healthcare services are provided to individuals and patient outcomes, requiring safety, effectiveness, timeliness, efficiency, equity, and people-centeredness.

Components of Health (WHO)

Includes safety, effectiveness, timeliness, efficiency, equity, and people-centeredness.

Continuous Quality Improvement (CQI)

A structured organizational process for involving personnel in planning and executing continuous improvements to provide quality healthcare.

Characteristics of CQI in healthcare

Includes a link to the strategic plan, a quality council of top leadership, training programs, mechanisms for selecting improvement opportunities, process improvement teams, staff support for analysis and redesign, personnel policies that motivate participation, and application of scientific methods and statistical process control.

Characteristic/Functions of Health Care CQI

1. Understanding and adapting to the external environment.

2.Empowering clinicians and managers to analyze and improve processes.

3. Adopting a planned, articulated philosophy of ongoing change and adaptation.

4. Developing a multidisciplinary approach that goes beyond conventional

departmental and professional lines;

5. Adopting a planned, articulated philosophy of ongoing change and adaptation;

6. setting up mechanisms to ensure implementation of best practices through

planned organizational learning

7. providing the motivation for a rational, data-based, cooperative approach to

process analysis and change; and developing a culture that promotes all of the

above.

CQI

CQI is simultaneously two things: a management philosophy and a management method.

Elements of CQI

Philosophical elements, Structural elements, Healthcare elements.

PDSA

PDSA cycles help test changes in small steps to improve systems. They allow quick feedback and adjustments, making sure solutions are practical and effective.

FOCUS

Find, Organize, Clarify, Understand, Select.

Need for CQI

The safety and quality of care has shown improvement since 2000 but further improvement is needed. External forcers are are increasing the demand for higher quality: Accreditation, legislation.

Dynamic character of CQI

CQI methodology is constantly being refined and tested: it is an evolutionary quality improvement mechanism.

Current state of CQI in healthcare

Improvement in quality and safety remains limited despite best efforts.

Diffusion theory

Provides one way of understanding the barriers and facilitators of CQI in healthcare.

Economic case for an innovation

Includes the returns to all the actors, not just the individual investing business unit.

Social case for an innovation

Involves measuring benefits, but not requiring positive returns on the investment.

Motivational Factors

Intrinsic motivation, capturing the intellectual capital of the workforce, reducing managerial overhead, lateral linkages.

Culture of excellence

Ensures excellence and high quality at every customer interface, shared by all in the organization.

Three types of leaders

Opinion, Champion, Boundary spanners.

Implementation definition

(A) specified set of activities designed to put into practice, an activity, or program.

Implementation science definition

The scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice.

Six Sigma's DMAIC process

Moves directly from the Improve step to the Control step without any mention of context-specific details.

Key ingredients for achieving outcomes

Integrating improvement and implementation.

Model for improvement and implementation

A framework that guides the process of improving and implementing health care practices.

Consolidated Framework for Implementation

A structured approach to ensure effective implementation of health care practices.

Active Implementation Frameworks

Definitions and strategies that promote effective implementation in health care settings.

Implementation Drivers

Factors that influence the successful implementation of health care practices.

Implementation strategies

○ Engage consumers

○ Use evaluative and iterative strategies

○ Provide technical assistance

○ Adapt and tailor to the context

○ Develop stakeholder relationships

○ Train and educate stakeholders

○ Support clinicians (and service providers)

○ Utilize financial strategies

○ Change infrastructure

QI in Digital Transformation

A concept discussed by Guest Lecturer Ruonan Lou, focusing on five blocks of digital transformation.

Understanding root cause analysis

A method for identifying the fundamental reasons for problems in health care.

Data Harmonization

The process of standardizing data from different sources to create a cohesive dataset.

Student Synthetic Dataset

An outline discussed by Guest Lecturer Sheraz Cheema, focusing on data for educational purposes.

BC PSLS

The Patient Safety and Learning System, a web-based tool used by BC's health authorities to report and learn from patient safety incidents.

PSLS Handler

A leadership role responsible for reviewing reported incidents and conducting evaluations.

PSLS Training Duration

About 1 hour, scheduled at your convenience and eligible for CPD credits.

Canadian Triage and Acuity Scale

CTAS has five levels of urgency in medical conditions.

Level 1: Resuscitation

Conditions that are threats to life or limb.

Level 2: Emergent

Conditions that are a potential threat to life, limb or function.

Level 3: Urgent

Serious conditions that require emergency intervention.

Level 4: Less urgent

Conditions that relate to patient distress or potential complications that would benefit from intervention.

Level 5: Non-urgent

Conditions that are non-urgent or that may be part of a chronic problem.

Quality Improvement (QI)

A systematic approach to improve health care services through measurement and analysis.

Data can be used to...

Used to evaluate the current situation, analyze, improve processes, and track progress.

Methods used for analyzing data in QI draws from:

biostatistics, economics, epidemiology

Industrial Statistical Tools

- widely tested in healthcare

- transferrable

-meaningful

-easy to understand

-easy to use

- help point of sources of error and variation

-indicate where improvements can be made most effectively

-should be used on a continuous basis

-different tools may be useful at different stages of QI projects

QI Measurement Tools

Includes flowcharts, cause and effect diagrams, check sheets, Pareto diagrams, histograms, run charts, regression analyses, and control charts.

Stages of QI

1. Describe the process 2. Identify the source of variation 3. Perform in-depth analyses 4. Weigh alternatives (opportunities for further investigation and aid with making choices for change) 5. Measure improvement (in response to change)

Attribute data

Describes categories or qualities (e.g., yes/no, pass/fail, colors).

Variable data

Measures quantities on a scale (e.g., height, weight, temperature).

CQI requires knowledge about the behaviour of systems, which is obtained from:

- data and other sources of information

- the application of tools and techniques that have been proven to be effective throughout the evolution of CQI

Process capability

Studies to understand the expected output of a process and its predictability.

Benefits of stable process

Includes productivity, greater speed, and reliability.

Process behavior chart

The most effective way to measure, document, analyze, and understand the capability of a process.

Turnaround time (TAT)

Turnaround time

- is what acceptable variation is dependent on

Statistical control

The basis of CQI activities to ensure processes are stable or 'in control'.

Voice of the process

Listening to the data and variation to inform improvement actions.

Understanding Variation

understanding the nature of process variation and measurement/statistical analysis