Quality Improvement Pt I

QI in healthcare is an approach to the __________ _____ and ___________ of the processes of providing ______ ____ ________ to meet the needs of patients and others

continuous study, improvement, health care services

what term did Dr. W. E. Deming's coin in his "14 principles of management"?

total quality management (TQM)

what did Deming propose that was considered a "japanese miracle"?

quality>price was a major influence of customer purchase

before Deming's ideas in 1950, how was Japan on products?

poor quality and cheap products

Deming's first principle: ___________ of the mission and goals, so there is reason to _______

delineation, improve

Deming's second principle: always strive for ___________ no matter how good the _______ (service)

improvement, product

Deming's third step: _______ the process rather than "_______ ___ ______"

improve, inspect for errors

Deming's fourth principle: plan for the ______ by analyzing ____-____ _____ and _______________ of product (service)

future, long term costs, appropriateness

Deming's fifth principles: allow the employee to contribute to ___________

improvement

Deming's sixth principle: _________ & _______ employees through _________

encourage, support, education

Deming's seventh principle: ensure _________ _______ for the ___________ system

qualified leaders, improvement

Deming's eighth principle: eliminate ____ by encouraging employees to _____ ___________

fear, offer suggestions

Deming's ninth principle: eliminate ________ ________; help employees understand the ____ for other ___________

staffing barriers, need, departments

Deming's tenth principle: require __________ to keep employees ________

management, informed

Deming's eleventh principle: emphasize _______ first rather than ________

quality, quantity

Deming's twelfth principle: promote and encourage ________ versus __________ ______

teamwork, individual effort

Deming's thirteenth principle: encourage and support employee's ___________ and ____-___________ program

educational, self improvement

Deming's fourteenth principle: _______ and _____ all employees in the "______________ _______"

support, train, transformation process

what are the two big challenges facing healthcare?

cost containment and quality concerns

what is the quoted definition for quality?

the extent to which products, services, processes, and relationships are free from defects, constraints, and items which do not add value for customers

what are some ways to describe quality?

absence of flaws, measure of excellence, customer's perception of the value of the outcome

what has continuous quality improvement demonstrated?

decrease in cost, increase in satisfaction, improved organization quality

what is the independent, not-for-profit organization dedicated to improving quality of care in healthcare settings?

joint commission

JC used to focus on individual departments/disciplines, but now...

focus on facility performance

what is the main focus of the joint commission?

doing the right thing and doing the right thing well

why has the name for quality assurance been changed to by the JC and why?

quality assessment/quality improvement/CQI, focus on ongoing improvement

what are some of the 2016 national patient safety goals from joint commission?

-2 pt identifiers

-get tests to staff on time

-label medicines before procedure

-mark surgery site

-prevent infection through handwashing

-identify suicidal patients

-ensure alarms are heard and responded to

what does the broader emphasis for quality efforts in radonc focus on today?

administrative, clinical, physical, technical

what federal agency ensures adequate protection of public health and safety and radioisotopes/brachytherapy guidelines?

nuclear regulatory commission

what federal agency regulates disposal, storage, and handling of nuclear waste material?

environmental protection agency

what federal agency monitors the transportation of hazardous materials such as radioactive agents?

department of transportation

what are agreement states?

states that have support of the NRC

what does it mean that alabama is an agreement state?

the state takes care of sources if they follow NRC guidelines

what professional organization has a focus on high quality patient care?

american college of radiology (ACR)

what professional organization is made of medical physicists which has produced numerous reports out of task groups looking at issues affecting radonc?

american association of physicists in medicine (AAPM)

AAPM example: TG 53 outlines....

a comprehensize QA programs for radiotherapy tx planning

what is an umbrella term for QA, QC, quality management, total quality improvement?

total quality management and continuous quality improvement

what is quality improvement defined?

a broad-based program to ensure excellence through data collection and evaluation

what does quality improvement refer to?

the assessment and activities related to human factors

what are some examples of quality improvement?

patient satisfaction, side effects of treatment, staff qualifications and education

what is quality control defined?

refers to activities related to technical factors and equipment

QC is the ___________ activities used to fulfill requirement of quality

operational

what are some examples of QC?

laser alignment, beam flatness, ODI accuracy

many feel it is more realistic (and less legally binding)...

to assess rather than assure quality

why do people believe the concept of CQI and TQM fit best?

so that results are measured and analyzed and corrected

CQI step 1: quality indicators are ___________

established

CQI step 2: __________ upon which outcomes can be measured are ___________

benchmarks, established

CQI step 3: data are _________ and ________

collected, analyzed

CQI step 4: _____________ occurs

brainstorming

CQI step 5: process improvements are ___________

implemented

CQI step 6: _______ ______ continues

ongoing review

what is the goal of CQI/TQM?

to continually exceed standards

how does CQI/TQM exceed standards?

focuses on organization as a whole, analyzing and responding to data, systems and processes rather an individuals, driven by customer satisfaction

what does PDSA mean?

plan, do, study, act

the QI team is composed of...

representatives from all areas of the radiation oncology department

who is responsible for establishing/approving a QI program and appointing team?

medical director

what are 5 tasks the QI committee are in charge of?

-develop and monitor program

-collect and analyze data

-determine areas for improvement

-implement changes

-evaluate results

what are some examples of QI activities to be reviewed by the committee?

chart checks, chart rounds, testing of equipment, qualifications of staff, policy and procedure review, portfilm/image review, patient and family education, pt satisfaction

what is the 80/20 rule called?

Pareto rule

what is the Pareto rule?

80% of problems are the result of 20% of the causes (80% of probs can be eliminated by resolving 20% of causes)

what can be used to put essential data in a format for reviewers to understand the information?

flowcharts, Venn diagram, histograms, Pareto chart, fishbone diagram, scatter plot

what is a pictorial representation of a process with each symbol representing something different?

flowcharts

what are circles that join to show a relationship between things?

venn diagram

what are bar graphs that show frequency of events?

histograms

what is a variation of a histogram in which the x-axis depicts the problems and the y-axis depicts the frequency?

pareto chart

what is also knows as the cause and effect diagram?

fishbone diagram

who was fishbone diagram created by the demonstrate the cause and effect of different conditions?

ishikawa

what is the head and bones in a fishbone diagram?

head is an error and bones are factors that could lead to the error

what are points plotting to determine the presence or absence of a correlation between two conditions?

scatter plot

whos responsibility is it to formulate and implement QI standards?

each individual department

what is the main criticism JC has with QI plans?

info is collected but little is done with that information

following the cold war, what did the FBI do?

reassigned many agents to investigate healthcare fraud and abuse

before the FBI changed things, what was payment life?

fee-for-service, with no fraud monitoring

today, what is required of all healthcare organizations that receive government reimbursements (Medicare/Medicaid)?

compliance programs

what is the purpose of compliance plans?

to educate employees about documentation, billing, and ethical standard in order to prevent unintended fraud

what does a compliance program prepare the organization for?

potential audit by the officer of inspector general (OIG)

fraud and abuse is felt to be such a problem that the dept of health and human services has...

allocated 500 million dollars to be used by OIG to find fraud, abuse, and non-compliance

Drs Couch and Ruan, pain management physicians were convicted on federal charges for...

committing healthcare fraud and illegally distributing pain pills

what did DRs. Couch and Ruan's charges include?

conspiracy to distribute controlled substances outside the usual course of professional and not for a legitimate medical purpose, ad conspiracy to commit healthcare fraud

what did Drs. Couch and Ruan order under false pretense?

urine tests billed to pt insurance companies because insurers would pay higher reimbursement rate

in one year patients came from over __ states to see Drs. Couch and Ruan. each dr wrote a narcotic pain Rx every ___ minutes. #_ in the state

20, 3.5, 1

from just ONE of many drug kickback schemes, Dr Ruan was recieving ________ per month and Dr. Couch was receiving _________

$80,000.00, $20,000.00

conviction for Couch and Ruan required them to pay restitution in the following amounts...

6.2 mill to Medicare, 3.7 mill to BCBS, 2.3 mill to Tricar, 1.7 mill to United

how long will each dr serve in prison?

20 years

in 1998 what was it estimated that medicare made improper payments of?

12.5 billion dollars

what are major causes of overpayment?

improper billing, upcoding, discrepancies of documentation

because of big-ticket charges or very high volumes, the OIG has specifically targeted these areas...

radiology, cardiology, rad onc, laboratory

what does CPT stand for?

current procedural terminology

who are CPT codes developed by?

the AMA organized with service lines

radonc CPT codes are with...

radiology codes, but different sections

what through levels of complexity are CPT codes grouped into?

simple, intermediate, complex

about how many radonc CPT codes are there?

50

CPT charges 77261-77263 are...

clinical tx planning

CPT charges 77280-77290 are...

simulation charges

CPT charges 77401-77416 are...

conventional EBRT

CPT charge 77418 is..

IMRT

what does ICD stand for?

internation classification of disease

#1 of OIG elements of a compliance plan:

written...

policies and procedures

#2 of OIG elements of a compliance plan:

a designated __________ _______ and/or __________ committee

compliance offer, compliance

#3 of OIG elements of a compliance plan:

________/_________ for all employees/staff

training/education