Quality and Performance Improvement Basics

Quality and Performance Improvement Basics

Learning Objectives

  • Describe healthcare provision risks.

  • Identify key safety and quality issues.

  • Emphasize the need for management and improvement in healthcare.

  • Differentiate system failures from individual behavior.

  • Apply principles of quality improvement to management.

  • Assess major quality improvement models.

  • Utilize quality improvement tools.

Definition of Quality

  • National Academy of Medicine: Quality enhances desired health outcomes.

  • Donabedian Model:

    • Structure: Quality personnel and facilities.

    • Process: Quality management and care production.

    • Outcomes: Results from structure and process quality.

Donabedian's Four Parts of Quality

  • Technical management

  • Interpersonal relationships

  • Amenities of care

  • Ethical care principles

Quality Assessment Questions

  1. Are the right things done? (Effectiveness)

  2. Are things done right? (Efficiency)

  3. Are right things done timely? (Timeliness)

Patient-Centered Care

  • Focuses on individual needs and preferences.

Importance of Quality

  • Underuse: Patients not receiving beneficial services (54.9% receive recommended care).

  • Overuse: Services used despite risks outweighing benefits (e.g., uncritical antibiotic use).

  • Misuse: Services provided incorrectly, causing harm (e.g., medical errors).

Complexity of Health Care

  • Dynamic and unpredictable.

  • High potential for human transaction failures.

Quality Improvement Methodologies

  • Emphasis on measurement, reliability, validity, and process variation.

Continuous Process Improvement

  • Structured processes involving personnel in planning ongoing improvements.

  • Based on the process part of Donabedian’s definition.

  • Key dimensions:

    • Process focus

    • Customer focus

    • Data-based decisions

    • Employee empowerment

    • Organization-wide scope

FOCUS/PDCA Framework

  1. Find: Determine process problems.

  2. Organize: Form a team.

  3. Clarify: Use techniques to define issues.

  4. Understand: Collect data and measure performance.

  5. Select: Identify improvements.

  6. Plan: Develop implementation strategy.

  7. Do: Implement process changes.

  8. Check: Evaluate outcomes.

  9. Act: Sustain or revise changes.

Six Sigma

  • Data-driven methodology targeting process variation.

  • Target performance: <3.4 defects per million opportunities.

DMAIC Process

  1. Define: Scope and timelines.

  2. Measure: Develop metrics.

  3. Analyze: Flowchart the process.

  4. Improve: Outline steps to achieve goals.

  5. Control: Ensure improvements are maintained.

Toyota Production System/Lean Principles

  • Focused on value and waste removal (e.g., overproduction, defects).

  • Emphasizes continuous improvement and respect for personnel.

Principles of High Reliability

  • Preoccupation with failure and careful diagnosis.

  • Sensitivity to operational demands.

  • Commitment to resilience and expert-driven decisions.

Change Management

  • Lewin’s Model: Unfreeze, Change, Freeze.

  • Kotter’s 8 Steps: Sense of urgency, coalition building, vision communication, empowerment, and institutionalization of new behaviors.

Quality Improvement Tools

  • Process mapping, flowcharts, data collection, root-cause analysis, Pareto charts.

Conclusion

  • Core policy issues: Quality, Access, Cost.

  • Notable improvement in U.S. healthcare quality, but challenges remain in access and cost relative to peers.