Quality, Patient Safety, and Communication

Quality in Health Care

• Quality = degree to which a service meets patient needs (STEEP: Safety, Timeliness, Effectiveness, Efficiency, Equity, Patient-centeredness)

• Key U.S. drivers: Hospital Value-Based Purchasing, TJC standards, CMS monitoring, peer-review organizations

Core Improvement Frameworks

• PDSA: Plan → Do → Study → Act (iterative cycles)

• Six Sigma: DMAIC — Define, Measure, Analyze, Improve, Control; target error rate 3/1\,000\,000 (≈0.000003)

• Lean Management: remove waste (time, excess work, unevenness)

• Disease Management: integrated system, evidence base, information systems, continuous QI

Typical QA Plan Steps

• Identify & rank problem → determine cause → create metrics → implement & analyze intervention → report & evaluate

Patient Safety

Movement & Ambulation

• Use legs + straight spine when lifting; begin ambulation early to prevent atelectasis & shorten stay

Electrical Safety Essentials

• Voltage drives current; current (amperes) = voltage ÷ resistance (ohms)

• Harm depends on magnitude, path, duration

• Macroshock >1 mA; microshock <1 mA (dangerous to invasive-line patients)

• Prevent with 3-wire grounding & regular equipment checks

Fire Safety

• Fire requires fuel + O_2 + ignition temperature

• OEAs intensify flames; keep combustibles & sparks away

• PASS (Pull, Aim, Squeeze, Sweep); RACE (Rescue, Alert, Contain, Evacuate)

General Safety Guidelines

• Clear environment of fall hazards; manage tubing/equipment

• MRI: NO ferromagnetic items; use MRI-compatible devices

• Store medical gas cylinders secured; avoid heat/sparks; note toxicity risks

Communication

Fundamentals

• Components: Sender, Message, Channel, Receiver, Feedback

• Two-patient identifiers: name + DOB or MRN; mandatory “read back” for critical info

Structured Tools

• SBAR: Situation, Background, Assessment, Recommendation

• I-PASS: Illness severity, Patient summary, Action list, Situation awareness/contingency, Synthesis by receiver

Improving Personal Skills

• Sender: share, relate, value disagreement, align verbal & non-verbal cues

• Listener: stop talking, avoid distractions, stay objective, active listening

• Feedback: attending, paraphrasing, clarification, perception check, reflecting feelings

• Minimize barriers: define terms, respect values, reduce status gaps, manage emotions/conflict

Conflict Management

• Main sources: poor communication, structural issues, personal behavior, role conflict

• Resolution styles: Competing, Accommodating, Avoiding, Collaborating, Compromising (choose per context)