Patient Safety and Quality Improvement PART 2 Diamse Campecino

Quality Improvement (QI)
•Quality is the “extent to which the clinician or organization

meets or exceeds the needs and expectations of patients”
•QI involves the systematic and continuous implementation of

changes that measurably improve patient care
•QI is based on the understanding that it is easier to improve
that which can be measured, thus QI entails monitoring and
assessment
Continuous Quality Improvement
•CQI is both a management philosophy (management’s job is to
optimize the system” Deming) and a management method:
(1) to achieve true process improvement;
(2) to gain a competitive advantage in the marketplace; or
(3) to conform to regulations and requirements.

The 6 Fundamental Domains of Quality
IOM
1.Safety: as safe in healthcare as in our home

2.Effectiveness: matching care to science; only “Appropriate” care -
avoiding overuse of ineffective care and underuse of effective care
3.Patient (Person) Centeredness: honoring the individual, and
respecting choices
4.Timeliness: less waiting for both patients and those who give care
5.Efficiency: reducing waste: “Improving my work is my work”
6.Equity: closing gaps in health status amongst groups
Classic Way to Define Impaired Quality
•Overuse (of procedures that cannot help) [Up to 15% of

actions]
•Underuse (of procedures that can help) [Up to 50% of
actions]
•Misuse (errors of execution)
“Science of (Q) Improvement”
•Basically the Scientific Method:

•Measure the current process (baseline status)
•Analyze the steps in the process (process mapping)
•Create a “Hypothesis” (change part of the process)
•Experiments changing the process (RCI: PDSA Cycle)
•Measuring the new results (QI and Pt safety)
•Analysis: accept (incorporate into your processes) or reject
the change studied
Laws of Improvement
 •“Every System is perfectly designed to get the results it gets”
If you want to improve results you must change the system!
 Transparency - Be open and honest about “failed” tests

 Attitude - To learn something new is Humbling, Willingness to Fail
 Agility - “What can I do by Next Tuesday?”
 Team Based -
Quality Improvement Methods
[EBM for H C Organizations]
1. Model of Improvement [Rapid Cycle
Improvement]
2. Lean Thinking
3. Theory of Constraints
4. Queuing Theory
5. Six Sigma
6. ISO 9001
7. Baldrige Criteria for Performance Excellence
Model for improvement
What are we trying to goals and aims
accomplish?
How will we know that a
change is an improvement? measures
What changes can we make
that will result in the change principles
improvements that we seek ?
Act Plan
testing ideas
before
Study Do implementing
changes
“Six Sigma”
•In statistics, a ‘sigma’ refers to the standard deviation from the
mean of a population
•Std Dev describes the likelihood of your next data point deviating
form the mean of the whole data set
•Six Sigma is all about variance reduction
•Variance is a symptom of waste
•High variance means lots of waste (low sigma)
•Six Sigma is very problem focused- It uses DMAIC to analyze a problem

•Define, Measure, Analyze, Improve and Control
•Thus, very similar to PDSA cycles/Rapid Cycle Improvement
Lean Thinking
Lean is an improvement methodology and mindset that
centers on:
•Eliminating waste
•The consistent delivery of Value
•The resolution of bottlenecks and constraints that affect the
consistent delivery of value by maximizing flow
In Lean, Value is defined by the Patient and family
*Leveraging Lean in Healthcare: Transforming Your Enterprise into a High Quality Patient Care Delivery System: Charles Protzman, George Mayzell, Joyce KerpcharAuerbach Publication: 2011
Continuous
Gemba Improvement
The starting place
for finding value Eliminating
waste
What is
LEAN
The thinking? The
5 S’s 7 W’s
Process / Developing
Flow an Eye
Mapping For Waste
5 S:
Sort, Set in Order, Shine, Standardize, Systematize
• 5 S: an organized, never ending, effort to
•Remove all physical waste out of the workplace that is not required
for doing work in that area
•Setting things in order
•Identify, label, allocate a place to store it so that it can be easily
found, retrieved and put away
Process Mapping: Current State to Future State
Not enough
Patient Patient Escorts Patient
Clerk requests Patient escorted to Arrives at
Arrives at Yes
ID + medical Pre- Outpatient Outpatient
Registration registered?
card Radiology Radiology
Desk
Not enough No
Registrars
Clerk
Registrar enters
assigns patient
patient to information into
Registrar system
Patient
Patient Clerk/Registrar Patient information Arrives at
Arrives at requests ID + scanned into Outpatient
Registration medical card System and Verified Radiology
Desk
Potential Solutions:
 Cross train clerks/registrars
 Card Reader + IT Integration into registration system
 Move Radiology Clerk Station Closer to Radiology
 Better Signs and Directions from registration to Radiology
The Cause-And-Effect Diagram
Used to systematically analyze the special causes of a problem. It begins with
major causes and works backwards to the root causes. It organizes the results
of the brainstorm. Also known as the fish-bone diagram and the Ishikawa
diagram (named after its inventor, Dr. Kaoru Ishikawa of Japan)
MAJOR CAUSE 1 MAJOR CAUSE 2 MAJOR CAUSE 3
Common Categories of Major Causes
(5Ms + E):
• Man (People)
THE EFFECT • Methods (Policies and Procedures)
(The Problem) • Materials (Supplies)
• Machine (Equipment)
• Money
• Environment
MAJOR CAUSE 4 MAJOR CAUSE 5
Evaluation of Board’s
Quality/Pt. Safety Role/Responsibility
1.Do high-quality hospital have better management
practices than low-quality hospitals?
2.Is there a relationship between hospital board

performance and management performance?
3.Do certain types of board practices correlate with

comparable management practices?
Board’s Role in Quality
What Does The Evidence Tell Us?
•Hospitals with high management attention on Quality are more likely
•To be High-quality hospitals (p < 0.01) [43% vs. 14%]
•One Std Dev increase in management performance was associated with a 20%
increase in being a high-quality hospital
•To have higher Board performance ( p < 0.001)
•How:
•Attention to Quality by Board Time spent (~25%) monitoring Quality: tracking effective use
of Board approved Metrics
•Result: Effective Board governance improves a hospital’s overall
performance – not just on Quality!
◦
Tsai, Jha, Gawande, Huckman, Bloom and Sadun. “Hospital Board and Management Practices Are Strongly Related to Hospital Performance on Clinical
Quality Metrics.” Health Affairs, 34 (8) (2015): 1304-1311.
“Board” Role in PS/QI
•The Ultimate responsibility for your Hospital delivering High

Quality Care (via Patient Safety and Quality Improvement) lies
with the Hospital Board of Trustees
•Having a Board level “Patient Safety and Quality Improvement”
subcommittee is equally important to having a Board “Finance”
subcommittee
•A minimum of 25% of every Board of Trustees’ Agenda should
be devoted to that hospital’s Patient Safety and Quality
Improvement program
Thank you!

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Quality Improvement (QI)

•Quality is the “extent to which the clinician or organization

•QI involves the systematic and continuous implementation of

(1) to achieve true process improvement;

(2) to gain a competitive advantage in the marketplace; or

(3) to conform to regulations and requirements.

1.Safety: as safe in healthcare as in our home

•Overuse (of procedures that cannot help) [Up to 15% of

•Basically the Scientific Method:

 Transparency - Be open and honest about “failed” tests

•Six Sigma is very problem focused- It uses DMAIC to analyze a problem

In Lean, Value is defined by the Patient and family

2.Is there a relationship between hospital board

3.Do certain types of board practices correlate with

•The Ultimate responsibility for your Hospital delivering High

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