Quality Improvement Overview. Paul vanostenberg, DDS. MS Vice President Accreditation and Standards Joint Commission International

Transcription

1 Quality Improvement Overview Paul vanostenberg, DDS. MS Vice President Accreditation and Standards Joint Commission International

2 The History of Improving We are perfect! Get rid of the bad apples! System Thinking Process Improvement Patient Safety NO ACTION Quality Assurance Continuous Quality Improvement PROACTIVE REACTIVE

3 Early Quality Movement Built on the passion of individuals Looked to the organized health professions for leadership Had few tools and methods to actually evaluate quality Often seemed to be a fad Had little data on the extent of poor quality

4 So I am called eccentric for saying in public that hospitals, if they wish to be sure of improvement, 1. Must find out what their results are. 2. Must analyze their results, to find their strong and weak points. 3. Must compare their results with those of other hospitals. 4. Must welcome publicity not only for their successes, but for their errors. Ernest A. Codman, M.D

5 The Minimum Standard The American College of Surgeons The Minimum Standard encompassed: Organization of the medical staff Regular convening of medical staff review Prohibition of fee splitting Completion and availability of patient records Availability of hospital clinical laboratory and x-ray departments Of 692 hospitals where the Minimum Standard was tested, only 89 met the requirements in full 5

6 Some Early Tools to Understand Quality Chart Audits were a valuable exercise however they were retrospective and rarely let to improvements Mortality and Morbidity Rounds also were informative but rarely led to significant improvements

7 Quality Considered Human Failure Quality Assurance emerges Punitive in nature Drove many quality issues underground

8 To Err Is Human: Building a Safer Health Care System Goal in 1999 was: 50% reduction of errors - next 5 years Among the recommendations: Engage consumers, purchasers, accreditors, regulators Effect a culture shift to make safety a top priority

9 Consideration of Quality in System Context Total Quality Management (TQM) Continuous Quality Improvement (CQI) Leadership for Quality emerges and the integration of patient care departments Movement to centralized quality functions quality departments Emergency of professional organizations focused on quality

10 Cause: Fax - ambiguous drug order Cause: information sys. - no max dose warnings Cause: Labeling - unclear expression of drug concentration Latent Failures Type: Improper dose/quantity Contributing factor: staff, inexperienced Triggers Patient information System Communication System Drug information System Drug Labeling System Other systems The latent failure model of complex system failure modified from James Reason, 1991 Harm Event 6

11 Patients

12 Emergence of the Patient Safety Movement Reenergized the quality movement by putting a patient face on it and bringing it to the bedside Brought measurement more clearly into the mix data driven improvement Brought better use of old tools Root cause analysis Failure mode effects analysis

13 Building the Business Case for Quality/Safety Measuring the impact of poor quality - liability claims Looking for greater process efficiency Better use of technology and other resources Pay for performance

14 Greater Governmental Oversight for Quality Rapid rise in national and international accreditation National databases on adverse events and near misses National measurement programs New types of public-private partnerships to provide quality oversight

15 Some Lessons Learned Quality is an evolutionary process that needs a meaningful and achievable starting point based in standards All health care delivery is based on repetitive systems even very simple ones that can be incrementally improved Most health care workers will improve those systems if given simple tools to do so

16 Some Lessons Learned Each country does not need to gather their own patient safety data it s a universal problem Incentives payment, more patients, etc. are always needed to keep the momentum for quality moving Recognition for improvement is essential

17 Thank You