1/22/2014. Defining Quality in Healthcare. Objectives. Topics of discussion. Quality for the non-quality Manager Session 1

Transcription

1 Defining Quality in Healthcare Quality for the non-quality Manager Session 1 Presented by Paul E. Frigoli, Ph.D.(c), R.N., C.P.H.Q., C.S.S.B.B. Certified Lean Six Sigma Master Black Belt Objectives At the end of the session the learner will be able to identify: A working definition for healthcare quality A working definition for evidence based practice The main functions performed by a quality department The importance of data gathering Topics of discussion What is quality? What is evidence based practice? What exactly does a quality office do for an institution? Data gathering: Why does it matter? Where do you get it? What do you do with it once you have it? Who gets to see the data? 1

2 Defining quality in healthcare Institute of Medicine The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Aspects of quality Healthcare quality includes four aspects: Receiving the best care possible for one's illness or condition The avoidance of errors or mistakes Respectful treatment by medical professionals Clear answers to your questions. Lean has a definition for quality healthcare The ideal state in healthcare: Defect-free delivery Exactly what the patient needs No waste in system No muda Individual attention to patients One-on-one care customized care On-demand healthcare Care exactly as requested, when requested Immediate response to problems Safer environment for patients and workers 2

3 Originally healthcare quality was defined by what it is not: Quality indicators clustered around the 5Ds: Death Disease Disability Discomfort, and Dissatisfaction Instead of the more positive components of quality. Defining quality in healthcare The IOM: six characteristics of high-quality care, Care must be: Safe Effective and reliable Patient-centered Timely Efficient Equitable What is evidence based practice? AHRQ Agency for Healthcare Research & Quality Federal Government agency Mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with the U.S. Department of Health and Human Services (HHS) and other partners to make sure that the evidence is understood and used. 3

4 AHRQ s definition of evidence-based practice Applying the best available research results (evidence) when making decisions about health care. Health care professionals who perform evidence-based practice use research evidence along with clinical expertise and patient preferences. Systematic reviews (summaries of health care research results) provide information that aids in the process of evidence-based practice. AHRQ s definition of evidence-based practice Example: Health care provider recommends acetaminophen to treat arthritis pain in a patient who has recently had stomach bleeding. The health care provider makes this recommendation because research shows that acetaminophen is associated with less risk for stomach bleeds than other common pain relievers. The health care provider's recommendation is an example of evidenced-based practice What exactly does a quality office do for an institution? Center of all quality activities Clearinghouse for all quality data collection Generates reports of quality data for the appropriate audience Assists the hospital in meeting the many standards prescribed by the accrediting bodies Collector of performance feedback including patient satisfaction 4

5 Data gathering: Why does it matter? Quality offices collect large volumes of data for various reasons: Requirements by the accrediting bodies (CMS, TJC, State, Health Department, etc) Department-specific requirements Hospital strategic initiatives Marketing purposes Internal process improvement opportunities Public reporting programs To improve healthcare processes globally Where do you get it? Data is collected from various sources depending on the type 1. Clinical Data (outcome measures) 2. Satisfaction Data 3. Financial Data 4. Facility data 5. Volume data Clinical data Core Measures review Analysis of patient medical record Variance reports 5

6 Satisfaction Data Patient satisfaction surveys Follow-up phone calls Patient complaints Media (including social media) Employee satisfaction surveys Medical staff satisfaction surveys Vendor surveys Financial Data Business Office CFO Insurance providers CMS Billing information Budget reports Facility Data Number of beds List of services offered Addresses Contact information 6

7 Volume data Numbers of patients, cases, births, deaths Visits to the ED Number of surgeries Census reports HR reports What do you do with it? Reported to appropriate venues Public Reporting Web Site Core Measures Mortality data Patient Satisfaction Financial data Internal reporting Board of Directors Quality Committee Executive Leaders and Medical Staff All staff Reporting of Data - External Reported to appropriate venues Public Reporting Web Sites Core Measures Mortality data Patient Satisfaction Financial data Accrediting bodies Clinical measures Performance metrics Outcomes data Local authorities Health Department, Police, Fire, Coroner 7

8 Reporting of Data - Internal Reported to appropriate venues Board of Directors Quality Committee Executive Leaders and Medical Staff All levels of staff Balanced Scorecards Public reporting of data Hospital Compare Checkpoint Metastar (QIO Quality Improvement Organization) State Vital Statistics Office 8