Healthcare Quality: Basic concepts
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Transcript of Healthcare Quality: Basic concepts
بســـــم الله الرحمـــــن الرحـــــيم
In the name of Allah. Most Gracious, Most Merciful
QMD/ CPD Program
HEALTHCARE QUALITY BASIC CONCEPTS
Dr. Yasser Sami AmerMBBCh, MS Pediatrics, MS HC Informatics, CPHQ
Supervisor, R&D, QMD, KSUMCCPGs Advisor , KSUHs, AUHs
Member, NAHQ, USAMember, G-I-N Adaptation & Implementation Working Groups
Learning objectivesBy the end of this session, participants should be able to know:-
Basic concepts of Health Care Quality• Healthcare Organizations (CAS)• Definitions of Healthcare Quality (HCQ)• Dimensions of HCQ• Aspects of HCQ• Resources• Careers
An Indian tale Six Blind Men and the Elephant
http://www.youtube.com/watch?v=qPlJWk8-b4E
All of them were correct,and all of them were wrong !
current debates about HC Reform is like a modern version of the elephant
fable!• Various groups of stakeholders have banded
together to come up with their "solution” to the problems of current healthcare models.
• Too much is spent, outcomes are not good enough, and too many people are harmed.
• As solutions are presented, not only are the stakeholders convinced of their merit, they are also certain that counterproposals are wrong.
A complex adaptive system is comprised of a heterogeneous and diverse network of interacting and independent agents/elements that learn and adapt over time. Complex system behaviors are often said to be emergent and subject to self-organization. In short, the macro-level behavior of the system is more than the sum of the micro-level.
C – A – S
Inclusion of significant number of elements
Capacity to change and to
learn from experience
Set of connected or
interdependent things
HEALTHCARE ORGANIZATIONS (HCO) are Complex adaptive systems
C – A – S
Nursinga good example of complex adaptive system
Quality “as dictionary defined”
Noun peculiar and essential character, superiority of kind, degree or grade of excellence
Adjective having a high degree of excellence.
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Perfection of One's Work. The Messenger (peace be upon him) said: "Allah loves that if one does a
job he perfects it."
من اإلتقــــان إلى ............ اإلحســـان
In practice …………= doing right things right the first time
= the right care for every person every time
= first NO harm
Definitions of Quality in Healthcare o
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Healthcare QualityThe extent to which health services provided to individuals and patient populations improve desired health outcomes. The care should be based on the strongest clinical evidence and provided in a technically and culturally competent manner with good communication and shared decision making.
IOM 2001
KAIZENKAI = change, ZEN = good/ for the better
KAIZEN = continual improvement
Standards are created when experts are able to
understand what the right things are and now
the right things are best achieved
Quality = Compliance with the Standards
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Quality of care is ………AccessibleEffectiveSafeAccountable Fair
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Why do we need Quality in Healthcare?
•Increasing costs of healthcare in the presence of rising demands and limited resources.
•Variation in quality of medical performance and outcomes in similar health organizations.
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Inspection phase (1920-1940)
Total Quality Management (TQM) phase (Continuous Quality Improvement-CQI)
(1986 and currently)
Quality Control phase (1940-1960)
Quality Assurance phase (1970-1985)
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Three Aspects of QualityMEASURABLE
PERCEPTIVEAPPRECIATIVE
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Measurable Quality
Can be defined objectively as compliance with, or adherence to standards.
•Clinically, these standards may take the form of CPGs or protocols, or they may establish acceptable expectations for patient and organizational outcomes.
•Standards serve as guidelines for excellence.PROVIDERS ASPECT OF CARE
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Appreciative Quality
Is the appraisal of excellence beyond minimal standards and criteria.
•Requires the judgments of skilled, experienced practitioners and sensitive, caring persons.
• Peer review bodies rely on the judgments of like professionals in determining the quality or non-quality of specific patient-practitioner interactions.
PEER REVIEW/ ACCREDITATION BODIES, EXPERTISE AND SKILLED PERSON ASPECT OF CARE
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Perceptive QualityIs the degree of excellence which is perceivedby the recipient or the observer of care ratherthan by the provider of care.
Is generally based more on the degree ofcaring expressed by physicians, nurses, andother staff than on the physical environmentand technical competence.
RECEPIENT/ PATIENT ‘customer’ ASPECT OF CARE
ALL THE THREE ASPECTS OF QUALITY ARE ABSOLUTELY
ESSENTIAL TO OUR CONSIDERATION OF THE OUTCOME AND ALL ASSOCIATED PROCESS AND
STRUCTURE OF HEALTHCARE DELIVERY
Key Dimensions of Quality
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1. Safe2. Timely3. Effective4. Efficient5. Equitable6. Patient-centered7. Efficacy 8. Appropriateness9. Availability10.Continuity11.Respect and Caring
KEY DIMENSIONS OF QUALITY CARE PERFORMANCE
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Is the intervention/ setting relevant, correct given the need? Appropriateness
Is there sufficient access to care? Are there undue restrictions? Availability/ accessibility
Is care coherent and connected (considered less expensive)?Are there gaps or redundancies in care (considered more expensive)?“coordinated care” or “care coordination” in chronic diseased patients with mutli-morbidities
Continuity
Does data indicate desired and cost-effective treatment outcomes?Provide care based on scientific knowledge and EBP
Effectiveness
Does the proposed treatment have the capacity to produce the desired outcome, as demonstrated in the literature? (is it evidence-based?)
Efficacy
Are tests and treatments provided in a manner that conserves resources? Efficiency
to what extent the patient/designee/family was involved in the decisions and care provided, and treated with respect and dignity.
Respect & Caring
Does care protect patients, reduce risk, and reduce liability? Safety
Is care/intervention prompt/provided at the most beneficial necessary time?
Timeliness
Dimensions of Performance
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EFFECTIVENESS• Definition: Whether a drug or other treatment
works in real life. Effectiveness studies of drugs look at whether they work when they are used the way that most people take them. Effectiveness means that most people who have the disease would improve if they used the treatment.
• Example: antidepressant drugs are considered to be effective for the treatment of depression. These drugs have been examined in many clinical trials and other types of research studies (EBP).
AHRQ Glossary of Terms
EFFICACY• Definition: Whether a drug or other treatment works
under the best possible conditions. In a research study about efficacy, the study participants are carefully selected, and the researchers can make sure the drug is taken properly and stored properly. The study participants may differ from other people in the general public who have the disease. A treatment that has efficacy under the best conditions may not work as well in a different group of people with the same disease. AHRQ Glossary of Terms
Efficacy (cont’d)
Example: a recent clinical trial compared people treated with insulin to people treated with oral medicine for diabetes. Only people with no other medical problems were enrolled in the study, and most were under age 65. The people treated with insulin had better improvement in their blood glucose than the people treated with oral medicines.This study is considered an efficacy study, because only younger people without any other health problems were included. Many people who have diabetes are over age 65 and have other problems such as heart disease. It is not known whether the same results would be found in these people.
Changing the Healthcare Delivery System
As part of the agenda for change, the IOM’s Committee on Quality of Health Care in America established aims for the 21st century healthcare system. The committee proposed six improvement aims to address key dimensions of healthcare quality that were performing at far lower levels than they should be.
They suggested that healthcare at a minimum should be: STEEEP !
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Framework for Quality: Six Key Areas of IOM Report
Six key areas of quality of healthcare are needed to be monitored. Healthcare should be:(Acronym: STEEEP)– Safe – Timely– Effective– Efficient– Equitable– Patient-centered
The Healthcare Customer
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A “customer”is one who receives goods or services .
It is a concept utilized in TQM philosophy to identify the needs, expectations, and preferences of all who are affected by the healthcare services we
provide.
Customers are our "dependents"; they rely on us for a service or product.
The Concept of the CustomerExternal Custom
ersOutside organiza
tion
Patient, family,
vendors
Internal Custom
ersWithin
organization
Clinicians,
nurses, clerks
Healthcare System
Quality of Care
Standards for Licensure
Addresses the structure
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Quality of Care
Standards for Certification (e.g.. ISO)o Focus an capability rather than results o Thus address structure and Process than
on the outcome.
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Quality of Care
Standards for Accreditation Addresses Structure, Process and Outcome of care.
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StandardIs defined as an explicit predetermined expectation set by a competent authority, that describes an organization’s acceptable performance level.
Standards Should be :Optimal Achievable When met would lead to highest possible quality in a system
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Resources in HCQ
AHRQuality Indicators
CPGs
www.qualityforum.org/Home.aspx
ISQua http://www.isqua.org/
Janet Brown, BA, BSN, RN, CPHQ, FNAHQwas active in the healthcare quality field since 1978 as an administrative director, consultant, and nationally known
educatorhttp://jbqs.com/about-janet
Careers in HCQ (in USA)Healthcare Quality Professional
(Academic degrees OR Professional certificates)
• Thomas Jefferson University/ Jefferson School of Population Health: MS in Healthcare Quality & Safety
• Northwestern University Feinberg School of Medicine/ Center for Education in Health Sciences: Graduate Programs in Healthcare Quality and Patient Safety (MS, PhD & certificate)
• National Association for Healthcare Quality: Certified Professional in Healthcare Quality
• ISQua: Fellowship Programme
CPHQ• Information management• Performance Improvement• Strategic leadership and people
management• Patient safety• Accreditation and continuous readiness• Change management
Questions? Tanong? सवाल? ?سواالت
Acknowledgment
Dr. Magdy Gamal Youssef,MBBCh, MS OBGYN, DTQM, CPHQ
Former Director, Healthcare Quality Directorate, Alexandria University Hospitals, Alexandria, Egypt
Dr. Yasser Sami AmerEBCPGs Advisor & Trainer
[email protected]@ksu.edu.sa