quality midterm2

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Scatter Plot

compares two variables (x- and y-axis); shows if there is a correlation

Baldrige National Quality Program

disciplined approach to addressing key patient/customer and stakeholder requirements and key operational requirements...built around cycles of learning

Snapshot reports

display data from one period; show relative strengths and weaknesses

In the PDCA model, we are trying to sustain the improvement and monitor improvement, why would we be monitoring and not making any changes?

if we don't have to make any changes, that means we are actually meeting out performance expectations so it is a good thing

Rapid cycle improvement

look at the process, make adjustments/small changes where they're needed, then reassess and see if more changes are needed; usually over a few days or a short period of time

"Scope creep"

make sure you have a well-defined scope or goal because without it, the process could go on forever

Nationally Recognized Practice Guidelines

measures are evidence-based

Run Chart/Line Chart

measuring something over time; total % or rate is shown (rate would by x1000)

Lean performance model

model works to eliminate inefficiencies adversely affecting performance (goal is to minimize waste)

Six Sigma improvement model

model works to reduce performance variability (goal is to try and get two zero errors/defects)

Special-cause Variation Rule #1

one point on or outside of the upper or lower control limit line

Why would someone choose to display outcome measures as a rate instead of a percentage?

outcome measures are usually comparative data, and rates smooth the data out (device days) so it is easier to compare the number (rate)

Six Sigma black belt

person with more knowledge in Six Sigma as far as the tools used and statistical analysis

What is the most common type of healthcare performance measure?

process measures

Conditions of participation

quality standards related to the CMS Medicare program

U.S. Commerce and National Institute of Standards and Technology (NIST)

reviews, develops, and disseminates evaluation criteria

Special-cause Variation rule #4

run of seven or more consecutive points either above or below the mean (centerline)

FOCUS-PDCA

same as PDCA, but the FOCUS part is different in the top areas; more formal; helps people work through the steps; more structured approach

Histogram

separated into rankings; shows central tendency (tails on either side); look for the L-curve

Special-cause Variation rule #3

seven consecutive points trend up or down, crossing the centerline (mean)

Control Charts

similar to line charts, but shows upper and lower control limits (usually +/- 3 standard deviations from the mean) - look for outliers

Tabular report

small amount of data from a short period of time; different time periods or different time periods; usually a chart (think Excel); doesn't necessarily have to have a time period on it

Goal

something that the organization wants to achieve; not always going to be a benchmark, but it can be

Pareto Chart

sorts performance data in order of increasing or decreasing frequency (can sit on either left or right side); ordered most significant to least significant; helps to determine what problems need to be solved and in what order

Special-cause Variation rule #2

two out of three (two or more) consecutive points fall close/near the upper or lower control limit line

Special-cause variation

unexpected variation in performance that results from a non-random event; must be investigated; something unnatural occurs

Bar Graph

usually displays ratios; ratio measures actual performance over expected performance (ratio should be less than or equal to 1)

Pie Chart

usually just for one single variable, one thing you're looking at; shows the breakdown of different types of whatever it is you're looking at

Statistical Process Control (SPC) tools

usually used for line graphs and control charts; used to distinguish between common-cause and special-cause variations in performance

Common-cause variation

variation in performance that doesn't result from a specific cause but is inherent (essential) in the process being measured; normal performance flucuations

National Quality Forum (NQF)

"seal of approval" for healthcare quality measures; where the standard practice guidelines come from

Six Sigma levels (higher the level, lower the defect rate)

-1 Sigma = 32% defect rate -2 Sigma = 50% defect rate -6 Sigma = 99.999% defect rate

3 Aims for the National Quality Strategy

-better care -health people/healthy community -affordable care

Examples of HROs

-commercial airlines -nuclear power -air traffic control

Steps in performance improvement

-define the improvement gaol -analyze current practices -design and implement improvements -measure success

2 Roles of Leaders

-find and fix system problems -reinforce and build accountability

Lean project steps

-identify performance problem -evaluate current work processes -identify areas of opportunity -find root cause of problems -design a better way of working -create implementation plan -identify expected improvements -make process changes and measure results

Quality Management (QM) activties

-measurement -assessment -improvement

9 Levers of the National Quality Strategy

-measurement and feedback -public reporting -learning and technical assistance -certification, accreditation, and regulation -consumer incentives and benefits design -payment -health information technology -innovation and diffusion -workforce development

Examples of structure measures

-number of nurse's hours working in a 24-hour period -number of disaster drills conducted annually

6 National Quality Strategy Priorities

-patient safety -person- and family-centered care -communication and coordination of care -preventative care -community health -making care affordable

Examples of outcome measures

-percentage of patients who developed a catheter-related UTI -number of patients who developed ventilator-related PN

Examples of process measures

-percentage of women who had a mammogram in the past 12 months -readmission rate -handwashing

Signs of need to improve performance

-performance doesn't meet expectations; no signs of special-cause variation -performance meets expectations; there are signs of special-cause variation -performance doesn't meet expectations; there are signs of special cause variation

HRO Principles

-preoccupation with failure -reluctance to simplify -sensitivity to operations -commitment to resilience -deference to expertise

6 Quality Dimensions

-safe -effective -patient-centered -timely -efficient -equitable

Baldrige

-secretary of commerce -proponent of quality management as a key to the USA's prosperity and long-term strength

Factors to consider in displaying measurement data

-type of data to be reported -audience for the data -intended use of the information

Baldrige Core Values

-visionary leadership -patient-focused -organizational and personal learning -valuing staff and partners -agility -focus on the future -managing for innovation -management by fact -social responsibility and community health -focus on results and creating value -systems perspective

Who created the PDCA (plan do check act) improvement model?

Shewart

Who created the National Quality Award in honor of Baldrige?

U.S. Congress

Goal of quality management

achieve maximum customer satisfaction at the lowest overall cost to the organization while continuing to improve the process

Benchmark

an idea of where your organization may eventually want to be, but a goal is what helps you get there over time; could be nationally set, or where another organization is

High Reliability Organization

an organization that has very few accidents/errors, but yet they're a very high-risk company industry

Outcome Measures

assess discrete patient end-points, final product, or end results

Structure Measures

assess the adequacy of the environment in which medical care takes place; the organization's capacity to provide care

Process Measures

assess what is being done and whether the system is working how it should; checking to make sure the services are delivered properly


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