Quality and Performance Improvement in Healthcare

Establishment of a PI program

* Define and implement the organization wide PI model. * Establish a staff education plan to train employees in PI. * Prioritize and define PI measures. * Define data collection and reporting responsibilities. * Appoint PI teams when process variation exceeds established benchmarks. * Maintain a process of reporting significant findings and corrective actions to the board of directors and other stakeholders

What are 5 key areas in which accountable care organizations must meet quality standards?

*Patient/caregiver care experiences *Care Coordination *Patient Safety *Preventive health * At-risk population/frail elderly health(HHS 2011)

JACHO Joint Commission of Accreditation of Healthcare Organization.

1952 took over hospital standardization program and the process became known as accreditation rather than standardization

Opportunity for improvement

A healthcare structure product service process or outcome that does not meet its customers expectations and therefore could be improved.

Total Quality management (TQM)

A management philosophy developed in the mid 20th century by W. Edwards Deming (1986) and others who encouraged industrial organizations to focus on the quality of their products as their paramount mission.

Process measure

A measure that focuses on a process that leads to a certain outcome, meaning that a scientific basis exists for believing that the process, when executed well, will increase the probability of achieving a desired outcome.

Outcome measure

A measure that indicated the result of the performance of a function or process.

Lean

A quality improvement technique involving a systematic method to streamline processes to eliminate waste. Successful implementation of Lean Techniques in a healthcare.

Normal group technique

A quality improvement technique that allows groups to narrow the focus of discussion or to make decisions without becoming involved in extended circular discussions.

Performance measures

A quantitative tool that provides an indication of an organization's performance in relation to a specified process or outcome.

Quality Assurance (QA)

A set of activities designed to measure the quality of a service, product or process with remedial action as needed to maintain a desired standard.

QA

A term commonly used in healthcare to refer to quality monitoring activities during the 1970s and 1980s at which time it connoted a retrospective review of care provided with admonishment of providers for substandard care.

Retrospective Payment system

A type of fee for service payment in which healthcare providers are paid for services provided to patients in the past.

Brainstorming

An idea generation technique in which a team leader solicits creative input from team members

System Thinking

An objective way of looking at work-related ideas and processes with the goal of allowing people to uncover ineffective patterns of behavior and thinking and the finding ways to make lasting improvements.

Sentinel events

An unexpected occurrence involving death or serious physical or psychological injury or risk thereof. The phrase or risk thereof includes any process variation for which a recurrence would carry a significant chance of serious adverse outcome.

HIPAA

As part of this legislation the secretary of HHS was directed to create healthcare integrity and protection data bank.

Managed Care

Control cost by requiring beneficiaries to seek services from a preapproved list of providers by limiting access to specialists and expensive diagnostic and treatment procedures and by requiring preauthorization for inpatient hospitalization and surgery

The Joint Commission (TJC)

Current name for the organization previously known as JCAH and JCAHO

Improving Medicare Post-Acute Care Transformation Act of 2014. (IMPACT Act)

Established a quality reporting program for skilled nursing care that required long term care hospitals, skilled nursing facilities, home health and inpatient rehabilitation facilities to submit standardized data pertaining to resource use, hospitalization and discharge to the community

CMS Centers for medicare and medicaid Services

HCFA the agency that managed the medicare system changed its name to this in 2002.

North Carolina

In 1903 this state passed the first nurse registration bill and other states soon followed.

American College of Surgeons (ACS)

In 1917 _________ established foundation for the hospital standardization program

Indicator Measurement System (IMS)

In 1994 as part of JCAHOs changes they required data collection for initial indicator sets referred to as ______________.

JCAHO Oryx Initiative

In 1997-98 this was designed to incorporate outcomes measurement and monitoring into the accreditation process for hospitals LTC and Home care networks and later was expanded to include home health and behavioral health organizations.

National Patient Safety Goal

In 2003 JCAHO implemented this change

Affordable Care Act (ACA)

Mandated increased quality measure reporting by payers and providers at all levels of care by implementing penalties for poor care in terms of reimbursement and by improving access for the millions of Americans who prior to the act's implementation, had nowhere to turn but the nations emergency departments. New reporting of quality measures would establish a quality measurement program for medicare and require long term care and hospice facilities to submit data on their quality of care for the first time.

Performance of improvement team (PI)

Members of the healthcare organization who have formed a functional or cross functional group to examine a performance issue and make recommendations with respect to its improvement.

TQM

Mobilized individuals directly involved in a work process to examine and improve the process with the goal of achieving a better product or outcome

Certification

Need before you can perform duties on the job for medical professions. (Licensure,registration or ______)

High Reliability organizations (HRO's)

Organizations that know that unexpected change can sometimes be prevented or at least anticipated and even prepare for through a preoccupation with failure and sensitivity to operations and weak signals of trouble.

Leadership Group

Oversee organization wide PI activities. Responsible for setting the mission and overall strategic direction of the organization.

Accountable Care Organization (ACO)

Proposed in the Affordable Care Act of 2010 an ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. An ACO would agree to manage all of the healthcare needs of a minimum of 5,000 medicare beneficiaries for at least three years

Value-bases purchasing

Seen primarily in the public sector a system in which purchasers hold providers of healthcare accountable for both the costs of healthcare and its quality. In private sector pay for performance programs are more common and base providers payment on performance and incentives

Core Measures

Sets of patient care characteristics that the Joint Commission and Centers for Medicare and Medicaid Services have determined to reflect the quality of care an organization can provide for important diagnoses.

Abraham Flexner

Studies of Medical education found that medical schools that existed at that time were inadequate and that there were no standards for education of physicians.

Cost

The amount of financial resources consumed in the provision of healthcare services.

1872

The first general training school for nurses was developed.

New York

The first to begin the practice of medical licensure

Structure

The foundation of care giving which includes building equipment technologies professional staff and appropriate policies

Systems

The foundations of caregiving, which include buildings(environmental services), equipment(technical services), professional staff( human resources), and appropriate polices(administrative systems).

Performance measurement

The indicator of a healthcare organization's performance in relation to a specified process or outcome.

Processes

The interrelated activities in healthcare organizations that promote effective and safe patient outcomes across services and disciplines within an integrated environment.

Process

The interrelated activities of healthcare organizations including governance managerial support and clinical services that affect patient outcomes across departments and disciplines within an integrated environment.

Continuous Monitoring

The regular and frequent assessment of healthcare processes and their outcomes and related costs.

Outcomes

The results of care treatment and services in terms of the patients expectations needs and quality of life which may be positive and appropriate or negative and diminishing.

Outcome

The results of care, treatment and services in terms of the patients expectations needs and quality of life which may be positive or negative and diminishing.

Sigma

The standard deviation used in descriptive statistics to determine how much an event or observation varies from the estimated average of the population sample.

Process redesign

The steps in which focused data are collected and analyzed, the process is changed to incorporate the knowledge gained from the data collected, the new process is implemented and the staff is educated about the new process.

Benchmarking

The systematic comparison of the product services and outcomes of one organization with those of a similar organization.

Hill-Burton Act

This legislation established funding to build new hospitals to create better place for patient care to occur.

AMA (American Medical Association)

This organization was formed in 1840 to represent the interests of physicians.

Donabedian

This quality improvement model assesses healthcare from four perspectives: structure, process, outcome and cost

1965

Title XVIII was created in this year which incorporated requirements for evaluating quality and appropriateness of inpatient care.

Affinity diagrams

To organize and prioritize ideas after the initial brainstorming session. Useful when the team generates a large amount of information.

QI toolbox techniques

Tools that facilitate the collection , display and analysis of data and information and that help team members stay focused including cause and effect diagrams graphic presentations and others.

Six Sigma

Uses statistics for measuring variation in a process with the intent of producing error free results.

Benchmark

also known as a standard of performance or best practices for a particular process or outcome