quality midterm2
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
