Quiz 1 - Quality and Performance Improvement in Health care chps 2-9

Outcomes

The final RESULTS of care, treatment, and services in terms of the patient's expectations, needs, and quality of life, which may be positive and appropriate or negative and diminishing

Systems

The foundations of CAREGIVING, which include BUILDINGS (environmental services), equipment (technical services), professional STAFF(human resources), and appropriate POLICIES (administrative systems) and PROCEDURES.

Processes

The interrelated activities in healthcare organizations that promote effective and safe patient outcomes across services and disciplines withing an integrated environment. HOW YOU ARE DOING ACTIVITIES OF HEALTHCARE.

Reliability

The level at which an organization can provide an offered product or service when requested and as advertised Example: ER promises that patients will receive care within 15 minutes. To be deemed reliable by customers, that 15 minute goal must e met when they up for emergency services

Utilization Review (UR)

The process of determining whether the medical care provided to a specific patient is necessary according to pre-established objective screening criteria at time frames specified in the organization's utilization management plan

What does the Joint Commission's require for performance Improvement

To appoint a leadership group to oversee organization-wide PI activities. The leadership group is composed of the senior governing, administrative, and management groups of a healthcare organization that are responsible for setting the mission and overall strategic direction of the organization. health record delinquency rate at less than 50% (The Joint commission will cite the healthcare organization with a requirement for improvement if the total average health record delinquency rate exceeds 50 percent of the average monthly discharges in any one quarter. Hospitals commonly set the benchmark for their health record delinquency rate at less than 50 percent.)

Perceived quality

consists of the organization's reputation for the quality of its services and consumer reaction to these services and products based on their experiences with the organization

Case management

the principal process by which organizations optimize the continuum of care for their patients.

Outcomes measures

the result of the process of systematically tracking a patient's clinical treatment and responses to that treatment, including measures of morbidity and functional status, for the purpose of improving care. An outcome measure may be the effect of care, treatment, or services on a customer, such as an unanticipated adverse event.

Continuum of care

the totality of healthcare services provided to a patient and his or her family in all settings, from the least to the most extensive. The emphasis is on treating individual patients at the level of care required by their course of treatment.

What is the criteria used to establish performance measure?

# of patient records with appropriate documentation ------------------------------------------- Number of patient records reviewed

What are the 4 steps to case management

1. Perform pre-admission care planning (intiated when the patient's physician contacts a healthcare to schedule an episode of care service) 2. Perform care planning at the time of admission (case manager confirms that the patient meets the admission criteria for an admitting diagnosis). 3. Review the Progress of care( cm reviews the patient's progress throughout the entire episode of care) 4. Conduct discharge planning

core processes involved in care, treatment, and services to patients are

1. assessing patient needs 2. planning care, treatment, services 3. providing the care, treatment, and services that the patient needs 4. Coordinating care, treatment, and services

team member

A performance improvement team role responsible for participating in team decision making and plan development; identifying opportunities for improvement; gathering, prioritizing, and analyzing data; and sharing knowledge, information, and data that pertain to the process under study

Interview

A series of "open-ended" questions delivered to the selected respondents whose answers must be analyzed to identify common themes and perceptions

Action Plan

A set of initiatives that are to be undertaken to achieve a performance improvement goal

Systems 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 then finding ways to make lasting improvements "we're all parts of a whole"B

Benchmarking

An organization compares its current performance with its own internal historical data, or uses data from a similar external organizations across the country. A "standard" of performance or best practice, for a particular process or outcome.

Histogram

Bar graph that displays data proportionally -Displays large amounts of continuous data that are difficult to interpret in lists or other nongraphic forms -Shows the relative frequency of the various data categories indirectly using the height of the bars -Shows the distribution of the absolute frequencies of the data in the grouped intervals

Ground rules

Basic rules expectations for team members and include discussion of attendance, time management, participation, communication, decision-making, documentation, room arrangements, and cleanup.

What are the QI Toolbox Techniques

Brainstorming, Affinity diagrams, Nominal group technique

patient centered care

Care that involves the patient and the patient's family in care decisions; a respect for the patient's values, preferences, and expressed needs; and an emphasis on the provider's cultural competence.

Rapid movement team

Constructs relatively simple fixes that improve work processes without going through the whole PI process and without the need to involve other departments. Thus, an improvement can be implemented without a major investment of time, personnel, and resources.

Quarterly reports

Document based on the recorded meeting minutes and should include information about PI activities, such as summaries of data collection, conclusions, and recommendations

Pivot Table

Excel tool to summarize data according to categories. Example: they may used to summarize charges according to department, counts of coded data elements, etc.

ordinal data (aka ranked data)

Express the comparative evaluation of various characteristics or entities, and relative assignment of each, to a class according to a set of criteria Many surveys use a Likert scale to quantify or rank statements. A Likert scale allows the respondent to state the degree to which he or she agrees or disagrees with a statement.

Process measure

Focuses on a way of delivering services that leads to a certain outcome. A scientific or experiential basis must exist for believing that the process, when executed as designed, will increase the probability of achieving a desired outcome. Example of process measures: are the percentage of antibiotics administered immediately prior to ope reduction internal fixation surgeries or the decision to incision time for cesarean sections

Standards of care

For a healthcare organization to define optimal car, it must first establish a set of clinical decisions and actions taken by clinicians and other representatives of healthcare organizations in accordance with state and federal laws, regulations, and guidelines

nominal group technique

Gives each member of the team an opportunity to select the most important ideas from the affinity diagram. This technique allows groups to narrow the focus of discussion or to make decisions without getting involved in extended, circular discussions during which the more vocal members dominate. All of the ideas obtained earlier are written in a place where everyone can see them. Team members vote on the various issues or ideas to determine which should be considered first. The facilitator writes the numeral "1" by the idea that each team member chooses as most important. This process continues until all of the team members have ranked all of the issues or ideas on a numerical scale.

External customers

Individuals from outside the organization who receive products or services from within the organization Examples: patients, family members of patients, and friends of patients

Internal customers

Individuals within the organization who receive products or services from an organizational unit or department Example: surgeons are the internal customers of the pathology lab, and emergency are physicians

Agenda

Plan of action; purpose. A list of the tasks to be accomplished during a meeting

Cross-functional PI team

Involves more than one department, service area, or discipline. Example: cross-functional team may be needed to address a shortage of blood or blood products in a hospital that cares for emergency, surgical, and obstetrics patients, any of whom may need blood at any time during their hospital stay. Individuals from all areas, including the laboratory, admin, surgery, obstetrics, and the ED, may need to help set priorities and explain the particular needs of their own areas.

Unstructured brainstorming

Members of the team offer ideas as they come to mind. Some members may have no ideas to offer, and others may contribute a number of ideas

Discrete data

Numerical values that represent whole numbers. Can be displayed in bar graphs Example: the number of children in a family or the number of unbillable patient accounts

High Reliability Organizations (HROs)

Organizations that know that unexpected change can sometimes be prevented or at least anticipated and even prepared for through a preoccupation with failure and sensitivity to operations and weak signals of trouble. Encourages mindfulness, awareness to foresee errors ahead of time to fix them before it escalates. Encourages employees to speak up when they see something wrong. Mindlessness and distraction occur when employees are hurried or overloaded. (nurse administering meds and gets interrupted. Losing focus on medication administration is an example of mindlessness and is a prime situation where medical errors can occur.)

survey

Questions asked that must have measuring process capabilities. It is easier to aggregate data from a survey than from an interview because surveys usually are composed of structured responses.

Customers

Receive a product or service as a result of an organizational process. Example: HIT is a customer of the patient registrar or admitting clerk because the HIT professional relies on the patient registrar to collect accurate demographic information to properly identify the patient in the EHR and assign the correct health record number.

Severity of illness

Refers to how sick the patient is, or what level of care the patient requires, such as intensive care or general medical care

Intensity of service

Refers to the type of services or care the patient requires

Who does CLIA oversee

Regulate Laboratory services

What are the Performance Improvement Frameworks

Six Sigma Lean Lean Six Sigma High reliability organizations (HROs)

Benefits of Storytelling

Team accomplishments are documented PI team work is presented Employees are informed of important organizational quality issues Empathy created among staff for patients Forum for recognition of quality work

Lean

The concept of implementing value and eliminating waste. A quality improvement technique often seen in the manufacturing sector. -Streamline processes in: -Overproduction (ordering duplicate tests) -Wasting time (long wait times for patients) -Waste of stock on hand (outdated or unused medications) -Waste of movement (time spent walking from one area to the next -Waste of defective (documenting the wrong information on a patient's record) -Waste in transportation (moving patients unnecessarily -Waste in processing (duplicate forms or redundant capture of information

Clinical practice standards

The established criteria against which the decisions and actions of healthcare practitioners and other representatives of healthcare organizations are assessed in accordance with state and federal laws, regulations, and guidelines

Bar Graphs

Used to display discrete categories of data

CRAF

Used to document the minutes of meetings. -Conclusions of group discussions -Recommendations made by the committee or team -Actions that the committee, team, or individual members decided to take -Follow-Up activity

Check Sheets

Used to gather data based on sample observations in order to detect a pattern. The team should consider the four W questions -Who will collect the data? -What data will be collected? -Where will the be collected? -When will the data be collected?

Control chart

Used to measure key processes over time -Focuses attention on any variation in the process -Helps the PI team determine whether that variation is normal or a result of special circumstances Normal variation (aka common cause variation, or the expected variance in a process, because the process will not or cannot be performed in exactly the same manner each and every time. Special variation- when a special circumstance or unexpected event occurs in the process.

Six Sigma

Uses statistics for measuring variation in a process with the intent of producing error-free results. To improve processes and delivery of care in it's organizations. Refers to the standard deviation used in descriptive statistics to determine how much an event or observation varies from the estimated average of the population sample

When should the team-based approach be considered?

When the improvement opportunity is complex, or involves multiple departments or multiple work units within a department.

Pareto Chart

a kind of bar graph that uses data to determine priorities in problem solving. Helps the PI team to focus on problems and their causes.

Team leader

a manager who is responsible for facilitating team activities toward achieving key results

Indicator

a performance measure that enables healthcare organizations to monitor a process to determine whether it is meeting requirements.

continuous data

assume an infinite number of possible values in measurements that have decimal values as possibilities. Displayed in histograms Example: weight, blood pressure and temperature

Assurance

describes knowledge and courtesy of the staff that provide the goods and services. Trust

Vision Statement

describes what the organization or PI team initiative will look like or be in the future, or it describes some milestones the organization or PI team will reach in the future. Example: Safe and timely laboratory services are provided 98% of the time.

Timekeeper

helps the team manage its time and notifies the team during meetings of time remaining on each agenda item in an effort to keep the team moving forward on its PI project.

Mission Statement

identifies the PI team, what it does, and who it serves Example: Evaluate hospital laboratory services for patients with regard to safety issues, error-reduction processes, and delivery of services while maintaining 94 percent compliance with these services

Nominal data (categorical data)

include values assigned to name-specific categories. Usually displayed in bar graphs and pie charts Example: health insurance status can be subdivided into three groups (yes, no, or don't know) or three categories (1, 2, 3)

Lean Six Sigma

incorporates the attributes of Lean by focusing on the elimination of waste and removal of unnecessary steps in a process in order to increase the speed at which a process is done. Attributes of Six Sigma are incorporated in order to improve accuracy, such as the reduction of variation within processes leading to increased optimization. By the two methodologies, the characteristics of each work together to decrease waste and eliminate variation, creating process that have both speed and accuracy to provide better care to patients with increased quality.

Functional PI team

involves staff from a single department or service area,

Team recorder

keeps minutes of the team's work during the meetings, including any documentation required by the organization

structured brainstorming

leader solicits input from team members by going around the table or room. Each team member comments on the issue in turn or passes util the next round. The process continues until participants have no new ideas to suggest or u til the time period set in the meeting's agenda has elapsed

Storytelling

report format that explains the PI purpose, process undertaken, analysis, and results of team activities in an easily understood manner by anyone interested. Key elements to successful storytelling: Organization• Structure• Timeliness• Frequency• Connection• Celebration• Feedback

Line Chart/Graph

simple plotted chart of data that shows the progress of a process over time. By analyzing the chart, the PI team can identify trends, shifts, or changes in a process over time. The chart tracks the time frame on the horizontal axis and the measurement on the vertical axis

Team facilitator

someone who knows the PI process well and has facilitated such a team in the past. The facilitator may be required to train the team in the PI process and quality improvement tools. The facilitator also is required to understand the process to be improved and is primarily responsible for ensuring that an effective PI process occurs.

Empathy

staff's willingness to relate to customers during the provider-customer relationship as fellow human beings who have feelings and emotions.

Responsiveness

the ability to provide prompt service

Features

the aspect of healthcare services that distinguish one organization from another or that add particular value in the customer's evaluation of an organization.

Storyboard

typically a physical display presentation on a cardboard trifold, which may be created using printouts of documents and graphs created on a computer

Affinity diagrams

used to organize and prioritize ideas after the initial brainstorming session. This type of diagram is useful when the team generates a large amount of information.The team members agree on the primary categories or groupings from the brainstorming session, and then secondary ideas are listed under each primary category. This process may be completed manually using adhesive notes or using a software tool. All ideas can easily be transferred from one category or grouping to another as team members work to group or rate ideas. (think posted notes laid out in 3 stacks)

Pie Chart/Graph

used to show the relationships of each part of a whole. Shows how each part contributes to the total product or process