Introduction to Quality Tools

1. Quality Tools,
Data Collection
& Indicators
Prepared & Presented by:
Ms. Alaa M Abdeen
CPHQ,DTQMH, LSSGB
CQI Director

2. INTRODUCTION
Quality is Defined As:
 Doing the right things (What component) right
(How component) the first time and every time.
 Healthcare that is Accessible, Effective, Safe,
Accountable and Fair.
 According to Juran quality is :
Freedom from deficiencies.
Product features.

3. Key Dimensions of Quality
1.Appropriateness
2.Availability
3.Competency
4.Continuity
5.Effectiveness
6.Efficacy
7.Efficiency
8.Prevention & early
detection
9.Respect & caring
10.Safety
11.Timeliness
:: Dimensions of qualityperformance ::
Quality Concepts

4. Appropriateness
The degree to which the provided
care/intervention is :
relevant to the patient's clinical
needs,
given the current state of
knowledge.
Quality Concepts

5. Efficacy
The potential, capacity, or capability
to produce the desired effect or
outcome, e.g., through scientific
research (evidence-based) findings.
•Ex. Specific antibiotic has high
efficacy against certain bacteria.

6. Effectiveness
 The degree to which care is provided in the
correct manner, given the current state of
knowledge, to achieve the desired or
projected outcome(s)for the individual.
 E.g.
Unplanned readmission rate is 3% less than
national average
The average blood sugar level of diabetic
patients attending the clinic is…

7. Efficiency
The relationship between the outcomes
(results of care) and the resources used
to deliver care.
The delivery of a maximum number of
units of healthcare for a given unit of
health resources
 Reducing readmissions
 LOS
 Cost

8. The Juran Trilogy

9. Quality Planning is defined as
 The activity of developing the products and
processes required to meet customer needs by
determining who the customers are as well as
their needs;
 Developing product features and processes that
respond to needs and produce desired product
features; and transferring the resulting plans to
the operating forces.
The Juran Trilogy

10. Quality Control / Measurement is
The Evaluation of actual quality
performance, comparing actual
performance to quality goals and
acting on the differences
The Juran Trilogy

11. Quality Management/ Improvement is:
A planned, systematic, organization-
wide (or network wide) approach to
the monitoring, analysis, and
improvement of organization
performance, there by continually
improving the quality of patient care
and services provided and the
likelihood of desired patient
outcomes.
The Juran Trilogy

13. Quality does not occur by
accident!!
 What does the customer actually want?
Identify, understand and agree
customer requirements
 How are you going to meet those requirements?
Plan to achieve them

14. Quality improvement methodologies
are Many………such as;
F IND OPPORTUNITY
O RGANIZE A TEAM
C LARIFY THE PROCESS
U NDERSTAND THE PROBLEM
S ELECT A DESIRED OUTCOME
FOCUS-PDCA
1. Plan
2. Do3. Check
4. Act
THE DEMING CYCLE

15. Continuous QI should be viewed as a
cycle.
PDCA = Plan, Do, Check, Act
 Plan (P): identify the problem, analyze the situation,
and develop an implementation plan
 Do (D): Implement plan, collect data.
 Check (C): analyze collected data, compare
obtained results against expected results.
 Act (A): Reinforce plan, if results are as expected; OR
Revise plan (using PDCA cycle), if results are not as
expected.
THE DEMING CYCLE

16. Quality improvement tools
Can be categorized into:
 Tools of Teams
Tools to process Analysis
Tools to plan
Tools for Problem Solving(RCA)
Tools of Data Collection
INTRODUCTION

17. Teams
Tools
 Brainstorming
 Affinity Diagram
 Prioritization matrix
 Pareto chart

18. BRAINSTORMING
 Define the subject and direction
of the session;
 Allow time for initial, individual
thought;
 Establish a time limit for the entire
session;
 Request ideas according to the
predetermined structure;
 Clarify all ideas generated to
assure accuracy and
understanding.
Five steps of brainstorming

19. AFFINITY DIAGRAM
 The affinity diagram
organizes a large number
of ideas into their natural
relationships.
 Can be used after a
brainstorming exercise.

20. Prioritization Matrix
It is a tool used to select one option from a group of
alternatives, be they problems or solutions, or to put
the options into priority order is all need to be done.
It promotes objective decision making.

21.  A theory that suggests that more than 80% of the
problem is caused by less than 20% of the Causes
 "the vital few Vs. the useful many"
Paretto Diagram
VITAL
FEW
Useful Many
80
%

22. Process
Analysis Tools
When you want to
understand a work process
or some part of a process,
The Following Tools can
Help;
Flowchart
Histograms
Control Charts
Spaghetti Diagram

23. FLOWCHARTSRegistration Process
flowchart

24. Classification of Flowchart’s shapes
FLOWCHARTS

25. Control Charts

26. Used in Tracking process/ Improvement
Control Charts

27. Histograms
Used for Continuous Data such as
Weight, Time, Height.. Etc.
As well as Control Charts its distribution
gives indication on stability/ Variation in
a process

28. SPAGHETTI DIA.

29. Planning
Tools
After identifying the
problem(s) we have to
develop a plan for
improvement
We can use either :
Gantt Chart or
Action Plan

30. Gantt Chart
Gantt Chart is useful in planning for a
project schedule where one step (stage)
depends upon another or some steps are
occurring simultaneously

31. ACTION PLAN
HowWhereWhenWhoWhat

32. RCA (Root Cause Analysis)
It is a problem solving
methodology that can be
done by many tools :
• 5 Whys
• Cause & Effect
Diagram = Fish Bone
Diagram (ISHIKAWA
Diagram)
Scatter Diagram
It is used to determine the Root
cause/causes of any problem by
categorizing the possible causes
into well represented form.
PROBLEM
SOLVING
TOOLS

33. )5P) If we are
discussing
process problem
(5M) If we are
discussing
product problem
People Manpower
Provisions(resour
ces)
Materials
Procedures Methods
Place(environme
nt)
Machines
Patron(Patient) Measurements
Fishbone DiagramDefined categories

34. FISH BONE

35. Scatter Diagram

36. DATA
COLLECTION
TOOLS
& How to Use Data

37. What are the sources of Useful
Data?!
 Medical Records
 Direct Observation
 Staff feedback (OVR, Staff Satisfaction
Questionnaires……)
 Patient/family feedback (Patient Satisfaction
Questionnaires, Patient Complaints….)
Data Sources

38. TYPES OF DATA COLLECTION TOOLS: (HARD
COPY OR ONLINE
Types
DATA
SHEET OR
WORK
SHEET
CHECK
SHEET OR
TALLY SHEET
SURVEY OR
QUESTION
NAIRE
INTERVIEW
OR FOCUS
GROUP
DATA COLLECTION TOOLS

39. Criteria for assessing how fit a data
collection method is :
 Does the tool really measure the process or
aspect of care and its indicator?
 Will you get the information you really need?
 Will the data you get be interpretable?
 Is it efficient in terms of time, sample size, & staff
availability?!
 Availability of knowledge & skill in its
construction and use.
Data Collection

40. considerations
Keep as short as simple as possible
Include all data elements necessary to
monitor specified issues indicator
Use data definition rules
Provide appropriate definition of terms
and key for using the tool

41. You Can not Improve/ Manage
what you cannot Measure,
And you can’t Measure what
you can’t Define

42. Why Measure?!
 All Decisions should be based on information derived
from reliable data
 To Compare with own previous performance
 To know that there is a problem
 Know its size, Identify the trends, and differentiate
common cause from special cause variations.
 To know the success or failure of the pilot
interventions.
INDICATORS

43. Why Measure?!
 To Compare your performance with Others!!
 That is called Benchmarking:
It is a management tool & a measurement
process used to compare your own performance
against others considered to have “ Best Practice”
 Best Practice is identified through scientific
evidences.
INDICATORS

44. What is an Indicator
 Are Reliable and valid measures used to
screen/assess organizational and practitioner
performance issues, but not direct measure of
quality.
 Indicator is a number which reflects your
performance.
INDICATORS

45. What is an Indicator?!
 Examples:
- Average waiting time in Outpatient Clinics
- % of Healthcare Acquired Infections
- Medication Errors
- Rate of Hb A1c Testing
- Patient Satisfaction
- Staff satisfaction
INDICATORS

46. Types of Indicators are:
 Structure Indicators, e.g. Availability of
Emergency Medications, Staffing Ratios
 Process Indicators e.g. Rate of foot exam for
diabetic patients, Monitoring of blood & Blood
products Administration..Etc.
 Outcome Indicators, e.g. % of diabetic
patients developing foot ulcers, Blood
Utilization C/T Ratio, Patient Falls.. Etc..
INDICATORS

47. What are criteria for choosing Indicators?!
 Remember: Work SMART NOT Hard….
 High Volume/ High Risk
 Low Volume/ High Risk
 Problem Prone
 High Cost
 Complex/ Interdisciplinary Processes
Are the Most vital processes to monitor via
indicators.
INDICATORS

48. Quality is a Journey…
Not A Destination…..
REMEMBER….

49. REFERENCES
 Slide Share
 Janet Brown
 AUC Educational Materials

50. QUESTIONS?!!