1. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Health Care,Health Care,
Not only qualityNot only quality
But also improvementBut also improvement
Rule # TwoRule # Two
Health Care Quality isn’t aHealth Care Quality isn’t a
destination but a Tripdestination but a Trip

2. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
AgendaAgenda
31-05-201031-05-2010
Health Care QualityHealth Care Quality
Methods for Policies andMethods for Policies and
ProceduresProcedures
ImplementationImplementation
““Problem Solving”Problem Solving”

3. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
PartsParts
------------------
1- PDCA= Plan, Do Check, Act1- PDCA= Plan, Do Check, Act
2- FOCUS= Find, Organize,2- FOCUS= Find, Organize,
Clarify, Understand, SelectClarify, Understand, Select
3- SE = Sentinel Events3- SE = Sentinel Events
4- SWOT= Strength, Weakness,4- SWOT= Strength, Weakness,
Opportunity, ThreatsOpportunity, Threats
5- TF= Team Formation5- TF= Team Formation

4. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
PART 1PART 1
PDCAPDCA
Plan Do Check ActPlan Do Check Act
Used for a problem seen forUsed for a problem seen for
1st time1st time
Also called “Deming Cycle”Also called “Deming Cycle”

5. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
PDCA: -
It is a simple, logical,
and systematic approach to
1- Compose a new process
2- Problem solving.

6. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Plan:
1- Design a timeline of resources
,activities, training and target
dates.
2-Develop a data collection plan.
3- Assess tools for measuring
outcomes.
4- Determine when to get
the target

7. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Do:
Collect DATA & implement
interventions.

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Check:
analyze results of data
and evaluate reasons
for variation.

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Act:
act on what is learned and determine
next steps.
1-If the intervention is successful, work
to make it part of operating procedure.
2- If it is not successful, analyze
sources of failure, design new solutions
and repeat the PDCA cycle.

10. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
PART 2PART 2
FOCUSFOCUS
In case a process already exists,
Begin with FOCUS

11. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
FOCUSFOCUS
Stands for:Stands for:
• Find a process to improve
• Organize to improve a process
• Clarify what is known
• Understand variation
• Select a process improvement

12. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Step 1 "F" Find
a problem, process improvement
opportunity.
• Problem identified through
assessment or through prioritization?
• What is your baseline data ,
• Who are the internal and external
customers?
• Write a one or two sentence of the
improvements that is needed.

13. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Step 2
"O" Organize
• One team that knows about the problem or
process in review.
 Who would be helpful?
 Tell the selected team to achieve the
purpose of the project.
 Plan and decide who is going to be the
leader, as well as who is going to write and
document.

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Step 3.
"C" Clarify current knowledge of
the process/problem.
A problem well stated is a
problem half solved.

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Analyze the process
the background of the problem?
What is the cost of the process?
Is there customer complaints,
incidents?
Is the problem chronic or
sporadic?
Use tools: flowcharting and
brainstorming.

16. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Step 4. "U" for Understand
1-Causes of process variation
and find possible causes of
problem.
2-Investigate unusual
happenings that require some
research & analysis.
The Ishikawa or cause-effect fishbone
diagram
M.M.M.M.E.
men (personnel, staffing and training), materials or
items used, the methods or operating procedures,
machines or equipment such as computer systems,
and the environment such as sound and workload

17. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Step4 follow
M.M.M.M.E. mnemonic
Men (personnel, staffing and
training)
Materials or items used
Methods or operating
procedures
Machines or equipment such as
computer systems,
Environment such as sound and
workload

18. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Step4 follow
Ask yourself questions, what
might be the cause?
Is the problem affected by
employee fatigue related to on-
call schedule?

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Step 5
"S" Selects
•Select the performance
improvement to consider as
priority
•select an improvement
strategy

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RememberRemember
"Quality is never an accident, it
is always the result of:
1.high intention
2. sincere effort
3. intelligent direction
4. skillful execution.
It represents the wise choice of
many alternatives."

21. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Step 5 followfollow
Define: goal, process, or outcome
improvement.
Questions to ask :
 Will the action eliminate the
problem?
Will process variation be decreased?
1. Identify the potential action,
solution, alternative
2.consider many alternative actions &
choose the best solution or first steps

22. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Part3Part3
SE = SentinelSE = Sentinel
EventsEvents

23. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
DefinitionDefinition::
A “Sentinel Event” is an
unexpected occurrence involving
death or serious physical or
psychological injury, not related
to the natural course of a
patient’s illness or underlying
condition.

24. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
“serious physical or
psychological injury” specifically
includes loss of limb or function.
That includes any process
which would carry a significant
chance of a serious adverse
outcome and includes delays in
diagnosis and treatment.

25. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Outcome is not death or major permanent
loss of function:
• Suicide
• Homicide
• Surgery on the wrong patient or body part
• Impairment (major/permanent loss of bodily
function – i.e. serious physical or
psychological injury not result of an
underlying medical condition.
• Any unexpected death with no relation to
underlying medical condition
• Rape
• Child Abduction or discharge to the
wrong family
• Hemolytic Blood Transfusion

26. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Part 4Part 4
SWOT=SWOT=
Strength, Weakness,Strength, Weakness,
Opportunity, ThreatsOpportunity, Threats

27. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Definition
Methodically and honestly assessing
your company’s strengths and
weaknesses plus the opportunities and
threats. It gives you a rare opportunity
for objective analysis.
A SWOT analysis helps you match
your company’s resources to threats
and opportunities in the competitive
environment.

28. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
SWOT
Set an objective for the analysis
Set adequate time for
information-gathering
Evaluate the results of your
analysis against your original
objective

29. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
SWOT
easy to use
combines quantitative and
qualitative analysis
encourages interdepartmental
collaboration
can help you set a strategic
plan or present new ideas to
your team.

30. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
1.List external opportunities
2.List external threats.
3.List internal strengths.
4.List internal weaknesses.
Match 1 and 2
With 3 and 4
To obtain strategies

31. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Strengths can come
from many sources,
•team members,
•product line,
•bank account,
•Production process,
•patents,
•market share.

32. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
SWOT Assess in 3 AreasSWOT Assess in 3 Areas
1- The level of1- The level of serviceservice wewe
provideprovide
2- The2- The competencecompetence of ourof our
teams workingteams working
3- The3- The performanceperformance of ourof our
hospitalhospital

33. Prepared By Dr Gamal Soliman
•
•
Strength-Opportunity Strategies
Expand globally
Increase sales staff
Increase advertising
Develop new products
Diversify
Weakness-Opportunity
Strategies
Joint venture
Acquire competitor
Expand nationally
Backward integration
Strength-Threat Strategies
Diversify
Acquire competitor
Expand locally
Re-engineer
Weakness-Threat Strategies
Increase promotion
Retrench
Restructure
Downsize

34. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Part 5- TFPart 5- TF
Team FormationTeam Formation

35. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
"a team is a collection of individuals who exist
within a larger social system.
This system over here is a hospital,
These people who can be identified
by themselves and others as a team,
who are interdependent,
and who perform tasks that affect
other individuals and groups.

36. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
Types of Teams:
1-Project (Task) Teams
Well-defined assignments are
the focus of the Project (or
Task) Team.
2- Cross-functional Teams
The Cross-functional Team is
comprised of members from
different departments.
3- Self-directed Teams
"empowered to make certain
decisions about their work”

37. Prepared By Dr Gamal SolimanPrepared By Dr Gamal Soliman
BENEFITS OF TEAMS
• a proven tool for change;
• a means to tap into the
experiences and ideas of
employees at all levels of the
medical practice;
• greater productivity, more
effective use of resources,
increased
• creativity and innovation,
and higher quality decision
making,
• which can in turn lead to
the development of a more
sound organization
• empowerment at all levels
of the organization.