Quality and reliability in health care


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Describes various Quality and Reliability techniques in order to increase the efficiency in Medical field.

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Quality and reliability in health care

  1. 1. Quality in Health Care Kiran Hanjar 1MS12MIA03 II sem, IEM MSRIT
  2. 2. Introduction • The history of quality in health care may be traced back to the 1860s • In 1914, in the Untied States E.A. Codman (1869–1940) studied the results of health care with respect to quality, and emphasized the issues • Over the years, many other people have contributed to the field of quality in health care • Each year billions of dollars are being spent on health care worldwide. For example, in 1992 the United States spent $840 billion on health care, or 14% of its gross domestic product (GDP)
  3. 3. Health Care Quality Terms and Definitions • Health care. This is services provided to individuals or communities for promoting, maintaining, monitoring, or restoring health • Quality. This is the extent to which the properties of a product or service generate/produce a desired outcome • Quality assurance. This is the measurement of the degree of care given (assessment) and, when appropriate, mechanisms for improving it. • Total quality management. This is a philosophy of pursuing continuous improvement in each and every process through the integrated efforts of all concerned individuals associated with the organization • Quality of care. This is the level to which delivered health services satisfy established professional standards and judgements of value to consumers • Quality improvement. This is the total of all the appropriate activities that create a desired change in quality
  4. 4. Health Care Quality Terms and Definitions • Clinical audit. This is the process of reviewing the delivery of care against established standards to identify and remedy all deficiencies through a process of continuous quality improvement • Cost of quality. This is the expense of not doing effectively all the right things right the first time. • Quality assessment. This is the measurement of the degree of quality at some point in time, without any effort for improving or changing the degree of care. • Dimensions of quality. These are the measures of health system performance, including measures of effectiveness, appropriateness, efficiency, safety, continuity, accessibility, capability, sustainability, and responsiveness. • Adverse event. This is an incident in which unintended harm resulted to an individual receiving health care.
  5. 5. Reasons for the Rising Health Care Cost Medical malpractice Use of new technology Aging population REASONS Other specialization of physicians Cost of poor quality Variance in practice and poor incentives to control cost
  6. 6. Comparisons of Traditional Quality Assurance and TQM with Respect to Health Care No. Area (characteristic) Traditional quality assurance Total quality management 1 Purpose Enhance quality of patient care for patients Enhance all products and services quality for patients and other customers 2 Aim Problem solving Continuous improvement, even when no deficiency/ problem is identified 3 Leadership Physician and clinical leaders (i. e., clinical staff chief and quality assurance committee) All leaders (i. e., clinical and non-clinical) 4 Customer Customers are review organizations and professionals with focus on patients Customers are review organizations, patients, professionals, and others
  7. 7. Continued… No. Area (characteristic) Traditional quality assurance Total quality management 5 Scope Clinical processes and outcomes All processes and systems (i. e., clinical and nonclinical) 6 Focus Peer review vertically focused by clinical process or department Horizontally focused peer review for improving all processes and individuals 7 People involved Appointed committees and quality assurance program Each and every person involved with process 8 Methods Includes hypothesis testing, chart audits, indicator monitoring, and nominal group techniques Includes checklist, force field analysis, quality function deployment, control chart, fishbone diagram, Pareto chart 9 Outcomes Includes measurement and monitoring Includes also measurement and monitoring
  8. 8. Comparisons of quality assurance and quality improvement in health care institutions No. Area (characteristic) Quality improvement Quality assurance 1 Goal Satisfy customer requirements Regulatory compliance 2 Participants Every associated person Peers 3 Viewpoint Proactive Reactive 4 Focus All involved processes Physician 5 Review technique Analysis Summary 6 Customers Patients, caregivers, payers, technicians, support staff, managers, etc. Regulators 7 Performance measure Need/capability External standards 8 Direction Decentralized through the management line of authority Committee or central coordinator 9 Functions involved Many (clinician and support system) Few (mainly doctors) 10 Action taken Implement appropriate improvements Recommend appropriate improvements 11 Defects studied Special and common causes Outliers special causes
  9. 9. Health Care-related Quality Goals Four important health care-related quality goals •Aim to maximize patients’ and families’ involvement in the care experience by using shared decision making and improving patient involvement in care choices. •Ensure, in an effective manner, the assessment of employee, patient, and medical staff satisfaction periodically by incorporating survey standards and benchmarking. •Implement recommendations concerning compassionate care of dying and carefully address the spiritual needs of patients and families through pastoral care.
  10. 10. Health Care-related Quality Goals Goal I: Provide a good person-centered compassionate care that respects dignity of all individuals Goal IV: Engage all employees, physicians and board members in system efforts to implement TQM GOALS Goal II: Establish a good system perspective on analyzing and communicating information, data on the quality, cost of care Goal III: Effectively support a quality management mechanism that is useful for further coordination of care across the continuum of providers
  11. 11. Ten steps that can be used in improving quality in the health care system
  12. 12. Quality Tools for Use in Health Care Cost benefit analysis Multivoting Force field analysis Brainstorming Check sheets Methods for improving quality in health care Prioritization matrix Cause & effect diagram Scatter diagram Affinity diagram Process flow chart Control chart histogram
  13. 13. Implementation of Six Sigma Methodology in Hospitals Steps involved in the implementation of DMAIC Six Sigma
  14. 14. Potential advantages of implementation of Six Sigma methodology in hospitals • Measurement of essential health care performance requirements on the basis of commonly used standards. • Establishment of shared accountability with respect to continuous quality improvement. • The implementation of the methodology with emphasis on improving customers’ lives, could result in the involvement of more health care professionals and support personnel in the quality improvement effort. • Better job satisfaction of health care employees.
  15. 15. Implementation Barriers Poor support from physicians Governmental regulations Rather long project ramp up times Risk of methodology Barriers Difficulty in obtaining base-line data on process performance Nursing shortage Costs(start-up & maintenance)
  16. 16. Reference: •Applied Quality and Reliability, B.S.Dhillon