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Hosqa
- 1. Hospital QualityHospital Quality AssuranceAssurance Abdulaziz Al-Saddique Pharm.D.Abdulaziz Al-Saddique Pharm.D. Associate Executive Director for QualityAssociate Executive Director for Quality Management, King Saud University Hospitals &Management, King Saud University Hospitals & College of MedicineCollege of Medicine
- 2. QUALITYQUALITY Defined as the “Quality of aDefined as the “Quality of a Product or Service measuredProduct or Service measured by the extent to which itby the extent to which it satisfies our Customer !”satisfies our Customer !”
- 3. TOTAL QUALITYTOTAL QUALITY Defined as “ the culture of anDefined as “ the culture of an organization where continuousorganization where continuous improvement is integrated intoimprovement is integrated into all activities.”all activities.”
- 4. Shakespeare onceShakespeare once said:said: ““ Reputation, reputation,Reputation, reputation, reputation, O’ I have lost myreputation, O’ I have lost my reputation.reputation. I have lost that immortal part ofI have lost that immortal part of me and what is left is bestial.”me and what is left is bestial.”
- 5. Why Hospital QualityWhy Hospital Quality Assurance?Assurance? Customers needCustomers need EthicsEthics CompetitionCompetition Trends of Health Care standardsTrends of Health Care standards Economical forcesEconomical forces
- 6. Historical Development ofHistorical Development of Hospital Quality AssuranceHospital Quality Assurance The First era:The First era: Florence Nightingale, Called for systematicFlorence Nightingale, Called for systematic inquiry into the nature of care processes thatinquiry into the nature of care processes that might be related this outcome variability inmight be related this outcome variability in 18631863 Ernest Codman, Called for systematicErnest Codman, Called for systematic evaluation process with a view towardevaluation process with a view toward improving care. Also observing variation inimproving care. Also observing variation in patient outcomes among several hospitals inpatient outcomes among several hospitals in 1916.1916.
- 7. Historical Development ofHistorical Development of Hospital Quality AssuranceHospital Quality Assurance Codman’s ideas were embodied in theCodman’s ideas were embodied in the founding of the American College offounding of the American College of Surgeons in 1913. This body set about theSurgeons in 1913. This body set about the task of establishing quality standards.task of establishing quality standards. 1917, the college established a five-part1917, the college established a five-part “minimum standard,” and the Hospital“minimum standard,” and the Hospital Standardization Program was born.Standardization Program was born.
- 8. Historical Development ofHistorical Development of Hospital Quality AssuranceHospital Quality Assurance Second era:Second era: Accreditation standards evolved slowlyAccreditation standards evolved slowly through the 1950s and early 1960sthrough the 1950s and early 1960s Donabedian and the Joint Commission’s,Donabedian and the Joint Commission’s, formed a theoretical framework for patientformed a theoretical framework for patient care evaluation. Donabedian is wellcare evaluation. Donabedian is well recognized for his structure, process, outcomerecognized for his structure, process, outcome model of quality evaluation.model of quality evaluation.
- 9. Historical Development ofHistorical Development of Hospital Quality AssuranceHospital Quality Assurance Third era:Third era: Berwick, Batalden, and James discoverBerwick, Batalden, and James discover Deming, Juran, and “Japan Industry QualityDeming, Juran, and “Japan Industry Quality Program.Program. Berwick and Batalden researched theBerwick and Batalden researched the industrial methods publicized by the Japaneseindustrial methods publicized by the Japanese experience.experience. Berwick and Batalden implementedBerwick and Batalden implemented TQM/CQI theory in Health Care.TQM/CQI theory in Health Care.
- 10. Starting from whereStarting from where the others stoppedthe others stopped TOTAL QUALITYTOTAL QUALITY MANAGEMENT / CONTINUOUSMANAGEMENT / CONTINUOUS QUALITY IMPROVEMENT ISQUALITY IMPROVEMENT IS THE ANSWER TO ANYTHE ANSWER TO ANY HOSPITAL QUALITYHOSPITAL QUALITY MANAGEMENT PROGRAMMANAGEMENT PROGRAM
- 11. Key Components forKey Components for SuccessSuccess Vision and values DrivenVision and values Driven LeadershipLeadership Physician InvolvementPhysician Involvement Customer-focusedCustomer-focused Continuous Improvement infrastructureContinuous Improvement infrastructure CommunicationCommunication
- 12. Integration of QualityIntegration of Quality Improvement ConceptsImprovement Concepts Establishment of an Infrastructure.Establishment of an Infrastructure. The organization must establish anThe organization must establish an infrastructure within which the cycle ofinfrastructure within which the cycle of improvement can operate. The JCAHOimprovement can operate. The JCAHO standards is the optimal infrastructure thatstandards is the optimal infrastructure that any health care facility should adopt.any health care facility should adopt.
- 13. Integration of QualityIntegration of Quality Improvement ConceptsImprovement Concepts the JCAHO infrastructure composed of:the JCAHO infrastructure composed of: quality council of steering committeequality council of steering committee quality improvement adviser or coach andquality improvement adviser or coach and quality improvement teamsquality improvement teams
- 14. Integration of QualityIntegration of Quality Improvement ConceptsImprovement Concepts Vision:Vision: The vision of the organizationThe vision of the organization begins with its leadership.begins with its leadership. Developing a quality improvement planDeveloping a quality improvement plan Communication role in CQICommunication role in CQI Training for CQITraining for CQI Customer focusCustomer focus Quality council roleQuality council role Quality coach/advisorQuality coach/advisor Educating managers and staffEducating managers and staff
- 15. Integration of QualityIntegration of Quality Improvement ConceptsImprovement Concepts Focusing on quality improvementFocusing on quality improvement activitiesactivities Concurrent support systemsConcurrent support systems Quality Improvement projectsQuality Improvement projects Financial considerationsFinancial considerations
- 16. Stages of TeamsStages of Teams functionsfunctions Quality Improvement TeamsQuality Improvement Teams FormingForming StormingStorming NormingNorming PerformingPerforming
- 17. Quality ImprovementQuality Improvement TeamsTeams FormingForming The group selected are not a team yet, butThe group selected are not a team yet, but members seek each other’s inputmembers seek each other’s input StormingStorming Members try to express their individualityMembers try to express their individuality and resist group pressures and influence.and resist group pressures and influence.
- 18. Quality ImprovementQuality Improvement TeamsTeams NormingNorming Conflict between the group is resolved.Conflict between the group is resolved. Group cohesion develops and a sense ofGroup cohesion develops and a sense of group identity begins to emerge. There isgroup identity begins to emerge. There is willingness to listen to and accept the viewswillingness to listen to and accept the views of others. The group develops feelings ofof others. The group develops feelings of mutual respect, harmony and trust.mutual respect, harmony and trust.
- 19. Quality ImprovementQuality Improvement TeamsTeams PerformingPerforming The team works harmoniously towards aThe team works harmoniously towards a common goal.common goal.
- 21. Implementation of Organization-Implementation of Organization- Wide Monitoring and EvaluationWide Monitoring and Evaluation ActivitiesActivities Assessment and improvement methodsAssessment and improvement methods Ten-Step process approved by JCAHO:Ten-Step process approved by JCAHO: Assign responsibilityAssign responsibility Delineate scope of care and serviceDelineate scope of care and service Identify important aspects of care and serviceIdentify important aspects of care and service Identify indicatorsIdentify indicators Establish a means to trigger evaluationEstablish a means to trigger evaluation Collect and organize dataCollect and organize data
- 22. Implementation of Organization-Implementation of Organization- Wide Monitoring and EvaluationWide Monitoring and Evaluation ActivitiesActivities Ten-Step process approved by JCAHO (cont.):Ten-Step process approved by JCAHO (cont.): Initiate evaluationInitiate evaluation Take actions to improve care and serviceTake actions to improve care and service Assess the effectiveness of the actions andAssess the effectiveness of the actions and ensure that improvement is maintainedensure that improvement is maintained Communicate results to relevant individuals andCommunicate results to relevant individuals and groupsgroups
- 23. Joint CommissionJoint Commission Standards and CQI/TQMStandards and CQI/TQM CQI/TQMCQI/TQMSTANDARDS
- 24. CQI ToolsCQI Tools P-TEAM APPROACHP-TEAM APPROACH FLOW CHARTSFLOW CHARTS CAUSE / EFFECT DIAGRAMSCAUSE / EFFECT DIAGRAMS LINE GRAPHSLINE GRAPHS PROBLEM ANALYSISPROBLEM ANALYSIS MODIFICATIONMODIFICATION IMPLEMENTATION / MONITORING PLANIMPLEMENTATION / MONITORING PLAN
- 25. CQI ToolsCQI Tools P-TEAM APPROACHP-TEAM APPROACH FLOW CHARTSFLOW CHARTS CAUSE / EFFECT DIAGRAMSCAUSE / EFFECT DIAGRAMS LINE GRAPHSLINE GRAPHS PROBLEM ANALYSISPROBLEM ANALYSIS MODIFICATIONMODIFICATION IMPLEMENTATION / MONITORING PLANIMPLEMENTATION / MONITORING PLAN
- 26. P-TEAM APPROACHP-TEAM APPROACH PP- PLOT (FLOW CHART)- PLOT (FLOW CHART) TT- THEORIZE- THEORIZE EE- EXAMINE- EXAMINE AA- ANALYZE- ANALYZE MM- MODIFY- MODIFY
- 27. CQI ToolsCQI Tools P-TEAM APPROACHP-TEAM APPROACH FLOW CHARTSFLOW CHARTS CAUSE / EFFECT DIAGRAMSCAUSE / EFFECT DIAGRAMS LINE GRAPHSLINE GRAPHS PROBLEM ANALYSISPROBLEM ANALYSIS MODIFICATIONMODIFICATION IMPLEMENTATION / MONITORING PLANIMPLEMENTATION / MONITORING PLAN
- 28. Flow ChartsFlow Charts Doctor writs order Nurse reviewDoctor writs order Nurse review Porter picks up orderPorter picks up order RPh fills orderRPh fills order Porter to deliver orderPorter to deliver order
- 29. CQI ToolsCQI Tools P-TEAM APPROACHP-TEAM APPROACH FLOW CHARTSFLOW CHARTS CAUSE / EFFECT DIAGRAMSCAUSE / EFFECT DIAGRAMS LINE GRAPHSLINE GRAPHS PROBLEM ANALYSISPROBLEM ANALYSIS MODIFICATIONMODIFICATION IMPLEMENTATION / MONITORING PLANIMPLEMENTATION / MONITORING PLAN
- 30. Cause Effect DiagramCause Effect Diagram StaffStaff Waiting time too long Policy & Procedure Computer Down
- 31. CQI ToolsCQI Tools P-TEAM APPROACHP-TEAM APPROACH FLOW CHARTSFLOW CHARTS CAUSE / EFFECT DIAGRAMSCAUSE / EFFECT DIAGRAMS LINE GRAPHSLINE GRAPHS PROBLEM ANALYSISPROBLEM ANALYSIS MODIFICATIONMODIFICATION IMPLEMENTATION / MONITORING PLANIMPLEMENTATION / MONITORING PLAN
- 32. Line GraphLine Graph 0 200 400 600 800 1000 1200 1400 1600 1800 2000 Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec Procedures UCL LCL
- 33. CQI ToolsCQI Tools P-TEAM APPROACHP-TEAM APPROACH FLOW CHARTSFLOW CHARTS CAUSE / EFFECT DIAGRAMSCAUSE / EFFECT DIAGRAMS LINE GRAPHSLINE GRAPHS PROBLEM ANALYSISPROBLEM ANALYSIS MODIFICATIONMODIFICATION IMPLEMENTATION / MONITORING PLANIMPLEMENTATION / MONITORING PLAN
- 34. CQI ToolsCQI Tools P-TEAM APPROACHP-TEAM APPROACH FLOW CHARTSFLOW CHARTS CAUSE / EFFECT DIAGRAMSCAUSE / EFFECT DIAGRAMS LINE GRAPHSLINE GRAPHS PROBLEM ANALYSISPROBLEM ANALYSIS MODIFICATIONMODIFICATION IMPLEMENTATION / MONITORING PLANIMPLEMENTATION / MONITORING PLAN
- 35. ModificationModification INPUTINPUT OUTPUTPROCESS Service Performance Measures Plot Theorize Examine Modify OK
- 36. CQI ToolsCQI Tools P-TEAM APPROACHP-TEAM APPROACH FLOW CHARTSFLOW CHARTS CAUSE / EFFECT DIAGRAMSCAUSE / EFFECT DIAGRAMS LINE GRAPHSLINE GRAPHS PROBLEM ANALYSISPROBLEM ANALYSIS MODIFICATIONMODIFICATION IMPLEMENTATION / MONITORING PLANIMPLEMENTATION / MONITORING PLAN
- 37. Quality QuotesQuality Quotes ““ DO NOT MAKE THEM SICKDO NOT MAKE THEM SICK WHILST THEY ARE TRYINGWHILST THEY ARE TRYING TO GET WELL”TO GET WELL”