RACMA Quality demystified RACMA candidates RACMA candidates

RACMA Origins of quality in health Origins of quality in health QUALITY CONTROL QUALITY ASSURANCE What do these terms mean? What do these terms mean? What outcomes are QA and QC expected to achieve? What outcomes are QA and QC expected to achieve? Who is involved in assessing QC and QA? Who is involved in assessing QC and QA?

RACMA Quality Control Quality Control QUALITY CONTROL QUALITY CONTROL Maintenance of standards to particular specifications Maintenance of standards to particular specifications Involves regular monitoring to ensure that factors remain within predetermined limits Involves regular monitoring to ensure that factors remain within predetermined limits Aimed at ensuring safety for patients, staff and visitors Aimed at ensuring safety for patients, staff and visitors Health services have a broad system of QC which permeates every part of the service Health services have a broad system of QC which permeates every part of the service

RACMA Quality Assurance Quality Assurance QUALITY ASSURANCE Maintenance of standards to assure a defined level of practice Maintenance of standards to assure a defined level of practice Regular assessment to monitor and take action if fails to meet the criteria Regular assessment to monitor and take action if fails to meet the criteria Criteria are not as rigid Criteria are not as rigid Used to measure if a QI activity has achieved its aims Used to measure if a QI activity has achieved its aims Involves only a small number of staff Involves only a small number of staff

RACMA What is QI? QUALITY IMPROVEMENT Pro-active approach to assessing whether we are doing the right thing in the right way Pro-active approach to assessing whether we are doing the right thing in the right way Directed at adding value for all stakeholders Directed at adding value for all stakeholders May affect efficiency, effectiveness, customer service, appropriateness of care May affect efficiency, effectiveness, customer service, appropriateness of care Relies on all staff being connected to the strategic direction of the organisation Relies on all staff being connected to the strategic direction of the organisation

RACMA Relationship between QC, QA and QI CQI QA QC QI

RACMA Principles of CQI Have been around for a long time,using a variety of names eg (TQM/ CQI /Six Sigma) Have been around for a long time,using a variety of names eg (TQM/ CQI /Six Sigma) Based on commitment of leadership to providing autonomy and ability to use initiative to all staff (within parameters) Based on commitment of leadership to providing autonomy and ability to use initiative to all staff (within parameters) Acknowledges the contributions of all staff to improving the organisation Acknowledges the contributions of all staff to improving the organisation

RACMA Quality has been hijacked by the emphasis on clinical governance

RACMA Quality must involve all staff as only by working with all staff can we improve processes of care and decrease risk to patients and staff

RACMA Basic principles of a good CQI system Committed leadership Committed leadership A customer focus in which both internal and external customers are identified A customer focus in which both internal and external customers are identified An emphasis on teamwork An emphasis on teamwork A respect for people A respect for people An understanding of the importance of processes and systems An understanding of the importance of processes and systems An ethos that we should do the right thing in the right way An ethos that we should do the right thing in the right way

RACMA Success of CQI depends on Educated and committed management Educated and committed management A vision of what CQI will deliver in the context of organisational strategy A vision of what CQI will deliver in the context of organisational strategy Education of key staff Education of key staff Establishing some pilot improvement projects which bear fruit Establishing some pilot improvement projects which bear fruit A working coordination mechanism A working coordination mechanism

RACMA Success of CQI depends on A known and practical reward and recognition program A known and practical reward and recognition program An understanding by management of their new role An understanding by management of their new role Involvement of large number of staff Involvement of large number of staff A willingness by management to let go A willingness by management to let go

RACMA A competent and innovative medical administrator can seize the opportunity to lead an organisation wide quality effort, by influencing at senior levels

RACMA A quality systems Framework A quality systems Framework Structure - material and health resources, operational characteristics, organisation characteristics Structure - material and health resources, operational characteristics, organisation characteristics Process –giving and receiving of care by the health care provider and other parts of the system ( includes technical, interpersonal, access, continuity of care) Process –giving and receiving of care by the health care provider and other parts of the system ( includes technical, interpersonal, access, continuity of care) Outcome –health status of individual patients and communities Outcome –health status of individual patients and communities (Donabedian,A 1988) (Donabedian,A 1988)

RACMA Problem solving What often happens when we try to solve problems? What often happens when we try to solve problems? Why do don’t we always get the best solutions? Why do don’t we always get the best solutions?

RACMA Effective problem solving Effective problem solving (Or the 80/20 rule) When solving problems we need to be aware that: 80 (90)% OF WHAT GOES WRONG IS DUE TO THE PROCESS AND ONLY 20 (10)% IS DUE TO THE INDIVIDUAL PEOPLE 80 (90)% OF WHAT GOES WRONG IS DUE TO THE PROCESS AND ONLY 20 (10)% IS DUE TO THE INDIVIDUAL PEOPLE

RACMA To solve problems effectively We need to do the right thing in the right way We need to do the right thing in the right way First we ask “Is this the right thing to do? Should we do it at all? IS THE CHANGE A GOOD IDEA? First we ask “Is this the right thing to do? Should we do it at all? IS THE CHANGE A GOOD IDEA? Then we ask “Is this the right way to do it?” HAS THE CHANGE BEEN PROPERLY PLANNED AND EXECUTED? Then we ask “Is this the right way to do it?” HAS THE CHANGE BEEN PROPERLY PLANNED AND EXECUTED?

RACMA The Window of Improvement

RACMA Structured problem solving Determine what the problem is and the outcomes which need to be achieved Determine what the problem is and the outcomes which need to be achieved Involve all of the right people in the process Involve all of the right people in the process Track the present process so all understand what happens now and the roles of all involved Track the present process so all understand what happens now and the roles of all involved Understand where variations occur in the process Understand where variations occur in the process

RACMA FOCUS-PDCA Find a process to improve Find a process to improve Organise a team who knows the process Organise a team who knows the process Clarify present understanding of the process Clarify present understanding of the process Understand the causes of variation Understand the causes of variation Select a process for improvement Select a process for improvement Plan the change Plan the change Do the change Do the change Check that it has worked Check that it has worked Act to hold the gain Act to hold the gain

RACMA FOCUS -PDCA works because Decisions are based on data not on hunches Decisions are based on data not on hunches People who redesign the process are those who work in the process People who redesign the process are those who work in the process All key areas and divisions are represented All key areas and divisions are represented All improvements are commenced with local and senior management support All improvements are commenced with local and senior management support The team has fun and develops skills - cohesiveness The team has fun and develops skills - cohesiveness

RACMA Definition of a problem A problem can be defined as any situation where there is a gap perceived between what is and what should be: A problem can be defined as any situation where there is a gap perceived between what is and what should be: Current situation Desired situation Opportunity Statements

RACMA Case Study Twelve months ago, the respiratory unit in a large health service developed a clinical pathway for patients presenting to the ED with symptoms of asthma. This pathway is regarded as best practice for patient care and considerable effort has gone into defining the pathway. Although the pathway is supposed to commence at the time of ED presentation, the uptake of the pathway is sporadic and usually does not begin until the patient has been admitted to the respiratory ward. Patients who are admitted to other wards, often do not commence the pathway at all. Twelve months ago, the respiratory unit in a large health service developed a clinical pathway for patients presenting to the ED with symptoms of asthma. This pathway is regarded as best practice for patient care and considerable effort has gone into defining the pathway. Although the pathway is supposed to commence at the time of ED presentation, the uptake of the pathway is sporadic and usually does not begin until the patient has been admitted to the respiratory ward. Patients who are admitted to other wards, often do not commence the pathway at all. Define the problem- what needs improvement? Define the problem- what needs improvement?