Quality Measurement: It’s Everyone’s Responsibility Kay Bensing, MA, RN ADVANCE for Nurses

Objectives Identify three resources that provide the best information about quality healthcare. Describe the role of allied healthcare professionals in advocating for quality care. Discuss the relationship of collaboration to quality.

Measuring Personal Quality How much time do you spend selecting?

Quality Defined Over the years, quality in healthcare has been defined in many different ways Agency for Healthcare Research and Quality definition: “Doing the right thing at the right time in the right way for the right person — and achieving the best possible results.”

Quality: A National Priority Healthcare Research and Quality Act of 1999 Agency for Healthcare Research and Quality reauthorized Mission: “Serve as a scientific and research agency for all Americans” ( is one of best resources for healthcare professionalswww.ahrq.gov

History of Quality Measurement Joint Commission beginnings — American College of Surgeons (1951) retrospective data Deming’s 14 points to Improve Quality — quality circles (1970s) Donabedian — Quality Assurance model — process and outcomes Donald Berwick, MD — total quality management (TQM)

QA and CQI Differences QA Driven by regulatory and accrediting agencies Focus on who is responsible for errors Relies on inspections to identify errors Periodically measures quality Management is top to bottom CQI Internally driven Systems approach Seeks to prevent errors by clarifying and improving processes Shared governance leadership

Leapfrog Group In 1998, Fortune 500 companies met to discuss inferior care they were purchasing for their employees. Collaboration among 170 companies initially. Goal was to provide incentives for providers if “big leaps were made in safety, quality and healthcare value.” Incentives included computerized order-entry for physicians, EBP hospital referral, intensivists in critical care, meet Leapfrog Safe Practice Scores based on National Quality Forum-endorsed safe practice data

Seminal Quality Documents Institute of Medicine Studies 1999 – “To Err is Human” 2001 – “Crossing the Quality Chasm: A New Healthcare System for the 21st Century”

Crossing the Quality Chasm Indicators Safety Effectiveness Patient-centered care Timeliness Equity Efficient

“Many people don’t think there is any problem related to quality in healthcare.” – Trudy Lieberman, Consumer Reports, 2002 “Americans believe bigger is better, the doctor is always right and we have the best healthcare system in the world.”

Rand Corporation Study June 2003 Largest and most comprehensive study about quality of care done at the time Research included Americans with health insurance Examples of findings: Only 45% of post-MI patients received beta blockers. Only 39 percent of patients diagnosed with pneumonia received recommended care.

National Commission for Quality Assurance The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving healthcare quality. NCQA has helped to build a consensus around important healthcare quality issues by working with large employers, policymakers, doctors, patients and health plans.

Healthcare Effectiveness Data & Information Set (HEDIS) HEDIS® Measure Development Process Developing a measure is a multistep process: Identifying the clinical area to evaluate Conducting an extensive literature review Developing the measure with the appropriate MAP and other panels Vetting with various stakeholders Performing a field-test that looks at feasibility, reliability and validity

NCQA Report 2008 Good News: 1 in 3 Americans are enrolled in health plans that measure quality Blood pressure control rates improved 76% in 6-year period Bad news: 50 million Americans are uninsured Still too many areas where there is a lack of evidence about what is best care for patients Beta blockers prescribed for post-MI patients still low

Nursing Contributions to Quality Nursing’s Safety and Quality Initiatives introduced in 1994 by ANA Board of Directors Linda Aiken’s research Magnet hospitals

Systems View of Health-Related Programs Systems View for three primary care programs: training session for CHWs, diarrhea control program and drug supply Inputs CHWs, Trainers, Teaching Material Processes Training sessions Outcomes Competent CHWs * The outcomes of one system often become the inputs of another.

Foundations of Quality Monitoring Data collection – routine activity integrated into daily tasks Data collected regularly and over time so trends can be monitored Data used to identify presence and causes of system problems that can result in poor perfromance Data used to guide management decisions

Measuring Quality Data Ongoing Monitoring Spot Checks Incremental Approach

Steps in Quality Monitoring Step 1: Decide what information you need 1.Select health services to be monitored 2.Describe process of care 3.Draw systems review of the services 4.Make critical standards explicit 5.Develop performance standards

Measuring Quality Step 2: Collect the data 1.Choose appropriate data collection methods 2.Design monitoring tools 3.Test the tools 4.Select monitoring strategy 5.Collect data

Measuring Quality Step 3: Use the information and results 1.Tabulate results 2.Analyze results 3.Interpret and use results 4.Design a data storage and retrieval system 5.Disseminate information

What is Six Sigma? Developed in mid-1980s by Motorola to come up with solutions to counter customer dissatisfaction competitive pressures

Six Sigma Philosophy What is critical to customers? How well are you performing today? How can you leverage facts and data? How can you sustain improvement?

Have Fun Familiarize and use resources Good care and quality is your responsibility

About This Presentation Brought to you by ADVANCE for Nurses. Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No O-09), an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Visit to be tested on this presentation.