QUALITY ASSURANCE PROJECT What is Quality?

QUALITY ASSURANCE PROJECT Dimensions of Quality Effectiveness Efficiency Technical Competence Safety Accessibility Interpersonal Relations Continuity Amenities

QUALITY ASSURANCE PROJECT Perspectives on Quality Client / Family Provider Health Care Administration & Management Community

QUALITY ASSURANCE PROJECT “The quality of technical care consists in the application of medical science and technology in a way that maximizes its benefits to health without correspondingly increasing its risks. The degree of quality is, therefore, the extent to which the care provided is expected to achieve the most favorable balance of risks and benefits.” Definition of Quality Avedis Donabedian, M.D., 1980

QUALITY ASSURANCE PROJECT Definition of Quality ODI Consulting “Doing the right thing, right, the first time. Doing it better the next time.”

QUALITY ASSURANCE PROJECT Definition of Quality M.I. Roemer and C. Montoya Aguilar, WHO, 1988 “...proper performance (according to standards) of interventions that are known to be safe, that are affordable to the society in question, and have the ability to produce an impact on mortality, morbidity, disability, and malnutrition.”

QUALITY ASSURANCE PROJECT “Quality is conformance to requirements or specifications.” Definition of Quality Phil Crosby, 1979

QUALITY ASSURANCE PROJECT “Quality is compliance with standards.” Definition of Quality QA Project Contract, 1997

QUALITY ASSURANCE PROJECT Quality Definitions Meet or exceed standards User “fit” User expectations Technical accuracy

QUALITY ASSURANCE PROJECT What is Quality Assurance? QA, QI, QM, TQM, CQI Alphabet Soup

QUALITY ASSURANCE PROJECT Components of a System InputsProcessesOutcomes OutputsEffects Impacts

QUALITY ASSURANCE PROJECT Quality Assurance System INPUTS Client expectations Organizational structure Trained personnel Budget Standards Political support Organizational culture PROCESSES Quality Design Planning for quality Setting standards Monitoring quality Supervision Quality Improvement Accreditation OUTCOMES Staff performance monitored Compliance with standards Increased efficiency Culture of quality Increased access and utilization Satisfied clients Improved health outcomes

QUALITY ASSURANCE PROJECT SS PSM QA Problem SolvingMonitoring Standard Setting

QUALITY ASSURANCE PROJECT QD QI QC QA Quality Improvement Quality Control Quality Design

QUALITY ASSURANCE PROJECT Design Control Improve Quality Design Organizational Restructuring Process Redesign Standard Setting Audit Quality Assessment Monitoring Systems Supervision Self Evaluation Team-Based Problem Solving Management Action Feedback Individual Action Planning Q?

QUALITY ASSURANCE PROJECT Definition of Quality Assurance “Process of measuring quality, analyzing the deficiencies discovered, and taking action to improve performance followed by measuring quality again to determine whether improvement has been achieved. It is a systematic, cyclical activity using standards of measurement.” Dr. Heather Palmer, US expert in ambulatory care

QUALITY ASSURANCE PROJECT Dr. Avedis Donabedian “All the arrangements and activities that are meant to safeguard, maintain, and promote the quality of care.” Definition of Quality Assurance

QUALITY ASSURANCE PROJECT The Quality Assurance Project, 1993 “Quality Assurance is that set of activities that are carried out to set standards and to monitor and improve performance so that the care provided is as effective and as safe as possible.” Definition of Quality Assurance

QUALITY ASSURANCE PROJECT Drs. Ruelas andFrenk QA work in Mexico “A systematic process for closing the gap between actual performance and desirable outcomes…” Definition of Quality Assurance

QUALITY ASSURANCE PROJECT Definition of Quality Management “...a systematic managerial transformation designed to address the needs and opportunities of all organizations as they try to cope with increasing change, complexity and tension within their environments.” Dr. Donald Berwick, Institute for Healthcare Improvement

QUALITY ASSURANCE PROJECT Definition of Quality Improvement Joint Commission on Accreditation of Healthcare Organizations “…an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others. Synonyms and near synonyms include continuous quality improvement (CQI), continuous improvement, performance improvement, and total quality management. “

QUALITY ASSURANCE PROJECT Continuous Improvement Act Plan Study Do Act Plan Study Do Act Plan Study Do Act Plan Study Do

QUALITY ASSURANCE PROJECT Philip Crosby Quality is free - remove un-quality things, which are all the actions that involve not doing jobs right the first time People-focused interventions targeted at zero defects

QUALITY ASSURANCE PROJECT Deming’s 14 Points of Management Create constancy of purpose toward quality improvement Adopt a philosophy which expects good products and services Cease dependence on inspection and build quality into the product or service Don’t award business solely on the basis of price tag Improve constantly the system of production and service Institute on-the-job training

QUALITY ASSURANCE PROJECT Deming’s 14 Points of Management (cont’d.) Institute leadership with an aim to help people and machines do better jobs Drive out fear Break down barriers between departments Eliminate slogans, exhortations and targets Eliminate number quotas and management by objective, substitute leadership Remove barriers to pride of workmanship Institute education and self-improvement Take action to accomplish the transformation

QUALITY ASSURANCE PROJECT The Juran Trilogy ® Quality Planning Quality Control Quality Improvement

QUALITY ASSURANCE PROJECT Shewart Cycle Plan Do Act Check

QUALITY ASSURANCE PROJECT Principles of Managing Quality

QUALITY ASSURANCE PROJECT Systems/ process focus Leadership Principles of Managing Quality Team work Data Client focus

QUALITY ASSURANCE PROJECT Leaders and Quality “In our experience, no quality improvement effort has ever been successful without top management’s involvement.” J. M. Juran

QUALITY ASSURANCE PROJECT Specific Actions for Leaders Define the vision - communicate it and model its attainment Approve financial investment in improving quality Provide and approve time spent in quality pursuits

QUALITY ASSURANCE PROJECT Specific Actions for Leaders Require training and learning about quality - attend and present it yourself Reward quality - look for it, recognize it Tie reward systems to quality Serve on teams

QUALITY ASSURANCE PROJECT Specific Actions for Leaders Lead the quality effort –communicate the plans for quality assessment and improvement –approve specific improvement projects –receive / request reports of QI efforts –“walk the talk”

QUALITY ASSURANCE PROJECT Two Major Theories of Client Satisfaction With Health Care Expectancy-value theory: Satisfaction = Perceived care > Expectations of care Exchange theory: Satisfaction = Value of care > Cost of care

QUALITY ASSURANCE PROJECT Expectancy-Value Theory: Problems Whether expectations are met does not seem to correlate with satisfaction –low expectations  low satisfaction –high expectations  high satisfaction People often have only vague or superficial expectations Interview process may “elicit” expectations where none existed Useful to think about “unrealistic” vs. “realistic” expectations

QUALITY ASSURANCE PROJECT Exchange Theory Value > Cost = Satisfaction Cost > Value = Dissatisfaction Changes in EITHER cost or value change the degree of satisfaction Cost Value

QUALITY ASSURANCE PROJECT Exchange Theory Focuses on what people value –their desires for services, the severity of their needs Focuses on the costs (hidden and actual) of obtaining services Could help explain why: –People usually report being satisfied –Patients’ and providers’ satisfaction with same encounter differ –Patients’ and family members’ satisfaction with services differ

QUALITY ASSURANCE PROJECT “In God we trust All others please bring data”

QUALITY ASSURANCE PROJECT “Every system is perfectly designed to achieve exactly the results it achieves”

QUALITY ASSURANCE PROJECT Stages of Team Development Forming Storming Norming Performing Closing

QUALITY ASSURANCE PROJECT Components of a System InputsProcessesOutcomes OutputsEffects Impacts