Continuous Improvement: What Will it Take? Leadership commitment Leadership commitment A new management A new management model model New skills New skills Strategy Strategy

Core Principles of Managing Quality Intention to improve Intention to improve Focus on customers Focus on customers Focus on process and system Focus on process and system Proper use of measurement and statistics Proper use of measurement and statistics Involvement of everyone Involvement of everyone Continuous testing of changes Continuous testing of changes On-going training On-going training Collaboration, valuing interdependency Collaboration, valuing interdependency Key role of leaders Key role of leaders

Pursuing Improvement: Five Guiding Question Who depends on you? Who depends on you? What do they need? What do they need? How do you know? How do you know? How well are you meeting their needs? How well are you meeting their needs? How do you know? How do you know?

Alphabet Soup of Q programs QA TQM QI ’s QM PI 1990’s 2000 IOM (2002) Organizational & clinical __________________________ ISO 9000, Baldrige

Web sites IOM report – “To Err is Human” (2002) “Crossing the Chasm” “Crossing the Chasm” (success stories) rea.htm rea.htm __________________________ Data Sets – Comparative Data HEDIS, ORYX, OASIS Healthgrades.com (NCQA (JCAHO) LTC CMS) CMS) QUIC.gov (2002)

Definition of Quality Meeting the needs and exceeding the expectations of those we serve. Meeting the needs and exceeding the expectations of those we serve. Delivering all and only the care that the patient and family needs. Delivering all and only the care that the patient and family needs.

Quality: A Strategic Necessity Cost escalation Cost escalation Variation in practice Variation in practice Standardize Standardize Purchaser dominance Purchaser dominance Issues of public trust Issues of public trust Integrated systems and managed care Integrated systems and managed care New information systems New information systems

TAXONOMY OF QUALITY Outcome Process Structure Traditional Triad - Avedis Donabedian

TAXONOMY OF QUALITY Cost Efficiency Clinical Quality Service Quality Newer Triad for Organizational Performance Community Needs - Brent James

Performance improvement is the integration of a customer-focused, continuous- improvement philosophy, analytical skills, people skills, and a structure and organization, within an internal and external culture affected by leadership

Categories and Point Value for the Malcolm Baldrige National Quality Award Examination Leadership120 Leadership120 The way senior executives create and sustain corporate citizenship, customer focus, clear value, and expectations and promote quality and performance excellence Information Analysis75 Information Analysis75 Management and effectiveness of the use of data and information to support customer- driven performance and market excellence Strategic Planning55 Strategic Planning55 The way the company sets strategic direction, how it determine plan requirements, and how plan requirements relate to performance management

Categories and Point Value for the Malcolm Baldrige National Quality Award Examination Human Resource Development and Management140 Human Resource Development and Management140 Company’s effort to develop and utilize the work and to maintain an environment conductive to full participation, continuous improvement, and personal and organizational growth Process Management140 Process Management140 Process design and control, including customer-focused design, product and service delivery, support services, and supply management Business Results220 Business Results220 Company’s performance and improvement in key business areas (product, service, and supply quality, productivity, and operational effectiveness and related financial indicators)

Categories and Point Value for the Malcolm Baldrige National Quality Award Examination Customer Focus and Satisfaction 250 Customer Focus and Satisfaction 250 Company’s knowledge of the customer, customer service systems, responsiveness to customer, customer satisfaction TOTAL POINTS1000 TOTAL POINTS1000

Understand customer need Identify processes and Outcomes that meet Customer need Assess performance compared with Professional or ”best-of- Class” standards Define indicators to measure performance Establish performance expectations Monitor performance and compare with expectations Provide feedback to Providers and customers Implement improvements Complaints Analysis Satisfaction Surveys Focus Groups Request for Proposal Treating Disease Managing Health Service Quality Appropriateness Review Peer Review Benchmarking Outcomes Assessment Structure, Process and Outcome Criteria Case Mix Adjustment Profiling, Report Cards Practice Guidline Case Management QI Teams