1. I am delighted to be here for this inaugural meeting “Quality and outcomes” I am thrilled to be assigned this topic “what does Quality mean? I feel as though I am laying the foundation for the conf….
What Does Quality Mean For Perfusion? Robert C. Groom, MS, CCP Director of Cardiovascular Perfusion Maine Medical Center

2. Disclosures No relevant conflicts related to this presentation
I have rather strong opinions about quality
While I don’t have any conflicts of interest related to this topic. I do want to disclose that I have rather strong opinions about quality. But evidently that you share a strong feelings about this topic as well since you spent your hard earned money to be here today

4. Outline What is quality. How is quality made (or lost)
  Outline What is quality? How is quality made (or lost)? Where is quality made? What is the formulae for quality improvement?
Over the next 20 minutes I will ask and attempt to answer these questins …..

5. What’s love got to do with it?
I almost forgot. The fifth question, Tina Turner’s question, That will be the bonus question. We shall clear that up as well.

6. qua l·i·ty kwälətē/ noun-
1. the standard of something as measured against other things of a similar kind.
2. the degree of excellence of something a distinctive attribute or characteristic possessed by someone or something.
Ok what is quality?

7. Quality- algebraic definition
To define it algebraically one could say that quality is that closeness of an object to perfection.

8. “Simply put, health care quality is getting the right care to the right patient at the right time – every time.”
Carolyn M. Clancy  M.D. 
Agency for Healthcare Quality and Research 
Carolyln Clancy said this and she should know, she is the director of the Agnecy for healthcare quality and research.

9. Avedis Donabedian The Father of Quality Care
Medicine is a sacred mission
Healthcare should be centered on the patient
Described three pillars of Quality
Born in Beirut, LebanonArmenian descent Father - physician Studied at American University- MD MPH Harvard UniversityUniversity of Michigan- Prof. of Public HealthBorn Armenian descent.

10. Pillars of Quality Avedis Donabedian
Pillars of Quality
Avedis Donabedian
Milbank Memorial
Fund Quarterly, 1966, 44: 166–206.
Structure-
Is the environment of care safe? 
Processes-
Are the right things are done in the right way?
Outcomes-
Does the treatment produce effective results?
Gotta haves… must have all three. If you have two the thing will fall down. A safe building, the right people, the right equipment
Processes are things doe the right way? Does the treatment produce the desired effect?

11. How is quality made in perfusion?
How is quality made? What is the mortar and materials used to create these three pillars

12. How is Quality Made? -Structure -Process -Outcome PDU NNE SpC
AMSECT Standards and Guidelines 2013
Standard 1: Institutionally-based Protocols
Standard 2: Qualification, Competency of Staff
Standard 3: Perfusion Record
Standard 4: Checklist
Standard 5: Communication
Standard 6: Safety Devices
Standard 7: Monitoring
Standard 8: Anticoagulation
Standard 9: Blood Management
Standard 10: Gas Exchange
Standard 11: Blood Flow
Standard 12: Blood Pressure
Standard 13: Quality Improvement
Standard 14: Maintenance
Standard 15: Duty Hours
PDU
NNE
SpC

13. ARS #1 Does your center participate in the STS registry?
1. Yes
2. No
3. Don’t know

14. ARS #2 Does your perfusion team receive periodic STS reports on your center’s performance?
1. yes 2. no

15. Here is an example of a center’s observed rate of renal failure from the STS registry with a comparision of the rate from the entire registry and from a group considered as like centers

16. ARS # 4 Do you participate in a perfusion registry?
1. PerFORM
2. PUD
3. NNE
4. Specialty Care
5. JaSECT
6. None

17. Science
Context
Guideline

18. Science- tells us what we can do.
Standards and Guidelines- tell us what we should do
Registries- tell us what we actually do.

21. Where is quality made?
ADM >OR>ICU>FLR

23. What is the formula for Quality Improvement?

24. How do we improve quality?
Best Possible
Care
Generalizable
Scientific
Evidence
Context +
The second major piece is the context of our system, it is a study of the patterns of the way our work is done and the variation that occurs, the interdependiencies of the practioners in the system- it is knowing what we do and how our system works.
With these two major pieces in place we then proceed to the improvement part which involves linking the processes (what the Micro system does) to the outcome. With all of these pieces we can then proceed to improvement.
Measurement of your system
Enumerative Statistics
Published Guidelines
RCTs
Observational studies Case-control studies Case Series
Intelligent Action!

25. Avedis Donabedian Final teachings on quality care
Ultimately the secret of quality is love…
You have to love your patient, your profession and your God…
Born in Beirut, LebanonArmenian descent Father - physician Studied at American University- MD MPH Harvard UniversityUniversity of Michigan- Prof. of Public HealthBorn in Beirut, Lebanon
Armenian descent. He was one of the shakers and movers that did pioneering work about Quality Improvement. With his theory about structure, process, and outcomes. An amazing man who near the end of his life summed it by saying the theory was just a tool but the ultimate secret of quality is love.

26. Donabedian’s Philosophy
“Systems awareness and systems design are important for health professionals, but are not enough….
It is the ethical dimension of individuals that is essential.
Ultimately, the secret of quality is love.”

27. ARS # 5 Do you love your work?
1= yes
2= No

28. Summary 1. What is quality. Right stuff 2. How is quality made
  Summary 1. What is quality? Right stuff 2. How is quality made? Science, Standards & Registries 3. Where is quality made? Where clinicians touch patients How do we improve quality? Evidence + Context Improvement
Over the next 19minutes we will consider these four questions …..

29. What’s love got to do with it?
EVERYTHING!
I almost forgot. The fifth question, Tina Turner’s question, That will be the bonus question. We shall clear that up as well.

30. “The only way to do great work
is to love what you do.”
Steve Jobs

32. Atul Gwande Become a Positive Deviant
Ask Questions
Don’t complain- have dialog about interesting problems
Count Something
Write Something
Change
Better- Gwande Metropolitan Books