1. “Quality Improvement – Who Cares?”
Julietta Fiscella, MD, CPE, FCAP
Chief, Department of Pathology,
Cytopathology & Laboratory Medicine
Clinical Associate Professor,
Pathology & Laboratory Medicine
Quality and Compliance Department

2. Quality Improvement - Who Cares?
Institute of Medicine (IOM) definition:
“Quality of care is the degree to which health service for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

3. Quality Improvement - Who Cares?
“Quality healthcare consists of necessary
medical professional processes that result in cure, significant measured improvement in the patient’s condition, alleviation of pain or other desired outcomes, and provides real value for the dollars spent.”

4. Quality Improvement - Who Cares?
Quality “Doing the right thing for the right people at the right time and doing it right the first time”

5. Quality Improvement - Who Cares?
OBJECTIVES:
Briefly discuss why the need for quality in
healthcare is of growing importance
Discuss our Laboratory Quality Program
Brief discussion of cost and its relation to quality
in a value based healthcare system
The future of quality improvement and reporting

6. Quality Improvement - Who Cares?
“To Err is Human: Building a Safer Health System”
“Crossing the Quality Chasm”

7. Quality Improvement - Who Cares?
IOM Action Plan:
Safety – avoiding injury
Effectiveness – implementing scientific knowledge
Patient centeredness – preferences, needs and values
Timeliness – reducing delays and wait times
Efficiency – avoiding waste
Equity – reducing disparity

8. Quality Improvement - Who Cares?
In 2007, the Institute for Healthcare Improvement launched the Triple Aim framework of healthcare; this initiative focused on three themes:
Improve the health of the defined population
Enhance the patient care experience (including
access and reliability)
Reduce or at least control the per capita costs of care

9. Quality Improvement - Who Cares?
QMS – A formalized quality management system modeled after (CLSI): QMS for Healthcare - HS1-A2A
CLSI published document (GP35-A), describing the use of quality indicators for process improvement and to monitor lab quality
CLSI’s 12 Quality Systems Essentials (QSEs)

10. Quality Improvement - Who Cares?
Quality System Essentials (QSEs)
Documents & Records: QSE 1
Organization: QSE 2
Assessments - Internal & External: QSE 3
Customer Service & Satisfaction: QSE 4
Corrective Action & Preventive Action: QSE 5

11. Quality Improvement - Who Cares?
Quality System Essentials (con’t):
Personnel: QSE 6
Equipment: QSE 7
Purchasing and Inventory: QSE 8
Process Improvement: QSE 9
Facility & Safety: QSE 10
Information Management: QSE 11

12. Quality Improvement - Who Cares?
Audits / Inspections
Internal
Tracer audits (NYSDOH requirement)
General audits
CAP (self-audits)
External
CAP, AABB, NYSDOH, FDA, TJC,
vendors and/or reference labs

13. Quality Improvement - Who Cares?
OCCURRENCE MANAGEMENT

14. Quality Improvement - Who Cares?
RL Solutions
Hospital reporting system
Many levels of severity for reporting

15. Quality Improvement - Who Cares?
Medical Error Risk Management (MERM)
Representatives from MCIC, nursing, legal, quality, pharmacy, patient relations and the Chief Quality Officer determine whether an event should be documented as:
RCA
NYSDOH
PSRM
Hospital Quality Board

16. Quality Improvement- Who Cares?
Common Laboratory Metrics:
Lost samples
Corrected reports
Failed proficiency testing
Customer complaints
Turnaround times
Division-specific Metrics:
Identify and monitor indicators that measure
critical aspects of service, high risk or problem-
prone areas

18. Quality Improvement - Who Cares?
VALUE = QUALITY / COST

19. Quality Improvement - Who Cares?
COSTS OF MISLABELED SPECIMENS
Consider the efforts of all staff involved:
Discover error and notify SMS
Check for erroneous results reported and remove
Check for other patient / tube involvement
Notify floor of error and ask for redraw
Redraw and send new specimen
SMS processing
Analysis / report time

20. Quality Improvement - Who Cares?
COSTS OF MISLABELED SPECIMENS (con’t) Consider the efforts of all staff involved: Average hourly wage = $20.00 (RN = $30, PCT = $15, SMS Tech = $15, Lab Tech = $20) Estimated Test Cost = $10 40 x 20 x 10 = $

21. QUALITY CONTINUUM Analytical Phase CLIA/CAP AQ QA AQ
- Lack of Awareness
- Oblivious
CLIA/CAP QA
Checklist Mentality
Aim to Meet Minimum Requirement AQ
Focus on Analytical quality
Reactive not proactive

22. QUALITY CONTINUUM Organization Excellence QM Performance Excellence
TQM QM QM
Formalized QMS
Operational Transparency Metrics
Track Cost of Quality
Organization Honesty
TQM
Benchmarking
Feedback Loops
Employee Involvement
Fact-based Decision Making
Systems Thinking
Aim to Meet Customer Requirements
Reporting Culture
Proactive
Performance Excellence
Include Entire Organization and
all Management Systems
Innovation
Long-Term Success
Aim for Best Practices
Achieving Benchmarks
Learning Organization

23. Quality Improvement - Who Cares?
Future
Tracking the cost of quality
Quarterly dashboards for all units
Total employee engagement