1. Quality Improvement: A Strategy for Success Overview May 5, 2015
Patricia Breen, RN,BSN,FCN
Bureau of Primary Health Care/HRSA

2. Learning Objectives
Name the three aims of the National Quality Strategy
Recall the six dimensions of healthcare performance
Identify components of a robust Quality Improvement (QI) Program
Identify available QI resources

3. National Focus on Quality
Institute of Medicine report
HHS National Quality Strategy
Accreditation (TJC/AAAHC )
Required element of Public Health Service Act Sec. 330 grants
FTCA application
NCQA Patient Centered Medical Home (PCMH) recognition
Meaningful use (HIT)
Patient awareness/satisfaction

4. National Quality Strategy’s
Three Aims
Better Care: Improve the overall quality of care,
by making health care more patient-centered
reliable, accessible, and safe.
2. Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.
3. Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

5. Definition
“Quality Improvement is a continuous ongoing process designed to improve patient outcomes”. (

6. Quality Improvement
Continuous proactive approach
Commitment is critical
Culture is crucial
Customer focused
Driven by data
Encompasses:
Assessing
Implementing
Evaluating
Processes
and Systems

7. Six dimensions of health care performance
Provides strong foundation to support the delivery of
quality health care that is:
Safe
Effective
Patient-centered
Timely
Efficient
Equitable
Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century. March National Academies Press. 7

8. - Antoine de Saint Exuprey
Have a Plan
“A Goal without a Plan
is Just a Wish”.
- Antoine de Saint Exuprey

9. Components of an Integrated QI Plan

10. Organization–wide program Framework or model for QI activities
Components
Mission/ Vision
Organization–wide program
Framework or model for QI activities
Measurable goals
QI processes for identification /response to problems
Periodic review of QI Plan
Risk management integration
Additional Elements 10

11. Mission/ Vision
Reflects what you are trying to accomplish at an organizational level
Defines Goals/Purpose such as: Appropriate Care, Every Patient, Every Time
May incorporate providing full access to care, utilization of best practices, ensuring effective information flow, mitigating risk in a fiscally responsible manner
Delineates authority and scope

12. Organization – wide program
Clinical director whose focus of responsibility is to support the QI/QA program
QI committee composed of cross section of staff : clinical, non-clinical, administrative
The team is critical to the development and execution of the plan
Leadership involved in QI decision making
One overall QI committee for multiple sites

13. Framework or model for QI activities
Broadly:
Assess your safety culture
Consider patient population
Develop process for collection of identified data
Use data to guide quality improvement activities
Ultimately need a method to identify and define the problem, generate alternatives, select a strategy, implement a process, and evaluate the results.

14. How much? Why? How? What ‘s next? Data in primary care
enough to direct improvement efforts without being an undue burden
Why?
To understand population served
To assess whether changes made are leading to improvement in care
How?
Analyze, Prioritize, Trend
What ‘s next?
Impact, Monitor

15. Model for QI activities
Specifically:
Rapid cycle Improvement: Plan-Do-Study-Act (PDSA)
FADE ( focus, analyze, develop, execute/evaluate)
DMAIC (define, measure, analyze, improve, control)
FOCUS (find, organize, clarify, understand, select)
Six Sigma/ LEAN (purpose, process, people)
Expanded Chronic Care Model

16. Measures/Benchmarks Uniform Data System(UDS) measures
The Healthcare Effectiveness Data and Information Set (HEDIS)
National Quality Forum Performance Measures
Benchmarks (Healthy People 2020; ANA National Database of Nursing Quality Indicators)
Best Practices (ACOG, AAFP, AMA)
Databases :AHRQ’s National Health Care Quality Report; National Healthcare Disparities Report
CMS Meaningful Use Clinical Quality Measures
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
According to the American Productivity and Quality Center, benchmarking is the “process of identifying,
understanding, and adapting outstanding practices from organizations anywhere in the world to help your
organization improve its performance.”

17. Goals
Set SMART goals:
Specific
Measurable
Achievable
Realistic
Time-specific
Set Stretch goals

18. RM Overlap with QI A Measure of Quality: Implementing a QI/QA Program
ECRI- April 2012 archived audio conference

19. QI Processes for identification of/ response to problems
Reporting system
Patient Satisfaction Surveys
Patient/ Provider complaints
Tools
Cause and Effects Diagrams/ Fishbone Charts
Flow charts
5 Whys
Root Cause Analysis (RCA)
Failure Mode Effects Analysis ( FMEA)

20. Factors to Consider when analyzing an event
Patient Characteristics
Task Factors
Caregiver Factors
Team Factors
Work Environment Factors
Department Factors
Institutional Factors
Pronovost, P. Understanding the Science of Safety.

21. Periodic review of QI Plan
Board review and approval on a regular basis as evidenced by Board signatures or minutes
Evaluate, Integrate, Celebrate, and Disseminate

22. Risk management Integration
Proper Credentialing and privileging
Appropriate Supervision of staff
Periodic assessment of the appropriateness of the utilization of services and the quality of services provided or proposed to be provided to individuals served by the health center
Tracking policies and procedures
Triage policies and procedures
Policies and Procedures for investigating and addressing medical malpractice claims

23. Risk Management Process

24. Additional Elements
Maintain confidentiality of patient records
Know and comply with state regulations
Regular QI meetings and regular reports to the Board
Document QI activities in QI committee Minutes and Board minutes
Attendees, agenda items, discussion topics, recommendations, action items, responsible parties, timeline

25. QI + The National Quality Three Aims and Your FQHC
Better Care: Improve the overall quality of care,
by making health care more patient-centered
reliable, accessible, and safe.
2. Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.
3. Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

26. ECRI Clinical Risk Management Resources
Guidance articles
Self-assessment questionnaires
Education and training tools
Toolkits
Sample policies and tools
Archived webinars
Archived Virtual Conference
E-learn continuing education
Electronic fetal monitoring online education
Biweekly E-news
Monthly Get Safe! assessment checklists
Quarterly Practice Alert! assessment tools
Quality in Action newsletter
(610) , x5200

28. FTCA Website: http://www.bphc.hrsa.gov/ftca/
General Contact Information
FTCA/BPHC Help Line
Phone: BPHC ( )
9:00 AM to 5:30 PM (ET)
FTCA Website:

29. Bureau of Primary Health Care Office of Quality Improvement
Contact Information
Patricia M. Breen RN
Public Health Analyst
Bureau of Primary Health Care
Office of Quality Improvement
5600 Fishers Lane, 16W61C
Rockville, Maryland 20857
Phone: