1. INTRODUCTION TO QUALITY MANAGEMENT

2. DIAGNOSTIC IMAGING IS THE MULTI-STEP PROCESS

3. THERE ARE NUMEROUS SOURCES OF VARIABILITY IN BOTH HUMAN FACTORS AND EQUIPMENT THAT CAN PRODUCE SUBQUALITY IMAGES

4. THE PURPOSE OF QUALITY MANAGEMENT PROGRAM IS TO CONTROL OR MINIMIZE THOSE VARIABLES

5. VARIABLES IN DIAGNOSTIC IMAGING
EQUIPMENT
IMAGE RECEPTOR
PROCESSING
VIEWING CONDITIONS
COMPETENCY OF THE TECHNOLOGIST, INTERPRETER, AND SUPPORT STAFF.

6. LEVELS OF QUALITY OF GOODS
EXPECTED QUALITY
PERCEIVED QUALITY
ACTUAL QUALITY

7. SINCE 1980 HEALTHCARE DELIVERY IS UNDERGOING DRAMATIC CHANGES!!
THESE CHANGES ARE GREATLY AFFECTING
DIAGNOSTIC IMAGING DEPARTMENTS

8. HEALTHCARE CHANGES

9. CHANGES IN HEALTH CARE THAT AFFECT IMAGING DEPARTMENTS
ADVANCES IN TECHNOLOGY
LEGISLATION AND GOVERNMENT REGULATIONS
JCAHO PROCEDURES
CORPORATE BUYOUTS AND MERGERS
METHODS OF REIMBURSEMENT FOR SERVICES

10. ADVANCES IN TECHNOLOGY
COST OF INSTALLATION & MAINTENANCE

11. LEGISLATION AND GOVERNMENT REGULATIONS
SAFE MEDICAL ACT 1990
MAMMOGRAPHY QUALITY STANDARDS ACT OF 1992
INCREASED RESPONSIBILITY OF DIAGNOSTIC DEPARTMENT
MANAGERS AND STAFF TO DOCUMENT PROPER EQUIPMENT
OPERATION AND PROCEDURES.

12. CORPORATE BUYOUTS AND MERGERS

13. CORPORATE BUYOUTS AND MERGERS
SINCE ,000 HOSPITALS CLOSED

14. JCAHO PROCEDURES
TQM QA

15. METHODS OF REIMBURSEMENT FOR SERVICES
HMO’S
LOWER REIMBURSMENT RATE!!!

16. CONCEPT OF SCIENTIFIC MANAGEMENT UNTIL 1980
HISTORY OF Q.M.
1900 FREDERICK WINSLOW – FATHER OF SCIENTIFIC MANAGEMENT
CONCEPT OF SCIENTIFIC MANAGEMENT UNTIL 1980

17. HISTORY OF Q.M. 1980 W. EDWARDS DEMING & JOSEPH JURAN
CONCEPT OF QUALITY IMPROVEMENT

18. SOME IMAGING DEPT. SINCE 1930s SYSTEMATICALLY MONITOR THEIR EQUIPMENT TO SAVE MONEY AND INCREASE EFFICIENCY

19. GOVERNMENTAL ACTIONS 1968 RADIATION CONTROL FOR HEALTH AND SAFETY ACT
1980 OSHA
1981 CONSUMER PATIENT RADIATION HEALTH AND SAFETY ACT
SMDA OF 1991
1992 MQSA
1996 HIPPA
2000 CARE ACT

20. 1968 RADIATION CONTROL FOR HEALTH AND SAFETY ACT
REQUIRED US DEPT. OF HEALTH TO DEVELOP AND ADMINISTER STANDARDS THAT WOULD REDUCE HUMAN EXPOSURE FROM ELECTRONIC DEVICES.
BRH – REG. ACTION IN 1974 TO CONTROL THE MANUFACTURE AND INSTALLATION OF MEDICAL AND DENTAL DIAGNOSTIC EQUIPMENT
JACHO ADOPTED THESE RECOMMENDATIONS

21. 1980 OSHA
IN RESPONSE TO OUTBREAK OF HIV AND HEPATITIS B VIRUSES, MANDATED THE POLICY ON BLOOD-BORNE PATHOGENS.
OSHA ALSO MONITORS WORKPLACE FOR OCCUPATIONAL EXPOSURE TO RADIATION AND CHEMICALS.

22. 1981 CONSUMER PATIENT RADIATION HEALTH AND SAFETY ACT
ADDRESSED ISSUES OF UNNECESSARY REPEAT EXAMS
IT ESTABLISHED MINIMUM STANDARD FOR ACCREDITATION OF EDUC. PROGRAMS IN RADIOLOGIC SCIENCEAND FOR THE CERTIFICATION OF EQUIPMENT OPERATORS!!!!!!

23. SMDA OF 1991
REQUIRES MEDICAL FACILITY TO REPORT TO FDA ANY MEDICAL DEVICE THAT CAUSED INJURY OR DEATH OF A PATIENT!

24. 1992 MQSA
MANDATED Q.A. PROGRAMS FOR ALL FACILITIES PERFORMING MAMMOGRAPHY STUDIES – FDA APPROVAL.
IT ALSO SPECIFIED STANDARD AND REQUIREMENTS FOR EQUIPMENT, TECHNOLOGISTS, DOCTORS INTERPRETING THE RADIOGRAPHS, AND MEDICAL PHYSICISTS.

25. HIPAA OF 1996
SIMPLIFICATION OF H.C. STANDARDS TO ESTABLISH NATIONAL STANDARDS FOR HEALTHCARE E-COMMERCE
CONFIDENTIALITY OF PATIENT RECORDS!!!!!!

26. ACCREDITATION IS VOLUNTARY!!!
JCAHO
INCE 1970 REQUIRES HOSPITALS AND OTHER HEALTHCARE PROVIDERS TO PERFORM AND DOCUMENT Q.M. PROCEDURES FOR THE FACILITIES TO GET ACCREDITATION
ACCREDITATION IS VOLUNTARY!!!

27. LACK OF ACCREDITATION HOSPITALS MAY NOT BE ABLE TO
HAVE RESIDENCY PROGRAMS
HOLD CERTAIN LICENSES
HAVE MEDICAID CERTIFICATION
RECEIVE MALPRACTICE INSURANCE

28. ENHANCEMENT OF PATIENT CARE
QUALITY ASSURANCE
IS AN ALL-ENCOMPASING MANAGEMENT PROGRAM USED TO ENSURE EXCELLENCE IN HEALTHCARE THROUGH THE SYSTEMATIC COLLECTION AND EVALUATION OF DATA.
PRIMARY OBJECTIVE:
ENHANCEMENT OF PATIENT CARE

29. QUALITY MANAGEMENT
PART OF THE QA ASSURANCE PROGRAM THAT DEALS WITH TECHNIQUES USED IN MONITORING AND MAINTENANCE OF THE TECHNICAL ELEMENTS OF THE SYSTEMTHAT AFFECT THE QUALITY OF THE IMAGE

30. Q.M. DELAS WITH EQUIPMENT AND INSTRUMENTATION

31. QUALITY CONTROL LEVELS OF TESTING
NONINVASIVE- SIMPLE
NONINVASIVE AND COMPLEX
INVASIVE AND COMPLEX

32. CONTINUOUS QUALITY IMPROVEMENT
INCORPORATED BY JCAHO IN 1991

33. C.Q.I.

34. KAIZEN

35. CQI SYNONYMS TQM- TOTAL QUALITY MANAGEMENT TQC - TOTAL QUALITY CONTROL
TQI – TOTAL QUALITY IMPROVEMENT
SQC – STATISTICAL QUALITY CONTROL

36. FOCUS IS ON THE ORGANIZATION AS
C.Q.I DOES NOT REPLACE QA INSTEAD OF JUST ENSURING & MAINTAINING QUALITY IT CONTINUALLY IMPROVES QUALITY BY FOCUSING ON IMPROVING THE SYSTEM
FOCUS IS ON THE ORGANIZATION AS
THE WHOLE

37. C.Q.I INTERNALLY MOTIVATED
EVERY EMPLOYEE CONTRIBUTES TO THE SUCCESS OF THE ORGANIZATION

38. C.Q.I. PROCEES IMPROVEMENT PREMISES
85/15 RULE
80/20 RULE
WORKERS KNOW THEIR WORK BETTER THAN OUTSIDER
STRUCTURED PROBLEM SOLVING SUCCESSFUL IN PROBLEM SOLVING
QUALITY IMPROVEMENT – JOB OF EVERYONE IN THE ORGANIZATION

39. PROCESS
ORDERED SERIES OF STEPS THAT HELP ACHIEVE A DESIRED OUTCOME.

40. PARTS OF THE PROCESS SUPPLIER INPUT ACTION OUTPUT
CUSTOMER : INTERNAL EXTERNAL

41. PROBLEM IDENTIFICATION AND ANALYSIS:
TEAMS – 2 PEOPLE OR MORE!
IDEAL: 6 – 12 PEOPLE

42. GROUP DYNAMICS TOOLS BRAINSTORMING FOCUS GROUPS
QUALITY IMPROVEMENT TEAM
QUALITY CIRCLES
MULTI-VOTING
CONSENSUS
WORK TEAMS
PROBLEM SOLVING TEAMS

43. 1985- JCAHO 10- STEP MONITORING AND EVALUATION PROCESS
ASSIGN RESPONSIBILITY
DELINEATE THE SCOPE OF CARE SERVICE
IDENTIFY THE IMPORTANT ASPECTS OF CARE AND SERVICES
IDENTIFY INDICATORS
ESTABLISH MEANS TO TRIGGER EVALUATION
COLLECT AND ORGANIZE DATA
INITIATE EVALUATION
TAKE ACTION TO IMPROVE CARE AND SERVICES
ASSESS EFFECTIVENESS OF ACTIONS AND MAINTAIN IMPROVEMENTS
COMMUNICATE RESULTS TO AFFECTED INDIVIDUALS

44. ASSIGN RESPONSIBILITY

45. DELINEATE THE SCOPE OF CARE SERVICE

46. IDENTIFY THE IMPORTANT ASPECTS OF CARE AND SERVICES

47. IDENTIFY INDICATORS
SENTINEL EVENT – INDIVIDUAL EVENT SIGNIFICAN EVENT TO TRIGGER FURTHER REVIEW.
AGGREGATE DATA – RELATES TO QUANTIFICATION OF PROCESS RELATED TO MANY CASES.

48. INDICATORS: APPROPRIATNESS OF CARE – IS IT NECESSARY?
CONTINUITY OF CARE – DEGREE OF COORDINATION AMONG PRACTITIONERS.
EFFECTIVENESS OF CARE – THE LEVEL OF BENEFIT.
EFFICACY – THE LEVEL OF BENEFIT UNDER IDEAL CONDITIONS
EFFICIENCY – OUTCOME OBTAINED WHEN THE HIGHEST QUALITY CARE IS DELIVERED.
RESPECT & CARING
SAFETY IN THE CARE ENVIRONMENT
TIMELINESS OF CARE
COST OF CARE
AVAILABILITY OF CARE

49. ESTABLISH MEANS TO TRIGGER EVALUATION

50. COLLECT AND ORGANIZE DATA

51. INITIATE EVALUATION

52. TAKE ACTION TO IMPROVE CARE AND SERVICES

53. ASSESS EFFECTIVENESS OF ACTIONS AND MAINTAIN IMPROVEMENTS

54. COMMUNICATE RESULTS TO AFFECTED INDIVIDUALS

55. JACHO CYCLE FOR IMPROVEMENT
DESIGN.
MEASURE
ASSESS
IMPROVE

56. DESIGN.
SYSTEMATIC PLANNING AND IMPLEMENTATION

57. MEASURE
COLLECTION OF VALID AND RELIABLE DATA

58. ASSESS HISTORICAL DATA DESIRED PERFORMANCE LIMITS PRACTICE GUIDELINES
EXTERNAL REFERENCE DATABASE
BENCHMARKING

59. IMPROVE
DATA
IMPROVE
ANALYSIS