240 likes | 616 Views
Two patients limp into two different medical clinics with
E N D
1. Quality Improvement in Healthcare The National Opportunities
24-10-07
3. Three Part Problem...
Improve Individual Experience
Improve Population Health
Control Inflation of Per Capita Costs
The root of the problem in health care is that the business models of almost all health care organizations depend on keeping these three aims separate. Society on the other hand needs these three aims optimized (given appropriate weightings on the components) simultaneously.
--- (Tom Nolan, PhD)
4. 17 years to apply 14% of research knowledge to patient care!
Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yrbk of Med Informatics 2000; 65-70
10. Balas EA, Boren SA. Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000: Patient-centered Systems. Stuttgart, Germany: Schattauer,
2000:65–70. <abalas@health.missouri.edu>10. Balas EA, Boren SA. Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000: Patient-centered Systems. Stuttgart, Germany: Schattauer,
2000:65–70. <abalas@health.missouri.edu>
5. Misuse McGlynn, et al: The quality of health care delivered to adults in the United States. NEJM 2003; 348: 2635-2645 (June 26, 2003)
439 indicators of clinical quality of care
30 acute and chronic conditions, plus prevention
Medical records for 6712 patients
Participants had received 54.9% of scientifically indicated care (Acute: 53.5%; Chronic: 56.1%; Preventive: 54.9%)
Conclusion: The “Defect Rate” in the technical quality of American health care is approximately 45%
6. Quality Improvement “Health Care Quality Improvement is a broad range of activities of varying degrees of complexity and methodological and statistical rigor through which health care providers develop, implement and assess small-scale interventions and identify those that work well and implement them more broadly in order to improve clinical practice.”
Mary Ann Bailey, The Hastings Center
8. “A New Health System for the 21st Century
11. Aim Aligned
Timed
Numeric
Unachievable
12. Measures
13. R Lloyd, Institute for Healthcare Improvement
15. R Lloyd, Institute for Healthcare Improvement
16. Scottish Patient Safety Alliance
17. Step 1 The Scottish Patient Safety Programme
18. Aims Make care safer by a measurable amount
Mortality: 15% reduction
Adverse Events: 30% reduction
Build improvement capacity in NHS Scotland
19. Interventions Critical Care
E.g: ventilator acquired pneumonia rate
Ward
E.g.: Crash call rate
Medicines management
E.g.: Adverse drug events
Theatres
E.g.: Surgical site infection rate
Leadership
E.g.:Safety walkarounds
20. New lessons 1 ? 2 ? 5 ? all
Spread and sustainability
Capacity building
21. Board/Hospital Structure
22. NHS - opportunity for Improvement in Healthcare? For
Single system
Universal access
Population approach
Team working
No other incentives
Loyal and motivated workforce Against
Negativity
Sparse clinical leadership
Professional silos
Organisational silos
Low level of improvement skills
23. “Do not be content with mediocrity. Do your job so well that nobody could do it better. “ Martin Luther King