بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. The First Era: Nightingale ,1863: • Systematic enquiry of processes Ernest Codman,1910: • Variability of outcomes • Effectiveness of treatment American college of surgeons,1917: • Hospital Standardization Program

3. The Second Era Avedis Donabedian,1980: Structure Process Outcome

4. The Third Era Brent James,1990:Applying TQM in health care IOM,1999: Direct relationship between quality of care and patient outcome(Patient Safety…)

5. A new paradigm (late 80s) because of: • Medical errors and nursing negligence • Appearance of evidence-based medicine • Medical ethics • Increasing healthcare costs • Nurse physician gap + • Complexity in health care organizations

6. Medical errors Dr Mahdavi One Error On Every Patient Every Day

7. Empowerment Keys Knowledge Management Creating autonomy Replacing hierarchy with teams

9. Accreditation QI Cycle problem standards audit repeat incentive behavior Next Problem

10. Accreditation infrastructure Strategic planning Process management Data collection Quality improvement planning Indicators Orientation program Job description Competency testing

11. Avoid Falsification

12. Accreditation Precursors Leadership(innovative Organization) Hierarchy To Teambuilding Project Management Change Management Model(e.G: Lewin’s Model) Empowered Learning Model(esp: Common Standards) Focus On Knowledgeables

13. Public Reporting In late 1980s : case mix _adjusted mortality by CMS))rates In early 1990s: mortality rate on open heart surgery and individual surgeons (angioplasty)

14. Leader Stays calm when things break down Adapts smoothly to changing situations Willing to delegate authority Refuses to micromanage Is always positive and optimistic

15. Leader • Employs a “big picture” – yet contextualized – approach • Succinctly explains “mission, standards and priorities.” • Maintains the highest ethical standards and insists that others do the same • Promotes a sense of teamwork throughout the organization

16. Leader • Recognizes that a “zero-defects mentality” is unrealistic • Allows others to fail • Listens well • Communicates well(tongue ,ear ,brain ,heart , Circumstances) • Displays high level of optimism ,confidence and positive thinking • Is patient

17. Leader • Has a sense of humor(and welcome to criticism) • Is initiative • Is transparent • Develops leaders around him/her • Uses good word • Has abundance mentality(not scarcity mentality)

18. با تشکر والسلام عليکم