Quality Control in Healthcare: A Comprehensive Course

1. King Saud UniversityCollege of Business AdministrationDepartment of Health Administration - Masters` Program PA 509-Quality Control in Healthcare Second Semester 1439/ 1440 Mohammed S. Alnaif, Ph.D. E-mail: alnaif@ksu.edu.sa Mohammed S Alnaif

2. Quality Control in Healthcare Introduction Course Learning Objectives: Gain a deep understanding for the development of the science of studying and measuring variation in daily work and the application of that work to the improvement of patient care. Define performance management, and describe the key components of a performance management system; To examine the various dimensions and levels of health system performance; Mohammed S Alnaif

3. Quality Control in Healthcare Introduction Course Learning Objectives: To identify the measurement instruments and analytical tools needed to implement successful performance measurement; To explore the implications for the design and implementation of performance measurement systems; To examine the implications of performance measurement for policy-makers, politicians, regulators and others charged with the governance of the health system. Mohammed S Alnaif

4. Quality Control in Healthcare Introduction To attain quality, it is well to begin by establishing the “vision” for the organization, along with policies and goals. Conversion of goals into results (making quality happen) is then done through managerial processes—sequences of activities that produce the intended results. Mohammed S Alnaif

5. Quality Control in Healthcare Introduction Managing for quality makes extensive use of three such managerial processes: Quality planning Quality control Quality improvement These processes are now known as the “Juran trilogy.” Mohammed S Alnaif

6. Quality Control in Healthcare Figure 1 Juran Trilogy Mohammed S Alnaif

7. Quality Control in Healthcare Quality Control Defined. “Quality control” is a universal managerial process for conducting operations so as to provide stability—to prevent adverse change and to “maintain the status quo.” To maintain stability, the quality control process evaluates actual performance, compares actual performance to goals, and takes action on the difference. Mohammed S Alnaif

8. What is performance? • “Performance” must be defined in relation to explicit goals reflecting the values of various stakeholders (such as patients, professions, insurers, regulators). • In reality, however, very few performancemeasurement systems focus on health outcomes valued by customers. Mohammed S Alnaif

9. Measurement • “Measurement” implies objective assessment but does not itself include judgement of values or quality; these may be added by those who later present and interpret the data. Mohammed S Alnaif

10. Performance measures • Performance measures are designed to measure systems of care and are derived from clinical or practice guidelines. Data that is defined into specific measurable elements provides an organization with a meter to measure the quality of its care. Mohammed S Alnaif

11. Performance measurement • Performance measurement is a process by which an organization monitors important aspects of its programs, systems, and processes. • In this context, performance measurement includes the operational processes used to collect data necessary for the performance measures. Mohammed S Alnaif

12. Performance management • Performance management is a forward-looking process used to set goals and regularly check progress toward achieving those goals. • In practice, an organization sets goals, looks at the actual data for its performance measures, and acts on results to improve the performance toward its goals. Mohammed S Alnaif

13. Quality Control in Healthcare Quality Control Quality control is one of the three basic managerial processes through which quality can be managed. The others are quality planning and quality improvement. The performance-improvement plan consists of a detailed strategy for undertaking specific projects to address improvement opportunities. Performance-improvement projects are not undertaken in isolation but rather as part of a cohesive performance-improvement program. Mohammed S Alnaif

14. Quality Control in Healthcare The Relation to Quality Assurance Quality control and quality assurance have much in common. Each evaluates performance. Each compares performance to goals. Each acts on the difference. However they also differ from each other. Mohammed S Alnaif

15. Quality Control in Healthcare The Relation to Quality Assurance Quality control has as its primary purpose to maintain control. Performance is evaluated during operations, and performance is compared to goals during operations. The resulting information is received and used by the operating forces. Mohammed S Alnaif

16. Quality Control in Healthcare The Relation to Quality Assurance Quality assurance’s main purpose is to verify that control is being maintained. Performance is evaluated after operations, and the resulting information is provided to both the operating forces and others who have a need to know. Others may include plant, functional, or senior management; corporate staffs; regulatory bodies; customers; and the general public. Mohammed S Alnaif

17. Quality Control in Healthcare Quality Control The Feedback Loop Quality control takes place by use of the feedback loop. A generic form of the feedback loop is shown in Figure 1.2. Cybernetic System, or self regulating system is controlled in order to adjust the future functioning of the system within a predetermined set of standards. Mohammed S Alnaif

18. Figure 1.2. Cybernetic System The Feedback Loop Input Resources Output work results & objective Conversion Process Monitor Sensors Control Process Corrective Actions Standards Dr. Mohammed Alnaif

19. Quality Control in Healthcare Quality Control The progression of steps in Figure 1.2 is as follows: A sensoris “plugged in” to evaluate the actual quality of the control subject—the product or process feature in question. The performance of a process may be determined directly by evaluation of the process feature, or indirectly by evaluation of the product feature—the product “tells” on the process. Mohammed S Alnaif

20. Quality Control in Healthcare Quality Control The progression of steps in Figure 1.2 is as follows: The sensor reports the performance to a monitor. The monitor also receives information on what is the quality goalor standard. The monitor compares actual performance to standard. If the difference is too great, the monitor energizes a control. The controlstimulates the process(whether human or technological) to change the performance so as to bring quality into line with the quality goal. Mohammed S Alnaif

21. Quality Control in Healthcare Quality Control Note that in Figure 1.2 the elements of the feedback loop are functions. These functions are universal for all applications, but responsibility for carrying out these functions can vary widely. Much control is carried out through automated feedback loops (Cybernetic System), or self regulating system . No human beings are involved. Common examples are the thermostat used to control temperature and the cruise control used in automobiles to control speed. Mohammed S Alnaif

22. Quality Control in Healthcare Quality Control Another frequent form of control is self-control carried out by a human being. An example of such self-control is the village artisan who performs every one of the steps of the feedback loop. The artisan chooses the control subjects, sets the qualitygoals, senses what is the actual quality performance, and judge conformance, he becomes the control in the event of nonconformance. Mohammed S Alnaif

23. Quality Control in Healthcare Quality Control Quality control focuses on the process of producing the product or service with the intent of eliminating problems that might result in defects. Planning for control is the activity which provides the system—the concepts, methodology, and tools—through which HSOs personnel can keep the operating processes stable and thereby produce the service features required to meet customer needs Mohammed S Alnaif

24. Quality Control in Healthcare Quality Control Tools, methods, and procedures are analogous to the tip of the iceberg. We can observe HSOs using tools and methods for improvement. We can see HSOs making a flowchart, plotting a control chart, or using a checklist. These tools and procedures are the logical results of systems and models that HSOs put in place (knowingly and unknowingly). Mohammed S Alnaif

25. Quality Control in Healthcare Quality Control HSOs may use several tools and procedures to make improvements, and these tools might form one part of an improvement system. Although we can observe HSOs using the tools of the system, the system itself is invisible and cannot be observed. These systems come from theories that might be shared among many people who work together to improve quality, or they may come from ideas held by individuals. Mohammed S Alnaif

26. Quality Control in Healthcare Quality Control One of the difficult things about quality is explaining how a toolis different from a processor system. For example the current emphasis on leanproduction and Six Sigma are a quality management system. Neither is actually a tool; both are systems that provide an effective integration of many different tools. Mohammed S Alnaif

27. Quality Control in Healthcare Quality Control other Terms Healthcare analytics consists of the systems, tools, and techniques that help HCOs gain insight into current performance, and guide future actions, by discerning patterns and relationships in data and using that understanding to guide decision making. Mohammed S Alnaif

28. Quality Control in Healthcare Quality Control Healthcare quality is paramount. Ensuring healthcare that is safe, effective, efficient, equitable, patient centered, and timely is fundamental to all current and future healthcare systems, whether big, small, global, national, or regional. Mohammed S Alnaif

29. Quality Control in Healthcare Quality Control This course provides the practical tools necessary for measuring and improving healthcare performance and promoting transparency of clinical pathways and outcomes. Mohammed S Alnaif

30. Quality Control in Healthcare Quality Control We will Start by: Discussing foundational healthcare quality principles. Define performance management, and describe the key components of a performance management system Discuss critical quality issues at the organizational and microsystem levels. Discuss the influence of the environment and emerging trends on the organizations, teams, and individuals delivering healthcare services and products. Mohammed S Alnaif

31. The Quality of Healthcare Definitions of Quality Every initiative taken to improve quality and outcomes in health systems has as its starting point some understanding of what is meant by ‘quality’. Without this understanding, it would be impossible to design the interventions and measures used to improve results. Mohammed S Alnaif PhD,

32. The Quality of Healthcare Definitions of Quality Carrying out interventions correctly according to pre-established standards and procedures, with an aim of satisfying the customers of the health system and maximizing results without generating health risks or unnecessary costs. Conformance to specification Mohammed S Alnaif PhD,

33. The Quality of Healthcare Definitions of Quality The Oxford English Dictionary(1988) defined quality as “the degree or grade of excellence”. Mohammed S Alnaif PhD,

34. The Quality of Healthcare Definitions of Quality Agency for health care research and quality defined quality as "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Mohammed S Alnaif PhD,

35. The Quality of Healthcare Definitions of Quality National Association of Quality Assurance Professionals described quality as “the level of excellence produced and documented in the process of patient care, based on the best knowledge available and achievable at a particular facility.” Mohammed S Alnaif PhD,

36. The Quality of Healthcare Definitions of Quality Institute of Medicine (IOM) “Degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with professional knowledge.” Mohammed S Alnaif PhD,

37. The Quality of Healthcare IOM’s Six Aims for Improvement, these are known as Performance Domain Safety Effectiveness Patient-centeredness Timeliness Efficiency Equity Mohammed S Alnaif PhD,

38. The Quality of Healthcare IOM’s Six Aims for Improvement Safety Safe, delivering health care which minimizes risks and harm to service users Example: Computerized physician order entry system to prevent medication errors Example: Surgeons “sign your site” of the body part that will be operated upon Mohammed S Alnaif PhD,

39. The Quality of Healthcare IOM’s Six Aims for Improvement Effectiveness Effective, delivering health care that is adherent to an evidence base and results in improved health outcomes for individuals and communities, based on need Avoid overuse and underuse of services Mohammed S Alnaif PhD,

40. The Quality of Healthcare IOM’s Six Aims for Improvement Effectiveness Example: Redesign processes based on best practices such as ensuring that patients at risk for heart disease take appropriate medications Example: Implement utilization management to reduce inappropriate hospital use Mohammed S Alnaif PhD,

41. The Quality of Healthcare IOM’s Six Aims for Improvement Patient-centeredness Acceptable/patient - centered, delivering health care which takes into account the preferences and aspirations of individual service users and the cultures of their communities Respect patient needs, preferences, and culture Mohammed S Alnaif PhD,

42. The Quality of Healthcare IOM’s Six Aims for Improvement Timeliness Accessible, delivering health care that is timely, geographically reasonable, and provided in a setting where skills and resources are appropriate to medical need Reduce waits for those who receive and who give care Mohammed S Alnaif PhD,

43. The Quality of Healthcare IOM’s Six Aims for Improvement Efficiency Efficient, delivering health care in a manner which maximizes resource use and avoids waste Reduce waste of facilities, equipment, supplies, and people Mohammed S Alnaif PhD,

44. The Quality of Healthcare IOM’s Six Aims for Improvement Efficiency Example: implement inventory management systems to reduce amount of drugs and other supplies on hand Example: Use flexible staffing systems based on patient numbers and needs to adjust number of nurses per patient care unit Mohammed S Alnaif PhD,

45. The Quality of Healthcare IOM’s Six Aims for Improvement Inefficiency = Waste Waits and Delays Operating Room Throughput Emergency Department Diversions Medical Records Availability Mismatch Between Capacity and Demand Mohammed S Alnaif PhD,

46. The Quality of Healthcare IOM’s Six Aims for Improvement Equity Equitable, delivering health care which does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location, or socioeconomic status Reduce racial, ethnic, geographic and socio-economic differences Mohammed S Alnaif PhD,

47. The Quality of Healthcare IOM’s Six Aims for Improvement Equity Example: Provide healthcare services in every region of the country Example: Train more physicians from minority racial and ethnic groups Example: Establish universal health insurance coverage Mohammed S Alnaif PhD,

48. The Quality of Healthcare Definitions of Quality Quality must be defined in terms of experience and outcomes of the patient and the population that generates patients Mohammed S Alnaif PhD,

49. The Quality of Healthcare Definitions of Quality There is a growing field of research concerning evidence for quality. This research reinforces a more scientific and systematic approach to the use of information concerning interventions on quality. Mohammed S Alnaif PhD,

50. The Quality of Healthcare WHO suggest seven activities (“elements”) Stakeholder involvement Situational analysis Confirmation of health goals Quality goals Choosing interventions for quality Implementation process Monitoring progress Mohammed S Alnaif PhD,