implementing performance improvement programs
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7/29/2019 Implementing Performance Improvement Programs
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Implementing a
Performance ImprovementProgram
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TQM – Total Quality Management
QI – Quality Improvement
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Rationale for Performance
Improvement
Achieving total quality
Continuously upgrading performancetargets from previously accepted
minimal standards
Improve the system, rather than focuson the errors of individuals
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Steps for TQM Implementation
1. Management Awareness
- - build awareness and commitment intop management
- - Create a TQM steering committee
- - Appoint a TQM coordinator - - Orient other staff on TQM
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2. Mobilization
- - Assess organization’s readiness for TQM
- - Establish a TQM training program
- - Organize quality teams in work areas
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3. Launching of Performance Improvement
Activities
- - Pilot a quality improvement project in one
area then gradually extend it to other areas
- - Continuously evaluate process and outcome
- - Continuously reinforce quality improvementprograms
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Documentation-Evaluation-Action
Triad
1. Documentation
- - Safety- - Consistency of Purpose
- - Standardization
- - Improvement
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2. Evaluation
- - Structure, Process and OutcomeStandards
- - Are the right interventions being done?- Are they safe and efficacious?
- - Are interventions performed correctly?
- - Are the procedures being done are theones that matter?
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3. Action- - Compliance of healthcare
organizations with standards of
performance- - Best measured through:
- 1. effective identification of problems
and opportunities for improvement- 2. improving performance based on the
information
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The Plan-Do-Check-Act Cycle
(PDCA)1. Plan
- Identify the problem
- Understand the current situation by clarifying
processes and causes of variations from
standards
- Set targets and decide on what the situationshould be if the problem was resolved
- Identify indicators of improvement
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- - Collect relevant data
- - Analyze the problem
- - Analyze the root causes- - Create a plan for action
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2. Do
- Develop and implement countermeasures
- Propose as many solutions to the vitalfew root causes
- Narrow down solutions to the mosteffective and practical countermeasures
- Implement countermeasures
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3. Check
- Confirm effectiveness of countermeasures- Monitor implementation of countermeasures
- Document the effectiveness of
countermeasures by collecting data
- Analyze data
- Determine if the problem has been solved, if
targets have been achieved, if standards
have been reached- Reflect on the lessons learned from the
problem solving steps
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4. Act
- Standardize and institutionalize
countermeasures- Present the results to a hospital-wide
forum and get top management
approval to adopt the solutions
throughout the hospital
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QUALITYIMPROVEMENT
TOOLS
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I. Problem Identification
Tools
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1. Affinity Diagram
Used to sort several ideas or issues intomeaningful groups
Simplifies the analysis process as itnarrows down the focus on a certain
issue by identifying important aspects or creating useful categories
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2. Brainstorming
Team thinking
Generates multiple perspectives on a given
issue by generating as many ideas aspossible from the members
Encourages all members to express their ideas, prevents domination of discussion by
few people
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3. Flowchart
A map or a pictorial representation of theelements of a process or a sequence of
events and interrelationships Used to understand the intricacies of a
process
Facilitates needed simplification and
standardization by identifying bottlenecks inthe process, missing or redundant steps andproblem areas
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4. Nominal Group Technique
Team brainstorming method useful for balancing member participation and reachingconsensus on the relative importance of
issues, problems or solutions
Allows the team to see major causes of disagreement
Instills ownership of ideas and commitment tothe team’s choice
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II. Problem DescriptionTools
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1. Bar Graph
Plots the frequency of occurrence of
different kinds of events during set timeintervals
Shows differences in data collectedduring different periods of time
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2. Check Sheet
Systematic recording and compilation of
historical data or qualitative andquantitative observations on a certain
phenomenon aimed at detection of
patterns and trends
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3. Force Field Analysis
Used to identify and enhance factors
which facilitate organization objectivesand pinpoint and minimize those that
act as obstacles
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4. Line Graph
Shows the evolution of a process or its output
over a period of time
Measures certain parameters of a process
observed over a given time frame
Spots trends and other patterns occurring in aprocess as it shows the peaks and lows
reflected in the quantitative data
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5. Pareto Chart
Pareto Diagram, Pareto Graph
Useful in identifying problems that require
further study due to the frequency of
incidence and in prioritizing the search for solutions
Shows which of the several causes of a
problem are the most significant and whichhave less bearing in the occurrence of the
problem
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6. Pie Chart
A pictorial representation of an entire
unit as constituted by its different parts
The proportion of the different
components are displayed and the
interrelationships between the different
parts are seen
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III. Problem Analysis Tools
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1. Fishbone Diagram
Ishikawa Diagram, Cause and Effect Diagram
Used to show the many possible causes of a
problem and the possible actions to solve it
Identifies and graphically displays inincreasing detail all possible causes to a
problem or condition to get to its root cause
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2. Matrix Diagram
Used to show a graphic representation of the
presence and strength of relationships
between two sets of information or activities
Used to compare the relationships between
certain requirements and the work processesthat deliver those requirements
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3. Scatter Plot Diagram
Scatter Diagram, Dot Chart,
Scatter Chart
Shows the relationship between two
variables
Indicates a relationship and does not
signal a causation
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IV. Solution Development
Tools
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1. Prioritization Matrix
Selection Grid
A screening tool used to narrow downoptions trough a systematic comparison
of choices using a set of criteria
Allows basic disagreements on issues
to surface for prompt resolution
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2. Process Decision
Program Chart (PDCP)
Used to graphically illustratecontingency planning
Possible problems and difficulties inimplementation are determined andstrategies for dealing with them aredetermined in advance
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3. Tree Diagram
Graphic tool used to map out detailed
group of tasks marked for
implementation
- Stratification – breaks down a goalexpressed in broad terms into
increasing levels of detailed actions
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V. Quality Monitoring Tools
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1. Control Chart
Used to monitor developments in a
process over time
Indicates the time when a process
registers values outside acceptable
limits, times when improvement effortsare needed in a process
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2. Histogram
Bar Chart, Frequency Distribution Chart
Displays the frequency of occurrence of
data values and shows the spread of
data distribution
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3. Radar Chart
Spider Chart, Spider Web Chart
Graphical display of the differencesbetween actual and ideal performance
Identifies relative strengths andweaknesses of activities
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Quality Circles and Teams
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Group of 5 to 10
workers, the front
liners, from one
work area of thehospital who meet
regularly to identify
and solve problems
in their work areausing their own
resources
QC with a bigger scope in at least 2respects:
- Involves managersas well as frontliners
- Involves more than
one area or processof work and oftentackles cross-functional issues
Quality Circle Quality Teams
QC/QT A h t
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QC/QT Approach to
Problem Solving
1. Select a theme.
2. Understand the current situation and set
targets.
3. Create a plan of action.
4. Analyze the root causes.
5. Develop and implement countermeasures.
6. Confirm effectiveness of countermeasures.7. Standardize and institutionalize
countermeasures.
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Quality Improvement
Activities
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1. Clinical Practice Guidelines
Are systematically developedstatements which assist in formulating
practitioner and patient decisions aboutappropriate health care for specificclinical circumstances
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2. Clinical Pathways
An interdisciplinary plan of care that
outlines the optimal sequencing and
timing of interventions and expected
outcomes for patients with a particular
diagnosis, procedure or symptom
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3. Medical Audits
Used to identify opportunities to improve
procedures used in the diagnosis,
treatment and care of specific patients
and the associated use of resources
and resulting outcomes
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4. Utilization Review
Assesses the appropriateness and the
efficiency of the use of resources
Focuses on the cost effectiveness of
interventions used
Identifies providers who need to attain a
more efficient resource use
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5. Complaints Analysis
Complaint – expression of
dissatisfaction of a customer
Complaints data – considered welcome
opportunities to learn from dissatisfied
patients and identify areas for
improvement
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6. Expanded Incident
Monitoring
Used to routinely identify, process,
analyze, and report incidents to preventtheir recurrence
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7. Morbidity & Mortality
Meetings Review deaths and adverse outcomes among
patients of a specified clinical group or
specialty
Provides a venue to critically analyze the
circumstances surrounding the outcomes of care provided by an individual or a
multidisciplinary group of clinicians
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8. Sentinel Event Monitoring
Identifies potentially serious breaches in
practice standards
Includes any process variation for which
recurrence could carry a significantchance of a serious adverse outcome
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9. Credentialing &
Clinical Privileging
Specifies the conditions individualpractitioners should meet before being
granted clinical privileges
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10. Variance Reporting &
Analysis A deviation from what has been
specified in the clinical pathway
Used to routinely document and identify
the most common causes of deviationfrom routine care for prioritized problem
solving
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