bus 285 total quality management dr. connolly [email protected] 924-3144...
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BUS 285BUS 285Total Quality ManagementTotal Quality Management
Dr. ConnollyDr. [email protected]@son.sjsu.edu
924-3144924-3144June 9, 2004June 9, 2004
IRC 302IRC 302408-924-2874408-924-2874Office HoursOffice Hours
WebCT Faculty Chat Office Tuesdays 4:00 – WebCT Faculty Chat Office Tuesdays 4:00 – 5:00PM5:00PM
Wednesday 3:30PM IRCWednesday 3:30PM IRC
Expected OutcomesExpected Outcomes
Recognize course Recognize course requirementsrequirements
Select presentation Select presentation topictopic
Assign readingsAssign readings Orientation to Orientation to
webcasting and webcasting and use of webCT shelluse of webCT shell
Orientation to Orientation to quality in health quality in health carecare
Course RequirementsCourse Requirements
Meeting course objectivesMeeting course objectivesClass participation 30 pts; including Class participation 30 pts; including
reading assignmentsreading assignmentsPresentation of a quality management Presentation of a quality management
tool 30 ptstool 30 ptsEvaluation of a quality management Evaluation of a quality management
program 40 ptsprogram 40 ptsOptional final take home exam, 10 ptsOptional final take home exam, 10 pts
Learning EnvironmentLearning Environment
On campus, IRC 302On campus, IRC 302 Webcasting live or archivesWebcasting live or archives WebCTWebCT
Discussion Board (post all Discussion Board (post all responses to classes)responses to classes)
EmailEmail Chat Room Office hours & Chat Room Office hours &
Student ChatStudent Chat Assignment informationAssignment information ModulesModules Grading sheetsGrading sheets
Webcasting Environment Webcasting Environment
Watching live and questionsWatching live and questionsQuestions will be answered during the Questions will be answered during the
first 10 minutes of class again 5 first 10 minutes of class again 5 minutes before break time and again minutes before break time and again before end of classbefore end of class
Telephone in classroom 408-924-2874Telephone in classroom 408-924-2874Emergency only desk top 408-924-6653Emergency only desk top 408-924-6653
Archive: watch and respond to each Archive: watch and respond to each reading presented within 1 week; post reading presented within 1 week; post to Discussion Board on WebCT for that to Discussion Board on WebCT for that classclass
Learning EnvironmentLearning Environment
Videostreaming & Videostreaming & webcast: live or webcast: live or archivedarchived
Reading AssignmentsReading Assignments Prepare as outlined in Prepare as outlined in
syllabussyllabus Post on Discussion Board Post on Discussion Board
for class designatedfor class designated Briefly present in class on Briefly present in class on
campuscampus Students webcasting must Students webcasting must
respond, at least one respond, at least one sentence to each reading sentence to each reading presented; post on presented; post on Discussion Board within 1 Discussion Board within 1 week of classweek of class
Presentation Topics 30 PtsPresentation Topics 30 Pts BenchmarkingBenchmarking Run Chart DiagramRun Chart Diagram Evaluation GridEvaluation Grid Flow Chart Matrix Check ListFlow Chart Matrix Check List Force Field AnalysisForce Field Analysis Pareto ChartPareto Chart Root cause analysis/Sentinel EventsRoot cause analysis/Sentinel Events Scatter DiagramScatter Diagram Focus groupsFocus groups Quality Improvement Story BoardingQuality Improvement Story Boarding Report CardsReport Cards Consumer SatisfactionConsumer Satisfaction Fishbone chart/cause & effect Fishbone chart/cause & effect
diagramdiagram Control chartsControl charts
Presentation RequirementsPresentation Requirements20 - 30 minutes on campus20 - 30 minutes on campus
One week before, email Power Point file to One week before, email Power Point file to [email protected]@sjsu.edu, label, BUS285, class date, your , label, BUS285, class date, your name; name; no animations, transitions or audiono animations, transitions or audio
Two readings, one research on tool presented Two readings, one research on tool presented posted one week before for students on posted one week before for students on Discussion Board for presentation dateDiscussion Board for presentation date
Post Power Pt file on Discussion Board WebCTPost Power Pt file on Discussion Board WebCT Collect Peer Evaluations on campus and your e-Collect Peer Evaluations on campus and your e-
mail within WebCTmail within WebCT Post teaching objectives Post teaching objectives Evaluate teaching; measure stated objectivesEvaluate teaching; measure stated objectives
Evaluation of Quality Evaluation of Quality Management Program 40 ptsManagement Program 40 pts
Due July 28, 2004Due July 28, 2004 See syllabus for detailsSee syllabus for details Prepare using Criteria providedPrepare using Criteria provided Must have Executive SummaryMust have Executive Summary Must be congruent with APA formatMust be congruent with APA format Maximum 10 pagesMaximum 10 pages Upload to Assignment area in WebCT or Upload to Assignment area in WebCT or
provide 2 copies turn in on campusprovide 2 copies turn in on campus Your recommendations are critical; based Your recommendations are critical; based
on your evaluation and literatureon your evaluation and literature
Optional Final ExaminationOptional Final ExaminationDue August 2, 2004Due August 2, 2004
10 extra points can 10 extra points can be gained if the be gained if the optional final take optional final take home essay home essay examination is examination is selectedselected
2 essay questions 2 essay questions will be prepared will be prepared from 6 choicesfrom 6 choices
Total Quality ManagementTotal Quality ManagementImproving quality is an ethical Improving quality is an ethical imperative (Wurzbach, 1997)imperative (Wurzbach, 1997)
What is it?What is it?TQM, coined 1985 Naval Air Systems TQM, coined 1985 Naval Air Systems
CommandCommandWhat are the driving forces?What are the driving forces?How do we know if we have it?How do we know if we have it?What is your responsibility as a What is your responsibility as a
manager and or administrator?manager and or administrator?
Are we doing the right thing Are we doing the right thing right? (Fitzpatrick,1994)right? (Fitzpatrick,1994)
Macro ForcesMacro Forces MedicareMedicare Consumer movementConsumer movement American industry, American industry,
Deming’s TQMDeming’s TQM Financial constraintsFinancial constraints JCAHJCAH Managed careManaged care Employee benefit Employee benefit
programsprograms Third-party payorsThird-party payors Demands for access & Demands for access &
qualityquality Integrated health care Integrated health care
systemssystems
Defining Health Care QualityDefining Health Care Quality
Effectiveness of the organizationEffectiveness of the organizationValue-laden attribute meeting Value-laden attribute meeting
expected standardsexpected standardsExcellence and qualityExcellence and qualityEthical concepts beneficence, Ethical concepts beneficence,
prudence & justiceprudence & justiceCannot be measured directlyCannot be measured directlyCulturally competent careCulturally competent care
ANA, Nursing’s Safety & Quality ANA, Nursing’s Safety & Quality Initiative 1994Initiative 1994
Educate RNs about quality Educate RNs about quality measurementmeasurement
Inform public & Inform public & purchasing/regulating consituencies purchasing/regulating consituencies about safe, quality health careabout safe, quality health care
Investigating research methods and Investigating research methods and data sources for empirical evaluation data sources for empirical evaluation of safety and qualityof safety and quality
IOM Rules for Redesign IOM Rules for Redesign (2001)(2001)
Care is based on continuous healing Care is based on continuous healing relationshipsrelationships
Care is customized according to patient Care is customized according to patient needs & valuesneeds & values
The patient is the source of controlThe patient is the source of control Knowledge is shared & information flows Knowledge is shared & information flows
freelyfreely Decision making is evidence-basedDecision making is evidence-based
IOM Redesign RulesIOM Redesign Rules
Safety is a system propertySafety is a system propertyTransparence is necessaryTransparence is necessaryNeeds are anticipatedNeeds are anticipatedWaste is continuously decreasedWaste is continuously decreasedCooperation among clinicians is a Cooperation among clinicians is a
prioritypriority
Managed Care EnvironmentManaged Care Environment
Focus on outcomesFocus on outcomesResearch based practiceResearch based practiceHigh quality careHigh quality careCost-effective interventionsCost-effective interventionsResponsible for widespread Responsible for widespread
application of information application of information technologytechnology
Report Card: Managed CareReport Card: Managed CareAccessAccessQuality/AppropriatenessQuality/AppropriatenessPromotion/PreventionPromotion/PreventionOutcomesOutcomes
General health improvedGeneral health improvedQuality of life improvedQuality of life improvedTreatment reduces Treatment reduces
psychological stresspsychological stressMore productive & independentMore productive & independent
IOM Crossing The Quality IOM Crossing The Quality Chasm: Changes Needed Chasm: Changes Needed
(2001)(2001)SafeSafeEffectiveEffectivePatient-centeredPatient-centeredTimelyTimelyEfficientEfficientequitableequitable
IOM Environment Changes IOM Environment Changes (2003)(2003)
Applying evidence to health care Applying evidence to health care deliverydelivery
Using information technologyUsing information technologyAligning payment policies with Aligning payment policies with
quality improvementquality improvementPreparing the workforcePreparing the workforce
AACN: Role New Clinical AACN: Role New Clinical Nurse Leader (2004)Nurse Leader (2004)
Leadership in care of sick across all Leadership in care of sick across all environmentsenvironments
Design and provision of health promotion Design and provision of health promotion and risk reduction services for diverse and risk reduction services for diverse populationspopulations
Provision of evidence-based practiceProvision of evidence-based practice Population-based health care to Population-based health care to
individuals, clinical populations & individuals, clinical populations & communitiescommunities
Clinical Nurse Leader Role Clinical Nurse Leader Role Cont.Cont.
Clinical decision-makingClinical decision-makingDesign and implementation of plans Design and implementation of plans
of careof careRisk anticipationRisk anticipationParticipation in identification and Participation in identification and
collection of care outcomescollection of care outcomesAccountability for evaluation and Accountability for evaluation and
improvement of point of care improvement of point of care outcomesoutcomes
Clinical Nurse Leader Role Clinical Nurse Leader Role Cont.Cont.
Mass customizationMass customizationClient and Community advocacyClient and Community advocacyEducation & information Education & information
managementmanagementDelegation & oversight of care Delegation & oversight of care
delivery & outcomesdelivery & outcomes
Clinical Nurse Leader Role Clinical Nurse Leader Role Cont.Cont.
Team management & collaboration Team management & collaboration with other health professional team with other health professional team membersmembers
Development & leveraging of human, Development & leveraging of human, environmental & material resourcesenvironmental & material resources
Management & use of client –care & Management & use of client –care & information technologyinformation technology
Theoretical Frameworks for Theoretical Frameworks for EvaluationEvaluation
Total Quality ManagementTotal Quality Management
Continuous ImprovementContinuous Improvement
Donabedian’s ModelDonabedian’s Model
Donabedian’s ModelDonabedian’s ModelStructureStructure
ProcessProcess
OutcomesOutcomes
Structural ComponentsStructural Components
Organizational structureOrganizational structureEducation of nurses & workforceEducation of nurses & workforceNursing standards of careNursing standards of careRatio of total nursing staff to patientsRatio of total nursing staff to patientsChanges in market placeChanges in market placePolitical influencesPolitical influencesTechnologyTechnologyManagement philosophiesManagement philosophies
Process ComponentsProcess Components
Interpersonal relationships between Interpersonal relationships between nurses and patients, among staff & nurses and patients, among staff & supervisorssupervisors
Nursing knowledge and Nursing knowledge and competenciescompetencies
Change of shift reportChange of shift reportPractice environmentPractice environment
Outcomes Sensitive to Outcomes Sensitive to NursingNursing
Functional healthFunctional health Physiologic healthPhysiologic health Psychological Psychological
healthhealth Health knowledge Health knowledge
and behaviorand behavior Perceived healthPerceived health Family healthFamily health
Patient Outcome ComponentsPatient Outcome Components
Mortality ratesMortality rates Length of stayLength of stay Adverse incidentsAdverse incidents Pain managementPain management Skin integritySkin integrity FallsFalls
ComplicationsComplications Patient and family Patient and family
satisfactionsatisfaction Ability to cope with Ability to cope with
illnessillness Growth & Growth &
development of development of patientpatient
Adherence to a Adherence to a discharge plandischarge plan
Nurse OutcomesNurse Outcomes
SatisfactionSatisfaction RetentionRetention AutonomyAutonomy SicknessSickness AbsenteeismAbsenteeism Work pressureWork pressure
InvolvementInvolvement Peer cohesionPeer cohesion Supervisor supportSupervisor support InnovationInnovation QOLQOL Burn outBurn out
Deming’s PointsDeming’s Points13. Institute a vigorous program of 13. Institute a vigorous program of
education and self improvement for education and self improvement for everyone.everyone.
8. Drive out fear. Create Trust. 8. Drive out fear. Create Trust. Create a climate for innovation.Create a climate for innovation.
5. Improve constantly and forever 5. Improve constantly and forever the system of production and the system of production and service.service.Walton, M. (1990). Deming management at work. New York: PerigeeWalton, M. (1990). Deming management at work. New York: Perigee..
Summary TQMSummary TQM
Leadership must support the processLeadership must support the processOrganization must be customer orientedOrganization must be customer orientedQuality improvement is linked to Quality improvement is linked to
customer judgmentscustomer judgmentsEmployees must be empowered to be Employees must be empowered to be
creative, to contribute develop & learncreative, to contribute develop & learnOrganization is process focusedOrganization is process focusedOrganization uses visionary managementOrganization uses visionary management
Failing to meet the customer’s Failing to meet the customer’s expectation of quality will expectation of quality will
result in customer result in customer dissatisfaction and is usually an dissatisfaction and is usually an
indicator of poor quality indicator of poor quality (Ludwig-Beymet et al. 1993)(Ludwig-Beymet et al. 1993)
THE ENDTHE ENDTHANK YOU FOR LISTENINGTHANK YOU FOR LISTENING