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B Y / D r .

O s a m a F a h i m

2

0 1 1

Y O U R

C P H

Q G

U I D E T O S

U C E S S

A comprehensive guide, to healthcare

quality professionals. Who are

preparing to undertake the CPHQ

exam. This guide is based on the CPHQ

exam guidelines and my personal

experience. Divided into Four Parts:

Leadership, Improvement, Information

and patient Safety

ByDr. Osama Fahim

[email protected]



Blank page



Copyright 2010 @ Cairo to ALP

The first edition of this book

Was completed in 2010

All rights are reserved

To the publisher and author

For comments or more books by the author

Email:

[email protected]



Contents

CPHQ: Practice to be the best

1. Introduction and Test Taking Tips:

What is Quality and why

What is CPHQ and why to certify

Test taking strategy

2. Foundation, Techniques and Tools:

Process analysis tools (e.g., fishbone, Pareto chart, run chart,

scatter gram, control chart)

Statistical techniques to describe data (e.g., mean, standard

deviation)

Statistical process control (e.g., common and special cause

variation, random variation, trends)

Statistical techniques to evaluate data (e.g., t-test, regression)

Communication

3. Using Data for Improvement:

Confidentiality of performance improvement activities, records,

and reports

Information for committee meetings (e.g., agendas, reports,

minutes)

Customer needs/expectations (e.g., surveys, focus groups, teams)

Data inventory listing activities (i.e., what is available from which

sources?)



Data collection methodology and Analysis

Computerized systems for data collection and analysis Epidemiological theory in data collection and analysis

Comparative data, benchmarking , outcomes Incident/occurrence reports

Decision making

4. Strategy and Leadership:

leadership values and commitment

the organization’s quality culture

organization-wide strategic planning

Identify internal / external customer/supplier relationships

organizational vision and mission statement

goals and objectives

performance measures (e.g., balanced scorecards, dashboards,

core measures)

lines of authority/accountability

performance improvement models (e.g., FOCUS, PDCA, Six Sigma)

national/international excellence/quality models

accreditation process

financial benefits of a quality program performance improvement oversight group (e.g., Quality Council,

Steering Council, QM Committee)

performance improvement team or teams and team structure

(e.g., cross functional, self-directed)



Quality champions (e.g., process owners, quality, and patient

safety)

performance measures/indicators

written plan for a risk management program

survey processes (i.e., accreditation, licensure, Certification) cost analysis and departments budget

5. Continuous Improvement:

process improvement activities and Teams performance improvement action plans and projects

process and outcome measures

evidence-based practice guidelines

external quality awards (e.g., Malcolm Baldrige, Magnet)

credentialing and privileging process medication usage review

medical record review

infection control processes

peer review

service specific review (pathology,radiology, pharmacy, nursing) patient advocacy (e.g., patient rights, ethics)

risk management: prevention and identification mortality review failure mode and effects analysis quality department

Education and Training



Integration between:

performance improvement incorporated into the employeeperformance appraisal system

findings from performance improvement incorporated into

the credentialing/appointment/privilege delineation process data analysis results incorporated into the performance

improvement process

outcome of risk management assessment incorporated into

the performance improvement process

outcome of utilization management assessment

incorporated into the performance improvement process

quality findings incorporated into governance and

management activities (e.g., bylaws, administrative policies,

and procedures) accreditation and regulatory recommendations incorporated

into the organization

Evaluation of:

measures, teams, projects, Surveys, Accreditation

performance/productivity reports

patient/member/customer satisfaction

practitioner profiling

complaint analysis

6. Change Management and Innovation:

Organization quality and safety culture

ISO, Lean and Six sigma



Introduction

If, it is quite difficult to find quality in your workplace, it is rather easier to

start doing something that will be recognized.

When I started to do this book, I was faced by two things to make it simple or to make

it comprehensive. But I decided to make it by both ways. Comprehensive yet simple

and I hope that you will find it like that.

When we speak about healthcare quality we have to distinguish it from quality in other

sectors as in manufacturing or other service providing organizations.

Lastly I would wish for all of you to get the results that we were looking for and that

this guide will do that for you.

Yours sincerely,

Osama fahim



Chapter I

Introduction and Test Taking Tips



What is Quality?

The tale of the five blind men’s first encounter with an elephant depicts how each man

describes an elephant based upon which part of the elephant's anatomy he happen to

touch. A similar problem occurs when trying to define quality. How each person

describes the 'elephant' is substantially different.

The term 'quality' is often used in a vague, blurred way.

There are as many definitions of quality as there are quality consultants, but the

common element of the business definitions is that the quality of a product or service

refers to the perception of the degree to which the product or service meets the

customer's expectations. Quality has no specific meaning unless related to a specific



function and/or object. Quality is a perceptual, conditional and somewhat subjective

attribute.

The business meanings of quality have developed over time. Various interpretations

are given below:

1. ISO 9000: "Degree to which a set of inherent characteristics fulfills

requirements." The standard defines requirement as need or expectation.

2. Six Sigma: "Number of defects per million opportunities."

3. Subir Chowdhury: "Quality combines people power and process power."

4. Philip B. Crosby: "Conformance to requirements." The requirements may not

fully represent customer expectations; Crosby treats this as a separate problem.

5. Joseph M. Juran: "Fitness for use." Fitness is defined by the customer.

6. Noriaki Kano and others, present a two-dimensional model of quality: "must-be

quality" and "attractive quality." The former is near to "fitness for use" and the

latter is what the customer would love, but has not yet thought about.

Supporters characterize this model more succinctly as: "Products and services

that meet or exceed customers' expectations."

7. Robert Pirsig: "The result of care."

http://en.wikipedia.org/wiki/Subir_Chowdhury

http://en.wikipedia.org/wiki/Customer

http://en.wikipedia.org/wiki/Product_%28business%29

http://en.wikipedia.org/wiki/Service_%28economics%29

http://en.wikipedia.org/wiki/Service_%28economics%29

http://en.wikipedia.org/wiki/Product_%28business%29

http://en.wikipedia.org/wiki/Customer

http://en.wikipedia.org/wiki/Subir_Chowdhury



Purpose of six sigma :To make customer happier and increase profits

8. Genichi Taguchi, with two definitions:

a. "Uniformity around a target value." The idea is to lower the standard

deviation in outcomes, and to keep the range of outcomes to a certain number

of standard deviations, with rare exceptions.

b. "The loss a product imposes on society after it is shipped." This definition of

quality is based on a more comprehensive view of the production system.

http://en.wikipedia.org/wiki/Standard_deviation






9. American Society for Quality: "A subjective term for which each person has his

or her own definition. In technical usage, quality can have two meanings:

a. The characteristics of a product or service that bear on its ability to satisfy

stated or implied needs;

b. A product or service free of deficiencies."

10. Peter Drucker: "Quality in a product or service is not what the supplier puts in.

It is what the customer gets out and is willing to pay for."

11. W. Edwards Deming: concentrating on "the efficient production of the quality

that the market expects," and he linked quality and management: "Costs go

down and productivity goes up as improvement of quality is accomplished by

better management of design, engineering, testing and by improvement of

processes."

12. Gerald M. Weinberg: "Value to some person".



Philip Crosby’s definition is easily toppled: if requirements are wrong, then failure isguaranteed. His focus is the domain of QA where, without a specification, quality

cannot be measured and thus controlled. You cannot have zero defects if you do not

have a standard against which to measure defectiveness.

This reflects the early days, where quality was clearly about product. Quality control,

and later QA, was our domain - we didn’t care about customers; the research and

design department was responsible for designing the job and sales and marketing for

selling it. But those halcyon days of definitive specifications and jobs for life are long

gone.



Though Juran takes a step further down the value chain, to the use of the product or

service (at which point customers had forced their way into the frame), he stillpresupposes that we can fully understand how the product will be used, which is a

great challenge (and not always possible). As Deming himself said, some things are

‘unknown and unknowable’.

ISO 8402 recognises this uncertainty with its ‘implied need’. It uses the word ‘entity’

as opposed to the ‘product or service’ definition of its earlier (1986) version, indicating

a broadening uncertainty. Nonetheless, it suffers again from a simplistic, single-minded

focus - all we need to do is to figure out what is wanted and then deliver it.

The quality models are a step further into broader business. Here, although processes

are important, quality is much more about people: customers are there, but so too are

stakeholders - employees, partners, suppliers, shareholders and society. Perhaps

wisely, the models avoid nailing down a specific definition of quality, leaving us without

a definition that encompasses a broader business view.

ISO9000:2000 steps in this direction also, talking about ‘customer and other

interested parties’, but leaves the definition of quality at a rather generalised ‘degree

to which a set of inherent characteristics fulfils requirements’ .

If someone talks about 'working on quality', they may simply mean activities designed

to improve the organization and its services.

Quality is essentially about learning what you are doing well and doing it better. It alsomeans finding out what you may need to change to make sure you meet the needs of

your service users. Quality is about:



knowing what you want to do and how you want to do it

learning from what you do

using what you learn to develop your organization and its services

seeking to achieve continuous improvement

Satisfying your stakeholders - those different people and groups with an interest

in your organization.

Quality in business, engineering and manufacturing has a pragmatic interpretation

as the non-inferiority or superiority of something. Quality is a perceptual,

conditional and somewhat subjective attribute and may be understood differently

by different people. Consumers may focus on the specification quality of a

product/service, or how it compares to competitors in the marketplace. Producers

might measure the conformance quality, or degree to which the product/service

was produced correctly.

The CQI defines quality in terms of innovation and care:



Why Quality

No doubt that everyone will benefit from applying quality:

1- The organization:

a. Better product or service

b. Improve process

c. Reduce scrap and cost of production

d. Customer satisfaction

e. Increase profit

2- The Employees:

a. Increase satisfaction

b. Increase production



3- The society:

a.

Better product and service4- The Customers:

a. Increase satisfaction

b. Decrease price for service or product

Brief History of Quality



The history of quality management, from mere 'inspection' to Total Quality

Management, and its modern 'branded interpretations such as 'Six Sigma', has led tothe development of essential processes, ideas, theories and tools that are central to

organizational development, change management, and the performance improvements

that are generally desired for individuals, teams and organizations.

Levels of Quality

cphq text book

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