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118 Cards in this Set
- Front
- Back
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An approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others
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Quality Improvement in health care
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An approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others
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Quality Improvement in health care
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Synonyms of QI
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CQI, CI and TQM, TQC and SQC
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What year was QI adapted by JCAHO
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1991
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Based on .........
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W. Edward Demings 14 pts for management and on the Japanese Mgt style
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What dramatic changes led to changes in healthcare since the 80s
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technology, equip and proc advances, leg and govt regs JCAHO procedures
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What technology, equip, and procedure advances have been made
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Conformal tx, 3D tx planning, MLC-IMRT, HDR, LDR, Record and Verify, CT sim, PET-CT, Gated RT, Dynamic Wedging
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What Leg and Govt regs led to healthcare changes
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The safe Medical Devices Act(AAPM Report #35) - 1990, AAPM Report # 40 - 1994, OSHA mold room regs, EPA, FDA (effects blood-borne pathogens to disposal of processing chemicals
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JCAHO has gone from a philosophy of QA to one of
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TQM
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Why since 1980 have some hospitals closed in the US and others have been purchased by For-Profit Healthcare Org or have merged
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to condense cost and/ or reduce competition
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Previous fee for service reimbursement has been replaced by managed care plans such as
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HMOs (PPOs)
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HMOs (PPOs)
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the lower rate of reimbursemnet from these plans has reduced the operating budgets of many depts.
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In 1970s JCAHO began requiring specific AM procedures for facilities to ....
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obtain accreditation
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Accreditation is voluntary but if hospitals and med centers do not have it they may not:
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Posess Medicaid Certification, Hold Certain Licenses, Have residency programs for training physicians, obtain reimbursements from insurance co., receive malpractice ins.
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Before 1991 _________ and ___________ were the QM methods used by JCAHO
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QA and QC
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An all encompassing management program used to ensure excellence in healthcare through the systematic collection and eval of data
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QA
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the objective, systematic monitoring of the qualiy and appropriateness of pt care
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primary purpose
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the qa program should be related to
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structure, process, and outcome, all of which can be measured
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the main emphasis in QA was on _________that can lead to variations in quality care before 1991
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human factors
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activities important in providing a service
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aspect of care
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an example of aspect of care
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scheduling
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indicator
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what is to be monitored
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an example of indicator
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pt waiting times
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yardsticks, gauges how to measure
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criteria
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an example of criteria
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all pt on the tx machine will be treated w/in 10 minutes of their scheduled appt time
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expected level of compliance
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standard
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an example of standard
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treats pts w/in 10 min of scheduled appt time 100% of the time or number of errors 0%
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states an expected level of compliance
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threshold
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an example of threshold
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only cases falling below the threshold are reviewed; pts waiting longer than 10 min of their scheduled appt time would be reviewed
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The three levels of QC that deals w/ instrumentation and equip.
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Level 1: Noninvasive and Simple, Level 2: Noninvasive and Complex; Level 3 Invasive and Complex
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Level 1: Noninvasive and Simple; evaluations can be performed by any ____________ and include tests such as _______________, laser check, ______________, and beam output
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therapist, congruency film check and machine warm up
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Level 2: Noninvasive and Complex: these evaluations should be performed by _______________. Uses more sophisticated euipment such as special test tools, meters, and computerized multiple fxn unit.
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therapist trained in QC procedures
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Example of Level 2 procedure
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weekly checks performed w/ a water phantom on accelorators
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Level 3 Invasive and Complex: evaluations require some __________ and should be performed by a ___________
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dissassembly of the machine and engineers or physicists
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Example off Level 3 procedure
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replacement of the feild light, thyrotron, xray tube
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Types of QC tests
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Acceptance testing, commissioning, routine performance evaluations, error correction tests
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acceptance testing
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performed on new equipment to demonstrate that it is performing w/in the manufacturers specification and criteria
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who performs acceptance testing
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physicists
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who performs commissioning tests
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physicists
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obtaining data for tx planning
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commissioning
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specific tests performed on the equipment in use after a certain amount of time has elapsed
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routine perfomance evaluations
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who performs routine perfomance evaluations
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physicists and therapists
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evaluate equipment that is malfunctioning or not performing at specification
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error correction tests
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who performs error correction tests
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physicists and engineers
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Example of error correction tests
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when faults and interlocks occur on accelorators and simulators
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American Statistician
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Dr. W. Edward Deming
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_____________ taught the Japanese managers and engineers quality as a system vs. quantity
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Dr. W. Edward Deming
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In WWII ___________ won over _____________ in America
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mass production; quality
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According to Deming quality is not only achieved but
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maintained
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Delineating the health care organization's __________- and __________, so that there is a reason for improving
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mission, goals and improvement
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Instead of setting _____________, which are expected levels of compliance always strive for ______ no matter how good the product (service)
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thresholds; improvement
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Improve the _________ rather than
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process; "inspect for errors"
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plan for the future by analyzing
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long term costs and appropriateness of product (service)
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Allow the _________ to contribute to the improvement process
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employee
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Encourage and support employees through
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education
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Ensure qualified leaders for the
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improvement system
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Eliminate ___ by encouraging employees to offer suggestions
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fear
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Eliminate _________ by helping employees to understand the needs of other depts or sxns
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staffing barriers
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Management should always __________ employee______ of ___________
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keep; informed; whats happening
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Emphasize quality rather than
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quantity
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Promote and encourage ____________versus individual performance
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teamwork
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Encourage and support an employee's __________- and ___________
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educational and self-improvement program
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Support and __________all employees in the transformation process
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train
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Focus on the ______instead of the ___________
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process; individuals
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focus on the organization as a ____________ rather than
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whole; individual depts
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Problems and variability w/ the process are the main cause of
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poor quality
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85/15
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the process is the problem 85% of the time and the people aer the problem 15% of the time
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80/20
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80% of the problems are the result of 20% of the causes
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what is a process
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an ordered series of steps that help achieve a desired outcome
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supplier
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provides goods or services
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input
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information or knowledge necessary to achieve the desired outcome
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action
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activity to achieve the desired outcome
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output
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influenced by the first 3 steps: supplier, input, axn
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customer
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person, dept, org that needs or wants the desired outcome
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2 kinds of customers
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internal and external
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internal
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physicians/employees
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external
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pts and families
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satisfaction of the customers is the driving force behind
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CQI
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parts of a process
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supplier, input, axn, output, customer
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group dynamic tools
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brainstorming, focus group, QI team
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brainstorming
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group process used to develop a large collection of ideas w/o regard to merit or validity
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focus group
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smaller group that focuses on a particular problem and derives a solution
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QI team
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group of individuals who implement the solutions derived by the focus group
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flow chart
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pictorial representation of the individual steps in a process; shows relationship among various steps and can help identify sites of possible system failure
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oval
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terminal symbol
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diamond
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decision symbol
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rectangle
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activity symbol
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Quality Circles
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group dynamic tool normally composed of supervisors and workers who are from the same dept or who may have the same fxn in a sim. dept
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Multi-voting
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everyone is provided w/ a list of brainstorming ideas and vote to eliminate nonessential topics and arrive at the most important
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consensus
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method of coming to an agreement acceptable to all members
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work teams
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Self-managed teams that are highly trained and able to take whatever necessary axn to eliminate problems
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problem-solving teams
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teams work on specific tasks to solve particular problems; normally fxn to identify, analyze, and then solve both quality and productivity issues
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control chart
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modification of trend chart; upper and lower limits determined and placed on a central line of accepted norm
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Step 1 of the JCAHO 10-step monitoring and evaluation process (QA)
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Assign Responsibility; the medical director is ultimately responsible w/ the tasks delegated to a supervisor or QA therapist, physicist
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Step 1 of the JCAHO 10-step monitoring and evaluation process (CQI)
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Assign Responsibility; both intra-dept and inter-dept committees work together w/ participation of hospital management
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Step 2 of the JCAHO 10-step monitoring and evaluation process (QA)
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Delineate the scope of care and service: major services of a particular dept are listed
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Step 2 of the JCAHO 10-step monitoring and evaluation process (CQI)
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Delineate the scope of care and service: scope of care or service for the hospital as a whole is defined
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Step 3 of the JCAHO 10-step monitoring and evaluation process (QA)
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identify important aspects of care and service: specific dept tasks or fxns are identified w/ emphasis on high volume, high risk and high risk problem prone
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Step 3 of the JCAHO 10-step monitoring and evaluation process (CQI)
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Identify Important Aspects of Care and Services; the entire hospital determines the key fxns to be monitered: care of pts, leadership, use of meds, use of blood and blood components, determination of appropriateness of admissions and continued hospitalization
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Step 4 of the JCAHO 10-step monitoring and evaluation process
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identify indicators; a valid and reliable quantitative process or outcome msr related to one or more dimensions of performance
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2 types of indicators
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sentimental and aggregate
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sentimental indicator
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identifies an individual event or phenomenon that is significant enough to trigger futher review each time it occurs: death
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aggregate indicator
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quantifies a process or outcome related to a many cases; may occur freq and may be desirable or undesirable
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Federal Agencies
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FDA, Center for Devices and Radiologic Health, OSHA
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FDA
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regulates radiation emitting electronic products (any ionizing, non-ionizing electromagnetic or particulate radiation)
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CDRH
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covers medical devices (voluntary component) linear accelerators, simulators, diag
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OSHA
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can assess fines for non-compliance
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State
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IN State Dept of Health (ISDH), Indoor and Radiologic Health (IRH) Rule 6.1 X-rays in the Healing ARts Title 410
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IRH
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responsibility for reg all sources of radiation in the State of IN
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six main areas of IRH responsibility
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Rad emergency response, Rad materials compliance, Rad machine compliance, Radon info and cert, Indoor air quality info
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Rule 6.1 Xrays in the Healing Arts Title 410
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estab rules and req for xray fac, equip and operators
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Institutional
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Accreditation agencies
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Accreditation org
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formal process by which a recognized body, usually a non-govt org, assess and reog that a health care
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Accreditation programs
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JCAHO
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How often must an org undergo on-site survey by JCAHO survey team
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every 3 years
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How often must an lab undergo on-site survey by JCAHO survey team
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every 2 years
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JCAHO has ________ board members
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28
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The 1997 the ________ program was launche; the next evolution in accreditation to integrate the use of outcomes and other performance msrmt data into the accreditation process
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ORYX
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