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What is the new method of quality assurance and how is it different from classical QA?
QI involves both prospective and retrospective reviews. It is aimed at improvement—measuring where you are and figuring out ways to make things better. It specifically attempts to avoid attributing blame and to create systems that prevent errors from happening. It is a continuous process (also known as continuous quality improvement or CQI) that must occur consistently in an ongoing fashion, unlike the QA entity, which is static.
Six IOM quality aims
Care that is: 1. Safe 2. Timely 3. Effective 4. Efficient 5. Equitable 6. Patient-centered.
Six core competencies of MOC
1. Patient Care—Provide care that is compassionate, appropriate, and effective treatment for health problems and to promote health. 2. Medical Knowledge—Demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and their application in patient care. 3. Interpersonal and Communication Skills—Demonstrate skills that result in effective information exchange and teaming with patients, their families, and professional associates (e.g., fostering a therapeutic relationship that is ethically sound and uses effective listening skills with nonverbal and verbal communication; working as both a team member and at times as a leader). 4. Professionalism—Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diverse patient populations. 5. Systems-based Practice—Demonstrate awareness of and responsibility to larger context and systems of healthcare. Be able to call on system resources to provide optimal care (e.g., coordinating care across sites or serving as the primary case manager when care involves multiple specialties, professions, or sites). 6. Practice-based Learning and Improvement—Able to investigate and evaluate patient care practices, appraise and assimilate scientific evidence, and improve the practice of medicine.
The two core management principles of Lean are:
relentless elimination of waste and
respect for people with long-term relationships among employer, employee, suppliers, and customers, based on continuous improvement and mutual trust.
Lean Tool set:
Value Stream Mapping Five S Pull Systems “Just-in-Time” Error-proofing
Value Stream Mapping
a tool to help understand and improve the material and information flow within a process. The end product is a visual flow map, in a simple graphical format, of the whole process from end to end in a method that is easy to understand by those working through the process. The graphic format encourages10and supports a team approach and provides a mechanism to constructively critique activity. Very specific data can be collected and displayed for process steps, wait steps, and information flow. In process improvement projects, one can display the existing flows, or the Current State Map, and explore and define the improved or altered process, or the Future State Map.
The Five S tool
focused on standardization of work areas. Goals are to eliminate clutter, establish “a place for everything and everything in its place,” standardize the manner in which work flows across the station, and maintain the new simplified state. The Five S process is necessary, but not sufficient, in Lean improvement processes. Five S: (translated from the Japanese seiri, seiton, seiso, seiketsu, and shitsuke) Sorting Straightening Systematic cleaning Standardizing Sustaining
Pull systems, just-in-time
or kanban, are system fundamentals that differentiate Lean and TPS from more common assembly line practices of overproducing at individual work steps, thus creating large piles of inventory that must be stored or inventoried until actually needed by the next process step. Inventory or work accumulating in queue is a fundamental source of waste. In theory, pull systems work to emulate one-piece flow where the next step of work on an item occurs immediately at the completion of the prior step, the prior step is not creating any more than the next step can handle, and the next step is not idly waiting on the prior step for work. In practice, this is managed by producing a small buffer of inventory and implementing alert systems (kanbans) that signal readiness for additional parts or work. Pull-systems and kanbans are practical solutions to the unreality of true, consistent one-piece flow. The small inventories and need for signaling is viewed as “necessary waste”—useful, but to be minimized.
Error-proofing
a concept of defining and standardizing process steps and quickly addressing new sources of error with further refinement of the steps. Recognition of error or defect obligates a team member to “stop the line,” or draw immediate attention to the defect so that supervisors and problem-solving teams can address the defect and the variation in process that caused it. It is systems-focused inquiry, rather than individually focused, thus maintaining the goodwill of the team members. Smoothness of workflow from end to end is the ultimate goal of Lean systems. Poor flow results from two primary issues: 1) unreasonable work due to poor organization and 2) pushing beyond natural limits. Poor organization induces moving things around, awkward transitions, potentially dangerous tasks, and uneven tempo of work. Pushing beyond natural limits leads to shortcuts, idiosyncratic decision making, and multiple variations in process. It is important to note once again that this view focuses on system impositions on workers rather than flawed employees.
Design-Measure-Analyze-Improve-Control
The Six Sigma version of this process is DMAIC: Design-Measure-Analyze-Improve-Control. This refers loosely to striving for near perfection in the performance of a process or production of a product. The name derives from the Greek letter sigma, often used to refer to the standard deviation of a normal distribution. By definition, 95 percent of a normally distributed population falls within two standard deviations of the average (or “2 sigma”). This leaves 5 percent of observations as “abnormal” or “unacceptable.” Six Sigma targets a defect rate of 3.4 per million opportunities—six standard deviations from the population average.
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