Overview
Quality Improvement:
A Strategy for Success
May 5, 2015
Patricia Breen, RN,BSN,FCN
Bureau of Primary Health Care/HRSA
Learning Objectives
• Name the three aims of the National Quality
Strategy
• Recall the six dimensions of healthcare
performance
• Identify components of a robust Quality
Improvement (QI) Program
• Identify available QI resources
National Focus on Quality
• Institute of Medicine report
• HHS National Quality Strategy
• Accreditation (TJC/AAAHC )
• Required element of Public Health Service Act
Sec. 330 grants
• FTCA application
• NCQA Patient Centered Medical Home (PCMH)
recognition
• Meaningful use (HIT)
• Patient awareness/satisfaction
National Quality Strategy’s
Three Aims
1. Better Care: Improve the overall quality of care,
by making health care more patient-centered
reliable, accessible, and safe.
2. Healthy People/Healthy Communities: Improve
the health of the U.S. population by supporting
proven interventions to address behavioral, social,
and environmental determinants of health in addition
to delivering higher-quality care.
3. Affordable Care: Reduce the cost of quality health
care for individuals, families, employers, and
government.
Definition
“Quality Improvement is a
continuous ongoing process
designed to improve patient
outcomes”.
(www.hrsa.gov/healthit/toolbox)
Quality Improvement
• Continuous proactive approach
• Commitment is critical
• Culture is crucial
• Customer focused
• Driven by data
• Encompasses:
• Assessing
• Implementing
• Evaluating
Processes
and Systems
Six dimensions of health care
performance
Provides strong foundation to support the delivery of
quality health care that is:
• Safe
• Effective
• Patient-centered
• Timely
• Efficient
• Equitable
Institute of Medicine, Crossing the Quality Chasm: A New Health System for
the 21st Century. March 2001. National Academies Press.
Have a Plan
“A Goal without a Plan
is Just a Wish”.
- Antoine de Saint Exuprey
Components of an
Integrated QI Plan
Components
• Mission/ Vision
• Organization–wide program
• Framework or model for QI activities
• Measurable goals
• QI processes for identification /response to
problems
• Periodic review of QI Plan
• Risk management integration
• Additional Elements
Mission/ Vision
• Reflects what you are trying to accomplish at an
organizational level
• Defines Goals/Purpose such as: Appropriate
Care, Every Patient, Every Time
• May incorporate providing full access to care,
utilization of best practices, ensuring effective
information flow, mitigating risk in a fiscally
responsible manner
• Delineates authority and scope
Organization – wide program
• Clinical director whose focus of responsibility is to
support the QI/QA program
• QI committee composed of cross section of staff :
clinical, non-clinical, administrative
• The team is critical to the development and
execution of the plan
• Leadership involved in QI decision making
• One overall QI committee for multiple sites
Framework or model for
QI activities
Broadly:
• Assess your safety culture
• Consider patient population
• Develop process for collection of identified data
• Use data to guide quality improvement activities
Ultimately need a method to identify and define the
problem, generate alternatives, select a strategy,
implement a process, and evaluate the results.
Data in primary care
How much?
• enough to direct improvement efforts without being an
undue burden
Why?
• To understand population served
• To assess whether changes made are leading to
improvement in care
How?
• Analyze, Prioritize, Trend
What ‘s next?
• Impact, Monitor
Model for QI activities
Specifically:
• Rapid cycle Improvement: Plan-Do-Study-Act
(PDSA)
• FADE ( focus, analyze, develop, execute/evaluate)
• DMAIC (define, measure, analyze, improve,
control)
• FOCUS (find, organize, clarify, understand, select)
• Six Sigma/ LEAN (purpose, process, people)
• Expanded Chronic Care Model
Measures/Benchmarks
• Uniform Data System(UDS) measures
• The Healthcare Effectiveness Data and Information Set
(HEDIS)
• National Quality Forum Performance Measures
• Benchmarks (Healthy People 2020; ANA National
Database of Nursing Quality Indicators)
• Best Practices (ACOG, AAFP, AMA)
• Databases :AHRQ’s National Health Care Quality
Report; National Healthcare Disparities Report
• CMS Meaningful Use Clinical Quality Measures
• Consumer Assessment of Healthcare Providers and
Systems (CAHPS)
Goals
Set SMART goals:
• Specific
• Measurable
• Achievable
• Realistic
• Time-specific
Set Stretch goals
RM Overlap with QI
A Measure of Quality: Implementing a QI/QA Program
ECRI- April 2012 archived audio conference
QI Processes for identification
of/ response to problems
•Reporting system
•Patient Satisfaction Surveys
•Patient/ Provider complaints
Tools
•Cause and Effects Diagrams/ Fishbone Charts
•Flow charts
•5 Whys
•Root Cause Analysis (RCA)
•Failure Mode Effects Analysis ( FMEA)
Factors to Consider when
analyzing an event
•Patient Characteristics
•Task Factors
•Caregiver Factors
•Team Factors
•Work Environment Factors
•Department Factors
•Institutional Factors
Pronovost, P. Understanding the Science of Safety.
Periodic review of QI Plan
•Board review and approval on a regular basis as
evidenced by Board signatures or minutes
•Evaluate, Integrate, Celebrate, and Disseminate
Risk management Integration
• Proper Credentialing and privileging
• Appropriate Supervision of staff
• Periodic assessment of the appropriateness of the
utilization of services and the quality of services
provided or proposed to be provided to individuals
served by the health center
• Tracking policies and procedures
• Triage policies and procedures
• Policies and Procedures for investigating and
addressing medical malpractice claims
Risk Management Process
Additional Elements
• Maintain confidentiality of patient records
• Know and comply with state regulations
• Regular QI meetings and regular reports to the
Board
• Document QI activities in QI committee Minutes
and Board minutes
o Attendees, agenda items, discussion topics,
recommendations, action items, responsible
parties, timeline
QI + The National Quality
Three Aims and Your FQHC
1. Better Care: Improve the overall quality of care,
by making health care more patient-centered
reliable, accessible, and safe.
2. Healthy People/Healthy Communities: Improve
the health of the U.S. population by supporting
proven interventions to address behavioral, social,
and environmental determinants of health in addition
to delivering higher-quality care.
3. Affordable Care: Reduce the cost of quality health
care for individuals, families, employers, and
government.
ECRI Clinical Risk
Management Resources
• Guidance articles
• Self-assessment
questionnaires
• Education and training
tools
• Toolkits
• Sample policies and tools
• Archived webinars
• Archived Virtual
Conference
• E-learn continuing
education
• Electronic fetal monitoring
online education
• Biweekly E-news
• Monthly Get Safe!
assessment checklists
• Quarterly Practice Alert!
assessment tools
• Quality in Action newsletter
Clinical_RM_Program@ecri.org
(610) 825-6000, x5200
26
General Contact Information
FTCA/BPHC Help Line
Phone: 1-877-974-BPHC (877-974-2742)
9:00 AM to 5:30 PM (ET)
Email: BPHChelpline@hrsa.gov
FTCA Website: http://www.bphc.hrsa.gov/ftca/
Contact Information
Patricia M. Breen RN
Public Health Analyst
Bureau of Primary Health Care
Office of Quality Improvement
5600 Fishers Lane, 16W61C
Rockville, Maryland 20857
Phone: 301- 443-6349
Email: pbreen@hrsa.gov