HS 8900: Quality Improvement in Healthcare
Objective: To provide students with an in depth knowledge of the structure
and process of quality improvement in hospitals and health systems.
Time/Location: Thursdays 2pm – 5pm
Professor: Steve Meurer, Ph.D,
Executive Director of the Quality Institute and Chief Quality Officer, DeKalb Regional
Health System
Email: meurer_steve@dkmc.org
Phone: 404-501-5645
Office Hours: By Appointment
David Cowan, 678-521-0353, dcowan@gatech.edu
Required Materials:
1) The Tipping Point: How Little Things Can Make a Big Difference by Malcolm Gladwell. Little
Brown and Company. 2000.
a. Have it read by the R2 – I3: Relationships: Personality Tests class (Class Week #7)
2) The Healthcare Quality Book: Vision, Strategy and Tools by Ransom, Joshi & Nash. AUPHA
Press, 2005.
Projects:

Quality Champion: Choose an individual/methodology to report & present how they relate to
quality. Biography, background, contributions, why do they deserve to be a champion?
Maximum of 5 pages double spaces, 15 minute presentation.
o Possible topics, not exhaustive:
 Don Berwick, MD (IHI)
 Florence Nightengale
 W. Edwards Deming
 Dartmouth Atlas
 Earnest Codman, MD
 The Bell Curve
 Avedis Donabedian
 Leapfrog
 Paul Batalden, MD
 Institute of Medicine
 Steve Shortell
 Six Sigma
 Brent James, MD
 Lean

Indicator: Choose a process within your current job/GRA and develop an indicator to measure
improvement. Report should relate back to semester topics. Maximum of 12 pages, manuscript
format, 30 minute presentation. Grading is not solely result focused (did I improve the process)
but also accounts for process/methodology involved.
Grading:
Attendance and Participation: 15%
Case Studies: 25%
Quality Champion Project: 20%
Indicator Project: 40%
Extra Credit:
Read and summarize before relevant lecture:
1. Good to Great: Why Some Companies Make the Leap and Others Don’t by Jim Collins. October,
2001. (Structure-Process-Outcome)
2. Driven by Paul R. Lawerence and Nitin Nohria. Jossey-Bass, September, 2003 R2 – I3: Incentive
Class
Date
Topic
1
1/11
Introduction from David Cowan
“The Doctor”
2
1/18
Syllabus Intro
Components of Quality: Introduction, Name, & Product and
Person, U.S. News World Report, Healthgrades & Solucient
3
1/25
Components of Quality: Compliance & Patient Safety
Components of Quality: Service Excellence
4
2/1
Components of Quality: Structure-Process-Outcome
What is a Quality Department?
5
2/8
Quality Champion Project Presentations
6
2/15
Introduction to R2 – I3.
R2 – I3: Relationships ~Personality Tests
The Tipping Point
2/22
No Class (students at HIMSS conf)
7
3/1
R2 – I3: Resources ~ ED Game
R2 – I3: Innovation ~ Survivor Game
8
3/8
R2 – I3: Information ~ Red Bead
Statistics
9
3/15
R2 – I3: Information cont.
3/22
No Class – Spring Break
10
3/29
R2 – I3: Incentive
Pay for Performance
11
4/5
Methodologies – CQI, Six Sigma / Lean
11
4/12
Indicator Presentations
12
4/19
Indicator Presentations cont.
4/26-27 all day
HS Symposium
Weekly Readings: (To be read before the selected class week. Articles will be sent out prior.)
Class
2
Topic: Introduction/What is Quality?
TEXT:




3
The Healthcare Quality Book: (85 pages)
Chapter 1, Healthcare Quality and the Patient
Chapter 2, Basic Concepts of Healthcare Quality
Chapter 3, Variation in Medical Practice and Implications for Quality
Chapter 4, Quality Improvement Systems, Theories and Tools
Topic: Components of Quality: Compliance & Patient Safety
TEXT: The Healthcare Quality Book: (45 pages)
 Chapter 18, Accreditation: Its Role in Driving Accountability in Healthcare
 Chapter 11, Patient Safety and Medical Errors
ARTICLES: (60 pages)
 “To Err is Human: Building a Safer Health System: Executive Summary”. IOM: (2000): (16 pages)
 “HealthGrades:Quality Study: May 2005”. Health Grades, Inc (25 pages)
 “Error, stress, and teamwork in medicine and aviation: cross sectional surveys”. J Bryan Sexton,
Eric J Thomas, Robert L Helmreich. Bristish Medical Journal, March 2000 320(7237): 745–749
 “Measuring Comparative Hospital Performance.” Griffith JR, Pattullo A, Alexander JA, Jelinek RC:
Journal of Healthcare Management, 47(1):42-57, January/February 2002.
Case Study #1 Due
3
Topic: Components of Quality: Service Excellence, “The Doctor”
TEXT: (30 pages + excerpts)
 The Healthcare Quality Book: Chapter 9, Measuring and Improving Patient Experiences of Care
 Patient Satisfaction: Understanding and Managing the Experience of Care. Irwin Press, Ph.D.
Excerpts.
ARTICLES: (17 pages)
 Exploring the Impact of Service Excellence on Hospital Success. April 15, 2005. The Advisory
Board (12 pages)
 “Is personality a determinant of patient satisfaction with hospital care?” A. A. J. Hendriks, E. M. A.
Smets, M. R. Vrielink, S. Q. Van Es, and J. C. J. M. De Haes. International Journal for Quality in
Health Care. April 2006. (5 pages)
Case Study #2 Due
4
Topic: Components of Quality: Structure-Process-Outcome, What is a Quality Department?
TEXT: The Healthcare Quality Book: (50 pages)
 Chapter 5, The Search for a Few Good Indicators
 Chapter 6, Data Collection
 Chapter 14, Organizational Quality Infrastructure
 Chapter 15, Implementing Quality as the Core Organizational Strategy
 Chapter 16, Implementing Healthcare Quality Improvement
HSR, April 2006. Quality Improvement
ARTICLES:
 Meurer, Steve. “Continuous Quality Improvement”
 “The Forgotten Component of the Quality Triad: Can We Still Learn Something from "Structure"?”
Joint Commission Journal on Quality and Patient Safety, Volume 27, Number 9, September 2001,
pp. 484-493 (10 pages)
Case Study #3 Due
6
Topic: Introduction to R2 – I3 , R2 – I3: Relationships ~Personality Tests & R2 – I3: Resources ~
ED Game
TO DISCUSS: Results of Predictive Index Personality Test
TEXT:
The Tipping Point: How Little Things Can Make a Big Difference by Malcolm Gladwell
7
Topic: R2 – I3: Innovation / Resources ~ Survivor Game
TEXT:
The Healthcare Quality Book: (60 pages)
 Chapter 12, Information Technology
 Chapter 13, Leadership for Quality
Diffusion of Innovations. Rogers. Excerpts.
ARTICLES: (19 pages)
 “Spreading Innovation”. Berwick, D. Quality Connection. Winter 1997
 “Coaching and leadership for the diffusion of innovation in health care: A different type of multiorganization improvement collaborative”. Green PL, Plsek PE. 2002 Joint Commission Journal on
Quality Improvement. Feb, 55-71.
Case Study #4 Due
8
Topic: R2 – I3: Information ~ Red Bead, Statistics
TEXT:
The Healthcare Quality Book: (50 pages + excerpts)
 Chapter 7, Statistical Tools for Quality Improvement
 Chapter 10, Dashboards and Scorecards: Tools for Creating Alignment
Measuring Quality Improvement in Healthcare. Carey and Lloyd. Excerpts.
ARTICLES:
 Dartmouth Atlas
9
Topic: R2 – I3: Information cont.
ARTICLES: (53 pages)
 “Variation in Hospital Length of Stay: Do Physicians Adapt Their Length of Stay Decisions to What
Is Usual in the Hospital Where They Work?” Judith D. de Jong, Gert P. Westert, Ronald Lagoe,
Peter P. Groenewegen. Health Services Research. Volume 41 Page 374 - April 2006 (21 pages)
 Statistical Testing: Is What You See Really There? Kazandjian, Vahe. (10 pages)
 Fundamental Issues in Data Collection & Analysis: Data, Definition, Validity & Reliability. Appel,
Francis (4 pages)
 Using Control Charts to Access Performance Measurement Data Lee K, McGreevey C. Joint
Comm. 2002 Feb;28(2):90-101.
 “Statistical issues in reporting quality data: small samples and casemix variation”. Alan M.
Zaslavsky. International Journal for Quality in Health Care 2001. Volume 133. (8 pages)
Case Study #5 Due
10
Topic: R2 – I3: Incentive & Pay for Performance
TEXT: (15 pages)
The Healthcare Quality Book, Chapter 19, How Purchasers Select and Pay for Quality
ARTICLES:
 Healthcare Technology: Pay for Performance: Fad or Forever? Kaveh Safavi, M.D., J.D., Solucient,
LLC. HCT Project Volume 2, July 17, 2004 (6 pages)
 Early experience with pay-for-performance: from concept to practice. Rosenthal MB; Frank RG; Li
Z; Epstein AM. JAMA. 2005; 294(14):1788-93 (ISSN: 1538-3598) (5 pages)
 Pay-for-Performance Incentive Programs: 2004 National Study Results. Baker, Geof & Carter,
Beau. Med-Vantage Inc. First-Quarter 2005.
 Clinical Advisory Board (2 books)
Case Study #6 Due
11
Topic: Continuous Quality Improvement; Six Sigma and Lean
ARTICLES:
 “Classic CQI integrated with comprehensive disease management as a model for
performance improvement.” Joshi MS, Bernard DB. Journal on Quality Improvement 1999
Aug; 25(8) :383-95.
 TBA: Lean/Six Sigma
TEXT:
Chapter 5: Implementing CQI: The Quality Imperative: Measurement and Management of Quality in
Healthcare. Etienne Minvielle, John R. Kimberly. World Scientific Publishing Company (January 2000)
14
Topic: Indicator Presentations
15
Topic: Indicator Presentations cont.