Chapter 1

Changing Perspectives in Quality
•
• “Quality in a product or behavior. service is not what the supplier puts in.
It is what the customer conversations in healthcare that if avoided can gets out and is willing to pay for.”
• Participants can identify 2 skills that are essential to effective communication.
2

3
Value =
Quality of Care/Services + Outcomes
Cost

4
Governance
Clinical Mgmt
Support

5
Clinical
Support
Management
Governance

6
• Productive Work is Accomplished Through
Processes.
• Sound Customer-Supplier Relationships are
Absolutely Necessary for Sound Quality
Management.
• The Main Source of Quality Defects is
Problems in the Process.
• Poor Quality is Costly.

7 QUALITY MANAGEMENT:
BASIC PRINCIPLES
• Understanding the Variability of Processes is
Key to Improving Quality.
• Quality Control Should Focus on the Most
Vital Processes.
• The Modern Approach to Quality is
Thoroughly Grounded in Scientific and
Statistical Thinking.

8
QUALITY MANAGEMENT:
BASIC PRINCIPLES
• Total Employee Involvement is Critical.
• New Organizational Structures Can Help Achieve
Quality Improvement.
• Quality Management Employs:
– Quality planning
– Quality control (measurement)
– Quality Improvement

9
• An Organizational Management Philosophy and
Top-Level Commitment to Foster a Belief in the
Value of:
 Customers
 Employees/staff
 Management
 Teamwork
 Deming’s 14 points

10
 CQI is a Management Approach of Study and Improving Processes
 It is a Management Method for Creating
TQM
 At CQI’s Core is a Quality Culture/Patient
Safety Culture

11
 Organizational Commitment
 Quality Culture
 Customer Focus
 Team Emphasis on Improving Systems and
Processes
 Constant Learning and Improving

12
 Understand Principles of TQM and CQI
 Develop a Healthcare Quality Strategy
 Participate in Preparation for External Awards
 Articulate to Leadership How to Use
 TQM and CQI
 Data Measurement
 Assessment
 Improvement
 Lead and facilitate change within the organization

13
System:
Perceived whole whose elements hang together effecting each other
Systems Thinking:
A body of principles, methods, and tools focused on the interrelatedness of forces in a system

14
Systemic Structure Key
Components:
 Process flows,
 Attitudes & perceptions,
 Ways decisions are made,
 Hierarchy
 The system working with all its parts

15
Four Levels in Systems:
 Events (occurrences)
 Patterns of Behavior (trends over time)
 System Structure (decisions, relationships, efforts, targets, incentives, etc.)
 Mental Models (beliefs, assumptions, mind sets about ways work gets done)

16
• Cause and Effect Relationships
A affects B affects C
• Process Diagrams Show a Flow or Sequence of
Activities
A then B then C

• Who are the various owners of the process?
• What group of people have some stake or ownership of different parts of the process?
• You can address the symptoms, but until you address the problem you can not resolve it
• Addressing the symptoms is call the Band-Aid approach
17

• MD writes order
• Sent to Pharmacy by Nursing
• Pharmacy fills the order
• Pharmacy sends the medication up to the Nursing
Unit
• Nurses give the medication
• Nurses & MD monitors the patient’s condition
18

• What if the doctor’s handwriting can not be read and doctor is not available?
• What if the Pharmacy decides not to fill it until later?
Or if the Pharmacy has no medication
• What if it does not get to the unit until after the time it was needed?
• What if the nurses are too busy to be able to give the medication on time?
19

• What if Nursing decides to change the times they administer the medications and does not tell the
Pharmacy?
• What if the Pharmacy does not have a medication and does not contact the doctor until after clinic hours and the MD is not on call?
• What if Pharmacy decides to send the medication in 2 pouches instead of just one?
20

• You need to examine the players and determine who will be affected by any actions that you take
• You want to expand your clinic?
– How many more practitioners ?
– Nursing staff to run the clinic & move patients around?
– Lab work increase of workload?
– Radiology increase of workload?
– Pharmacy have needed medications?
• CAN NOT DO IT BY YOURSELF when you want to do something like this
21

• “Customer” – One Who Receives
Goods or Services
• External Customer – Those Outside the Organization Receiving Services
• Internal Customer – Those
Performing Work, but Dependent
On Others Within the Organization
Performing Work
• Customer Supplier Relationships
22

• Listen To & Communicate With Customers;
• Identify and Address True Needs;
• Optimize Treatment Patterns and Outcomes:
• Enhance Performance of Internal Processes;
• Respond to Requests For Information;
• Build Trust, Respect, and Loyalty in
Relationships
• Patient Centered Care
• Coordination of Care
23

• Dissemination of cultural transformation and performance improvement information
 within the organization and
 to our customers!
24

IDENTIFYING CUSTOMERS AND THEIR
NEEDS
• Identifying Customer Needs & expectations:
 Surveys and interviews
 Focus groups
 Research
 Brainstorming
 Teams
25

• Culture – Basic Set of Assumptions
About People, How People Work
Together and How Work Gets Done.
26

IMPACT OF ORGANIZATIONAL CULTURE
 Organizational Ethics
 Patient Safety
 Corporate Compliance
 Organizational Change
 Performance and Productivity
 Internal and External Customers
27

• Most organizations have different organizational cultures, including different healthcare organizations
• Healthcare must change into a Quality and Patient
Safety culture if we are to survive
• There must be a Patient Centered culture
• Care must be Evidence-Based
• Teamwork is essential
28

 Just Culture – Blame Free
 Adoption of “Quality / Patient Safety Culture”
 Commitment to Excellence
 Long-range Strategic Planning
 Flexible Management Styles
 Systems Thinking
 Delegation and Empowerment
 Team Building
 Increase Communication
29

Visionary Leadership
Systems
Thinking
Inspiration
Management’s Commitment
Employee
Involvement Team Building
Calculated Risk
Taking
Implementation Engagement
Innovation
30

• Need to start with defining quality at an organization
• Assess where the organization is in terms of the organizational culture
• Develop and design what the new Quality /
Patient Safety Culture will look like and how to get there
31

REDESIGNING
THE ORGANIZATION
 Sustained Approach
 Downsizing
 Restructuring/Rightsizing
 Organizational Structure
 Reengineering
32

Work
Redesign
Customer
Focus
Service
Integration
Management
Restructuring
Cross Training
33

• Types:
– Horizontal
Hospital
A
Hospital
D
– Vertical
Hospital
B
Hospital
Hospital C
Rehab
LTC
Clinic
• Degrees of Integration
34

Coordination of Clinical
Processes and Services
Appropriate Sharing of Facilities and
Services
Cost
Effective
Care
Avoid
Unnecessary
Duplication
35

• Awareness of Statutory & Regulatory
Requirements
– OSHA
– HIPAA
– PPACA
• Quality & Reimbursement
– Capitation
– Pay for Performance