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7/31/2019 TQM Trainign Workshop
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Time Topic
Day1
9:00am Historyo Qua ityManagement
10:00am DynamicsofHealthcare
11:00 11:15am CoffeeBreak
11:15 BariarstoQualityImprovements
12:15 QualitManagement
Philosophies
1:15 GeneralDiscussion
Day2
9:00am StepstoQualityImprovement
10:00am Value
of
Including
Medical
Staff
in
Quality
Improvements
11:00 11:15 CoffeeBreak
11:15am TeamBuildingInQualityEfforts
12:15 GeneralDiscussion
Day3
9:00am QualityImprovementTools,ADashthroughData
10:00am TQMSixSigmaTurningStrategyintoResults
3/27/2008Dr. A. Saddique 2
11:00am 11:15 CoffeeBreak
11:15 12:15 Practical
Application
and
General
Discussion
1:30pm GroupsWorkshoponCQIApplications
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Dr. Abdulaziz A. SaddiqueSix Sigma Master Black Belt
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Six Si ma Master Black BeltSix Si ma Master Black Belt
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Wh Hos ital ualit Assurance?
Ethics
Competition ren s o ea t are tan ar s
Economical forces
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2000BC Code of Hammurabi - 2000 BC
The Responsibility For QualityCare Rests Solely With The
Individual Who Provides The Care
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1752AD Benjamin Franklin- first US hospital
The Accountability Of The GoverningBody Was Limited To Fundraising
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Brown 1-42
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Florence Nightingale
Advocated a uniform system forcollecting and evaluating hospital
s a s cs.
From statistics on the mortality of British
indicated a drop in mortality rate from
32.% to 2.% within six months
Nutting and Dock, 1907,pg142
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Florence Nightingale -
Early Process Standards For NursingPractice
- First rule of good nursing was to keep the air
the patient breathes as pure as the external air,without chilling the patient
-and symptoms of a change in the patientscondition
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Nightingale -Notes on Nursing(1860)
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1863AD
Florence Nightingale
n a e e use o osp a e s o
indicators of health in order to promote
beds.
From this data s ecific medical and sur ical
treatments was correlated with diagnostic
categories and morality rates calculated
(Brook and Avery 1975,pg3)
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Emory Groves, British physician
Established a follow-up system for particular
categories of diseases to allow assessment of
long-term results-
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1908AD
An industrial system called theTaylorsystem
was developed that separated planning from
.
but at the expense of quality
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1 10ADDr Abraham Flexner
Released a study of the quality of medical
schools in the united states which stimulated the
e m na on o p oma m s.
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1912ADEA Codman -
Opened an end results hospital - instituting a
system of medical audit - emphasized:
e mpor ance o censure or cer ca on o prov ers
(2) the accreditation of institutions
(3) the severity or the stage of the disease(4) the issue of co-morbidity
(5) the health and illness behavior of the patient
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1913ADAmerican College of Surgeons
Formed as an accrediting body,- generated minimum standards for
- developed the first hospital standardization
program (They suggested 5 standards only)
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1950
American Nurses Association -
Published A Code For Nurses
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1952
JCAHCO (Joint Commission on Accreditation ofHospitals)
Established as responsible for the quality assurance function
succeeded the American college of surgeons
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1965Darling vs. Charleston Community Memorial Hospital
The Governing Body And The Hospital Held AccountableFor The Selection Of Medical Staff And The ualit Of
Care Rendered In The Hospital.
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1973
-
Legislation enacted - mandated the
implementation of a Quality Assessment
System
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e mo ern are:
W.Edward Demin
Philip CrosbyKaoru IshikawaVilfredo Pareto
Jose h M JuranGenichi Tagushi
W. A. Shewhart
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.
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1. Deming14 Points for Management
.Do Things right the first time
Spend less time in rework
Build trust in your products
xpan n e mar e anHire More People
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Stay in Business
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Defined the our qua ty a so utes:- The definition of quality is conformance to requirements.-
- The performance standard is zero defects
- The measurement of quality is the price ofnoncon ormance.
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Ishikawais best known for developing
the cause an e ec agram(also called the fishbone diagram)
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ParetoAn Italian engineer
Developed the are o c ar A basic but powerful tool of managerial analysis
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Used the pareto chart and its demonstration of misdistribution
Formulated The Pareto Principle: 80/20 Rule
-The bulk of failures (80%) being
traceable to a vital few (20%)
corrective actions towards thesevital few and awa from
the trivial many
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Genichi
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Created the Poka-Yoke system to ensure-
measures.
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Armand V.
Developed concepts of 'Total Quality
Control', Contributed to 'cost of quality' and quality
systems engineering and practice
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Is responsible for the Control Chart-Another basic tool of ualit control:The control chart is a chart with statistically
determined upper and lower limit, which is used to
cause of the variability.
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1981
JCAHCO -
The joint commission required all hospitals
to have a written quality assurance plan.
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JCAHCO(Joint Commission) -Launched agenda for change. The goal of thisprogram was to develop an outcome-oriented
mon or ng an eva ua on process
Quality Improvementwas dramatic as itcontained two critical elements:
1.Philosophy2. Problem-Solving/Graphical Techniques
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(JCAHCO)
Published principles of organization andmana ement effectiveness in healthcare
organizations-
articulated the concept of total qualitymanagement (TQM)
Then in 1992 Accreditation Manual for Hos ital.
- The Commission initiated aTransition to continuous quality improvement.
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Riyadh Quality Management Networkorme y a s u y group or e exam. rew o
nearly 100 individuals from all major hospitals in riyadhand interested corporations for presentations related toquality implementation
Then in 2001 Healthcare ualit Mana ement Network.became a chapter of the Saudi National Quality Committee
and National Association of Healthcare Quality (USA), its,
Quality Management Network (HQMN).
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arc ,ISO (International Organization for
-
Com leted a re ort on the uidelines for
implementing ISO 9000 quality management systems
in the health care sector goal to establish a standardfor the healthcare sectoraccepted by north America,
Australia, British standards, European commission
-organized by Canadian Standards Association / Standards Council of Canada
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Total uality ManagementIs the concept of a healthcare organizationmeasuring their effectiveness and
establishing projects to improve their
e ec veness a suppor ng e pa en s an
practitioners at the point of care
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y y ,
continuously changing therefore, we
allows adaptation of the changes and
develop.
,
to identify problems or pending
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QUALITY PRODUCTS SURVIVE
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AND SPEAKS FOR ITS CREATORS
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Dr. Abdulaziz Saddique Pharm.D., CPHQ, CSSMBB
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Healthcare is a service that is provided toour patients to cure disease, decreasesuffering, improve the quality of life orprolong life.
The trial for better care is a never endingprocess.
Clinical Research is the key to developmentof new procedures, new drugs, or defining.
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e s rev s ng s s an ar s o
care practically every year to keep up.
Governments and individuals are
healthcare.
devised
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The Paradox of Healthcare
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The Paradox of Healthcare
Highly trained practitioners; widespread state-of-the-art technology; unparalleled biomedical
research; unequaled expenditures; excellent care
for some individuals
Care fragmented and difficult to access; too many
people not assured access; uncertain value of
expen itures; growing isenc antment wit care
process by patients, practitioners and payers;
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urrent pract ce epen s upon t eclinical decision makin ca acit
and reliability of autonomousof problems that routinely exceed
cognition.
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October 15, 2001IOM Annual Meeting
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ynam cs o ea care
Development of the diagnostic procedures,techniques and understanding of the
. Improvement of Monitoring procedures
Develo ment of Dru Industr Development of healthcare performance
standards ene c ng neer ng an rea men o
hereditary diseases. Escalation of Healthcare Cost
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ynam cs o ea care
a en s eman o ua y erv ce.
Patients and Governments demand toecrease cos .
Governments demand to know more
. Global Quality Awareness.
ange s no op ona s a mus .
Healthcare is a Business.
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ase on a t e eman s.
More Shifting to Privatization.
The Competition.
The New JCAHO Standards. Overall World Economy
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e n t on o ua ty n ea t care
American Medical Association
improvement of /or maintenance of
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e n on o ua y n ea care
e n t on:
The degree of adherence to generallyrecognize contemporary stan ar sof good practice and achievement of
an c pa e ou comes or par cu ar service, procedure or clinical problem
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Definition of Quality In Healthcare
improve the services provided to
meet our patients expectations.
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Regardless of which model is chosen by theOrganization it should contain the following:
Knowledge of systems
Knowledge of Variation
now e ge o syc o ogy; an
Theory of Knowledge
. .
improvement knowledge
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To meet the changing demand ofhealthcare marketplace the organizationmust have:
Short-term initiatives:
Improve effectiveness, time MGMT,efficiency, and other dimensions of
per ormance o t e major processesin their basic services.
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.
Long-term initiatives:
create customer-focused, learning
healthcare system.
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Healthcare management system
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pec ca ons
development in healthcare.
staff and maximize their productivity, as
Provide means for Continuosim rovement.
Provide integration of Professionalknowledge with improvementknowledge.
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-
governments organizations to assurethe ualit of services rovided.
Standards are essential in the developedcountries, however, in developingcountr es t s cons ere as t es toindividuals activities.
to another, and this affects theunderstanding of Quality.
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Continuous Quality improvement efforts
and not just Quality Assurance. pp ca on o a managemen sys em
which meets the continuous qualityimprovement based on patients needs.
Determination of customers needs baseon competition.
minimal cost by maximal utilization ofthe available resources.
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Examples of Quality Improvement and Cost
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onta nment e orts
Change from problem driven to Goal-oriented
management. re en a ng. Information management utilizing Statistical
methods to evaluate performance andremova o error.
Case management and evaluation of servicesbased on preset standards, to achieve
.
Integration of all these systems in a completedatabase.
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TQM is The
FIDO DIDO
Thank you & Seeyou oon
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r. u az z a que Six Sigma Master Black Belt
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n organ ze osop y a see s
to meet client needs and exceeds
, rework and waste , by using a
identifies and improves all aspects ofcare and services on an on oin basis
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Quality Improvement promotes: Client
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1. Identification of clients, their needs,
2. Response to changes in client needs
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QI Promotes Leadership
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. rgan za ona cu ure
2. Planning3. Resources
4. Quality
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. ec ve commun ca on among eam
members and between teams. ocus on mprovements to team s
functioning
. ross unct ona nter sc p naryrepresentation
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. eve opmen ,se ec on an
monitoring of indicators. epor ng o n ca or mon or ng
and results
. ee ac on n cator resu ts
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:
Voluntary and not mandatory Private
commitment to safe , highqualityservice
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. v u -
set Standards and improves the
2. Involves examining everyday
standards of excellence
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Benefits of Accreditation
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Benefits of Accreditation
1. Shows commitment to Quality
2. Supports learning across organization3. Encourages self-reflection
4. Improves communication, collaboration
an ntegrat on among epartments
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Also
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romo es eam u ng
Increases credibility Demonstrates accountability
Improves productivity
Obtain valuable advice fromsurveyors,.
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The Value of Accreditation
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Accreditation may benefit health care institution by:
v ng t em a compet t ve a vantage
Accreditation provides evidence of quality patient care thathelps level the playing field for organizations doing the same
Strengthening community confidence
Achieving accreditation is a visible demonstration to patients
providing the highest quality services
Assisting recognition from insurers , associations ,,
Increasingly, accreditation is becoming a prerequisite foreligibility for reimbursement, for association membership ,for communit awareness and for contract or rants
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In addition
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Validating Quality Care to Patients
ccre a on an ar s are ocus on one goa . a s ng esafety and quality of care to the highest possible level.
Achieving accreditation is a strong validation that u have
Helping you organize and strengthen your improvementefforts
Accreditation encompass state of the art performanceimprovement concepts that help you continuously improvequality
Enhancing staff education
The survey process is design to be educational, not punitive .Accreditation surveyors are trained to help you improve yourinternal procedures and day to day operation
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Also
Improving Risk Management
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Improving Risk ManagementBy enhancing risk management efforts ,accreditation may
, .can also assist in lowering adverse events or outcomes for
the organization ,and more importantly, for the patient theor anization
Facilitating Staff Recruitment
As Staff recruitment become more difficult , achieving
commitment to quality and patient safety will enhancerecruitment efforts
romo ng eam u ng s s s a
The process of obtaining and maintaining accreditationdemands a team approach to good patient care. Establishingprocesses an systems t at support t s emonstrat on sachieved through good team activities
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u y
achieving accreditation ac s a mem er can e p ensure a
safe environment where high quality
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To get Accreditation
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To get Accreditationis
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Chan eis
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manner in which an individual or
behaviors to another
,and becoming different
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maybe
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.
quo of the organization initiated by
impact either or both the work and
.2. Unplanned : any change to the status
on a random . It takes long time
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Factors Enforcing Change
WTOIMF
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WHOGlobalizationWorld Bank
Economic
developments
GovernanceCitizens / Industry
e ec s a
Laws
Rules
Regulations
Local Governance
Guidelines
Implementation
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Execution
wh or anizations need to Chan e?
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Improve market share Increase effectiveness Increase learning Improve public image
Increase client satisfaction Improves outcomes ,
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Forces that pushes organizations to
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Forces that pushes organizations toChange
1. External changes
. 3. Environmental factors
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Changes in law and regulations
Changes in customer needs and want Changes in technology
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structure such as new changes.
better work environments
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Environmental factors
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with the improvement of information,technology . All leading to increase inthe speed of individual events
Environmental com lexit :organizations become very complex
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One of nastiest and most debilitating
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There is not a more potent killer of
to change
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Resistance to is one of the
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Positive resistance is based on rational
evidence that the cost of change
Negative resistance based on emotions
of the outcomes of change because oftheir ersonal needs or fears
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Fear of unknown Social relations
Habits Failure to recognize the need for change
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continue
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Loss: change has unacceptable personal
costs Inadequacy : the benefit from the change
are not seen as sufficient
Anxiety : fear of being unable to copewith the new situation
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Organizational level
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Threat to existing balance of power Structural inactivity
Work group inactivity
Previously unsuccessful efforts
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Other sources
of
Resistance to Change
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g
Ignorance : a failure to understand the
Mistrust : motives for changes areconsidered sus icious
Disbelief : a feeling that the way forwardwill not work
Powercut : a fear that sources of
influences and control will be eroded
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Other sources
of
Resistance to Change
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: The way forward is dislikeecause an a ternat ve s pre erre
Change threatens the
estruction o existing socia networ
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r ca y assess ngwhether change will
vo ng ea ng wurgent and pressing
personalconse uences of
what really needs to bedone
change3/27/2008Dr. A. Saddique 118
ey e emen s o e ec ve
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Change agent skills Teamwork
Supportive organization culture
Implementation plan
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organization goes through a structural
Address the resistance to change
se a par c pa on approac
Communicate the change effectively
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continue
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u
personal agenda u an ma n a n comm men
Monitor to ensure compliance
Predict the likely impact of change onthe organization
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Process
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influential mangers and workers on
compelling need to change roa part c pat on o wor orce must e
engaged and committed for changeinitiatives
Management must constantly communicatemission, vision, philosophy, process and
Change and process improvement takestime and is a never ending process
3/27/2008Dr. A. Saddique 122
continue
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gnor ng c ange on y causes trou e
Change is happening everywhere ,whoever
The sooner the change is addressed theless ad ustment is necessar
To change is to be fearless
Ada t to the new chan e behavior
Enjoy being flexible to the changingenvironment
3/27/2008Dr. A. Saddique 123
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Th i s quo t e f r om chap t e r s ix o f Th e Pr in ceon i n i t i at i ng
change ,
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"We must bear in mind, then, that there is nothing
,
success, than an attempt to introduce a new order of
ngs n any s a e. or e nnova or as orenemies all those who derived advantages from the
old order of things, whilst those who expect to be
benefited by the new institutions will be but
lukewarm defenders.
3/27/2008Dr. A. Saddique 125
Machiavelli and the Difficulty of Change
This indifference arises in part from fear of theird h f d b h l
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adversaries who were favored by the existing laws,
and partly from the doubt of men who have no faithin anything new that is not the result of well-
established experience. Hence it is that, whenever
the opponents of the new order of things have the
of partisans, whilst the others defend it but feebly,''.
3/27/2008Dr. A. Saddique 126
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. .. .
3/27/2008 127
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129
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o Inspection
o Quality Control
o Quality Assurance
o Total Quality Management
3/27/2008Dr. A. Saddique 130
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3/27/2008Dr. A. Saddique 131
Inspection
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3/27/2008Dr. A. Saddique 132
Quality Control
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3/27/2008Dr. A. Saddique 133
Quality Control
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3/27/2008Dr. A. Saddique 134
Quality Control
QC is the systematic assessment ofgoods and services to check their
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goods and services to check their
conformance
It will not improve quality, just
highlight when it is not present
In many cases QC does not identifythe root cause of the non-conformance
3/27/2008Dr. A. Saddique 135
Quality Assurance
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3/27/2008Dr. A. Saddique 136
Quality Assurance
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3/27/2008Dr. A. Saddique 137
Quality Assurance
y u
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yorganizational activities to increase
opt on an use o t r partyapproval, such as a major customer
3/27/2008Dr. A. Saddique 138
Total Quality Management
Represents the most advanced stage ofqua ty eve opment
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q y p
A Management philosophyApplication of QM to all aspects of business
Focused on the requirements of the customer
Recognizes the importance of suppliersCompany wide approach
Continual improvement
Integration of all quality systems and procedureseve opmen o organ za ona cu ure
3/27/2008Dr. A. Saddique 139
TQM Principles
Internal customer supplier relationship
Continuous Improvement
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Continuous Improvement
TeamworkEmployee participation/ development
Suppliers and customers integrated into
Honesty, sincerity & care
3/27/2008Dr. A. Saddique 140
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3/27/2008Dr. A. Saddique 142
W. Edwards Deming
Defined ualit as continualimprovement of a stable system.
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improvement of a stable system.
Most quality problems (90%) arecaused by poor systems, not byworkers. Management is responsible.
ate t e term .14 points of management must be
choose).
3/27/2008Dr. A. Saddique 143
Demings 14 Points
. wi f d d
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improvement of products and
become competitive and staying in-
creating jobs), rather than short-runrofits.
3/27/2008Dr. A. Saddique 144
Demings 14 Points
Two problems 1) problems of today,and 2) problems of tomorrow, for the
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company that hopes to stay in.
Problems of tomorrow require
3/27/2008Dr. A. Saddique 145
Demin s 14 Points
. A opt t e new p i osop y yf i ll l d
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refusing to allow commonly accepted, , ,
and errors. Accept the need toestablish leadershi for chan e. The
new philosophy must start at the top,with senior management, if it is toave cre y w cus omers,
suppliers, and employees.
3/27/2008Dr. A. Saddique 146
Demings 14 Points
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3/27/2008Dr. A. Saddique 147
Demings 14 Points
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3/27/2008Dr. A. Saddique 148
Demings 14 Points
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3/27/2008Dr. A. Saddique 149
Demin s 14 Points
Continuous: oin on or extendinwithout interruption or break.
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p
1) not changing, remaining the same,
specifically
a) remaining firm in purpose,b) remaining steady in loyalties,
c) remaining free from variation or change;
stable..
3/27/2008Dr. A. Saddique 150
Demings 14 Points
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3/27/2008Dr. A. Saddique 151
Demings 14 Points
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3/27/2008Dr. A. Saddique 152
Demings 14 Points
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3/27/2008Dr. A. Saddique 153
Demings 14 Points
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3/27/2008Dr. A. Saddique 154
Demings 14 Points
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3/27/2008Dr. A. Saddique 155
Demings 14 Points
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3/27/2008Dr. A. Saddique 156
Demings 14 Points
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3/27/2008Dr. A. Saddique 157
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3/27/2008Dr. A. Saddique 158
Demings 14 Points
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3/27/2008Dr. A. Saddique 159
Demings 14 Points
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3/27/2008Dr. A. Saddique 160
Demings 14 Points
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3/27/2008Dr. A. Saddique 161
Metanoia
The first process that must be
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p
managers. It involves how theyerceive the business and their
relationships with customers,suppliers, and employees.
T is trans ormation is iscontinuous.
3/27/2008Dr. A. Saddique 162
1. Lack of constancy of purpose
2. Emphasis on short-term profits
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3. Evaluation of performance, merit rating, orannua rev ew
4. Mobility of top management
5. Running a company on visible figures alone("counting the money")
.
7. Excessive costs of warranty, fueled by
3/27/2008Dr. A. Saddique 163
. ,
Deadly Diseases, Obstacles
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2. Management takes pride and develops
courage for new direction
3. Management explain to personnel in the
4. Divide every company into stages identifyingthe next stage as the customer
3/27/2008Dr. A. Saddique 164
.
(using Deming Cycle)
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( g g y )
6. Everyone can take part in a team to improve
7. Embark on construction of or anisation for
quality (involving knowledgeable
3/27/2008Dr. A. Saddique 165
1. Ne lect of lon -ran e lannin andtransformation
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2. The supposition that solving problems,au oma on, ga ge s, an new mac nery wtransform industry
.
4. Our problems are different
5. Obsolescence in schools
6. Reliance on quality control departments
7. Blaming the workforce for problems
3/27/2008Dr. A. Saddique 166
.
9. False starts
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10. The unmanned computer
. ee ng spec ca ons
12. Inadequate testing of prototypes
13. "Anyone that comes to try to help us must
"
3/27/2008Dr. A. Saddique 167
.
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2. Knowledge of statistical theory
3. Theory of Knowledge
4. Knowledge of Psychology
3/27/2008Dr. A. Saddique 168
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Phili Crosb
3/27/2008Dr. A. Saddique 169
Quality is Free - Crosby
Quality is free. Its not a gift, but it is free.at costs money are t e un-qua ty
things-all the actions that involve not doing
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. If you do things right the first time, you will
not spend money fixing them or doing
them all over again. Crosby claimed that all quality
. .quality is free
3/27/2008Dr. A. Saddique 170
Quality is Free - Crosby
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3/27/2008Dr. A. Saddique 171
Quality is Free - Crosby
In Quality is Free, Crosby defined an
ddi i l li b ildi l
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additional ualit buildin toolsincluding the Quality ManagementMaturity Grid which enables a company
to measure its present quality positionand pinpoint areas that needimprovement
3/27/2008Dr. A. Saddique 172
14-steps to Quality Improvement - Crosby
Crosby identifies fourteen steps to qualityimprovement, whether you manage a
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arge p ant or run a sma us ness:
1) Make sure that management people
are committe to qua ity.2) Gather representatives from each
department to form quality
improvement team.
3/27/2008Dr. A. Saddique 173
14-steps to Quality Improvement - Crosby
3) Measure processes to determinewhere current and potential qualityproblems lie.
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4) Evaluate the cost of quality andexplain its use as a management tool.
5) Rise to all employee the qualityawareness and personal concern.
6) Take actions to correct problems
identified through previous steps.
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14-steps to Quality Improvement - Crosby
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3/27/2008Dr. A. Saddique 175
14-steps to Quality Improvement - Crosby
ncourage emp oyees o commun ca eto management the obstacles they face
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.12)Recognize and appreciate those who
artici ate.
13)Establish quality councils tocommunicate on a regular basis.
14)Do it all over again to emphasis that the
quality improvement program neveren s.
3/27/2008Dr. A. Saddique 176
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3/27/2008Dr. A. Saddique 177
Fishbone (Cause and Effect or Ishikawa)
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3/27/2008Dr. A. Saddique 178
Fishbone (Cause and Effect or Ishikawa)
vQuality
ea s o ncrease un ers an ng o
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ea s o ncrease un ers an ng ocomplex problems
sua an presentat ona too
3/27/2008Dr. A. Saddique 179
Fishbone (Cause and Effect orIs i awa
y y
Recently some computer programs
ave een crea e o ma e s one
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ave een crea e o ma e s oneDiagrams
3/27/2008Dr. A. Saddique 180
u v y u ,process, or service
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3/27/2008Dr. A. Saddique 181
e ps r ng a pro em n o g
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3/27/2008Dr. A. Saddique 182
Creating Fishbone Diagrams(1 of 4)
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3/27/2008Dr. A. Saddique 183
Creating a Fishbone Diagram
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3/27/2008Dr. A. Saddique 184
Creating a Fishbone Diagram (3 of 4)
.each of the major causes
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.their respective major causes
-
causes dividing with increasedspecificity
3/27/2008Dr. A. Saddique 185
Creating a Fishbone Diagram (4 of 4)
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3/27/2008Dr. A. Saddique 186
xamp e
:
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Poor Service(backbone)
(head)
3/27/2008Dr. A. Saddique 187
xamp e
:
Appearance
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pp
Poor Service
ReliabilityAttention
3/27/2008Dr. A. Saddique 188
xamp e
, , :
ResponsivenessAppearance
timeequipment
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personnelfacility
q p
Poor ServiceOne on one
accuracy
Attention Reliability
serv cedependability
3/27/2008Dr. A. Saddique 189
xamp e
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3/27/2008Dr. A. Saddique 190
xerc se
,Ishikawa) Diagram for the following:
that the productivity of its workers is well
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that the productivity of its workers is wellbelow the standard. After interviewing itsemp oyees, was no ce a a vas ma or y
felt dissatisfied and unhappy with their work.Your boss has asked you and a group of yourpeers to n t e causes o wor erdissatisfaction . Include all possible causes to
at least the secondary level.
3/27/2008Dr. A. Saddique 191
ummary
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3/27/2008Dr. A. Saddique 192
ummary
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3/27/2008Dr. A. Saddique 193
ummary
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3/27/2008Dr. A. Saddique 194
-
Italian Economist
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3/27/2008Dr. A. Saddique 195
The Pareto Diagram
It is a s ecial t e of vertical bar chart
in which the categorized responses
are lotted in the descendin order oftheir percentages, and combined with
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p g ,a cumulative percentage polygon on
the same scale. Useful when there are many
categories
Vertical axis shows the %, horizontalaxis categories.
3/27/2008Dr. A. Saddique 196
Pareto diagram
Axis for bar50
100
120chart shows
% i d
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4080
100% invested
10
20 40
60
category.
0 0
graph shows
cumulative
3/27/2008Dr. A. Saddique 197
Stocks Bonds Savings CD % invested.
Jurans Quality Trilogy
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3/27/2008Dr. A. Saddique 198
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Quality Planning
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3/27/2008Dr. A. Saddique 200
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Quality Control
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3/27/2008Dr. A. Saddique 202
Quality Improvement
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3/27/2008Dr. A. Saddique 203
Quality Improvement (cont.)
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3/27/2008Dr. A. Saddique 205
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206
:
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)(
3/27/2008Dr. A. Saddique 207
ua ty n ea t care: erspect ve
The right care
At the right time
Delivered safely
Delivered efficiently
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e ve ed e c e t y
Constantly improved
3/27/2008Dr. A. Saddique 208
Performance Im rovement is theprocess by which we assure the
delivery of Efficacious and
ppropr a e care or n v ua pa enin a Timely manner, Effective and
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y ,,
Safe and Efficient with Respect andCaring for the patient.
3/27/2008Dr. A. Saddique 209
1. Vision and values driven
.3. Physician involvement
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. us omer- ocuse
5. Infrastructure for continuous improvement
. ommun cat on
3/27/2008Dr. A. A. Saddique 210
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3/27/2008Dr. A. Saddique 211
Not h in g Happens Un less you hav e ad ream
Integration of Quality
Vision.
The vision of the organization
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g
eg ns w s ea ers p.
3/27/2008Dr. A. A. Saddique 212
1. Vision and values driven
2. Leadership
3 Ph i i i l t
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3. Ph sician involvement
4. Customer-focused
6. Communication
3/27/2008Dr. A. A. Saddique 213
Vision to unify all the quality improvement
ro ect .
Chief motivators during the massivechange in philosophy as a result of
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change in philosophy as a result ofapplying TQM.
They have the power to change the systemsbefore crisis is reached.
3/27/2008Dr. A. A. Saddique 214
They have the ability to allocate resourcesnecessary for solving the problems and
. Priority for quality improvement can be
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for it. Allocate ade uate trainin time for ever
level of the organization.
3/27/2008Dr. A. A. Saddique 215
1. Vision and values driven
. ea ers p3. Physician involvement
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4. Customer-focused
5. Infrastructure for continuous improvement
6. Communication
3/27/2008Dr. A. A. Saddique 216
Medical Staff involvement
Medical staff are:
The driving force of the healthcare facility.
The heads of the healthcare teams.
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The heads of the healthcare teams.
The operators of the organization.
Carry the responsibility of the well beingof the patients.
3/27/2008Dr. A. A. Saddique 217
1. Vision and values driven
2. Leadership
3 Ph sician involvement
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3. Ph sician involvement
4. Customer-focused
6. Communication
3/27/2008Dr. A. A. Saddique 218
Healthcare is a business:
In business the customer is always right
us omer sa s ac on s e ma n o ec ve othe healthcare facility
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facilities We are for the service of the atient
We are all customers for one another
3/27/2008Dr. A. A. Saddique 219
1. Vision and values driven
2. Leadership
3 Ph sician involvement
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3. Ph sician involvement
4. Customer-focused
6. Communication
3/27/2008Dr. A. A. Saddique 220
Infrastructure for Continuous
improvement
sta s ment o an n rastructure.
The organization must establish aninfrastructure within which the cycleof improvement can operate. The
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p p
JCAHO standards is the optimalinfrastructure that any health carefacility should adopt.
3/27/2008Dr. A. A. Saddique 221
Integration of Quality
JCAHO infrastructure com osed of: Quality council of steering committee ualit im rovement adviser or coach
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ualit im rovement adviser or coachand Quality improvement teams
3/27/2008Dr. A. A. Saddique 222
Inte ration of ualit Im rovementConcepts
u u .
Quality council or steering committee.
qua y mprovemen a v ser or coac an . quality improvement
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improvement process.
3/27/2008Dr. A. Saddique 223
Policy & Procedure
Indicators Benchmarks
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DataTIPTIPTIP
Stay in the solution, not the
problem. Green light thinking is
an energizing way to solve
problems and build
3/27/2008Dr. A. Saddique 224
team sp r t.
1. Vision and values driven
2. Leadership
3. Ph sician involvement
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4. Customer-focused
6. Communication
3/27/2008Dr. A. A. Saddique 225
Staff involvement's through:
Top management vision communication
Suggestion programs Teams
ro em so v ng ee ac mon or ng
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ro em so v ng ee ac mon or ng
Quality improvement programs
3/27/2008Dr. A. A. Saddique 226
P OPL WHO PLAN TH,
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,
BATTLE THE PLAN..
3/27/2008Dr. A. Saddique 227
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3/27/2008Dr. A. Saddique 228
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Ten-Step process approved by JCAHOcont. :
Initiate evaluation
Take actions to improve care and service
A th ff ti f th ti d
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Assess the effectiveness of the actions and
ensure that improvement is maintained
and groups
3/27/2008Dr. A. A. Saddique 230
Stage I:
heads and use the feedback form to assess
de artments views re ardin their services.
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Encouraging each department to have- -
Procedure manual.
3/27/2008Dr. A. Saddique 231
Assist departments that require
assistance with the develo ment of their
Policy and Procedure manual, by
id idi l P li d
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guidance, providing sample Policy and
3/27/2008Dr. A. Saddique 232
and set a priority listing of the problems
assessment tasks to evaluate the
.
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Incident reports evaluation to identify the
poss e pro ems.
Administration views and comments.
3/27/2008Dr. A. Saddique 233
patients and employees satisfaction.
In-patients survey (completed).
- .
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Employees survey. .
Trainers training program.
3/27/2008Dr. A. Saddique 234
Stage II: Assessing t e current po icies an
procedures with respect to theCAHO CI and other hos itals o eratin
standards. Revising the Policies and procedures as
.
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Reengineering some of the policies androcedures as needed.
This will continue along with the trainingof the trainers and moving to training of
.
3/27/2008Dr. A. Saddique 235
Continue monitorin of the
problems lists and working with theadministrations and the departments
to so ve ex st ng an new pro emsas they occur.
v -
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policy and procedures.
program for all new staff (Mandatory
for three da s .
3/27/2008Dr. A. Saddique 236
Stage III:
Completion of the P & P revision andupdate.
ev ew cos cen ers: Services that consume the majority of the
bud et.
Services that shows inappropriate use of
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Services that shows inappropriate use of
the resources..
Establishment of policies to arrest
excessive cost.
3/27/2008Dr. A. Saddique 237
Development of standardization in
routine clinical operations. Clinical Policies.
r t ca at ways. Carry out an Auditing System: .
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External Auditing. .
3/27/2008Dr. A. Saddique 238
for:
. Problem solving.
.
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Prepare for accreditation.
resources.
3/27/2008Dr. A. Saddique 239
Inte ration of ualit Im rovementConcepts
Quality Improvement (QI) Plan
uca ng anagers an s a Focusing QI activities
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TIPTIPTIPThere is no Quality
Improvement without
3/27/2008Dr. A. Saddique 240
Inte ration of ualit Im rovementConcepts
u u v y y
Information Summarization,
oor na on, ssem na on anPresentation
mp ementat on o rgan zat on-w e
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Monitoring and Evaluation Activities
3/27/2008Dr. A. Saddique 241
. Select the new Standards.
and evaluation activities.
Get your benchmarking.
Document your actions.
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y
Get your Physicians involved.
3/27/2008Dr. A. Saddique 242
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3/27/2008Dr. A. Saddique 243
Integration of Quality
Improvement Concepts
Developing a quality improvement plan
ommun ca on ro e n Training for CQI
Customer focus
Quality council role
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Quality council role
Quality coach/advisor ucat ng managers an sta
3/27/2008Dr. A. A. Saddique 244
Integration of Quality
Focusing on quality improvement
activities Concurrent support systems
Quality improvement projects
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Q y p p j
Financial considerations
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easur ng qua y requ res useof both standards and
performance measures.
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TIPTIPTIPListening to you customers
will till you a lot about
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the quality of your
services
v y z woperating standards even if it was not
.Your responsibility is to find and
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try to change it or modify it.
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Basic Ste s In PerformanceImprovement
Find your operating standards Understand your system
ent y pro ems Quantify the size of each problem
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People are not problems,
make our eo le roblem
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solvers
s : n a ays an e
Assess the Situation. Get the facts.
enera e poss e so u ons w greenlight, non-judgmental thinking.
.
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TIPTIPTIPLook at problems as
opportunities for Improvement
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e term per ormance mp es t ata responsible health care providing
y: Can be identified.
s e accoun a e or s o serve
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behavior.
the aspect of care being evaluated.
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Concentrate on the Process.
Identify areas of improvement.
Set priority listing for improvement tasks. Use a systematic approach to problem
so v ng.
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Involves people who does the work.
problem on hand.
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Health care performance measurement
on research (a "performancemeasure") to evaluate a: Managed care organization (MCO).
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Health plan or program. Hospital.
Health care practitioner.
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Looks at past performance
Measures outcome
TIPTIPTIP
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Look for your staff satisfaction
and use them to empower
your performance
im rovement rocess
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" " uthe approach being used is:
. Systematic.
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,purchasers make informed choices
Increase accountabilit in health care
Compare providers
Desi n health lans
And benefit packages
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Teamwork empowers
people.
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power to improve Hel or anizations demonstrate
performance Good data leads to action, and
e er ou come
I l d i li TIPTIPTIP
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Involves doctors in quality TIPTIPTIPMaster the basics. High
achievers are skilled at what
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.
What Does PerformanceMeasurement Require?
umust:
. Be based on scientific evidence.
.
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What Do Performance MeasurementResults Tell Us?
u udescribe an observed level of
,of parental satisfaction with referrals,
,of morbidity or mortality secondary to
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medical intervention
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What Types of Measures Can We Use?
apply to various aspects of health care,no standardized set of categories has yet
. Early Quality Categories Avedis Donabedian, M.D., a pioneer in the
science o measuring ea t care qua ity,established a set of quality categoriesin ol ing str ct re process and o tcomes
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involving structure, process, and outcomes.
Structure. The resources and organizationalarrangements are in place to deliver care.
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Examples
.
Percentage of physicians who are
oar cer e . Presence of quality improvement
programs.
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provider activities are carried out todeliver care.
Examples: Percentage of females of specified age
rece v ng mammograp y.
Percentage of patients with asthma forh i t di ti d d
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Percentage of patients with asthma forwhom appropriate medications are ordered.
Number of times adolescents are providedguidance on smoking avoidance.
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provider activities.
Number of patients successfully treated.
effective functioning.
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deaths.
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.
Use of the best currently available medicalknowledge.
measures. However, outcomes are difficult tointerpret because they can be significantly affectedby patient characteristics such as: Age. Age can affect health care outcomes.
Health status Healthier people are likely to havebetter health care outcomes
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Health status. Healthier people are likely to havebetter health care outcomes. Socioeconomic characteristics. Better diets and
healthier environments relate to better health careoutcomes.
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Difficulties with Rates
-for some areas of health care treatmentand services. It is thus ossible in
these areas, to say that a rate is "high"or "low" or that a quality problem doesor does not exist.
Example: Standards exist for the
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Example: Standards exist for theappropr ate types, num er, an t m ngof vaccinations for children. Thus, rates
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Quality Improvement
one of the tools needed for effectiveualit im rovement initiatives. You
can use performance measurement toestablish the initial or baseline level ofper ormance an to re-measure
performance after the quality
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performance after the quality .
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GET and MAINTAIN STAKEHOLDER AGREEMENT
e er ormance mprovemen rocesse er ormance mprovemen rocess
CONSIDER
INSTITUTIONAL
DEFINE
DESIRED
PERFORMANCE
CONTEXT
MISSION
FIND ROOTCAUSES
Why does the
SELECTINTERVENTIONS
What can be doneGAPGAP
IMPLEMENT
INTERVENTIONS
STRATEGIES
CULTUREDESCRIBE
gap exist?
performance gap?
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CULTURE
CLIENT and
COMMUNITY
PERSPECTIVES
PERFORMANCE
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Eff ic iency
Qua l i t y
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Pat ien t Safe t y
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following:
Means to evaluate performance
Means to decrease Cost
Means to improve performance
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3/27/2008Dr. A. Saddique 268
To establish quality program it requires a set
the basis for accreditation of the healthcareorganization.
ets wor ing stan ar s or a stairrespective of their background andex ertise
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ex ertise.
Allows staff contribution in decision making
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Quality provides tools to evaluate
as staff performance. Also it provide the ground for overall
ea t care organizationa assessment.
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Cost containment is essential especially in a
Quality management can provide means todecrease waste and maximize the utilization
.
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Measure determination
Ex ert anels for s ecific measures
Evidence in peer-reviewed journals
Adoption of other robust outcome reports
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p p
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A roach
urrent ocus o measurement
Clinical evidence-based measures
Vo ume Measures
Process Measures
Adoption of staffing standards
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Recommendations
possible
specifications and user guides Promote o en s stemsincludin risk
adjustment
Accept notion that reports can differ int t
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spec c ty or erent au ences
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Policy Agenda
ssess nee or man a ory repor ng o
healthcare information in specific quality areas
ssess s a e vs. e era vs. pr va e ro e n
assuring quality in healthcare
public reporting
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teps o er ormance
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. .
Guiding Cycle
RGANISE
LARIFY
NDERSTAND
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ELECT
Dr. A. Saddique279
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Obst acles a re t hose f r i gh t fu l t h in gs yousee w hen you fa i l t o f ocus on you r goal s.
rganize a team that knows the
process
nderstand causes of processi ti
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pvariation
Dr. A. Saddique281
ot
Anal ze
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Anal zeModify
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Surgery Process Chart:
Elec
Adm
OP workup
OP visit InvestigationAnaes
ConsultnDay Booking
AdmitFit
Prep &Premed
PostopPreopReassess
Unfit
IP
Workup
urgeryRecovery
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EndDischargeDisch Planning
OP Follow-Up
Dr. A. Saddique283
Quality Improvement TechniquesCauseCause--effect / Ishikawa Diagram / Fishbone:effect / Ishikawa Diagram / Fishbone:
EFFECT
M M M
M P
9
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2849
Policy & ProcedureSupplyDelay
Waiting time
Short
Schedule Slow
ComputerSickness
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p
StaffSickness
Dr. A. Saddique285
1600
1800
UCL
1000
1200
LCL
x-
400
600
Procedures
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0
Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec
Dr. A. Saddique 286
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QI is a Science: Statistical Approachvera mprovemen ra egy
Remove special causes Process change Process change
Outcome
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Stable rocess Stable rocess Stable rocess
Dr. A. Saddique288
Special causes present
Average is too high
Common causevariation is high
Average is too high
Common causevariation reduced
Average too high
Common causevariation low
Average reduced
Techniques
TOOLS
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Dr. A. Saddique289
. . . Evaluate processes, not individuals
workplace
Benchmark for continuous improvement
decisions
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Build strong customer-supplier relations
Dr. A. Saddique29005/04/97
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Dr. A. Saddique29105/04/97
. .
Guiding Cycle
LAN O
HECK
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Dr. A. Saddique292
PLAN THE STRATEGY FOR THE CHANGE
CHECK THE RESULTS OF THE CHANGE
EVALUATE THE PROCESS CHANGES
QUARTERLY)
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Dr. A. Saddique293
Find a Process to Improve
rgan ze a eam at nows t e rocess
Clarify current knowledge of the process
Understand the causes of process variation
Select the process improvement
PDCA Cycle
PLANACT
* Improvement* Data collection
* To hold gain
* Continue
Improvement
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* Improvement
* Data collection
* Data for Process
improvement
Dr. A. Saddique294
DO
CHECK
* Data analysis- us omer v ew- Worker view
PDSA Cycle: ImplementationPLAN Hypothesis: What do you expect to accomplish?
Action Plan: Who? Does What? When?
What are the data collection procedures?
How will the chan e be im lemented?
What are the results? What are the process indicators?
STUDY What happened? What are we learning?
as ere successWhat will we do with the results?
ACT
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What will we do with the results?What else needs to be done?
Dr. A. Saddique295
Are there more change ideas?What do we do to hold the gains ?
Priorities Opportunities for change Forming the team to evaluate the
rocess
Setting the team to work
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Dr. A. Saddique296
z
z
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z
Dr. A. Saddique297
Summary
Quality can be measured Methods of measurement should be publicly
available to allow for replication and
improvement Public reporting will differ across user types
and is different from internal quality
improvement Consensus is goodbut will it drive change?
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Policy makers are involvedwhether or not
t ey want to e.
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,
STARTS WITH ONE
STEP
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Overuse e . Antibiotics C-Section Underuse (eg. Mammography, Beta-
Misuse (eg. Medical errors)
i.e., appropriateness of care
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Standards Implementation
ua ty anagement
Computers & Information Technology
Evidence Based Guidelines Local Knowledge Based Pathways
Science of Improvement
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z
z
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* Not all change is improvement but all
im rovement is chan e
* Not all improvement is qualityimprovement
QI has a defined methodology
Defined statistical a roach Defined set of tools
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3/27/2008Dr. A. Saddique 306
Im rovement in Healthcare
Expert knowledge
Content knowledge
System Thinking
Statistical Variation
Scientific Method
Psychology of Change
Traditional Improvement Continuous Quality
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p Q y
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Paul Batalden MD
ystem t n ng
Knowledge of variation
Knowledge for improvement Ps cholo of chan e
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Deming
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Focus on systems (Systems theory) Develop ideas for change and test
em c en c me o Understand the variation of data
Understand reasons and motivation of
people to act on data Use a balanced set of measures (Value
compass)
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compass)
3/27/2008Dr. A. Saddique 310
Once we be in to measure im ortant
quality characteristics and outcomes, wenotice variation.
We question measurements that display
no variation.
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3/27/2008Dr. A. Saddique 311
Often, single data points alone areuninformative, but data displayed overtime can provide information formprovemen .
The primary purpose of understanding.
Interaction among process variables,
methods, procedures, people,i i f i
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e ui ment information measurement
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and environment.
SHAPE
READ
CENTER
SP
SEQUENCE
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1990 Paul E. Plsek & Associates - Used with permission
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v Organization change tools
Epidemiology methods
Outcomes assessment (Value Compass)
General financial accounting
Activit based cost accountin
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I science is a ma or business stratefor leading corporations such as GeneralElectric (Six Sigma), Toyota, Motorola,
Hewlett Packard and medical groupssuch as Mayo Clinic.
Baldrige Award for the Healthcare Sector.
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QI science in healthcare is worldwide
National forum has 2000+ attendeeseach year from around the world
The European forum has almost 1000attendees from around the world
There are peer reviewed journals devotedexclusively to improvement research and
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3/27/2008Dr. A. Saddique 317
y w w w How do we know what we do works?
How can we improve what we do?
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Model for Improvement
What are we trying to accomplish?
How will we know that a change
Is an improvement?
What changes can we make thatWill result in an improvement?
PlanAct
Check Do
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Small rapid cycles of change
Plan
Check Do
Act
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320
Focus on processes of careFunctional
Access Assess Dx Rx Follow-up
to improve outcome
Clinical Satisfaction
Costs
Patientwith need
Patientwith need
met
Feedback
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unc onaHealth Status
General and Disease-specific Physical function Mental function Pain/Symptom Relief
SatisfactionClinical
Mortality Complications
Patient
Staff
Referring Physician
Access, Retention & Loyalty
Costs
Mutual Respect & TrustGot what I want and need when I
wanted it and needed it
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3/27/2008Dr. A. Saddique 322
Indirect Social Market Share & Volume
UNDERSTAND PROCESS: What is the current
process or baseline state of affairs?
SatisfactionClinical
Access
SystemAssessment Dx Rx
FunctionalHealth Status
Physical function
Mental function
Process-Outcome Model of Care
Costs
Mortality
Complications
Cost
Market Share
Follow-up
Patient with I Tool
nee or:
Team Work: Who should work on this improvement?Multidisciplinary Team
Pareto Charts
Focus Groups
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3/27/2008Dr. A. Saddique 323
Baseline DataBenchmark Data
III. CHANGE IDEAS: What changes
at eas o we ave or c ang ng w at sdone (process) to get better results?enera e ange eas:
ClinicalAccess Assessment Dx Rx
FunctionalHealth Status
(What we are trying to improve).Process-Outcome Model of Care
Satisfaction
Costs
Outcomes
Follow-up
need for:
1.
PDCA ProjectsPre
Assessment Diagnosis Treatment Discharge&F/U
2.
3.
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3/27/2008Dr. A. Saddique 324
PLAN Hypothesis: What do you expect to accomplish? Action Plan: Who? Does What? When?
What are the data collection procedures?
What are the process indicators?
What happened?
What are we learning?
Was there success?
What will we do with the results?
What else needs to be done?
ACT
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Are there more change ideas? What do we do to hold the gains ?
Rudimentar Ri orous
Problem Solving now needs
an Implementation Plan
Publishable
Research
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All CABG (22 month period)
9
10
6
7
Rate%
2
3
4
Mortality
0
1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
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Surgeon
OConnor et al JAMA 266:803, 1991
Standardized ost-o mana ement
Implemented an extubation protocol
Decreased number of pre-op coag tests ange type o prop y act c ant ot c
Changed myocardial preservationtec n ques
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3/27/2008Dr. A. Saddique 329
Standardized ost-o care and transfers
Critical pathways in care units
Multidisciplinary work groups to
Redesigned existing operating rooms
e ocate ypass pump n
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3/27/2008Dr. A. Saddique 330
Dedicated o eratin room staff for
cardiac surgery program
One perfusionist rather than two
Enhanced internal review of all deaths
ssessment o surgeon resourceutilization
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3/27/2008Dr. A. Saddique 331
Expected and Observed Mortality for
All Patients Undergoing CABG
10
Expected Mortality Observed Mortality
Preintervention
=
Intervention
=
Postintervention
=
67
8
2
34
01
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Quarter
OConnor et al JAMA 275:841, 1996
Example of Performance
Improvement
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Intensified atient education
Outpatient treatment of rejection
Reduced # of lab tests m te t e use o arentera nutr t on
Switch from IV cyclosporine to PO
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80%
90%
50%
60%BeforeAfter
20%
30%Benchmark
0%
2 Year SurvialRate
Rejection Steroid ResistantRejection
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21
20
25
1415Before
5
10fter
0
Length of Stay
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(P
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(P 0.01)
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Ive got two jobs, doing my job seeing the
patient and helping to make my job in thesystem I work in betterimproving the system
as a w o e.
that is the real new challenge for doctors.
..Don Berwick, M.D.
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is Accountability
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Knowledge
Skill
Professionalism
Communication
Improvement & continual learning
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Model for im rovement I Framework
Focus on Process of Care
Involve everyone (Systems Thinking)
Collaborative practice (Teamwork)
Balanced set of measures (Value Compass)
Do cycles of change to gain knowledge(Scientific Method)
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Facilitation of Teams
None of us is as smart as all of us
.Six Sigma Master Black Belt
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346
Team w or k i s t h e ab i l i t t o w or k t o et h er
t o w a r d s a co m m o n v i si on I t i s a fu e l t h a t a l l o w s
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t o w a r d s a co m m o n v i si on . I t i s a f u e l t h a t a l l o w sco m m o n p eo p le t o at t a i n u n co m m o n r e su l t s .
A high performing task group whose
common performance objectives .
A team is
a group o peop e w o co ec ve y wor
towards the accomplishment of team goals.
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348
What is Team Buildin ?
effective team
A-team approach is important and beneficial to quality
improvement processes
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QUALI TY MANAGEMENT I N ACTI ON
Customer satisfaction
rment
Mission
,Vision, ValuesEducation Manage By Fact
processes
Teamwork
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omp ex an mu - ace e pro ems n ea care.Integration of divergent points of view.
Collaboration & cooperation to achieve rapid
progress/success .
Knowledge process..
Greater number of ideas.
Greater acceptance of solutions.
g er mp emen a on ra e ,overcom ng pro ems n
relationships, commitment and lack of clarity.
Mutual support
A positive Team experience can contribute to the sense ofempowerment and a satisfying Work climate
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A positive Team experience can contribute to the sense ofempowerment and a satisfying Work climate .
Essentials For a performanceImprovement Team :
Recognized and supported by leadership .
Limited in sco e to a workable roblem
, opportunity for improvement .
.
Include all the people involved in the process
.
Be driven by data .
Be clear in role and expectations
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Be clear in role and expectations .
Task Teams .
ro ec eams .
Functional Teams
Self Directed Team
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Teamwork requires leadership with vision
of a clear goal, a flow of strong
communication and the inspiration anddrive to get the job done.
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Individual concernThe Task
Team skills
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The Team
TEAM
= eam ac a or
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Forming Closing
Storming Performing
Norming
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Stages Of Team Development
Occurs when the team gets togetherForming
Stormin Occurs when the team hits its first
disagreement or conflict
Normingee ng o re e
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