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AIDS TO CLINICAL IMPROVEMENT

By:

Dr. Gamal AbdulrahmanP.I. Physician

On 31 May, 2007@ 11:45 hrs

INTRODUCTION

WHO BELIEVES IMPROVING QUALITY REDUCES COST?

• Overuse (inappropriate procedures & medical treatments, where the risk to the patient outweighs any potential benefit.)

• Under use (Failure to deliver care that would benefit the patient.

• Misuse

GOAL

• The goal is the best possible medical outcomes at the lowest necessary cost

INTRODUCTIONQUALITY IMPROVEMENT IS THE SCIENCE

OF PROCESS MANAGEMENTStart With knowledge of:• Processes• Systems• Human Psychology• Variation• A system for ongoing learning

INTRODUCTION

HOW DO CLINICIANS REDUCE COSTS?

• Improving the Quality of Care by managing processes of care.

MANAGING A PROCESS MEANS:

• The right data• In the right format• At the right time & place• In the right hands (the

clinicians who operate the process)

PATIENTS’ QUALITY FACTORS

• Hospital cleanliness• Smoothness of admission & discharge• Accuracy & clarity of billing statements• Courtesy of Hospital employees• Response times for calls & requests• Level of technology available • Nurse Competency• Availability of physician specialists in the

field

PATIENTS’ QUALITY FACTORS

• “track record” for medical complications

• Availability of good emergency care• Price –reasonable• Respect patient’s rights for decision

DEFINITION

A CUSTOMER (Patient) is anyone who has expectations regarding a process’s operation or outputs.

Expectations arises from past experiences, current needs, unique internal preferences.

QUALITY HEALTH CARE SHOULD BE: Safe - avoiding injuries to patients from the care that is intended to help them.•Effective - providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding under use and overuse, respectively).

QUALITY HEALTH CARE SHOULD BE:

o Patient centered - providing care that

is respectful of and responsive individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

o Timely - reducing waits and

sometimes harmful delays for both those who receive and those who give care.

QUALITY HEALTH CARE SHOULD BE:

• Efficient - avoiding waste, including

waste of equipment, supplies, ideas, and energy.

• Equitable - providing care that does not

vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

CLASSES OF OUTCOMES

1. Physical Outcomes• Medical outcomes: complications & therapeutic

goals• Includes functional status measures (patient

perceptions of medical outcomes)

2. Service Outcomes• Satisfaction : patient & families, communities,

professionals, purchasers, & employees• Includes access issues (eg. waiting times)

1. Cost Outcomes• Another outcome of a clinical process• Includes the cost of the burden of disease.

MEDICAL OUTCOMES

Medical outcomes relate directly tohealth care costs. Are of 3 types:1. Therapeutic goals/biologic function2. The patient’s ability to function (functional

status, as reported by the patient)3. Complications (process failures/defects)

SERVICE OUTCOMES

Are of 2 types:

1. The physician-patient relationship.2. Access issues : convenience Vs hassle

(scheduling, travel times, registration, physical comfort, waiting times etc)

COST OUTCOMES

Quality & cost are two sides of a coin, anything you do to one,

affects the other.

VARIATION IN CLINICAL PRACTICE

Variation in hospitalization rates – the “decision to treat”.High rates of care judged inappropriate or equivocal.Variation in the process of care – the “manner of treatment”Variation in “expert” opinion – perceived treatment outcomes.

REASONS FOR PRACTICE VARIATION

• Complexity (how many factors can the human mind simultaneously balance to optimize an outcome).

• Lack of valid clinical knowledge. • Subjective judgment/uncertainty

(subjective evaluation is notoriously poor across groups or overtime).

• Human error (humans are inherently fallible information processors).

CLINICAL STANDARDS

• CLINICAL PRACTICE: Peer review, clinical audit & confidential enquiries are examples of this approach which may involve single or multiple professional groups & their interface with management.

• CLINICAL COMPETENCE: system to assess individual practitioners against clear criteria in order to recognize achievement & to promote continuing development.