Quality Improvement Application

8/8/2019 Quality Improvement Application

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Quality Improvement In Hospitals

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1Introduction:Quality Improvement is a formal approach to the analysis of performance and

systematic efforts to improve it. There are numerous models used;

FADE PDSA

Six Sigma (DMAIC)

CQI (Continuous Quality Improvement).

TQM (Total Quality Management).

These models are all means to get at the same thing: Improvement. They are

forms of ongoing effort to make performance better.

In industry, quality efforts focus on topics like product failures or work-related

injuries.

In administration, one can think of increasing efficiency or reducing re-work.

In medical practice, the focus is on reducing medical errors and needless

morbidity and mortality.

In Healthcare, the definition of quality can be complex and controversial because of the

different views of people with a stake in good Healthcare. A few different stakeholders

and what does each of these stakeholders want?

Providers Payers

Employers Patients

The decisions around the conflicts between what these stakeholders want often

determine if a QI project will be a success.

Hospitals are very important for humans. Every day any one can visit it. Care and

awareness from every individual in the hospital is very important. And also the nurses

and doctors must be qualified .Failing hospitals cause Death of people. We must

improve quality of them to achieve the customer satisfaction and happiness andimprove human health care.


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1-Problems in hospitals:

(1.1) Long waiting time:-

One of the most serious problems that the waiting time of patients is very long. They

are waiting without any care. Because in the variation in patients arrival time and

lack of nurses, there are critical cases that can not stand any waiting time like heart

problems, breathing problems and bleeding. Which if they waited more time they

would come to death.

(1.2) Lack of doctors:-

As well as a shortage of nurses, the emergency service suffered from a lack of

senior doctors. That during night there were no senior doctors, middle grade coverat all the night, also many critical problems occur at night such as breathing

problems.

(1.3)Resuscitation:-

Resuscitation is a key part of any medical service provision, the lack of suction

equipment on trolleys for patients with breathing problems is a very critical problem.

Junior doctor and also inspectors were sleeping during the night as patients had

stopped breathing.

(1.4)Cleanness:- In public hospitals cleaning is not very sufficient, beds are not clean and there are

flies in the operation rooms and also polluted blood.

(1.5)Parking problems:-

Parking is not very large. And not designed very well, it must be designed for every

category of people. Such as handicapped people, and easy for leaving it.

Handicapped must park at the beginning of the park. To make matters worse the

pay machine does not accept debit or credit cards so if a person does not have

enough cash they have to worry about how they are going to get the car out of the

car park.


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2-Questionnaire

Patient:-

How long do you wait?

o Less than 10 min

o 10 min-30 min

o 30 min-45 min

o 45 min-1 hr

o More than 1 hr

When do you arrive?

o 1 hr-30 min early

o 10min-30min early

o On time

o 15 min-30 min late

o 30 min-45 min late

How many doctors are available?

o 1

o 2

o 3

o 4

o 5

o 6

How do you consider the overall cleanliness?

o Excellent

o Good

o Adequate

o Poor

o Very poor


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Do you have a car?

o Yeso No

Do you find a place in the parking?

o Yes easilyo Sometimeso No never

How do you consider the care received?

o Excellento Goodo

Adequate

o Pooro Very Poor

How do you consider the information received?

o Excellento Goodo Adequateo Pooro Very poor

Indicate your degree of satisfaction with:

Response time:

o Very satisfiedo Satisfiedo Neither satisfied or dissatisfiedo Dissatisfiedo Strongly dissatisfied


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Employees:-

Do you have a car ?

o Yes

o No

Do you find a place in the parking?

o Yes easily

o Sometimes

o No never

How many rooms are available?

o 3

o 4

o 5

o 6

o 7

o More than 7

How many workers are available?

o 2

o 3

o 4

o 5

o 6

o More than 6

How do you consider the quality of care offered by the department?

o Excellento Goodo Adequateo Pooro Very poor

What is your degree of personal satisfaction with the work done?

o Very satisfiedo Satisfiedo Neither satisfied or dissatisfiedo Dissatisfiedo Strongly dissatisfied


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Sample Medical History Questionnaire:

Name:-

Date of Birth: - Sex:-Address:-Emergency Contact: - Phone:-

Please circle YES or NO and provide additional details where requested onall three sides of this form.

1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?

NO YES (list)_____________________________________________ 2. Do you take any prescribed medication on a permanent or semi-permanent basis(steroids, anti-inflammatory, antibiotics, insulin, etc.)?

NO YES (list..And..Give..Reason)

_______________________________________________ 3. Have you ever had an epileptic seizure?

NO YES

_______________________________________________

4. Have you ever been told by a doctor that you have epilepsy?

NO YES (list..Any..Medication)

________________________________________________ 5. Have you ever been treated for diabetes?

NO YES (list..Any..Medication)

________________________________________________ 6.Have.you.ever.been.told.by.a.doctor.that.you.were.anemic?

NO YES When?

What.treatment?

_______________________________________________

7. Have you ever been told by a doctor that you have sickle cell anemia?

NO YES

_______________________________________________


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8. Do you have or have you ever had high blood pressure?

NO YES (list any medication)

________________________________________________ 9. Do you have, or have you ever had, the following diseases?

Heart disease (heart murmur, rheumatic fever, other)

NO YES (give name and date)

_________________________________________________

Lung disease (pneumonia, other)


_________________________________________________

Kidney disease (infections, other)


________________________________________________

Liver disease (mononucleosis, hepatitis, other)


_________________________________________________ 10. Have you ever been told by a doctor that you have asthma?

NO YES (list any medication)

________________________________________________ 11. Do you have or have you ever had a hernia or rupture?

NO YES (if so, has it been repaired?)

________________________________________________

12. Have you been knocked out or become unconscious in the past three years?

NO YES (if so, describe and give date)

_______________________________________________

13. Have you had a concussion or other head injury in the past three years?

NO YES (if so, describe and give date)

________________________________________________

14. Have you stayed overnight in a hospital due to a head injury?

NO YES (if so, list date)


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15. Have you ever had a neck injury involving bones, nerves, or disks that disabled you for a

week or longer?

NO YES Type of injury Dates

________________________________________________________________________

16. Do you wear glasses or contacts during competition?

NO YES

________________________________________________________________________

17. Do you wear any of the following dental appliances?

NO YES (Circle those that apply)

Permanent bridge Braces .Removable retainer Permanent retainerRemovable partial plate Full plate Permanent crown or jacket

________________________________________________________________________

18. Have you had a broken bone (fracture) in the past two years?

NO YES

What bone? Right or left? Dates

19. Have you had a shoulder injury in the past two years that disabled you for a week or

longer (dislocation, separation, etc.)?

NO YES

Type of injury? Right or left? Dates

20. Have you ever had shoulder surgery?

NO YES

What was done and why? Right or left? Dates

21. Have you ever injured your back?

NO YES Type of injury? Dates

________________________________________________________________________

22. Do you have back pain?

NO YES (Circle any that apply)

Seldom Occasionally Frequently With Heavy Lifting

________________________________________________________________________


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23. Have you injured your knee in the past two years?

NO YES

________________________________________________________________________

24. Have you been told by a doctor or athletic trainer that you injured the cartilage in your

knee?

NO YES Right or left? Dates

________________________________________________________________________

26. Have you ever had knee surgery?

NO YES What was done and why?

Right or left? Dates

________________________________________________________________________

27. Have you had a severe ankle sprain in the past two years?

NO YES

________________________________________________________________________

28. Do you have a pin, screw, or plate in your body?

NO YES Where in your body?

Dates

29. Do you have any other conditions that we should be aware of (i.e., ulcers, pregnancy,

food..Or..Insect..Allergies,.tendonitis,.etc.)?

NO YES (Specify and give details)

________________________________________________________________________

30. Please give the dates of your last tetanus and polio shots:

Tetanus Polio

The questions on this form have been answered completely and truthfully to the best of my

knowledge.

Signature of Athlete (or parent if athlete is a minor) Date


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Selected problem

The most serious problem is the waiting time according to the questionnaire.

1-Quality tools

1.1 Histograms


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1.2 Flow Chart


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1.3 Fish bone diagram:

Increased Patient Wait Time

Machine

Method

Man Power

Material

Lack of Doctors

Technicians take long time gathering history

Patients late or early arrival

Unreliable Software

Untrained Technicians

Poor Scheduling systemEquipment availability

Patients Bunching

No Queuing System

2-Main Quality Indicators:

Tests Performance No of Doctors No of technicians Training

Technicians Behavior Equipment state

3-Solutions:

The clinic instituted a policy of seeing patients at the appointed time. The clinic formalized its training for technicians to reduce the variation in

exam times. The scheduling system itself is being restructured to anticipate the time

patients require completing vision tests before meeting with their doctors. The clinic also created a queuing system that limited the number of

patients entering the doctors' waiting area.


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4-Implementation:

If patients came early, they were told the clinic had to see patients who were

scheduled before them. If patients came later than 20 minutes, their visit had to

be approved by their physician. Patients are gradually learning that they can't

game the system by arriving at a different time than their scheduled visit. This

makes it easier to predict what tests will be needed and at what time.

A staff member created color-coded cards for each doctor. The number

allotted to each was based upon the number of patients he or she could see in

one hour. The cards were placed at a desk, which patients were allowed to pass

only when a card for his or her doctor was available.

There are two appointment times: one for meeting with the technician to gather

the history and perform refraction and any additional tests and a second for the

time at which the patient will see the physician. Depending on the tests

required. The arrival time may be as little as five minutes and as much as 60

minutes before the exam. Because the clinic's software system does not allow

schedulers to put two different appointment times in for one patient, the

schedulers now have to call patients to notify them of their arrival time. But

practice leaders are hopeful that its next software program will automate the

process.

5-Key Measures:

The data collection process focused on three measures, as defined below

Technician time:The goal is 10 minutes for each exam (the previous range was five to 21

minutes). The consultants determined that if the clinic could train the

technicians to complete both the history and the refraction in eight minutes

each, they could save the equivalent of one and one-half staff positions per

year. Because the clinic is growing, it would not lay off staff but would use any

extra staff to meet the needs of new physicians.

Wait times:

"We met the benchmark for a complete

eye exam, which is one hour and 16

minutes," says prior. The average prior

to implementation was three minutes

more. The clinic expects to see greater

time savings when it fully implements

the new scheduling system.


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Bunching:

Doctors only see one or two patients waiting for their visit at any given time.

That doesn't mean more patients aren't waiting, as there can still be clusters of

patients after 11 am or 4 pm. In those cases, the clinic managers or patient

coordinator tries to assign patients to different doctors to smooth out the flow.

The goal is to pull patients through the system at the pace at which doctors can

see them, rather than push them through without regard for such timing.

6-Conclusion:

Performance improvement in health care is a cyclical process. Healthcare

professionals are expected to look continuously for opportunities to improve the

quality of process, services, and outcomes.

Many improvement methodologies are applied and followed the model ofcontinuous performance monitoring, ongoing identification of improvement

opportunities and team based improvement process.

Remember that:

Improving Healthcare quality is a responsibility.

Measurement and improvement are possible.

Identifying the root cause before making changes.

Be creative in developing solutions.


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7-References

The OECD Health Care Quality Indicators Project: history

by SMattke - 2006 - Cited by 19 - Related articles - All 4 versions Its Health

Care Quality Indicators (HCQI) Project is attempting to . Mattke S. Monitoring

and improving the technical quality of medical care: a new..

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Quality Improvement Application