nQCHP
- 2. QMD/ CPD Program HEALTHCARE QUALITY BASIC CONCEP TS Dr. Yasser Sami Amer MBBCh, MS Pediatrics, MS HC Informatics, CPHQ Supervisor, R&D, QMD, KSUMC CPGs Advisor , KSUHs, AUHs Member, NAHQ, USA Member, G-I-N Adaptation & Implementation Working
- 3. Learning objectives By the end of this session, participants should be able to know:- Basic concepts of Health Care Quality • Healthcare Organizations (CAS) • Definitions of Healthcare Quality (HCQ) • Dimensions of HCQ • Aspects of HCQ • Resources • Careers
- 4. An Indian tale Six Blind Men and the Elephant http://www.youtube.com/watch?v=qPlJWk8- b4E
- 5. All of them were correct, and all of them were wrong !
- 6. current debates about HC Reform is like a modern version of the elephant fable! • Various groups of stakeholders have banded together to come up with their "solution” to the problems of current healthcare models. • Too much is spent, outcomes are not good enough, and too many people are harmed. • As solutions are presented, not only are the stakeholders convinced of their merit, they are also certain that counterproposals are wrong.
- 7. A complex adaptive system is comprised of a heterogeneous and diverse network of interacting and independent agents/elements that learn and adapt over time. Complex system behaviors are often said to be emergent and subject to self- organization. In short, the macro-level behavior of the system is more than the sum of the micro-level.
- 8. C – A – S Inclusion of significant number of elements Capacity to change and to learn from experience Set of connected or interdependen t things
- 9. HEALTHCARE ORGANIZATIONS (HCO) are Complex adaptive systems
- 10. C – A – S
- 11. Nursing a good example of complex adaptive system
- 12. Quality “as dictionary defined” Nou n peculiar and essential character, superiority of kind, degree or grade of excellence Adjectiv e having a high degree of excellence. 12
- 13. PerfectionofOne'sWork. The Messenger (peace be upon him) said: "Allah loves that if one does a job he perfects it." ...... اإلـسحــان ىإل اإلـقتـــان نم ......
- 14. In practice … … … … = doing right things right the first time = the right care for every person every time = first NO harm Definitions of Quality io n Healthcare 14
- 15. HealthcareQuality The extent to which health individuals provided to populations improve desired services and patient health outcomes. The care should be based on the strongest clinical evidence and provided in a technically manner with and culturally competent good communication and shared decision making. IOM 2001
- 16. KAIZEN KAI = change, ZEN = good/ for the better KAIZEN = continual improvement
- 17. Standards are created when experts are able to understand what the right things are and now the right things are best achieved 17 Quality = Compliance with the Standards
- 18. Quality of care is ……… Accessible Effective Safe Accountable Fair 18
- 19. Why do we need Quality in Healthcare? •Increasing costs of healthcare in the presence of rising demands and limited resources. •Variation in quality of medical performance and outcomes in similar health organizations. 19
- 20. Inspection phase (1920-1940) Total Quality Management (TQM) phase (Continuous Quality Improvement-CQI) (1986 and currently) 20 Quality Control phase (1940-1960) Quality Assurance phase (1970-1985)
- 22. Measurable Qualit y Can be defined objectively as compliance with, or adherence to standards. •Clinically, these standards may take the form of CPGs or protocols, or they may establish acceptable expectations for patient and organizational outcomes. •Standards serve as guidelines for excellence. PROVIDERS ASPECT OF CARE 22
- 23. Appreciative Quality Is the appraisal of excellence beyond minimal standards and criteria. •Requires the judgments of skilled, experienced practitioners and sensitive, caring persons. •Peer review bodies rely on the judgments of like professionals in determining the quality or non-quality of specific patient-practitioner interactions. PEER REVIEW/ ACCREDITATION BODIES, EXPERTISE AND SKILLED PERSON ASPECT OF CARE 23
- 24. Perceptive Quality Is the degree of excellence which is perceived by the recipient or the observer of care rather than by the provider of care. Is generally based more on the degree of caring expressed by physicians, nurses, and other staff than on the physical environment and technical competence. RECEPIENT/ PATIENT ‘customer’ ASPECT OF CARE 24
- 25. ALL THE THREE ASPECTS OF QUALITY ARE ABSOLUTELY ESSENTIAL TO OUR CONSIDERATION OF THE OUTCOME AND ALL ASSOCIATED PROCESS AND STRUCTURE OF HEALTHCARE DELIVERY
- 26. Key Dimensions of Quality 26
- 27. 27 1. Safe 2. Timely 3. Effective 4. Efficient 5. Equitable 6. Patient-centered 7. Efficacy 8. Appropriateness 9.Availability 10.Continuity 11.Respect and Caring KEY DIMENSIONS OF QUALITYCARE PERFORMANCE
- 28. 28 Appropriatenes s Is the intervention/ setting relevant, correct given the need? Availability/ accessibility Is there sufficient access to care? Are there undue restrictions? Continuity Is care coherent and connected (considered less expensive)? Are there gaps or redundancies in care (considered more expensive)? “coordinated care” or “care coordination” in chronic diseased patients with mutli-morbidities Effectiveness Does data indicate desired and cost-effective treatment outcomes? Provide care based on scientific knowledge and EBP Efficacy Does the proposed treatment have the capacity to produce the desired outcome, as demonstrated in the literature? (is it evidence-based?) Efficiency Are tests and treatments provided in a manner that conserves resources? Respect & Caring to what extent the patient/designee/family was involved in the decisions and care provided, and treated with respect and dignity. Safety Does care protect patients, reduce risk, and reduce liability? Timeliness Is care/intervention prompt/provided at the most beneficial necessary Dimensions of Performance
- 29. EFFECTIVEN ESS • Definition: Whether a drug or other treatment works in real life. Effectiveness studies of drugs look at whether they work when they are used the way that most people take them. Effectiveness means that most people who have the disease would improve if they used the treatment. • Example: antidepressant drugs are considered to be effective for the treatment of depression. These drugs have been examined in many clinical trials and other types of research studies (EBP).
- 30. EFFICA CY • Definition: Whether a drug or other treatment works under the best possible conditions. In a research study about efficacy, the study participants are carefully selected, and the researchers can make sure the drug is taken properly and stored properly. The study participants may differ from other people in the general public who have the disease. A treatment that has efficacy under the best conditions may not work as well in a different group of people with the same diseas e. AHRQ Glossary of Terms
- 31. Efficacy (cont’d) Example: a recent clinical trial compared people treated with insulin to people treated with oral medicine for diabetes. Only people with no other medical problems were enrolled in the study, and most were under age 65. The people treated with insulin had better improvement in their blood glucose than the people treated with oral medicines. This study is considered an efficacy study, because only younger people without any other health problems were included. Many people who have diabetes are over age 65 and have other problems such as heart disease. It is not known whether the same results would be found in these people.
- 32. 32 Changing the Healthcare Delivery System As part of the agenda for change, the IOM’s Committee on Quality of Health Care in America established aims for the 21st century healthcare system. The committee proposed six improvement aims to address key dimensions of healthcare quality that were performing at far lower levels than they should be. They suggested that healthcare at a minimum should be: STEEEP !
- 33. Framework for Quality: Six Key Areas of IO M Report 33 Six key areas of quality of healthcare are needed to be monitored. Healthcare should be: (Acronym: STEEEP) – Safe – Timely – Effective – Efficient – Equitable – Patient-centered
- 35. A “customer”is one who receives goods or services . It is a concept utilized in TQM philosophy to identify the needs, expectations, and preferences of all who are affected by the healthcare services we provide. Customers are our "dependents"; they rely on us for a service or product. 35
- 36. The Concept of the Customer
- 38. Quality of Care 38 Standards for Licensu re Addresses the structur e
- 39. Quality of Care Standards for Certification (e.g.. ISO) o Focus an capability rather than results o Thus address structure and Process than on the outcome. 39
- 40. Quality of Care Standards for Accreditation Addresses Structure, Process and Outcome of care. 40
- 41. 41 Standard Is defined as an explicit predetermined expectation set by a competent authority, that describes an organization’s acceptable performance level. Standards Should be : Optimal Achievable When met would lead to highest possible quality in a system
- 42. Resources in HCQ
- 45. CP Gs
- 49. Janet Brown, BA, BSN, RN, CPHQ, FNAHQ was active in the healthcare quality field since 1978 as an administrative director, consultant, and nationally known educator http://jbqs.com/about-janet
- 50. Careers in HCQ (in USA) Healthcare Quality Professional (Academic degrees OR Professional certificates) • Thomas Jefferson University/ Jefferson School of Population Health: MS in Healthcare Quality & Safety • Northwestern University Feinberg School of Medicine/ Center for Education in Health Sciences: Graduate Programs in Healthcare Quality and Patient Safety (MS, PhD & certificate) • National Association for Healthcare Quality: Certified Professional in Healthcare Quality • ISQua: Fellowship Programme
- 51. C P HQ • Information management • Performance Improvement • Strategic leadership and people management • Patient safety • Accreditation and continuous readiness • Change management
- 53. Acknowledgm ent Dr. Magdy Gamal Youssef, MBBCh, MS OBGYN, DTQM, CPHQ Former Director, Healthcare Quality Directorate, Alexandria University Hospitals, Alexandria, Egypt
- 54. Dr. Yasser Sami Amer EBCPGs Advisor & Trainer yasser3amer@yahoo.