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CONTENTS
ListofFiguresandTablesxvii
Prefacexxi
Acknowledgmentsxxv
AbouttheAuthorxxvii
Introductionxxix
PARTI:QUALITYMANAGEMENTFUNDAMENTALS1
1FoundationsofHealthCareQuality3
DefiningQuality4
ContributionsofQualityTheorists—NothingNewundertheSun5
FlorenceNightingale • ErnestA.Codman • WilliamAndrewShewhart
• WilliamEdwardsDeming • AvedisDonabedian • JosephM.Juran
• PhilipCrosby
QualityManagementMethodologies14
TotalQualityManagement • ContinuousQualityImprovement
viii Contents
OrganizationsMakinganImpactonQualityandSafetyStandards16
InstituteofMedicine • TheJointCommission
CentersforMedicareandMedicaidServices21
HospitalCompare • PatientEducation • PayforPerformance • NeverEvents
InstituteforHealthcareImprovement24
AgencyforHealthResearchandQuality25
NationalQualityForum27
TheLeapfrogGroup27
Data:TheFoundationofQualityManagement28
CaseExample:Falls • QualityIndicator • BarrierstoUsingQuality
DatatoAssessCare • CaseExample:CardiacSurgeryMortality
Summary32
KeyTerms33
QualityConceptsinAction33 References33
SuggestionsforFurtherReading34
UsefulWebsites35
2UnderstandingtheImpactofHealthCareReform37
TheAffordableCareAct38
AccountableCareOrganizations • HealthInsuranceExchanges
NewModelsofPayment42
BundledPayment • PioneerandAdvancePaymentAccountableCare Organization • ComprehensivePrimaryCareImprovement • Value-Based Purchasing • PayforPerformance • CaseExample:CommunicatingwithClinicians throughP4PData
NewModelsofProvidingCare47
Patient-CenteredMedicalHomes • CommunityHealthCenters • Preventionand Wellness • LocalPreventionEfforts • CaseExample:InfluenzaVaccination
NewModelsforCollectingData53
Background • AdvantagesofElectronicHealthRecords • ChallengestoEffective UseofElectronicHealthRecords • InternationalClassificationofDiseasesCodes ImprovingInterpersonalCommunication56
NarrativeMedicine • ImprovingDocumentation • LookingAhead
Summary60
KeyTerms60
QualityConceptsinAction61
References61
SuggestionsforFurtherReading62
UsefulWebsites63
3MakingtheCaseforChange65
WhatIsInvolvedinChange?66
NewModelsofCare • CaseExample:AdvancedIllnessScreening • ImprovingQuality
ManagingandMeasuringQualityintheReformEnvironment69
MeasuringQualityPerformance • MeasuringCareintheCommunity
WhoIsInvolvedinChange?71
Leaders • Managers • Governance • CaseExample:DevelopingaQuality StructureforChange • AdministratorsandClinicians • Monitoring Quality • QualityManagers
ChangingCommunication77
BreakingDownSilos • EducatingPatients • CaseExample:Confronting Choices • HealthLiteracy • CommunicatingacrossInstitutionsand Organizations • OrganizingInformation • CommunicatingInformation
TheRoleofDatainPromotingChange86
TablesofMeasures • QualityMeasures • PerformanceImprovement
Summary89
KeyTerms90
QualityConceptsinAction90
References91
SuggestionforFurtherReading92
UsefulWebsites92
4NewChallengesforHealthCareProfessionals93
MeetingStatisticalExpectationsforStandardsofCare94
TheEvolutionofQuality • MeasuresofQuality • CaseExample: HeartFailureReadmission
Contents
MeetingPatientExpectations97
HCAHPS • CaseExample:ClevelandClinic
RoleofDashboards100
LeadershipReports
RoleofDataAnalysis104
CaseExample:AssessingHigh-RiskPregnancy • DataforPerformanceImprovement
UnderstandingDifferentKindsofData105
ChallengeswithHealthInformationTechnology • DifferentDataSourcesandClinical Research • DataandQuality
ManagingCareforChronicIllnessacrosstheContinuum109
TheMedicareChronicConditionsDashboard • QualityMeasures
• CaseExample:Readmission
ManagingAggregatedPatientCareIssues112
Population-BasedMeasures • CaseExample:Aspirin Administration • Microsystems/Macrosystems • MicrosystemsandLean
• CaseExample:TotalJointReplacement
ImprovingCommunication121
Teamwork • CaseExample:ImprovingCardiacMortality
Summary127
KeyTerms127
QualityConceptsinAction127
References128
SuggestionsforFurtherReading129
UsefulWebsites130
5ImprovingPatientSafety133
UnderstandingMedicalErrorsandAdverseEvents134
ReportingPatientSafetyIssues • SystemsErrors • Institutionalizing ErrorPrevention • TheNecessityofCultureChange
High-ReliabilityOrganizations139
GuidingPrinciples • BecomingaHigh-ReliabilityOrganization
TheRoleofQualityManagementinPromotingaSafetyCulture142
UsingQualityDatatoPromoteSafety • CaseExample:MonitoringFalls
• MonitoringwithMeasures • CaseExample:APACHE
PrioritizingImprovements147
UsingDatatoDefinePriorities • CaseExample:UnderstandingSuicide • DefiningPrioritiesLocally • CaseExample:ImplementingPrioritization
ExpandingDataSources:PartnershipstoDevelopBestPractice154
CaseExample:CollaborationstoPromotePatientSafety
LeadingOrganizationalImprovements155
SupportingQualityData • BusinessIntelligence
TheRoleofNursingLeadersinPromotingSafety158
CommunicationStrategies • IntegratingNewResponsibilities • Transformational Leadership • CaseExample:MonitoringPatientSafety
TheRoleoftheMedicalStaffinPromotingSafety162
ProvidingEducationtoNewPhysicians • CaseExample:ResidentEducationProgram PromotingSafetythroughEffectiveCommunication165
BreakingDownSilos • CaseExample:ReducingLengthofStayforStrokePatients
Summary169
KeyTerms169
QualityConceptsinAction169
References170
SuggestionsforFurtherReading170
UsefulWebsites171
PARTII:APPLYINGQUALITYTOOLSANDTECHNIQUES173
6WorkingwithQualityToolsandMethods175
IdentifyingaProblem176
Cause-and-EffectDiagram • Flowchart • Checklist • RunChart • Histogram
DescribingInformation183
Mean • Median • Mode
Variability185
Range • StandardDeviation • BellCurve
MakingUseofData188
Significance
Contents
UsingQualityToolsandTechniquestoImproveSafety189
RootCauseAnalysis • CaseExample:SepsisMortality • FailureMode andEffectsAnalysis • CaseExample:BloodTransfusion
ClinicalPathwaysorCareMaps195
CareMapCharacteristics • Variance • ImprovingEfficiency • CaseExample: CreatingGuidelines
ImprovingPerformance:Plan-Do-Study-Act201
Plan • Do • Study • Act • CaseExample:WorkplaceViolence
Summary206
KeyTerms206
QualityConceptsinAction206
SuggestionsforFurtherReading207
UsefulWebsites207
7WorkingwithQualityData209
WorkingwithMeasurements210
Compliance • CaseExample:UsingDatatoChangePractice • Performance Improvement • CaseExample:PressureInjuryPerformanceImprovementInitiative
UnderstandingIssuesinDataCollection214
CaseExample:StandardizingData • MovingfromManualtoElectronic Records • ExtractingAccurateDatafromElectronicHealthRecords
UsingDatatoUnderstandAppropriatenessofCare218
CaseExample:AnalyzingMortality • AnalyzingEnd-of-LifeCare • CaseExample: UnderstandingMortality
TheValueofAggregatedDatainPerformanceImprovement222
CaseExample:ImprovingTransplantMortality
TheRoleofDatainManagingChronicDisease225
UnderstandingReadmission • CaseExample:HeartFailureReadmissions
UsingDatatoMonitorVariability230
ControlChart • VarianceAnalysis
PubliclyReportedData234
HospitalCompare
InterpretingandMakingUseofData237
AdministrativeConcerns • DataAnalyticsintheFuture
QualityManagementintheFuture239
Summary240
KeyTerms241
QualityConceptsinAction241
References241
SuggestionsforFurtherReading242
UsefulWebsites242
8WorkingwithQualityandSafetyMeasures245
CommitmenttoQuality246
TheFutureofQuality
UsingMeasurestoUnderstandCare247
FortheConsumer • FortheAdministrator • ForthePhysician
DefiningtheMeasure250
DefinetheNumeratorandtheDenominator • MeasuringforImprovement
ProcessMeasures253
CaseExample:MedicationMeasures • ComplyingwithProcessMeasures • CaseExample:MammographyRate • UnderstandingVariables • Making ComplianceMeaningful • CaseExample:ReducingCentralLineInfections
PayforPerformance263
P4PMeasures
PatientSatisfactionMeasures264
InterpretingPatientSatisfactionScores • UnderstandtheProcess • RefinetheProcess • DefineExpectations
MonitoringMeasures268
DashboardsinthePast • DashboardsToday • PerformanceDetails
SafetyandEnvironmentofCareMeasures273
CaseExample:MonitoringSafety • LinkingEnvironmentalandClinicalVariables
Summary277
KeyTerms277
QualityConceptsinAction277
References278
SuggestionsforFurtherReading279
UsefulWebsites279
9TranslatingInformationintoAction281
MaximizingEfficiency282
Throughput • Bottlenecks • TheoryofConstraints • Queueing Theory • CaseExample:ManagingThroughput
DeterminingAppropriateLevelsofCare288
End-of-LifeCare/AdvancedIllness289
TheReformMandate
UnderstandingMortality291
FinancialImplications • MortalityData
ImprovingICUCare295
CaseExample:IntroducingAPACHE
AnalyzingReadmission298
CaseExample:Readmission
UsingDataforImprovements299
CaseExample:JointReplacementSurgery • CaseExample:BariatricSurgery
Patient-CenteredCare303
SF-36 • CaseExample:QualityofLife
DeliveringtheMessage305
DataandNursingStaff • DataandMedicalDirectors • MultidisciplinaryTeams • WorkingwithMeasures
Summary308
KeyTerms308
QualityConceptsinAction309 References309
SuggestionsforFurtherReading310 UsefulWebsites311
10PreparingfortheFuture313
TheNewQualityManagement314 TheNewRoleofAdministrators
TheBusinessofHealthCare315
ImprovetheProduct • MeasuresofSuccess • Transparency • CaseExample: ImprovingaHospitalinTrouble
MeasurementsAretheNutsandBoltsofQuality319
KnowWhattheDataMean • MaketheDataUseful • MeasuresReflectValues
GettingEveryoneonBoard322
CaseExample:ImprovingTransplantServices • ChangingBehavior
• CaseExample:UnderstandingComplexProcesses
ChallengesfortheFuture324
NewStrategies • BreakDowntheSilos
Summary326
KeyTerms327
QualityConceptsinAction327
SuggestionsforFurtherReading327
UsefulWebsites328
Index329
LISTOFFIGURESANDTABLES
Figures
1.1CausesofPatientMortalityPieChart6
1.2CausesofPatientMortalityHistogram6
1.3MedicationErrorRateParetoChart,January2011–June201112
1.4HospitalCompareWebpageforUnplannedReadmissions22
1.5HospitalCompareforWaitingTimes23
1.6QualityIndicator31
2.1Value-BasedPerformanceataCommunityHospital46
2.2Value-BasedPerformanceataTertiaryHospital46
3.1ScreeningTooltoIdentifyAdvancedIllness67
3.2DimensionsofCare83
3.3LinesofCommunication84
3.4JCPACCommunication85
4.1InpatientLikelihoodtoRecommend99
4.2QualityandSafetyVectorofMeasuresDashboard102
4.3HospitalComparisonDashboard103
4.4RawHeartFailureReadmissionRate112
4.5TacticsandTeamResponsibilities118
4.6PatientFriendlyCareMapforHipReplacementSurgery119
4.7PreoperativeContinuumofCare120
4.8PostoperativeContinuumofCare120
5.1FallswithInjury144
5.2AnalyticsandInterpretation145
5.3MonthlyEmergencyDepartmentData149
5.4RawSepsisandSevereSepsis/SepticShockMortalityRate, January2008–September2014150
5.5DischargeFollow-UpInformationHeartFailure152
5.6PrioritizationMatrix153
5.7SerumLactateOrdertoResultwithin90MinutesforSevere Sepsis/SepticShockintheEmergencyDepartment155
5.8IntegratingData/GeneratingReports158
5.9PatientOutcomeMonitoringTool162
5.10CommunicationacrosstheCareContinuum168
6.1FallsCause-and-EffectDiagram178
6.2Flowchart179
6.3Time-OutChecklist180
6.4NewbornDeliveriesRunChart182
6.5WaitingTimeforEmergencyDepartmentTriage182
6.6StandardDeviationFormula186
6.7BloodPressureBellCurve187
6.8ComparingRCAandFMEA193
6.9TransfusionFlowchart194
6.10HipReplacementCareMap196
6.11VarianceAnalysis:CAPChart198
6.12VarianceAnalysis:CAPOutcomeBarChart198
6.13QualityImprovementthroughCarePathways200
6.14ImprovedEfficiencyandThroughput201
6.15ClinicalGuidelinesCreationMethodology202
6.16PDSACycle203
7.1Hospital-AcquiredPressureInjuryIndex213
7.2MortalitySurveillanceToolSummaryReport219
7.3KidneyTransplantDataInput223
7.4WoundInfectionRate224
7.530-DayObservedReadmissionRateforHeartFailureAnalysis227
7.6HeartFailureReadmissionsbyAge227
7.7HeartFailureReadmissionAnalysis:HFDischargesbyDischarge Disposition228
7.8KnowYourHeartFailureZones229
7.9ControlChartof Clostridiumdifficile 233
7.10HospitalCompareBenchmarkReport:InpatientClinical Measures—InpatientSurgicalInfectionPrevention235
7.11TimelyHeartAttackCare236
8.1HospitalMedicationAdministrationProcess254
ListofFiguresandTables
8.2MedicationErrorMeasures255
8.3ExecutiveSummaryMedicationMeasures256
8.4MedicationSafetyAlert257
8.5MammographyRate260
8.6IndependentVariables261
8.7Non-ICUCentralLine–AssociatedBSIControlChart263
8.8PublicReportingScores269
8.9ExecutiveSummary270
8.10Risk-AdjustedMortalityIndex271
8.11Non-ICUCentralLine–AssociatedBSIIndex272
8.12Non-ICUCentralLine–AssociatedBSIIndexPivotView273
8.13SafetyServicesQuarterlyReport275
9.1Throughput284
9.2AmbulatorySurgeryLogTracking288
9.3AdvancedIllness291
9.4APACHEReports296
9.5BariatricPreoperativeChecklist302
9.6SF-36PhysicalandMentalHealthComponent AnalysisbyTimePoint304
10.1DataOverload320
Tables
3.1InpatientQualityIndicators87
3.2TableofMeasuresforAmbulatoryServices88
7.1KidneyTransplantTableofMeasures224
9.1BariatricTableofMeasures303
PREFACE
WhenIbegantothinkaboutrevisingtheoutdated QualityHandbook forHealthCareOrganizations:AManager’sGuidetoToolsandPrograms (Jossey-Bass,2004),mygoalwastointroduceandexplorethemanychanges thathavemadeanimpactonhealthcareinthelastdecade.IquicklyrealizedthatIcouldn’tsimplyrevisethebookforasecondedition;toomuchhad changed.Anentirelynewbookintroducingqualitymanagementwasneeded ifIwantedittobeofvaluetohealthcareprofessionalsandstudents.This IntroductiontoHealthCareQuality:Theory,Methods,andTools seemednecessary. Eventhechangeintitlesisrevealing.Qualityisnolongerthesolepurview ofmanagers.Tothecontrary,noweveryone—clinicians,administrators,executives,patients—involvedinhealthcareservicesneedstoworkwithinaqualityframeworkandbefamiliarwithqualitymanagementprocesses.Students whohopetoworkinhealthcare,whetherintheclinical,administrative,or policy-makingroles,needtoknowthefundamentalsofqualitymanagement tosucceed.Physicians,nurses,pharmacists,andpublichealthpolicymakersall needtoinvolvethemselvesinperformanceimprovementactivitiesandunderstandhowtotransformdataintousefulinformationinordertotakeaction. Administratorsandexecutiveshavetomeetthegoalsofspecificqualitymeasuressetbygovernmentagenciesinordertobereimbursedforthedeliveryof careandmedicalservices.
Mybooksaredesignedtobeofpracticalusetostudentsandprofessionals andarebasedonmyexperienceworkinginthefieldofqualitymanagement
Preface fordecadesandteachingfundamentalsofqualityallovertheworld.Ihavethe goodfortuneofbeingpartofavasthealthcaresystemthatencompassesthe entirespectrumofhealthcareservices—21hospitals,theFeinsteinInstitute forMedicalResearch,theKrasnoffQualityManagementInstitute,theCenterforLearningandInnovation,rehabilitationandskillednursingfacilities,a homecarenetwork,ahospicenetwork,andprogressivecarecenters—offering arangeofoutpatientservices;ambulatoryfacilities;psychiatriccare;long-term nursingcare;andchildren’sorganizations.ThusIhavedirectandimmediate accesstotheissuesthatmostconcernadministratorsandexecutives,floorand unitmanagers,clinicians,policymakers,ITprofessionals,andothers.Writing frompersonalexperiencegivesmetheopportunitytosharepracticalissues ofqualityinactionandrelaythedirectapplicationofqualitymanagement theory,methods,andtools.
IhavealwaysbeenachampionofqualityandIliketothinkanadvocate forpatients’rightsandpatientsafety.Ihaveworkeddiligentlytoferretout gapsincareandpotentialgapsinsafetytoimproveperformance,andfurther communicationandaccountabilityacrossthehospitalandthecontinuumof care.IfollowedthispathbecauseIbelieveinthetenetsofqualitymanagement; Ibelieveintheobjectivityofdatatomakeacaseforgoodorpoorcare.Ibelieve innumbers,inmeasurements,intrackingimprovementsandinterventions overtimeusingreliableandvaliddata.
ButitwasnotuntilImyselfbecameapatientthatmytheoreticalexpertisequicklybecameofimmediateandpracticalconcern.Asapatient,Ifound myselfvulnerabletoissuesofsafetyandcommunicationfailuresthatIhadwrittenaboutandspokenaboutbuthadneverdirectlyexperienced.AlthoughI hadalwaysunderstoodtheimportanceofpatientidentification,forexample, untilIwasreceivingchemotherapyandthenursesmadeabsolutelysurethatI wasgettingthecorrectdoseofthecorrectmedicationsinthecorrectmanner, andaskedmemultipletimestoconfirmmyname,Ididn’trealizehowreassuringitwastoknowthattheproceduresdevelopedtoensureproperpatient identificationwereinplaceandbeingfollowed.WhenIneededmyMRIresults tobetransmittedtomyoncologistinatimelyfashion,Ididn’twantanyfailuresofcommunicationtotakeplace.Ensuringqualitycarebecamedeeply personal.
AndalthoughIamprobablybettereducatedthanmostaboutdealingwith healthcaredata,IfoundthatwhenIwasconfrontedwiththreeverydifferent plansofcarefromthreeveryhighlyregardedphysicians,Ineededtounderstandmortalityratesandcomplicationsfromtreatment,numbers,variation, andevidenceinanewway.Howmanypatientswithmyparticularveryrare cancerhadeachdoctortreatedandwithwhatoutcome?Irealizedhowvaluablemyexperienceasaqualityprofessionalwas.Iknewwhatquestionsto ask.Qualitycareis,ofcourse,agoalfororganizationstostrivefor,butitis alsoforeveryone.Irealizedthateveryone—healthcareprofessionals,patients,
Preface xxiii andpotentialpatients—shouldbequalitymanagers.Thisbook,then,isfor everyone.
Newmodelsofhealthcareareso-calledpatient-centered,makingpatients centraltothecareplanandtreatmentprocess.Again,tome,thisisnolonger theory.Itisinfactcriticalthatpatientsunderstandwhatishappeningtothem, whytheyarehavingthetreatmenttheyarehaving,whatthepredictedoutcomeswillbe,andwhatcomplicationsmightoccur.Alltheseissues,basicto qualitymanagement,werenowbasictome.Allpatientsshouldindeedbe treatedholistically.Wearenotdefinedbyourdiseaseorourillness;weare peoplewithpsychosocialexperiencesandneeds,someofusmorecapable thanothersorsimplyluckierthanothersinbeingabletotakegoodcareof ourselves.
Everyoneshouldbeaqualitymanager.Everyonewillhaveoccasionto interactwithahealthcaredeliverysystemofonekindoranother,eitherfor themselvesorforfamilyandlovedones.Everyoneneedstobeschooledabout quality,howtoassesscare,whattolookfor,whatisexpected,whatshouldnot betolerated.Everyoneshouldbeanadvocateforqualitycare.Ihopethisbook willbeusefultoprofessionalsandnonprofessionalsalike.
ACKNOWLEDGMENTS
Iwanttothankthemanypeoplewhohavemadethisbookpossible.Thanks toDr.WilliamTap,andtheextraordinaryteamofhealthprofessionalsat MemorialSloanKettering,whereIreceivedgoodcare:theintelligenceand compassion,professionalismandexpertisethateverypatientdeservesandso fewreceive.Ican’tthankyouenough.AndthankstoDr.SamuelKenan,of NorthwellHealth,whosesurgeryskillsandoncologyknowledgesavedmylife. Thankstothemanypeople,presentandpast,whohaveworkedtomake theNorthShore–LIJHealthSystem,nowNorthwellHealth,excelinquality. AbrahamKrasnoff,JohnGallagher,andLawrenceScherrbelievedin qualitymanagementandinme.Thechairoftheboardoftrustees,Mark Claster,hasbeenachampionofqualityformanyyearsandhasbeeninstrumentalinshapingqualityconceptsfortheboardandforthehealthsystem. MichaelDowling,theCEOofNorthwellHealth,hastrustedmeandsupportedmeinestablishingtheKrasnoffQualityManagementInstituteandis committedtobuildingthebest-qualityhealthsystempossible.Hisexecutive teamofMarkSolazzo,DavidBattinelli,MD,GeneTangney,andothershave madequalityapriorityandhaverecognizeditsimportanceinestablishing andmaintainingoutstandingcare.
TotheentireKrasnoffteam,especiallyDebiBakerforhersupportwith graphicsandcarefulperusalofthemanuscript;MeganSmithforherconstant supportwitheverything;MarcellaDeGeronimo,KevinMasick,EricHamilton, RosemarieLinton,LarryLutsky,AnneMarieFried,andtherestofthegroup
xxvi Acknowledgments fortheirgenerouswillingnesstooffertheirexpertise;andeveryoneelsewho hassharedtheirprofessionalsmartswithmeinthewritingofthisbook,many manythanks.ThanksalsotomyfriendandcolleagueAliceGreenwoodfor hercommitmentandsupportandeditorialprowess,whosecontributionshave madearealdifferenceinthisbook.Hercapacitytotranslatecomplexideas intoaccessiblelanguageforabroadaudiencehashelpedtomakemybooks notonlysuccessfulbutapleasuretowrite.
ThankstothewonderfulfolksatJossey-Bass,includingthelateAndy Pasternack,whoencouragedthisnewvolume;toSethSchwartzandMelinda Noackfortheirintelligence,goodhumor,andsupport;tothepeopleatWiley, PatriciaRossi,MonicaRogers,JeevarekhaBabu,andthecopyeditor,Debra Manette,forshepherdingthebookintopublication;andtotherestofthe team:Youmadetheproductionofthisbookarealpleasure.
Andasalwaystomywonderfulfamily—mychildren,Adam,Stefanie, Hillel,Stacey,James,andStacy—andmyextraordinarygrandchildren—Kylie, Lila,Jack,Nico,andAmber—yourlovecarriedmethroughthischapterofmy life,andyourfaithinmehasbeeninspiring.
Tomywife,Doris,towhomIoweeverything!
ABOUTTHEAUTHOR
YosefD.Dlugacz,Ph.D.,istheSeniorVicePresidentandChiefofClinicalQuality,Education,andResearchoftheKrasnoffQualityManagement InstituteoftheNorthwellHealthsystem.Thegoaloftheinstituteistobridge thegapbetweentheoreticalknowledgelearnedintheacademicsettingand therealitiesofapplyingqualitymanagementmethodsintoday’shealthcare reformenvironment.Dr.Dlugacz’sresearchfocusesondevelopingmodelsthat linkquality,safety,goodclinicaloutcomes,andfinancialsuccessforincreased valueandimprovedefficiencies.
Dr.Dlugacz’smethodologieshavebeenpraisednationallyandinternationally,andhehasappearedinnumerousteleconferencespromotingqualityand safety.ManyofthebestpracticesthathaveresultedfromthequalitymanagementperformanceimprovementprocesshehasestablishedhavebeenpublishedbyTheJointCommissionasstandardsfortheentireindustry.
Hisacademicappointmentshaveincluded:AssociateProfessorofScience EducationattheNorthwellHofstraSchoolofMedicine;AdjunctProfessorof InformationTechnologyandQuantitativeMethodsattheHofstraUniversity FrankG.ZarbSchoolofBusiness;VisitingProfessortoBeijingUniversity’s MBAProgram;andProfessoratBaruchMt.Sinai,MBAprogram,CityUniversityofNewYork.
Dr.Dlugaczhaspublishedwidelyinhealthcareandqualitymanagement journalsonavarietyofclinicalcareandqualitytopics.TheHealthcare FinancialManagementAssociationpublishedhisarticle“High-QualityCare
AbouttheAuthor
ReapsFinancialRewards”initsStrategicFinancialPlanningpublication.His book TheQualityHandbookforHealthCareOrganizations:AManager’sGuide toToolsandPrograms (Jossey-Bass,2004)hasbeenpraisedasavaluabletext fornewqualityprofessionals.Hisbook MeasuringHealthCare:UsingQuality DataforOperational,Financial,andClinicalImprovement (Jossey-Bass,2006) helpstoeducateprofessionalsabouttherelationshipbetweenqualitycare andfinancialsuccess. Value-BasedHealthCare:LinkingFinanceandQuality (Jossey-Bass,2010),whichexplorestherelationshipbetweenqualitycareand organizationalefficiency,wasselectedfora2010Bugbee-FalkAwardfrom theAssociationofUniversityProfessionalsinHealthAdministrationand nominatedfortheACHE/HamiltonBookoftheYearAward.Dr.Dlugacz wasinvitedtowritetwochaptersfor ErrorReductioninHealthCare:ASystem’s ApproachtoImprovingPatientSafety,editedbyPatriceSpath(Jossey-Bass,2011).
Dr.DlugaczreceivedhisPhDinsociologyfromtheGraduateCenterof theCityUniversityofNewYork.
INTRODUCTION
Healthcareischanging—itsdelivery,itsstructures,evenitsunderlyingphilosophy.Wellness,ratherthansickness,isnowthefocusofgovernment concern.Thepatientexperienceofhealthandwell-being,ratherthanthe physician’sinterpretation,isnowcentral,andpatientexpectationsaremeasured,communicated,andmeaningfulforfinancialsuccess.Smallerhealth careorganizationsarebandingtogethertobecomelargerhealthcaresystems becausefinancialefficienciesdictatesuchcollaborations.Dataareabundantly availabletotrackvariousaspectsofcare.Allthesechangesencouragenewways ofthinkingabouthealthcareandtheorganizationsthatdeliverthatcare; thoseprofessionalswhohopetounderstandandthriveinthisnewenvironmentrequirequalitytools,techniques,information,andeducation.
IntroductiontoHealthCareQuality:Theory,Methods,andTools isdesignedto familiarizehealthcareprofessionalsandstudents,administrativeandclinical leaders,andpolicymakerswithcontemporaryissuesinqualitymanagement inthenewhealthcarereformenvironment.Inaddition,duetotherapidly changingtechnologyfortrackingmedicalinformation,suchastheelectronichealthrecord,qualitymanagersandhealthprofessionalswillneed tohaveincreasedfamiliaritywithdatabasedevelopment,dataanalyticsand statistics,theroleofmeasurementsinmonitoringquality,andperformance improvementmethodologiesifhealthorganizationsaretosucceedinthe increasinglycompetitivemarketplace.Becausegovernmentagenciesare linkingqualityvariablestofinancialsuccess,healthprofessionalstodayare
requiredtocommunicateinformationaccuratelyandtransparentlyandmeet newlyestablishedbenchmarksforthedeliveryofcare.Thisbookisdesigned tohelpprofessionalsmeettheseneeds.
Qualityprofessionals,indeedallhealthcareprofessionals,arerequiredto workwithinnewmodelsofhealthcaredelivery,suchasthepatient-centered medicalhome,accountablecareorganizations,value-basedpurchasing,bundledpayments,andpayforperformance.Communityprogramsthatencouragewellnessandpreventionarenowreimbursedwhereasundertheolder models,hospitalservicesandpatientvolumecontrolledfinancialoutcomes. Itisanewhealthcareworld,andthoseinvolvedinitrequirenewinformation andnewskills.
Thepurposeofthisbookistoprovidejustthat:togiveprofessionals andstudentsthetoolstheyneedtoworkeffectivelywithintheincreasingly data-drivenhealthcareenvironment.Qualitydataprovidethefoundation ofcaredecisions,performanceimprovementinitiatives,prioritizationof resources,documentationaboutmeetingexpectations,analyzingmarket competition,andunderstandingthepatientexperience.Physiciansand othercliniciansareexpectedtoworkwithinthequalityframework,collect data,reportoutcomes,collaborateinmultidisciplinaryteams,anddevelop communicationstrategiesasneverbefore.Inpatienthospital,ambulatory centers,andhealthcaresystemleadershiphavetobecomeinvolvedinquality dataandmeasurementsinordertoadministereffectivelyandmaximize reimbursements.Patients,whoarethehealthcareconsumers,aremoreable thaneverbeforetoaccesscomparativeinformationaboutdifferentcare facilitiesandprovidersandmakeinformedchoicesaboutwheretheyspend theirhealthcaredollars.
Thisbookaddressesthesequalityissuesfromthepointofviewofmypersonalexperienceasaqualityprofessionalforthepast30years.Itoffersexperiential,practical,andappliedexamplesofhands-onimplementationofhowthe fundamentalsofqualitymanagementcanimproveefficiencyandeffectiveness oforganizationalandclinicalprocesses,basedonmycareerastheSeniorVice PresidentofQualityManagementandastheExecutiveDirectoroftheKrasnoff QualityManagementInstitute,forNorthwellHealth(formerlytheNorth Shore-LIJHealthSystem),oneofthelargestintegratedhealthsystemsinthe UnitedStates.Mygoalistoshowqualitymanagementinaction,offeringtheoreticalinformationandpracticalexampleswithineachchapter.Theexercises attheendofeachchapter,“QualityConceptsinAction,”aredesignedtoreinforcethequalityconceptsdiscussedinthatchapterinappliedsituations.The references,suggestionsforfurtherreading,andusefulwebsitesattheendof eachchapterprovidestudentsofhealthcarequalitywithrichresourcematerial forfurtherexplorationofthequalityconceptsandideasinthechapter.
Thematerialinthechaptersnotonlyexposesinterestedprofessionals toqualitymanagementfundamentalsbutalsoattemptstoprovokecreative
