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5ImprovingPatientSafety133

UnderstandingMedicalErrorsandAdverseEvents134

ReportingPatientSafetyIssues • SystemsErrors • Institutionalizing ErrorPrevention • TheNecessityofCultureChange

High-ReliabilityOrganizations139

GuidingPrinciples • BecomingaHigh-ReliabilityOrganization

TheRoleofQualityManagementinPromotingaSafetyCulture142

UsingQualityDatatoPromoteSafety • CaseExample:MonitoringFalls

• MonitoringwithMeasures • CaseExample:APACHE

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

MeasurementsAretheNutsandBoltsofQuality319

KnowWhattheDataMean • MaketheDataUseful • MeasuresReﬂectValues

GettingEveryoneonBoard322

CaseExample:ImprovingTransplantServices • ChangingBehavior

• CaseExample:UnderstandingComplexProcesses

ChallengesfortheFuture324

NewStrategies • BreakDowntheSilos

Summary326

KeyTerms327

QualityConceptsinAction327

SuggestionsforFurtherReading327

UsefulWebsites328

Index329

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

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

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

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

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Introduction to health care quality: theory, methods, and tools 1st edition - The ebook with rich co

CONTENTS

5ImprovingPatientSafety133

PREFACE

ACKNOWLEDGMENTS

INTRODUCTION