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MSU Texas Quality Improvement in Medical Imaging Unit 1 notes
Terms in this set (32)
described as defensive and reactive.
This means that quality assurance of the past concentrated on satisfying (defensive) agency requirements and regulations and many times made changes after citations were received (reactive).
Traditional quality assurance
focuses on processes: making changes (proactive) in order to rise to exceed expectations rather than merely meeting what is required or minimal (deliberate). Possible citable problems are fixed before committed reviews.
deals with the "whole picture" rather than on individuals.
the focus is to exceed the standard, and to prevent future problems.
Continuous quality improvement
measure performance against standards.
Performance standards are met by eliminating those who are displaying poor performance.
the focus is on single events and individuals.
traditional quality assurance approach
Comparison of QA and CI
wide variance in approach leads to wide variance in outcome.
Small differences add up and will eventually degrade quality rather than improve it.
Some type of management of methods and approached is necessary to prevent this variance.
Getting there (the outcome)
devised a scientific management system which used experts to develop mandatory standards for workers. This system was built around the idea that workers really didn't have the desire or ability to make systems better so they had to constantly be controlled and directed. It did significantly improve productivity, but without input from workers.
You have a great piece of equipment that is capable of producing very accurate and important test results, but the technologists don't use the equipment correctly; or your organization has designed a very accessible chart retrieval system, but the people using it don't return borrowed charts
Doing the right things wrong:
You have an inefficient system for scheduling patients for pre-admission tests and the people using this system make many mistakes when they enter people's names and appointment times.
Doing the wrong things wrong:
Using that same inefficient scheduling system, employees do a perfect job of entering people's names, appointment times, and all other information.
Doing the wrong things right:
You have excellent equipment and you use it correctly 100 percent of the time.
Doing the right things right:
appropriateness and effectiveness of clinical procedures is key to optimal clinical outcomes. If the right things are done right, then the appropriate things have been done effectively.
Is the action relevant and necessary and, if so, how can we be sure it will be done right? In other words, how do we insure appropriateness and effectiveness?
Optimal Clinical Outcomes
If you were doing the right things right, all care would be appropriate. The patient would meet diagnostic criteria to indicate removal of the gallbladder. If antibiotics were prescribed, the right drug at the right time and in the right dose would be prescribed and administered. There would be no avoidable complications of either the surgery or the process of care. The surgery would be performed expeditiously and skillfully without the development of infection.
Appropriate things done effectively (right things done right).
Assume that the patient does not meet clinical criteria for having a cholecystectomy, but the surgeon recommends it and the patient undergoes the procedure. The surgery is inappropriate. All goes well during the surgery, and the patient is discharged in a timely fashion without complications or errors. Being in a position to evaluate outcomes better than appropriateness, the patient believes that the right things were done right. It is up to health care providers to apply their professional standards to ensure that the right things are being done for patients and being done right.
Another example of wrong things done right involves the administration of antibiotics for prophylaxis. If the patient doesn't need antibiotic prophylaxis or doesn't need a third generation cephalosporin for antibiotic prophylaxis and it is administered at the right time and in the right dose, you have another example of doing the wrong things right, or the inappropriate things effectively.
Inappropriate things done effectively (wrong things done right).
Doing inappropriate things ineffectively falls into the ultimate disaster zone. The most obvious example of this situation is that of a patient who dies as the result of undergoing an unnecessary surgical procedure.
The preceding model points out that even if patients perceive health care services to be of high quality, professionals must use their expertise to judge the appropriateness and effectiveness of decisions made on behalf of those patients and the process of care provided. Optimal clinical outcomes will then result.
Inappropriate things done ineffectively (wrong things done wrong).
Many different groups of customers judge the quality of health care services-patients, their families and friends, physicians, internal customers, payers, and the community. Each of these customer groups has expectations of the organization's service.
patients want the best state of health they can achieve; convenient, timely service; courteous, compassionate treatment from the staff; and accurate information about their condition. Their families and friends also typically want sufficient information, access to the patient, and responsiveness and compassion from hospital staff members. Physicians want your organization to be user-friendly (easy to practice in) and supportive of their efforts to serve their patients. Payers want information in a timely fashion and optimal health outcomes for patients at the lowest possible cost.
are those who are affected by services of the organization but who are from outside the facility. Examples of external customers are outpatients, physicians, patient family and friends, visitors, and other agencies who refer patients or services, or who supply goods.
are those who are from the providing facility. Examples of internal customers are facility staff, inpatients, each internal department, and administration.
A satisfied customer, whether external or internal, results when quality is high and their needs have been met. There are three levels of customer satisfaction:
The minimum assumed level of satisfaction has been achieved. The physician orders an examination and the patient assumes that it is correct.
The physician orders an examination and the technologist calls to inform the physician that the patient is pregnant.
The physician orders an examination which is performed in a timely manner, and the patient reports extreme satisfaction with care, because he/she received prompt, courteous attention.
Remember that the term "customer" applies to everyone with whom the organization has contact - patients, staff, administration, family members, visitors, vendors, etc. The "customer" always wants to be treated fairly and with respect, just as you do. Everyone involved with the organization must meet the needs of everyone else if peak satisfaction is to be reached. When working on a problem, do not discount anyone, even if that person is the one working on the problem. For example, say the issue is that wait times for patients are too long. Just because it is the technologist complaining doesn't mean he/she is not considered a customer. Everyone involved in the process is a customer.
When trying to recruit and retain employees, care must be taken to make the organization the type of place an employee can be proud of and be a reflection of that pride.
Keeping the right employees for the right reasons is critical to a stable and efficient workforce. If managers do not develop the employees and work diligently to keep them, then we have an onslaught of unfilled vacancies, short-term employees and high sign-on bonuses. While increases in pay may not always be the option readily available, many things can be done to keep good employees.
even though the premise of continuous quality improvement focuses on process rather than a person, a bad employee sometimes cannot be saved. There may be times when the removal of an employee, or a change in their job position will be the only solution to a problem. CQI does not mean that everyone is suited to the organization or should be worked around. In fact, retaining a particularly troublesome employee can erode the process and the attitudes of people around them that an improvement program is nearly impossible.
CQI can help provide documentation of problems with an employee and ensure a fair review of that employee's performance.
Staff Retention Cont...
Providing the best service at the lowest cost insures success. It is important to lessen the causes of inefficiency in order to reduce cost. Customers are happier throughout the organization especially those most directly involved. Cost should never be the only or most important factor to consider when implementing a quality improvement program, but it cannot be ignored. Certainly, when resources are being wasted, whether those resources be goods or people, the cost is significantly increased. By improving efficiency, costs will decrease and valuable resources can be allocated where they will do the most good.
Realizing that constant change must occur in order to constantly improve. One of the mistakes that are typically made when making changes is the failure to expect the discovery of new problems. Change can be the proverbial "can of worms" but that does not mean that improvement is impossible - it just may be slower in moving forward than is hoped.
Rapid changes in healthcare leads to rapid changes in patient needs, and wide variability in needs. With those changes, processes must be revised, added, and eliminated to best serve customers.
Identifying problems with work processes versus employee shortcomings demonstrates that by improving process capability, and eliminating process variability, consistency and predictability increase and the mean level of outputs also increases.
Without the support of the technical director, radiologists, and supervisors, quality improvement would not be attainable. Identifying customer expectation, and planning for the implementation of a quality management program are critical for forward progress of the program. In addition, proper follow-up, documentation, and testing are necessary to identify trends and track solutions.
the most important components are the ones that deal with people--getting the staff involved, providing feedback, incentives and recognition will help bind the organization into a group effort working towards the same goal.
It should be recognized that, even though a continuous quality improvement program will save money in the long run, initially some financial commitment will be necessary. The cost may be highest in man-hours - it takes a great deal of people to make this system work, and with the discovery of problem causes, the solutions may also require financial support.
Strategies: 11 strategy components
FOUR FACETS OF A COMPREHENSIVE STRATEGY FOR CONTINUOUS QUALITY IMPROVEMENT
FOUR FACETS OF A COMPREHENSIVE STRATEGY FOR CONTINUOUS QUALITY IMPROVEMENT
· The physician orders the examination, expecting that it will be done correctly and in a timely manner;
· The technologist expects the examination ordered is appropriate and that the patient will be informed and ready for it;
· The patient expects the examination to be quick and painless;
· The nursing staff expects that no equipment will be disturbed and that little participation or intervention will be necessary;
· The radiologist expects the films to be of high diagnostic quality and that as much information is available as possible;
· The physician expects a report of the findings without avoidable problems.
As you can see, any breach in this loop would result in more time, more cost, and decreased customer satisfaction.
1. Customers- Remember how we defined customers previously? With this in mind, think about why the customer is the heart of the strategy.
The focus must be on highest quality. Improved performance improves customer satisfaction.
2. Performance improvement
You can have the finest staff on earth, but if the work processes are inefficient, staff talent is being wasted. Improving the process improves performance and again increases customer satisfaction.
3. Process improvement
If everyone involved with the organization is interested in and will work toward improvement, the other three facets will fall in line.
4. Supportive environment
It is understandable that any organization wants to make money. But it has been proven time after time that if no attention is paid to the wants and needs of the customer, soon there will be no customer. Recognizing that the customer is not limited to one segment of the population has resulted in the analysis of worker development and training. By doing that, valuable employees are retained, a sense of ownership is instilled, and by focusing on the process rather than the person, efficiency is increased and costs are decreased. No system is perfect, but the effort to improve how an organization functions is much more effective than assuming that people are the sole cause of problems. Take some time and try to determine where your organization fits into use of quality improvement as a system to help decrease costs, and eliminate waste and loss of valuable resources. Also keep in mind that the provider (sometimes, that means you as a provider of diagnostic imaging) is also a customer of the process that you conduct every day.
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