Quality Improvement

The degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
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Terms in this set (91)
The degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
Quality
Providing patients with appropriate services in a technically competent manner, with good communication, shared decision making, & cultural sensitivity
High-quality care
Systematic & continuous actions that lead to measurable improvement in healthcare services & the health status of targeted patient groups.
Quality improvement
Evaluation of medical & nursing processes for quality & effectiveness compared to accepted standards in order to correct problems before they harm patients & to prevent errors in treatment.
Quality management
What is the aim of quality management?
Provide cost-effective care by preventing overuse, misuse, & underuse of medical resources.
What are the six aims of quality improvement proposed by Crossing the Quality Chasm?
Safe
Effective
Patient-centered
Timely
Efficient
Equitable
Federal initiative programs that provide & collect data that identify areas for improvement & encourage facilities to meet quality goals.
The Joint Commission
National Database of Nursing Quality Indicators (NDNQI)
Patient Safety & Quality: An Evidence-Based Handbook for Nurses
Act that was passed by congress in 2010 & enacted to make healthcare affordable for all Americans
Affordable Care Act (ACA)
Three broad aims to improve the health of the population developed by USDHHS
National Quality Strategy
What are the 3 aims of the National Quality Strategy?
Better Care
Healthy People/Healthy Communities
Affordable care
Two levels that performance can be assessed onInterprofessional IntraprofessionalPerformance assessment that occurs within a group of individuals with similar positions in a healthcare system & includes peer reviews, audits, & outcomes managementIntraprofessional assessmentProfessional critique of colleague's work based on predetermined standardsPeer reviewPeer review allows nurses to assess other nurses in aSafe & nonpunitive environmentWhat are the benefits of a peer review?Nurses analyze complicated cases - determine standards by which they will be held accountable Issues discussed by those w/ firsthand knowledge Produces recommendations that the nursing staff will understand & acceptAudit performed after the patient's dischargeRetrospective auditAudit performed while patient is still undergoing careConcurrent auditExamination of records to verify accuracy & proper use.AuditAn audit usually examines financial or medical records, & can be forA single patient Group of similar patients Individual clinician Unit Whole familyIf the audit is focused on one discipline (ex: nursing) it is consideredIntraprofessionalIf the audit is focused on multiple disciplines (ex: Nursing & physicians) it is consideredInterprofesionalAudit that allows changes if needed to prevent adverse events or improve patient's careConcurrent auditAudit that compares care provided to one patient with care provided to patients with similar conditions, & recommendations are made to change procedures if neededRetrospective auditAudit that is used to evaluate the adequacy of the nursing care the patient is receiving & to determined whether desired outcomes are being met.Concurrent auditUses patient experiences to guide improvement in all areas of healthcare by providing a link between medical interventions & health outcomes & between health outcomes & cost of care.Outcomes managementAn outcomes management system implementsEvidence based practices Guides cases decision making Incorporates better, more efficient clinical management Provides info to improve servicesOutcomes management can be used both to discoverAreas for improvement Analyze areas of excellenceSystem that collects info from patients to measure their health status in the areas of physical, mental, & social well-being.Patient Reported Outcomes MeasurementA patient w/ diabetes & obesity who is recovering from bariatric surgery may require care from a surgeon, a physician, a nurse, & a dietitian. This is an example ofInterprofessional assessmentIn addition to peer reviews, audits, & outcomes management, interprofessional assessments includeUtilization reviewsAnalyzes the use of resources to identify areas of overuse, misuse, & underuse.Utilization reviewWhat is required by Medicaid for specific services & by the Joint Commission for facility accreditation?Utilization reviewWhat is used to identify areas in which resources are being overused, such as urinary catheterization for incontinent patients who are ambulatory or areas in which resources are lacking such as inadequate staffing?Utilization reviewMethod that is used to compare the performance of an individual or organization to industry standards.BenchmarkingWhat is based on established models of high-quality performance & may reflect the performance of industry leaders, scientific or clinical research, or recommendations of professional organizations such as the ANA?Standards of careQuality improvement model that states that standards usually relate to three dimensions of high-quality care; structure, process, & outcomesThe Donabedian Model of Quality ImprovementStandards that focus on the steps used to lead to a particular outcome. They are used to determine whether a set of steps exists & whether those steps are being followed.Process standardsStandards that focus on the performance of a process. such as the number of bedridden patients who develop a pressure injury.Outcome standardsBenchmarking uses ____________, statistics, that reflect the organization's performance in a specific area, to compare the quality of care within the organization to industry standards.indicatorsStatistics that reflect the organizations performanceIndicatorsIndicators must beMeasurable Objective Sensitive to changes in performanceAn unexpected ocurrence: death, serious or physical psychologic injury; or risk of injury that occurs while patient is admitted.Sentinel eventIf sentinel event occurs, organizations are expected to respond appropriatelyRoot cause analysis: Problem solving to identify root cause of faults Develop a plan to reduce future risk of reoccurrence Implementing improvements Monitoring effectiveness of improvementsOccurs when a nurse does something that should have not been done/doesn't do something that should have been done.Breach of care or breach of dutyNurses can reduce risk of committing breach of care byReporting problem to supervisor Remaining current in skills/education Basing all care on nursing model Documenting care & responseAnalysis required by The Joint Commission for sentinel events & is recommended for any adverse eventRoot cause analysisWhat is the goal of root cause analysis?Identify the reasons for failures/problems Develop action plan for improvementFocuses on systems & processes, not on individual performance, & analyzes both special causes (factors that cause variation beyond what is normal) & common causes (factors that occur b/c of normal variation in the system)Root cause analysisThe action plan should includeIdentification of who is implementing/overseeing improvements Timelines for implementing changes Strategies for measuring effectiveness of changesHarm experienced by patient as result of exposure to a medicationAdverse drug eventA comprehensive management philosophy that is used to improve quality productivity by using data & statistics to improve processes.Total quality management (TQM)What is the hallmark of total quality management)Involves teamwork throughout organization, including both suppliers & costumersProcess of collecting & analyzing data to determine whether standards are being met.Quality assuranceA system of quality improvement most often associated w/ TQM isPlan-Do-Study-Act (PDSA)Individuals on the TQM team define the goal, collect data, & outline a strategy to reach the goal in what phase of PDSA?PlanPhase of PDSA when the plan is implemented on a small scale to determine whether it will be effective.DoPhase of PDSA in which the outcomes of the "Do" phase are analyzed & compared to the expected outcomes.StudyPhase of PDSA where the team must decide whether the goal was met, plan further changes, & decide whether the original goal is attainable based on the results of the previous interventions. If the goal was met the team must decide whether the changes should be implemented throughout the organization.ActA structural organization process for involving personnel in planning & executing a continuous flow of improvements to provide quality health care that meets or exceed expectations.Continuous quality improvementContinuous quality improvement (CQI) is a costumer-driven process. In healthcare the costumer can be ______________ or ________________Internal or ExternalWhat type of costumers are employees of a healthcare system such as nurses, physicians, therapists, medical record staff, billing specialists, & other employees?Internal costumersWhat type of costumers are individuals who seek healthcare, their family members, significant others, insurance companies, suppliers, agencies, & law enforcement?External costumersWhat is the end goal of continuous quality improvement?Customer satisfactionWhat type of quality improvement is system focused, emphasizing on the system errors rather than individual errors requiring involvement by everyone with knowledge of the system.Continuous quality improvementQuality improvement program that is used to reduce variation within a process to produce a near-perfect product.Six SigmaSix sigma primarily uses the _______________ system to improve outcomes.DMAIC Define the problem Measure data related to current process, problem, & desired goal Analyze data to determine cause-and-effect relationships Improve developing & implementing solutions to problems Control implementing measure, monitoring to ensure goals metExperts in Six Sigma who can assist in data calculations & function as a resource for the teamMaster Black BeltsThe Six Sigma team is led by a ___________ w/ extensive knowledge of Six Sigma.Black BeltTeam members with some experience w/ Six Sigma.Green beltsMembers that are relatively new to the six sigma system.Yellow & White beltsCombines strategies of Six Sigma with the Lean system.Lean Six SigmaWhat is the objective of the Lean System?Eliminate waste (anything that does not bring value to the customer) & maximize value.When is Six Sigma most successful?When the entire organization (administrators & clinicians) are involved in planning & implementing changesAudit that analyzes things outside of Ct/staff relationshipStructural auditsAudit that analyzes how care is providedProcess auditAudit that analyzes the results of nursing careOutcome auditsQuality improvement program used to identify defects (anything that could lead to patient dissatisfaction)Six SigmaWhat does the D stand for in the Six Sigma DMAIC system used to improve outcomes?Define the problem, determine the goal, & form a team to address the problem.What does the M stand for in the Six Sigma DMAIC system used to improve outcomes?Measure: obtain data related to the current process, the problem, & the desired goalIn what phase of the DMAIC system is obtaining data related to the current process, the problem & the desired goal implemented?MeasureIn what phase of the DMAIC system is looking at the data to determine cause-&-effect relationships related to the problem implemented?AnalyzeIn what phase of the DMAIC system is developing solutions to problems & implementing those solutions done?ImproveIn what phase of the DMAIC system is implementing measures to sustain positive changes & continuously monitor the process to ensure goals are being met done?ControlEvaluates processes to prevent errors in overuse, misuse, & underuse of resources (staff & materials) via data & statistics.Quality managementLooks at processes & identifies performance deficiencies. Measures the performance against a standard set by the organization (benchmarking). These standards are based on accreditation & professional standards (The Joint Commission)Quality ImprovementAttempts to balance the blame-free environment w/ appropriate accountability by focusing on correcting problems that lead individuals to engage in unsafe behaviors.Just cultureEach member has the responsibility to take action to prevent errors & also to respond to errors, recognizing that errors are more often the result of system failures than individual error, & that when individual error does occur it is more likely to be accidental than willful or neglectful.Just cultureStandards relate to material resources, Human Resources, & general organizational structure.Structure StandardsStandards that focus on the steps used to lead to a particular outcome. They are used to determine whether a set of steps exists & whether those steps are being followed.Process standardsStandards focus on the performance of a process, such as the number of bedridden patients who develop a pressure injury.Outcomes standard______________ must be measurable, objective, & sensitive to changes in performance.Indicators