Transcript of Quality health care
- 1. Quality Health Care Practice Dr PS Deb
- 2. What is Quality? Product Services Good Perfect Satisfactory
Punctual Robust Beautiful Error free
- 3. Quality Tea
- 4. Quality? Producer or Provider User or Customer The totality
of features and characteristics of a product or service that bear
on its ability to satisfy stated or implied needs (ISO)
- 5. the degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and
are consistent with current professional knowledge Quality of
care
- 6. Process
- Step of action intended to achieve a results
History Exam Lab Diagnosis Treatment
- 7. Process variation Error (Sigma) 3.4 6 230 5 6210 4 66800 3
308,000 2 690,000 1 DPMO S
- 8. 1. Error of execution - the failure of a planned action to
be completed as intended 2. Error of planning - the use of a wrong
plan to achieve an aim Medical error
- 9. Medical Error
- Harvard Medical Practice Study 84
-
- 3.7% of hospitalization resulted in some form of iatrogenic
event of these: 50% preventable, 13.6% fatal
-
- 1300.000 disability annually
-
- 16.6% admission adverse event
-
-
- permanent disability 13.7%
-
- 51% events were preventable
- Institute of Medicine Report 99
-
- 44,000 to 98,000 deaths annually due to medical errors
- 10. Nature of Adverse Events
-
- medication-related (19.4%)
-
- therapeutic mishap (7.5%)
- Operative and post-operative complications (12.1%),
- Medication errors (11.6%),
- Wrong-site surgeries (11%),
JCAHO 2002
- 11. Medical error extent of problem
- Less than one death per 100 000 encounters
- One death in less than 100 000 but more than 1000
encounters
- More than one death per 1000 encounters
- 12. Medication Errors Commonest Cause of Injury
-
- 6% from transcribing order
- 770,000 drug-related injuries yearly
-
- Many result in death or other serious outcome
- 2-7 adverse drug events/100 admissions
- 13. Why do people make mistakes?
- Cognitive models of performance
-
- Skill-based (unconscious, rapid, effortless)
-
- Rule-based (if X, then Y)
-
- Knowledge-based (novel problem solving)
-
- Skill-based leads to slips
-
- Rule and knowledge-based lead to mistakes
- 14. Why do Medication Errors Occur?
- Sound alikes, look alikes
-
-
-
-
- Lasix/Losec Accupril/Accutane Zocor/Zoloft Doxepin/Loxepine
Xanax/Zantac
- Failure to recognize Allergies
- Failure to recognize drug interactions
-
- Not searching for interaction
-
- Not knowing patient on a drug - or herbal
- Decimal point errors (or mg. Vs. mcg.)
- Verbal orders (though at least one study shows verbal orders
less likely to result in errors!)
- 15. Conditions that Create Errors
- Excess number of handoffs
- Variable information available
- 16. Examples of Design Flaws
- Naming, packaging, labeling
- Metric vs. English system
- Matching staffing with demand
- Accepting mediocre performance
- Sort and shoot approaches to error
- 17. Look & sound-alike medications
- 18. Evolution of Health Care Quality Regulatory Learning
Management Punish Academic Quality practice Hammurabi (2100 B.C.)
Standardization (1917) ACS HSP (JCAHO: 1951 1980s) Hippocrates (300
B.C.) Controlled Trials (1840s) Industrial Revolution (1800 AD)
Sigma, ISO, TQM
- 19. Quality control - Standard
- An acknowledged measure of comparison for quantitative or
qualitative value
- A basis for comparison; a reference point against which other
things can be evaluated; they set the measure for all subsequent
work
- 20. Quality Control TQM ISO Accreditation Six Sigma
- 21. Standardization - ISO
- International Standard Organization - European manufacturing
industry 1946
- Provide standards for the development, implementation and
management of a quality management system
- ISO 9000 - a management tool to promote "quality control" in a
manufacturing and service sector business to health care
providers
- 22. The ISO 9000 Core Standards
- ISO 9000:2000 - quality management principles and
fundamentals.
- ISO 9001:2000 - customer and regulatory requirements, such as
JCAHO, NCQA, URAC or state and federal requirements.
- ISO 9004:2000 - beyond ISO 9001 requirements to meet and exceed
customer expectations efficiently.
- ISO 19011 - planning and conducting quality audits.
- 23. ISO 9000
- Document what you do and do what you document
-
- control of non-conformances,
- 24. ISO 9001-2000
- Specific for health care industry
- It describe what must be done to make up a quality system, not
how to set it.
- a process based system rather than a compliance/standards
requirement based system
- It insure for continued quality improvement
- Problems and process variation are dealt with quickly
- 25. Clauses in the ISO 9001
- Quality Management System
- Management Responsibility
- Measurement, Analysis and improvement
- 26. The act of the granting recognition that maintains suitable
standards Accreditation
- 27. Organizational Structure ACS 1913 HSP - 1917 JCAHO - 1951
JCR - 1997 JCI - 1997
- 28. International Accreditation
- October 1997 JCAHO Board decision to provide international
accreditation
- Decision based on work in over 30 countries and consistent
requests form health care organizations to be evaluated against
JCAHO standards, viewed as the benchmark for hospitals
- 29. P ATIENT- C ENTERED S TANDARDS
- Access to Care and Continuity of Care (ACC)
- Patient and Family Rights (PFR)
- Assessment of Patient (AOP)
- Patient and Family Education (PFE)
- 30. H EALTH C ARE O RGANIZATION M ANAGEMENT S TANDARDS (HCO)
- Quality Management & Improvement (QMI)
- Governance, Leadership & Direction (GLD)
- Facility Management & Safety (FMS)
- Staff Qualifications & Management (SQE)
- Management of Information (MOI)
- Prevention and Control of Infection (PCI)
- 31. A CCESS TO C ARE/ C ONTINUITY OF C ARE (ACC)
- Correctly match the patients health care needs with the
services available from health care organization.
- Integrate and coordinate the services provided to the patient
in the organization.
- Plan for discharge and follow-up.
- Patient entry to organization
- Determination and prioritize patient need
- Connecting patient care inside organization
- Reconnecting patient with community resources
- 32. P ATIENT AND F AMILY R IGHTS (PFR)
- Improve patient outcomes by:
-
- Respecting patient rights
-
- Understanding and safeguarding the cultural, psychosocial and
spiritual values of each patient.
- Identify patient and family expectations
- Inform patients and family of rights
- Provide ethical business framework
- 33. A SSESSMENT OF P ATIENTS (AOP)
- Determine care needs based on assessment
- Assessment by qualified individual
- Assess physical, psychological, social needs of patients -
financial factors
- Provide timely laboratory and radiology services
- Reassess patients appropriately
- 34. C ARE OF P ATIENTS (COP)
- Care is planned, coordinated and provided in a setting that is
supportive and responsive to the unique needs of each patient.
- Plan and deliver uniform care to all patients - especially
frail and vulnerable
- Make care seamless through effective communication
- Provide safe anesthesia care
- Provide safe surgical care
- Support patient nutrition need
- 35. P ATIENT AND F AMILY E DUCATION (PFE)
- Improve patient health outcomes by promoting healthy behaviors
and involving the patient in care and care decisions.
- Support Patient and family participation in care process
- Provide effective education
- Use education resources efficiently
- 36. Q UALITY M ANAGEMENT AND I MPROVEMENT (QMI)
- Continuously improve patient health outcomes:
- Provide leadership for quality
- Monitor clinical and managerial processes and outcomes
- Plan, implement, and sustain improvements
- 37. G OVERNANCE, L EADERSHIP AND D IRECTION (GLD)
- Effective leadership supports excellent patient care.
- Identify governance structure and responsibility
- Provide collaborative leadership of the organization
- Provide responsible leadership at department and service
level
- 38. F ACILITY M ANAGEMENT & S AFETY (FMS)
- Provide a safe, functional and supportive facility for
patients, families, staff members and visitors to:
-
- Reduce and control hazards and risks
-
- Prevent accidents and injuries
- Understand facility risks and plan to reduce the risks
- Inspect, test, and maintain medical equipment
- Inspect, test, and maintain utility systems
- Educate staff to participate in risks reduction
- 39. S TAFF Q UALIFICATIONS & E DUCATION (SQE)
- An appropriate number of qualified people are available to
fulfill the health care organizations mission and meet the needs of
the patients it serves.
- Plan the number and types of staff
- Orient and educate everyone to their responsibilities
- Gather, verify, evaluate, and use medical/dental
credentials
- Gather, verify, evaluate, and use nursing credentials
- Gather, verify, evaluate, and use other professional
credentials
- 40. M ANAGEMENT OF I NFORMATION (MOI)
- To obtain, manage and use information to improve:
-
- Individual and overall organization performance
- Identify information needs
- Plan system to meet those needs
- Create and use an effective patient clinical record
- Combine and compare data and information
- 41. P REVENTION AND C ONTROL OF I NFECTIONS (PCI)
- To identify and reduce the risks of acquiring and transmitting
infections among patients, employees, doctors, contract workers,
volunteers, students and visitors.
- Understand infection risks in entire organization
- Plan and implement surveillance and prevention strategies
- Provide effective leadership and support
- 42. WHAT HOW ACCREDITATION ISO
- 43. Capability Maturity Model (CMM) 1- Initial Ad hoc, chaotic
2- Repeatable tack cost, schedule, function 3 Defined Documented,
standardized 4 Managed 5 - Optimized
- 44. Hippocratic oath
- I swear to practice Quality Medicine to fulfill, to the best of
my ability and judgment, this covenant:
- I will respect the hard-won scientific gains of those
physicians in whose steps I walk, and gladly share such knowledge
as is mine with those who are to follow. I will apply, for the
benefit of the sick, all measures which are required, avoiding
those twin traps of overtreatment and therapeutic nihilism. I will
remember that there is art to medicine as well as science, and that
warmth, sympathy, and understanding may outweigh the surgeon's
knife or the chemist's drug. I will not be ashamed to say "I know
not," nor will I fail to call in my colleagues when the skills of
another are needed for a patient's recovery. I will respect the
privacy of my patients, for their problems are not disclosed to me
that the world may know. Most especially must I tread with care in
matters of life and death. If it is given me to save a life, all
thanks. But it may also be within my power to take a life; this
awesome responsibility must be faced with great humbleness and
awareness of my own frailty. Above all, I must not play at God. I
will remember that I do not treat a fever chart, a cancerous
growth, but a sick human being, whose illness may affect the
person's family and economic stability. My responsibility includes
these related problems, if I am to care adequately for the sick. I
will prevent disease whenever I can, for prevention is preferable
to cure. I will remember that I remain a member of society, with
special obligations to all my fellow human beings, those sound of
mind and body as well as the infirm. If I do not violate this oath,
may I enjoy life and art, respected while I live and remembered
with affection thereafter. May I always act so as to preserve the
finest traditions of my calling and may I long experience the joy
of healing those who seek my help.
- 45. Ayubouwan