BUS 285BUS 285Total Quality ManagementTotal Quality Management

Dr. ConnollyDr. Connollyconnollydr@son.sjsu.educonnollydr@son.sjsu.edu

924-3144924-3144June 9, 2004June 9, 2004

IRC 302IRC 302408-924-2874408-924-2874Office HoursOffice Hours

WebCT Faculty Chat Office Tuesdays 4:00 – WebCT Faculty Chat Office Tuesdays 4:00 – 5:00PM5:00PM

Wednesday 3:30PM IRCWednesday 3:30PM IRC

Expected OutcomesExpected Outcomes

Recognize course Recognize course requirementsrequirements

Select presentation Select presentation topictopic

Assign readingsAssign readings Orientation to Orientation to

webcasting and webcasting and use of webCT shelluse of webCT shell

Orientation to Orientation to quality in health quality in health carecare

Course RequirementsCourse Requirements

Meeting course objectivesMeeting course objectivesClass participation 30 pts; including Class participation 30 pts; including

reading assignmentsreading assignmentsPresentation of a quality management Presentation of a quality management

tool 30 ptstool 30 ptsEvaluation of a quality management Evaluation of a quality management

program 40 ptsprogram 40 ptsOptional final take home exam, 10 ptsOptional final take home exam, 10 pts

Learning EnvironmentLearning Environment

On campus, IRC 302On campus, IRC 302 Webcasting live or archivesWebcasting live or archives WebCTWebCT

Discussion Board (post all Discussion Board (post all responses to classes)responses to classes)

EmailEmail Chat Room Office hours & Chat Room Office hours &

Student ChatStudent Chat Assignment informationAssignment information ModulesModules Grading sheetsGrading sheets

Webcasting Environment Webcasting Environment

Watching live and questionsWatching live and questionsQuestions will be answered during the Questions will be answered during the

first 10 minutes of class again 5 first 10 minutes of class again 5 minutes before break time and again minutes before break time and again before end of classbefore end of class

Telephone in classroom 408-924-2874Telephone in classroom 408-924-2874Emergency only desk top 408-924-6653Emergency only desk top 408-924-6653

Archive: watch and respond to each Archive: watch and respond to each reading presented within 1 week; post reading presented within 1 week; post to Discussion Board on WebCT for that to Discussion Board on WebCT for that classclass

Learning EnvironmentLearning Environment

Videostreaming & Videostreaming & webcast: live or webcast: live or archivedarchived

Reading AssignmentsReading Assignments Prepare as outlined in Prepare as outlined in

syllabussyllabus Post on Discussion Board Post on Discussion Board

for class designatedfor class designated Briefly present in class on Briefly present in class on

campuscampus Students webcasting must Students webcasting must

respond, at least one respond, at least one sentence to each reading sentence to each reading presented; post on presented; post on Discussion Board within 1 Discussion Board within 1 week of classweek of class

Presentation Topics 30 PtsPresentation Topics 30 Pts BenchmarkingBenchmarking Run Chart DiagramRun Chart Diagram Evaluation GridEvaluation Grid Flow Chart Matrix Check ListFlow Chart Matrix Check List Force Field AnalysisForce Field Analysis Pareto ChartPareto Chart Root cause analysis/Sentinel EventsRoot cause analysis/Sentinel Events Scatter DiagramScatter Diagram Focus groupsFocus groups Quality Improvement Story BoardingQuality Improvement Story Boarding Report CardsReport Cards Consumer SatisfactionConsumer Satisfaction Fishbone chart/cause & effect Fishbone chart/cause & effect

diagramdiagram Control chartsControl charts

Presentation RequirementsPresentation Requirements20 - 30 minutes on campus20 - 30 minutes on campus

One week before, email Power Point file to One week before, email Power Point file to atn@sjsu.eduatn@sjsu.edu, label, BUS285, class date, your , label, BUS285, class date, your name; name; no animations, transitions or audiono animations, transitions or audio

Two readings, one research on tool presented Two readings, one research on tool presented posted one week before for students on posted one week before for students on Discussion Board for presentation dateDiscussion Board for presentation date

Post Power Pt file on Discussion Board WebCTPost Power Pt file on Discussion Board WebCT Collect Peer Evaluations on campus and your e-Collect Peer Evaluations on campus and your e-

mail within WebCTmail within WebCT Post teaching objectives Post teaching objectives Evaluate teaching; measure stated objectivesEvaluate teaching; measure stated objectives

Evaluation of Quality Evaluation of Quality Management Program 40 ptsManagement Program 40 pts

Due July 28, 2004Due July 28, 2004 See syllabus for detailsSee syllabus for details Prepare using Criteria providedPrepare using Criteria provided Must have Executive SummaryMust have Executive Summary Must be congruent with APA formatMust be congruent with APA format Maximum 10 pagesMaximum 10 pages Upload to Assignment area in WebCT or Upload to Assignment area in WebCT or

provide 2 copies turn in on campusprovide 2 copies turn in on campus Your recommendations are critical; based Your recommendations are critical; based

on your evaluation and literatureon your evaluation and literature

Optional Final ExaminationOptional Final ExaminationDue August 2, 2004Due August 2, 2004

10 extra points can 10 extra points can be gained if the be gained if the optional final take optional final take home essay home essay examination is examination is selectedselected

2 essay questions 2 essay questions will be prepared will be prepared from 6 choicesfrom 6 choices

Total Quality ManagementTotal Quality ManagementImproving quality is an ethical Improving quality is an ethical imperative (Wurzbach, 1997)imperative (Wurzbach, 1997)

What is it?What is it?TQM, coined 1985 Naval Air Systems TQM, coined 1985 Naval Air Systems

CommandCommandWhat are the driving forces?What are the driving forces?How do we know if we have it?How do we know if we have it?What is your responsibility as a What is your responsibility as a

manager and or administrator?manager and or administrator?

Are we doing the right thing Are we doing the right thing right? (Fitzpatrick,1994)right? (Fitzpatrick,1994)

Macro ForcesMacro Forces MedicareMedicare Consumer movementConsumer movement American industry, American industry,

Deming’s TQMDeming’s TQM Financial constraintsFinancial constraints JCAHJCAH Managed careManaged care Employee benefit Employee benefit

programsprograms Third-party payorsThird-party payors Demands for access & Demands for access &

qualityquality Integrated health care Integrated health care

systemssystems

Defining Health Care QualityDefining Health Care Quality

Effectiveness of the organizationEffectiveness of the organizationValue-laden attribute meeting Value-laden attribute meeting

expected standardsexpected standardsExcellence and qualityExcellence and qualityEthical concepts beneficence, Ethical concepts beneficence,

prudence & justiceprudence & justiceCannot be measured directlyCannot be measured directlyCulturally competent careCulturally competent care

ANA, Nursing’s Safety & Quality ANA, Nursing’s Safety & Quality Initiative 1994Initiative 1994

Educate RNs about quality Educate RNs about quality measurementmeasurement

Inform public & Inform public & purchasing/regulating consituencies purchasing/regulating consituencies about safe, quality health careabout safe, quality health care

Investigating research methods and Investigating research methods and data sources for empirical evaluation data sources for empirical evaluation of safety and qualityof safety and quality

IOM Rules for Redesign IOM Rules for Redesign (2001)(2001)

Care is based on continuous healing Care is based on continuous healing relationshipsrelationships

Care is customized according to patient Care is customized according to patient needs & valuesneeds & values

The patient is the source of controlThe patient is the source of control Knowledge is shared & information flows Knowledge is shared & information flows

freelyfreely Decision making is evidence-basedDecision making is evidence-based

IOM Redesign RulesIOM Redesign Rules

Safety is a system propertySafety is a system propertyTransparence is necessaryTransparence is necessaryNeeds are anticipatedNeeds are anticipatedWaste is continuously decreasedWaste is continuously decreasedCooperation among clinicians is a Cooperation among clinicians is a

prioritypriority

Managed Care EnvironmentManaged Care Environment

Focus on outcomesFocus on outcomesResearch based practiceResearch based practiceHigh quality careHigh quality careCost-effective interventionsCost-effective interventionsResponsible for widespread Responsible for widespread

application of information application of information technologytechnology

Report Card: Managed CareReport Card: Managed CareAccessAccessQuality/AppropriatenessQuality/AppropriatenessPromotion/PreventionPromotion/PreventionOutcomesOutcomes

General health improvedGeneral health improvedQuality of life improvedQuality of life improvedTreatment reduces Treatment reduces

psychological stresspsychological stressMore productive & independentMore productive & independent

IOM Crossing The Quality IOM Crossing The Quality Chasm: Changes Needed Chasm: Changes Needed

(2001)(2001)SafeSafeEffectiveEffectivePatient-centeredPatient-centeredTimelyTimelyEfficientEfficientequitableequitable

IOM Environment Changes IOM Environment Changes (2003)(2003)

Applying evidence to health care Applying evidence to health care deliverydelivery

Using information technologyUsing information technologyAligning payment policies with Aligning payment policies with

quality improvementquality improvementPreparing the workforcePreparing the workforce

AACN: Role New Clinical AACN: Role New Clinical Nurse Leader (2004)Nurse Leader (2004)

Leadership in care of sick across all Leadership in care of sick across all environmentsenvironments

Design and provision of health promotion Design and provision of health promotion and risk reduction services for diverse and risk reduction services for diverse populationspopulations

Provision of evidence-based practiceProvision of evidence-based practice Population-based health care to Population-based health care to

individuals, clinical populations & individuals, clinical populations & communitiescommunities

Clinical Nurse Leader Role Clinical Nurse Leader Role Cont.Cont.

Clinical decision-makingClinical decision-makingDesign and implementation of plans Design and implementation of plans

of careof careRisk anticipationRisk anticipationParticipation in identification and Participation in identification and

collection of care outcomescollection of care outcomesAccountability for evaluation and Accountability for evaluation and

improvement of point of care improvement of point of care outcomesoutcomes

Clinical Nurse Leader Role Clinical Nurse Leader Role Cont.Cont.

Mass customizationMass customizationClient and Community advocacyClient and Community advocacyEducation & information Education & information

managementmanagementDelegation & oversight of care Delegation & oversight of care

delivery & outcomesdelivery & outcomes

Clinical Nurse Leader Role Clinical Nurse Leader Role Cont.Cont.

Team management & collaboration Team management & collaboration with other health professional team with other health professional team membersmembers

Development & leveraging of human, Development & leveraging of human, environmental & material resourcesenvironmental & material resources

Management & use of client –care & Management & use of client –care & information technologyinformation technology

Theoretical Frameworks for Theoretical Frameworks for EvaluationEvaluation

Total Quality ManagementTotal Quality Management

Continuous ImprovementContinuous Improvement

Donabedian’s ModelDonabedian’s Model

Donabedian’s ModelDonabedian’s ModelStructureStructure

ProcessProcess

OutcomesOutcomes

Structural ComponentsStructural Components

Organizational structureOrganizational structureEducation of nurses & workforceEducation of nurses & workforceNursing standards of careNursing standards of careRatio of total nursing staff to patientsRatio of total nursing staff to patientsChanges in market placeChanges in market placePolitical influencesPolitical influencesTechnologyTechnologyManagement philosophiesManagement philosophies

Process ComponentsProcess Components

Interpersonal relationships between Interpersonal relationships between nurses and patients, among staff & nurses and patients, among staff & supervisorssupervisors

Nursing knowledge and Nursing knowledge and competenciescompetencies

Change of shift reportChange of shift reportPractice environmentPractice environment

Outcomes Sensitive to Outcomes Sensitive to NursingNursing

Functional healthFunctional health Physiologic healthPhysiologic health Psychological Psychological

healthhealth Health knowledge Health knowledge

and behaviorand behavior Perceived healthPerceived health Family healthFamily health

Patient Outcome ComponentsPatient Outcome Components

Mortality ratesMortality rates Length of stayLength of stay Adverse incidentsAdverse incidents Pain managementPain management Skin integritySkin integrity FallsFalls

ComplicationsComplications Patient and family Patient and family

satisfactionsatisfaction Ability to cope with Ability to cope with

illnessillness Growth & Growth &

development of development of patientpatient

Adherence to a Adherence to a discharge plandischarge plan

Nurse OutcomesNurse Outcomes

SatisfactionSatisfaction RetentionRetention AutonomyAutonomy SicknessSickness AbsenteeismAbsenteeism Work pressureWork pressure

InvolvementInvolvement Peer cohesionPeer cohesion Supervisor supportSupervisor support InnovationInnovation QOLQOL Burn outBurn out

Deming’s PointsDeming’s Points13. Institute a vigorous program of 13. Institute a vigorous program of

education and self improvement for education and self improvement for everyone.everyone.

8. Drive out fear. Create Trust. 8. Drive out fear. Create Trust. Create a climate for innovation.Create a climate for innovation.

5. Improve constantly and forever 5. Improve constantly and forever the system of production and the system of production and service.service.Walton, M. (1990). Deming management at work. New York: PerigeeWalton, M. (1990). Deming management at work. New York: Perigee..

Summary TQMSummary TQM

Leadership must support the processLeadership must support the processOrganization must be customer orientedOrganization must be customer orientedQuality improvement is linked to Quality improvement is linked to

customer judgmentscustomer judgmentsEmployees must be empowered to be Employees must be empowered to be

creative, to contribute develop & learncreative, to contribute develop & learnOrganization is process focusedOrganization is process focusedOrganization uses visionary managementOrganization uses visionary management

Failing to meet the customer’s Failing to meet the customer’s expectation of quality will expectation of quality will

result in customer result in customer dissatisfaction and is usually an dissatisfaction and is usually an

indicator of poor quality indicator of poor quality (Ludwig-Beymet et al. 1993)(Ludwig-Beymet et al. 1993)

THE ENDTHE ENDTHANK YOU FOR LISTENINGTHANK YOU FOR LISTENING