Continuous Continuous Improvement:Improvement: What What

Will it Take?Will it Take?

Leadership commitmentLeadership commitment A new management A new management

modelmodel New skillsNew skills StrategyStrategy

Core Principles ofCore Principles ofManaging QualityManaging Quality

Intention to improveIntention to improve Focus on customersFocus on customers Focus on process and systemFocus on process and system Proper use of measurement Proper use of measurement

and statisticsand statistics Involvement of everyoneInvolvement of everyone Continuous testing of changesContinuous testing of changes On-going trainingOn-going training Collaboration, valuing Collaboration, valuing

interdependencyinterdependency Key role of leadersKey role of leaders

Pursuing Improvement:Pursuing Improvement:Five Guiding QuestionFive Guiding Question

Who depends on you?Who depends on you? What do they need?What do they need? How do you know?How do you know? How well are you meeting How well are you meeting

their needs?their needs? How do you know?How do you know?

Alphabet Soup ofAlphabet Soup ofQ programsQ programs

QAQA TQM TQM QI QI

19701970 1966 19661970’s1970’s

QMQM PI PI

1990’s1990’s 2000 2000

IOM (2002)IOM (2002)

Organizational & clinicalOrganizational & clinical

____________________________________________________

ISO 9000, BaldrigeISO 9000, Baldrige

Web sitesWeb sitesIOM report – “To Err is Human”IOM report – “To Err is Human”

(2002)(2002) “ “Crossing the Chasm”Crossing the Chasm”

www.iom.eduwww.iom.eduwww.brownspath.comwww.brownspath.comwww.ihi.orgwww.ihi.org (success stories) (success stories)www.qualityindicators.ahrg.govwww.qualityindicators.ahrg.govwww.fmeainfocentre.com/download_arwww.fmeainfocentre.com/download_area.htmea.htmwww.healthgrades.comwww.healthgrades.comwww.ahima.org/conventionwww.ahima.org/convention____________________________________________________

Data Sets – Comparative DataData Sets – Comparative DataHEDIS, ORYX, OASIS Healthgrades.comHEDIS, ORYX, OASIS Healthgrades.com(NCQA (JCAHO) LTC(NCQA (JCAHO) LTC CMS)CMS)

QUIC.gov (2002)QUIC.gov (2002)

Definition of QualityDefinition of Quality

Meeting the needs and Meeting the needs and exceeding the exceeding the expectations of those we expectations of those we serve.serve.

Delivering Delivering all and onlyall and only the the care that the patient and care that the patient and family needs.family needs.

Quality: A Strategic Quality: A Strategic NecessityNecessity

Cost escalationCost escalation Variation in practiceVariation in practice StandardizeStandardize Purchaser dominancePurchaser dominance Issues of public trustIssues of public trust Integrated systems and Integrated systems and

managed caremanaged care New information systemsNew information systems

TAXONOMY OF QUALITY

Outcome

Process

Structure

Traditional Triad

-Avedis Donabedian

TAXONOMY OF QUALITY

Cost Efficiency

Clinical Quality Service Quality

Newer Triad for Organizational Performance

Community Needs

-Brent James

Performance Performance improvement is the improvement is the

integration of a integration of a customer-focused, customer-focused,

continuous-continuous-improvement improvement

philosophy, analytical philosophy, analytical skills, people skills, skills, people skills, and a structure and and a structure and

organization, within an organization, within an internal and external internal and external culture affected by culture affected by

leadershipleadership

Categories and Point Value for Categories and Point Value for the Malcolm Baldrige National the Malcolm Baldrige National

Quality Award ExaminationQuality Award Examination

LeadershipLeadership 120120

The way senior executives create and sustain The way senior executives create and sustain corporate citizenship, customer focus, clear corporate citizenship, customer focus, clear value, and expectations and promote quality value, and expectations and promote quality and performance excellenceand performance excellence

Information AnalysisInformation Analysis 7575Management and effectiveness of the use of Management and effectiveness of the use of data and information to support customer-data and information to support customer-driven performance and market excellencedriven performance and market excellence

Strategic PlanningStrategic Planning 5555

The way the company sets strategic direction, The way the company sets strategic direction, how it determine plan requirements, and how how it determine plan requirements, and how plan requirements relate to performance plan requirements relate to performance managementmanagement

Categories and Point Value for Categories and Point Value for the Malcolm Baldrige National the Malcolm Baldrige National

Quality Award ExaminationQuality Award Examination

Human Resource Development and Human Resource Development and ManagementManagement 140140

Company’s effort to develop and utilize the work and to Company’s effort to develop and utilize the work and to maintain an environment conductive to full participation, maintain an environment conductive to full participation, continuous improvement, and personal and continuous improvement, and personal and organizational growthorganizational growth

Process ManagementProcess Management 140140Process design and control, including customer-focused Process design and control, including customer-focused design, product and service delivery, support services, design, product and service delivery, support services, and supply managementand supply management

Business ResultsBusiness Results 220220

Company’s performance and improvement in key Company’s performance and improvement in key business areas (product, service, and supply quality, business areas (product, service, and supply quality, productivity, and operational effectiveness and related productivity, and operational effectiveness and related financial indicators)financial indicators)

Categories and Point Value for Categories and Point Value for the Malcolm Baldrige National the Malcolm Baldrige National

Quality Award ExaminationQuality Award Examination

Customer Focus and SatisfactionCustomer Focus and Satisfaction250250

Company’s knowledge of the customer, customer Company’s knowledge of the customer, customer service systems, responsiveness to customer, customer service systems, responsiveness to customer, customer satisfactionsatisfaction

TOTAL POINTSTOTAL POINTS 10001000

Understand customer need

Identify processes and Outcomes that meetCustomer need

Assess performance compared with Professional or ”best-of-Class” standards

Define indicators tomeasure performance

Establish performanceexpectations

Monitor performanceand compare withexpectations

Provide feedback toProviders and customers

Implement improvements

Complaints AnalysisSatisfaction SurveysFocus GroupsRequest for Proposal

Treating DiseaseManaging HealthService Quality

AppropriatenessReviewPeer ReviewBenchmarkingOutcomes Assessment

Structure, Process and Outcome CriteriaCase Mix Adjustment

Profiling, Report Cards

Practice GuidlineCase ManagementQI Teams