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Transcript of CPHQ Text Book
8/3/2019 CPHQ Text Book
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B Y / D r .
O s a m a F a h i m
2
0 1 1
Y O U R
C P H
Q G
U I D E T O S
U C E S S
A comprehensive guide, to healthcare
quality professionals. Who are
preparing to undertake the CPHQ
exam. This guide is based on the CPHQ
exam guidelines and my personal
experience. Divided into Four Parts:
Leadership, Improvement, Information
and patient Safety
ByDr. Osama Fahim
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Blank page
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Copyright 2010 @ Cairo to ALP
The first edition of this book
Was completed in 2010
All rights are reserved
To the publisher and author
For comments or more books by the author
Email:
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Contents
CPHQ: Practice to be the best
1. Introduction and Test Taking Tips:
What is Quality and why
What is CPHQ and why to certify
Test taking strategy
2. Foundation, Techniques and Tools:
Process analysis tools (e.g., fishbone, Pareto chart, run chart,
scatter gram, control chart)
Statistical techniques to describe data (e.g., mean, standard
deviation)
Statistical process control (e.g., common and special cause
variation, random variation, trends)
Statistical techniques to evaluate data (e.g., t-test, regression)
Communication
3. Using Data for Improvement:
Confidentiality of performance improvement activities, records,
and reports
Information for committee meetings (e.g., agendas, reports,
minutes)
Customer needs/expectations (e.g., surveys, focus groups, teams)
Data inventory listing activities (i.e., what is available from which
sources?)
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Data collection methodology and Analysis
Computerized systems for data collection and analysis Epidemiological theory in data collection and analysis
Comparative data, benchmarking , outcomes Incident/occurrence reports
Decision making
4. Strategy and Leadership:
leadership values and commitment
the organization’s quality culture
organization-wide strategic planning
Identify internal / external customer/supplier relationships
organizational vision and mission statement
goals and objectives
performance measures (e.g., balanced scorecards, dashboards,
core measures)
lines of authority/accountability
performance improvement models (e.g., FOCUS, PDCA, Six Sigma)
national/international excellence/quality models
accreditation process
financial benefits of a quality program performance improvement oversight group (e.g., Quality Council,
Steering Council, QM Committee)
performance improvement team or teams and team structure
(e.g., cross functional, self-directed)
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Quality champions (e.g., process owners, quality, and patient
safety)
performance measures/indicators
written plan for a risk management program
survey processes (i.e., accreditation, licensure, Certification) cost analysis and departments budget
5. Continuous Improvement:
process improvement activities and Teams performance improvement action plans and projects
process and outcome measures
evidence-based practice guidelines
external quality awards (e.g., Malcolm Baldrige, Magnet)
credentialing and privileging process medication usage review
medical record review
infection control processes
peer review
service specific review (pathology,radiology, pharmacy, nursing) patient advocacy (e.g., patient rights, ethics)
risk management: prevention and identification mortality review failure mode and effects analysis quality department
Education and Training
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Integration between:
performance improvement incorporated into the employeeperformance appraisal system
findings from performance improvement incorporated into
the credentialing/appointment/privilege delineation process data analysis results incorporated into the performance
improvement process
outcome of risk management assessment incorporated into
the performance improvement process
outcome of utilization management assessment
incorporated into the performance improvement process
quality findings incorporated into governance and
management activities (e.g., bylaws, administrative policies,
and procedures) accreditation and regulatory recommendations incorporated
into the organization
Evaluation of:
measures, teams, projects, Surveys, Accreditation
performance/productivity reports
patient/member/customer satisfaction
practitioner profiling
complaint analysis
6. Change Management and Innovation:
Organization quality and safety culture
ISO, Lean and Six sigma
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Introduction
If, it is quite difficult to find quality in your workplace, it is rather easier to
start doing something that will be recognized.
When I started to do this book, I was faced by two things to make it simple or to make
it comprehensive. But I decided to make it by both ways. Comprehensive yet simple
and I hope that you will find it like that.
When we speak about healthcare quality we have to distinguish it from quality in other
sectors as in manufacturing or other service providing organizations.
Lastly I would wish for all of you to get the results that we were looking for and that
this guide will do that for you.
Yours sincerely,
Osama fahim
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Chapter I
Introduction and Test Taking Tips
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What is Quality?
The tale of the five blind men’s first encounter with an elephant depicts how each man
describes an elephant based upon which part of the elephant's anatomy he happen to
touch. A similar problem occurs when trying to define quality. How each person
describes the 'elephant' is substantially different.
The term 'quality' is often used in a vague, blurred way.
There are as many definitions of quality as there are quality consultants, but the
common element of the business definitions is that the quality of a product or service
refers to the perception of the degree to which the product or service meets the
customer's expectations. Quality has no specific meaning unless related to a specific
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function and/or object. Quality is a perceptual, conditional and somewhat subjective
attribute.
The business meanings of quality have developed over time. Various interpretations
are given below:
1. ISO 9000: "Degree to which a set of inherent characteristics fulfills
requirements." The standard defines requirement as need or expectation.
2. Six Sigma: "Number of defects per million opportunities."
3. Subir Chowdhury: "Quality combines people power and process power."
4. Philip B. Crosby: "Conformance to requirements." The requirements may not
fully represent customer expectations; Crosby treats this as a separate problem.
5. Joseph M. Juran: "Fitness for use." Fitness is defined by the customer.
6. Noriaki Kano and others, present a two-dimensional model of quality: "must-be
quality" and "attractive quality." The former is near to "fitness for use" and the
latter is what the customer would love, but has not yet thought about.
Supporters characterize this model more succinctly as: "Products and services
that meet or exceed customers' expectations."
7. Robert Pirsig: "The result of care."
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Purpose of six sigma :To make customer happier and increase profits
8. Genichi Taguchi, with two definitions:
a. "Uniformity around a target value." The idea is to lower the standard
deviation in outcomes, and to keep the range of outcomes to a certain number
of standard deviations, with rare exceptions.
b. "The loss a product imposes on society after it is shipped." This definition of
quality is based on a more comprehensive view of the production system.
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9. American Society for Quality: "A subjective term for which each person has his
or her own definition. In technical usage, quality can have two meanings:
a. The characteristics of a product or service that bear on its ability to satisfy
stated or implied needs;
b. A product or service free of deficiencies."
10. Peter Drucker: "Quality in a product or service is not what the supplier puts in.
It is what the customer gets out and is willing to pay for."
11. W. Edwards Deming: concentrating on "the efficient production of the quality
that the market expects," and he linked quality and management: "Costs go
down and productivity goes up as improvement of quality is accomplished by
better management of design, engineering, testing and by improvement of
processes."
12. Gerald M. Weinberg: "Value to some person".
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Philip Crosby’s definition is easily toppled: if requirements are wrong, then failure isguaranteed. His focus is the domain of QA where, without a specification, quality
cannot be measured and thus controlled. You cannot have zero defects if you do not
have a standard against which to measure defectiveness.
This reflects the early days, where quality was clearly about product. Quality control,
and later QA, was our domain - we didn’t care about customers; the research and
design department was responsible for designing the job and sales and marketing for
selling it. But those halcyon days of definitive specifications and jobs for life are long
gone.
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Though Juran takes a step further down the value chain, to the use of the product or
service (at which point customers had forced their way into the frame), he stillpresupposes that we can fully understand how the product will be used, which is a
great challenge (and not always possible). As Deming himself said, some things are
‘unknown and unknowable’.
ISO 8402 recognises this uncertainty with its ‘implied need’. It uses the word ‘entity’
as opposed to the ‘product or service’ definition of its earlier (1986) version, indicating
a broadening uncertainty. Nonetheless, it suffers again from a simplistic, single-minded
focus - all we need to do is to figure out what is wanted and then deliver it.
The quality models are a step further into broader business. Here, although processes
are important, quality is much more about people: customers are there, but so too are
stakeholders - employees, partners, suppliers, shareholders and society. Perhaps
wisely, the models avoid nailing down a specific definition of quality, leaving us without
a definition that encompasses a broader business view.
ISO9000:2000 steps in this direction also, talking about ‘customer and other
interested parties’, but leaves the definition of quality at a rather generalised ‘degree
to which a set of inherent characteristics fulfils requirements’ .
If someone talks about 'working on quality', they may simply mean activities designed
to improve the organization and its services.
Quality is essentially about learning what you are doing well and doing it better. It alsomeans finding out what you may need to change to make sure you meet the needs of
your service users. Quality is about:
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knowing what you want to do and how you want to do it
learning from what you do
using what you learn to develop your organization and its services
seeking to achieve continuous improvement
Satisfying your stakeholders - those different people and groups with an interest
in your organization.
Quality in business, engineering and manufacturing has a pragmatic interpretation
as the non-inferiority or superiority of something. Quality is a perceptual,
conditional and somewhat subjective attribute and may be understood differently
by different people. Consumers may focus on the specification quality of a
product/service, or how it compares to competitors in the marketplace. Producers
might measure the conformance quality, or degree to which the product/service
was produced correctly.
The CQI defines quality in terms of innovation and care:
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Why Quality
No doubt that everyone will benefit from applying quality:
1- The organization:
a. Better product or service
b. Improve process
c. Reduce scrap and cost of production
d. Customer satisfaction
e. Increase profit
2- The Employees:
a. Increase satisfaction
b. Increase production
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3- The society:
a.
Better product and service4- The Customers:
a. Increase satisfaction
b. Decrease price for service or product
Brief History of Quality
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The history of quality management, from mere 'inspection' to Total Quality
Management, and its modern 'branded interpretations such as 'Six Sigma', has led tothe development of essential processes, ideas, theories and tools that are central to
organizational development, change management, and the performance improvements
that are generally desired for individuals, teams and organizations.
Levels of Quality