Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive...

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Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 07/03/22

Transcript of Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive...

Page 1: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Quality Management in Your Practice:A Nuts and Bolts Primer

Richard P. Dutton, MD MBAExecutive DirectorAnesthesia Quality Institute

04/11/23

Page 2: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Some people need feedback on their work performance

Page 3: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Introduction

• I am an anesthesiologist.

• I have led QM programs at the department and hospital levels

• Now I get to try it at the national level!

Page 4: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Introducing Yourself

Please send us a message (in the system or by email to [email protected]):

– Who are you? What is your title?– Why are you listening?– Do you have any specific questions or topic

areas?

Page 5: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Why Have Quality Management?

• To improve patient outcomes

• To improve business efficiency

• To meet regulatory requirements

Page 6: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

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The Challenge

The government wants to know that Ma and Pa are getting the healthcare they deserve … and that our taxes pay for.

Page 7: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

The Eight Step Program: One

Who’s in charge here?

An effective QM program often depends on the initiative of a single person

Page 8: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

What the leader does …

• Promotion of open dialogue

• Timely feedback

• Getting "buy in" from providers

• Support after a bad outcome– Accurate analysis by experts– A forum for discussion– Prevention of future events

Page 9: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

The Eight Step Program: Two

What do we need to know?

Sometimes, knowing your destination makes it easier to find the best route

Page 10: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Typical QM Questions

• How many cases did we do last year?

• How many deaths?– Anesthesia related?– Preventable?

• How many complications?

• How satisfied are our patients?

• How do our results compare with others?

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Page 11: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Data: Indicators

• Business (numbers, times, dollars)

• Outcomes (deaths, complications)

• Processes – Steps that lead to outcomes … – Often problematic

• Focused reviews

• Sentinel events

Page 12: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

The Quality Triangle

RiskFactors

Outcomes

Process

Page 13: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

The Eight Step Program: Three

Gather the data!

•First, steal as much as you can

•Only then consider making your own

Page 14: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

He who has the data controls the futureHe who has the data controls the future

Page 15: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

What to Collect?

• “Administrative” data

• AIMS data

• Hospital EHR data

• Quality and outcome data– Your group– Other specialties

• Patient satisfaction information

• Anecdotes

Page 16: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

How to Make Your Own Data

http://aqihq.org/AQIVendors.aspx

Page 17: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

The Eight Step Program: Four

Share with your friends

•Produce a regular QM report

•Publish it internally

•Excerpt it externally

Page 18: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

“We have lots of information technology, we just don’t have any information”

Page 19: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Who has your data already?

• The federal government

• CMS – Medicare Data

• AHRQ – CAHPS Data

• Private insurance companies

• The Joint Commission

• The ABA

• Your IT vendors

Page 20: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Data “Safety”

• You cannot hide your data

• You can see yourself as others will see you

• You can pre-empt illegitimate use

Page 21: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

The Eight Step Program: Five

Capture the interesting cases

One of your goals should be to learn from the mistakes of others -- this is more fun than making the mistakes yourself.

Page 22: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Lessons From Aviation

The US National Civil Aviation Review Commission Chaired by Senator Norman Mineta“Avoiding Aviation Gridlock & Reducing the Accident Rate,” December 1997.

•FOQA and other safety risk management programs are based on trust.

• Keeping this data confidential is the key to acquiring it in the first place.

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Focus on Systems

• Not about weeding out "bad apples”

• W. Edwards Deming: 94% of the potential for improvement resides in system performance, only 6% is individual

• Dutton’s corollary: “system performance” usually equals “communication”

Page 25: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Management BY Anecdote

• Over-reaction to isolated events

• Layered bureaucracy

• Failure to discover root causes

• Failure to assess both benefits and risks

• Frequent disposal of both baby and bathwater!

Page 26: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Management OF Anecdotes

• Have a process for addressing sentinel events– Discovery– Reporting– Disclosure– Fact finding: who?– Analysis– Discussion and System Changes

Page 27: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.
Page 28: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

The Eight Step Program: Six

Change things.

Don’t be afraid to tinker with your systems and processes.

Page 29: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

PACU Reintubation Rate

Provider Education

andRocuronium

Removed

Rocuronium Introduced

Page 30: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

The Eight Step Program: Seven

Lather, rinse, repeat

QM becomes easier over time, and more effective. You want to embed this

process in the fabric of your

practice.

Page 31: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Control Chart AnalysisAnesthesiology

Page 32: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

The Eight Step Program: Eight

Report your data externally. Collect benchmarks you can use.

Participate in the AQI!

Page 33: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Where is the Improvement?

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Admissions

Deaths

z-score

Page 34: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

“The unexamined life is not worth living.”

-- Socrates, Apology 38a

Page 35: Quality Management in Your Practice: A Nuts and Bolts Primer Richard P. Dutton, MD MBA Executive Director Anesthesia Quality Institute 10/11/2014.

Contact Us!

www.aqihq.org

or

[email protected]