What is Quality? QUALITY ASSURANCE PROJECT Dimensions of Quality Effectiveness Efficiency Technical Competence Safety Accessibility Interpersonal Relations Continuity Amenities QUALITY ASSURANCE PROJECT Perspectives on Quality Client / Family Provider Health Care Administration & Management Community QUALITY ASSURANCE PROJECT Definition of Quality “The quality of technical care consists in the application of medical science and technology in a way that maximizes its benefits to health without correspondingly increasing its risks. The degree of quality is, therefore, the extent to which the care provided is expected to achieve the most favorable balance of risks and benefits.” • Avedis Donabedian, M.D., 1980 QUALITY ASSURANCE PROJECT Definition of Quality “Doing the right thing, right, the first time. Doing it better the next time.” • ODI Consulting QUALITY ASSURANCE PROJECT Definition of Quality “...proper performance (according to standards) of interventions that are known to be safe, that are affordable to the society in question, and have the ability to produce an impact on mortality, morbidity, disability, and malnutrition.” • M.I. Roemer and C. Montoya Aguilar, WHO, 1988 QUALITY ASSURANCE PROJECT Definition of Quality “Quality is conformance to requirements or specifications.” • Phil Crosby, 1979 QUALITY ASSURANCE PROJECT Definition of Quality “Quality is compliance with standards.” • QA Project Contract, 1997 QUALITY ASSURANCE PROJECT Quality Definitions • • • • Meet or exceed standards User “fit” User expectations Technical accuracy QUALITY ASSURANCE PROJECT What is Quality Assurance? QA, QI, QM, TQM, CQI Alphabet Soup QUALITY ASSURANCE PROJECT Components of a System Inputs Processes Outputs QUALITY ASSURANCE PROJECT Outcomes Effects Impacts Quality Assurance System INPUTS PROCESSES OUTCOMES • Client expectations • Quality Design • Staff performance monitored • Organizational structure • Planning for quality • Trained personnel • Setting standards • Compliance with standards • Budget • Monitoring quality • Increased efficiency • Standards • Supervision • Culture of quality • Political support • Quality Improvement • Organizational culture • Accreditation • Increased access and utilization • Satisfied clients • Improved health outcomes QUALITY ASSURANCE PROJECT Standard Setting SS QA PS Problem Solving QUALITY ASSURANCE PROJECT M Monitoring Quality Design QD QA QI Quality Improvement QUALITY ASSURANCE PROJECT QC Quality Control Design Organizational Restructuring Process Redesign Quality Design Planning Standard Setting Audit Quality Assessment Team-Based Problem Solving Management Action Feedback Individual Action Improve QUALITY ASSURANCE PROJECT Q? Monitoring Systems Supervision Self Evaluation Control Definition of Quality Assurance “Process of measuring quality, analyzing the deficiencies discovered, and taking action to improve performance followed by measuring quality again to determine whether improvement has been achieved. It is a systematic, cyclical activity using standards of measurement.” • Dr. Heather Palmer, US expert in ambulatory care QUALITY ASSURANCE PROJECT Definition of Quality Assurance “All the arrangements and activities that are meant to safeguard, maintain, and promote the quality of care.” • Dr. Avedis Donabedian QUALITY ASSURANCE PROJECT Definition of Quality Assurance “Quality Assurance is that set of activities that are carried out to set standards and to monitor and improve performance so that the care provided is as effective and as safe as possible.” • The Quality Assurance Project, 1993 QUALITY ASSURANCE PROJECT Definition of Quality Assurance “A systematic process for closing the gap between actual performance and desirable outcomes…” • Drs. Ruelas and Frenk QA work in Mexico QUALITY ASSURANCE PROJECT Definition of Quality Management “...a systematic managerial transformation designed to address the needs and opportunities of all organizations as they try to cope with increasing change, complexity and tension within their environments.” • Dr. Donald Berwick, Institute for Healthcare Improvement QUALITY ASSURANCE PROJECT Definition of Quality Improvement “…an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others. Synonyms and near synonyms include continuous quality improvement (CQI), continuous improvement, performance improvement, and total quality management. “ • Joint Commission on Accreditation of Healthcare Organizations QUALITY ASSURANCE PROJECT Continuous Improvement QUALITY ASSURANCE PROJECT Philip Crosby • Quality is free - remove un-quality things, which are all the actions that involve not doing jobs right the first time • People-focused interventions targeted at zero defects QUALITY ASSURANCE PROJECT Deming’s 14 Points of Management • Create constancy of purpose toward quality improvement • Adopt a philosophy which expects good products and services • Cease dependence on inspection and build quality into the product or service • Don’t award business solely on the basis of price tag • Improve constantly the system of production and service • Institute on-the-job training QUALITY ASSURANCE PROJECT Deming’s 14 Points of Management (cont’d.) • Institute leadership with an aim to help people and machines do better jobs • Drive out fear • Break down barriers between departments • Eliminate slogans, exhortations and targets • Eliminate number quotas and management by objective, substitute leadership • Remove barriers to pride of workmanship • Institute education and self-improvement • Take action to accomplish the transformation QUALITY ASSURANCE PROJECT The Juran Trilogy® Quality Planning Quality Improvement QUALITY ASSURANCE PROJECT Quality Control Shewart Cycle Act Check QUALITY ASSURANCE PROJECT Plan Do Principles of Managing Quality QUALITY ASSURANCE PROJECT Principles of Managing Quality Leadership Client focus Data Team work Systems/ process focus QUALITY ASSURANCE PROJECT Leaders and Quality “In our experience, no quality improvement effort has ever been successful without top management’s involvement.” J. M. Juran QUALITY ASSURANCE PROJECT Specific Actions for Leaders • Define the vision - communicate it and model its attainment • Approve financial investment in improving quality • Provide and approve time spent in quality pursuits QUALITY ASSURANCE PROJECT Specific Actions for Leaders • Require training and learning about quality - attend and present it yourself • Reward quality - look for it, recognize it • Tie reward systems to quality • Serve on teams QUALITY ASSURANCE PROJECT Specific Actions for Leaders • Lead the quality effort – communicate the plans for quality assessment and improvement – approve specific improvement projects – receive / request reports of QI efforts – “walk the talk” QUALITY ASSURANCE PROJECT Two Major Theories of Client Satisfaction With Health Care Expectancy-value theory: Satisfaction = Perceived care > Expectations of care Exchange theory: Satisfaction = Value of care > Cost of care QUALITY ASSURANCE PROJECT “In God we trust All others please bring data” QUALITY ASSURANCE PROJECT “Every system is perfectly designed to achieve exactly the results it achieves” QUALITY ASSURANCE PROJECT Stages of Team Development Forming Storming Norming Performing Closing QUALITY ASSURANCE PROJECT Components of a System Inputs Processes Outputs QUALITY ASSURANCE PROJECT Outcomes Effects Impacts