QUALITY ASSURANCE

1
QUALITY ASSURANCE CHANGE

• STRATEGIC MANAGEMENT IN HEALTHCARE
• 3 MARCH , 2009

2
QUALITY

• DOING THE RIGHT THINGS RIGHT, THE FIRST TIME
  EVERY TIME
• Quality of conformance absence of defects
• Quality of design customer satisfaction

3
CUSTOMERS

• PAYORS
• PATIENTS
• ANY DOWNSTREAM USER OF OUTPUT
• VIRTUALLY EVERYONE IN YOUR ORGANIZATION

4
HEALTHCARE QUALITY

• MEDICAL OUTCOMES
• PATIENT SATISFACTION
• CLIENT SATISFACTION

5
EVALUATION OF QUALITY

• ACCURATE DIAGNOSES
• IMPROVEMENT AT DISCHARGE
• MORBIDITY MORTALITY
• EFFICACY OF TREATMENT
• TOTALITY OF A PRODUCT THAT BEARS ON ABILITY TO
  SATISFY NEEDS OR WANTS

6
CQI

• CONTINUOUS QUALITY IMPROVEMENT
• IF IT AINT BROKE IT CAN STILL BE IMPROVED
• IF IT ISNT PERFECT MAKE IT BETTER

7
CONTINUOUS QUALITY IMPROVEMENT

• PROACTIVE APPROACH THAT ASSUMES ALL PROCESSES CAN
  BE IMPROVED
• ASSUMES A REASONABLE LEVEL OF QUALITY TO BEGIN
  WITH
• ASSUMES YOU ARE DOING THE RIGHT THINGS ALREADY

8
ELEMENTS OF CQI

• ORGANIZATION WIDE
• PROCESS FOCUSED
• TEAM-BASED
• PROSPECTIVE AND ONGOING
• USES OUTPUT OR INSPECTION MEASURES
• CUSTOMER DRIVEN

9
GOAL OF PROCESS IMPROVEMENT

• DO IT RIGHT THE FIRST TIME
• CORRECTIONS ARE EXPENSIVE
• 99 IS NOT GOOD ENOUGH
• 6000 STEPS TO BUILDING A CAR
• 60 THINGS WRONG WITH YOUR CAR
• SOME WILL BE FATAL FLAWS

10
DEMING

• POOR QUALITY
• IS THE RESULT OF BADLY DESIGNED OR MALFUNCTIONING
  PROCESSES
• CAN BE PREVENTED
• PREVENTED BY REDUCTION OF VARIABILITY

11
JURAN

• QUALITY IS FITNESS FOR USE - FREE FROM
  DEFICIENCIES AND MEETING CUSTOMER NEEDS
• QUALITY TRILOGY
• PLANNING
• CONTROL
• IMPROVEMENT

12
CROSBY

• QUALITY IS FREE WHAT COSTS IS NONQUALITY
  PRODUCTION
• COST OF QUALITY
• NONCONFORMANCE COST TO FIX IT
• CONFORMANCE COST TO EVALUATE AND IMPROVE

13
OUTLIERS

• UNDESIRABLE
• PREVENT FUTURE OCCURRENCES
• DESIRABLE
• CAN IT BE DUPLICATED?

14
HEALTHCARE QUALITY

• YOUR BODY IS NOT A CAR
• ALL TREATMENTS HAVE RISKS
• ALL TREATMENTS HAVE FAILURES
• EVERYONE IS GOING TO DIE

15
ORGANIZATIONAL CHANGE
16
Organizational Change

• Any discernable modification in any aspect of an
  organizations purpose or objectives. culture,
  strategies, tasks, technologies, people, or
  structures.

17
Managing Change

• Four stage model
• Identification
• Planning
• Implementation
• Evaluation

18
Why Change

• Organizations, like people, are always growing or
  dying.
• Changes carry a variety of costs and should never
  be undertaken unless reasons are compelling.

19
Resistance to Change

• When people are part of the status quo, even
  minor changes are disruptive.
• Individuals pay selective attention to the
  environment according to their interests and
  selectively interpret the information they
  receive.
• All change is personal and personnel.

20
Reasons for Resistance

• Insecurity or uncertainty
• Inconvenience
• Implies the current situation is bad
• Relationships change
• Individual and group status changes
• Economic losses
• Resentment of exercise of power
• Union opposition

21
Personal Personnel

• RIF pay cuts
• Hiring freeze
• Downsizing means more work for fewer people.
• New jobs go to new people
• Survivor guilt

22
Reducing Resistance

• Education and communication
• Participation
• Support adjustment
• Negotiate agreement
• Manipulate or co-opt the opposition
• Coercion inappropriate?

23
Platitudes/Truths

• Diapers and politicians should be changed
  regularly and for the same reason.
• No one likes to be changed but a baby.
• All change is stressful.