implementing performance improvement programs

7/29/2019 Implementing Performance Improvement Programs

http://slidepdf.com/reader/full/implementing-performance-improvement-programs 1/53

Implementing a

Performance ImprovementProgram



TQM – Total Quality Management

QI – Quality Improvement



Rationale for Performance

Improvement

Achieving total quality

Continuously upgrading performancetargets from previously accepted

minimal standards

Improve the system, rather than focuson the errors of individuals



Steps for TQM Implementation

1. Management Awareness

- - build awareness and commitment intop management

- - Create a TQM steering committee

- - Appoint a TQM coordinator - - Orient other staff on TQM



2. Mobilization

- - Assess organization’s readiness for TQM

- - Establish a TQM training program

- - Organize quality teams in work areas



3. Launching of Performance Improvement

Activities

- - Pilot a quality improvement project in one

area then gradually extend it to other areas

- - Continuously evaluate process and outcome

- - Continuously reinforce quality improvementprograms



Documentation-Evaluation-Action

Triad

1. Documentation

- - Safety- - Consistency of Purpose

- - Standardization

- - Improvement



2. Evaluation

- - Structure, Process and OutcomeStandards

- - Are the right interventions being done?- Are they safe and efficacious?

- - Are interventions performed correctly?

- - Are the procedures being done are theones that matter?



3. Action- - Compliance of healthcare

organizations with standards of

performance- - Best measured through:

- 1. effective identification of problems

and opportunities for improvement- 2. improving performance based on the

information



The Plan-Do-Check-Act Cycle

(PDCA)1. Plan

- Identify the problem

- Understand the current situation by clarifying

processes and causes of variations from

standards

- Set targets and decide on what the situationshould be if the problem was resolved

- Identify indicators of improvement



- - Collect relevant data

- - Analyze the problem

- - Analyze the root causes- - Create a plan for action



2. Do

- Develop and implement countermeasures

- Propose as many solutions to the vitalfew root causes

- Narrow down solutions to the mosteffective and practical countermeasures

- Implement countermeasures



3. Check

- Confirm effectiveness of countermeasures- Monitor implementation of countermeasures

- Document the effectiveness of

countermeasures by collecting data

- Analyze data

- Determine if the problem has been solved, if

targets have been achieved, if standards

have been reached- Reflect on the lessons learned from the

problem solving steps



4. Act

- Standardize and institutionalize

countermeasures- Present the results to a hospital-wide

forum and get top management

approval to adopt the solutions

throughout the hospital



QUALITYIMPROVEMENT

TOOLS



I. Problem Identification

Tools



1. Affinity Diagram

Used to sort several ideas or issues intomeaningful groups

Simplifies the analysis process as itnarrows down the focus on a certain

issue by identifying important aspects or creating useful categories



2. Brainstorming

Team thinking

Generates multiple perspectives on a given

issue by generating as many ideas aspossible from the members

Encourages all members to express their ideas, prevents domination of discussion by

few people



3. Flowchart

A map or a pictorial representation of theelements of a process or a sequence of

events and interrelationships Used to understand the intricacies of a

process

Facilitates needed simplification and

standardization by identifying bottlenecks inthe process, missing or redundant steps andproblem areas



4. Nominal Group Technique

Team brainstorming method useful for balancing member participation and reachingconsensus on the relative importance of

issues, problems or solutions

Allows the team to see major causes of disagreement

Instills ownership of ideas and commitment tothe team’s choice



II. Problem DescriptionTools



1. Bar Graph

Plots the frequency of occurrence of

different kinds of events during set timeintervals

Shows differences in data collectedduring different periods of time



2. Check Sheet

Systematic recording and compilation of

historical data or qualitative andquantitative observations on a certain

phenomenon aimed at detection of

patterns and trends



3. Force Field Analysis

Used to identify and enhance factors

which facilitate organization objectivesand pinpoint and minimize those that

act as obstacles



4. Line Graph

Shows the evolution of a process or its output

over a period of time

Measures certain parameters of a process

observed over a given time frame

Spots trends and other patterns occurring in aprocess as it shows the peaks and lows

reflected in the quantitative data



5. Pareto Chart

Pareto Diagram, Pareto Graph

Useful in identifying problems that require

further study due to the frequency of

incidence and in prioritizing the search for solutions

Shows which of the several causes of a

problem are the most significant and whichhave less bearing in the occurrence of the

problem



6. Pie Chart

A pictorial representation of an entire

unit as constituted by its different parts

The proportion of the different

components are displayed and the

interrelationships between the different

parts are seen



III. Problem Analysis Tools



1. Fishbone Diagram

Ishikawa Diagram, Cause and Effect Diagram

Used to show the many possible causes of a

problem and the possible actions to solve it

Identifies and graphically displays inincreasing detail all possible causes to a

problem or condition to get to its root cause



2. Matrix Diagram

Used to show a graphic representation of the

presence and strength of relationships

between two sets of information or activities

Used to compare the relationships between

certain requirements and the work processesthat deliver those requirements



3. Scatter Plot Diagram

Scatter Diagram, Dot Chart,

Scatter Chart

Shows the relationship between two

variables

Indicates a relationship and does not

signal a causation



IV. Solution Development

Tools



1. Prioritization Matrix

Selection Grid

A screening tool used to narrow downoptions trough a systematic comparison

of choices using a set of criteria

Allows basic disagreements on issues

to surface for prompt resolution



2. Process Decision

Program Chart (PDCP)

Used to graphically illustratecontingency planning

Possible problems and difficulties inimplementation are determined andstrategies for dealing with them aredetermined in advance



3. Tree Diagram

Graphic tool used to map out detailed

group of tasks marked for

implementation

- Stratification – breaks down a goalexpressed in broad terms into

increasing levels of detailed actions



V. Quality Monitoring Tools



1. Control Chart

Used to monitor developments in a

process over time

Indicates the time when a process

registers values outside acceptable

limits, times when improvement effortsare needed in a process



2. Histogram

Bar Chart, Frequency Distribution Chart

Displays the frequency of occurrence of

data values and shows the spread of

data distribution



3. Radar Chart

Spider Chart, Spider Web Chart

Graphical display of the differencesbetween actual and ideal performance

Identifies relative strengths andweaknesses of activities



Quality Circles and Teams



Group of 5 to 10

workers, the front

liners, from one

work area of thehospital who meet

regularly to identify

and solve problems

in their work areausing their own

resources

QC with a bigger scope in at least 2respects:

- Involves managersas well as frontliners

- Involves more than

one area or processof work and oftentackles cross-functional issues

Quality Circle Quality Teams

QC/QT A h t



QC/QT Approach to

Problem Solving

1. Select a theme.

2. Understand the current situation and set

targets.

3. Create a plan of action.

4. Analyze the root causes.

5. Develop and implement countermeasures.

6. Confirm effectiveness of countermeasures.7. Standardize and institutionalize

countermeasures.



Quality Improvement

Activities



1. Clinical Practice Guidelines

Are systematically developedstatements which assist in formulating

practitioner and patient decisions aboutappropriate health care for specificclinical circumstances



2. Clinical Pathways

An interdisciplinary plan of care that

outlines the optimal sequencing and

timing of interventions and expected

outcomes for patients with a particular

diagnosis, procedure or symptom



3. Medical Audits

Used to identify opportunities to improve

procedures used in the diagnosis,

treatment and care of specific patients

and the associated use of resources

and resulting outcomes



4. Utilization Review

Assesses the appropriateness and the

efficiency of the use of resources

Focuses on the cost effectiveness of

interventions used

Identifies providers who need to attain a

more efficient resource use



5. Complaints Analysis

Complaint – expression of

dissatisfaction of a customer

Complaints data – considered welcome

opportunities to learn from dissatisfied

patients and identify areas for

improvement



6. Expanded Incident

Monitoring

Used to routinely identify, process,

analyze, and report incidents to preventtheir recurrence



7. Morbidity & Mortality

Meetings Review deaths and adverse outcomes among

patients of a specified clinical group or

specialty

Provides a venue to critically analyze the

circumstances surrounding the outcomes of care provided by an individual or a

multidisciplinary group of clinicians



8. Sentinel Event Monitoring

Identifies potentially serious breaches in

practice standards

Includes any process variation for which

recurrence could carry a significantchance of a serious adverse outcome



9. Credentialing &

Clinical Privileging

Specifies the conditions individualpractitioners should meet before being

granted clinical privileges



10. Variance Reporting &

Analysis A deviation from what has been

specified in the clinical pathway

Used to routinely document and identify

the most common causes of deviationfrom routine care for prioritized problem

solving

implementing performance improvement programs

Documents