Measuring Quality Improvement in Healthcare , livre ebook

ASQ Quality Press - Robert C. Lloyd , Raymond G. Carey

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140 pages

English

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This ground-breaking book addresses the critical, growing need among health care administrators and practitioners to measure the effectiveness of quality improvement efforts. Written by respected healthcare quality professionals, Measuring Quality Improvement in Healthcare covers practical applications of the tools and techniques of statistical process control (SPC), including control charts, in healthcare settings. The authors' straightforward discussions of data collection, variation, and process improvement set the context for the use and interpretation of control charts. Their approach incorporates "the voice of the customer" as a key element driving the improvement processes and outcomes. The core of the book is a set of 12 case studies that show how to apply statistical thinking to health care process, and when and how to use different types of control charts. The practical, down-to-earth orientation of the book makes it accessible to a wide readership. "Only authors who have used statistics and control charts to solve real-world healthcare problems could have written a book so practical and timely." - Barry S. Bader, Publisher The Quality Letter for Healthcare Leaders "Many clinicians and other healthcare leaders underestimate the great contributions that better statistical thinking could make toward reducing costs and improving outcomes. This fascinating and timely book is a fine guide for getting started." - Donald M. Berwick, M.D. President and CEO, Institute for Healthcare Improvement Associate Professor of Pediatrics, Harvard Medical School Contents: Planning Your CQI Journey, Preparing to Collect Data, Data Collection, Understanding Variation, Using Run and Control Charts to Analyze Process Variation, Control Chart Case Studies, Developing Improvement Strategies, Using Patient Surveys for CQI, Formulas for Calculating Control Limits

Sujets

Business

Qualité, hygiène, sécurité, environnement

Health Care Issues

Healthcare

Health care

Health

Fitness

Informations

Publié par	ASQ Quality Press
Date de parution	25 septembre 2001
Nombre de lectures	2
EAN13	9781636940816
Langue	English

Informations légales : prix de location à la page 0,3050€. Cette information est donnée uniquement à titre indicatif conformément à la législation en vigueur.

Extrait

Measuring Quality Improvement in Healthcare
Measuring Quality Improvement in Healthcare
A Guide to Statistical Process Control Applications
Raymond G. Carey, Ph.D.
Robert C. Lloyd, Ph.D.
Measuring Quality Improvement in Healthcare: A Guide to Statistical Process Control Applications
Raymond G. Carey and Robert C. Lloyd
Library of Congress Cataloging-in-Publication Data
Carey, Raymond G.
Measuring quality improvement in healthcare: a guide to statistical process control applications / Raymond G. Carey, Robert C. Lloyd.
p. cm.
Includes bibliographical references and index.
ISBN 0-527-76293-8
1. Medical care-Quality control-Statistical methods. 2. Health facilities-Evaluation-Statistical methods. I. Lloyd, Robert C. 11. Title.
RA399.AlC365 1995
362.1 068 5-dc20
95-5101
CIP
2001 by ASQ
All rights reserved. No part of this book may be reproduced in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.
ISBN 0-527-76293-8
Acquisitions Editor: Ken Zielske
Project Editor: Annemieke Koudstaal
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Special Marketing Representative: David Luth
ASQ Mission: The American Society for Quality advances individual and organizational performance excellence worldwide by providing opportunities for learning, quality improvement, and knowledge exchange.
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To place orders or to request a free copy of the ASQ Quality Press Publications Catalog, including ASQ membership information, call 800-248-1946. Visit our web site at www.asq.org or visit our online bookstore at http://qualitypress.asq.org .

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Contents
List of Figures
List of Tables
Foreword
Preface
Acknowledgments
Chapter 1. Planning Your CQI Journey
What Is Quality?
Who Is Interested in Quality?
A Quality Improvement Road Map
Chapter 2. Preparing to Collect Data
Identifying an Opportunity for Improvement
Prioritizing Opportunities
Organizing a Team
Clarifying the Process with Flowcharts
Standardizing the Process
Identifying Key Quality Characteristics
Developing Operational Definitions
Chapter 3. Data Collection
Data versus Information
Components of a Data Collection Plan
A Template for Data Collection
Chapter 4. Understanding Variation
Depicting Variation
Common versus Special Causes of Variation
Consequences of Not Understanding Variation
Chapter 5. Using Run and Control Charts to Analyze Process Variation
Constructing Run Charts
Using Run Charts
Using a Run Chart to Help Improve the Preadmission Testing Process
Why Use Control Charts?
The Elements of a Control Chart
Basic Control Chart Theory
Type I and Type II Errors
Dividing a Control Chart into Zones
Deciding Which Control Chart to Use
Chapter 6. Control Chart Case Studies
Applying Statistical Thinking to Healthcare Processes
Case Studies
Analyzing the Net Operating Margin
CBC Laboratory Turnaround Time
Tracking the Success of Physical Therapy
Days to Mail a Patient Invoice
Admission Time into an Intensive Care Unit
Emergency Room Bed Transfer Time
Platelet Counts
Primary Caesarian Sections
Ranking Hospitals on Patient Satisfaction
Patient Falls
Use of Restraints with Psychiatric Patients
Medication Errors
Chapter 7. Developing Improvement Strategies
The Type of Variation Determines Your Strategy
Right and Wrong Strategies
Changing a Common-Cause System
Tools to Identify KPVs
Continued Monitoring
How Much Improvement Is Enough?
Chapter 8. Using Patient Surveys for CQI
A Self-Test on Survey Research
Function of Patient Surveys in CQI
Reliability and Validity
Why Is Reliability Important?
How Much Reliability Is Enough?
Sampling
Interviewer and Nonresponse Bias
Report Format
Benchmark Data
Evaluating the Effectiveness of Interventions
Summary
Appendix. Formulas for Calculating Control Limits
The -R Chart
The XmR Chart
The p-Chart
The c-Chart
The u-Chart
References
List of Figures
FIGURE 1.1 . The difference between quality assurance and quality improvement.
FIGURE 1.2 . What is quality?
FIGURE 1.3 . Process improvement flowchart.
FIGURE 2.1 . Pareto diagram of patient complaints.
FIGURE 2.2 . What can go wrong in a process?
FIGURE 2.3 . ER bed transfers of adults to medical / surgical units during days and afternoons only.
FIGURE 3.1 . Framework for a data/information system.
FIGURE 3.2 . Sampling options.
FIGURE 4.1 . Patient wait time to see a physician.
FIGURE 4.2 . Average wait time by day.
FIGURE 4.3 . Who is the better shot?
FIGURE 5.1 . Run chart of total inpatient falls.
FIGURE 5.2 . Run chart for the use of restraints with psychiatric patients.
FIGURE 5.3 . Preadmission testing.
FIGURE 5.4 . Elements of a control chart.
FIGURE 5.5 . The normal distribution.
FIGURE 5.6 . The relationship between a normal distribution and a control chart.
FIGURE 5.7 . Balancing the risk.
FIGURE 5.8 . Dividing a control chart into zones.
FIGURE 5.9 . Control chart decision tree.
FIGURE 6.1 . Net operating margin for Hospital A.
FIGURE 6.2 . Net operating margin for Hospital B.
FIGURE 6.3 . CBC turnaround time.
FIGURE 6.4 . Speed of ambulation for physical therapy patients before therapy treatments.
FIGURE 6.5 . Speed of ambulation for physical therapy patients after therapy treatments.
FIGURE 6.6 . Days to mail a patient invoice.
FIGURE 6.7 . ICU admission time for open heart surgery patients.
FIGURE 6.8 . ICU admission time before and after the process was standardized.
FIGURE 6.9 . ICU admission time before and after March intervention.
FIGURE 6.10 . ICU admission time in April.
FIGURE 6.11 . Total time from ER to in bed on the unit.
FIGURE 6.12 . Time from ER call to bed assigned.
FIGURE 6.13 . Time from bed assigned to patient in bed.
FIGURE 6.14 . Platelet count.
FIGURE 6.15 . Proportion of primary C-sections.
FIGURE 6.16 . Proportion of excellent ratings of overall quality.
FIGURE 6.17 . Inpatient falls before and after the introduction of a falls prevention program.
FIGURE 6.18 . Inpatient falls after the introduction of a falls prevention program.
FIGURE 6.19 . Use of restraints with psychiatric patients.
FIGURE 6.20 . Follow up: Use of restraints with psychiatric patients.
FIGURE 6.21 . Medication error rate for the new director.
FIGURE 6.22 . Medication error rate for the past 20 weeks.
FIGURE 7.1 . Appropriate management response to common and special causes of variation.
FIGURE 7.2 . Process improvement flowchart.
FIGURE 7.3 . The relationship between a KQC and its KPVs.
FIGURE 7.4 . KQC improvement strategy.
FIGURE 7.5 . Total IV medication errors.
FIGURE 7.6 . Type of IV medication errors.
FIGURE 7.7 . IV medication errors: incorrect dose.
FIGURE 7.8 . ER bed transfer cause-and-effect diagram.
FIGURE 8.1 . Relating the voice of the customer to the voice of the process.
FIGURE 8.2 . Selecting the appropriate data collection method.
FIGURE 8.3 . Sample report page from an enumerative study of inpatients.
FIGURE 8.4 . Physician care subscales for eight quarters.
List of Tables
TABLE 2.1 . Examples of Key Quality Characteristics (KQCs)
TABLE 3.1 . Trauma Measurement Team: Data Collection Plan
TABLE 4.1 . Patient Wait Time
TABLE 5.1 . The Choice of a Control Chart Depends on the Problem and How It Is Structured
TABLE 6.1 . Financial Report to the Board of Trustees
TABLE 6.2 . Net Operating Margin
TABLE 6.3 . C-Section Data
Foreword
On January 1, 1993, I had the distinct privilege and honor of attending a New Year s Day reception at the home of my friend and colleague, R. Clifton Bailey of the Health Care Financing Administration. In attendance for what would be his last New Year s Day was W. Edwards Deming. At the reception, upon recognizing that a number of us were working in healthcare quality, Deming remarked that healthcare is a system in need of improvement. None of us disagreed. A fascinating discussion ensued. Regrettably, Dr. Deming died on December 20,1993, at age 93, but his legacy and teachings live on.
Statisticians are very familiar with the concepts of measurement and statistical process control (SPC), and have been applying them in the industry for decades. However, prior to the mid-1980s, measurement and SPC had not been extensively applied in the healthcare setting. Quality measurement and management systems based heavily upon the application of measurement, SPC, and the teachings of Deming and other quality experts, have since been developed in individual hospitals and hospital systems. Although a wide variety of statistical and quality management techniques have been applied, the simpler techniques, such as descriptive measures, graphical displays, control charts, and survey methods have been best received, understood, and used.
Now quality reform has expanded into the managed care world. In particular, performance measurement in managed care is increasingly employing statistical concepts and approaches for quality improvement. Managed care organizations are now increasingly embracing and applying these quantitative methods in quality management.
The healthcare system, as Dr. Deming observed, needs improvement. Real healthcare reform must have quality improvement as its foundation. Comprehensive, systematic quality