Defining Quality

Defining Quality2013 Albuquerque Area Dental Chiefs/PreventionCoordinators Meeting

June 05, 2013

Kristina Rogers, MMI, CPCJohn M. Shutze, MPH, CQIA

Learning Objectives

• Define Quality

• Identify Approaches to Quality

• Identify Types of Measures for Quality

Defining Quality Quality Philosophies & Definitions

Approaches to Quality

Picking Appropriate Quality Measures

Activity

• Draw An Image Of Quality–First Thing That Comes To Mind

• 5 Minutes Total To Complete This Exercise

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What Is Quality? Quality Philosophies

Definitions of Quality

Quality PhilosophiesQuality Guru

1. W.E. Deming

2. Joseph Juran

3. Philip Crosby

View of Quality

1. It’s Up To Management

2. It’s Not Accidental

3. Quality Vaccine

Common Definitions

I’ll Know It When I See It

Fitness For Use

Conformance to Requirements

What Is Quality?

• Know It When I See It

• Fitness for Use

• Conformance to Requirements

• Meeting Customer Expectations

• Exceeding Customer Expectations

• Superiority to Competitors

• Safe

• Effective

• Patient-Centered

• Timely

• Efficient

• Equitable

Approaches To Quality IHI/PDSA

Lean

Six Sigma

Accreditation

IHI/Model for Improvement

PDSA Cycles

• Increase Belief Change Will Result in Improvement

• Small Tests = Small Risk

• Rapid Cycle Testing = Quick Feedback

• Multiple Cycles = Iterative Learning

• List of Changes & Outcomes for an Improvement Process

LeanEliminating Waste & The Pursuit of Perfection

What Is Lean?• Toyota Production System• Reduce Waste (muda)• Change for the Better

(kaizen)• More Customer Value• Pursue Perfection

Six SigmaEliminating Errors & Improving The Bottom-Line

What Is Six Sigma?• Motorola• Fact-Based, Data Driven• Defect

Reduction/Prevention• Customer Centered• Bottom-Line Results• Project Based

AccreditationJoint CommissionPatient-Centered Medical Home

Accreditation to Drive Quality

• Systems Approach• Set of Standards• Provides Direction• Helps Build Capacity

Summary of Approaches

Focus Methodology

IHI/PDSA Set Aims, Establish Measures & Test Changes PDSA

Lean Eliminate Waste Gemba, 5-S, Value Stream Map

Six Sigma Reduce Variation DMAIC

Lean Sigma

Increase Speed & Reduce Variation Six Sigma, Lean

Approaches & ToolsIHI Lean Six Sigma

Process AnalysisProcess Flowchart X XSpaghetti Diagram XCause Analysis5-Whys XFishbone Diagram X X XData Collection & AnalysisCheck Sheet X XPareto Chart X XScatter Plot/Diagram XHistogram XRun Chart X XControl Chart X X* Additional tools are available for each approach. The primary references used for this toolkit include

the Institute for Healthcare Improvement (IHI) and the American Society for Quality (ASQ). Lean Sigma uses a combination of tools from both the lean and six sigma.

Picking Quality Measures Uses of Measures

Types of Measures

Developing Measures

Uses of Quality Measures

Quality Measure

s

Improvement

ResearchAccountabilit

y


Improvement Research Accountability

Purpose Practice New Knowledge

Discover New Knowledge

Evaluating, Judging

Performance





Evaluating, Judging

Performance

Tests Many Sequential, Observable

One Large Test

No Test, Evaluate Current

Performance





Evaluating, Judging

Performance


One Large Test


Performance

Data“Just Enough,”

Small Successive Samples

All Relevant, Available

Data

“Just In Case” Data, As Much As

Possible





Evaluating, Judging

Performance


One Large Test


Performance

Data“Just Enough,”

Small Successive Samples

All Relevant, Available

Data

“Just In Case” Data, As Much As

Possible

Duration Sequential Tests

Long Period To Get Results

No Tests

Types of MeasuresMeasure Type1. Structural

2. Process

3. Outcome

4. Balancing

Focus1. Infrastructure &

Capacity

2. Delivery of Care

3. Ultimate Goal

4. Different Perspectives

A Good Measure Is…

• Aligned With The Mission

• Important to Customers

• Actionable

• Accessible to People

More Tips…

• Plot Data Over Time

• Use Sampling

• Make It Routine

• Use Qualitative & Quantitative Data

The Details

Measure Number of Fluoride Applications for 0-5 year olds

Operational Definition

Sum of ADA Codes 1203, 1206, and V07.31

Baseline FY 2012 – 438Target FY 2013 – 25% increase to 548Owner John Doe, Dental HygienistData Source National Dental Data Mart

Frequency Quarterly

Actions Review current projects. Brainstorm ideas for improvement

Display Bar graph broken down by quarter, comparing current FY quarter to previous FY quarter

Questions?

ReferencesAssociates in Process Improvement (August, 2007). The improvement handbook: models, methods & tools for improvement. Version for : IHI Improvement Advisor Development Program.

Bauer, J.E., Duffy, G.L., Westcott, R.T. (2006). The quality improvement handbook (2nd ed.). Milwaukee, WI: American Society for Quality

Bialek, R., Duffy, G.L., Moran, J.W. (2009). The public health quality improvement handbook. Milwaukee, WI: American Society for Quality.

Duke, O. (Sept, 2008). Driven by metrics. Quality Progress. Milwaukee, WI: American Society for Quality.

National Quality Measures Clearinghouse. Tutorials on quality measure. Available at: www.qualitymeasures.ahrq.gov/tutorial/index.aspx

Defining Quality

Documents

Transcript of Defining Quality