Safety and Quality in Health Care 2020-
Measuring Healthcare
Sharon Campbell
2020
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Unit Review
Assignments
-Discussion Board
-Assignment 2
-Assignment 3
Tutorial catch up
Measuring Quality
Quality
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Why measure Quality?
• Accountability
• To identify areas for improvement
• To demonstrate improvements
• Can quality of care be defined?
• Do patients deserve to know what the results of those
measurements are?
Measuring Quality
• There are scientific ways to measure health care quality.
• These tools have mostly been used by health professionals.
• They use measures to review and improve the quality of care
they provide.
• A quality measure is information from a patient's record or an
operational process that is converted into a rate, percentage or time
that shows how well providers are taking care of their patients.
The Quality Cycle
Has the action Collection of data
improved the - ideas,
situation, do we complaints,
meet the compliments,
standards? surveys, audits,
MONITORING incidents,
FOLLOWUP
ACTIVITIES indicators
FEEDBACK
To all Staff
ACTION ASSESSMENT
Take steps to improve,
implement change, trials, Analyse data. See where any
rectify problems gaps or problems are in
system/processes.
Monitoring
• Performance or clinical indicators
• Questionnaires / Surveys
• Clinical/Peer Review
• Utilisation Review
• Criteria Audit
• Computer reports / routine statistics
• Exit interviews
• Rates / Trends
Assessment
• Assess the data collected
• Review results trends
• Do we need more data?
• Highlight problems that can be fixed
• Provide alternate solutions to the problems
Clinical Indicators
• A performance indicator developed
specifically to measure the outcome of
clinical care
• E.g. Number of patients having a
colonoscopy which results in a perforation
of the colon
• E.g. Number of patients with AMI who
receive thrombolytic therapy within one
hour of presentation to hospital
Clinical Review
• A formal process that evaluates the quality
and appropriateness of patient care by a
health practitioner
• E.g. KEMH Inquiry – review of all patients
with eclamptic seizures, Caesarean
hysterectomy, PPH requiring a transfusion,
maternal deaths
Criteria Audit
• A formal process of reviewing care or treatment against an
agreed set of standards and/or criteria
• E.g. Cholecystectomy admissions and standards set by the
Australian College of Surgeons
Evidence Based Medicine
• A scientific approach to the practice of medicine based on
clinically relevant information
• Review relevant current research of topics of interest e.g.
Cochrane collaboration
Risk Management
• A management strategy that monitors and addresses risks
to reduce the chance of incidents/harm or costs
• Incident Management System will provide data on trends
and high risk activities
Utilisation Review
• Activities associated with monitoring the
appropriate use of resources.
• E.g monitoring the necessity of medical
tests
• E.g. monitoring efficient usage of the
operating theatres
Consumer
Surveys/Questionnaires
• Asking patients/consumers to feedback on quality and
satisfaction with service
• Useful part of QI program
• Limitations
Quality Tools
• Identify problem areas
• Help to prioritise problems
• Assist to identify causes or contributing factors
• Generate alternate solutions
• Allow opportunities for improvement
Quality Tools
• Working with Ideas • Working with Numbers
– Brainstorming – Check sheets
– Cause and Effect – Control charts
– Affinity diagrams – Histogram
– Relationship diagrams – Pareto chart
– Flowcharts – Scatter chart
– Tree diagrams – Run chart
– Matrix diagrams
– Radar charts
Tools for Diagnosing
Problems
• Brainstorming
• Encourages creativity and
generates ideas
• Requires a group with a facilitator
• Can be structured or unstructured
• Can be written or verbal
Affinity Diagram
• Combining ideas into similar groups / themes
• Usually used after brainstorming
• Creates ‘headings’ of similarity
Multivoting
• A voting process that narrows a broad list of
ideas to those that are most important
• Used to narrow a list of ideas to the critical
few or those of highest priority
Nominal Group Technique
• Quickly identifies issues / problems
according to priority or importance
• Requires input from a group
• Usually follows brainstorming and affinity
processes
Cause & Effect Diagram
• Also known as ‘fishbone’ diagram
• Identifies and organises causes of an
observed problem
• Asks the question “why does this happen?”
• Summarising major causes under four
categories e.g. people, machines, methods,
materials or policies, procedures, people
and plant
Fiiishbone· Mapping
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Focus Groups
• Obtains information and qualitative data
from internal/external customers
• Allows you to hear from your customers –
often in depth
Things we are doing well Opportunities for improvement
Tools for Analysing Problems
Flow Charts
• Benefits:
– Promotes understanding of the processes
– Provides a tool for training
– Identify problem areas and improvement
opportunities
– Depicts customer – supplier relationships
Flow Charts
• A diagram illustrating a process or activity
• Helps identify redundancies, inefficiency
and misunderstandings
• Used when teams are identifying problems,
analysing problems for causes and planning
solutions
Flow Chart Symbols
Start / End
Process Step
Decision
Connector
Example
•
Histogram
• Displays frequencies or numbers of
different events – Bar Chart
• Shows distribution or spread of data
• Shows whether variation is symmetric or
skewed
Example
Pareto Chart
• Similar to a Histogram, except frequency is
in descending order
• Allows categorisation of occurrences and
focus by priority or important issues
• Based on 80 / 20 Rule – 80% of problems
are caused by only 20% of possible causes
• Generally gain more by tackling the tallest
bar first
Example
Check Sheets
• Collects information on How Often
something is occurring
• Simple and easy to use
• Set time period and sample size
• Tally individual data sheets
• Evaluate the data
Check Sheet
Type of Problem Count Total
Loose forms in record 1 1 1 1 4
Nursing section 11111111 8
not signed
Progress notes 11 2
not dated
Run Charts
• Graph of measurements made over time,
normally shown as a line graph
• Show levels of performance over time
• Monitors actions taken to improve
performance
• Identifies trends, movement away from
average
Example
Coded Records 2020
800
Average records
700 coded per month
600
500
No. of Records
400
300
200
100
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
Control Chart
• Run chart with the addition of:
– Upper and Lower Control Limits
– Statistically determined
– Provides for limits of allowed variability
• Also known as a Statistical Process Control
(SPC) Chart
• Aims to determine variability and reduce it
as much as economically possible
Example
Records Coded 2004
800
700
Averagerecords
coded per month
600
500
No. of Records
400
300
200
100
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
Tree Diagram
• Depicts a broad goal into detailed actions in
order to assist the team to achieve the stated
goals
• Action plans remain visibly linked to goals
• Actions flow logically from identified goals
• Helps understand the complexity of the
project
Force Field Analysis
• Also known as ‘barriers and aids analysis’
• Identifies factors that support or oppose the
proposed solution to a problem
Driving Forces Restraining Forces
(+ve) (-ve)
SUMMARY
• To improve quality of care you have to
measure it
• Monitoring activities help us to ensure over
time that quality patient care is being
provided
• Quality tools assist us to diagnose and
analyse problems and to identify where we
should put improvement efforts