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Case Introduction to Quality Assurance and Quality Management Methods

MHM 505 MOD 1 Case

Module 1 – Case
Introduction to Quality Assurance and Quality Management Methods
Assignment Overview
Please view these short videos:
Mark R. Chassin, M.D., FACP, M.P.P., M.P.H., President, The Joint Commission

A “Never” Event – Devastating Falls in a Hospital

Part 1:
You are attending a general meeting with management to discuss proposed changes in the Quality Assurance program secondary to a “never event” occurring in your organization [you can consider any never event offered by the AHRQ]. After the presentation and during a question and answer period, several nurses indicate that the “never event” occurred because of inadequate staffing. Several surgeons joined the nursing staff in these allegations.
1 What would your response be to their statements?
2 Discuss what a “never event” is.
3 Discuss what never event occurred that was discussed at this meeting. You must pick one never event.
4 Discuss how you would go about examining the validity of their statements.
5 What measures you would implement on an ongoing basis to prevent a recurrence of the “never event”.
Part 2:
In this module, you also learned about 4 approaches to quality assurance- TQM, CQI, Lean & Six Sigma.
1 Which of these approaches would lend to preventing a “never event”?

Assignment Expectations
Please support your position with adequate references in a 4-6 page paper (This does not include the title or reference page).
— Main Area End ——–
Module 1 – Background
Introduction to Quality Assurance and Quality Management Methods
Required Reading
Adams, G. W. (2015). Forensic Research.
Darbyshire, P., Ralph, N., & Caudle, H. (2015). Editorial: Nursing’s mandate to redefine the sentinel event. Journal of clinical nursing.
Gitlow, H., Zuo, Q., Ullmann, S. G., Zambrana, D., Campo, R. E., Lubarsky, D., & Birnbach, D. J. (2013). The cause of never events in hospitals. International Journal of Lean Six Sigma, 4, (3), p. 338.
Hurst, K. (2015). Editorial, Volume 28.4: Asking health and social care staff to go the extra QA mile. International Journal of Health Care Quality Assurance, 28(4).
Jebb, P., Esegbona-Adeigbe, S., Justice, S., & Crumbie, A. (2014). Never say never event: Should unsafe staffing in hospitals be classed as a ‘never event’? Nursing Standard, 28 (19), p28-29.
Lad, Pramod, M.,Dahl, Rebecca. (2013). An institutional review board-based clinical research quality assurance program. Accountability in Research, 20(1), 13-26.
Li-MacDonald, Bonnie X, Pyhtila, Jessica, Brandt, Nicole J. (2014). Medications and Falls: Addressing the Risk through Pharmacist-Led Quality Initiatives. Journal of Gerontological Nursing, 40(1) 8-12.
Lord, Sue. (2013) Are staffing levels adequate in your department: if not what are you doing about it? The Journal of Perioperative Practice, 23(6), 122.
Mehtsun, W. T., Ibrahim, A. M., Diener-West, M., Pronovost, P. J., & Makary, M. (2013) Surgical never events in the United States. Surgery. 153(4) 465.
Padhy, K. C. (2013). Total quality management: An overview. Srusti Management Review 6 (1) 119-124.
Pulakanam, V. (2012). Costs and savings of six sigma programs; An empirical study. The Quality Management Journal, 19(4), 39-54.
Schattenkirk, Dale. (2012) Building sustainable internal capacity for quality within a healthcare environment. TQM Journal, 24(4)374-382.
Storye, John. (2013). Factors affecting the adoption of quality assurance technologies in healthcare. Journal of Health Organization and Management, 27(4), 498-519
Agency for Health Care Research and Quality (n. d.). Never events. http://psnet.ahrq.gov/primer.aspx?primerID=3
— Main Area End ——–
Module 1 – Home
Introduction to Quality Assurance and Quality Management Methods
Modular Learning Outcomes
Upon successful completion of this module, the student will be able to satisfy the following outcomes:
Apply quality assurance concepts to “never events” in the health care setting.
Discuss and explain the history and the rationale supporting the need for quality assurance programs in the health care system.
Apply the principles of total quality management (TQM) and its relationship to quality assurance and Continuous Quality Improvement (CQI)
Module Overview
Understanding Healthcare Quality:
According to AHRQ (Agency for Healthcare Research and Quality)
Research has shown that science-based measures can be used to assess quality for various conditions and for specific types of care. For example, quality health care is:
Doing the right thing (getting the health care services you need).
In the right way (using the appropriate test or procedure).
To achieve the best possible results.
Providing quality health care also means striking the right balance of services by:
• Avoiding underuse (for example, not screening a person for high blood pressure.
• Avoiding overuse (for example, performing tests that a patient doesn’t need).
• Eliminating misuse (for example, providing medications that may have dangerous interactions).
The National Healthcare Quality Report and the National Healthcare Disparities Report present important information about the state of health care in America. These reports indicate that:
• Quality is improving in many areas, but change takes time.
• The gap between the best possible care and actual care remains large.
• Quality of care varies widely across the country.
• Continuing improvement in health care is possible.
Challenges in Healthcare
• In healthcare compliance, quality assurance programs serve as the middlemen between regulating authorities and the health care organizations. Consequently, quality assurance staff are commonly viewed as being the bearers of bad news, especially when it comes to enforcing new mandatory policies. Quality assurance staff may also experience barriers or challenges, such as being met with resistance when it comes to enforcing departments to create performance improvement projects. The bottom line is that quality assurance programs do not intend to create more work for the healthcare organization. They are just trying to monitor the compliance.
Quality assurance programs focus on implementing continuous quality improvement (CQI) throughout the organization. In order to understand how CQI works in an organization you must know the principles of total quality management (TQM) which forms the basis for a CQI program. The following are the 14 steps to TQM which are based on the work of Deming and Walton:
Based on his work with Japanese managers and others, Deming (1986; Walton, 1986) outlined 14 steps that managers in any type of organization can take to implement a total quality management program.
• Create constancy of purpose for improvement of product and service. Constancy of purpose requires innovation, investment in research and education, continuous improvement of product and service, maintenance of equipment, furniture and fixtures, and new aids to production.
• Adopt the new philosophy. Management must undergo a transformation and begin to believe in quality products and services.
• Cease dependence on mass inspection. Inspect products and services only enough to be able to identify ways to improve the process.
• End the practice of awarding business on price tag alone. The lowest priced goods are not always the highest quality; choose a supplier based on its record of improvement and then make a long-term commitment to it.
• Improve constantly and forever the system of product and service. Improvement is not a one-time effort; management is responsible for leading the organization into the practice of continual improvement in quality and productivity.
• Institute training and retraining. Workers need to know how to do their jobs correctly even if they need to learn new skills.
• Institute leadership. Leadership is the job of management. Managers have the responsibility to discover the barriers that prevent staff from taking pride in what they do. The staff will know what those barriers are.
• Drive out fear. People often fear reprisal if they “make waves” at work. Managers need to create an environment where workers can express concerns with confidence.
• Break down barriers between staff areas. Managers should promote teamwork by helping staff in different areas/departments work together. Fostering interrelationships among departments encourages higher quality decision-making.
• Eliminate slogans, exhortations, and targets for the workforce. Using slogans alone, without an investigation into the processes of the workplace, can be offensive to workers because they imply that a better job could be done. Managers need to learn real ways of motivating people in their organizations.
• Eliminate numerical quotas. Quotas impede quality more than any other working condition; they leave no room for improvement. Workers need the flexibility to give customers the level of service they need.
• Remove barriers to pride of workmanship. Give workers respect and feedback about how they are doing their jobs.
• Institute a vigorous program of education and retraining. With continuous improvement, job descriptions will change. As a result, employees need to be educated and retrained so they will be successful at new job responsibilities.
• Take action to accomplish the transformation. Management must work as a team to carry out the previous 13 steps.
The work of Deming and Walton was later modified by Mead and presented in the Table below. Notice that the essence of Deming’s work exists; however, it is modified to a greater extent and could be easily be applied to the healthcare setting.
Deming’s Principles of Total Quality Management (TQM)
Clarify your Concept
Define your mission/vision/goal — aim for constant improvement in the product or service you offer your clients. You cannot do this without maintaining a high level of motivation and satisfaction in the people that comprise your organization — consider that an aspect of your goal.
Realize your Concept
With clear vision and energetic motivation, make your concept a matter of daily practice:
• Have a long term, not short term profit orientation.
• Find, understand (the causes), and root out the 4 detriments (fear, jealousy, anger, revenge).
• Eliminate practices that undermine workers’ self / mutual respect and motivation (production quotas, sloganeering, sexist / racist expressions, favoritism / nepotism).
• Foster all chances for pride of workmanship and sharing in the improvement process.
System & Process Management [the Core of TQM Practice]
Study and understand in ever greater depth the process of production or service that you are delivering. Deming’s 85/15 rule: 85% of a worker’s effectiveness is determined by the system he works within, only 15% by his own skill. To break down your system into meaningful blocks for analysis, consider your “internal customers” of processes.
• Look at inputs from suppliers — when you understand the importance of quality and timeliness in your inputs, you will stop buying on low-bid only.
• Quantitative analysis of process — use Statistical Process Control, monitoring of critical variables, charting. Monitor before and after changes. Use Plan/Do/Check/Act cycle repeatedly.
• Monitor “outputs” throughout — when doing this, you can cease or de-emphasize end-point inspections. Refine the entire process; make everyone responsible.
Constant Learning
• Before hiring — rigorous pre-employment screening.
• Before working — rigorous pre-work training.
• Retrain on the job.
• Management must constantly learn from entire team as well as clients and competitors.
Teams and Leaders
All levels of the organization must be involved, starting with full commitment at the top. Eliminate organizational and physical barriers to teamwork. Eliminate performance ratings. Emphasize stability and constancy of effort — steady small gains rather than disruptive crash programs. Avoid unsettling changes without involving whole team. Involve suppliers, help them with Quality management. Involve your clients, get their feedback and ideas. Send your staff to both (suppliers and clients) to learn.
Reap the Rewards
Spread profits to workers as a team (but eliminate merit pay for short term performance). Enlist pride of workers in improving the system; empower people to take charge of work environment, safety issues, etc. Encourage pride of workmanship in delivering the product. Finally: spread what you have learned to the community.
Permissions: this document is Copyright ? A. Mead, 1996. It may be used for teaching purposes, or reprinted in any medium if proper attribution is given. Links from other Quality Management, CQI, or specific Deming-related sites are welcome.
As TQM became more popular and generally accepted by large corporations, variations of it became very common. Some of the variations were also very useful such as the “18 Cs of Quality Management”:
• Centrality: Quality is the heart of the job
• Commitment: Actions speak louder than words
• Consistency: Always hold steadfastly to the same principles
• Continuity: Stay the course; avoid stop-go
• Coherence: Clarity and harmony among ideas and actions
• Comprehensiveness: Cover all aspects in relevant detail
• Competence: Everyone must be trained and perform properly
• Conformance: Adhere to, and improve, care policies and processes
• Computation: Measure, provide feedback, monitor improvement
• Comparison: Judge your performance against what colleagues and competitors are achieving
• Credibility: Success must appear likely
• Communication: Tell everyone why quality matters and how to improve it
• Coordination: The left hand must know what the right hand is doing
• Collaboration: One for all and all for one
• Cooperation: The hospital is part of the larger health system
• Celebration: Success is not always its own reward
• Change: People like to change, when not being forced to change
• Cost: Quality management is a cost of doing business
Lean and Lean Six Sigma in Healthcare
Lean and Lean Six Sigma can be applied to health care settings once one knows how to apply the techniquest to patient care processes. Some authors argue that Lean and Six Sigma are the preferred approaches to quality improvement in health care.
• Lean Eliminate non-value-added activities and waste. Save time and money.
• Lean Six Sigma Increase patient satisfaction and reduce errors by improving your processes.

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