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Quality and Performance Improvement in Healthcare: Theory, Practice, and Management
Seventh Edition
Chapter 3
Identifying Improvement Opportunities Based on Performance Measure
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Objectives
Demonstrate how the principal aspects of healthcare are targeted for performance measurement
Assess the significance of outcomes and proactive risk reduction in performance improvement methodology
Apply brainstorming and the nominal group technique to performance improvement activities
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            Focus of Healthcare QI Philosophies
            Systems: The foundations of care giving
            Buildings
            Equipment
            Professional staff
            Appropriate policies 
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            Focus of Healthcare QI Philosophies
            Processes: Interrelated activities in healthcare organizations, which promote effective and safe patient outcomes across services and disciplines within an integrated environment
            Outcomes: The final results of care, treatment, and services in terms of the patient’s expectations, needs, and quality of life, which may be positive and appropriate or negative and diminishing 
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            Continuous Improvement Monitoring: Steps to Success
            Step 1—Identify performance measures
            Step 2—Identify the customers for each monitored process
            Step 3—Identify customers’ actual requirements with respect to the outcomes
            Step 4—The organization asks whether the outcomes of the current process actually meet the customers’ requirements
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            The Organization Identifies Its Performance Measures
            Process measure: Focuses on a process that leads to a certain outcome
            Outcome measure: Indicates the result of the performance of a function or process
            Benchmarking: Systematic comparison of the products, services, and outcomes of one organization with those of a similar organization
            Sentinel events: Significant injury to or the death of a patient or employee through avoidable causes
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            The Organization Identifies the Customers for Each Monitored Process
            Who is the receiver of the organization’s outcome or end product
            Internal customers: Individuals within the organization or department who receive products or services from an organizational unit or department
            External customers: Individuals from outside the organization or department who receive products or services from within the organization
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            Customers’ Actual Requirements Are Identified
            Factors most valued by the customer
            Examples:
            Good-tasting food at the right temperature
            Charts available for physician completion
            Qualified clinical staff
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            Are Our End Products Actually Meeting Customer Requirements?
            If yes, then no PI activities need to be performed
            If no, then a PI team may be formed to examine the process in greater detail, or
            An educational program may be developed to fine-tune organization members
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            QI Toolbox Techniques
            Brainstorming
            Affinity diagrams
            Nominal group technique
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            Registration for Day Surgery
            Step 1: Performance measure
            Registration information provided and surgery scheduled by physician’s office
            Preoperative workup completed
            Step 2: Customers for monitored process
            Patient and patient’s family
            Physician and office staff
            Surgery staff
            Registration staff
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            Registration for Day Surgery (continued)
            Step 3: Customers’ actual requirements
            One-time communication of registration information
            Preoperative workup completed before surgery and coordinated in one visit
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            Registration for Day Surgery (continued)
            Step 4: Customers’ requirements met
            Patient satisfaction surveys showed only 76% satisfaction with same-day surgery registration and preoperative workup processes
            Registration staff and physician office staff were hearing complaints from patients that registration process was cumbersome and not user-friendly
            Duplicate data collection occurred between physician’s office registration and same-day surgery registration
        © 2019 AHIMA
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Quality and Performance Improvement in Healthcare: Theory, Practice, and Management
Seventh Edition
Chapter 4
Using Teamwork in Performance Improvement
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© 20
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9 AHIMA
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Objectives
Demonstrate the effective use of teams in performance improvement activities
Compare and contrast the differences between the roles of the leader and the members in performance improvement teams
Illustrate the contributions that team charters, team roles, ground rules, listening, and questioning can make to improve the effectiveness of performance improvement teams
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            Three Approaches to Performance Improvement
            Rapid improvement team
            Disseminate information or develop an educational training program
            Develop a functional or cross-functional PI team
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            PI Team Composition
            Composition
            Which departments are involved in the process?
            Who are the customers of the process? Or, who will receive the product or service that the process produces?
            Who supplies the process? Or, who provides materials or services for use in the process under investigation?
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            PI Team Roles
            Leader
            Facilitator
            Member
            Recorder
            Timekeeper
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            PI Team Leader Activities
            Preparing for and scheduling meetings
            Sending out announcements of meetings and other necessary materials
            Conducting meetings
            Focusing the group’s attention on the task at hand
            Ensuring group participation and asking for facts, opinions, and suggestions
            Providing expertise in the organization’s PI methodology and PI tools and techniques
            Coordinating data collection
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            PI Team Leader Activities (continued)
            Assigning tasks
            Facilitating implementation of action plan items
            Critiquing the meetings
            Serving as the primary spokesperson and presenter for the team
            Keeping attendance records
            Contacting absent members personally to review the results of the meeting and provide any materials that were distributed during the meeting
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            PI Team Facilitator Activities
            Serving as advisor and consultant to team
            Acting as a neutral, nonvoting member
            Suggesting alternative PI methods or procedures to keep the team on target
            Managing group dynamics, resolving conflicts, modeling compromise
            Acting as coach and motivator for the team
            Assisting in consensus building when necessary
            Recognizing team and individual achievements
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            PI Team Member Activities
            Participating in decision making and plan development for the team
            Identifying opportunities for improvement
            Gathering, prioritizing, and analyzing data
            Sharing knowledge, information, and data that pertain to the process being investigated
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            PI Team Recorder Activities
            Recording information for the group
            Creating appropriate charts and diagrams
            Assisting with notices and supplies for meetings
            Distributing notices and other documentation to team members
            Developing meeting minutes
            Producing an agenda for new meetings with assignments for team members from the previous meeting
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            PI Team Timekeeper Activities
            Helps the team manage its time
            Notifies team during meetings of time remaining on each agenda item 
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Team Charters
            Explain what issues the team was implemented to address
            Describe the goal or vision
            List the initial members of the team and their respective departments
            Helpful to keep the team’s objective in focus
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            Mission Statements
            Organization-wide or team-based
            Should answer the following questions:
            What process is to be improved?
            For whom is the process performed?
            What products does the process produce?
            What is not working with the current process?
            How well must the process function?
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Sample Mission Statement
Evaluate hospital laboratory services for patients with regard to safety issues, error-reduction processes, and delivery of services while maintaining 94 percent compliance with these services.
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            Vision Statements
            A description of the ideal end-state
            A description of the way the process should function
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            Sample Vision Statement
            Safe and timely laboratory services are provided 98 percent of the time.
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            Ground Rules
            Ground rules are basic expectations for team members and include a discussion of:
            Attendance
            Time management
            Participation
            Communication
            Decision-making
            Documentation
            Room arrangements
            Clean up
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            Problem-Solving Techniques
            Inclusive: Gather all viewpoints and consider each
            Exclusive: Get a result as quickly as possible
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            Effective Team Objectives
            Establish goals cooperatively with all members participating
            Communicate in a two-way mode
            Value open expression of both ideas and feelings as important perspectives on organizational issues
            Distribute leadership and responsibility among all team members
            Distribute power among all team members
            Match decision-making techniques to the type of decision-making situations
            View periodic controversy and conflict among team members as a positive aspect of team growth
            Focus on the issues for which they have been organized to address
            Be cost-conscious in their PI efforts
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            QI Toolbox Technique: Agenda
            Lists the tasks to be accomplished during a meeting
            Ensures that every team member knows what items will be discussed or worked on
            Should be sent to all team members before the meeting
            This allows them to prepare ahead of time to discuss specific agenda items
            Should include an indication of how long the team will spend on each item
            Setting time frames for agenda items helps the team leader to keep the group focused on the process and moving forward
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            Continuum of Care Team Example
            Team leader: Emergency department intake coordinator
            Team members: Representatives from the business office, health information services, administration, utilization review, and finance
            Ad hoc members: Representatives from regulatory affairs, reception, nursing, case management, and an emergency department physician
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            Continuum of Care Team Example (continued)
            Mission Statement:
            Evaluate the emergency department’s clinical assessment process in regard to patient privacy, data collection, and staff communication while maintaining 95 percent patient and employee satisfaction with this process.
            Vision Statement:
            Design a centralized clinical assessment center to facilitate patient privacy, data collection, and staff communication
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