Quality Improvement in A Physician Performance & Safety DIscussion

Quality Improvement in A Physician Performance & Safety DIscussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Quality Improvement in A Physician Performance & Safety DIscussion 1. What challanges may qualify improvement committee encounter when attempting to measure physician. performance? Quality Improvement in A Physician Performance & Safety DIscussion 2.Describe the relationship between continous quality improvement and physician profiling. 3. Describe the strenghths and weakness of the profiles discussed in Chapter 7. attachment_1 “Some of the best minds in healthcare” Nancy M. Schlichting, President and CEO, Henry Ford Health System (from the foreword) THE HEALTHCARE QUALITY BOOK sed Revi and ated Upd SECOND EDITION VISION, STRATEGY, AND TOOLS Elizabeth R. Ransom, Maulik S. Joshi, David B. Nash, and Scott B.

Ransom, Editors THE HEALTHCARE QUALITY BOOK SECOND EDITION AUPHA HAP Editorial Board Sandra Potthoff, Ph.D., Chair University of Minnesota Simone Cummings, Ph.D. Washington University Sherril B. Gelmon, Dr.P.H., FACHE Portland State University Thomas E. Getzen, Ph.D. Temple University Barry Greene, Ph.D. University of Iowa Richard S. Kurz, Ph.D. Saint Louis University Sarah B. Laditka, Ph.D. University of South Carolina Tim McBride, Ph.D. St. Louis University Stephen S. Mick, Ph.D. Virginia Commonwealth University Michael A. Morrisey, Ph.D. University of Alabama—Birmingham Dawn Oetjen, Ph.D. University of Central Florida Peter C. Olden, Ph.D. University of Scranton Lydia M. Reed AUPHA Sharon B. Schweikhart, Ph.D. The Ohio State University Nancy H. Shanks, Ph.D. Metropolitan State College of Denver THE HEALTHCARE QUALITY BOOK SECOND EDITION VISION, STRATEGY, AND TOOLS Elizabeth R. Ransom, Maulik S. Joshi, David B. Nash, and Scott B. Ransom, Editors Health Administration Press, Chicago AUPHA Press, Washington, DC Your board, staff, or clients may also benefit from this book’s insight. For more information on quantity discounts, contact the Health Administration Press Marketing Manager at (312) 4249470.

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This publication is intended to provide accurate and authoritative information in regard to the subject matter covered. It is sold, or otherwise provided, with the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. The statements and opinions contained in this book are strictly those of the author(s) and do not represent the official positions of the American College of Healthcare Executives, of the Foundation of the American College of Healthcare Executives, or of the Association of University Programs in Health Administration. Copyright © 2008 by the Foundation of the American College of Healthcare Executives. Printed in the United States of America. All rights reserved. This book or parts thereof may not be reproduced in any form without written permission of the publisher. 12 11 10 09 08 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data The healthcare quality book : vision, strategy, and tools / [edited by] Elizabeth R. Ransom … [et al.].—2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-56793-301-7 (alk. paper) 1. Medical care—United States—Quality control. 2. Health services administration— United States—Quality control. 3.

Total quality management—United States. I. Ransom, Elizabeth R. [DNLM: 1. Quality of Health Care—organization & administration—United States. 2. Health Services Administration—United States. 3. Total Quality Management—organization & administration—United States. W 84 AA1 H443 2008] RA399.A3H433 2008 362.11068—dc22 2008017268 The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences-Permanence of Paper for Printed Library Materials, ANSI Z39.48-1984. ?™ Project manager: Jennifer Seibert; Acquisitions editor: Audrey Kaufman; Book designer: Scott R. Miller. Health Administration Press A division of the Foundation of the American College of Healthcare Executives One North Franklin Street Suite 1700 Chicago, IL 60606 (312) 424-2800 Association of University Programs in Health Administration 2000 14th Street North Suite 780 Arlington, VA 22201 (703) 894-0940 CONTENTS IN BRIEF FOREWORD ………………………………………………………………………………….xiii PREFACE………………………………………………………………………………………xv III Science and Knowledge Foundation 1 Healthcare Quality and the Patient, by Maulik S. Joshi and Donald Berwick………………………………………………………………….

3 2 Basic Concepts of Healthcare Quality, by Leon Wyszewianski ………………………………………………………………………………………25 3 Variation in Medical Practice and Implications for Quality, by David J. Ballard, Robert S. Hopkins III, and David Nicewander ………………………………………………………………………………………43 4 Quality Improvement: The Foundation, Processes, Tools, and Knowledge Transfer Techniques, by Kevin Warren ………………..63 III Organization and Microsystem 5 Milestones in the Quality Measurement Journey, by Robert C. Lloyd ……………………………………………………………….87 6 Data Collection, by John J. Byrnes ……………………………………109 7 Statistical Tools for Quality Improvement, by Jerod M. Loeb, Stephen Schmaltz, Linda S. Hanold, and Richard G. Koss ……131 8 Physician and Provider Profiling, by David B. Nash, Adam Evans, and Richard Jacoby …………………………………………………………169 9 Measuring and Improving Patient Experiences of Care, by Susan Edgman-Levitan …………………………………………………….187 10 Dashboards and Scorecards: Tools for Creating Alignment, by Michael D. Pugh …………………………………………………………….217 v vi Contents in Brief 11 Patient Safety and Medical Errors, by Frances A. Griffin and Carol Haraden ………………………………………………………………..243 12 Information Technology Applications for Improved Quality, by Richard E. Ward ……………………………………………………………..269 13 Leadership for Quality, by James L. Reinertsen …………………..311 14 Organizational Quality Infrastructure: How Does an Organization Staff Quality?, by A. Al-Assaf…………………………331 15 Implementing Quality as the Core Organizational Strategy, by Scott B. Ransom, Thomas J. Fairchild, and Elizabeth R. Ransom …………………………………………………………………………………….349 16 Implementing Healthcare Quality Improvement: Changing Clinician Behavior, by Valerie Weber and John Bulger …………377 IIII Environment 17 The Quality Improvement Landscape, by Jean Johnson, Ellen Dawson, and Kimberly Acquaviva ……………………………..407 18 Accreditation:

Its Role in Driving Accountability in Healthcare, by Greg Pawlson and Paul Schyve ……………………………………..433 19 How Purchasers Select and Pay for Quality, by Francois de Brantes …………………………………………………………457 INDEX ………………………………………………………………………………………475 ABOUT THE AUTHORS …………………………………………………………………….491 DETAILED CONTENTS FOREWORD ………………………………………………………………………………….xiii PREFACE ……………………………………………………………………………………..Quality Improvement in A Physician Performance & Safety DIscussion xv III Science and Knowledge Foundation 1 Healthcare Quality and the Patient, by Maulik S. Joshi and Donald Berwick………………………………………………………………….3 Important Reports………………………………………………………………4 A Focus on the Patient ………………………………………………………..6 Lessons Learned in Quality Improvement………………………………7 Case Study ……………………………………………………………………….17 Conclusion ………………………………………………………………………21 Study Questions ……………………………………………………………….22 Notes ………………………………………………………………………………22 References ……………………………………………………………………….23 2 Basic Concepts of Healthcare Quality, by Leon Wyszewianski…25 Definition-Related Concepts ………………………………………………25 Measurement-Related Concepts………………………………………….33 Implications ……………………………………………………………………..39 Study Questions ……………………………………………………………….39 Note ……………………………………………………………………………….40 References ……………………………………………………………………….40 3 Variation in Medical Practice and Implications for Quality, by David J. Ballard, Robert S. Hopkins III, and David Nicewander ………………………………………………………43 Background and Terminology …………………………………………….45 Scope and Use of Variation in Healthcare …………………………….47 Clinical and Operational Issues …………………………………………..48 Keys to Successful Implementation and Lessons Learned from Failures ……………………………………………………………………..51 Case Study ……………………………………………………………………….53 Conclusion ………………………………………………………………………56 Study Questions ……………………………………………………………….56 References ……………………………………………………………………….59 vii viii Detailed Contents 4 Quality Improvement: The Foundation, Processes, Tools, and Knowledge Transfer Techniques, by Kevin Warren ………………..63 The Quality Foundation…………………………………………………….63 Quality Improvement Processes and Approaches …………………..67 Quality Tools……………………………………………………………………73 Knowledge Transfer and Spread Techniques …………………………76 Conclusion ………………………………………………………………………81 Study Questions ……………………………………………………………….81 Note ……………………………………………………………………………….82 References ……………………………………………………………………….82 III Organization and Microsystem 5 Milestones in the Quality Measurement Journey, by Robert C. Lloyd ……………………………………………………………….87 The Measurement Challenge………………………………………………88 Milestones Along the Quality Measurement Journey……………..88 Conclusion …………………………………………………………………….105 Study Questions ……………………………………………………………..105 Notes …………………………………………………………………………….105 References ……………………………………………………………………..106 6 Data Collection, by John J. Byrnes ……………………………………109 Categories of Data…………………………………………………………..109 Considerations in Data Collection …………………………………….109 Sources of Data ………………………………………………………………112 Case Study in Clinical Reporting ………………………………………123 Conclusion …………………………………………………………………….127 Study Questions ……………………………………………………………..127 Acknowledgments …………………………………………………………..127 Notes …………………………………………………………………………….128 References ……………………………………………………………………..129 Suggested Reading ………………………………………………………….129 7 Statistical Tools for Quality Improvement, by Jerod M. Loeb, Stephen Schmaltz, Linda S. Hanold, and Richard G. Koss ………..131 Fundamentals of Performance Measurement ………………………131 Control Chart Analysis …………………………………………………….Quality Improvement in A Physician Performance & Safety DIscussion 138 Comparison Chart Analysis ………………………………………………142 Using Data for Performance Improvement …………………………147 Conclusion …………………………………………………………………….149 Study Questions ……………………………………………………………..150 Appendix 1: Control Chart Formulas ………………………………..150 Detailed Contents Appendix 2: Comparison Chart Formulas…………………………..154 Appendix 3: Case Studies …………………………………………………158 Notes …………………………………………………………………………….166 References ……………………………………………………………………..166 8 Physician and Provider Profiling, by David B. Nash, Adam Evans, and Richard Jacoby …………………………………………………………169 Background and Terminology …………………………………………..169 Scope and Use of Profiling in Healthcare …………………………..171 Keys to Successful Implementation and Lessons Learned ……..178 Case Study ……………………………………………………………………..179 Study Questions ……………………………………………………………..183 References ……………………………………………………………………..184 9 Measuring and Improving Patient Experiences of Care, by Susan Edgman-Levitan …………………………………………………….187 Regulatory and Federal Patient Survey Initiatives………………..188 Using Patient Feedback for Quality Improvement……………….190 Scope and Use of Patient Experiences in Healthcare ……………197 Keys to Successful Implementation …………………………………..204 Lessons Learned, or “The Roads Not to Take” …………………..206 Case Study ……………………………………………………………………..210 Conclusion …………………………………………………………………….212 Study Questions ……………………………………………………………..212 Notes …………………………………………………………………………….212 References ……………………………………………………………………..213 Other Useful Resources……………………………………………………214 10 Dashboards and Scorecards: Tools for Creating Alignment, by Michael D. Pugh …………………………………………………………….217 Background and Terminology …………………………………………..217 Scope and Use of Dashboards and Scorecards in Healthcare …219 Clinical and Operational Issues …………………………………………225 Keys to Successful Implementation and Lessons Learned ……..230 Case Study: St. Joseph Hospital ………………………………………..236 Conclusion …………………………………………………………………….238 Study Questions ……………………………………………………………..241 Notes …………………………………………………………………………….242 References ……………………………………………………………………..242 11 Patient Safety and Medical Errors, by Frances A. Griffin and Carol Haraden ………………………………………………………………..243 Background and Terminology …………………………………………..243 Scope and Use in Healthcare Organizations ……………………….247 ix x Detailed Contents Clinical and Operational Issues …………………………………………258 Case Study: OSF Healthcare System ………………………………….Quality Improvement in A Physician Performance & Safety DIscussion 261 Conclusion …………………………………………………………………….266 Study Questions ……………………………………………………………..267 References ……………………………………………………………………..267 12 Information Technology Applications for Improved Quality, by Richard E. Ward ……………………………………………………………..269 Background and Terminology …………………………………………..269 Taking a Lesson from Other Industries………………………………272 The Emerging Field of Medical Informatics ……………………….274 Two Tiers of Clinical Information Technologies………………….274 Technologies for Different Types of Clinical Care Management Initiatives ……………………………………………..278 Requirements and Architecture Framework for Clinical Information Technology…………………………………………….279 Workflow Automation Technology Applied to Clinical Processes………………………………………………………284 Other Clinical Information Technology Components ………….286 Information Needed for Practice Improvement on a National Level…………………………………………………………..289 Case Examples ………………………………………………………………..291 Overall Return on Investment of Clinical Information Systems ………………………………………………….295 Key Strategy Debates……………………………………………………….301 The Challenge ………………………………………………………………..306 Study Questions ……………………………………………………………..309 References ……………………………………………………………………..309 13 Leadership for Quality, by James L. Reinertsen …………………..311 Background ……………………………………………………………………311 Scope and Use of Leadership Concepts in Healthcare ………….315 Clinical and Operational Issues …………………………………………319 Keys to Successful Quality Leadership and Lessons Learned …320 Case Study of Leadership: Interview with William Rupp, MD ……………………………………………………322 Conclusion …………………………………………………………………….327 Study Questions ……………………………………………………………..327 Notes …………………………………………………………………………….327 References ……………………………………………………………………..328 14 Organizational Quality Infrastructure: How Does an Organization Staff Quality?, by A. Al-Assaf…………………………331 Quality Assurance, Quality Improvement, Quality Control, and Detailed Contents Total Quality Management…………………………………………331 Management Commitment ………………………………………………332 Allocation of Resources ………………………………………. … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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