Health Care Quality Management: Tools and Applications

Health Care Quality Management: Tools and Applications In todays challenging health care environment, health care organizations are faced with improving patient outcomes, redesigning business processes, and executing quality and risk management initiatives. Health Care Quality Management offers an introduction to the field and practice of quality management and reveals the best practices and strategies health care organizations can adopt to improve patient outcomes and program quality. Health Care Quality Management is filled with illustrative case studies that show how business processes can be restructured to achieve improvements in quality, risk reduction, and other key business results and outcomes. The book clearly demonstrates how to effectively use process analysis tools to identify issues and causes, select corrective actions, and monitor implemented solutions. The author includes vital information on the use of statistical process control to monitor system performance (variables) and outcomes (attributes). The book also contains multiple data sets that can be used to practice the skills and tools discussed and reviews examples of where and how the tools have been applied in health care. In addition, the author includes information on root cause analysis and failure mode effects analysis and offers, as discussion, the clinical tools and applications that are used to improve patient care.

Figures and Tables  xi Preface  xix The Author xxvi Part 1: The State of Quality Management in Health Care Chapter 1 Quality in Health Care 3 Introduction  3 The Goal of Quality Management  5 Quality Pioneers in Health Care 12 Requisite Skills for Improving Health Care 19 Quality Control in Industry 23 System Thinking 27 Summary  33 References  35 Chapter 2 Error and Variation 37 Introduction  37 The Medical Decision–Making Process 37 Human Error and James Reason 40 Small Area Variations and John Wennberg 43 Practice Guidelines and Brent James 49 The Structure–Process–Outcome Paradigm 50 The Three Faces of Quality 51 Underuse, Overuse, and Misuse 55 Controlling Variation and Improving Outcomes 57 Summary  58 References  60 Chapter 3 Regulating the Quality and Quantity of Health Care 63 Introduction   63 Licensure, Accreditation, and Credentialing 65 Malpractice   71 The Economics of Health Care Markets 73 A Brief History of Health Care Financing in the United States 88 Pay for Performance and the CMS Quality Initiative 102 Summary  105 References  108 Part 2: Quality Management Tools Chapter 4 Process Analysis Tools 113 Introduction 113 Tools to Identify Problems 116 Tools to Identify Causes 137 Tools to Identify Solutions 146 Tool to Monitor Progress 152 Summary  155 References  159 Chapter 5 Root Cause Analysis 161 Introduction 161 Root Cause Analysis 162 Single–Event Analysis 178 Multiple–Event Analysis 189 Prevention and Recovery 199 Cases and Applications 205 Summary  212 References  214 Chapter 6 Statistical Process Control for Monitoring System Performance  217 Introduction  217 Statistics Review 220 Types of Variation 226 Setting Performance Targets 228 Statistical Process Control for Continuous Data: X − and R Charts 231 Tinkering  255 Cases and Applications 257 Summary  261 References  264 Chapter 7 Statistical Process Control for Monitoring Failure Rates  265 Introduction  265 Statistical Process Control for Binomial Data: p and np Charts 266 Establishing Valid Control Limits 282 Constant and Variable Control Limits 284 Rebasing Control Limits and Monitoring Changes over Time 287 Cases and Applications 290 Improving Performance Using SPC 295 Summary  296 References  299 Chapter 8 Statistical Process Control for Monitoring Nonconformities  301 Introduction  301 Statistical Process Control for Counts: c and u Charts  302 Medicare Hospital Quality Initiative Example 312 Cases and Applications 317 Selecting a Control Chart 321 Benefits of SPC  323 Inhibitors of the Use of SPC 325 Summary  329 References  332 Chapter 9 Exploring Quality Issues with Statistical Tools 333 Introduction 333 Chi–Square Analysis 335 Analysis of Variance 344 Analysis of Means 350 Regression Analysis354 Quality Improvement and Research 362 Summary  365 References  370 Chapter 10 Failure Mode and Effects Analysis 373 Introduction 373 General System Theory 374 The Value Chain 383 Failure Mode and Eff ects Analysis 386 Designing Better Systems 398 Summary  403 References  406 Part 3: Medical Practice Management Chapter 11 Practice Policies 411 Introduction 411 Practice Policies  413 Computer Decision Support427 Cases and Applications 428 Summary  432 References  434 Chapter 12 Case, Disease, and Outcomes Management 437 Introduction 437 Case Management 440 Disease Management 449 Outcomes Management 463 Summary  468 References  470 Chapter 13 Profiling, Economic Credentialing, and Risk Adjustment  473 Introduction 473 Physician Profiling and Report Cards 476 Academic Detailing 485 Economic Credentialing 488 Risk Adjustment 490 Summary  505 References  507 Chapter 14 Benchmarking and Implementation 511 Introduction 511 Benchmarking and Best Practice 512 Balanced Scorecards 523 Dashboards 531 Implementation Strategies 537 Summary  542 References  544 Chapter 15 The Future of Quality Management in Health Care 547 Introduction 547 Bringing It All Together 549 Value and What an Employee (or Manager) Should Do 558 The Future of Health Care and Quality Management 561 Summary  564 References  566 Index  567

Thomas K. Ross, PhD, is assistant professor of health services and information management in College of Allied Health Sciences at East Carolina University, Greenville, North Carolina.