Quality Flashcards Preview

HMGT 6332 > Quality > Flashcards

Flashcards in Quality Deck (37):
1

3 core problems in healthcare

Access
Quality
Cost

2

Definition of access

Access is a measure of the “fit” between characteristics of providers and health services and characteristics and expectations of clients.

3

Five dimensions of access

Availability (adequacy of supply of physicians and facilities)
Accessibility (location wise)
Accommodation (manners, like systems, hours, service)
Affordability
Acceptability(satisfaction)

4

Number of Americans died because of healthcare

48 million in 2011

5

United States health expenditures in 2010

2.5 trillion and $8,402 per capital

6

Average US life expectancy and rank

Rank 27th, 78 years

7

Highest life expectancy country in the world

Japan 81 years( per capita expenditure half of the US)

8

Factors contributing to growth in costs

*The prevalence of chronic diseases(慢性病的流行)
*Changing nature of disease management(感染数量增加)
*Increasing complexity of healthcare (knowledge, technology, training systems, longer life spans)
*growth in demand for healthcare(population and longer life span)
*structural factors(为了更好的质量要走一步一步重复的程序和流程)
*shortage of healthcare providers
*administration and payroll costs(太多行政人员)
*uncompensated care(free healthcare)
*social factors(drug和酒精滥用,在healthcare上花钱越来越多,STDs,肥胖)

9

Factors contributing to poor quality

*Localized consumption
*Low elasticity of demand of healthcare(质量没有因为需求上去而跟上)
*Need for specialized knowledge by consumers(医疗知识太专业,病人无法分辨医疗质量的好坏)
*Non-discretionary nature of demand for healthcare(受伤发生得很偶然)
*market impecfactions

10

Need for quality in healthcare(提高质量的必要性)

*error(44000 Americans die b/c medical errors)
*variation(races&minorities, diseases, locations, institutions)
*usage(overuse, underuse, misuse)

11

Perfect market

*complete information sharing
*a lot of buyers and sellers
*no barrier to entry
*the product is not branded

12

Difference between lean and six sigma

Lean - cut waste
Six sigma - reduce variations

13

Who introduced six sigma

Bill Smith from Motorola in 1987

14

DMAIC (for existing process)

Define
Measure
Analyze
Improve
Control

15

DMADV (for new process)

Define
Measure
Analyze
Design
Verify

16

Hipporate and Galen

Theory of humor

17

William Harvey

1628 Discovery of circulation of blood

18

James Lind

1747 Discovery that citrus fruits prevent scurvy

19

Florence Nightingale

1855Hygiene

20

Ignza Semmelweis

1848 Washing hands after autopsies

21

The establishment of American medical Association

1847

22

Minimum standards

Launched in 1917
*Organizing hospital medical staff
* limiting staff membership to well-educated competent and a licensed physicians and surgeons
* framing rules and regulations to ensure regular staff meetings and clinical review
* Keeping medical records that included the history and physical examination and laboratory results and establishing supervise diagnostic and treatment facilities such as clinical laboratories in the radiology department

23

Joint commission on Accreditation of hospitals established

1951
Abandoned minimum standards in 1966

24

Difficulties in defining quality in healthcare

Problems of defining service
Scoop of the definition of quality (is it individual or public)
Quality of care for special population
Goal of care: longevity or quality
Presence of comorbidities(同时患有好几种疾病)
Patient preference
Inadequate knowledge of medical science

25

The definition of quality by Institute of medicine

The degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with current professional knowledge

26

The definition of quality by Institute of medicine is

* includes a measure of scale
* encompasses a wide range of elements of care
* identifies both individuals and populations as proper target for quality assurance efforts
* is go oriented
* recognize a stochastic attributeattribute of outcome but values expected net benefit
*Underscores the importance of Outcomes and links the process of healthcare with outcomes
* highlights importance of individual patient’s and society’s preferences and values
* emphasizes constraints on professional performance by medical science

27

Individual Measures of quality assurance

* professionalism
* accountability
* licensing
* certification and recertification
* accreditation
* hospital privileges
* critical pathways
* Report cards

28

Institutional forces for quality

* mandatory reporting of hospital errors
* voluntary reporting of hospital errors
* professional standards review organization (PSROs)
* Peer review organization
* Quality improvement organization
* consumer activism

29

The problem of report cards

* goal distortion(更多关注硬件设施)
* Cream-skimming(医生选择低风险的患者,而不是病危患者)
* complexity of information

30

SIMPA

Specified value
identify value stream
make it flow
pull
always improving

31

Difficulties of estimating value

* costs(indirect costs,uninsured patients, overuse, new technologies)
*benefits(patient,institutions, society)
* quantifying costs and benefits

32

Categories of waste(downtime)

Defects
over-processing
waiting
Non-utilized resources
transportation
Inventory
motion
excess production

33

Reasons for waste in healthcare

Reasons for transportation waste
lack of access
increasing use of emergency facilities
reasons for inventory waste
routines
failure to fix the root cause
defensive medicine (scared of malpractice)
direct to consumer marketing
Fraud
Fragmentation and lack of coordination
Fee for service(The number of patients matters)

34

5S

Sort
straighten
shine
standardize
sustain
(Safety)

35

Cando

Clearing up
arranging
neatness
discipline
Ongoing improvement

36

Value stream mapping

The step creates value for the customer
the step enables value to be created
the step does not create value = waste

37

Make it flow quality at source

Poke- yoke
Jidoka
Crew resource management