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• Health Care Quality Management: Tools and Applications
• Copyright
• Contents
• Figures and Tables
• Preface
• What the Book Will Not Discuss
• The Central Idea of the Text
• Overview of the Book
• Acknowledgments
• The Author
• Part 1: The State of Quality Management in Health Care
• Chapter 1: Quality in Health Care
• Introduction
• The Goal of Quality Management
• Defining Quality
• Defining Health Care Quality
• Quality Pioneers in Health Care
• Ignaz Semmelweis (1818–1865)
• Florence Nightingale (1820–1910)
• Ernest Codman (1869–1940)
• Requisite Skills for Improving Health Care
• Evolution of Production Processes
• Quality Control in Industry
• Walter Shewhart (1891–1967)
• W. Edwards Deming (1900–1993)
• Kaoru Ishikawa (1915–1989)
• Evolution of Quality Management
• System Thinking
• Summary
• References
• Chapter 2: Error and Variation
• Introduction
• The Medical Decision-Making Process
• Human Error and James Reason
• Small Area Variations and John Wennberg
• John Wennberg
• Practice Guidelines and Brent James
• The Structure-Process-Outcome Paradigm
• The Three Faces of Quality
• Underuse, Overuse, and Misuse
• Controlling Variation and Improving Outcomes
• Summary
• References
• Chapter 3: Regulating the Quality and Quantity of Health Care
• Introduction
• Licensure, Accreditation, and Credentialing
• Occupational Licensing
• Suspended Licenses
• Licensing of Facilities
• Accreditation
• Credentialing
• Malpractice
• The Economics of Health Care Markets
• Demand and Supply of Medical Services
• The Decision to Purchase
• The Demand Curve
• The Decision to Produce
• The Supply Curve
• Health Insurance and Moral Hazard
• Copayments
• Caveats
• Supplier-Induced Demand and the Target Income Hypothesis
• A Brief History of Health Care Financing in the United States
• Reimbursement Methodologies and Operating Incentives
• Reimbursement and Overuse, Underuse, and Misuse
• Return on Investment on Delivering High-Quality Care
• Revenue
• Cost of Treatment
• Cost of Quality Improvement
• Impact on Net Income
• Pay for Performance and the CMS Quality Initiative
• Summary
• References
• Part 2: Quality Management Tools
• Chapter 4: Process Analysis Tools
• Introduction
• Tools to Identify Problems
• Pareto Charts
• Stratification Charts
• Histograms
• Check Sheets
• Tools to Identify Causes
• Cause and Effect Diagrams
• Cause and Effect Example: Medication Error
• Scatter Diagrams
• Flowcharts
• Tools to Identify Solutions
• Multivoting
• Q-sort
• Tool to Monitor Progress
• Run Chart
• Summary
• References
• Chapter 5: Root Cause Analysis
• Introduction
• Root Cause Analysis
• The Goal of RCA and Types of Error
• Why Do Errors Occur?
• Classifying Error
• The Causes of Error
• The Root Causes of Medical Events
• Types of Root Cause Analyses
• Single-Event Analysis
• Data Collection Techniques
• Data Analysis and Identifying a Cause
• Implementing Corrective or Preventive Action
• Multiple-Event Analysis
• Data Collection
• Data Analysis
• Implementing Preventative Action
• Adding Cases to the Adverse Event Data Base
• Prevention and Recovery
• Cases and Applications
• Single-Event Analysis: The Wrong Patient
• Multiple-Event Analysis: Patient Falls in VA Facilities
• Summary
• References
• Chapter 6: Statistical Process Control for Monitoring System Performance
• Introduction
• Why Don’t Systems Produce the Expected Output?
• When Is Corrective Action Required?
• Statistics Review
• Types of Variation
• Setting Performance Targets
• Statistical Process Control for Continuous Data: X and R Charts
• Emergency Room Wait Time Example
• Medication Management Example
• Diagnosing the Problem
• Comparing Performance across Shifts
• Performance across Days
• Identifying the Major Causes of a Problem
• Tinkering
• Cases and Applications
• SPC and Cardiac Surgery: Application 1
• SPC and Hip Replacement: Application 2
• SPC and Door-to-Needle Time: Application 3
• Summary
• References
• Chapter 7: Statistical Process Control for Monitoring Failure Rates
• Introduction
• Statistical Process Control for Binomial Data: p and np charts
• Accuracy of Surgical Coding Example
• Heart Failure and Smoking Cessation Counseling Example
• Establishing Valid Control Limits
• Constant and Variable Control Limits
• Rebasing Control Limits and Monitoring Changes over Time
• Cases and Applications
• SPC and Cardiac Rehabilitation Guidelines: Application 1
• SPC and Thyroid Surgery Complications: Application 2
• SPC and Emergency Room Services: Application 3
• SPC and Anesthesia Administration: Application 4
• Improving Performance Using SPC
• Summary
• References
• Chapter 8: Statistical Process Control for Monitoring Nonconformities
• Introduction
• Statistical Process Control for Counts: c and u Charts
• Medical Record Coding Example
• Dietary Concerns Example
• Medicare Hospital Quality Initiative Example
• Cases and Applications
• SPC and MRSA: Application 1
• SPC and a Public Health Outbreak: Application 2
• SPC and Volume of Surgical Procedures: Application 3
• Selecting a Control Chart
• Benefits of SPC
• Inhibitors of the Use of SPC
• Final Thoughts on SPC
• Summary
• References
• Chapter 9: Exploring Quality Issues with Statistical Tools
• Introduction
• Chi-Square Analysis
• Applications of Chi-Square Analysis
• Analysis of Variance
• Applications of ANOVA
• Analysis of Means
• Applications of ANOM
• Regression Analysis
• Multiple Regression
• Applications of Regression Analysis
• Quality Improvement and Research
• Summary
• References
• Chapter 10: Failure Mode and Effects Analysis
• Introduction
• General System Theory
• Outcome
• Output
• Throughput
• Input
• Feedback
• The Value Chain
• Failure Mode and Effects Analysis
• The FMEA Process
• Designing Better Systems
• Summary
• References
• Part 3: Medical Practice Management
• Chapter 11: Practice Policies
• Introduction
• Practice Policies
• Variety of Practice Policies
• Practice Policy Components
• Implementation of Practice Policies
• Implementation Approaches to Avoid
• Uses and Barriers of Practice Policies
• Computer Decision Support
• Cases and Applications
• Summary
• References
• Chapter 12: Case, Disease, and Outcomes Management
• Introduction
• Case Management
• Case Management Functions
• Measurement and Accountability
• Case Management Cases
• Disease Management
• Opportunities for Improvement
• Developing a Disease Management Program
• Role of Self-Care
• Disease Management Goals
• General Structure of a Disease Management Program
• Disease Management Cases
• Outcomes Management
• Outcomes Management Cases
• Summary
• References
• Chapter 13: Profiling, Economic Credentialing, and Risk Adjustment
• Introduction
• Physician Profiling and Report Cards
• Developing a Practice Profile
• Profiling Cases
• Concerns over the Use of Practice Profiles
• Academic Detailing
• The Academic Detailing Process
• Academic Detailing Cases
• Economic Credentialing
• Risk Adjustment
• Risk Factors
• Risk Adjustment Systems
• Summary
• References
• Chapter 14: Benchmarking and Implementation
• Introduction
• Benchmarking and Best Practice
• The Benchmarking Process
• Benchmark Data Sources
• Balanced Scorecards
• Dashboards
• Implementation Strategies
• Summary
• References
• Chapter 15: The Future of Quality Management in Health Care
• Introduction
• Bringing It All Together
• Quality and Variation
• Quality Management Tools
• Medical Practice Management
• Value and What an Employee (or Manager) Should Do
• The Future of Health Care and Quality Management
• Three Conditions for Reform
• Summary
• References
• Index