Tài liệu The Healthcare Quality Book: Vision, Strategy, and Tools pdf

THE HEALTHCARE

QUALITY BOOK

Vision, Strategy,

and Tools

AUPHA

HAP Editorial Board

Frederick J. Wenzel

University of St. Thomas, Minneapolis, MN

G. Ross Baker, Ph.D.

University of Toronto

Sharon B. Buchbinder, R.N., Ph.D.

Towson University, Towson, MD

Caryl Carpenter, Ph.D.

Widener University, Chester, PA

Leonard Friedman, Ph.D.

Oregon State University, Corvallis

William C. McCaughrin, Ph.D.

Trinity University, San Antonio, TX

Thomas McIlwain, Ph.D.

Medical University of South Carolina, Charleston

Janet E. Porter, Ph.D.

University of North Carolina at Chapel Hill

Lydia Reed

AUPHA, Arlington, VA

Louis Rubino, Ph.D., FACHE

California State University–Northridge

Dennis G. Shea, Ph.D.

Pennsylvania State University, University Park

Dean G. Smith, Ph.D.

University of Michigan, Ann Arbor

Mary E. Stefl, Ph.D.

Trinity University, San Antonio, TX

Linda E. Swayne, Ph.D.

University of North Carolina–Charlotte

Douglas S. Wakefield, Ph.D.

University of Iowa, Iowa City

Scott B. Ransom

Maulik S. Joshi

David B. Nash

Health Administration Press, Chicago, Illinois

AUPHA Press, Washington, D.C.

AUPHA

HAP

THE HEALTHCARE

QUALITY BOOK

Vision, Strategy,

and Tools

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) 424-9470.

This publication is intended to provide accurate and authoritative infor￾mation in regard to the subject matter covered. It is sold, or otherwise pro￾vided, 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 © 2005 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.

09 08 07 06 05 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

The healthcare quality book : vision, strategy, and tools / [edited by

Scott B. Ransom, Maulik Joshi, David Nash.

p. cm.

Includes bibliographical references and index.

ISBN 1-56793-224-X (alk. paper)

1. Medical care—United States—Quality control. 2. Health

services administration—United States—Quality control. 3. Total

quality mangement—United States. I. Ransom, Scott B. II. Joshi,

Maulik. III. Nash, David B.

RA399.A3H433 2004

362.11'068—dc22

2004052331

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. ∞

Acquisitions editor: Audrey Kaufman; Project manager: Joyce Sherman;

Cover designer: Megan Avery

Health Administration Press Association of University Programs

A division of the Foundation in Health Administration

of the American College of 2000 N. 14th Street

Healthcare Executives Suite 780

One North Franklin Street Arlington, VA 22201

Suite 1700 (703) 894-0940

Chicago, IL 60606

(312) 424-2800

Some images in the original version of this book are not

available for inclusion in the eBook.

CONTENTS IN BRIEF

Academic Foreword, Stephen M. Shortell.............................................xix

Executive Foreword, Gail Warden.........................................................xxi

Preface .................................................................................................xxiii

Acknowledgments...............................................................................xxvii

Part I Science and Knowledge Foundation

1 Healthcare Quality and the Patient, Donald Berwick and

Maulik S. Joshi .............................................................................3

2 Basic Concepts of Healthcare Quality, Leon Wyszewianski .......25

3 Variation in Medical Practice and Implications for Quality,

David J. Ballard, Robert S. Hopkins III, and

David Nicewander......................................................................43

4 Quality Improvement Systems, Theories, and Tools,

Mike Stoecklein ..........................................................................63

Part II Organization and Microsystem

5 The Search for a Few Good Indicators, Robert C. Lloyd ..........89

6 Data Collection, John J. Byrnes...............................................117

7 Statistical Tools for Quality Improvement, Kwan Y. Lee,

Linda S. Hanold, Rick G. Koss, and Jerod M. Loeb................145

8 Physician and Provider Profiling, David B. Nash and

Adam Evans..............................................................................167

v

9 Measuring and Improving Patient Experiences of Care,

Susan Edgman-Levitan.............................................................183

10 Dashboards and Scorecards: Tools for Creating Alignment,

Michael D. Pugh ......................................................................213

11 Patient Safety and Medical Errors, Frances A. Griffin and

Carol Haraden..........................................................................241

12 Information Technology Applications for Improved Quality,

Richard E. Ward.......................................................................267

13 Leadership for Quality, James L. Reinertsen ............................309

14 Organizational Quality Infrastructure: How Does an

Organization Staff Quality? A. Al-Assaf ...................................329

15 Implementing Quality as the Core Organizational Strategy,

Scott B. Ransom, Narendra Kini, Michael L. Jones, and

Elizabeth R. Ransom................................................................349

16 Implementing Healthcare Quality Improvement:

Changing Clinician Behavior, Valerie Weber and

John Bulger..............................................................................371

Part III Environment

17 Medical Malpractice and Medicolegal Implications of

Quality, Troyen A. Brennan, Ann Louise Puopolo,

John L. McCarthy, Robert Hanscom, and Luke Sato..............399

18 Accreditation: Its Role in Driving Accountability in

Healthcare, Greg Pawlson and Paul Schyve .............................411

19 How Purchasers Select and Pay for Quality,

Francois de Brantes ..................................................................435

Appendix 1. Control Chart Formulas..................................................453

Appendix 2. Comparison Chart Formulas ...........................................459

Appendix 3. Case Studies.....................................................................465

Index....................................................................................................475

About the Authors ...............................................................................491

vi Contents in Brief

DETAILED CONTENTS

Academic Foreword, Stephen M. Shortell.............................................xix

Executive Foreword, Gail Warden.........................................................xxi

Preface .................................................................................................xxiii

Acknowledgments...............................................................................xxvii

Part I Science and Knowledge Foundation

1 Healthcare Quality and the Patient, Donald Berwick and

Maulik S. Joshi .............................................................................3

Important Reports ........................................................................4

A Focus on the Patient...................................................................6

Lessons Learned in Quality Improvement.......................................7

Case Study...................................................................................17

Conclusion ..................................................................................22

Study Questions ...........................................................................23

References ...................................................................................24

2 Basic Concepts of Healthcare Quality, Leon Wyszewianski .......25

Definition-Related Concepts .......................................................26

Measurement-Related Concepts ...................................................32

Conclusion ..................................................................................39

Study Questions ...........................................................................40

References ...................................................................................40

3 Variation in Medical Practice and Implications for Quality,

David J. Ballard, Robert S. Hopkins III, and

David Nicewander......................................................................43

Background and Terminology......................................................43

Scope and Use of Variation in Healthcare....................................47

Clinical and Operational Issues ..................................................48

vii

Keys to Successful Implementation and Lessons

Learned from Failures .............................................................50

Case Study...................................................................................52

Conclusion ..................................................................................54

Study Questions ...........................................................................57

References ...................................................................................58

4 Quality Improvement Systems, Theories, and Tools,

Mike Stoecklein ..........................................................................63

Theories, Paradigms, and Assumptions: Foundation of the

Iceberg Model ..........................................................................63

Systems and Processes: Middle of the Iceberg Model .......................67

Tools, Methods, and Procedures: Tip of the Iceberg Model..............75

Application of Quality Improvement Science in Healthcare .........80

The First and Second Curves of Healthcare Quality

Improvement ...........................................................................82

Case Study: A Second Curve Example .........................................82

Conclusion ..................................................................................84

Study Questions ...........................................................................85

References ...................................................................................85

Part II Organization and Microsystem

5 The Search for a Few Good Indicators, Robert C. Lloyd ..........89

National Indicator Initiatives ....................................................90

The Measurement Challenge........................................................94

Milestones Along the Quality Measurement Journey.....................95

Conclusion ................................................................................113

Study Questions .........................................................................113

References .................................................................................115

6 Data Collection, John J. Byrnes...............................................117

Categories of Data: Case Example.............................................117

Considerations in Data Collection.............................................119

Sources of Data .........................................................................121

Case Study in Clinical Reporting..............................................133

Conclusion ................................................................................139

Study Questions .........................................................................140

References .................................................................................142

7 Statistical Tools for Quality Improvement, Kwan Y. Lee,

Linda S. Hanold, Rick G. Koss, and Jerod M. Loeb................145

Fundamentals of Performance Measurement .............................145

viii Detailed Contents

Detailed Contents ix

Control Chart Analysis .............................................................152

Comparison Chart Analysis.......................................................157

Using Data for Performance Improvement................................162

Study Questions .........................................................................165

References .................................................................................165

8 Physician and Provider Profiling, David B. Nash and

Adam Evans..............................................................................167

Background and Terminology....................................................167

Scope and Use of Profiling in Healthcare...................................169

Keys to Successful Implementation and Lessons Learned .............175

Case Study ................................................................................178

Study Questions .........................................................................180

References .................................................................................180

9 Measuring and Improving Patient Experiences of Care,

Susan Edgman-Levitan.............................................................183

Regulatory and Federal Patient Survey Initiatives....................184

Using Patient Feedback for Quality Improvement .....................186

Scope and Use of Patient Experiences in Healthcare...................193

Keys to Successful Implementation and Lessons Learned.............200

Lessons Learned, or “The Roads Not to Take”.............................203

Case Study ................................................................................207

Conclusion ................................................................................209

Study Questions .........................................................................209

References .................................................................................210

10 Dashboards and Scorecards: Tools for Creating Alignment,

Michael D. Pugh ......................................................................213

Background and Terminology....................................................213

Scope and Use of Dashboards and Scorecards in Healthcare .......215

Clinical and Operational Issues ................................................222

Keys to Successful Implementation and Lessons Learned .............227

Case Study: St. Joseph Hospital ..................................................233

Conclusion ................................................................................235

Study Questions .........................................................................236

References .................................................................................240

11 Patient Safety and Medical Errors, Frances A. Griffin and

Carol Haraden..........................................................................241

Background and Terminology....................................................241

Scope and Use of Patient Safety Considerations in Healthcare .....245

Clinical and Operational Issues ................................................257

Case Study: OSF Health System .................................................259

Conclusion ................................................................................264

Study Questions .........................................................................264

References .................................................................................265

12 Information Technology Applications for Improved Quality,

Richard E. Ward.......................................................................267

Background and Terminology....................................................267

Taking a Lesson from Other Industries ......................................270

The Emerging Field of Medical Informatics...............................272

Two Tiers of Clinical IT ............................................................272

Technologies for Different Types of Clinical Care Management

Initiatives .............................................................................276

Requirements and Architecture Framework for Clinical IT.......278

Workflow Automation Technology Applied to Clinical Processes.....283

Other Clinical IT Components ..................................................285

Case Examples...........................................................................289

Overall Return on Investment of Clinical Information Systems......293

Key Strategy Debates .................................................................300

The Challenge ...........................................................................305

Study Questions .........................................................................307

References .................................................................................307

13 Leadership for Quality, James L. Reinertsen ............................309

Background and Overview ........................................................309

Scope and Use of Leadership Concepts in Healthcare..................314

Clinical and Operational Issues ................................................318

Keys to Successful Quality Leadership and Lessons Learned ........319

Case Study of Leadership: Interview with William Rupp, M.D. .....321

Study Questions .........................................................................326

References .................................................................................327

14 Organizational Quality Infrastructure: How Does an

Organization Staff Quality? A. Al-Assaf ...................................329

Management Commitment .......................................................330

Allocation of Resources .............................................................333

Organizational Structure..........................................................334

Increasing Awareness of Healthcare Quality..............................336

Mapping Quality Improvement Interventions ...........................337

Challenges, Opportunities, and Lessons Learned ........................342

Study Questions .........................................................................347

References .................................................................................347

x Detailed Contents

Detailed Contents xi

15 Implementing Quality as the Core Organizational Strategy,

Scott B. Ransom, Narendra Kini, Michael L. Jones, and

Elizabeth R. Ransom................................................................349

Implementing Quality in Healthcare Organizations .................351

Case Study: Entering the Digital Era ........................................364

Study Questions .........................................................................369

References .................................................................................369

16 Implementing Healthcare Quality Improvement:

Changing Clinician Behavior, Valerie Weber and

John Bulger..............................................................................371

Understanding Change Management in Healthcare .................371

Active Implementation Strategies ..............................................379

Addressing the Cost of Implementation......................................384

Keys to Successful Implementation and Lessons Learned .............386

Case Studies ..............................................................................388

Conclusion ................................................................................393

Study Questions .........................................................................393

References .................................................................................393

Part III Environment

17 Medical Malpractice and Medicolegal Implications of

Quality, Troyen A. Brennan, Ann Louise Puopolo,

John L. McCarthy, Robert Hanscom, and Luke Sato..............399

Background and Terminology....................................................399

Scope and Use of Medicolegal Implications of Quality in

Healthcare ............................................................................401

Clinical and Operational Issues ................................................403

Keys to Success and Understanding Failure ...............................407

Study Questions .........................................................................409

References .................................................................................410

18 Accreditation: Its Role in Driving Accountability in

Healthcare, Greg Pawlson and Paul Schyve .............................411

Background and Terminology ...................................................411

Scope and Use of Accreditation in Healthcare:

Successes and Failures ............................................................415

The Future of Accreditation: Challenges and Changes ...............421

Conclusion ................................................................................429

Study Questions .........................................................................430

References .................................................................................431

19 How Purchasers Select and Pay for Quality,

Francois de Brantes ..................................................................435

Background and Terminology....................................................436

Bridges to Excellence..................................................................438

Defining the Program Specifications—The “What”....................442

Designing the Program Implementation—The “How” ...............450

Conclusion ................................................................................450

Study Questions .........................................................................451

References .................................................................................451

Appendix 1. Control Chart Formulas..................................................453

Appendix 2. Comparison Chart Formulas ...........................................459

Appendix 3. Case Studies.....................................................................465

Index....................................................................................................475

About the Authors...............................................................................491

xii Detailed Contents

LIST OF FIGURES

Preface Figure 1: The Healthcare Quality Book Overview . . . . . . . . xxiv

Figure 1.1: Four Levels of the Healthcare System . . . . . . . . . . . . . . . 7

Figure 1.2: Improving Critical Care Processes: Mortality Rates

and Average Ventilator Days. . . . . . . . . . . . . . . . . . . . . . . 9

Figure 1.3: Improving Effectiveness: Asthma Symptom-Free

Days and Average HbA1c Levels . . . . . . . . . . . . . . . . . . 13

Figure 1.4: Improving Patient Safety: Percent of Medication

Lists on All Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Figure 1.5: Improving Patient Centeredness: Percent of

Patients’ Self-Management Goals Met . . . . . . . . . . . . . . 15

Figure 1.6: Improving Efficiency: Average Minutes Spent with

Clinician in an Office Visit . . . . . . . . . . . . . . . . . . . . . . . 16

Figure 1.7: Improving Timeliness: Days to Third Next Available

Appointment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Figure 1.8: Improving Equity: Disparity by Race for Key

Effectiveness Measures . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Figure 1.9: Improving Vitality: Percent of Office Team

Reporting a Stressful Work Environment. . . . . . . . . . . . 18

Figure 3.1: Percent of Medicare Enrollees Admitted to

Intensive Care During the Last Six Months of Life

(by Hospital Referral Region, 1995–96) . . . . . . . . . . . . 44

Figure 3.2: Pneumococcal Vaccine Screening and Administration

for Patients Hospitalized with Community-Acquired

Pneumonia: Irving Hospital, Baylor Health Care

System, Dallas, Texas, January 1999–June 2003 . . . . . . 55

Figure 3.3: Pneumococcal Vaccine Screening and Administration

for Patients Hospitalized with Community-Acquired

Pneumonia: Irving Hospital, Baylor Health Care

System (BHCS; Excluding Irving), Dallas, Texas,

June 2002–June 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . 56

xiii