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INTRODUCTION TO QUALITY MANAGEMENT

INTRODUCTION TO QUALITY MANAGEMENT. DIAGNOSTIC IMAGING IS THE MULTI-STEP PROCESS. THERE ARE NUMEROUS SOURCES OF VARIABILITY IN BOTH HUMAN FACTORS AND EQUIPMENT THAT CAN PRODUCE SUBQUALITY IMAGES. THE PURPOSE OF QUALITY MANAGEMENT PROGRAM IS TO CONTROL OR MINIMIZE THOSE VARIABLES.

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INTRODUCTION TO QUALITY MANAGEMENT

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  1. INTRODUCTION TO QUALITY MANAGEMENT

  2. DIAGNOSTIC IMAGING IS THE MULTI-STEP PROCESS

  3. THERE ARE NUMEROUS SOURCES OF VARIABILITYIN BOTH HUMAN FACTORS AND EQUIPMENT THAT CAN PRODUCE SUBQUALITY IMAGES

  4. THE PURPOSE OF QUALITY MANAGEMENT PROGRAM IS TO CONTROL OR MINIMIZE THOSE VARIABLES

  5. VARIABLES IN DIAGNOSTIC IMAGING • EQUIPMENT • IMAGE RECEPTOR • PROCESSING • VIEWING CONDITIONS • COMPETENCY OF THE TECHNOLOGIST, INTERPRETER, AND SUPPORT STAFF.

  6. LEVELS OF QUALITY OF GOODS • EXPECTED QUALITY • PERCEIVED QUALITY • ACTUAL QUALITY

  7. SINCE 1980 HEALTHCARE DELIVERY IS UNDERGOING DRAMATIC CHANGES!! THESE CHANGES ARE GREATLY AFFECTING DIAGNOSTIC IMAGING DEPARTMENTS

  8. HEALTHCARE CHANGES

  9. CHANGES IN HEALTH CARE THAT AFFECT IMAGING DEPARTMENTS • ADVANCES IN TECHNOLOGY • LEGISLATION AND GOVERNMENT REGULATIONS • JCAHO PROCEDURES • CORPORATE BUYOUTS AND MERGERS • METHODS OF REIMBURSEMENT FOR SERVICES

  10. ADVANCES IN TECHNOLOGY COST OF INSTALLATION & MAINTENANCE

  11. LEGISLATION AND GOVERNMENT REGULATIONS • SAFE MEDICAL ACT 1990 • MAMMOGRAPHY QUALITY STANDARDS ACT OF 1992 INCREASED RESPONSIBILITY OF DIAGNOSTIC DEPARTMENT MANAGERS AND STAFF TO DOCUMENT PROPER EQUIPMENT OPERATION AND PROCEDURES.

  12. CORPORATE BUYOUTS AND MERGERS

  13. CORPORATE BUYOUTS AND MERGERS BUYOUTS MERGERS SINCE 1980 1,000 HOSPITALS CLOSED

  14. JCAHO PROCEDURES TQM QA

  15. METHODS OF REIMBURSEMENT FOR SERVICES • HMO’S LOWER REIMBURSMENT RATE!!!

  16. HISTORY OF Q.M. • 1900 FREDERICK WINSLOW – FATHER OF SCIENTIFIC MANAGEMENT CONCEPT OF SCIENTIFIC MANAGEMENT UNTIL 1980

  17. HISTORY OF Q.M. • 1980 W. EDWARDS DEMING & JOSEPH JURAN • CONCEPT OF QUALITY IMPROVEMENT

  18. SOME IMAGING DEPT. SINCE 1930s SYSTEMATICALLY MONITOR THEIR EQUIPMENT TO SAVE MONEY AND INCREASE EFFICIENCY

  19. GOVERNMENTAL ACTIONS • 1968 RADIATION CONTROL FOR HEALTH AND SAFETY ACT • 1980 OSHA • 1981 CONSUMER PATIENT RADIATION HEALTH AND SAFETY ACT • SMDA OF 1991 • 1992 MQSA • 1996 HIPPA • 2000 CARE ACT

  20. 1968 RADIATION CONTROL FOR HEALTH AND SAFETY ACT • REQUIRED US DEPT. OF HEALTH TO DEVELOP AND ADMINISTER STANDARDS THAT WOULD REDUCE HUMAN EXPOSURE FROM ELECTRONIC DEVICES. • BRH – REG. ACTION IN 1974 TO CONTROL THE MANUFACTURE AND INSTALLATION OF MEDICAL AND DENTAL DIAGNOSTIC EQUIPMENT JACHO ADOPTED THESE RECOMMENDATIONS

  21. 1980 OSHA • IN RESPONSE TO OUTBREAK OF HIV AND HEPATITIS B VIRUSES, MANDATED THE POLICY ON BLOOD-BORNE PATHOGENS. • OSHA ALSO MONITORS WORKPLACE FOR OCCUPATIONAL EXPOSURE TO RADIATION AND CHEMICALS.

  22. 1981 CONSUMER PATIENT RADIATION HEALTH AND SAFETY ACT • ADDRESSED ISSUES OF UNNECESSARY REPEAT EXAMS • IT ESTABLISHED MINIMUM STANDARD FOR ACCREDITATION OF EDUC. PROGRAMS IN RADIOLOGIC SCIENCEAND FOR THE CERTIFICATION OF EQUIPMENT OPERATORS!!!!!!

  23. SMDA OF 1991 • REQUIRES MEDICAL FACILITY TO REPORT TO FDA ANY MEDICAL DEVICE THAT CAUSED INJURY OR DEATH OF A PATIENT!

  24. 1992 MQSA • MANDATED Q.A. PROGRAMS FOR ALL FACILITIES PERFORMING MAMMOGRAPHY STUDIES – FDA APPROVAL. • IT ALSO SPECIFIED STANDARD AND REQUIREMENTS FOR EQUIPMENT, TECHNOLOGISTS, DOCTORS INTERPRETING THE RADIOGRAPHS, AND MEDICAL PHYSICISTS.

  25. HIPAA OF 1996 • SIMPLIFICATION OF H.C. STANDARDS TO ESTABLISH NATIONAL STANDARDS FOR HEALTHCARE E-COMMERCE • CONFIDENTIALITY OF PATIENT RECORDS!!!!!!

  26. JCAHO • INCE 1970 REQUIRES HOSPITALS AND OTHER HEALTHCARE PROVIDERS TO PERFORM AND DOCUMENT Q.M. PROCEDURES FOR THE FACILITIES TO GET ACCREDITATION ACCREDITATION IS VOLUNTARY!!!

  27. LACK OF ACCREDITATIONHOSPITALS MAY NOT BE ABLE TO • HAVE RESIDENCY PROGRAMS • HOLD CERTAIN LICENSES • HAVE MEDICAID CERTIFICATION • RECEIVE MALPRACTICE INSURANCE

  28. QUALITY ASSURANCE • IS AN ALL-ENCOMPASING MANAGEMENT PROGRAM USED TO ENSURE EXCELLENCE IN HEALTHCARE THROUGH THE SYSTEMATIC COLLECTION AND EVALUATION OF DATA. PRIMARY OBJECTIVE: ENHANCEMENT OF PATIENT CARE

  29. QUALITY MANAGEMENT • PART OF THE QA ASSURANCE PROGRAM THAT DEALS WITH TECHNIQUES USED IN MONITORING AND MAINTENANCE OF THE TECHNICAL ELEMENTS OF THE SYSTEMTHAT AFFECT THE QUALITY OF THE IMAGE

  30. Q.M. DELAS WITH EQUIPMENT AND INSTRUMENTATION

  31. QUALITY CONTROL LEVELS OF TESTING • NONINVASIVE- SIMPLE • NONINVASIVE AND COMPLEX • INVASIVE AND COMPLEX

  32. CONTINUOUS QUALITY IMPROVEMENT • INCORPORATED BY JCAHO IN 1991

  33. C.Q.I.

  34. KAIZEN

  35. CQI SYNONYMS • TQM- TOTAL QUALITY MANAGEMENT • TQC - TOTAL QUALITY CONTROL • TQI – TOTAL QUALITY IMPROVEMENT • SQC – STATISTICAL QUALITY CONTROL

  36. C.Q.I DOES NOT REPLACE QAINSTEAD OF JUST ENSURING & MAINTAINING QUALITY IT CONTINUALLY IMPROVES QUALITY BY FOCUSING ON IMPROVING THE SYSTEM FOCUS IS ON THE ORGANIZATION AS THE WHOLE

  37. C.Q.I • INTERNALLY MOTIVATED • EVERY EMPLOYEE CONTRIBUTES TO THE SUCCESS OF THE ORGANIZATION

  38. C.Q.I. PROCEES IMPROVEMENT PREMISES • 85/15 RULE • 80/20 RULE • WORKERS KNOW THEIR WORK BETTER THAN OUTSIDER • STRUCTURED PROBLEM SOLVING SUCCESSFUL IN PROBLEM SOLVING • QUALITY IMPROVEMENT – JOB OF EVERYONE IN THE ORGANIZATION

  39. PROCESS • ORDERED SERIES OF STEPS THAT HELP ACHIEVE A DESIRED OUTCOME.

  40. PARTS OF THE PROCESS • SUPPLIER • INPUT • ACTION • OUTPUT • CUSTOMER : INTERNAL EXTERNAL

  41. PROBLEM IDENTIFICATION AND ANALYSIS: • TEAMS – 2 PEOPLE OR MORE! IDEAL: 6 – 12 PEOPLE

  42. GROUP DYNAMICS TOOLS • BRAINSTORMING • FOCUS GROUPS • QUALITY IMPROVEMENT TEAM • QUALITY CIRCLES • MULTI-VOTING • CONSENSUS • WORK TEAMS • PROBLEM SOLVING TEAMS

  43. 1985- JCAHO 10- STEP MONITORING AND EVALUATION PROCESS • ASSIGN RESPONSIBILITY • DELINEATE THE SCOPE OF CARE SERVICE • IDENTIFY THE IMPORTANT ASPECTS OF CARE AND SERVICES • IDENTIFY INDICATORS • ESTABLISH MEANS TO TRIGGER EVALUATION • COLLECT AND ORGANIZE DATA • INITIATE EVALUATION • TAKE ACTION TO IMPROVE CARE AND SERVICES • ASSESS EFFECTIVENESS OF ACTIONS AND MAINTAIN IMPROVEMENTS • COMMUNICATE RESULTS TO AFFECTED INDIVIDUALS

  44. ASSIGN RESPONSIBILITY

  45. DELINEATE THE SCOPE OF CARE SERVICE

  46. IDENTIFY THE IMPORTANT ASPECTS OF CARE AND SERVICES

  47. IDENTIFY INDICATORS • SENTINEL EVENT – INDIVIDUAL EVENT SIGNIFICAN EVENT TO TRIGGER FURTHER REVIEW. • AGGREGATE DATA – RELATES TO QUANTIFICATION OF PROCESS RELATED TO MANY CASES.

  48. INDICATORS: • APPROPRIATNESS OF CARE – IS IT NECESSARY? • CONTINUITY OF CARE – DEGREE OF COORDINATION AMONG PRACTITIONERS. • EFFECTIVENESS OF CARE – THE LEVEL OF BENEFIT. • EFFICACY – THE LEVEL OF BENEFIT UNDER IDEAL CONDITIONS • EFFICIENCY – OUTCOME OBTAINED WHEN THE HIGHEST QUALITY CARE IS DELIVERED. • RESPECT & CARING • SAFETY IN THE CARE ENVIRONMENT • TIMELINESS OF CARE • COST OF CARE • AVAILABILITY OF CARE

  49. ESTABLISH MEANS TO TRIGGER EVALUATION

  50. COLLECT AND ORGANIZE DATA

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