QUALITY ASSURANCE & CHANGE

1. QUALITY ASSURANCE & CHANGE STRATEGIC MANAGEMENT IN HEALTHCARE 3 MARCH , 2009

2. QUALITY • DOING THE RIGHT THINGS RIGHT, THE FIRST TIME & EVERY TIME • Quality of conformance – absence of defects • Quality of design – customer satisfaction

3. CUSTOMERS • PAYORS • PATIENTS • ANY DOWNSTREAM USER OF OUTPUT • VIRTUALLY EVERYONE IN YOUR ORGANIZATION

4. HEALTHCARE QUALITY • MEDICAL OUTCOMES • PATIENT SATISFACTION • CLIENT SATISFACTION

5. EVALUATION OF QUALITY • ACCURATE DIAGNOSES • IMPROVEMENT AT DISCHARGE • MORBIDITY & MORTALITY • EFFICACY OF TREATMENT • TOTALITY OF A PRODUCT THAT BEARS ON ABILITY TO SATISFY NEEDS OR WANTS

6. CQI • CONTINUOUS QUALITY IMPROVEMENT • IF IT AIN’T BROKE IT CAN STILL BE IMPROVED • IF IT ISN’T PERFECT MAKE IT BETTER

7. CONTINUOUS QUALITY IMPROVEMENT • PROACTIVE APPROACH THAT ASSUMES ALL PROCESSES CAN BE IMPROVED • ASSUMES A REASONABLE LEVEL OF QUALITY TO BEGIN WITH • ASSUMES YOU ARE DOING THE RIGHT THINGS ALREADY

8. ELEMENTS OF CQI • ORGANIZATION WIDE • PROCESS FOCUSED • TEAM-BASED • PROSPECTIVE AND ONGOING • USES OUTPUT OR INSPECTION MEASURES • CUSTOMER DRIVEN

9. GOAL OF PROCESS IMPROVEMENT • DO IT RIGHT THE FIRST TIME • CORRECTIONS ARE EXPENSIVE • 99% IS NOT GOOD ENOUGH • 6000 STEPS TO BUILDING A CAR • 60 THINGS WRONG WITH YOUR CAR • SOME WILL BE FATAL FLAWS

10. DEMING • POOR QUALITY • IS THE RESULT OF BADLY DESIGNED OR MALFUNCTIONING PROCESSES • CAN BE PREVENTED • PREVENTED BY REDUCTION OF VARIABILITY

11. JURAN • QUALITY IS FITNESS FOR USE - FREE FROM DEFICIENCIES AND MEETING CUSTOMER NEEDS • QUALITY TRILOGY • PLANNING • CONTROL • IMPROVEMENT

12. CROSBY • QUALITY IS FREE – WHAT COSTS IS NONQUALITY PRODUCTION • COST OF QUALITY • NONCONFORMANCE – COST TO FIX IT • CONFORMANCE – COST TO EVALUATE AND IMPROVE

13. OUTLIERS • UNDESIRABLE • PREVENT FUTURE OCCURRENCES • DESIRABLE • CAN IT BE DUPLICATED?

14. HEALTHCARE QUALITY • YOUR BODY IS NOT A CAR • ALL TREATMENTS HAVE RISKS • ALL TREATMENTS HAVE FAILURES • EVERYONE IS GOING TO DIE

15. ORGANIZATIONAL CHANGE

16. Organizational Change • Any discernable modification in any aspect of an organization’s purpose or objectives. culture, strategies, tasks, technologies, people, or structures.

17. Managing Change • Four stage model • Identification • Planning • Implementation • Evaluation

18. Why Change • Organizations, like people, are always growing or dying. • Changes carry a variety of costs and should never be undertaken unless reasons are compelling.

19. Resistance to Change • When people are part of the status quo, even minor changes are disruptive. • Individuals pay selective attention to the environment according to their interests and selectively interpret the information they receive. • All change is personal and personnel.

20. Reasons for Resistance • Insecurity or uncertainty • Inconvenience • Implies the current situation is bad • Relationships change • Individual and group status changes • Economic losses • Resentment of exercise of power • Union opposition

21. Personal & Personnel • RIF & pay cuts • Hiring freeze • Downsizing means more work for fewer people. • New jobs go to new people • Survivor guilt

22. Reducing Resistance • Education and communication • Participation • Support adjustment • Negotiate agreement • Manipulate or co-opt the opposition • Coercion – inappropriate?

23. Platitudes/Truths • Diapers and politicians should be changed regularly and for the same reason. • No one likes to be changed but a baby. • All change is stressful.