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QUERI. Robert L Jesse, MD, PhD Chief Consultant Medical Surgical Service. Transforming Healthcare. Transactional Quality and Management: a healthcare redesign process through which clinical practices are both enhanced and ensured by real-time insights into their systems .

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queri

QUERI

Robert L Jesse, MD, PhDChief Consultant Medical Surgical Service

transforming healthcare
Transforming Healthcare
  • Transactional Quality and Management:

a healthcare redesign process through which clinical practices are both enhanced and ensured by real-time insights into their systems.

      • Quality is integrated into the workflow
      • Data is aggregated through the process
      • Quality and safety are driven by efficiency
transactional quality and management
Transactional Quality and Management

Guiding Principle #1:

If data is important enough that it is needed to manage the patient and/or the system, then it must be acquired as an integral part of the work process and not through retrospective data collection.

transactional quality and management5
Transactional Quality and Management
  • Guiding Principle #2:

“Solutions” must make the work easier, and not impose undue burden or require re-work.

    • No pain for the gain
    • Technology must facilitate the workflow and not encumber it.
transactional quality and management6
Transactional Quality and Management
  • Guiding Principle #3:

Real-time visibility into the system must be available, and it must be transparent across the enterprise:

    • Manage all patient-health system interactions
      • location and times - waits and delays
    • Manage patient-staff relationships
      • Include patient-staff transitions (handoffs)
    • Manage all tests and procedures in real-time
      • From scheduling to completion
      • Concurrent documentation
transactional quality and management7
Transactional Quality and Management
  • Guiding Principle #4:
    • In order to deliver evidence-based care we must have evidence-based management.
      • Clinical processes support
      • Administrative processes support
      • IT support
      • Materials management
        • Equipment
        • Beds
      • Staff Management
      • Point of service logistical support
transactional quality and management8
Transactional Quality and Management
  • Guiding Principle #5:

In order to ensure that we effectively manage the delivery of evidence-based care we must manage complexity

Data

Information

Knowledge

Wisdom

slide9

Hierarchy of Healthcare Systems

Structure and Function

VHA Strategies

Characteristics

Goals

Fully

Integrated

Health System

Predictive

Analytics

Longitudinal

Health

Management

Distributed

Healthcare

Patient as node

on Wide Area

Health Network

Value

Optimizing

Clinical

Performance

Clinical

Decision

Support

Engineering

Care Delivery

Integrated

Hospital/Clinic

Efficiencies

Effectiveness

Level of Implementation Complexity

Integrated

Workflow

Processing

Evidence

Based

Management

VHA Systems

Redesign

Efficiency

Accessible

Health Data

Electronic

Health Record

Responsiveness

System

Model

Service

Offering

Information

Process

Performance Improvement Levers

healthcare from a systems perspective
Healthcare From a Systems Perspective
  • Engineering Principles Apply
    • Supply must always exceed demand
      • Erlang’s law (?)
      • Any service delay is unacceptable
    • Action when and where needed
      • Just-in-time supply chain management
    • Multiple steps and processes are involved
      • Map processes and pre-specify the plan
      • Parallel process when ever possible
    • Complexity must be managed
summary
Summary
  • Data must be acquired as an integral part of the workflow process.
  • Adoption is dependant on workload burden.
  • Real-time visibility into- and transparency across the enterprise are required.
  • Evidence-based management is needed to ensure evidence-based care.
  • Knowledge and complexity management are crucial to moving forward.