leadership for quality and safety l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Leadership for Quality and Safety PowerPoint Presentation
Download Presentation
Leadership for Quality and Safety

Loading in 2 Seconds...

play fullscreen
1 / 66

Leadership for Quality and Safety - PowerPoint PPT Presentation


  • 224 Views
  • Uploaded on

Leadership for Quality and Safety. David B. Nash, MD, MBA The Dr. Raymond C. and Doris N. Grandon Professor of Medicine and Chairman, Department of Health Policy www.jefferson.edu/dhp. … all hospitals are accountable to the public for their degree of success…

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Leadership for Quality and Safety' - niveditha


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
leadership for quality and safety

Leadership for Quality and Safety

David B. Nash, MD, MBAThe Dr. Raymond C. and Doris N. Grandon

Professor of Medicine and

Chairman, Department of Health Policy

www.jefferson.edu/dhp

slide5
… all hospitals are accountable to the public for their degree of success…

If the initiative is not taken by the medical profession, it will be taken by the lay public.

1918 Am Coll Surg

imperatives of the new century
Imperatives of the New Century
  • Accountable for the health status of defined populations
  • Global Budgets/Targets
  • Incentives to actively manage clinical care
  • Incentives to provide a coordinated continuum of care
  • Incentives for continuous quality improvement
  • The demand for value
slide12

The Seamless Continuum of Care

Community

Patients

Preventionand Wellness

Primary

Care

AcuteCare

ChronicCare

RehabilitativeCare

SupportiveCare

  • Rehab Units
  • Physical Occupational Therapy Centers
  • Recovery Centers
  • Home Health Centers
  • Hospices
  • Home Health Agencies
  • Hospitals
  • Nursing Homes
  • Home Health Agencies
  • Occupational Health
  • Wellness Centers
  • Physician Offices
  • Physician Groups
  • Physician Groups
  • Hospitals
  • Ambulatory Surgery Centers
slide13

Effective

Efficient Safe, etc.

Greater Market Sensitivity

Performance Comparison

(Apologies to Tom Lee and Arnie Milstein)

slide14

Definition of Quality Institute of Medicine

“The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

slide20

FIGURE 5-1

Making change possible.

ten commandments crossing the quality chasm
Current Rules

Care is based primarily on visits

Professional autonomy drives variability

Professionals control care

Information is a record

Decision making is based on training and experience

Ten CommandmentsCrossing the Quality Chasm

New Rules

  • Care is based on continuous healing relationships
  • Care is customized according to patient needs and values
  • The patient is the source of control
  • Knowledge is shared freely
  • Decision making is evidence-based

Don Berwick 2002

ten commandments cont d
Current Rules

“Do no harm” is an individual responsibility

Secrecy is necessary

The system reacts to needs

Cost reduction is sought

Preference is given to professional roles over the system

Ten Commandments (cont.d)

New Rules

  • Safety is a system property
  • Transparency is necessary
  • Needs are anticipated
  • Waste is continuously decreased
  • Cooperation among clinicians is a priority

Don Berwick 2002

slide24

A need for unified governance

NoAmerican Quality Improvement Community

Certify

Performance

Measures

Implement

Performance

Measures

NCQA

AQA, HQA

CAHPS

NQF

JCAHO

CMS

Plans

Multiple Public and Private Sector Stakeholders

100 different P4P Programs

PricewaterhouseCoopers

Source: Tooker/ACP

hospital accountability for quality
Hospital Accountability for Quality

External Forces

  • Leapfrog
  • CMS, the MMA, the OIG
  • National programs like Premier
  • Employer-based Pay for Performance
  • State-based error reporting
medical staff structure
Medical Staff Structure
  • Anachronistic; referral pattern preservation
  • Not agile; who is in charge for CPOE?
  • Limiting privileges needed, not expanding
  • New drugs and biotechnology products
needed physician leadership
Needed: Physician Leadership
  • Home-grown vs. new managerial class
  • What is the skill set? (ACPE)
  • Cross Cultural agents
tools for physician leaders
Tools for Physician Leaders
  • Treatment standards and protocols
  • Leapfrog criteria
  • Hospitalist programs
  • Technology – CPOE, ambulatory EMR
  • Practice Profiling
  • Safety culture engineering
  • External benchmarking
governance support for the leadership standards
Governance Support for the Leadership Standards
  • Put quality and safety on every agenda
  • Ask to see a dashboard of quality and safety indicators
  • Support investment in system improvements that will improve safety even in light of weak financial ROI
  • Link executive compensation to quality and safety improvements
governance structure for quality and safety
Governance Structure for Quality and Safety
  • Explicitly link a Board level strategic Vision Metric to quality and safety
  • Ex: A 75% reduction in medical errors over three years
  • Ex: A 50% reduction in unexplained clinical variation in 3 major DRGs over 2 years
slide57

Effective

Efficient Safe, etc.

Greater Market Sensitivity

Performance Comparison

(Apologies to Tom Lee and Arnie Milstein)

slide58

Nash’s Immutable Rule

High quality care costs less!

slide63

“It’s always better to have them in the tent pissing out, than outside the tent pissing in.”

President Lyndon Baines Johnson

slide64

“The institutionalization of leadership training is one of the key attributes of good leadership.”

John P. Kotter,

Harvard Business School

slide66
David B. Nash, MD, MBA

Chair, Department of Health Policy

Thomas Jefferson University

1015 Walnut Street, Suite 115

Philadelphia, PA 19107

Tel: 215-955-6969

Email: david.nash@jefferson.edu

Website: www.jefferson.edu/dhp