MAT/543 MAT543 MAT 543 WEEK 9 Homework

MAT 543 WEEK  9 Homework

Week 9 Homework

• Homework
• Chapter 14: Exercise 14-2 (page 297 of the text).

Chapter 14 Quality Analysis

LEARNING OBJECTIVES

1. To describe how statistical process control can be used to monitor and improve the services provided by healthcare organizations.

2. To describe the use of total quality management and continuous quality improvement methods and models to enhance system performance.

3. To analyze service systems using run charts and control charts.

REAL WORLD SCENARIO

A multispecialty group practice is striving to serve its patients promptly. It has defined a late patient as one who is brought into a medical examination room more than 5 minutes after the scheduled appointment. Patients who wait in the waiting room more than 5 minutes after the scheduled time of their appointment are late patients. The practice has collected the following data over a 10-day period (Table 14-1).

Number of Patients Who Waited

It should be noted that this multispecialty group practice gives approximately the same number of available appointments each day. Based on this, does the clinic need to redesign its patient care systems to better serve its patients? Is there a problem? If yes, describe it and recommend an approach. If no, explain your logic.

LEARNING OBJECTIVE 2: TO DESCRIBE THE USE OF TOTAL QUALITY MANAGEMENT AND CONTINUOUS QUALITY IMPROVEMENT METHODS AND MODELS TO ENHANCE SYSTEM PERFORMANCE

CQI and TQM are methods used to diagnose and improve systems performance. They focus on adapting inputs and conversion processes to realize new or revised system outcomes. These methods and models must be a part of the repertoire of the quality analyst

CQI and TQM focus on what is done (i.e., tasks), by whom (i.e., responsibility), and in what sequence (i.e., process). They identify modification that will improve the system outcome. The names CQI and TQM demonstrate their orientation to “quality,” even though both can be used to improve service efficiency and effectiveness as well as service quality. The use of these techniques in health care has been influenced by many factors, including quality improvement as an accreditation requirement in hospitals and other healthcare providers. In some instances, corporate healthcare systems have adopted TQM as the company-wide approach to identify and improve patient care in all aspects of operations. They are very appropriate techniques to improve systems that involve many servers.

In health care, TQM represents a significant change in orientation involving the provision of clinical care and may represent a true management innovation. It focuses the attention of clinicians and managers on the total process of providing patient care. It de-emphasizes focus on specific individuals and departments in the functionally organized bureaucracy. It recognizes the responsibilities assigned to specific individuals as part of the total process or system. It is a systems-oriented model that builds the capacity to analyze, design, or redesign and implement with some important modifications and considerations.

TQM acknowledges the difference between clinical quality and service quality and offers methods to examine the processes used to provide services to patients. Quality is viewed as a system outcome that can and must be controlled and managed. As a management method, it forces systems to specify indicators of quality, monitor themselves against these indicators, and identify and correct extreme variations. TQM strives to improve the quality of patient care from both a clinical and service perspective.

TQM is a formal methodology designed to improve the operation of a system. It focuses on outcomes and strives to identify strategies to change conversion processes to improve service outcomes. As such, the quality of service can be improved using TQM. Efficiency can be improved using TQM. In other words, TQM is a systems improvement methodology. As methods to analyze and design systems, TQM is based upon specific concepts and skills. TQM has a specific language and requires users and those required to train and support users to be able to use specific techniques.

Brainstorming

Using TQM requires all workers to think, manage, and work. It does not segregate by level or role within the organization. Brainstorming is a technique used to facilitate group thinking. It is frequently used with a facilitator. Brainstorming is the process of collecting ideas from all members of a group without rendering any judgment or evaluation of the ideas. Participants are free to offer anything either new or something that builds upon the comment of others. Brainstorming usually separates discussion of the ideas from the presentation of the ideas. Group process techniques suggest that results be recorded on a neutral space, such as a flip chart. Participants should focus on the neutral space to guard against any negative or positive reaction to any specific idea. This includes individual reactions that may involve subtle body language. Brainstorming can be used to identify problems and develop solutions to problems. A typical question could be, “How could we improve the quality of service rendered to our patients?”

Consensus Building Techniques

Brainstorming puts ideas on the table for the group to consider. Different perspectives often conflict. Processes to identify ideas can only be considered successful when the process facilitates and builds consensus and ownership of the ideas. Consensus building techniques are used to avoid individualized argument and confrontation, maintain the substance of the ideas as the focus of the process, and identify those ideas that the group can agree are important and relevant. Under the heading “nominal group techniques” a manager can find numerous techniques and games a facilitator can use to build and identify group consensus. Consensus is not total agreement or the agreement of a simple majority. It is the willingness of the group to own the idea. This is a very important distinction. Typically, nominal group processes use multiple rounds of voting and discussion until the group (not just a majority in the group) is comfortable that their ideas have been heard and the group’s ideas are ones that they can own and embrace. As discussion evolves, it is sometimes necessary to halt activities and add to the group representatives from other parts of the organization. It is essential that the group include experts from those parts of the organization included or implied in the desired improvement. The membership of the group as well as the facilitator’s ability to insure a neutral environment is essential for the success of brainstorming.

Force Field Analysis

Force field analysis (FFA) is used to create group consensus as well as to examine problems and issues the group feels merit improvement. It requires the group to identify “driving forces” that the group believes are causing the need to change or “the problem.” It also requires the group to identify the “restraining forces” that are impeding the ability to change. Users generally believe that working to eliminate a restraining force is more successful than enhancing a driving force. The group then lists the desired improvement at the top and then identifies “driving forces” and “restraining forces.” Typically, specific driving forces are linked with specific restraining forces. The technique forces participants to broaden their thinking about a specific improvement and begin to identify and build a strategy (Figure 14-2).