INTRODUCTION TO QUALITY MANAGEMENT. DIAGNOSTIC IMAGING IS THE MULTI-STEP PROCESS.

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

VARIABLES IN DIAGNOSTIC IMAGING

• EQUIPMENT

• IMAGE RECEPTOR

• PROCESSING

• VIEWING CONDITIONS

• COMPETENCY OF THE TECHNOLOGIST, INTERPRETER, AND SUPPORT STAFF.

LEVELS OF QUALITY OF GOODS

• EXPECTED QUALITY

• PERCEIVED QUALITY

• ACTUAL QUALITY

SINCE 1980 HEALTHCARE DELIVERY IS UNDERGOING

DRAMATIC CHANGES!!

THESE CHANGES ARE GREATLY AFFECTING DIAGNOSTIC IMAGING DEPARTMENTS

HEALTHCARE CHANGES

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

ADVANCES IN TECHNOLOGY

COST OF INSTALLATION & MAINTENANCE

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.

CORPORATE BUYOUTS AND MERGERS

CORPORATE BUYOUTS AND MERGERS

SINCE 1980 1,000 HOSPITALS CLOSED

BUYOUTS MERGERS

JCAHO PROCEDURES

QA TQM

METHODS OF REIMBURSEMENT FOR

SERVICES

• HMO’S

LOWER REIMBURSMENT RATE!!!

HISTORY OF Q.M.

• 1900 FREDERICK WINSLOW – FATHER OF SCIENTIFIC MANAGEMENT

CONCEPT OF SCIENTIFIC MANAGEMENT UNTIL 1980

HISTORY OF Q.M.

• 1980 W. EDWARDS DEMING & JOSEPH JURAN

• CONCEPT OF QUALITY IMPROVEMENT

SOME IMAGING DEPT. SINCE 1930s

SYSTEMATICALLY MONITOR THEIR

EQUIPMENT TO SAVE MONEY AND INCREASE

EFFICIENCY

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

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

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.

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!!!!!!

SMDA OF 1991

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

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.

HIPAA OF 1996

• SIMPLIFICATION OF H.C. STANDARDS TO ESTABLISH NATIONAL STANDARDS FOR HEALTHCARE E-COMMERCE

• CONFIDENTIALITY OF PATIENT RECORDS!!!!!!

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!!!

LACK OF ACCREDITATIONHOSPITALS MAY NOT BE ABLE

TO • HAVE RESIDENCY PROGRAMS

• HOLD CERTAIN LICENSES

• HAVE MEDICAID CERTIFICATION

• RECEIVE MALPRACTICE INSURANCE

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

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

Q.M. DELAS WITH EQUIPMENT AND

INSTRUMENTATION

QUALITY CONTROL LEVELS OF TESTING

• NONINVASIVE- SIMPLE

• NONINVASIVE AND COMPLEX

• INVASIVE AND COMPLEX

CONTINUOUS QUALITY IMPROVEMENT

• INCORPORATED BY JCAHO IN 1991

C.Q.I.

KAIZEN

CQI SYNONYMS

• TQM- TOTAL QUALITY MANAGEMENT

• TQC - TOTAL QUALITY CONTROL

• TQI – TOTAL QUALITY IMPROVEMENT

• SQC – STATISTICAL QUALITY CONTROL

C.Q.I DOES NOT REPLACE QA

INSTEAD OF JUST ENSURING & MAINTAINING QUALITY IT CONTINUALLY

IMPROVES QUALITY BY FOCUSING ON

IMPROVING THE SYSTEM

FOCUS IS ON THE ORGANIZATION AS THE WHOLE

C.Q.I

• INTERNALLY MOTIVATED

• EVERY EMPLOYEE CONTRIBUTES TO THE SUCCESS OF THE ORGANIZATION

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

PROCESS

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

PARTS OF THE PROCESS

• SUPPLIER

• INPUT

• ACTION

• OUTPUT

• CUSTOMER : INTERNAL EXTERNAL

PROBLEM IDENTIFICATION AND ANALYSIS:

• TEAMS – 2 PEOPLE OR MORE!

IDEAL: 6 – 12 PEOPLE

GROUP DYNAMICS TOOLS

• BRAINSTORMING• FOCUS GROUPS• QUALITY IMPROVEMENT TEAM• QUALITY CIRCLES• MULTI-VOTING• CONSENSUS• WORK TEAMS• PROBLEM SOLVING TEAMS

1985- JCAHO 10- STEP MONITORING AND EVALUATION

PROCESS

1. ASSIGN RESPONSIBILITY2. DELINEATE THE SCOPE OF CARE SERVICE3. IDENTIFY THE IMPORTANT ASPECTS OF CARE AND

SERVICES4. IDENTIFY INDICATORS5. ESTABLISH MEANS TO TRIGGER EVALUATION6. COLLECT AND ORGANIZE DATA7. INITIATE EVALUATION8. TAKE ACTION TO IMPROVE CARE AND SERVICES9. ASSESS EFFECTIVENESS OF ACTIONS AND MAINTAIN

IMPROVEMENTS10. COMMUNICATE RESULTS TO AFFECTED INDIVIDUALS

ASSIGN RESPONSIBILITY

DELINEATE THE SCOPE OF CARE SERVICE

IDENTIFY THE IMPORTANT ASPECTS OF CARE AND SERVICES

IDENTIFY INDICATORS

• SENTINEL EVENT – INDIVIDUAL EVENT SIGNIFICAN EVENT TO TRIGGER FURTHER REVIEW.

• AGGREGATE DATA – RELATES TO QUANTIFICATION OF PROCESS RELATED TO MANY CASES.

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

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

JACHO CYCLE FOR IMPROVEMENT

• DESIGN.

• MEASURE

• ASSESS

• IMPROVE

DESIGN.

• SYSTEMATIC PLANNING AND IMPLEMENTATION

MEASURE

• COLLECTION OF VALID AND RELIABLE DATA

ASSESS

• HISTORICAL DATA

• DESIRED PERFORMANCE LIMITS

• PRACTICE GUIDELINES

• EXTERNAL REFERENCE DATABASE

• BENCHMARKING

IMPROVE

DATA ANALYSIS IMPROVE