Introduction to Health Care Quality

YOSEF D. DLUGACZ, PHD, is the Senior Vice President and Chief of Clinical Quality, Education and Research of the Krasnoff Quality Management Institute of the Northwell Health system. The goal of the Institute is to bridge the gap between theoretical knowledge learned in the academic setting and the realities of applying quality management methods in today's health care reform environment. Dr. Dlugacz's research focuses on developing models that link quality, safety, good clinical outcomes and financial success for increased value and improved efficiencies.

• List of Figures and Tables xviiPreface xxiAcknowledgments xxvAbout the Author xxviiIntroduction xxixPART I: QUALITY MANAGEMENT FUNDAMENTALS 11 Foundations of Health Care Quality 3Defining Quality 4Contributions of Quality Theorists—Nothing New under the Sun 5Quality Management Methodologies 14Organizations Making an Impact on Quality and Safety Standards 16Centers for Medicare and Medicaid Services 21Institute for Healthcare Improvement 24Agency for Health Research and Quality 25National Quality Forum 27The Leapfrog Group 27Data: The Foundation of Quality Management 28Summary 32Key Terms 33Quality Concepts in Action 33References 33Suggestions for Further Reading 34Useful Websites 352 Understanding the Impact of Health Care Reform 37The Affordable Care Act 38New Models of Payment 42New Models of Providing Care 47New Models for Collecting Data 53Improving Interpersonal Communication 56Summary 60Key Terms 60Quality Concepts in Action 61References 61Suggestions for Further Reading 62Useful Websites 633 Making the Case for Change 65What Is Involved in Change? 66Managing and Measuring Quality in the Reform Environment 69Who Is Involved in Change? 71Changing Communication 77The Role of Data in Promoting Change 86Summary 89Key Terms 90Quality Concepts in Action 90References 91Suggestion for Further Reading 92Useful Websites 924 New Challenges for Health Care Professionals 93Meeting Statistical Expectations for Standards of Care 94Meeting Patient Expectations 97Role of Dashboards 100Role of Data Analysis 104Understanding Different Kinds of Data 105Managing Care for Chronic Illness across the Continuum 109Managing Aggregated Patient Care Issues 112Improving Communication 121Summary 127Key Terms 127Quality Concepts in Action 127References 128Suggestions for Further Reading 129Useful Websites 1305 Improving Patient Safety 133Understanding Medical Errors and Adverse Events 134High-Reliability Organizations 139The Role of Quality Management in Promoting a Safety Culture 142Prioritizing Improvements 147Expanding Data Sources: Partnerships to Develop Best Practice 154Leading Organizational Improvements 155The Role of Nursing Leaders in Promoting Safety 158The Role of the Medical Staff in Promoting Safety 162Promoting Safety through Effective Communication 165Summary 169Key Terms 169Quality Concepts in Action 169References 170Suggestions for Further Reading 170Useful Websites 171PART II: APPLYING QUALITY TOOLS AND TECHNIQUES 1736 Working with Quality Tools and Methods 175Identifying a Problem 176Describing Information 183Variability 185Making Use of Data 188SignificanceUsing Quality Tools and Techniques to Improve Safety 189Clinical Pathways or Care Maps 195Improving Performance: Plan-Do-Study-Act 201Summary 206Key Terms 206Quality Concepts in Action 206Suggestions for Further Reading 207Useful Websites 2077 Working with Quality Data 209Working with Measurements 210Understanding Issues in Data Collection 214Using Data to Understand Appropriateness of Care 218The Value of Aggregated Data in Performance Improvement 222The Role of Data in Managing Chronic Disease 225Using Data to Monitor Variability 230Publicly Reported Data 234Interpreting and Making Use of Data 237Quality Management in the Future 239Summary 240Key Terms 241Quality Concepts in Action 241References 241Suggestions for Further Reading 242Useful Websites 2428 Working with Quality and Safety Measures 245Commitment to Quality 246The Future of QualityUsing Measures to Understand Care 247Defining the Measure 250Process Measures 253Pay for Performance 263P4P MeasuresPatient Satisfaction Measures 264Monitoring Measures 268Safety and Environment of Care Measures 273Summary 277Key Terms 277Quality Concepts in Action 277References 278Suggestions for Further Reading 279Useful Websites 2799 Translating Information into Action 281Maximizing Efficiency 282Determining Appropriate Levels of Care 288End-of-Life Care/Advanced Illness 289The Reform MandateUnderstanding Mortality 291Improving ICU Care 295Analyzing Readmission 298Case Example: ReadmissionUsing Data for Improvements 299Patient-Centered Care 303Delivering the Message 305Summary 308Key Terms 308Quality Concepts in Action 309References 309Suggestions for Further Reading 310Useful Websites 31110 Preparing for the Future 313The New Quality Management 314The New Role of AdministratorsThe Business of Health Care 315Measurements Are the Nuts and Bolts of Quality 319Getting Everyone on Board 322Challenges for the Future 324Summary 326Key Terms 327Quality Concepts in Action 327Suggestions for Further Reading 327Useful Websites 328Index 329